Ethical responsibilities of pharmacists when selling complementary medicines: a systematic review

Objective

The widespread sale of complementary medicines in community pharmacy raises important questions regarding the responsibilities of pharmacists when selling complementary medicines. This study reviews the academic literature that explores a pharmacist's responsibilities when selling complementary medicines.

Methods

International Pharmaceutical Abstracts, Embase, PubMed, Cinahl, PsycINFO and Philosopher's index databases were searched for articles written in English and published between 1995 and 2017. Empirical studies discussing pharmacists’ practices or perceptions, consumers’ expectations and normative studies discussing ethical perspectives or proposing ethical frameworks related to pharmacists’ responsibilities in selling complementary medicines were included in the review.

Key findings

Fifty‐eight studies met the inclusion criteria. The majority of the studies discussing the responsibilities of pharmacists selling complementary medicines had an empirical focus. Pharmacists and consumers identified counselling and ensuring safe use of complementary medicines as the primary responsibilities of pharmacists. No formal ethical framework is explicitly employed to describe the responsibilities of pharmacists selling complementary medicines. To the degree any ethical framework is employed, a number of papers implicitly rely on principlism. The studies discussing the ethical perspectives of selling complementary medicines mainly describe the ethical conflict between a pharmacist's business and health professional role. No attempt is made to provide guidance on appropriate ways to resolve the conflict.

Conclusion

There is a lack of explicit normative advice in the existing literature regarding the responsibilities of pharmacists selling complementary medicines. This review identifies the need to develop a detailed practice‐specific ethical framework to guide pharmacists regarding their responsibilities when selling complementary medicines.

     

The provision of care provided by the pharmacy workforce in relation to complementary medicines in Australia

BackgroundThe use of complementary medicines (CMs) is prevalent across the world. Some CMs, such as St John's Wort, when taken with specific pharmaceutical medicines, may cause drug-herb interactions. In this context, pharmacists have the opportunity to play an important role in preventing harm to patients.ObjectiveThe aim of this study was to explore real-life pharmacy practice in relation to CMs in New South Wales, Australia.MethodsThe study design involved ‘pseudo-patient’ pharmacy visits while posing as a patient's relative requesting St John's Wort and using a standardized set of questions to document details of the interaction with a range of pharmacy staff.ResultsOf the 110 metropolitan pharmacy visits made, the pharmacy workforce who were involved in assisting the pseudo-patient's request included 51 pharmacists (46.4%), 57 pharmacy assistants (51.8%) and 1 naturopath (0.9%). Advice that may have resulted in harm to the patient, was offered by pharmacists in 11.8% (n = 13) of the encounters, and 20.9% (n = 23) by pharmacy assistants. Conversely, advice that prevented harm was provided by only 17.3% (n = 19) pharmacists and 10.9% (n = 12) pharmacy assistants. History-taking was not attempted by 84 pharmacy staff.ConclusionThe majority of pharmacy staff involved in this study did not manage a request for a CM with known drug-herb interactions in a way that would prevent harm. These findings highlight the need for the pharmacy workforce to engage in education and training in CMs, with a focus on how to consult evidence-based resources regarding interactions in the interest of patient safety.     

Perspectives on privacy in the pharmacy: The views of opioid substitution treatment clients

BackgroundMany pharmacists practise in settings in which protecting privacy can be difficult. To address this, some community pharmacies are rearranging their retail space to provide private areas for clinical consultations. Such facilities are deemed particularly important when dealing with clients who have sensitive medical conditions, such as opioid dependence.ObjectiveTo explore Opioid Substitution Treatment (OST) patients’ perceptions of privacy in a community pharmacy setting, with a particular focus on the layout of the community pharmacy.MethodsWe conducted semi-structured interviews with OST clients. Recruitment and the interviews were conducted at state government drug and alcohol clinic. The interviews were audio recorded and transcribed verbatim. The data were analysed in NVivo using the framework approach.ResultsWe interviewed fourteen OST clients. Most participants were concerned about privacy and considered that the pharmacy layout could enhance or hinder privacy. However, they disagreed about exactly which pharmacy layout was most privacy-protecting. In addition, a small group of clients interviewed who had a very positive relationship with pharmacists believed that the relationship contributed to their confidence that their privacy was protected.ConclusionsThere is little consensus amongst consumers about how to protect privacy in the community pharmacy. The range of views expressed by clients in this study may reflect the lack of consensus about the nature of privacy in health ethics. Attention to the meaning of and rationales for privacy protections may be helpful when designing pharmacy layouts to meet the needs of a broad range of consumers. An enclosed or screened private area which can be used as a consultation area for all private pharmacy discussions, including for OST dosing, could be a solution to addressing these varying views on privacy in the pharmacy. Further attention to enhancing the pharmacist and client relationship may assist in reducing sensitivity about privacy.     

临床药师参与重症医学科药物治疗实践的体会

目的 探讨重症医学科临床药师开展工作所需技能。方法 结合工作中典型案例进行分析和阐述。结果 重症医学科临床药师深入临床培养临床思维、与医护人员积极沟通,并结合药学专业知识及循证医学证据,协助临床解决实际用药问题。结论 重症医学科临床药师开展工作时需兼具临床与药学两种思维,并注重用药细节,充分运用循证医学证据。     

Roles and responsibilities of pharmacists with respect to natural health products: Key informant interviews

BackgroundAlthough many pharmacies sell natural health products (NHPs), there is no clear definition as to the roles and responsibilities (if any) of pharmacists with respect to these products.ObjectiveThe purpose of this study was to explore pharmacy and stakeholder leaders' perceptions of pharmacists' professional NHP roles and responsibilities.MethodsSemi-structured key informant interviews were conducted with pharmacy leaders (n = 17) and stakeholder (n = 18) leaders representing consumers, complementary and alternative medicine practitioners, conventional health care practitioners, and industry across Canada.ResultsAll participants believed a main NHP responsibility for pharmacists was in safety monitoring, although a one challenge identified in the interviews was pharmacists' general lack of NHP knowledge; however, stakeholder leaders did not expect pharmacists to be experts, but should have a basic level of knowledge about NHPs.ConclusionParticipants described pharmacists' professional roles and responsibilities for NHPs as similar to those for over-the-counter drugs; more awareness of existing NHP-related pharmacy policies is needed, and pharmacy owners/managers should provide additional training to ensure front-line pharmacists have appropriate knowledge of NHPs sold in the pharmacy.     

Consumer attitudes towards community pharmacy services in Saudi Arabia

Objective The purpose of this study was to determine consumer attitudes towards community pharmacy and their preferences for the introduction of new services. Methods A self‐completion questionnaire was developed and 1,144 consumers in 55 community pharmacies were invited to complete it. The questionnaire covered consumers' choice of pharmacy; their perceptions of, and actual interactions with, community pharmacists; advice from pharmacists about general health and prescribed medicines; and privacy in the pharmacy. Respondents were asked for their views about five possible new services. Setting The study was based in community pharmacies in Riyadh City, Saudi Arabia. Key findings The response rate was 79.6%. Fifty‐nine per cent of respondents often or sometimes visited a particular pharmacy. One‐quarter of respondents perceived community pharmacists as having a good balance between health and business matters, while 56.1% thought pharmacists were more concerned with the business. The majority of respondents (69.7%) said they felt comfortable asking the pharmacist for advice. Just under half (44.8%) felt that pharmacists allowed them enough time to discuss their problem fully and listened well. In addition, 58.5% of respondents indicated that their pharmacists showed sensitivity to privacy by speaking more quietly across the counter. In 14.4% of situations pharmacists were reported to use a private area within the pharmacy when discussing personal or private matters. Most respondents (65.2%) indicated that their pharmacist was willing to discuss their health problems and tried to understand their feelings. Consumers' priorities for new services were: monitoring blood pressure; measuring weight, height and temperature; monitoring blood sugar; and monitoring cholesterol. Conclusion This study showed that most pharmacy customers feel comfortable seeking advice from their pharmacist. Although many pharmacists were reported to show sensitivity to a possible lack of privacy in the pharmacy, few respondents reported that their pharmacy had a private area for discussion. Customers' views on possible new services were generally positive, with the exception of patient medication records.     

Self-medication in Poland: the pharmacist’s advisory role in Warsaw

Background

Easy access favours the informative role that pharmacists play in Poland with regard to the proper use of medicinal products as well as preventing illness and promoting health.

Objective

The aim of the present study was to define situations in which patients ask a pharmacist for advice and to identify the most important factors that affect the patients’ decisions in seeking advice from a pharmacist.

Method

n all, 101 patients (69 women, 32 men) aged 19–67 years participated in the study. The study was conducted using a structured interview research method. Patients were asked to answer a set of closed-ended questions related to their habits regarding the purchase of medicines and the factors that affected their decision to seek the advice of a pharmacist.

Main outcome measure

Factors determining the choice to contact a pharmacy.

Results

Patients seldom asked pharmacists for advice: 77 of the patients “rarely” or “never” went to a pharmacy to consult the pharmacist. When patients did ask the pharmacist for advice, it was mainly concerning the choice of over-the-counter medicines. The most important reason for patients visiting a pharmacy for advice was the large number of pharmacies in Poland and their ease of access; the long queues of people in busy pharmacies and the lack of confidentiality in the pharmacy were considered negative factors.

Conclusion

The current advisory role of pharmacists in Poland seems of minimal importance to the public.     

Consumer,physician, and payer perspectives on primary care medication management services with a shared resource pharmacists network

BackgroundHealth care reform initiatives are examining new care delivery models and payment reform alternatives such as medical homes, health homes, community-based care transitions teams, medical neighborhoods and accountable care organizations (ACOs). Of particular interest is the extent to which pharmacists are integrated in team-based health care reform initiatives and the related perspectives of consumers, physicians, and payers.ObjectivesTo assess the current knowledge of consumers and physicians about pharmacist training/expertise and capacity to provide primary care medication management services in a shared resource network; determine factors that will facilitate/limit consumer interest in having pharmacists as a member of a community-based “health care team;” determine factors that will facilitate/limit physician utilization of pharmacists for medication management services; and determine factors that will facilitate/limit payer reimbursement models for medication management services using a shared resource pharmacist network model.MethodsThis project used qualitative research methods to assess the perceptions of consumers, primary care physicians, and payers on pharmacist-provided medication management services using a shared resource network of pharmacists. Focus groups were conducted with primary care physicians and consumers, while semi-structured discussions were conducted with a public and private payer.ResultsMost consumers viewed pharmacists in traditional dispensing roles and were unaware of the direct patient care responsibilities of pharmacists as part of community-based health teams. Physicians noted several chronic disease states where clinically-trained pharmacists could collaborate as health care team members yet had uncertainties about integrating pharmacists into their practice workflow and payment sources for pharmacist services. Payers were interested in having credentialed pharmacists provide medication management services if the services improved quality of patient care and/or prevented adverse drug events, and the services were cost neutral (at a minimum).ConclusionsIt was difficult for most consumers and physicians to envision pharmacists practicing in non-dispensing roles. The pharmacy profession must disseminate the existing body of evidence on pharmacists as care providers of medication management services and the related impact on clinical outcomes, patient safety, and cost savings to external audiences. Without such, new pharmacist practice models may have limited acceptance by consumers, primary care physicians, and payers.     

The ethical challenges in pharmacy practice in community Pharmacies: A qualitative study

BackgroundPharmacists as a group of health care professionals, face different types of ethical challenges in their everyday routine that may impede pharmaceutical care.ObjectivesIn this study, we aimed at evaluation and recognition of the ethical challenges of pharmacy practice in community pharmacies.MethodsThis exploratory study was conducted as a qualitative study consisting of open-ended in-depth interviews and focus group discussions followed by content analysis. The study participants were chosen from pharmacists with PharmD degree who had at least 4 years work experience and were the founders or technical managers of community pharmacies, either as governmental or private. Interviews continued until data saturation and transcribed verbatim. The content analysis was done by Graneheim and Lundman method. The codes were generated, and categorized. After assessment and final modifications, the results of the study were discussed and confirmed in a focus group discussion conducted by 7 experts who teach medical ethics and/or pharmacy ethics.ResultsOverall, 40 pharmacists were interviewed (mean age 46 ± 11.3 years). The extracted ethical challenges of pharmacy practice were categorized into 3 main themes, 11 subthemes and 102 codes. The themes were achieved as challenges related to professionalism and professional practice, challenges related to professional communications and challenges related to regulations and policies.ConclusionTaken together, it seems that most of the challenges of pharmacy practice are related to professionalism and professional commitment; however, the regulations and policies provide serious obstacles for pharmacy practice and pharmaceutical care. More efforts towards teaching professionalism and modification of regulations and policies are recommended.     

Towards defining and supporting pharmacists' professional role associated with traditional and complementary medicines – A systematic literature review

BackgroundA review conducted in 2015 reported community pharmacists are willing to adopt a professional role in counselling consumers about the appropriate and safe use of traditional and complementary medicines (T&CM) but faced multiple barriers in doing so; including the role being poorly defined. This current review aimed to update and extend these findings, by identifying studies published since 2015 that reported on pharmacists across any setting.MethodsEligible studies published between January 01, 2016 and December 31, 2021 were identified across six databases (PubMed, Scopus, Web of Science, EMBASE, ScienceDirect and MEDLINE). A grounded theory approach was used to thematically synthesize the data extracted.FindingsA total 64 studies representing pharmacists across 30 countries were included for review. Study designs varied including cross-sectional surveys (n = 36), qualitative studies (n = 14), and pseudo-patient studies (n = 3). Eight studies reported on practice and/or bioethical responsibilities and 19 studies reported on factors that would enable pharmacists to fulfill these responsibilities, while 37 studies reported about both.ConclusionThese findings indicate research about pharmacists’ responsibilities associated with T&CM is evolving from gap analysis towards research that is proactive in advocating for change in multiple areas. These findings can be used to inform a consensus discussion among pharmacists and key stakeholders regarding a set of professional responsibilities that would serve in the development of: a clearly defined role and associated practice standards, and competency requirements that inform educational learning objectives for inclusion in undergraduate, post-graduate and continuing professional pharmacy education.     

我国临床药学建设与发展趋势(上篇)

目的:调整我国临床药学的发展方向,加速临床药师制和临床药师培训基地建设.方法:采用回顾和思考的方式,总结我国临床药学和临床药师制体系建设的现状、经验、不足与发展趋势.结果与结论:肯定临床药学和医院药学取得的成绩,明确临床药学学科和临床药师制体系建设的必要性,要坚持正确发展方向,药师应树立走出药房,面向临床,坚持以病人为中心、以合理用药为核心,服务患者的理念,转变观念与职责,走人才和科技发展的道路.     

Fighting against COVID-19: Innovative strategies for clinical pharmacists

BackgroundClinical pharmacists’ routine task is carrying out pharmaceutical care to ensure patients' safe and reasonable medication use. However, under public health emergencies, such as the outbreak of COVID-19, the work strategies of clinical pharmacists need to be modified according to the rapid spread of the disease, where information and resources are usually lack to guide them.ObjectiveTo retrieve and investigate the prevention and control measures of clinical pharmacists during the outbreak of novel coronavirus, summarize the roles and responsibilities of clinical pharmacists, and to propose innovative strategies for developing pharmacy services under the epidemic.MethodsThe Chinese and English databases, self-media network, website of professional society or medical institution, and clinical trial center platforms were searched, and clinical pharmacists involved in the work against COVID-19 were surveyed and interviewed. Investigate the challenges and needs of frontline medical staffs for treating patients, and formulate strategies based on the actual medical environment.ResultsClinical pharmacists play a vital role in leading the industry to formulate work instructions, provide frontline medical staff with drug information, and develop innovative pharmacy services to promote the rational use of medicines with collaborative teamwork and close communication according to the epidemic situation of COVID-19. Anti-epidemic work indeed has driven the development of remote pharmacy services.ConclusionFacing public health emergencies, clinical pharmacists can give full play to their professional expertise, analyze the current situation rationally, formulate telehealth strategies swiftly, and work in a united and efficient manner to provide innovative pharmacy services to ensure medication safety and rational use of medicine.     

Community pharmacy interventions to improve antibiotic stewardship and implications for pharmacy education: A narrative overview

BackgroundAntibiotic resistance is one of the world's most pressing public health problems, resulting in over 23,000 deaths per year. One of the main contributing factors to antimicrobial resistance is antibiotic misuse and overuse. Community pharmacists can play a role in reducing antibiotic resistance, since they are one of the most accessible healthcare professionals.ObjectiveThe purpose of this paper is to describe community pharmacy interventions and strategies to reduce antibiotic misuse and overuse and to discuss the implications for pharmacy training.MethodsA narrative overview strategy was employed to identify papers on antibiotic stewardship and the role of the community pharmacist. Our review examined potential stewardship strategies and interventions within community pharmacy practice that provide opportunities for pharmacists to engage or lead in the reduction of antimicrobial resistance.ResultsWe describe five promising community pharmacist-led intervention strategies: Collaborative Practice Agreements (CPAs), point-of-care (POC) testing, patient consultations, academic detailing and serving as an advocate for patients and other healthcare providersConclusionsThis review highlights topics that may warrant increased attention in pharmacy school curricula. Pharmacy schools may want to consider modifying their curricula to address the shifts in practice of the community pharmacist – emphasizing the expanded role of the pharmacist in patient care and public health issues such as outpatient antibiotic stewardship.     

“If I were to do this,how would I experience it?” Developing a theoretical framework for exploring pharmacists’ practice in the domain of assisted dying

BackgroundWorldwide, pharmacy practice is changing to include new roles and responsibilities. Laws enabling the implementation of assisted dying are expanding in international jurisdictions. Pharmacy practice in assisted dying is subsequently expanding. However, studies of how pharmacists experience their practice when engaged in assisted dying are absent. To progress research into the lived experiences of pharmacists practicing in assisted dying, the development of an inquiry framework to guide such research is the first step.ObjectiveThe objective was to develop a theoretical framework of inquiry for use in subsequent continuing research which may explore the actual experience of pharmacy practice in assisted dying.MethodsPerspectives were gathered from expert and senior pharmacists who were anticipating the imminent implementation of assisted dying practice. Analysis focused on understanding what aspects of practice experience were important to them. Interview-conversations centred on the question: If you had the chance to talk to experienced pharmacist practitioners who have been involved in the practice of assisted dying, what aspects regarding their experiences, would you like to know about? A conventional approach to qualitative content analysis was utilized to analyze the data.ResultsFindings summarized questions posed by pharmacists contemplating the implementation of assisted dying practice. These perspectives formed the foundation of a theoretical inquiry framework constituted by 8 inter-related dimensional range-continuums. Each range-continuum, designed to explore the lived experiences of pharmacists in practice, is defined. Examples of how the inquiry dimensions will be used to inform future exploratory research are offered within the framework.ConclusionsThe theoretical inquiry framework will be used to develop knowledge for pharmacists contemplating participation (or not) in assisted dying practice. It is timely to progress research that reveals the informed experiences of pharmacists that are actually practicing in this area. The framework may be adapted for researching pharmacists’ experience in other practice areas and contexts.