Evaluation of community pharmacists’ roles in screening and communication of risks about non-steroidal anti-inflammatory drugs in Thailand

Abstract

Self-administered questionnaires were distributed to all accredited pharmacies in Thailand, inviting the main pharmacist in each pharmacy to participate in this study. Findings Out of 406 questionnaires distributed, 159 were returned (39.2%). Almost all pharmacists claimed to engage in NSAID dispensing practice, but not all of them provided relevant good practice, such as, screening for risk factors (56.3-95.5%), communication on adverse drug reactions (ADRs) (36.9-63.2%) and ADR management (58.9-79.7%), history of gastrointestinal (GI) problems was frequently mentioned for screening, but many pharmacists did not screen for history of NSAID use (24.7-35.5%), older age (45.2-48.9%), concomitant drug (63.7%), and problems of cardiovascular (24.1%), renal (34.9-43.3%), and liver systems (60.3-61.0%). Male pharmacists were significantly less likely to inform users of non-selective NSAIDs about ADRs [odds ratio (OR) 0.44], while provision of information about selective NSAID ADRs was higher among pharmacy owners (OR 2.28), pharmacies with more pharmacists (OR 3.18), and lower in pharmacies with assistants (OR 0.41). Screening for risk factors, and risk communication about NSAIDs were not generally conducted in Thai accredited community pharmacists, nor were NSAID complications fully communicated. Promoting of community pharmacists' roles in NSAID dispensing should give priority to improving, especially in high-risk patients for taking NSAIDs.

Practices of healthcare professionals in communicating with nonsteroidal anti-inflammatory drug users in Thailand: a qualitative study

“…This practice may lead the public to believe that selective NSAIDs are better and safer to use. Clearly type of NSAID was a factor affecting other aspects of information provision, again confirming some of our survey results . CV side effects were only mentioned by a few participants in relation to selective NSAIDs and not with non‐selective drugs, despite similar risks .…”

“…However, our surveys of Thai health professionals have identified a range of factors affecting self‐reported information provision in addition to the type of NSAID. These include work setting, number of work colleagues, time available for direct patient contact and gender . Our patient survey also found that the duration of NSAID use and age were factors which affected whether or not they had received information about potential side effects and how to avoid or manage these .…”

“…A guideline for the interview was developed to elicit individuals’ experiences of providing information about NSAIDs to their patients, to gain insight into the risk information given. The topic guideline was based on literature review and gaps found in previous studies . The guideline was assessed for face validity by three pharmacists, who confirmed that it represented the study objectives, and any minor problems revised before collecting data.…”

“…Approximately, 75% of OPs and 84% of HPs claimed to provide patients with information about side effects, mainly gastrointestinal (GI) problems, and over 80% of both groups saw patient information leaflets (PILs) provided with medicines as appropriate useful sources for improving risk and benefit information. Our community pharmacist (CP) survey found that most claimed to screen patients for factors which could increase NSAID risks when supplying non‐selective COX‐2 NSAIDs, but did so less often if supplying selective NSAIDs . They were also less likely to provide information and advice about side effects with supply of selective NSAIDs than for non‐selective drugs .…”

“…Our community pharmacist (CP) survey found that most claimed to screen patients for factors which could increase NSAID risks when supplying non-selective COX-2 NSAIDs, but did so less often if supplying selective NSAIDs. [19] They were also less likely to provide information and advice about side effects with supply of selective NSAIDs than for non-selective drugs. [19] Patients on the other hand have indicated that, while the majority receive information about how to use NSAIDs and their indication, fewer than half report receiving information about side effects and they perceive the risks of NSAIDs as generally low.…”