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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4 Comments

  1. Bruce ANNABEL
    20/04/2020

    I would be interested to know the proportion of interactions that were with pharmacy assistants rather than pharmacists. Reason for the question is that traditional pharmacies and most discounters, hard and soft, leave OTC matters/enquiries to assistants. I have experienced this as a health consumer and observation recently plus historically so would be surprised if every interaction the study experienced was with a pharmacist who are mostly engaged in the dispensary.

    • Jarrod McMaugh
      20/04/2020

      Regardless of who had the interaction, the PIC is professionally responsible for the recommendations made by staff while they are PIC.

      If the pharmacist is making non-EBM recommendations, this is a breach of professional ethics (which are enforced by AHPRA) and they should undertake CPD in this area.

      If the assistants are making non-EBM recommendations, the PIC needs to take responsibility for ensuring they are trained appropriately

  2. George Papadopoulos
    21/04/2020

    The chronic issue with complementary therapies has been the lack of research. Research by Halberstein et al on rescue remedy suggests issues with trial design, poor scientific understanding of how and why this remedy works etc. I think the matter of flower essences is not one of prescribing placebo, rather one of whether this a modality that fits within the scope of practice of pharmacists. https://go.gale.com/ps/anonymous?id=GALE%7CA164807209&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=15332101&p=AONE&sw=w

    • Jarrod McMaugh
      21/04/2020

      Rescue Remedy is a type of homeopathy, and therefore shown to have no reliable evidence.

      Selling such a product – with the current evidence base – is unethical.

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