Self-reported competence of Estonian community pharmacists in relation to herbal products: findings from a health-system in transition.

Recent health-system reforms in Estonia have resulted in an increased emphasis on primary health care and evidence-based medicine. Community pharmacies are the primary source of herbal products, and pharmacists have an important role in ensuring the safe and effective use of herbal products. The objective of this study was to explore the self-reported competence of pharmacists and the self-reported provision of community pharmacy services in relation to herbal products. A survey instrument was mailed to a random sample of 154 (50%) community pharmacies in Estonia in February 2005. Responses were received from 114 pharmacists and six assistant pharmacists (response rate 77.9%). Among the respondents, 64.1% self-evaluated their knowledge of herbal products as good or excellent. However, only 35.0% reported they experienced no problems in counselling about herbal products, while only 35.8% recognized the importance of continuing education. Pharmacists attached a high level of importance to providing information about herbal products' mode of action, administration, potential side-effects and interactions. There was an apparent mismatch between pharmacists' self-reported competence and their self-reported provision of advice about herbal products. Health system reforms in Estonia may need to be accompanied by enhanced training for pharmacists to provide advice about the safe and appropriate use of herbal products.