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

Pharmacists' perspectives on recommending herbal medicines for acute infections: a qualitative study

BACKGROUND

Community pharmacists have an essential role in antimicrobial stewardship by providing self-care advice for self-limiting infections.

AIM

To explore community pharmacists' perceptions and experiences of advising patients on management of acute respiratory tract infections (RTIs) and urinary tract infections (UTIs), and to explore issues regarding use of over-the-counter (OTC) medicines, including herbal medicines.

DESIGN & SETTING

A qualitative study using semi-structured interviews with community pharmacists in England.

METHOD

Qualitative interviews with community pharmacists were carried out face to face and by telephone between November 2019 and March 2020. Data were collected through in-depth, semi-structured interviews, recorded and transcribed. A reflexive thematic analysis was undertaken.

RESULTS

In total, 18 community pharmacists were interviewed. Three main themes were identified. Theme 1 was self-management recommendations. Community pharmacists considered patients' preferences when recommending self-management strategies. Some believed that conventional OTC medications had quicker and stronger effects, while others preferred herbal OTCs as a more natural approach, particularly for less severe symptoms. Theme 2 was factors influencing pharmacists' recommendations for acute infections. This included pharmacists' perceptions of patient preferences, nature or severity of illness, research evidence, training, commercial pressures, and patient concerns about medication cost. Theme 3 was pharmacist-patient communication. Pharmacists sometimes experienced challenges with language barriers and patients' expectations of receiving antibiotics. Pharmacists emphasised the importance of being trusted by their patients. There was widespread acceptance of their role in self-management advice for acute illness and interest in the role of herbal medicines, but pharmacists did not feel confident in recommending these.

CONCLUSION

Pharmacists are central to the management of self-limiting infections. There is a need to educate the public about appropriate use of antibiotics and provide training and support for pharmacists on self-management strategies including herbal medicine.

Pharmacists‘ attitudes to dispensing food supplements to chronically ill patients: a pilot survey among community pharmacies in Bulgaria

Background: Within the last years, excessive utilization of food supplements for prevention and prophylaxis in different chronic diseases is observed. In order to extend the control on the arrangement of the market, utilization, and safety of food supplements, the European Commission took genuine regulatory steps to harmonize the criteria for FS and to guarantee that they are not giving deceiving information. However, excessive use, uncontrolled patients consumption, exposure to higher than recommended intakes, and even interaction with specific medicines can cause toxicity risks and pose serious health concerns. The aim of this study is to examine the tendency of pharmacists to correctly recommend food supplements to chronically ill patients in order to extend the pharmaceutical care and prevent side effects.

Materials and methods: The used method is an anonymous survey that was conducted by using the direct questionnaire method among master pharmacists and assistant pharmacists working in community pharmacies in Bulgaria.

Results: The results show that the majority of the pharmacists are willing to recommend food supplements and that they could participate in the monitoring of chronically ill patients with food supplements intake. On the other side, the survey shows that most of the patients are seeking for food supplements and do ask for advice.

Conclusion: In conclusion, pharmacists as the most accessible health care professionals can provide more detailed information concerning food supplements in order to avoid negative effects on the safety of chronically ill patients, especially with additional training in the field.

Community pharmacists' use, perception and knowledge on dietary supplements: a cross sectional study

Background:

Pharmacists are commonly tasked with recommending the appropriate dietary supplement and advising the patients of their correct and safe use. Previous research, conducted on pharmacy students, showed that they did not always use the evidence based sources of information, with personal use identified as a significant predictor influencing the decision to recommend a supplement.

Objectives:

To compare use, perceptions and knowledge of dietary supplements of pharmacists with different years of work experience and to explore factors that could influence their recommendation of supplements.

Methods:

A questionnaire based cross-sectional study was conducted on Croatian community pharmacists in September 2017. The questionnaire explored pharmacists’ demographic characteristics, use, perceptions and knowledge of dietary supplements. Pharmacists (N=102) were divided in two groups based on their work experience: P0 (<10 years) and P1 (≥10 years).

Results:

All included pharmacists had high knowledge scores without differences between groups (P0=10, IQR 9-12 vs P1=11, IQR 9-12, expressed as median and interquartile range (IQR), p=0.275). Less experienced pharmacists perceived there was less research conducted on the dietary supplements compared to their more experienced counterparts (P0=1, IQR 1-2 vs P1=2, IQR 2-3, expressed as median and interquartile range, p<0.001). Groups differed in sources used when choosing the appropriate supplement with P0 using higher quality sources such as systematic reviews in comparison to P1 (32.1% vs 8.7%, p=0.004). Pharmacists’ decision to recommend a dietary supplement was influenced by their personal use (odds ratio 0.216, 95%CI 0.068:0.689, p=0.01) and work experience (odds ratio 0.154, 95%CI 0.045:0.530, p=0.003).

Conclusions:

Pharmacists did not use the high quality sources when recommending dietary supplements and their decision to recommend the supplement was not based on objective evaluation of evidence. Further education about the practice of evidence-based pharmacy is necessary, with special emphasis on senior pharmacists who might have missed that aspect during their formal education.

Graph Convolutional Neural Network for a Pharmacy Cross-Selling Recommender System

Recent advancements in deep neural networks for graph-structured data have led to state-of-the-art performance in recommender system benchmarks. Adapting these methods to pharmacy product cross-selling recommendation tasks with a million products and hundreds of millions of sales remains a challenge, due to the intricate medical and legal properties of pharmaceutical data. To tackle this challenge, we developed a graph convolutional network (GCN) algorithm called PharmaSage, which uses graph convolutions to generate embeddings for pharmacy products, which are then used in a downstream recommendation task. In the underlying graph, we incorporate both cross-sales information from the sales transaction within the graph structure, as well as product information as node features. Via modifications to the sampling involved in the network optimization process, we address a common phenomenon in recommender systems, the so-called popularity bias: popular products are frequently recommended, while less popular items are often neglected and recommended seldomly or not at all. We deployed PharmaSage using real-world sales data and trained it on 700,000 articles represented as nodes in a graph with edges between nodes representing approximately 100 million sales transactions. By exploiting the pharmaceutical product properties, such as their indications, ingredients, and adverse effects, and combining these with large sales histories, we achieved better results than with a purely statistics based approach. To our knowledge, this is the first application of deep graph embeddings for pharmacy product cross-selling recommendation at this scale to date.

Evaluation of simulated drug dispensing and patient counseling in the course of pharmaceutical improvement: 2009 to 2015

Background

Aiming to facilitate the drug dispensing process and patient counseling, specific professional skills are required. The knowledge, skills and attitudes involved in this process can be improved. From 2012 to 2015, a nationwide course was held, in partnership with the Ministry of Health and the Federal University of Rio Grande do Sul (UFRGS) - Brazil, to train pharmacists working in primary health care through the development of their clinical and communication skills. One of the steps in this process involved the simulation of the drug dispensing process and patient counseling.

Objective

To evaluate the performance of pharmacists in drug dispensing and counseling through patient simulation role-playing held in a face-to-face meeting at the end of a training course.

Methods

A cross-sectional and retrospective study with analysis of patient simulation recordings and data collection using an assessment instrument with scores ranging from 0 to 10 points to assess pharmacist's behavior, skills, and technical knowledge.

Results

Participants presented poor-to-regular performance, with median scores equal to or lower than six. The median time of the drug dispensing simulation was five minutes and the patient counseling was eight minutes. Pharmacists had better scores in the simulation of asthma cases. In drug dispensing, 99.5% of pharmacists had difficulty checking the patient's time availability, 98.5% did not know how to use the devices, and 94.7% did not advise the patient on what to do if they forgot to take a dose. In patient counseling simulation, 1.18% of pharmacists remembered to advise on what do with medication leftovers, and 50.6% asked questions that induced the patient's responses.

Conclusions

The low-to-regular performance showed that pharmacists had difficulties at improving their skills in the performance of complete and effective drug dispensing and patient counseling.