Core Competencies in Natural Health Products for Canadian Pharmacy Students

By Byrne, Ani; Boon, Heather et al. | American Journal of Pharmaceutical Education, April 2010 | Go to article overview

Core Competencies in Natural Health Products for Canadian Pharmacy Students


Byrne, Ani, Boon, Heather, Austin, Zubin, Jurgens, Tannis, Raman-Wilms, Lalitha, American Journal of Pharmaceutical Education


INTRODUCTION

The majority of North Americans report using natural health products (NHPs), such as herbal medicines and vitamins (1,2) and often purchase them in pharmacies, (3,4) raising the question of what pharmacists should know about these products. This paper describes a consensus-based process which culminated in the identification of core competency statements for Canadian pharmacy students regarding natural health products (NHPs). NHPs are defined by Health Canada as substances found in nature that are manufactured and sold for medical or health-related uses, such at treating or preventing diseases. (5) The Natural Health Products Regulations (2004) legally categorized NHPs as "drugs" at the level of the Food and Drugs Act, (6) therefore NHPs are included in Canadian pharmacists' scope of practice. (7) In contrast, this class of products is known generically as dietary supplements, a subcategory of foods in the United States.

Many stakeholders believe that pharmacists play a key role regarding NHPs. (8-12) Pharmacy associations in Canada and the United States began publishing recommendations, statements, and guidelines regarding these products almost 10 years ago. (13-16) Additionally, consumers, pharmacists, pharmacy students, NHP industry representatives, and leaders from other health care professions have all identified the importance of pharmacists being able to counsel patients about NHPs, especially about adverse effects and drug interactions associated with NHP use. (8-12) The basis for pharmacists' involvement with these products is argued to be an extension of their established roles. (14) Pharmaceutical care is defined as "to accept responsibility for optimizing all of a patient's drug therapy, regardless of source (prescription, nonprescription, alternative, or traditional medicines), to achieve better patient outcomes and to improve the quality of each patient's life," (17 (p2-3)) indicating a clear expectation for pharmacists to be knowledgeable about NHPs as part of contemporary practice. The majority of pharmacists, however, have reported feeling ill-equipped to meet these expectations, and pharmacy curricular content pertaining to NHPs varies widely across North America. (8,11,18-20) Canadian and US research on pharmacists' knowledge of, and opinions, about NHP reveals: a lack of formal instruction about these products as demonstrated for example by low test scores related to NHP content, (11,18,19) inconsistent NHP content in pharmacy school curricula, (20,21) evidence that more training in NHPs results in higher test scores, (11,18,22) and an overall/general sentiment that the study of NHPs should be a mandatory part of the curriculum. (19,22)

Both Canadian and American pharmacists are expected to possess some knowledge about NHPs to become licensed. The Pharmacy Examining Board of Canada (PEBC), the national certification body of Canadian pharmacists, recommends that students planning to sit for the Qualifying Examination, or the Evaluating Examination for foreign-trained students, familiarize themselves with therapeutic considerations concerning alternative treatments, (23) the category to which NHPs belong. In the United States, passing the North American Pharmacist Licensure Examination (NAPLEX) is required for licensure in all 50 states, (24) and the test contains a competency specifically addressing knowledge of dietary supplements. (25) Also in the United States, the Accreditation Council for Pharmacy Education (ACPE) Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree (2007) requires pharmacists to be knowledgeable and competent in a wide-range of sciences, including the pharmaceutical sciences. (26) This encompasses the categories of pharmacognosy and alternative and complementary therapies, which include but are not limited to natural products, dietary supplements, herbal-drug interactions, and the Dietary Health Supplement and Education Act. …

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