An investigation of the views and practices of Australian community pharmacists on pain and fever management and clinical guidelines
Background: Fever and pain are common conditions in the Australian healthcare setting. Whilst clinical guidelines provide important therapeutic recommendations, evidence suggests they are not always followed. Given that community pharmacy is one of the most frequently accessed primary healthcare services, it is important to understand the views and practices of community pharmacists in pain and fever.
Objectives: To investigate the views and practices of Australian community pharmacists in pain and fever management, and their views on relevant clinical guidelines.
Methods: A cross-sectional study of community pharmacists in Australia was conducted using a customised, anonymous, self-administered, online questionnaire between March and May 2018. To capture a broad range of demographics, pharmacists were recruited via local industry contacts and the Pharmaceutical Society newsletter, with further recruitment through snowball sampling. The main outcomes measured were pharmacists’ views, practices and treatment recommendation of choice in pain and fever management, as well as views on clinical guidelines and training.
Results: A total of 113 pharmacists completed the survey. In general, paracetamol (72%) was preferred as a recommendation over ibuprofen, and was the drug of choice for most mild to moderate pain and fever scenarios. Majority of pharmacists reported good knowledge of pain and fever management, however, only approximately half reported recent pain management training. Greater than 87% of pharmacists believe that clinical guidelines are useful in fever management, and 79% of pharmacists believe that following clinical guidelines is important in pain management.
Conclusions: While most pharmacists recognise the importance of guidelines and demonstrated good pain and fever management, results suggests opportunities to promote additional education, upskilling, and research in this space to further optimise pain and fever management in the community.
Benrimoj SI, Frommer MS. Community pharmacy in Australia. Aust Health Rev. 2004;28(2):238-246.
Roberts AS, Benrimoj SIC, Chen TF, Williams KA, Hopp TR, Aslani P. Understanding practice change in community pharmacy: a qualitative study in Australia. Res Social Adm Pharm. 2005;1(4):546-564. https://doi.org/10.1016/j.sapharm.2005.09.003
Cannings J, Francis C, Jessop R. Consumer needs executive summary - 5th community pharmacy agreement. Australian Government Department of Health; 2015.
Amorin-Woods L, Beck R, Parkin-Smith G, Lougheed J, Bremner A. Adherence to clinical practice guidelines among three primary contact professions: a best evidence synthesis of the literature for the management of acute and subacute low back pain. J Can Chiropr Assoc. 2014;58(3):220-237.
Corbett M, Foster N, Ong BN. GP attitudes and self-reported behaviour in primary care consultations for low back pain. Fam Pract. 2009;26(5):359-364. https://doi.org/10.1093/fampra/cmp042
El-Radhi AS, El-Radhi AS, Carroll J, Klein N. Clinical Manual of Fever in Children. El-Radhi ASe, Carroll Je, Klein Ne, editors. Berlin: Springer; 2009.
Strong J, Melzack R, Van Griensven H, Strong J, Unruh AM. Pain : a textbook for health professionals. Second edition. ed. Edinburgh, New York: Churchill Livingstone/Elsevier; 2014.
Australian Bureau of Statistics. Characteristics of bodily pain in Australia. 4841.0- Facts at your fingertips. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4841.0Chapter12011 (accessed Dec 20, 2018).
NICE. Fever in under 5s: assessment and initial management [Internet]. United Kingdom: National Institute for Health and Care Excellence. Available from: https://www.nice.org.uk/guidance/cg160 (accessed Dec 20, 2018).
Acute pain: a general approach, In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2018.
Lugtenberg M, Burgers JS, Besters CF, Han D, Westert GP. Perceived barriers to guideline adherence: a survey among general practitioners. BMC Fam Pract. 2011;12:98. https://doi.org/10.1186/1471-2296-12-98
Slade SC, Kent P, Patel S, Bucknall T, Buchbinder R. Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain. Clin J Pain. 2016;32(9):800-816. https://doi.org/10.1097/AJP.0000000000000324
Pharmacy Board of Australia: Statistics AHPRA. Available at: http://www.pharmacyboard.gov.au/About/Statistics.aspx (accessed Dec 20, 2018).
Blyth FM, March LM, Brnabic AJM, Cousins MJ. Chronic pain and frequent use of health care. Pain. 2004;111(1-2):51-58. https://doi.org/10.1016/j.pain.2004.05.020
Brabers AEM, Van Dijk L, Bouvy ML, De Jong JD. Where to buy OTC medications? A cross-sectional survey investigating consumers’ confidence in over-the-counter (OTC) skills and their attitudes towards the availability of OTC painkillers. BMJ Open. 2013;3(9):e003455. https://doi.org/10.1136/bmjopen-2013-003455
Crook J. Fever management: evaluating the use of ibuprofen and paracetamol. Paediatr Nurs. 2010;22(3):22-26. https://doi.org/10.7748/paed2010.04.22.3.22.c7638
Kanabar D. A clinical and safety review of paracetamol and ibuprofen in children. Inflammopharmacology. 2017;25(1):1-9. https://doi.org/10.1007/s10787-016-0302-3
McSwan J, Scarf A. Managing children's pain and fever with ibuprofen. Aust Pharm. 2017;36(6):28-31.
Pierce CA, Voss B. Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review. Ann Pharmacother. 2010;44(3):489-506. https://doi.org/10.1345/aph.1M332
Wong T, Stang AS, Ganshorn H, Hartling L, Maconochie IK, Thomsen AM, Johnson DW. Combined and alternating paracetamol and ibuprofen therapy for febrile children. Cochrane Database Syst Rev. 2013;(10):CD009572. https://doi.org/10.1002/14651858.CD009572.pub2
Bardage C, Westerlund T, Barzi S, Bernsten C. Non-prescription medicines for pain and fever—A comparison of recommendations and counseling from staff in pharmacy and general sales stores. Health Policy. 2013;110(1):76-83. https://doi.org/10.1016/j.healthpol.2012.12.006
Bertille N, Pons G, Fournier‐Charrière E, Khoshnood B, Chalumeau M. National cross‐sectional study of nonsteroidal anti‐inflammatory drugs use highlights differences between parents and professionals and prompts safety concerns. Acta Paediatr. 2016;105(11):e543-e548. https://doi.org/10.1111/apa.13566
Bhati M, Duxbury AJ, Macfarlane TV, Downer MC. Analgesics recommended by dentists and pharmacists, and used by the general public for pain relief. Int J Health Promot Educ. 2000;38(3):95-103. https://doi.org/10.1080/14635240.2000.10806157
Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty; 2018.
Olsen AM, Fosbøl EL, Lindhardsen J, Andersson C, Folke F, Nielsen MB, Køber L, Hansen PR, Torp-Pedersen C, Gislason GH. Cause-specific cardiovascular risk associated with nonsteroidal anti-inflammatory drugs among myocardial infarction patients--a nationwide study. PLoS One. 2013;8(1):e54309. https://doi.org/10.1371/journal.pone.0054309
Becker WJ. Acute Migraine Treatment in Adults. Headache. 2015;55(6):778-793.
Rainsford KD. Ibuprofen: pharmacology, efficacy and safety. Inflammopharmacology. 2009;17(6):275-342. https://doi.org/10.1007/s10787-009-0016-x
Collins SL, Moore RA, McQuay HJ, Wiffen PJ. Oral ibuprofen and diclofenac in post-operative pain: a quantitative systematic review. Eur J Pain. 1998;2(4):285-291. https://doi.org/10.1016/S1090-3801(98)90027-1
Gazal G, Al-Samadani KH. Comparison of paracetamol, ibuprofen, and diclofenac potassium for pain relief following dental extractions and deep cavity preparations. Saudi Med J. 2017 Mar;38(3):284-291. https://doi.org/10.15537/smj.2017.3.16023
Morán M. An observer-blind comparison of diclofenac potassium, piroxicam and placebb in the treatment of ankle sprains. Curr Med Res Opin. 1990;12(4):268-274. https://doi.org/10.1185/03007999009111657
Moore N. Diclofenac Potassium 12.5mg Tablets for Mild to Moderate Pain and Fever. Clin Drug Investig. 2007;27(3):163-195. https://doi.org/10.2165/00044011-200727030-00002
Pergolizzi J, Ahlbeck K, Aldington D, Alon E, Coluzzi F, Dahan A, Huygen F, Kocot-Kępska M, Mangas AC, Mavrocordatos P, Morlion B, Müller-Schwefe G, Nicolaou A, Pérez Hernández C, Sichère P, Schäfer M, Varrassi G. The development of chronic pain: physiological CHANGE necessitates a multidisciplinary approach to treatment. Curr Med Res Opin. 2013;29(9):1127-1135. https://doi.org/10.1185/03007995.2013.810615
Mills S, Torrance N, Smith BH. Identification and management of chronic pain in primary care: a review. Curr Psychiatry Rep. 2016;18(2):22. https://doi.org/10.1007/s11920-015-0659-9
George PP, Molina J, Cheah J, Chan SC, Lim BP. The evolving role of the community pharmacist in chronic disease management-a literature review. Ann Acad Med Singapore. 2010;39(11):861-867.
Kress H-G, Aldington D, Alon E, Coaccioli S, Collett B, Coluzzi F, Huygen F, Jaksch W, Kalso E, Kocot-Kępska M, Mangas AC, Ferri CM, Mavrocordatos P, Morlion B, Müller-Schwefe G, Nicolaou A, Hernández CP, Sichère .. A holistic approach to chronic pain management that involves all stakeholders: change is needed. Curr Med Res Opin. 2015;31(9):1743-1754. https://doi.org/10.1185/03007995.2015.1072088
Lalonde L, Choinière M, Martin E, Lévesque L, Hudon E, Bélanger D, Perreault S, Lacasse A, Laliberté MC. Priority interventions to improve the management of chronic non-cancer pain in primary care: a participatory research of the ACCORD program. J Pain Res. 2015;8:203-215. https://doi.org/10.2147/JPR.S78177
Williams CM, Maher CG, Hancock MJ, McAuley JH, McLachlan AJ, Britt H, Fahridin S, Harrison C, Latimer J. Low back pain and best practice care: a survey of general practice physicians. Arch Intern Med. 2010;170(3):271-277. https://doi.org/10.1001/archinternmed.2009.507
Raffaeli G, Orenti A, Gambino M, Peves Rios W, Bosis S, Bianchini S, Tagliabue C, Esposito S. Fever and pain management in childhood: healthcare providers’ and parents’ adherence to current recommendations. Int J Environ Res Public Health. 2016;13(5):499. https://doi.org/10.3390/ijerph13050499
Hanna LA, Hughes CM. Pharmacists’ attitudes towards an evidence-based approach for over-the-counter medication. Int J Clin Pharm. 2012;34(1):63-71. https://doi.org/10.1007/s11096-011-9586-y
Egerton T, Diamond L, Buchbinder R, Bennell K, Slade S. A systematic review and evidence synthesis of qualitative studies to identify primary care clinicians' barriers and enablers to the management of osteoarthritis. Osteoarthritis Cartilage. 2017;25(5):625-638. https://doi.org/10.1016/j.joca.2016.12.002
Teng KA, Butler RS, Schramm S, Isaacson JH, Nielsen C, Paradis C. Physicians caring for physicians: the perspective of the primary care physician. South Med J. 2014;107(5):301-305. https://doi.org/10.1097/SMJ.0000000000000095
Abdu-Aguye SN, Shehu A, Ahmad UI. Management of musculoskeletal pain in retail drug outlets within a Nigerian community: a descriptive study. Pharm Pract (Granada). 2017;15(1):873. https://doi.org/10.18549/PharmPract.2017.01.873
Santos AP, Mesquita AR, Oliveira KS, Lyra DP Jr. Assessment of community pharmacists' counselling skills on headache management by using the simulated patient approach: a pilot study. Pharm Pract (Granada). 2013;11(1):3-7.