BackgroundMany consumers use natural health products (NHPs) concurrently with prescription medications. As NHP-related harms are under-reported through passive surveillance, the safety of concurrent NHP-drug use remains unknown. To conduct active surveillance in participating community pharmacies to identify adverse events related to concurrent NHP-prescription drug use.Methodology/Principal FindingsParticipating pharmacists asked individuals collecting prescription medications about (i) concurrent NHP/drug use in the previous three months and (ii) experiences of adverse events. If an adverse event was identified and if the patient provided written consent, a research pharmacist conducted a guided telephone interview to gather additional information after obtaining additional verbal consent and documenting so within the interview form. Over a total of 112 pharmacy weeks, 2615 patients were screened, of which 1037 (39.7%; 95% CI: 37.8% to 41.5%) reported concurrent NHP and prescription medication use. A total of 77 patients reported a possible AE (2.94%; 95% CI: 2.4% to 3.7%), which represents 7.4% of those using NHPs and prescription medications concurrently (95%CI: 6.0% to 9.2%). Of 15 patients available for an interview, 4 (26.7%: 95% CI: 4.3% to 49.0%) reported an AE that was determined to be “probably” due to NHP use.Conclusions/SignificanceActive surveillance markedly improves identification and reporting of adverse events associated with concurrent NHP-drug use. Although not without challenges, active surveillance is feasible and can generate adverse event data of sufficient quality to allow for meaningful adjudication to assess potential harms.

Objective  The objective of this case study was to explore how pharmacists involved in the Pharmacy Study Of Natural Health Product Adverse Reactions (SONAR) project perceived the barriers and facilitators to participating in clinical research. Methods  A total of 19 semi-structured interviews were completed with pharmacy staff members who had recently completed data collection in the SONAR study which involved asking patients if they had experienced any unwanted effects while taking natural products. Other data sources included detailed field notes and interviews with SONAR researchers. Basic content analysis with multiple coders was used to analyse the data and triangulation was used to highlight areas of consistency and contrasting view points across the data types. Key findings  None of the participating pharmacies was able to collect as much data as expected by the SONAR team. Lack of time was stated as the main reason why pharmacy staff had trouble with the data collection. However, observational data and detailed probing in interviews confirmed that data collection itself took very little time (seconds per patient). Lack of time was provided as a socially acceptable excuse that masked deeper issues related to fears associated with challenges modifying established work routines and perceived lack of value associated with research participation. Conclusion  To successfully engage pharmacists in practice-based natural health product research it is necessary to establish the direct and indirect benefits of participation because those that believe in the value of the research will make the time for participation.

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