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      Key stakeholder perspectives on the barriers and solutions to pharmacy practice towards complementary medicines: an Australian experience

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          Abstract

          Background

          Although pharmacists are entrusted to play a role in ensuring the safe and appropriate use of all medicines, in general, the inclusion of complementary medicines (CMs) into their professional practice has not been observed. The purpose of this study was to explore the perceptions and opinions of pharmacists and 8 key stakeholder leaders regarding the barriers that hinder pharmacists from providing care related to the use of CMs by patients/consumers and to identify solutions that would support pharmacists’ in extending their role in this area.

          Methods

          Semi-structured key informant interviews were conducted with 2 practicing pharmacists, 1 pharmacy owner, 1 key representative of a pharmacist professional organization, 1 key representative of a consumer advocacy group, 1 key representative of a medical professional organization, 1 key representative from a complementary medicine practitioner professional organization, 1 leader within a pharmacy school, 2 senior staff from a regulatory authority, and 1 key representative of the complementary medicine industry in Australia.

          Results

          A total of 9 barriers were identified in this study. Barriers including a lack of CMs knowledge, doubts about the evidence-base, a lack of research skills and access to reliable and reputable information dominated the discussions. A total of 7 solutions were proposed. Of those, the integration of CMs curricula into under-graduate and professional pharmacy education, and defining a clearer role for pharmacists’ standard of practice were considered the most important. Apposing opinions about the role of naturopaths in pharmacies were identified..

          Conclusion

          It is anticipated that pharmacists will be required to formalise a role in ensuring the safe and appropriate use of complementary medicines to fulfil their professional and ethical responsibilities. However, pharmacists in general are not ready to take up this extended role. Individual key stakeholder groups have considered the existing barriers and have proposed solutions that are isolated measures. To facilitate further developments related to CMs and the professional practice of pharmacy, collaborative efforts between key stakeholders are needed to strategically plan and execute an extended role in a unified manner.

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          Most cited references62

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          Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey.

          Data on the range of prescription and over-the-counter drug use in the United States are not available. To provide recent population-based information on use of all medications, including prescription and over-the-counter drugs, vitamins and minerals, and herbal preparations/natural supplements in the United States. Ongoing telephone survey of a random sample of the noninstitutionalized US population in the 48 continental states and the District of Columbia; data analyzed here were collected from February 1998 through December 1999. Use of medications, by type, during the preceding week, compared by demographic characteristics. Among 2590 participants aged at least 18 years, 81% used at least 1 medication in the preceding week; 50% took at least 1 prescription drug; and 7% took 5 or more. The highest overall prevalence of medication use was among women aged at least 65 years, of whom 12% took at least 10 medications and 23% took at least 5 prescription drugs. Herbals/supplements were taken by 14% of the population. Among prescription drug users, 16% also took an herbal/supplement; the rate of concurrent use was highest for fluoxetine users, at 22%. Reasons for drug use varied widely, with hypertension and headache mentioned most often (9% for each). Vitamins/minerals were frequently used for nonspecific reasons such as "health" (35%); herbals/supplements were also most commonly used for "health" (16%). In any given week, most US adults take at least 1 medication, and many take multiple agents. The substantial overlap between use of prescription medications and herbals/supplements raises concern about unintended interactions. Documentation of usage patterns can provide a basis for improving the safety of medication use.
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            Complementary and alternative medicine use in Australia: a national population-based survey.

            To investigate the use of and expenditure on 17 of the most popular forms of complementary and alternative medicine (CAM) by adult Australians, sociodemographic characteristics of CAM users, and communication between CAM users and their doctors. In May-June 2005, a sample of 1067 adults, 18 years and older, from all Australian states and territories, was recruited by random-digit telephone dialing and interviewed about their CAM use in the previous 12 months. In the 12-month period, 68.9% (95% CI: 66.1%-71.7%) of those interviewed used at least one of the 17 forms of CAM and 44.1% (95% confidence interval: 41.1%-47.1%) visited a CAM practitioner. The estimated number of visits to CAM practitioners by adult Australians in the 12-month period (69.2 million) was almost identical to the estimated number of visits to medical practitioners (69.3 million). The annual "out of pocket" expenditure on CAM, nationally, was estimated as 4.13 billion Australian dollars (US $3.12 billion). Less than half of the users always informed their medical practitioners about their use of CAM. The most common characteristics of CAM users were: age, 18-34; female; employed; well-educated; private health insurance coverage; and higher-than-average incomes. CAM use nationally in Australia appears to be considerably higher than estimated from previous Australian studies. This may reflect an increasing popularity of CAM; however, regional variations in CAM use and the broader range of CAM included in the current study may contribute to the difference. Most frequently, doctors would not appear to be aware of their patient use of CAM.
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              Costs of complementary and alternative medicine (CAM) and frequency of visits to CAM practitioners: United States, 2007.

              This report presents selected estimates of costs of complementary and alternative medicine (CAM) use among U.S. adults, the frequency of visits made to CAM providers, and the frequency of purchases of self-care CAM therapies. Data from the 2007 National Health Interview Survey (NHIS), which is conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, are used in this report. Estimates were derived from the Complementary and Alternative Medicine Supplement of the 2007 NHIS, sponsored by the National Center for Complementary and Alternative Medicine, which is part of the National Institutes of Health. Estimates were generated using the SUDAAN statistical package to account for the NHIS complex sample design. In 2007, adults in the United States spent $33.9 billion out of pocket on visits to CAM practitioners and purchases of CAM products, classes, and materials. Nearly two-thirds of the total out-of-pocket costs that adults spent on CAM were for self-care purchases of CAM products, classes, and materials during the past 12 months ($22.0 billion), compared with about one-third spent on practitioner visits ($11.9 billion). Despite this emphasis on self-care therapies, 38.1 million adults made an estimated 354.2 million visits to practitioners of CAM. About three-quarters of both visits to CAM practitioners and total out-of-pocket costs spent on CAM practitioners were associated with manipulative and body-based therapies. A total of 44% of all out-of-pocket costs for CAM, or about $14.8 billion, was spent on the purchase of nonvitamin, nonmineral, natural products.
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                Author and article information

                Contributors
                carolina_ung@yahoo.com.au
                joanna.harnett@sydney.edu.au
                haohu@umac.mo
                Journal
                BMC Complement Altern Med
                BMC Complement Altern Med
                BMC Complementary and Alternative Medicine
                BioMed Central (London )
                1472-6882
                9 August 2017
                9 August 2017
                2017
                : 17
                : 394
                Affiliations
                [1 ]State Key Lab of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Room 2057, N22 Research Building, Macao, China
                [2 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, Faulty of Pharmacy, , The University of Sydney, ; A15 - Pharmacy And Bank Building, Sydney, NSW Australia
                Author information
                http://orcid.org/0000-0001-9441-106X
                Article
                1899
                10.1186/s12906-017-1899-5
                5550952
                28793918
                65d305c1-6b94-486b-9f77-d5dade639c82
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 25 February 2017
                : 1 August 2017
                Funding
                Funded by: University of Macau
                Award ID: MYRG2015-00072-ICMS-QRCM
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Complementary & Alternative medicine
                pharmacist,barriers,solutions,pharmacy practice,complementary medicines,australia

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