Knowledge, Attitude, and Practice (KAP) of Pharmacists about Natural Products Used for Urolithiasis in Shiraz, Iran

Document Type : Original paper

Authors

1 Department of Traditional Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.

2 Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.

3 Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.

4 Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Background and objectives: We wanted to figure out how pharmacists make their judgments about the efficacy of natural products in urolithiasis and how they make suggestions about these products. Methods: A self-made descriptive questionnaire was designed, evaluated, and performed to assess pharmacists’ knowledge, attitude, and practice (KAP) about natural products in urolithiasis in 46 young pharmacists and final year pharmacy students in Shiraz. Results: In all of the KAP sections, Rowatinex®, Cystone®, and Sankol® were the most known, believed to be effective, and preferred pharmacist products. Respondents had received different education hours. About 54% of them believed their education was averagely adequate. Brochures (63.0%), web-search (60.9%), and applications (45.7%) were the primary resources used by pharmacists, mainly to check the instruction of use. About 80% of pharmacists were unaware of the mechanism of action of at least 5 of 14 products. Generally, respondents had a positive view of natural products. In addition, they thought price and advertisements were effective in patients’ and physicians’ choice of products. More than half of pharmacists preferred to use clinical trials (52.2%) rather than systematic reviews (19.6%). Conclusion: Providing a vast amount of information in the education process is not the best solution for preparing pharmacists for their role in community pharmacies. Besides the need for increasing clinical trials about complementary and alternative medicines and developing evidence-based databases, we need to train pharmacy students in professional ways to gain knowledge about complementary and alternative medicines.

Keywords


  • Alatab S, Pourmand G, El Howairis MEF, Buchholz N, Najafi I, Pourmand MR, Mashhadi R, Pourmand N. National profiles of urinary calculi: a comparison between developing and developed worlds. Iran J Kidney Dis. 2016; 10(2): 51–61.
  • Butterweck V, Khan S. Herbal medicines in the management of urolithiasis: alternative or complementary? Planta Med. 2009; 75(10): 1095–1103.
  • Food and Agriculture Organization of the United Nations (FAO). [Accessed 2020]. Available from: http://www.fao.org/3/i3545e/i3545e00.htm.
  • Bastani P, Amjad Nia A, Shabanpoor M, Mehravar S, Kashefian S. Knowledge, attitude and practice of Iranian pharmacists, body builders, and their coaches regarding sports supplements. J Res Pharm Pract. 2017; 6(3): 166–172.
  • Mehralian G, Yousefi N, Hashemian F, Maleksabet H. Knowledge, attitude and practice of pharmacists regarding dietary supplements : a community pharmacy- based survey in Tehran. Iran J Pharm Res. 2014; 13(4): 1457–1465.
  • Kheshti R, Namazi S, Mehrabi M, Firouzabadi D. Health careworkers’ knowledge, attitude, and practice about chronic pain management, Shiraz, Iran. Anesthesiol Pain Med. 2016; 6(4): 1–10.
  • Harnett J, Le TQ, Smith L, Krass I. Perceptions, opinions and knowledge of pharmacists towards the use of complementary medicines by people living with cancer. Int J Clin Pharm. 2018; 40(5): 1272–1280.
  • Lan W, Lee SY, Lee MX, Tong L. Knowledge, attitude, and practice of dry eye treatment by institutional chinese physicians in singapore. Sci World J. 2012; Article ID 923059.
  • Kwan D, Hirschkorn K, Boon H. U.S. and Canadian pharmacists’ attitudes, knowledge, and professional practice behaviors toward dietary supplements: a systematic review. BMC Complement Altern Med. 2006; 6: 1–10.
  • Iran Food and Drug Adminstration. Iran list of natural products. [Accessed 2020]. Available from: https://www.fda.gov.ir/fa/.
  • Polit DF, Beck CT. The content validity index: are you sure you know what’s being reported? Critique and recommendations. Res Nurs Health. 2006; 29(5): 489–497.
  • Lynn MR. Determination and quantification of content validity. Nurs Res. 1986; 35(6): 382–386.
  • Collins D. Pretesting survey instruments: an overview of cognitive methods. Qual Life Res. 2003; 12: 229–238.
  • Tangkiatkumjai M, Boardman H, Walker DM. Potential factors that influence usage of complementary and alternative medicine worldwide: a systematic review. BMC Complement Med Ther. 2020; 20(1): 1–15. 
  • Vanderwall C. Medical nutrition therapy: managing disease with individualized dietary recommendations and intervention. In: Lowry P, Penniston KL, Eds. Nutrition therapy for urolithiasis. Cham: Springer International Publishing, 2018.
  • Wertheim ML, Nakada SY, Penniston KL. Current practice patterns of urologists providing nutrition recommendations to patients with kidney stones. J Endourol. 2014; 28(9): 1127–1131.
  • Romics I, Siller G, Kohnen R, Mavrogenis S, Varga J, Holman E. A special terpene combination (Rowatinex®) improves stone clearance after extracorporeal shockwave lithotripsy in urolithiasis patients: results of a placebo-controlled randomised controlled trial. Urol Int. 2011; 86(1): 102–109.
  • Prosyannikov MY, Zolotuhin O, Madykin YY, Konstantinova OV, Voytko DA, Anokhin NV, Siskov AV. An influence of herbal plant based on the combination of natural terpenes, vitamin and essential oil on the spontaneous stone passage after extracorporeal shock-wave lithotripsy. Urologiia. 2021; 14(1): 87–93.
  • Azarfar A, Rafiee Z, Ravanshad Y, Saber Moghadam N, Bakhtiari E. Effect of herbal formulation “Cystone®” on urolithiasis. Jundishapur J Nat Pharm Prod. 2020; 15(3): 1–5.
  • Erickson SB, Vrtiska TJ, Lieske JC. Effect of Cystone® on urinary composition and stone formation over a one year period. Phytomedicine. 2011; 18(10): 863–867.
  • Goldaru pharmaceuticals. Sankol. [Accessed 2021]. Available from: https://www.goldaruco.com/product/sankol/.
  • Akbari F, Azadbakht M, Davoodi A, Vahedi L. Protective effect of "Sankol" herbal production kidney stone in Balb/C Mice. J Maz Univ Med Sci. 2019; 29(180): 1–7.
  • Mehrabi S, Manzouri L, Kohzadi A, Mehrabi F. Efficacy of tamsulosin versus tamsulosin plus "Lithorex-B" as medical expulsive therapy following extracorporeal shock-wave lithotripsy of kidney and upper ureteric stones; a randomized clinical trial. J Nephropharmacol. 2017; 6(2): 79–84.
  • Zhang H, Li N, Li K, Li P. Protective effect of Urtica dioica methanol extract against experimentally induced urinary calculi in rats. Mol Med Rep. 2014; 10(6): 3157–3162.
  • Gruenwald J, Brendler T, Jaenicke C, Ed. PDR for herbal medicines. Montvale (NJ): Thomson, 2007.
  • Vitkovskyy V. Efficacy evaluation of the phytotherapeutic drug "Canephron N" in the complex treatment of patients with urolithiasis using extracorporeal shock wave lithotripsy. Eureka Heal Sci. 2018; 6(6): 3–9.