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Pharmacists say they still lack access to independent, evidence-based information about complementary and alternative medicines

Australian pharmacists interviewed over the applicability of a new ethical framework for CAM advice and sales say they still need greater access to independent, evidence-based research around complementary and alternative medicines.

New research based on focus group interviews with pharmacists showed that the participants endorsed the newly developed CAM ethical framework, while identifying areas where they believed more work was required.

“To the extent that ethical considerations are discussed in the pharmacy literature, the conflict between supporting consumer choice and respecting autonomy, evidence-based practice and business considerations are frequently identified but rarely addressed,” the study authors said.

“Part of the problem is the lack of explicit ethical principles to guide decision-making”.

To alleviate this, a new framework (listed below) provides specific responsibilities that pharmacists should meet when selling and recommending complementary medicines and managing staff in relation to these products.

It makes a “distinction between pharmacy staff making an explicit recommendation to take a complementary medicine, and selling complementary medicines without an explicit recommendation,” the authors said.

“The framework suggests that recommendations for a complementary medicine must be consistent with current best evidence, and all sales of a complementary medicine should be accompanied with an offer of advice from a pharmacist.

A pharmacist must be available to provide that advice and to provide sufficient information to the consumer such that they can make an informed decision with regard to the purchase of the complementary medicine.

Since some consumers might refuse the offer of advice from a pharmacy, it is the responsibility of the pharmacist to have procedures in place to identify and intervene if a consumer is at significant risk of harm from complementary medicines”, said the authors, from the University of Queensland and Griffith University Schools of Pharmacy. 

The key responsibilities of pharmacists when selling complementary medicines

1. Pharmacists should provide evidence-based recommendations to consumers regarding complementary medicines 
2. Pharmacists should train all staff in a pharmacy to ensure that they provide evidence-based recommendations regarding complementary medicines and refer to a pharmacist when required 
3. When providing advice, pharmacists should provide sufficient information for consumers to make informed decisions regarding complementary medicines 
4. Pharmacists should setup the pharmacy so that consumers are provided an offer of advice from a pharmacist when purchasing complementary medicines; pharmacists should be available to provide that advice 
5. Pharmacists must be vigilant for possible harms related to complementary medicines and intervene if risk of harm is significant

What pharmacists say

The majority of the 17 pharmacists who participated in the focus group sessions found the framework “acceptable for practice and feasible for implementation with targeted support”.

They identified two important areas for targeted support in implementing the framework:

  • improved access to evidence-based information resources on complementary medicines; and
  • independent evidence-based education and training on complementary medicine for pharmacists and pharmacy support staff.

“I feel like it would be really helpful if there was a better database to look up interactions and all that type of thing because more often than not, I have to call either the company or look into it really far to make sure it doesn’t interact. So maybe extra training in that area like compulsory training,” one participant said.

Another participant highlighted the problem of compliance and “getting all the pharmacies on the same page”.

“If you’ve got pharmacies that are run by corporations and banner groups that are more for-profit versus small community pharmacies that are trying to provide a service. You’ve got to have these frameworks that are enforceable, maybe through QCPP [Quality Care Pharmacy Program] or a PBS [Pharmaceutical Benefits Scheme] listing, and make sure that everyone does the same things and stocks the same products and doesn’t stock the same products based on evidence”.

Others highlighted the issue of the TGA’s role and responsibility in oversight of CAMs. 

“Why should it be up to us as pharmacists?’, one participant asked.

“Why shouldn’t the TGA—when it goes to them in the first place to be approved, why is it even getting to us? Why are we required to make the decision? Why haven’t TGA done their job?”

The research was published in the journal BMC Medical Ethics.

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