Main Article Content
Knowledge, Attitude, Practice, Community pharmacy, Complementary medicine
Background: The people who use complementary medicines (CMs) believe that these medicines are safe and harmless. They could easily access CMs like herbal or traditional medicines in community pharmacies. Therefore, community pharmacists are important professionals in advising the safe choices of CMs and providing evidence-based information for customers to decrease adverse effects of CMs. Objectives: To systematically review knowledge, attitude, and practices of community pharmacists about CMs, and the factors associated with CM practices of dispensing, recommending and counseling patients, and answering the patients’ queries. Method: An electronic search was performed with four databases: PubMed, Scopus, SpringerLink and ScienceDirect, from 1990 to 19th May 2022. The inclusion criteria were studies 1) about knowledge, attitude, and/or practices of community pharmacists about CMs, 2) written in English, 3) conducted with quantitative methods, and 4) able to retrieve full text. Results: Twenty-three studies were included in this systematic review. Some studies showed that less than half of the pharmacists asked or counselled about CMs to their patients and answered the patients’ queries about CMs. Only 20% of the pharmacists did report CM side-effects. Training or education about CMs was a common factor associated with the CM practice of dispensing, recommending, counseling, and answering the patients’ queries about CMs. CMs recommended most by community pharmacists were vitamins & minerals, food or dietary supplements, fish oil and probiotics. The most common dispensed CMs were vitamins & minerals, herbs, food or dietary supplements, fish oil and essential oils. Lacks of reliable information sources and scientific evidence were common barriers for the CM practices. Being less expensive than conventional medicines motivated the pharmacists to recommend and discuss about CMs. The community pharmacists that participated in included studies suggested strengthening CM trainings and highlight the pharmacist role in CM therapy. Conclusion: A high percentage of community pharmacists did dispense CMs to their patients, while a low percentage of the pharmacists did report CM side effects. Pharmacists were most comfortable recommending and responding the patients’ CM queries. Training or education about CMs associated with CM dispensing, recommending, discussing, and answering the patients’ queries about CMs was recommended.
2. Zollman C, Vickers A. What is complementary medicine? BMJ. 1999;319(7211):693-696.
3. Myers SP, Cheras PA. The other side of the coin: safety of complementary and alternative medicine. Medical Journal ofAustralia. 2004;181(4):222-225.
4. Vanherweghem J-L. Misuse of herbal remedies: the case of an outbreak of terminal renal failure in Belgium (Chinese
herbs nephropathy). The Journal of Alternative and Complementary Medicine. 1998;4(1):9-13. https://doi.org/10.1089/acm.1998.4.1-9
5. Philips CA, Augustine P, Rajesh S, et al. Complementary and alternative medicine-related drug-induced liver injury in Asia.Journal of clinical and translational hepatology. 2019;7(3):263. https://doi.org/10.14218/JCTH.2019.00024
6. Kanjanarach T, Krass I, Cumming RG. Australian community pharmacists’ practice in complementary medicines: a structural equation modeling approach. Patient Educ Couns. 2011;83(3):352-359. https://doi.org/10.1016/j.pec.2011.05.003
7. Zollman C, Vickers A. Users and practitioners of complementary medicine. Bmj. 1999;319(7213):836-838. https://doi.org/10.1136/bmj.319.7213.836
8. Eisenberg DM, Kessler RC, Foster C, et al. Unconventional medicine in the United States--prevalence, costs, and patterns of use. New England Journal of Medicine. 1993;328(4):246-252. https://doi.org/10.1056/NEJM199301283280406
9. Gqaleni N, Moodley I, Kruger H, et al. Traditional and complementary medicine: health care delivery. South African Health Review. 2007;2007(1):175-188.
10. Bouldin AS, Smith MC, Garner DD, et al. Pharmacy and herbal medicine in the US. Social Science & Medicine. 1999;49(2):279-289.
11. Cuzzolin L, Benoni G. Attitudes and knowledge toward natural products safety in the pharmacy setting: An Italian study.Phytotherapy Research. 2009;23(7):1018-1023. https://doi.org/10.1002/ptr.2745
12. Ung COL, Harnett J, Hu H. Development of a strategic model for integrating complementary medicines into professional pharmacy practice. Research in Social and Administrative Pharmacy. 2018;14(7):663-672. https://doi.org/10.1016/j.sapharm.2017.07.012
13. Barnes J, Butler R. Community pharmacists’ professional practices for complementary medicines: a qualitative study in New Zealand. Int J Clin Pharm. 2020;42(4):1109-1117. https://doi.org/10.1007/s11096-020-01093-2
14. Kwol VS, Eluwole KK, Avci T, et al. Another look into the Knowledge Attitude Practice (KAP) model for food control: An investigation of the mediating role of food handlers’ attitudes. Food Control. 2020;110:107025.
15. Health Sciences Library. Creating a PRISMA flow diagram. 2021. https://guides.lib.unc.edu/prisma/step-by-step
16. Kmet LM, Cook LS, Lee RC. Standard quality assessment criteria for evaluating primary research papers from a variety of fields. 2004.
17. Bhagavathula AS, Elnour AA, Jamshed SQ, et al. Health professionals’ knowledge, attitudes and practices about
pharmacovigilance in India: A systematic review and meta-analysis. PloS one. 2016;11(3):e0152221. https://doi.org/10.1371/journal.pone.0152221
18. Wilson DB. Practical Meta-Analysis Effect Size Calculator [Online calculator] [cited 2022 Jaunary 31]. https://campbellcollaboration.org/research-resources/effect-size-calculator.html.
19. Alkharfy KM. Community pharmacists’ knowledge, attitudes and practices towards herbal remedies in Riyadh, Saudi Arabia.Eastern Mediterranean Health Journal. 2010;16(9):988-993.
20. Alsayari A, Almghaslah D, Khaled A, et al. Community Pharmacists’ Knowledge, Attitudes, and Practice of Herbal Medicines in Asir Region, Kingdom of Saudi Arabia. Evidence-based Complementary and Alternative Medicine. 2018;2018:1568139. https://doi.org/10.1155/2018/1568139
21. Chen X, Ung CO, Hu H, et al. Community Pharmacists’ Perceptions about Pharmaceutical Care of Traditional Medicine Products: AQuest ionnaire-Based Cross-Sectional Study in Guangzhou, China. Evid Based Complement Alternat Med. 2016;2016:7801637.https://doi.org/10.1155/2016/7801637
22. Coon SA, Stevens VW, Brown JE, et al. Comparison of dietary supplement product knowledge and confidence between pharmacists and health food store employees. Journal of the American Pharmacists Association. 2015;55(2):161-168. https://doi.org/10.1331/JAPhA.2015.14071
23. Shilbayeh SA. Exploring knowledge and attitudes towards counselling about vitamin supplements in Jordanian community pharmacies. Pharmacy Practice. 2011;9(4):242. https://doi.org/10.4321/s1886-36552011000400010
24. Shraim NY, Shawahna R, Sorady MA, et al. Community pharmacists’ knowledge, practices and beliefs about complementary and alternative medicine in Palestine: a cross-sectional study. BMC Complement Altern Med. 2017;17(1):429. https://doi.org/10.1186/s12906-017-1940-8
25. Medhat M, Sabry N, Ashoush N. Knowledge, attitude and practice of community pharmacists towards nutrition counseling.International Journal of Clinical Pharmacy. 2020:13(1):1456-1468. https://doi.org/10.1007/s11096-020-01106-0
26. Tahir M, Upadhyay DK, Iqbal MZ, et al. Knowledge of the Use of Herbal Medicines among Community Pharmacists and Reporting Their Adverse Drug Reactions. J Pharm Bioallied Sci. 2020;12(4):436-443. https://doi.org/10.4103/jpbs.JPBS_263_20
27. Tiralongo E, Braun LA, Wilkinson JM, et al. Exploring the integration of complementary medicines into australian pharmacy practice with a focus on different practice settings and background knowledge. Journal of Complementary and Integrative Medicine. 2010;7(1).
28. Thandar Y, Botha J, Mosam A. Community pharmacists’ knowledge, attitude and practices towards the use of complementaryand
29. Taing MW, Tan ETX, Williams GM, et al. Herbal and nutrient complementary medicines for weight loss: Community pharmacists’ practices, attitudes, recommendations, information and education needs. International Journal of Pharmacy Practice.2016;24(3):160-169. https://doi.org/10.1111/ijpp.12232
30. Barnes J, Abbot NC. Professional practices and experiences with complementary medicines: A cross-sectional study involving community pharmacists in England. International Journal of Pharmacy Practice. 2007;15(3):167-175.
31. Brown CM, Barner JC, Shah S. Community pharmacists’ actions when patients use complementary and alternative therapies with medications. J Am Pharm Assoc (2003). 2005;45(1):41-47. https://doi.org/10.1331/1544345052843011
32. Brown CM, Pena A, Resendiz K. Pharmacists’ actions when patients use complementary and alternative medicine with medications: A look at Texas–Mexico border cities. Journal of the American Pharmacists Association. 2011;51(5):619-622. https://doi.org/10.1331/JAPhA.2011.10021
33. Yao D, Hu Y, Harnett JE, et al. Community pharmacist’s perceptions and practice behaviors related to traditional and complementary medicines in China: A cross-sectional study. European Journal of Integrative Medicine. 2020;40:101225.
34. Al-Arifi MN. Availability and needs of herbal medicinal information resources at community pharmacy, Riyadh region, Saudi Arabia. Saudi Pharmaceutical Journal. 2013;21(4):351-360. https://doi.org/10.1016/j.jsps.2012.11.004
35. Song M, Ung COL, Lee VW-y, et al. Community pharmacists’ perceptions about pharmaceutical service of over-the-counter traditional Chinese medicine: a survey study in Harbin of China. BMC complementary and alternative medicine. 2017;17(1):9.https://doi.org/10.1186/s12906-016-1532-z
36. Taing MW, Clavarino AM, McGuire TM. Australian community pharmacists’ knowledge of popular herbal/nutrient weight-loss complementary medicines. Journal of Pharmacy Practice and Research. 2017;47(6):463-470.
37. Mahnashi MH. Knowledge, Attitude, Practice, and the Perceived Barriers with Respect to the Use of Herbal Medicines. Current Topics in Nutraceutical Research. 2021;19(1):29-35.
38. Lee KA, Harnett JE, Lam Ung CO, et al. The provision of care provided by the pharmacy workforce in relation to complementary medicines in Australia. Research in Social and Administrative Pharmacy. 2021;17(4):763-770. https://doi.org/10.1016/j. sapharm.2020.06.020
39. Siltrakool B. Assessment of Community pharmacists’ knowledge, attitude and practice regarding non-prescription antimicrobial use and resistance in Thailand. 2018