‘First, Do No Harm’: Factors that Influence Pharmacists Making Decisions about Over-the-Counter Medication

Background: Little is known about how community pharmacists make decisions about which over-the-counter (OTC) medication to supply to a patient and the role of clinical evidence in making those decisions.

Objective: To explore factors that influence product selection by the pharmacist and the role of evidence-based practice in this decision.

Methods: In this qualitative study, community pharmacists registered in Northern Ireland and recruited via advertising and various qualitative sampling techniques, participated in face-to-face, semi-structured interviews (June 2007–September 2007) to discuss issues around OTC medication, including the use of evidence, how they judged a product to be effective, and their views on evidence-based medicine and its application to OTC medication. All interviews were digitally recorded, fully transcribed and analysed using the principles of constant comparison.

Results: Twenty-six pharmacists participated in interviews. Safety was the overarching consideration for pharmacists when making decisions. The subordinate themes were product, patient and professional factors. In terms of the product subordinate theme, use or consideration of evidence was secondary in the selection of OTC medicines. Pharmacists considered the potential for harm in the first instance and if the product was deemed safe, although lacking any evidence for effectiveness, the product was supplied. In relation to patient factors, it emerged that pharmacists were influenced by patient demand for a particular OTC product and wanted to meet patient expectations, provided that the requested product was judged to be safe. Similarly, professional factors such as ethical considerations (primarily in relation to safety) and respecting patient choice also influenced decision making. However, pharmacists recognized the conflict between professional requirements to practise according to evidence-based principles and patient demands.

Conclusion: This study suggests that pharmacists considered safety above all other factors when recommending OTC products to patients, and evidence of effectiveness was seldom considered when selling OTC medicines. If evidence-based practice is to influence this type of decision, pharmacists need to use the evidence that is available and be prepared to discuss evidence with patients.