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Title: An examination of the role of the community pharmacist in the pharmacovigilance of herbal medicines
Author: Aggarwal, Anjana Mohini
Awarding Body: University College London
Current Institution: University College London (University of London)
Date of Award: 2008
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It is widely recognised that there is a need for further vigilance of herbal medicines and community pharmacists could play a key role in this area. Presently the spontaneous reporting system (yellow card scheme) is the main mechanism for the pharmacovigilance of herbal medicines (see section 1.5.7). However, such schemes have inherent limitations, particularly under-reporting of suspected ADRs, which are likely to be even more significant for herbal than for conventional medicines. The thesis comprises several separate studies, utilising different research methods. The main aims of the thesis were to identify and describe current practices and problems in pharmacovigilance for herbal medicines and identify methods for improvement through utilisation of community pharmacists. Current practices of national pharmacovigilance centres towards reporting ADRs associated with herbal medicines were shown to vary. Thus, it is advisable that further work is undertaken by these centres to harmonise their approach with each other to prevent any delays in signal detection. Through analysis of ADR reporting forms and accompanying guidelines for member states of the WHO-UMC programme, deficiencies in the UK's yellow card were identified for herbal medicines and specific modifications made to prompt for and capture more pertinent information required for herbal medicines. Both qualitative and quantitative data showed pharmacists to have a lack of understanding regarding the definition, categorisation, licensing requirements, quality controls and pharmacovigilance of herbal medicines. However, pharmacists did perceive that herbal medicines are an integral part of their professional practice and that if they are to take a lead they needed further education/training and information on these products. Publication of relevant information sources for pharmacists such as a herbal BNF was deemed desirable. In a pharmacists' survey 94% of respondents agreed/strongly agreed that "community pharmacists have a professional responsibility to be able to provide reliable, objective information and advice to patients and the public on the safe, effective and appropriate use of herbal medicines". Also, more than 90% of respondents felt that topics covering the efficacy, safety, toxicity and pharmacovigilance of herbal medicines should be included in the MPharm core curriculum. Thus, heads of schools of pharmacy, including new and proposed schools, need to consider whether or not their MPharm programme adequately prepares future pharmacists to advise on the safe, effective and appropriate use of herbal and complementary medicines. From a survey of UK schools of pharmacy it was concluded that the extent of teaching and content for both core and elective programmes for pharmacognosy and its related areas varied between institutions and thus the knowledge of graduates would vary accordingly. More consistency could be achieved by providing direction in the accreditation guidelines for UK pharmacy degree courses set out by the Royal Pharmaceutical Society of Great Britain. Due to the inherent problems associated with spontaneous reporting such as under-reporting, the final chapter explored an active surveillance method for herbal medicines. However, limitations such as missed consumer populations purchasing herbal medicines from non- pharmacy outlets and poor recruitment rates of community pharmacists resulted in the failure to fully implement the study protocol. This study showed that community pharmacy based active surveillance methods can be used to complement existing surveillance methods though, at this current time are not feasible for herbal medicines. The results reported in this thesis further emphasise the importance of the role of the community pharmacist in the pharmacovigilance of herbal medicines. The overall findings indicated that there needs to be greater awareness for and importance attributed to herbal medicines amongst healthcare professionals and that this will only be achieved through greater education for healthcare professionals and collaborative working between organisations such as the Schools of Pharmacy, RPSGB, MHRA and the WHO.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available