Understanding pharmacists’ experiences with advice-giving in the community pharmacy setting: A focus group study Amica Simmons-Yon a, *, Mary T. Roth b , Maihan Vu c , Dio Kavalieratos d , Morris Weinberger e,f , Jaya K. Rao b a Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Cecil G. Sheps Center for Health Services Research, UNC-Chapel Hill, NC, USA b Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, UNC-Chapel Hill, NC, USA c Center for Health Promotion and Disease Prevention, Department of Health Behavior & Health Education, UNC Gillings School of Global Public Health, UNC-Chapel Hill, NC, USA d Department of Health Policy and Management, UNC Gillings School of Public Health, Cecil G. Sheps Center for Health Services Research, UNC-Chapel Hill, NC, USA e Department of Health Policy and Management, UNC Gillings School of Public Health, UNC-Chapel Hill, USA f Durham VAMC Center for Health Services Research, Durham, USA 1. Introduction Americans value pharmacists for their expertise and advice in facilitating the safe use of prescription medications [1], over-the- counter (OTC) therapies, and complementary and alternative medicine (CAM) [2–4] as part of self-care [5,6]. In recent years, the availability and use of OTC and CAM treatments have grown explosively in the US [2]. Herbal, dietary supplements, and other natural products are among the most popular CAMs [2,7], and are commonly sold in community pharmacies. More than 70% of community pharmacists have encountered patients who use or inquire about CAM for self-care [2,3,8,9–11]. Some patients from vulnerable or underserved populations may consult pharmacists as their first step to receiving medical advice or health care for their symptoms [12,13]. Thus, pharmacists often provide patients with advice on use of OTCs and CAM as self-care treatments for symptoms. Previous studies examining symptom triage decisions of non- physicians have typically focused on nurses, paramedics, and emergency room personnel [14–17]. Few studies have examined pharmacists’ advice regarding symptoms. In one study [18], a standardized patient portraying the symptoms of undiagnosed Type 1 diabetes mellitus visited 8 community pharmacies to seek health advice. Although all pharmacists recommended physician follow-up (6 urgently), only 50% explicitly mentioned Type 1 diabetes mellitus as a potential diagnosis. In another study [19], the same standardized patient visited 10 pharmacies to obtain advice on managing acute low back pain symptoms. Consistent with evidence-based guidelines, pharmacists often recommended Patient Education and Counseling 89 (2012) 476–483 A R T I C L E I N F O Article history: Received 15 March 2012 Received in revised form 15 June 2012 Accepted 29 August 2012 Keywords: Complementary and alternative medicine Symptoms Self-care Pharmacist–patient interaction Pharmacy education A B S T R A C T Objective: To examine the experiences of community pharmacists providing advice about symptoms and complementary and alternative medicines (CAM). Methods: Ten licensed pharmacists and 21 student pharmacists working in community settings participated in 4 focus groups to discuss: patients’ questions about symptoms and CAM, comfort level providing advice, and factors prompting physician referrals. Focus group recordings were transcribed verbatim and interpreted using thematic text analysis. Results: Pharmacists’ dual role as advisors and medical liaisons emerged as primary themes. Participants reported that patients often seek their advice about self-care of symptoms to delay physician visits. Participants were comfortable giving advice; lack of medical history decreased their comfort level. Most were uncomfortable recommending CAM because of the lack of regulation and evidence. Participants suggested that pharmacy curricula expand training on symptom triage, pharmacist–patient communication, and CAM to prepare graduates for employment in community settings. Conclusion: Student and licensed pharmacists of this study voiced that they are often asked for advice on symptom management, but reported needing training to help provide appropriate advice to patients. Practice implications: The findings suggest that training strategies could help pharmacists appropriately triage and advise patients seeking self-care advice for their symptoms in the community setting. ß 2012 Elsevier Ireland Ltd. All rights reserved. * Corresponding asuthor at: 2206 Kerr Hall, CB #7573, Chapel Hill, NC 27599- 7573, USA. Tel.: +1 919 843 8757; fax: +1 919 966 8486. E-mail address: amica_yon@unc.edu (A. Simmons-Yon). Contents lists available at SciVerse ScienceDirect Patient Education and Counseling jo ur n al h o mep ag e: w ww .elsevier .co m /loc ate/p ated u co u 0738-3991/$ – see front matter ß 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.pec.2012.08.011