Joanna Harnett

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

BackgroundAlthough 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.MethodsSemi-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.ResultsA 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..ConclusionIt 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.

Probiotics and the Microbiome in Celiac Disease: A Randomised Controlled Trial

Background. There is limited research investigating the composition of the gastrointestinal microbiota in individuals with celiac disease (CoeD) reporting only partial symptom improvement despite adherence to a strict gluten-free diet (GFD). The aim of this research was to determine if the gastrointestinal microbiota could be altered by probiotic bacteria and provide a potential new therapy for this subgroup. Methods. A multicentre RCT was conducted between January and August 2011 in Australia. Participants included 45 people with CoeD reporting only partial symptom improvement despite adherence to a strict GFD for a minimum of 12 months. Participants took 5 g of VSL#™ probiotic formulation (n = 23) or 5 g placebo (n = 22) orally twice daily for 12 weeks. The main outcome measured was the efficacy of the probiotic formula in altering faecal microbiota counts between baseline and week 12. Safety was determined by safety blood and monitoring adverse events. Results. SPSS™ multivariate repeated measures analysis (95th confidence level) revealed no statistically significant changes between the groups in the faecal microbiota counts or blood safety measures over the course of the study. Conclusion. The probiotic formula when taken orally over the 12-week period did not significantly alter the microbiota measured in this population. The trial was registered with Australian and New Zealand Clinical Trials Register ACTRN12610000630011.

A systematic review - Biologically-based complementary medicine use by people living with cancer – is a more clearly defined role for the pharmacist required?

Background: Biologically‐based complementary medicines (BB‐CMs) including herbal, vitamin, mineral and nutritional supplements are frequently taken by people living with cancer. Pharmacists play an important and clearly defined role in the provision of standard cancer treatment. Due to the non‐prescription status and easy access to BB‐CMs, the role of the pharmacist in communicating to people living with cancer about their use is less clearly defined. Aim: To explore the role of the pharmacist in communicating to people living with cancer about their use of BB‐CMs. Methods: Eligible studies were identified in PubMed, Medline, EmBase, International Pharmaceutical Abstracts and Google Scholar. Articles published between 2003 and 2016 were included searching for “Complementary OR Herbal medicine OR vitamin OR nutritional supplement”; and “cancer OR oncology patient”; and “pharmacist role OR attitude OR belief OR communication”. Results: BB‐CM use is prevalent among people living with cancer for the management of side effects and are taken under the belief they are safe, natural and holistic. Fifty per cent of cancer patients do not disclose their BB‐CM use to their physicians due to a perception that it will be discouraged and/or their physician will not be knowledgeable about BB‐CMs. There are known drug‐herb/nutrient interactions but interestingly pharmacists are the least consulted health care professional (HCP). Conclusion: With adequate knowledge about BB‐CMs, pharmacists are well positioned as medication specialists to fill the current communication gap between people living with cancer and HCPs. Further research that informs the development of specific BB‐CM guidelines for pharmacists in the management of cancer are required. HighlightsBB‐CMs are frequently used by people living with cancer and frequently taken concomitantly with standard treatments.Pharmacists are well positioned as medication specialists to provide information about BB‐CMs to people living with cancer.Research that informs the development of specific guidelines for pharmacists about BB‐CMs is required.

Consultations with Naturopaths and Western Herbalists: Prevalence of Use and Characteristics of Users in Australia

OBJECTIVES To report the prevalence of naturopathic and Western herbal medicine service utilization in Australia, and describe the characteristics of individuals who use these services. DESIGN This is a national cross-sectional study. SETTINGS Online survey platform. SUBJECTS Purposive convenience sampling was used to recruit 2025 adults who were matched to Australian population demographics by gender, age, and state of residence. INTERVENTIONS A survey instrument consisting of 50 items covering demographics, health service utilization, health status, health literacy, and medicine disclosure to complementary health care providers. OUTCOME MEASURES The prevalence, frequency, and cost of naturopathy and Western herbal medicine consultations and sociodemographic characteristics of users of naturopathic and Western herbalist services and associations between these factors. RESULTS The final data set included 2019 participants: 6.2% (n = 126) consulted a naturopath and 3.8% (n = 76) a Western herbalist. These health services were most commonly used to improve well-being. An average of AUD

Perceptions, opinions and knowledge of pharmacists towards the use of complementary medicines by people living with cancer

102.67 and AUD

The prevalence and characteristics of complementary medicine use by Australian and American adults living with gastrointestinal disorders: A systematic review

49.64 was spent per user on consultations with naturopaths and Western herbalists, respectively, in the previous year. The most prevalent users were those between 18 and 29 years of age (39.3%), in a relationship (51%), employed (70%), and held a bachelor degree or higher (40.5%). Some degree of financial difficulty was reported by 65.4% of users. Having a chronic illness (p < 0.01) and using both conventional and complementary medicines (p = 0.05) were both associated with using naturopathic or Western herbal medicine services. Less than 40% of participants disclosed their use of conventional medicines to Western herbalists. CONCLUSIONS Naturopathy and Western herbal medicine services are used by a substantial number of Australian adults who also use conventional health services. Accordingly, research is needed to determine how these health professions can be better integrated into mainstream health care settings to improve patient-practitioner communication and safety related to the use of these health services.

Internationalization of Traditional/Complementary Medicine products: market entry as medicine

Background Biologically-based complementary medicine (BB-CM) use is prevalent amongst people living with cancer. Pharmacists play an important role in the provision of standard treatments for cancer. Less is known about pharmacist’s provision of BB-CM information. Objective This study investigated the opinions, perceptions and knowledge of pharmacists regarding the use of BB-CMs by people living with cancer and the facilitators and barriers to providing information and advice. Setting Australia. Method A cross-sectional 53-item survey was developed and the survey link distributed in two professional associations newsletters. The associations represent ~29,000 pharmacists. Questions were categories into pharmacist’s perceptions, opinions, and knowledge towards the use of BB-CM in cancer. Main Outcome Measure Scores obtained from responses to perception, opinion and knowledge statements and responses to demographic questions Results Respondents (n=70) were predominantly female (73%), Caucasian (66%) and under 40 years of age (78%). Respondents estimated that 19% of daily inquiries related to BB-CMs. Seventy-two per cent of respondents believed they had a responsibility to advise about the concomitant use of BB-CM with standard cancer treatments despite 60% reporting a lack of confidence in their knowledge. There was a moderate positive association (Spearman’s rho 0.41 p= 0.001) between a pharmacists confidence in their level of knowledge and their total knowledge scores. The main barriers to providing information about BB-CMs reported were inadequate training in BB-CMs (94%) and reservations about the evidence base for efficacy and safety (50%). Conclusion Pharmacists have a role to play in counselling people living with cancer about their use of BB-CMs and this role could be maximized with further training and education in this area.

Community pharmacist's responsibilities with regards to traditional medicine/complementary medicine products: A systematic literature review

AIM To report the prevalence and sociodemographic characteristics of complementary medicine (CM) use by Australian and American adults living with gastrointestinal (GI) disorders. METHOD Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline, Pubmed, Scopus and Web of Science were searched for studies published in English language between 1st January 2008 and 8th April 2018. Additionally, a Google Scholar search and risk of bias assessment were conducted. RESULTS Twelve (five American and seven Australian) studies, involving 53,991 adults were included. Data were extracted from studies reporting CM use by both specific populations with medically diagnosed GI disorders and the general population with self-reported GI disorders. CM use ranged from 23.6% to 44% (American) and 27.2% to 58% (Australian) by adults with medically diagnosed GI disorders. Whilst CM use was higher amongst females, with higher incomes and education levels. The prevalence of CM use by those with self-reported GI disorders varied from 0.31% to 80%. Herbal, probiotic supplements and mind-body practices were the most prevalent CMs used. The risk of bias assessment identified weaknesses in the external validity, principally related to poor study design. CONCLUSIONS There is a substantial use of CMs by American and Australian adults with GI disorders. Females with higher education and income are predominant users. There is a need to conduct up-to-date and well-designed prevalence and sociodemographic studies. Additionally, future studies should consider including health literacy and medicines disclosure scales in order to better understand CM use by this population.

Significantly higher faecal counts of the yeasts candida and saccharomyces identified in people with coeliac disease

Internationalization of Traditional/Complementary Medicine (T&CM) products is important for initiating and sustaining developments in this field. Particularly for traditional Chinese medicines (TCMs), the global market continues to expand due to an interest in the potential clinical benefits of traditional approaches that are largely considered lower risk and lower cost than many conventional treatments. While the benefits of internationalization hold clear advantages for the business of T&CM products, keeping abreast of regulatory processes in different countries and regions that regularly revise market entry requirements is challenging. At present, the regulations of T&CM products are country specific and largely based on a risk-based assessment with a focus on protecting the consumer. To date, systematic analysis of these regulatory differences between countries and regions is limited. Publically available information about the legal requirements for the market entry of T&CM products were obtained from the relevant regulatory authority’s websites for selected countries and regions (Macau-China, Hong Kong-China, Singapore, Australia, Canada, the European countries and the US). The market entry requirements in terms of quality, safety and efficacy of T&CM products for each country were analyzed and compared. Major differences were identified in the classification of T&CM products, market entry pathways, requirements of compliance with Good Manufacturing Practices; and level of evidence to demonstrate safety and efficacy based on historical use, non-clinical and clinical studies. Variations in the evaluation standards adopted by regulatory authorities pose a number of barriers and opportunities for the internationalization of T&CM products and have great implications for internationalization of TCMs from the sponsors’ and the regulators’ perspectives.