Integrating complementary and alternative medicine education into the pharmacy curriculum

Mindfulness-Based Stress Reduction (MBSR) for Chronic Pain Management in the Community Pharmacy Setting: A Cross-Sectional Survey of the General Public's Knowledge and Perceptions

Patient access to mindfulness-based stress reduction (MBSR), a complementary and integrative health approach that is proven to reduce chronic pain, can be increased via community pharmacy-based implementation. However, the general public's awareness and preferences regarding MBSR as a treatment option for chronic pain, including provider roles (pharmacist vs. non-pharmacist), are unclear. Therefore, the purpose of this study was to assess the U.S. general public's knowledge, attitudes, barriers, and programmatic preferences regarding MBSR for chronic pain management, particularly in the community pharmacy setting. A cross-sectional, anonymous online survey was distributed to U.S. adults ≥18 years via the Amazon Mechanical Turk (MTurk) online survey platform. The survey instrument was informed by Anderson's framework for health service utilization. Measures were assessed using multiple-choice and 5-point Likert-type scales (1 = strongly disagree, 5 = strongly agree). Primary outcome measures included: (1) knowledge and awareness of MBSR (12-items); (2) confidence in seeking out MBSR for pain (5-items); (3) barriers to receiving MBSR (11-items); (4) beliefs about MBSR in general (12-items); (5) beliefs about community pharmacy-delivered MBSR (15-items); and (6) preferences for MBSR classes/programs (6-items). Outcomes were analyzed using descriptive statistics, and influential factors associated with mean beliefs regarding community pharmacy-delivered MBSR for chronic pain management were assessed via multiple linear regression. Of the 302 survey respondents, the majority were white (79.1%) and female (50.7%), with a mean age of 44.65 years. Respondents' self-rated MBSR knowledge (mean [SD] scale score: 2.30 [0.68]) and confidence (2.65 [0.87]) were low, although perceived barriers to access were low overall (2.22 [0.53]). Beliefs regarding the use of MBSR for treatment of chronic pain were positive in general (3.67 [0.71]), but more negative regarding community pharmacy-delivered MBSR (2.38 [0.56]). Confidence in seeking out MBSR (β = 0.297, 95% CI = 0.219 to 0.375; p < 0.001) and current opioid use (β = 0.419, 95% CI = 0.147 to 0.690; p = 0.003) were positively associated with beliefs regarding pharmacy-delivered MBSR, while annual household income (β = -0.124, 95% CI = -0.244 to -0.004; p = 0.043) and level of bodily pain (β = -0.149, 95% CI = -0.291 to -0.008; p = 0.039) exerted statistically significant negative influences. Respondents preferred a hybrid MBSR class format including both online and in-person components (29.7%) as well as both group and individual session options (43.7%). In conclusion, further education is necessary to increase the public's perception of community pharmacies as a resource for complementary and integrative health.

Pharmacist and Student Knowledge and Perceptions of Herbal Supplements and Natural Products

We aimed to collect parallel perspectives from pharmacists and pharmacy students on their use, knowledge, attitudes, and perceptions about herbal supplements/natural products. Two cross-sectional descriptive survey questionnaires-one focusing on pharmacists and the other focusing on pharmacy students-were administered from March to June 2021 via Qualtrics. The surveys were sent out to preceptor pharmacists and pharmacy students currently enrolled at a single U.S. school of pharmacy. The questionnaires were composed of five main sections, including (1) demographics; (2) attitudes/perceptions; (3) educational experience; (4) resource availability; and (5) objective knowledge of herbal supplements/natural products. Data analysis primarily utilized descriptive statistics with relevant comparisons across domains. A total of 73 pharmacists and 92 pharmacy students participated, with response rates of 8.8% and 19.3%, respectively. A total of 59.2% of pharmacists and 50% of pharmacy students stated they personally used herbal supplements/natural products. Most respondents (>95% for both groups) considered vitamins/minerals safe, although a lower percentage agreed on this for herbal supplements/natural products (60% and 79.3% for pharmacists and pharmacy students, respectively). Patient inquiries in the pharmacy setting were most seen for vitamin D, zinc, cannabidiol, and omega-3. A total of 34.2% of pharmacists reported having training in herbal supplements/natural products as a required part of their Pharm.D. training, and 89.1% of pharmacy students desired to learn more. The median score on the objective knowledge quiz was 50% for pharmacists and 45% for pharmacy students. Ultimately, herbal supplements/natural products are recognized by pharmacists/pharmacy students as a consistent and embedded part of pharmacy practice, although there is a need to enhance knowledge and skills in this area.

The effectiveness of teaching complementary and alternative medicine based on the components of theory of planned behavior on nutrition students: multicenter research study

OBJECTIVE

Safe and beneficial use of complementary and alternative medicine (CAM) modalities results from integrating CAM education into curricula and increasing CAM knowledge. We sought how much teaching CAM procedures in a virtual environment can influence the components of the theory of planned behavior (TPB), including knowledge, attitude, behavioral intention, and behavior of nutrition students.

METHODS

This cross-sectional descriptive-analytic study was conducted on 162 undergraduate nutrition students were selected through convenience sampling based on inclusion criteria in 2021-2022. Data were collected through a validated researcher-made CAM questionnaire that was designed based on TPB questionnaire that consisted of four constructs (knowledge, attitude, behavioral intention, and behavior). The content validity index and content validity ratio of the questionnaire were evaluated.

RESULTS

Our results revealed that students who significantly scored the highest scores in attitude, behavioral intention, and behavior constructs were the students who claimed that "teaching two credits of CAM for nutrition students is not enough" (p. value =  < 0.001, < 0.001, and 0.005, respectively). In addition, these students used treatment methods of CAM for themselves, suggested treatment methods of CAM to others, and followed the recommendations of the CAM specialists (for three pairwise comparisons: p. value =  < 0.001, < 0.001, and < 0.001, respectively). The attitude could predict 70% of behavioral intention. However, attitude and behavioral intention could predict 90% of behavior.

CONCLUSION

Attitude was the most critical determinant influencing behavioral intention and behavior. CAM teaching using evidence-based CAM-ITM principles with a succinct, concerted, and collaborative curriculum, integration of CAM into continuing education, and integration of educational CAM programs continuously for several years into the academic curriculum in the actual setting influence the success of the educational CAM program.

Pharmacist Knowledge and Perceptions of Homeopathy: A Survey of Recent Pharmacy Graduates in Practice

Homeopathic products are available over the counter in many pharmacies in the United States and are popular among consumers, although there is no conclusive evidence of their therapeutic effects. Pharmacists are obligated to provide well-informed, evidence-based information on these products, but many graduates may not be receiving adequate training in this area. This report outlines the results of a survey assessing whether taking a focused elective course in complementary and integrative health (CIH) affects knowledge and perceptions regarding homeopathy. A 22-question survey was developed and distributed to graduates of Idaho State University College of Pharmacy. Responses on survey items were compared between those who had reported taking the CIH elective course and those who had not. Of the 475 pharmacists, 89 completed the survey (response rate of 18.7%). Pharmacists who had taken the CIH elective course reported being more comfortable answering patient questions (82% vs. 44%, p < 0.001), felt more able to make recommendations (75% vs. 36%, p < 0.001), and felt they could explain the proposed mechanism of action of homeopathic remedies to their patients (87% vs. 61%, p = 0.002). Those who took the elective course were also more likely to say that any benefits of homeopathy were due to the placebo effect (82% vs. 64%, p = 0.007). A significantly higher portion of respondents who had not taken the elective course indicated that they could benefit from further training on CIH topics when compared with those who had taken the elective course (85% vs. 51%, p = 0.02). There was no significant difference between groups with respect to their use of reliable resources (e.g., PubMed and Natural Medicines) vs. unreliable sources (other internet searches or personal anecdotes) when addressing CIH-related questions. These findings indicate that pharmacists with more focused training in CIH are more comfortable, confident, and knowledgeable when discussing homeopathy. Such education should be provided more broadly to students in colleges of pharmacy.

A Cross-Sectional Assessment of Complementary and Alternative Medicine (CAM) Use among Patients with Chronic Diseases (CDs) in Qassim, Saudi Arabia

This study aims to investigate CAM use among CD patients from Qassim, Saudi Arabia and to compare CAM practice with different demographic and disease characteristics of the participants. A cross-sectional study was conducted among CD patients. During the three-months of data collection period, a total of 377 patients were approached and 208 patients participated in the study, giving a response rate of 55.17%. A p value of <0.05 was considered as significant. Among the study population, 94 (45.2%) patients were CAM users. Diabetes mellitus patients were the majority (48 (51.06%)) followed by hypertensive patients (34 (36.17%)). Spiritual therapies were the most common CAM followed by herbal products. Among CAM users, 41 (19.7%) patients reported disclosing CAM use to their health care providers. Among all the sociodemographic variables, gender (p = 0.029), marital status (p = 0.034) and education level (p = 0.047) were significantly associated with CAM use. In conclusion, the use of CAM among CD patients was relatively high in Qassim. Patients reported using CAM without disclosing to their health care providers which is a major health risk. It is critical to counsel CD patients regarding rational and informed CAM use in order to prevent harmful and unwanted effects.

Yoga therapy knowledge in third-year pharmacy students: An education intervention

BACKGROUND AND PURPOSE

The omission of yoga education in health professions curricula limits health professionals from understanding how to support patient well-being in an integrated manner. The objective of this study was to examine the effectiveness of a yoga therapy-based educational intervention in increasing yoga knowledge of third-year pharmacy students.

EDUCATIONAL ACTIVITY AND SETTING

Students in the Pharmacognosy and Complementary and Alternative Medicine course received a three-hour educational intervention over two class meetings on yoga therapy during fall 2019. The pedagogical method of peer instruction was used, and pre- and post-questionnaires were administered online prior to and after the intervention. The instrument contained eight demographic, six yoga knowledge and participation, 10 yoga therapy, and 15 referral behavior questions.

FINDINGS

A statistically significant increase in yoga knowledge scores from 1.43 ± 0.9 before the education intervention to 5.69 ± 1.65 after the intervention occurred (P < .01) was found. A majority believed that yoga therapy should be included in the curriculum.

SUMMARY

Increases in post-questionnaire knowledge scores suggested that the educational intervention increased pharmacy students' knowledge of yoga therapy in our sample. Studies specific to yoga education in health professional students, especially in the United States, are scarce. Additionally, the impact of an educational intervention on yoga knowledge in pharmacy students has not been studied. Including yoga therapy in pharmacy curricula should be explored as greater integration of yoga in healthcare is likely to occur due to its effectiveness as an adjunct and widespread use.

Association of pharmacy students' cultural beliefs with perceived knowledge, beliefs, confidence, and experience with complementary medicine

BACKGROUND AND PURPOSE

Culture has been shown to inform patients' acceptance and use of complementary medicine (CM) treatment. It is unknown how a pharmacist or pharmacy student's culture may be associated with perceptions of CM relating to patient care. Gaining a better understanding of this concept within student populations may inform educational needs for programs situated within culturally diverse settings. The purpose of this study was to explore how pharmacy students' cultural beliefs influence perceived knowledge, confidence, and practice with respect to CM.

EDUCATIONAL ACTIVITY AND SETTING

A cross-sectional survey was distributed to all undergraduate pharmacy (professional years 1-4) and postgraduate doctor of pharmacy students. Results from the item "CM is an important aspect of my culture" were correlated with all other items using Spearman's correlation coefficient.

FINDINGS

Senior students who had completed a two-credit hour course appeared to be more confident in their practice skills relating to CM and showed positive correlations with culture and effectiveness of CM. Senior students acknowledged the importance of CM knowledge as a student and within pharmacy practice. Junior students showed a positive correlation with culture and past use.

SUMMARY

Pharmacy students in the Ccollege of pharmacy were positive towards the use of CM, with culture playing an important role. Students who perceived CM as an important aspect of their culture were more confident in their practice skills relating to CM. Future research is required to assess impact of students' cultural beliefs on practice.

Quality Indicators of Pharmaceutical Care for Integrative Healthcare: A Scoping Review of Indicators Developed Using the Delphi Technique

Background

Recently, measuring and benchmarking provision of healthcare services has drawn a considerable attention. This scoping review was conducted to identify, describe, and summarize studies in which the Delphi technique was used to develop quality indicators of pharmaceutical care. The study also aimed to identify activities and services that could be used to capture the impact of pharmacist in integrative medicine.

Methods

Databases were searched from inception to February 2020 using key terms that were combined using Boolean operators. Studies were included if they were relevant to development of quality indicators of pharmaceutical care with regard to medications or complementary and alternative medicine (CAM) modalities. Full text of the selected studies was imported into EndNote. Studies were screened and data were extracted into a standard extraction form.

Results

Data were extracted from 31 studies. Of those, 24 (77.4%) were related to provision of pharmaceutical services relevant to medications and 7 (22.6%) were related to provision of care using CAM modalities. Most of the studies (67.7%) were published in 2010 and beyond. Almost half of the studies (48.4%) originated from the United States, United Kingdom, and Canada. A total of 42 different activities and services that could be used as quality indicators were identified from the studies included in this review. Activities and services were related to history taking, performing reconciliations, identifying and resolving therapy problems, providing collaborative care, designing care plans, optimal performance, and continuing education.

Conclusions

Although there is an increasing interest in improving healthcare delivery, quality indicators of pharmaceutical services and those relevant to CAM provision in healthcare facilities adopting the integrated healthcare paradigm are still limited. Future studies are needed to develop validated quality indicators that could be successfully used in measuring and benchmarking quality of services in integrated healthcare facilities.

Complementary medicine products information-seeking by pregnant and breastfeeding women in Australia

OBJECTIVE

Complementary medicine product use in pregnancy and lactation is common but little is known about women's health literacy and information-seeking regarding this. The objectives of this study were to identify and explore pregnant or breastfeeding women's sources of, and rationale for seeking complementary medicine products information, the types of information sought, and how women felt their health care practitioners can help them receive information that meets their needs.

DESIGN

A qualitative research design consisting of in-depth interviews and focus group discussions was conducted. Data were thematically analysed. Participants also completed two validated health literacy screening tools.

SETTING

Communities in regional and metropolitan settings in Sydney and Northern New South Wales, and South-East Queensland, Australia.

PARTICIPANTS

Twenty-five women (n = 7 pregnant, n = 17 breastfeeding, n = 1 both pregnant and breastfeeding) who currently used complementary medicine products participated. Eleven women were pregnant with or breastfeeding their first child; 14 had between one and four older children.

FINDINGS

Twenty-four participants had high health literacy according to the validated screening tools. Around half of the participants had used complementary medicine products for most of their lives and 17 had used complementary medicine products to resolve or manage complex health conditions in adulthood or childhood. Women sought complementary medicine products information from three main sources. 1) Practical and safety information on complementary medicine products was sought from health care practitioners and published research; 2) health care practitioners were also sources of information on reasons for complementary medicine products recommendations and physiological actions; and 3) sharing experiences of complementary medicine products use with other mothers appeared to help women understand what to expect when taking complementary medicine products, support social-emotional wellbeing and encourage participants to look after their own health. Participants strongly expressed the desire for their mainstream biomedical health care practitioners to be more informed in, and open to, complementary medicine product use in pregnancy and breastfeeding.

KEY CONCLUSIONS

Participants' high health literacy skills may have influenced them to seek comprehensive information on complementary medicine products from a variety of professional and lay sources. Their use of complementary medicine products in pregnancy and breastfeeding was a natural consequence from previous positive experiences with complementary medicine products and/or therapies.

IMPLICATIONS FOR PRACTICE

Maternity care practitioners can positively enhance their interactions with pregnant or breastfeeding women who use complementary medicine products by respectfully discussing use within the context of these women's values and health goals, and by furthering their own education in complementary medicine products' safety, efficacy and indications in pregnancy and breastfeeding.

Advancing the pharmacist's role in promoting the appropriate and safe use of dietary supplements

BACKGROUND

Natural products (NPs) are widely purchased as dietary supplements (DS) in pharmacy outlets. U.S. pharmacists report multiple barriers in adopting a professional role that ensures the appropriate and safe use of DS.

OBJECTIVE

To elicit pharmacist and key stakeholder perceptions about the actions needed to enable pharmacists to fulfill a professional role related to DS use.

METHODS

An interview guide was developed based on the existing literature. A grounded theory approach involving in-depth, semi-structured key informant audio-recorded phone interviews. Audio recordings were transcribed verbatim, and thematic analysis using open coding, grouping, and categorizing into emergent themes was conducted.

RESULTS

22 interviews were conducted with 12 practicing pharmacists and 10 organizational representatives. In general, pharmacists proposed they could develop and promote themselves in this area, and all participants offered opinions about the actions they believed would facilitate the development of a more structured service and formalized role for pharmacists providing care related to DS use. Four key areas were identified (1) Education and training; (2) Strategies for ensuring high standards related to DS safety and quality assurance (3) Workplace resources (4) DS Research.

CONCLUSIONS

Despite the challenges facing pharmacy related to DS use, pharmacists and key stakeholders hold constructive and practical ideas about how to transform the current DS landscape into an opportunity that develops pharmacist's professional role and facilitates the appropriate and safe use of DS by Americans.

Pharmacy Competencies for Interprofessional Integrative Health Care Education

Objective. To address the gap in evidence-based knowledge among pharmacy students and practicing pharmacists regarding complementary and integrative health approaches due to insufficient education and a lack of standardized training. Methods. The National Center for Integrative Primary Healthcare (NCIPH) developed 22 pharmacy competencies linked to a set of 10 interprofessional "metacompetencies" in integrative health care. Results. The NCIPH pharmacy competencies are well-aligned with the current educational standards and Center for the Advancement of Pharmacy Education (CAPE) outcomes for pharmacy programs. Therefore, the NCIPH competencies may provide a foundation for the incorporation of interprofessional integrative health care education into pharmacy curricula. Conclusion. The NCIPH pharmacy competencies in integrative health care, linked to the interprofessional "metacompetencies," are aligned with educational standards and outcomes, and may serve as a basis for pharmacy curriculum.

Community pharmacists' views on the regulation of complementary medicines and complementary-medicines practitioners: a qualitative study in New Zealand

OBJECTIVES

To examine community pharmacists' perspectives on CMs regulation in New Zealand, where proposals for CMs regulations had recently been suspended and where, currently, CMs are only weakly regulated.

METHODS

Qualitative, in-depth, semi-structured interviews with New Zealand practising community pharmacists are identified through purposive and convenience sampling. Data were analysed using a general inductive approach.

KEY FINDINGS

Participants held mixed views regarding harmonisation of CMs regulations across Australia and NZ; some supported an NZ national regulatory framework for CMs, based on the Australian system. Participants recognised the current CMs regulatory framework in NZ as inadequate, that regulation was required to some extent, and that mandatory regulation was not necessarily required. A key reason given in support of CMs regulations was the need for greater assurances around quality of CMs. Participants also supported a regulatory framework that incorporated assessment of the safety of CMs, but were less convinced of the need for, or feasibility of, requiring evidence of efficacy from clinical trials. Participants believed that regulation of CMs practitioners, such as herbalists, and CMs retailers was important, although there were mixed views as to whether regulation should be statutory or whether self-regulation would be adequate.

CONCLUSIONS

On the basis of these findings, pharmacists would be expected to welcome proposals for national regulations for CMs in NZ: such regulations should address concerns regarding product quality, inappropriate health claims and supporting evidence, and therefore should support pharmacists in meeting their obligations under the NZ Pharmacy Council's Code of Ethics.

Community pharmacists' knowledge, practices and beliefs about complementary and alternative medicine in Palestine: a cross-sectional study

BACKGROUND

Complementary and alternative medicine (CAM) utilization is dramatically increasing among patients. As community pharmacies are a major provider of CAM products, community pharmacists need to have the sufficient knowledge and information to advice their patients, answer their inquiries and to be proactive in the healthcare process to ensure optimal therapy outputs and minimize both drug-drug and drug-herb interactions. Therefore, the main objective of this study was to assess the knowledge, beliefs, and practices of community pharmacists in Palestine about CAM.

METHODS

The study was conducted in a cross-sectional design in which a questionnaire was administered on a sample of licensed community pharmacists from Palestine. The questionnaire was of 5 sections: demographic and practice details of the participants, practice, beliefs, and knowledge about CAM. Mann-Whitney-U or Kruskal-Wallis tests were used to comparison of different issues as appropriate. P-values of <0.05 were considered significant.

RESULTS

A total of 284 community pharmacists were surveyed, however, 281 were included in the analysis as they met inclusion criteria. Out of the 281, 149 (53.0%) of the participants were males and the rest were females. About 40% of the participants were between 20 to 29 years old. Pharmacists frequently recommended CAM modalities. Exercises (84.0%) and food supplements (82.6%) were the most commonly recommended modalities. In the last year, vitamin B₁₂ was the most frequently prescribed supplement. The median knowledge score was 5 out of 8 and the median beliefs about CAM score was 4.0 out of 7.0.

CONCLUSIONS

CAM recommendations by pharmacists appear to be commonplace. Although their knowledge scores were fair to average, pharmacists still need more education and training about CAM in order to be more qualified to provide better pharmaceutical care and improve their patient's outcome.

Complementary and alternative medicine education in U.S. schools and colleges of pharmacy

INTRODUCTION

The objective of this survey is to provide an update on the state of complementary and alternative medicine (CAM) education and describe instructional and assessment methods across schools and colleges of pharmacy.

METHODS

One hundred thirty-five schools of pharmacy were contacted to participate in a survey describing the incorporation of CAM education into their respective curricula. The survey also inquired about perceived barriers and future plans for CAM-related courses.

RESULTS

Ninety-six schools responded to the survey (71.1%), with all schools reporting that CAM is incorporated into the curriculum. Topics covered, teaching strategies, and assessment methods varied among the 74 elective and 116 required courses described. Respondents listed lack of evidence to support CAM use as the most common barrier to CAM education, and 50% of respondents reported plans for expansion of CAM education at their schools.

CONCLUSIONS

CAM education in pharmacy curricula has grown over the last decade, but remains varied in topics taught and teaching methods.

Knowledge, perceptions, and attitudes toward complementary and alternative medicines among pharmacy students of a Malaysian Public University

Background:

The use of complementary and alternative medicine (CAM) is consistently on the rise worldwide. Consumers often consider pharmacists as a major source of information about CAM products and their safety. Due to the limitation of data, it is worth exploring the knowledge, perceptions, and attitudes of pharmacy students toward CAM.

Objective:

The objective of this study was to explore the knowledge, perceptions, and attitudes of pharmacy students regarding the use of CAM in Malaysia.

Materials and Methods:

A cross-sectional study was conducted for 3 months among Bachelor of Pharmacy students in a public sector University of Malaysia. A pretested, self-administered questionnaire, comprised four sections, was used to collect the data from 440 participants. Descriptive analysis was used, and Chi-square test was used to test the association between dependent and independent variables.

Results:

Of 440 questionnaire distributed, 287 were returned giving a response rate of (65.2%). The results showed that 38.6% participants gave correct answers when asked about the use of herbal products with digoxin. Majority of the participants were knowledgeable about supplementary therapy (25.3%) while the lack of knowledge was mostly evident in traditional Chinese medicines (73.7%). Majority of the students were either neutral (49.5%) or disagreed that (42.8%) CAM use is unsafe. Females were more in disagreement to the statements than males (P = 0.007). Majority of students also agreed to use CAM therapies for their health and well-being (51.2%).

Conclusion:

The study revealed that pharmacy students did not have adequate knowledge of CAM though their attitudes and perceptions were relatively positive.

Awareness, use, attitude and perceived need for Complementary and Alternative Medicine (CAM) education among undergraduate pharmacy students in Sierra Leone: a descriptive cross-sectional survey

BACKGROUND

The widespread use of CAM around the world requires health professionals including pharmacists to have the required knowledge to better advise their patients. This has lead to an increased need for the inclusion of CAM instruction into the mainstream undergraduate Pharmacy education. This study was designed to describe pharmacy students awareness, use, attitude and perceived need for CAM education at COMAHS-USL and at the same time, determine how these descriptive outcomes are influenced by the socio-demographic variables considered in this study.

METHODS

A descriptive cross-sectional survey was conducted among undergraduate pharmacy students (n = 90) at the College of Medicine and Allied Health Sciences, University of Sierra Leone using a structured questionnaire. Chi square, fisher exact test, and general linear model univariate analysis were used to compare data between independent cohorts.

RESULTS

All 90 (100%) of the students were aware and have used (except Ayurveda) at least one of the listed CAM modalities. Herbal/Botanical/Supplements followed by Spirituality/Prayer were the most commonly known and used CAM modalities. Almost two thirds of students considered the CAM modalities they have used to be effective and not harmful. Overall, pharmacy students had a positive attitude towards CAM (Mean attitudinal score = 34.9 ± 4. 5 (range 19-43)) with fourth and fifth year students showing a significantly less positive attitude as compared to the first, second and third year (B = -3.203 p = 0.001, 95% confidence interval -5.093 to -1.314). The media [53 (58.9%)] was the most frequent source of information about CAM. Nearly all students [89 (98.9%)] agreed that CAM knowledge is important to them as future pharmacist and that CAM should be included into the Pharmacy curriculum at COMAHS-USL [81 (90.0%)].

CONCLUSION

Pharmacy students in Sierra Leone are aware of and have used at least one of the CAM modalities and do show a positive attitude towards CAM. This was demonstrated by their overwhelming endorsement for CAM course to be part of the undergraduate pharmacy training at COMAHS-USL. This study among others will inform and guide the development and implementation of CAM instruction at COMAHS-USL.

An active learning complementary and alternative medicine session in a self-care therapeutics class

OBJECTIVE

To provide an interactive, non-supplement based complementary and alternative medicine (CAM) session in a self-care therapeutics class and to evaluate the effect of the session on pharmacy students' perceptions and knowledge of CAM.

DESIGN

Second professional year pharmacy students enrolled in a required 3-credit course titled Self-Care Therapeutics participated in an active learning session on CAM. Students physically engaged in 5 separate active learning CAM sessions including massage therapy, Tai Chi, yoga, progressive muscle relaxation, and Reiki.

ASSESSMENT

Students were assessed on both knowledge and perception of CAM. Concept mastery was assessed using a written examination and individual readiness assurance tests (iRAT) and team readiness assurance tests (tRAT). Perception of CAM was measured using both a presession and a postsession survey.

CONCLUSION

Participating in an intensive, active learning CAM session provided an opportunity to increase students' knowledge of CAM and an effective strategy for providing the learner with the experience to better envision incorporation into patient therapies.

A career exploration assignment for first-year pharmacy students

OBJECTIVE

To develop, implement, and assess student-learning outcomes from an assignment designed to expose first-year pharmacy students (P1) to a wide range of pharmacy career pathways.

DESIGN

Students enrolled in a required Pharmacy Practice and Ethics course at the Lebanese American University chose 1 pharmacist career to investigate from a suggested list of 28 career pathways. Students completed a literature review on the selected career, interviewed a pharmacist practicing that career path in Lebanon, wrote a paper, and prepared and delivered a summary presentation to their classmates about the career pathway. Students peer evaluated their classmates after each presentation.

ASSESSMENT

More than 85% of the students scored ≥70% on the assignment based on their achievement of student learning outcomes. Responses on an anonymous questionnaire showed that more than 94.6% of students were satisfied with the extent to which the course allowed them to meet the established learning outcomes.

CONCLUSION

A career exploration assignment provided pharmacy students with an opportunity to widen their knowledge and understanding of the different career pathways that are available for them.

An elective course on the basic and clinical sciences aspects of vitamins and minerals

Objective. To develop and implement an elective course on vitamins and minerals and their usefulness as dietary supplements. Design. A 2-credit-hour elective course designed to provide students with the most up-to-date basic and clinical science information on vitamins and minerals was developed and implemented in the doctor of pharmacy (PharmD) curriculum. In addition to classroom lectures, an active-learning component was incorporated in the course in the form of group discussion. Assessment. Student learning was demonstrated by examination scores. Performance on pre- and post-course surveys administered in 2011 demonstrated a significant increase in students' knowledge of the basic and clinical science aspects of vitamins and minerals, with average scores increasing from 61% to 86%. At the end of the semester, students completed a standard course evaluation. Conclusion. An elective course on vitamin and mineral supplements was well received by pharmacy students and helped them to acquire knowledge and competence in patient counseling regarding safe, appropriate, effective, and economical use of these products.

Factors affecting pharmacists' recommendation of complementary medicines - a qualitative pilot study of Australian pharmacists

Background

Complementary medicines (CMs) are widely used by the Australian public, and pharmacies are major suppliers of these medicines. The integration of CMs into pharmacy practice is well documented, but the behaviours of pharmacists in recommending CMs to customers are less well studied. This study reports on factors that influence whether or not pharmacists in Australia recommend CMs to their customers.

Methods

Data were collected from semi-structured interviews with twelve practicing pharmacists based in Brisbane, Australia. The qualitative data were analysed by thematic analysis.

Results

The primary driver of the recommendation of CMs was a desire to provide a health benefit to the customer. Other important drivers were an awareness of evidence of efficacy, customer feedback and pharmacy protocols to recommend a CM alongside a particular pharmaceutical medication. The primary barrier to the recommendation of CMs was safety concerns around patients on multiple medications or with complex health issues. Also, a lack of knowledge of CMs, a perceived lack of evidence or a lack of time to counsel patients were identified as barriers. There was a desire to see a greater integration of CM into formal pharmacy education. Additionally, the provision of good quality educational materials was seen as important to allow pharmacists to assess levels of evidence for CMs and educate them on their safe and appropriate use.

Conclusions

Pharmacists who frequently recommend CMs identify many potential benefits for patients and see it as an important part of providing a ‘healthcare solution’. To encourage the informed use of CMs in pharmacy there is a need for the development of accessible, quality resources on CMs. In addition, incorporation of CM education into pharmacy curricula would better prepare graduate pharmacists for community practice. Ultimately, such moves would contribute to the safe and effective use of CMs to the benefit of consumers.

Development and implementation of an herbal and natural product elective in undergraduate medical education

BACKGROUND

Medical students have consistently expressed interest in learning about alternative healing modalities, especially herbal and natural products. To fill this void in medical education at our institution, a novel elective was developed and implemented for fourth year medical students. This herbal/natural product course uses guest lecturers, classroom presentations, and active learning mechanisms that include experiential rotations, case-based learning, and team-based learning to increase student knowledge of herbal/natural product safety and efficacy.

METHODS

Knowledge outcomes were evaluated via administration of a pre- and post-course test (paired student t-test). End-of-course evaluations (Likert-type questions and narrative responses) were used to assess student opinion of knowledge and skills imparted by the elective and overall course content (mean, standard deviation).

RESULTS

Over three academic years, 23 students have enrolled in this elective. More than 60% of participants have been female and nearly half of the students (43%) have pursued residencies in primary care. Completion of the course significantly increased student knowledge of common herbal/natural product mechanisms, uses, adverse effects, and drug-interactions as determined by a pre- and post-course knowledge assessment (45%±10% versus 78%±6%; p<0.0001). The course was highly rated by enrollees (overall course quality, 4.6 of 5.0±0.48) who appreciated the variety of activities to which they were exposed and the open classroom discussions that resulted. While students tended to view some alternative medical systems with skepticism, they still believed it was valuable to learn what these modalities encompass.

CONCLUSIONS

Development and implementation of a herbal/natural product elective that engages undergraduate medical students through active learning mechanisms and critical analysis of the literature has proven effective in increasing knowledge outcomes and is deemed to be a valuable curricular addition by student participants. In the future, it will be of interest to explore mechanisms for expanding the course to reach a larger number of students within the time, financial, and logistical constraints that currently exist.

Student and faculty perspective toward the role and value of integration of natural product information into the pharmacy curriculum

BACKGROUND

Consumer use of natural products is a mainstay in our society and continues to grow in prevalence. As pharmacists are viewed as drug experts and are easily accessible to patients, it is important for them to have basic knowledge of natural products.

METHODS

Students and faculty members participating in a natural product elective were surveyed upon completion of the course about their perspectives regarding incorporation of covered information into the required curriculum.

RESULTS

The majority of students and faculty members agree with the necessity of natural product content in the pharmacy curriculum. Their ideas for ways of incorporating this information, however, differ.

CONCLUSION

Healthcare students and faculty are beginning to recognize the need for incorporation of Natural Product information into the curriculum and healthcare programs in the country should begin to rise to the occasion.

Patient expectations of 'effectiveness' in health care: an example from medical herbalism

AIMS AND OBJECTIVES

The study explored people's experiences of medical herbalism, with the aim of enhancing understanding about the use of herbalism in the context of contemporary UK health care.

BACKGROUND

The popularity and use of complementary and alternative medicine in westernised societies is now well documented, and medical herbalism, in particular, is enjoying a particularly strong revival of interest. Despite this, the reasons for its sustained popularity remain unclear.

DESIGN

The study was underpinned by Gadamerian hermeneutic phenomenology.

METHOD

Nineteen adult clients of medical herbalists were interviewed about their experiences. The processes of data collection and data analysis were informed predominantly by van Manen's phenomenological framework and by Kvale's framework for interview-based studies.

RESULTS

Herbalism more closely met participants' expectations of effective health care. The themes 'dealing with illness causation', 'patient-practitioner collaboration' and 'provision of authentic evidence' were fundamental to achieving effectiveness but were perceived as more easily attainable in the context of medical herbalism.

CONCLUSIONS

Health care is more likely to meet the expectations of patients when its purposes, methods and goals are negotiated and made explicit, from the perspectives of both patient and health care professional. Medical herbalism has the potential to contribute usefully to participants' healthcare, especially when used selectively and in conjunction with conventional health care.

RELEVANCE TO CLINICAL PRACTICE

The continued popularity of complementary and alternative medicine amongst the general public makes its acknowledgement in conventional health care more important than ever. In the context of the integrative health movement, it is therefore essential that health care professionals develop their understanding about patient practices and preferences, if a responsive health care system is to be maintained. Nurses are in a prime position to influence the knowledge base and future direction of integrative health care, especially in relation to the patient perspective.

Rural Australian community pharmacists' views on complementary and alternative medicine: a pilot study

Background

Complementary and alternative medicines (CAMs) are being used increasingly across the world. In Australia, community pharmacists are a major supplier of these products but knowledge of the products and interactions with other medicines is poor. Information regarding the use of CAMs by metropolitan pharmacists has been documented by the National Prescribing Service (NPS) in Australia but the views of rural/regional community pharmacists have not been explored. The aim of this pilot study was to explore the knowledge, attitudes and information seeking of a cohort of rural community pharmacists towards CAMs and to compare the findings to the larger NPS study.

Methods

A cross sectional self-administered postal questionnaire was mailed to all community pharmacists in one rural/regional area of Australia. Using a range of scales, data was collected regarding attitudes, knowledge, information seeking behaviour and demographics.

Results

Eighty eligible questionnaires were returned. Most pharmacists reported knowing that they should regularly ask consumers if they are using CAMs but many lacked the confidence to do so. Pharmacists surveyed for this study were more knowledgeable in regards to side effects and interactions of CAMs than those in the NPS survey. Over three quarters of pharmacists surveyed reported sourcing CAM information at least several times a month. The most frequently sought information was drug interactions, dose, contraindications and adverse effects. A variety of resources were used to source information, the most popular source was the internet but the most useful resource was CAM text books.

Conclusions

Pharmacists have varied opinions on the use of CAMs and many lack awareness of or access to good quality CAMs information. Therefore, there is a need to provide pharmacists with opportunities for further education. The data is valuable in assisting interested stakeholders with the development of initiatives to address the gaps in attitudes, knowledge and to improve effectiveness of information seeking behaviour.

Knowledge, skills, and resources for pharmacy informatics education

Pharmacy has an established history of technology use to support business processes. Pharmacy informatics education within doctor of pharmacy programs, however, is inconsistent, despite its inclusion as a requirement in the 2007 Accreditation Council for Pharmacy Education Standards and Guidelines. This manuscript describes pharmacy informatics knowledge and skills that all graduating pharmacy students should possess, conceptualized within the framework of the medication use process. Additionally, we suggest core source materials and specific learning activities to support pharmacy informatics education. We conclude with a brief discussion of emerging changes in the practice model. These changes are facilitated by pharmacy informatics and will inevitably become commonplace in our graduates' practice environment.

Perceptions, use and attitudes of pharmacy customers on complementary medicines and pharmacy practice

BACKGROUND

Complementary medicines (CMs) are popular amongst Australians and community pharmacy is a major supplier of these products. This study explores pharmacy customer use, attitudes and perceptions of complementary medicines, and their expectations of pharmacists as they relate to these products.

METHODS

Pharmacy customers randomly selected from sixty large and small, metropolitan and rural pharmacies in three Australian states completed an anonymous, self administered questionnaire that had been pre-tested and validated.

RESULTS

1,121 customers participated (response rate 62%). 72% had used CMs within the previous 12 months, 61% used prescription medicines daily and 43% had used both concomitantly. Multivitamins, fish oils, vitamin C, glucosamine and probiotics were the five most popular CMs. 72% of people using CMs rated their products as 'very effective' or 'effective enough'. CMs were as frequently used by customers aged 60 years or older as younger customers (69% vs. 72%) although the pattern of use shifted with older age. Most customers (92%) thought pharmacists should provide safety information about CMs, 90% thought they should routinely check for interactions, 87% thought they should recommend effective CMs, 78% thought CMs should be recorded in customer's medication profile and 58% thought pharmacies stocking CMs should also employ a complementary medicine practitioner. Of those using CMs, 93% thought it important for pharmacists to be knowledgeable about CMs and 48% felt their pharmacist provides useful information about CMs.

CONCLUSIONS

CMs are widely used by pharmacy customers of all ages who want pharmacists to be more involved in providing advice about these products.

Laughter and positive therapies: modern approach and practical use in medicine

The exploration of the possible strategies centered in positive emotions is a suggestion to investigate and probably useful to raise the efficiency of therapeutic interventions. Laughter and humor have been classified as part of the 24 personal strengths and are considered as one of the activities that encourage personal well-being, savoring, and promoting flow states. Laughter therapy, classified within alternative or complementary therapies in medicine, includes a group of techniques and therapeutic interventions aimed to achieve laughter experiences which result in health-related outcomes, both physiological and psychological. Recent advent of positive psychology has developed high interest and expectations in the benefits of adding positive techniques to laughter therapy (and to other mind-body therapies). Consequently with this modern approach positive laughter therapy was born, as add-on to conventional laughter therapy and positive psychology, with its contributions and limitations. Health professionals can exert an important role in order to disseminate overall benefits of "positive therapies" while applying them in real-world clinical settings, for both patients and themselves.