Pharmacists' perspectives on recommending herbal medicines for acute infections: a qualitative study

Background: Community pharmacists have an essential role in antimicrobial stewardship by providing self- care advice for self- limiting infections. Aim: To explore community pharmacists' perceptions and experiences of advising patients on management of acute respiratory tract infections (RTIs) and urinary tract infections (UTIs), and to explore issues regarding use of over- the- counter (OTC) medicines, including herbal medicines. Design & setting: A qualitative study using semi- structured interviews with community pharmacists in England. Method: Qualitative interviews with community pharmacists were carried out face to face and by telephone between November 2019 and March 2020. Data were collected through in- depth, semistructured interviews, recorded and transcribed. A reflexive thematic analysis was undertaken. Results: In total, 18 community pharmacists were interviewed. Three main themes were identified. Theme 1 was self- management recommendations. Community pharmacists considered patients' preferences when recommending self- management strategies. Some believed that conventional OTC medications had quicker and stronger effects, while others preferred herbal OTCs as a more natural approach, particularly for less severe symptoms. Theme 2 was factors influencing pharmacists' recommendations for acute infections. This included pharmacists' perceptions of patient preferences, nature or severity of illness, research evidence, training, commercial pressures, and patient concerns about medication cost. Theme 3 was pharmacist-patient communication. Pharmacists sometimes experienced challenges with language barriers and patients' expectations of receiving antibiotics. Pharmacists emphasised the importance of being trusted by their patients. There was widespread acceptance of their role in self- management advice for acute illness and interest in the role of herbal medicines, but pharmacists did not feel confident in recommending these. Conclusion: Pharmacists are central to the management of self- limiting infections. There is a need pharmacists on self- management strategies including herbal medicine.