No stress relief

Questions raised over the products many pharmacists are recommending to help patients who are suffering from stress

A study has revealed a number of shortcomings in the approach many pharmacists are taking in recommending OTC and alternative medicines to patients experiencing stress.

Over-the-counter products for stress almost always are complementary and alternative medicines (CAM) and no protocol exists for their recommendation and sale in community pharmacies, said researchers who conducted a series of mystery shopper visits to pharmacies requesting a natural product for stress.

The authors, from RMIT, Melbourne and the University of New England, Armidale, NSW, collected data from 100 pharmacies as part of the study.

The mystery shopper visits revealed “unsatisfactory outcomes across several areas of pharmacy practice in the participating community pharmacies,” the authors said.

“Although no official protocol exists for the provision of CAMs, pharmacists are nonetheless bound by the professional practice requirements relating to the provision of all non-prescription medicines.

These require the pharmacist to follow a ‘systematic process for gathering patient information, determining the severity of patient condition(s), and discussing potential solutions and points of referral’ and to ‘provide advice to optimise use’”.

Shortcomings in meeting the standards were evident in three key areas, the authors said: information gathering (questioning), counselling and the appropriateness of the selected product.

“The pharmacy visits revealed major shortcomings in questioning, counselling and product recommendation,” the authors said.

“There is a need to develop guidelines for pharmacists to make evidence-based decisions in recommending complementary and alternative medicine”.

The number of questions asked ranged from zero (13 pharmacists) to 7 (four pharmacists), with the average being 3.1 questions.

Provision of advice was generally better (a description of the suggested product was offered by 87 pharmacists) but was lacking in other areas (duration of use and side effects were explained by only 41 and 16 pharmacists respectively).

The most common product suggested was B-group vitamins (57 pharmacists) followed by a proprietary flower essence product (19 pharmacists). 

Suitable questioning to satisfy pharmacy practice requirements was lacking, the authors said, with only 55 pharmacists enquired about duration of symptoms and even fewer (44) asking about severity.

Despite the shoppers being of reproductive age only eight pharmacists enquired about pregnancy and breastfeeding, and four pharmacists incorrectly recommended the contra-indicated herb St. John’s wort.

Of the suggested products which contained herbs, no herb was found to be considered totally safe in pregnancy or breastfeeding, the authors said.

A “disturbing finding” was the choice of Bach Rescue Remedy by 27 pharmacists, representing the second most recommended product.

The authors said these remedies,registered as flower essences, are produced by placing fresh flowers in water yielding a ‘mother tincture’ which is then preserved with brandy.

“Flower remedies do not contain pharmacologically relevant amounts of the flowers from which they originated and thus have similarities to homeopathic medicines although are not classed as such,” they said.

Some pharmacists also recommended caffeine-containing stimulants, despite their links to anxiety and stress.

“There is a need to develop guidelines for pharmacists to make evidence-based decisions in recommending complementary and alternative medicine,” the authors concluded.

The study was published in Pharmacy Practice

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