Pharmacist perceptions of OTC analgesics revealed

Image of yellow bag with green pharmacy writing and a selection of medications to show pharmacist perceptions of OTC analgesics don't always match clinical evidence

A new survey published in SelfCare reveals that pharmacist perceptions of OTC analgesics, including ibuprofen, do not always reflect the clinical evidence.

The role of the community pharmacist in promoting self-care has become increasingly important in recent times, with the number of services expanding, due to the increased pressure experienced by GPs and the spiralling costs to the NHS. With 79% of the population of Great Britain having a pharmacy within one kilometre of their home, they are now recognised as being the most accessible healthcare professional.

Painful conditions are currently among the most commonly presenting minor ailments in general practice, and the scope for pharmacy input in supporting self-care for these is evident; so, it is vital that pharmacists and pharmacy support staff have relevant and evidence-based knowledge to inform their practice. A recent survey by the Royal Pharmaceutical Society (RPS) revealed nearly a third believe they have insufficient knowledge around different mechanisms of action, doses and contraindications for OTC analgesics.

Against this backdrop, a new online survey, run by IQVIA (formerly IMS Health) and funded by Reckitt Benckiser (RB) was conducted with 242 UK community pharmacists to explore OTC analgesic recommendations for specific pain states, and to understand their perceptions of analgesic efficacy and safety, in general, and in specific patient populations such as people with asthma.

Results of the survey highlight the disconnect between pharmacist perceptions on OTC analgesic safety and efficacy:

Efficacy

  • Just 13% of pharmacists believe paracetamol was more effective than OTC / branded ibuprofen, even though paracetamol was still most pharmacists’ first-line recommendation (89%) (n=251)
  • More recommendations were made for paracetamol (branded 41%, generic 24%) for the treatment of headache/migraine in comparison to ibuprofen (branded 17%, generic 18%) (n=251).

Safety

  • Most pharmacists (76%) believe that OTC / branded ibuprofen should always be taken with or after food (n=221)
  • Nearly two thirds of pharmacists (65%) believe paracetamol is safer than ibuprofen (n=242), with half of pharmacists believing OTC / branded ibuprofen is not as well tolerated as paracetamol (n=235).

Patient populations

  • Over 80% of pharmacists (86%) would never or infrequently recommend branded ibuprofen to patients suffering with minor GI problems (e.g. indigestion, heartburn or dyspepsia) (n=242)
    • 43% of pharmacists believe OTC / branded ibuprofen causes gastrointestinal (GI) bleeding (n=242)
  • More than three quarters of pharmacists (77%) would never or infrequently recommend branded ibuprofen to patients suffering with asthma (n=242)

Commenting on the results, Fin McCaul, Owner of Prestwich Pharmacy and co-author of the publication said: “Results show that pharmacists’ perceptions of analgesic safety and efficacy do not reflect the existing evidence base for OTC use, which may negatively impact on patient outcomes and satisfaction with pharmacy advice.

“Pharmacists’ beliefs around ibuprofen are extrapolated from prescription use, rather than the OTC evidence base, which demonstrates comparable safety for ibuprofen and paracetamol at OTC doses. Pharmacists’ advice on taking OTC ibuprofen with food and not recommending for patients with minor GI issues or asthma also contradicts the evidence and Summary of Product Characteristics.”

Terry Maguire, Senior Lecturer at School of Pharmacy, Queen’s University Belfast, Community Pharmacist and Investigator of the research added: “The results demonstrate that improved pharmacy education on the safety and efficacy of analgesics in the OTC environment is required to ensure patients receive advice that optimises clinical outcomes and reduces the risk of dissatisfaction with pharmacists’ recommendations.

“It is vital that pharmacists have access and training on the latest clinical evidence in over the counter (OTC) medication to ensure that patients are receiving the best advice from their pharmacists and effectively managing their pain.”