Clayton Kevin, Luxford Yoni, Colaci Joshua, Hasan Meral, Miltiadou Rebecca, Novikova Daria, Vlahopoulos Dean, Stupans Ieva
BPharm, B Health Sci (Naturopathy), Grad Dip Health.Sci (Herbal Medicine). School of Health, University of New England. Armidale, NSW (Australia).
PhD., Grad Dip PHC, GCTT, BSW, RN, RM. Senior Lecturer. School of Health, University of New England. Armidale, NSW (Australia).
Pharm Pract (Granada). 2020 Jan-Mar;18(1):1660. doi: 10.18549/PharmPract.2020.1.1660. Epub 2020 Mar 11.
Community pharmacists are often the first health professional approached to provide treatment for health issues, including the important mental health challenge, stress. Over-the-counter products for stress almost always are complementary and alternative medicines (CAM) and in Australia no protocol exists for their recommendation and sale in community pharmacies.
To assess the quality and relevance of community pharmacists' information gathering (questioning), counselling and product selection when interacting with customers requesting a CAM product for stress and consequently determine whether Australian pharmacy practice indicates the need for guidelines similar to those provided for 'pharmacy only' (S2) and 'pharmacist only' (S3) medicines.
A covert simulated patient was used to investigate the response of pharmacists to a request for a natural product for stress. The SPs documented the details of the pharmacist-simulated patient interaction immediately on leaving the pharmacy and then re-entered the pharmacy to debrief the pharmacist. The quality of the interaction was scored as a Total CARE (check, assess, respond, explain) Score, based on anticipated questions and counselling advice. The appropriateness of the product was scored as a Product Efficacy Score, based on evidence-based literature.
Data from 100 pharmacies was provided. Information gathering illustrated by the questioning components Check and Assess (C and A) of the total CARE score by pharmacists was poor. The number of questions asked ranged from zero (13 pharmacists) to 7 (four pharmacists), the average being 3.1 (SD 1.9). Provision of advice was generally better (a description of the suggested product was offered by 87 pharmacists) but was lacking in other areas (duration of use and side effects were explained by only 41 and 16 pharmacists respectively). The most common product suggested was B-group vitamins (57 pharmacists) followed by a proprietary flower essence product (19 pharmacists). A two-step cluster analysis revealed two sub-groups of pharmacists: one cluster (74 pharmacists) with a high Total CARE score provided an appropriate product. The other cluster (20 pharmacists) had a low total CARE score and provided an inappropriate product.
The pharmacy visits revealed major shortcomings in questioning, counselling and product recommendation. There is a need to develop guidelines for pharmacists to make evidence-based decisions in recommending complementary and alternative medicine.
社区药剂师常常是人们寻求健康问题治疗时接触到的首位医疗专业人员，这些健康问题包括重要的心理健康挑战——压力。用于缓解压力的非处方产品几乎都是补充和替代医学（CAM）产品，而在澳大利亚，社区药房中不存在针对此类产品推荐和销售的规范流程。
评估社区药剂师在与寻求缓解压力的CAM产品的顾客互动时，其信息收集（询问）、咨询及产品选择的质量和相关性，进而确定澳大利亚的药房实践是否表明需要制定类似于针对“仅药房销售”（S2）和“仅药剂师销售”（S3）药品所提供的指南。
采用隐蔽的模拟患者来调查药剂师对寻求天然抗压力产品请求的反应。模拟患者在离开药房后立即记录药剂师与模拟患者互动的细节，然后再次进入药房与药剂师进行汇报沟通。互动质量根据预期问题和咨询建议，以“全面关怀（检查、评估、回应、解释）评分”进行打分。产品的适宜性根据循证文献以“产品疗效评分”进行打分。
提供了来自100家药房的数据。药剂师在“全面关怀”评分中“检查”和“评估”（C和A）这两个询问环节所体现的信息收集情况较差。询问的问题数量从0个（13名药剂师）到7个（4名药剂师）不等，平均为3.1个（标准差1.9）。提供建议的情况总体较好（87名药剂师提供了所建议产品的描述），但在其他方面有所欠缺（分别仅有41名和16名药剂师解释了使用时长和副作用）。最常被推荐的产品是B族维生素（57名药剂师），其次是一种专利花精产品（19名药剂师）。两步聚类分析揭示了两类药剂师群体：一类（74名药剂师）“全面关怀”评分高且提供了适宜产品；另一类（20名药剂师）“全面关怀”评分低且提供了不适宜产品。
药房走访揭示了在询问、咨询和产品推荐方面存在的主要不足。有必要为药剂师制定指南，以便他们在推荐补充和替代医学产品时做出基于证据的决策。
