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

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          Abstract

          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.

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          Most cited references20

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          Why people use herbal medicine: insights from a focus-group study in Germany

          Background The use of herbal medicine, as one element of complementary and alternative medicine, is increasing worldwide. Little is known about the reasons for and factors associated with its use. This study derives insights for the use of herbal medicine in Germany regarding the usage aims, role played by the type of illness, reasons for preferred usage and sources of information. Methods Using a qualitative methodological approach, six focus groups (n = 46) were conducted. Two groups with young, middle-aged and elderly participants, respectively. After audiotaping and verbatim transcription, the data were analysed with a qualitative content analysis. Results We found that treating illnesses was the most frequently discussed aim for using herbal medicine over all age groups. Preventing illnesses and promoting health were less frequently mentioned overall, but were important for elderly people. Discussions on herbal medicine were associated with either mild/moderate diseases or using herbal medicine as a starting treatment before applying conventional medicine. In this context, participants emphasized the limits of herbal medicine for severe illnesses. Dissatisfaction with conventional treatment, past good experiences, positive aspects associated with herbal medicine, as well as family traditions were the most commonly-mentioned reasons why herbal medicine was preferred as treatment. Concerning information sources, independent reading and family traditions were found to be equally or even more important than consulting medicinal experts. Conclusions Although herbal medicine is used mostly for treating mild to moderate illnesses and participants were aware of its limits, the combination of self-medication, non-expert consultation and missing risk awareness of herbal medicine is potentially harmful. This is particularly relevant for elderly users as, even though they appeared to be more aware of health-related issues, they generally use more medicine compared to younger ones. In light of our finding that dissatisfaction with conventional medicine was the most important reason for a preferred use of herbal medicine, government bodies, doctors, and pharmaceutical companies need to be aware of this problem and should aim to establish a certain level of awareness among users concerning this issue. Electronic supplementary material The online version of this article (10.1186/s12906-018-2160-6) contains supplementary material, which is available to authorized users.
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            Potential factors that influence usage of complementary and alternative medicine worldwide: a systematic review

            Objectives To determine similarities and differences in the reasons for using or not using complementary and alternative medicine (CAM) amongst general and condition-specific populations, and amongst populations in each region of the globe. Methods A literature search was performed on Pubmed, ScienceDirect and EMBASE. Keywords: ‘herbal medicine’ OR ‘herbal and dietary supplement’ OR ‘complementary and alternative medicine’ AND ‘reason’ OR ‘attitude’. Quantitative or qualitative original articles in English, published between 2003 and 2018 were reviewed. Conference proceedings, pilot studies, protocols, letters, and reviews were excluded. Papers were appraised using valid tools and a ‘risk of bias’ assessment was also performed. Thematic analysis was conducted. Reasons were coded in each paper, then codes were grouped into categories. If several categories reported similar reasons, these were combined into a theme. Themes were then analysed using χ2 tests to identify the main factors related to reasons for CAM usage. Results 231 publications were included. Reasons for CAM use amongst general and condition-specific populations were similar. The top three reasons for CAM use were: (1) having an expectation of benefits of CAM (84% of publications), (2) dissatisfaction with conventional medicine (37%) and (3) the perceived safety of CAM (37%). Internal health locus of control as an influencing factor was more likely to be reported in Western populations, whereas the social networks was a common factor amongst Asian populations (p < 0.05). Affordability, easy access to CAM and tradition were significant factors amongst African populations (p < 0.05). Negative attitudes towards CAM and satisfaction with conventional medicine (CM) were the main reasons for non-use (p < 0.05). Conclusions Dissatisfaction with CM and positive attitudes toward CAM, motivate people to use CAM. In contrast, satisfaction with CM and negative attitudes towards CAM are the main reasons for non-use. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-020-03157-2.
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              Dietary Supplement Use, Knowledge, and Perceptions Among Student Pharmacists.

              Objective. To compare dietary supplement use between student pharmacists and the general population, and assess knowledge, attitudes toward use, and dietary supplement effectiveness; and to explore how student pharmacists view their education on dietary supplements. Methods. Paper questionnaires administered to student pharmacists collected data about their use, knowledge, and attitudes of dietary supplements. Use was compared to the 2007 National Health Interview survey findings. Results. Of 179 students who responded, 52% had used at least one dietary supplement in their lifetime versus 25% in the general population. Students perceived supplement label information as unhelpful, research into supplements inadequate, and supplements non-essential to health. Students thought supplement knowledge was important but their education was inadequate. Conclusion. Dietary supplement use was higher in this sample of student pharmacists than the general population. Student pharmacists had limited knowledge and need more education on dietary supplements.
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                Author and article information

                Contributors
                Journal
                Pharm Pract (Granada)
                Pharm Pract (Granada)
                Pharmacy Practice
                Centro de Investigaciones y Publicaciones Farmaceuticas
                1885-642X
                1886-3655
                Jan-Mar 2021
                25 February 2021
                : 19
                : 1
                : 2251
                Affiliations
                PhD, MPharm. Department of Pharmacy, School of Medicine, University of Split . Split (Croatia). jbukic@ 123456mefst.hr
                MPharm. Department of Pharmacy, School of Medicine, University of Split . Split (Croatia). branka.kuzmanic@ 123456gmail.com
                PhD, MPharm. Department of Pharmacy, School of Medicine, University of Split . Split (Croatia). drusic@ 123456mefst.hr
                MPharm. Split-Dalmatia County Pharmacy . Split (Croatia). mate.portolan@ 123456ljekarnasdz.hr
                PhD. Split-Dalmatia County Pharmacy . Split (Croatia). ante.mihanovic@ 123456yahoo.com
                PhD, MPharm. Assistant professor. Department of Pharmacy, School of Medicine, University of Split . Split (Croatia). aperisin@ 123456mefst.hr
                PhD, MPharm. Department of Pharmacy, School of Medicine, University of Split . Split (Croatia). dario.leskur@ 123456mefst.hr
                MPharm. Split-Dalmatia County Pharmacy . Split (Croatia). ana.petric@ 123456ljekarnasdz.hr
                MD, PhD. Associate professor. Department of Pathophysiology, School of Medicine, University of Split , Split (Croatia). jbozic@ 123456mefst.hr
                PhD; Professor. Agency for Medicinal Products and Medical Devices . Zagreb (Croatia). sinisa.tomic@ 123456halmed.hr
                MD, PhD. Professor. Department of Pharmacy, School of Medicine, University of Split . Split (Croatia). dmodun@ 123456mefst.hr
                Author notes

                Conceptualization: JB, DR, DM. Data curation: JB, BK, DL. Formal analysis: JB, DR, DL, ASP. Investigation: JB, BK, DR. Methodology: JB, BK, DR. Resources: MP, AM, AP, DM. Supervision: DM. Validation: MP, JB, ST, DM. Visualization: AP, ST, JB, AM. Writing – original draft: JB. Writing – review & editing: BK, DR, MP, AM, ASP, DL, AP, JB, ST, DM.

                Author information
                https://orcid.org/0000-0002-9316-5538
                https://orcid.org/0000-0002-0273-8821
                https://orcid.org/0000-0002-7018-4947
                https://orcid.org/0000-0002-6502-2628
                https://orcid.org/0000-0003-0946-6037
                https://orcid.org/0000-0001-7927-5311
                https://orcid.org/0000-0002-5126-3869
                https://orcid.org/0000-0001-9084-7114
                https://orcid.org/0000-0003-1634-0635
                https://orcid.org/0000-0002-3500-9940
                https://orcid.org/0000-0001-9508-9383
                Article
                pharmpract-19-2251
                10.18549/PharmPract.2021.1.2251
                7939115
                33727993
                ace08928-d93e-4874-a289-ce31cc1ac608
                Copyright: © Pharmacy Practice and the Authors

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY-NC-ND 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 December 2020
                : 21 February 2021
                Categories
                Original Research

                dietary supplements,evidence-based pharmacy practice,pharmacies,pharmacists,attitude of health personnel,health knowledge,attitudes,practice,cross-sectional studies,croatia

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