EXPLORING THE INTERFACE BETWEEN COMPLEMENTARY MEDICINE AND COMMUNITY PHARMACY IN MALAYSIA – A SURVEY OF PHARMACISTS
DOI:
https://doi.org/10.37268/mjphm/vol.18/no.1/art.242Keywords:
complementary medicine, integrative medicine, community pharmacists, pharmacy practice, quality use of medicinesAbstract
The use of complementary medicine (CM) is on the rise worldwide. In Malaysia, CM is available as over-the-counter products in community pharmacies and consumers expect pharmacists to be knowledgeable about CM. However, little is known about Malaysian community pharmacists’ attitude and knowledge of CM. This cross-sectional study aimed to investigate the extent of integration of CM into practice, taking into account community pharmacists’ attitudes towards CM, their role in recommending CM, their knowledge of the evidence-base for commonly used CM, further education and training needs, and knowledge of information sources which can be used by pharmacists for CM information. Ethics approval was obtained and a pilot study was conducted to validate the questionnaire. After amendments were made, community pharmacists were invited to complete a 41-item paper-based or web-based questionnaire. Invitations to complete the survey were sent by either social media, email or face-to-face invitation. A response rate of 27% (453/1662) was achieved providing data from 453 community pharmacists. Most respondents were female (63%), aged 24-72 years. Only 42% of pharmacists always asked their customers presenting with a prescription about concomitant CM use. Forty-two percent (42%) of pharmacists personally recommended CM and slightly more than half (58%) had notified manufacturers of CM products of any suspected adverse drug reactions. On average, pharmacists achieved a score of 54% for knowledge on CM-drug interactions and 71% for knowledge of clinically proven benefits. Most pharmacists (75%) obtained their CM product training through self-directed learning. In addition, most pharmacists (66%) supported CM education at the undergraduate level and almost all (94%) recognised the need for additional CM education for pharmacists. Malaysian registered pharmacists do not routinely ask customers about CM use, or recommend CM products, but have a positive attitude towards their use and were interested in learning more about CM.
References
1. Abuduli M, Wan Puteh S, Aljunid S. Role of traditional and complementary medicine in universal coverage. Malaysian J Public Health Med. 2011; 11(2): 1-5.
2. World Health Organisation. WHO traditional medicine strategy: 2014-2023. Geneva 2013 [Available from: http://apps.who.int/iris/bitstream/10665/92455/1/9789241506090_eng.pdf.
3. Catherine Z, Andrew V. What is complementary medicine? BMJ 1999; 319: 693.
4. Ministry of Health. Malaysia National Health Accounts: Health Expenditure Report 1997-2014, Putrajaya, Malaysia: Malaysia National Health Accounts (MNHA) Unit 2016: 78.
5. Kim YJ. The current studies of education for a traditional and complementary medicine in Malaysia. J Evid-Based Complementary Altern Med. 2017; 22(4).
6. Steel A, Leach M, Wardle J, Sibbritt D, Schloss J, Diezel H, Adams J. The Australian complemenatry medicine workforce: a profile of 1,306 practitioners from the PRCI study. J. Altern Complement Med. 2017; 00(00): 1-10
7. Al-Naggar RA, Bobryshev YV, Abdulghani M, RammohanS et. al. Complementary/alternative Medicine Use among Cancer Patients in Malaysia. World J Med Sci 2013; 8: 157-64.
8. Chui P, Abdullah K, Wong L, Taib N. Prayer-for-health and complementary alternative medicine use among Malaysian breast cancer patients during chemotherapy. BMC Complement Altern Med 2014; 14: 425.
9. Dhanoa A, Yong TL, Yeap SJL et. al. Complementary and alternative medicine use amongst Malaysian orthopaedic oncology patients. BMC Complement Altern Med 2014; 14: 404.
10. Raja Lexshimi RG, Oranye NO, Ho SE, Zuraida J, Zulkifli SZ. Complementary and alternative medicine use among breast cancer patients in a tertiary hospital in Malaysia. Malaysian J Public Health Med 2013; 13(1): 11-9.
11. Farooqui M, Hassali M, Shatar A et. al. Use of complementary and alternative medicines among Malaysian cancer patients: A descriptive study. J Tradit Complement Med 2015; 1-6.
12. Alshagga M, Al-Dubai S, Muhamad Faiq S, Yusuf A. Use of complementary and alternative medicine among asthmatic patients in primary care clinics in Malaysia. Ann Thorac Med 2011; 6: 115.
13. Kadir AA, Hamid AH, Mohammad M. Pattern of complementary and alternative medicine use among Malaysian stroke survivors: A hospital-based prospective study. J Tradit Complement Med 2016; 5: 157-60.
14. Egede L, Ye X, Zheng D, Silverstein M. The Prevalence and Pattern of Complementary and Alternative Medicine Use in Individuals with Diabetes. Diabetes Care 2002; 25: 324-9.
15. Ganasegeran K, Rajendran A, Al-Dubai S. Psycho-Socioeconomic Factors Affecting Complementary and Alternative Medicine Use among Selected Rural Communities in Malaysia: A Cross-Sectional Study. PLoS2014; 9(11): 112124.
16. Jamia J, Paraidathathu T, Azmi N. Knowledge and Attitudes of Pharmacy Students Regarding Traditional Medicine. Procedia Social and Behavioral Sci 2011; 18: 464-72.
17. Hasan S, Yong C, Babar M et. al. Understanding, perceptions and self-use of complementary and alternative medicine (CAM) among Malaysian pharmacy students. BMC Complement Altern Med 2011; 11: 95.
18. Farooqui M, Othman C, Kanakal M. Knowledge, Attitudes, Practices (KAP) of Complementary & Alternative Medicine (CAM) Amongst Diploma Pharmacy Students in Malaysia. Open Conf Proc J 2013; 4(1): 165.
19. Jamshed S, Khan M, Ahmad A, Elkalmi R. Knowledge, perceptions, and attitudes toward complementary and alternative medicines among pharmacy students of a Malaysian Public University. J Pharm Bioallied Sci 2016; 8(1): 34-8.
20. Siti Z, Tahir A, Farah A et al. Use of traditional and complementary medicine in Malaysia: a baseline study. Complement Ther Med 2009; 17(5-6): 292-9.
21. Tiralongo E, Braun L, Wilkinson JM et. al. Exploring the Integration of Complementary Medicines into Australian Pharmacy Practice with a Focus on Different Practice Settings and Background Knowledge. J Complement Integr Med 2010; 7(Art 37).
22. Brown J, Morgan T, Adams J et al. Complementary medicines information use and needs of health professionals: general practitioners and pharmacists. Sydney: 2008.
23. Kanjanarach T, Krass I, Cumming R. Australian community pharmacists’ practice in complementary medicines: A structural equation modeling approach. Patient Educ Couns 2011; 83(3): 352-9.
24. Bushett NJ, Dickson-Swift VA, Willis JA, Wood P. Rural Australian community pharmacists' views on complementary and alternative medicine: a pilot study. BMC Complement Altern Med 2011; 11: 103.
25. Semple S, Hotham E, Rao D et. al. Community pharmacists in Australia: barriers to information provision on complementary and alternative medicines. Pharm World Sci 2006; 28(6): 366-73.
26. Kwan D, Hirschkorn K, Boon H. U.S. and Canadian pharmacists' attitudes, knowledge, and professional practice behaviors toward dietary supplements: a systematic review. BMC Complement Altern Med 2006; 6(31).
27. Raosoft, Online sample size calculator. Accessed 10 June 2007, retrieved from [online] http://www.raosoft.com/samplesize.html.
28. Cronbach, IJ Coefficient alpha and the internal structures of tests. Psychometrica 1951:16, pp. 297-334.
29. Nunnally, JC & Bernstein, IH. Psychometric theory. New York: McGraw-Hill Inc, 1994.
30. Al-Osail, AM, Al-Sheikh, MH, Al-Osail, EM et. al. Is Cronbach’s alpha sufficient for assessing the reliability of the OSCE for an internal medicine course? BMC Research Notes 2015: 8: 582.
31. Chua SS, Wong WK, Lee HG, Yvonne R, Tan SH. Implementation of the benchmarking guidelines on community pharmacies in Malaysia. Malaysian J Pharmaceutical Sci 2008; 6(1): 13-31.
32. Pharmaceutical Services Division. List of Type A Licences 2016 [updated 4th July 2016. Available from: http://www.pharmacy.gov.my/v2/en/apps/lesen-a
33. Law of Malaysia. Act 775. Traditional and Complementary Medicine Act 2016. Kuala Lumpur, Malaysia: Pencetakan Nasional Malaysia Berhad, 2016.
34. Hasneezah H, Liyanatul N, Noor HI et. al. Analysing the health policy making process: national policy of traditional and complementary medicine in Malaysia. Int J Public Health Clin Sci 2016; 3(3): 2289-7577.
35. Sharon, L. and Zuraidah S. Consumer Purchase Intention toward Products Made in Malaysia vs. Made in China: A Conceptual Paper. Procedia Social and Behavioral Sci 2014; 130: 37-45.
36. Jayaraj P. Regulation of traditional and complementary medicinal products in Malaysia. Int J Green Pharmacy 2010; 4(1): 10.
37. Koh HL, Teo HH, Ng HL. Pharmacists' patterns of use, knowledge, and attitudes toward complementary and alternative medicine. J Altern Complement Med 2003; 9(1): 51-63.
38. Brown CM, Barner JC, Shah S. Community pharmacists' actions when patients use complementary and alternative therapies with medications. J Am Pharm Assoc 2005;45(1): 41-47.
39. Kemper KJ, Gardiner P, Gobble J, Woods C. Expertise about herbs and dietary supplements among diverse health professionals. BMC Complement Altern Med 2006; 6:15.
40. Hassali MA, Khan TM, Shafie AA. Use of drug information resources by the community pharmacist in Penang, Malaysia. Inform Prim Care 2010; 18(3): 213-6.
41. Borja-Hart N, Leachman B. Drug Information Resources Used by Chain Community Pharmacists in Tennessee. J Pharm Technol 2016; 1-6.
42. Charrois TL, Hill RL, Vu D, et al. Community identification of natural health product–drug interactions. Annals of Pharmacotherapy 2007;41(7-8):1124-1129.
43. Chang ZG, Kennedy DT, Holdford DA, Small RE. Pharmacists' knowledge and attitudes toward herbal medicine. Ann Pharmacother 2000; 34: 710-5.
44. Culverhouse S, Wohlmuth H. Factors affecting pharmacists’ recommendation of complementary medicines – a qualitative pilot study of Australian pharmacists. BMC Complement Altern Med 2012; 12(1): 183.
45. Tam K. Attitudes of Alberta Pharmacists Pertaining to Traditional Chinese Medicine Practice and Complementary Alternative Medicine. J Pharmaceutical Care and Health Systems 2014; 01(02).
46. Tiralongo E, Wallis M. Integrating complementary and alternative medicine evaluation into the pharmacy curriculum. Am J Pharm Educ 2008; 72: 74.
47. Ting K, Stratton-Powell D, Anderson C. Community pharmacists’ views on adverse drug reactions reporting in Malaysia: a pilot study. Pharm World Sci 2010; 32(3): 339-42.
48. Mehralian G, Yousefi N, Hashemian F, Maleksabet H. Knowledge, Attitude and Practice of Pharmacists regarding Dietary Supplements: A Community Pharmacy- based survey in Tehran. Iran J Pharm Res 2014; 13(4): 1457-65.
49. Braun L and Cohen M. Herbs and natural supplements: an evidence-based guide. 4th Edi. Vol 2. Australia: Elsevier. 2015.
50. Williamson EM. Stockley’s herbal medicines interactions. London: Pharmaceutical Press. 2013.
2. World Health Organisation. WHO traditional medicine strategy: 2014-2023. Geneva 2013 [Available from: http://apps.who.int/iris/bitstream/10665/92455/1/9789241506090_eng.pdf.
3. Catherine Z, Andrew V. What is complementary medicine? BMJ 1999; 319: 693.
4. Ministry of Health. Malaysia National Health Accounts: Health Expenditure Report 1997-2014, Putrajaya, Malaysia: Malaysia National Health Accounts (MNHA) Unit 2016: 78.
5. Kim YJ. The current studies of education for a traditional and complementary medicine in Malaysia. J Evid-Based Complementary Altern Med. 2017; 22(4).
6. Steel A, Leach M, Wardle J, Sibbritt D, Schloss J, Diezel H, Adams J. The Australian complemenatry medicine workforce: a profile of 1,306 practitioners from the PRCI study. J. Altern Complement Med. 2017; 00(00): 1-10
7. Al-Naggar RA, Bobryshev YV, Abdulghani M, RammohanS et. al. Complementary/alternative Medicine Use among Cancer Patients in Malaysia. World J Med Sci 2013; 8: 157-64.
8. Chui P, Abdullah K, Wong L, Taib N. Prayer-for-health and complementary alternative medicine use among Malaysian breast cancer patients during chemotherapy. BMC Complement Altern Med 2014; 14: 425.
9. Dhanoa A, Yong TL, Yeap SJL et. al. Complementary and alternative medicine use amongst Malaysian orthopaedic oncology patients. BMC Complement Altern Med 2014; 14: 404.
10. Raja Lexshimi RG, Oranye NO, Ho SE, Zuraida J, Zulkifli SZ. Complementary and alternative medicine use among breast cancer patients in a tertiary hospital in Malaysia. Malaysian J Public Health Med 2013; 13(1): 11-9.
11. Farooqui M, Hassali M, Shatar A et. al. Use of complementary and alternative medicines among Malaysian cancer patients: A descriptive study. J Tradit Complement Med 2015; 1-6.
12. Alshagga M, Al-Dubai S, Muhamad Faiq S, Yusuf A. Use of complementary and alternative medicine among asthmatic patients in primary care clinics in Malaysia. Ann Thorac Med 2011; 6: 115.
13. Kadir AA, Hamid AH, Mohammad M. Pattern of complementary and alternative medicine use among Malaysian stroke survivors: A hospital-based prospective study. J Tradit Complement Med 2016; 5: 157-60.
14. Egede L, Ye X, Zheng D, Silverstein M. The Prevalence and Pattern of Complementary and Alternative Medicine Use in Individuals with Diabetes. Diabetes Care 2002; 25: 324-9.
15. Ganasegeran K, Rajendran A, Al-Dubai S. Psycho-Socioeconomic Factors Affecting Complementary and Alternative Medicine Use among Selected Rural Communities in Malaysia: A Cross-Sectional Study. PLoS2014; 9(11): 112124.
16. Jamia J, Paraidathathu T, Azmi N. Knowledge and Attitudes of Pharmacy Students Regarding Traditional Medicine. Procedia Social and Behavioral Sci 2011; 18: 464-72.
17. Hasan S, Yong C, Babar M et. al. Understanding, perceptions and self-use of complementary and alternative medicine (CAM) among Malaysian pharmacy students. BMC Complement Altern Med 2011; 11: 95.
18. Farooqui M, Othman C, Kanakal M. Knowledge, Attitudes, Practices (KAP) of Complementary & Alternative Medicine (CAM) Amongst Diploma Pharmacy Students in Malaysia. Open Conf Proc J 2013; 4(1): 165.
19. Jamshed S, Khan M, Ahmad A, Elkalmi R. Knowledge, perceptions, and attitudes toward complementary and alternative medicines among pharmacy students of a Malaysian Public University. J Pharm Bioallied Sci 2016; 8(1): 34-8.
20. Siti Z, Tahir A, Farah A et al. Use of traditional and complementary medicine in Malaysia: a baseline study. Complement Ther Med 2009; 17(5-6): 292-9.
21. Tiralongo E, Braun L, Wilkinson JM et. al. Exploring the Integration of Complementary Medicines into Australian Pharmacy Practice with a Focus on Different Practice Settings and Background Knowledge. J Complement Integr Med 2010; 7(Art 37).
22. Brown J, Morgan T, Adams J et al. Complementary medicines information use and needs of health professionals: general practitioners and pharmacists. Sydney: 2008.
23. Kanjanarach T, Krass I, Cumming R. Australian community pharmacists’ practice in complementary medicines: A structural equation modeling approach. Patient Educ Couns 2011; 83(3): 352-9.
24. Bushett NJ, Dickson-Swift VA, Willis JA, Wood P. Rural Australian community pharmacists' views on complementary and alternative medicine: a pilot study. BMC Complement Altern Med 2011; 11: 103.
25. Semple S, Hotham E, Rao D et. al. Community pharmacists in Australia: barriers to information provision on complementary and alternative medicines. Pharm World Sci 2006; 28(6): 366-73.
26. Kwan D, Hirschkorn K, Boon H. U.S. and Canadian pharmacists' attitudes, knowledge, and professional practice behaviors toward dietary supplements: a systematic review. BMC Complement Altern Med 2006; 6(31).
27. Raosoft, Online sample size calculator. Accessed 10 June 2007, retrieved from [online] http://www.raosoft.com/samplesize.html.
28. Cronbach, IJ Coefficient alpha and the internal structures of tests. Psychometrica 1951:16, pp. 297-334.
29. Nunnally, JC & Bernstein, IH. Psychometric theory. New York: McGraw-Hill Inc, 1994.
30. Al-Osail, AM, Al-Sheikh, MH, Al-Osail, EM et. al. Is Cronbach’s alpha sufficient for assessing the reliability of the OSCE for an internal medicine course? BMC Research Notes 2015: 8: 582.
31. Chua SS, Wong WK, Lee HG, Yvonne R, Tan SH. Implementation of the benchmarking guidelines on community pharmacies in Malaysia. Malaysian J Pharmaceutical Sci 2008; 6(1): 13-31.
32. Pharmaceutical Services Division. List of Type A Licences 2016 [updated 4th July 2016. Available from: http://www.pharmacy.gov.my/v2/en/apps/lesen-a
33. Law of Malaysia. Act 775. Traditional and Complementary Medicine Act 2016. Kuala Lumpur, Malaysia: Pencetakan Nasional Malaysia Berhad, 2016.
34. Hasneezah H, Liyanatul N, Noor HI et. al. Analysing the health policy making process: national policy of traditional and complementary medicine in Malaysia. Int J Public Health Clin Sci 2016; 3(3): 2289-7577.
35. Sharon, L. and Zuraidah S. Consumer Purchase Intention toward Products Made in Malaysia vs. Made in China: A Conceptual Paper. Procedia Social and Behavioral Sci 2014; 130: 37-45.
36. Jayaraj P. Regulation of traditional and complementary medicinal products in Malaysia. Int J Green Pharmacy 2010; 4(1): 10.
37. Koh HL, Teo HH, Ng HL. Pharmacists' patterns of use, knowledge, and attitudes toward complementary and alternative medicine. J Altern Complement Med 2003; 9(1): 51-63.
38. Brown CM, Barner JC, Shah S. Community pharmacists' actions when patients use complementary and alternative therapies with medications. J Am Pharm Assoc 2005;45(1): 41-47.
39. Kemper KJ, Gardiner P, Gobble J, Woods C. Expertise about herbs and dietary supplements among diverse health professionals. BMC Complement Altern Med 2006; 6:15.
40. Hassali MA, Khan TM, Shafie AA. Use of drug information resources by the community pharmacist in Penang, Malaysia. Inform Prim Care 2010; 18(3): 213-6.
41. Borja-Hart N, Leachman B. Drug Information Resources Used by Chain Community Pharmacists in Tennessee. J Pharm Technol 2016; 1-6.
42. Charrois TL, Hill RL, Vu D, et al. Community identification of natural health product–drug interactions. Annals of Pharmacotherapy 2007;41(7-8):1124-1129.
43. Chang ZG, Kennedy DT, Holdford DA, Small RE. Pharmacists' knowledge and attitudes toward herbal medicine. Ann Pharmacother 2000; 34: 710-5.
44. Culverhouse S, Wohlmuth H. Factors affecting pharmacists’ recommendation of complementary medicines – a qualitative pilot study of Australian pharmacists. BMC Complement Altern Med 2012; 12(1): 183.
45. Tam K. Attitudes of Alberta Pharmacists Pertaining to Traditional Chinese Medicine Practice and Complementary Alternative Medicine. J Pharmaceutical Care and Health Systems 2014; 01(02).
46. Tiralongo E, Wallis M. Integrating complementary and alternative medicine evaluation into the pharmacy curriculum. Am J Pharm Educ 2008; 72: 74.
47. Ting K, Stratton-Powell D, Anderson C. Community pharmacists’ views on adverse drug reactions reporting in Malaysia: a pilot study. Pharm World Sci 2010; 32(3): 339-42.
48. Mehralian G, Yousefi N, Hashemian F, Maleksabet H. Knowledge, Attitude and Practice of Pharmacists regarding Dietary Supplements: A Community Pharmacy- based survey in Tehran. Iran J Pharm Res 2014; 13(4): 1457-65.
49. Braun L and Cohen M. Herbs and natural supplements: an evidence-based guide. 4th Edi. Vol 2. Australia: Elsevier. 2015.
50. Williamson EM. Stockley’s herbal medicines interactions. London: Pharmaceutical Press. 2013.
Downloads
Published
2018-08-03
How to Cite
Pei Nee Wong, Lesley A. Braun, & Thomas Paraidathathu. (2018). EXPLORING THE INTERFACE BETWEEN COMPLEMENTARY MEDICINE AND COMMUNITY PHARMACY IN MALAYSIA – A SURVEY OF PHARMACISTS. Malaysian Journal of Public Health Medicine, 18(1), 130–138. https://doi.org/10.37268/mjphm/vol.18/no.1/art.242
Issue
Section
Articles
