Community pharmacists' recommendations for natural products for stress in Melbourne, Australia: a simulated patient study

BACKGROUND: Community pharmacists are often the first health professional approached to provide treatment for health issues, including the important mental health challenge, stress. Over-the-counter products for stress almost always are complementary and alternative medicines (CAM) and in Australia no protocol exists for their recommendation and sale in community pharmacies. OBJECTIVE: To assess the quality and relevance of community pharmacists' information gathering (questioning), counselling and product selection when interacting with customers requesting a CAM product for stress and consequently determine whether Australian pharmacy practice indicates the need for guidelines similar to those provided for 'pharmacy only' (S2) and 'pharmacist only' (S3) medicines. METHODS: A covert simulated patient was used to investigate the response of pharmacists to a request for a natural product for stress. The SPs documented the details of the pharmacist-simulated patient interaction immediately on leaving the pharmacy and then re-entered the pharmacy to debrief the pharmacist. The quality of the interaction was scored as a Total CARE (check, assess, respond, explain) Score, based on anticipated questions and counselling advice. The appropriateness of the product was scored as a Product Efficacy Score, based on evidence-based literature. RESULTS: Data from 100 pharmacies was provided. Information gathering illustrated by the questioning components Check and Assess (C and A) of the total CARE score by pharmacists was poor. The number of questions asked ranged from zero (13 pharmacists) to 7 (four pharmacists), the average being 3.1 (SD 1.9). 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). A two-step cluster analysis revealed two sub-groups of pharmacists: one cluster (74 pharmacists) with a high Total CARE score provided an appropriate product. The other cluster (20 pharmacists) had a low total CARE score and provided an inappropriate product. CONCLUSIONS: The pharmacy visits revealed major shortcomings in questioning, counselling and product recommendation. There is a need to develop guidelines for pharmacists to make evidence-based decisions in recommending complementary and alternative medicine

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The provision of advice by pharmacy staff in eastern Indonesian community pharmacies

Background: Indonesian community pharmacies hold a strategic position from which to promote the rational use of medicines by providing appropriate advice for patients requesting self-medication. To date, published studies related to the provision of advice in Indonesian community pharmacies are limited and have been conducted only in more developed western Indonesia. No studies have been undertaken in eastern Indonesia, which is less developed than and culturally different from the western region. Objectives: This paper aims to: (1) describe the types and amount of advice provided by pharmacy staff for three scenarios in a patient simulation study and for two scenarios in pharmacy staff interviews; and (2) ascertain the frequency of appropriate advice given in response to the scenarios. Methods: A patient simulation study was conducted at community pharmacies in an eastern Indonesian provincial capital. Four weeks after completing a patient simulation study, structured interviews with pharmacy staff were conducted. Two cough scenarios and one diarrhoea scenario were developed for the patient simulation study. Meanwhile, two scenarios (an ACE inhibitor-induced cough and a common cough and cold) were developed for pharmacy staff interviews. The types and amount of advice provided by pharmacy staff were recorded on paper and assessed for its appropriateness. The determination of appropriate advice was based on the literature and by consensus of two Indonesian experts. Results: In patient simulation, the most common type of advice provided in all scenarios was product recommendations. In interviews, medical referrals and recommending cough and cold medicine were the most common types of advice provided for ACE inhibitor-induced cough and common cough and cold scenarios respectively. Appropriate advice was provided in less than 0.5% in the patient simulation study, but two-third of participants in the interviews responded to the scenarios appropriately. Conclusions: Pharmacy staff did not provide appropriate advice in practice, although they may have adequate knowledge. A contributing factor was insufficient information gathered in patient encounters. Optimising information-gathering practice by pharmacy staff is needed

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Preconception Counseling.

Preconception counseling is a way to discuss optimizing reproductive age women's health and chronic medical issues to facilitate the healthiest pregnancy possible. Preconception counseling is an important piece of care for reproductive aged women especially as nearly 50 percent of pregnancies in the U.S. are unplanned and important fetal development has already taken place prior to the initial obstetrics visit. Many opportunities are missed to provide this counseling; only approximately one-third of women receive it. Visits to primary care are the ideal time for this to occur. In this paper, topics to discuss will be presented along with some guides to optimizing chronic medical problems to improve pregnancy outcomes.

[Differences in the Provision of Lifestyle Counseling for Cardiovascular Disease Prevention Between Urban and Rural Regions in Germany. Findings from a National Survey of Primary Care Physicians]. / Stadt-Land-Unterschiede im Angebot von Lebensstilberatung zur Prävention kardiovaskulärer Erkrankungen in der Hausarztpraxis. Ergebnisse einer bundesweiten Hausärztebefragung.

AIMS: In Germany, shortages in primary care physicians (PCPs) were reported in some rural regions. In this paper, we explored if regional differences in the distribution of PCPs are associated with the provision of lifestyle counseling in primary care. METHODS: In a nationwide study, a total of 4,074 randomly selected PCPs were asked about provision of lifestyle counseling to their patients, their attitudes, and perceived barriers. RESULTS: PCPs from rural regions provided less frequently lifestyle advice for cardiovascular disease prevention. Compared to their colleagues in urban areas, more PCPs from rural regions believed that were inadequately qualified for the lifestyle counseling and that they had been less successful in helping patients to modify their lifestyles. Physicians from rural practices named more often than PCPs from urban practices a lack of adherence by the patients (65 vs. 57%), insufficient opportunities to collaborate with providers of preventive services (62 vs. 55%), and lack of time (66 vs. 52%; all p<0.001) as barriers in providing patients with lifestyle counseling. CONCLUSION: Taking into account the expected increased shortages in PCPs in rural regions, the results show the need for targeted interventions for improving lifestyle counseling in rural practices.