Simulated encounters reveal gaps in counselling on St John's Wort-oral contraceptive pill interactions among pharmacy personnel.

Abstract

Objectives: Complementary medicines (CM) are widely used and commonly taken with conventional treatments, raising concerns about possible interactions. The primary objective of this study was to explore whether pharmacists and pharmacy staff are identifying and preventing potential CM-drug interactions.

Methods: A simulated-patient study involving visits to 100 pharmacies in Sydney Australia. The simulated-patient requested advice about the safety of a herbal product containing Hypericum perforatum [St John's Wort (SJW)] and the oral contraceptive pill (OCP) using a scripted scenario. A standardized survey checklist was used to document the encounter.

Key findings: Of the 100 pharmacy visits made, advice was provided by a pharmacist (n = 85, 85%) or pharmacy assistant (n = 15, 15%) across 59 franchise and 41 independent pharmacies. Most pharmacists (n = 68, 80%) were able to identify the interaction between the OCP and SJW and advised not to take them concurrently. Referral to another healthcare professional was made by some pharmacists (n = 25, 29.4%), predominantly to medical practitioners and specialists (n = 25, 92%).

Conclusions: While most pharmacists and pharmacy staff who were consulted during this study were able to recognize the interaction between the OCP and SJW, overall there was limited history-taking, inconsistent referral practices, and variable quality and completeness of advice. These findings highlight the need for CM-specific counselling guidelines, and pharmacists' training and continuing professional education to support safer integration of CM in pharmacy practice.