Attitudes of parents and pharmacy staff to the Medicines and Health Care Regulatory Agency’s (MHRA) guidance on the treatment of children aged under six with cough medicines.

Focal points • The aim of the study was to ascertain the attitudes of parents and pharmacy staff regarding the impact of enforcing MHRA guidance on the use of cough medicines in children aged under six. • Parents lacked confidence in the advice of pharmacists if they could see the ‘forbidden’ products containing pictures of toddlers on display in the pharmacy or if they knew the product could be purchased from a supermarket. • Staff were frustrated because the availability of such medicines in supermarkets undermined their advice to parents. • Further research is needed in order to inform and enforce policy on the advertising and availability of cough medicines and ensure that children aged under six are not placed at risk.
Introduction It is widely recognized that it is preferable for patients to self-manage minor illness, such as upper respiratory tract infection, rather than to utilize the more costly resources of a GP 1. The MHRA, however, has issued guidance 2 advising health care professionals that cough medicines containing certain antitussives, expectorants, nasal decongestants and antihistamines should no longer be used in the treatment of children under the age of six. Consequently, staff in a rural community pharmacy in Leicestershire refused to sell these cough medicines for such children. This action, however, tended to cause resentment and confusion among parents. In order to substantiate or refute anecdotal evidence, a service evaluation was conducted adopting qualitative methods. Method A convenience sample was obtained of six parents with children - four boys aged 5 years, 5 years, 4 years & 3 years respectively; two girls aged 4 years & 0 years, 9 months) who attended a rural pharmacy in Leicestershire intending to purchase a cough medicine for the child. Separate topic guides were devised to conduct semi-structured interviews with: a) parents and b) pharmacy staff. Interviews with parents explored their experience of discussing the treatment of their child after having been refused a cough mixture. Interviews with three pharmacy assistants and two pharmacists explored their approach to counselling parents wishing to purchase a cough medicine. Interviews were audio recorded and verbatim transcripts produced. The evaluation was deemed by the NHS research ethics service not to require NHS ethical approval but informed consent was, nevertheless, obtained. A thematic content analysis of the transcripts was performed based on an interpretive and phenomenological epistemology. Results Three key themes were derived from the analysis: Theme 1: ‘Efficacy and risk associated with cough medicines’. Parents were surprised to learn that certain ingredients of cough medicines could be harmful to young children. Theme 2: ‘Disruption to Lifestyle’. Parents described the stress experienced when a child had a cough and their reluctance to allow cough to recover without giving medication. Theme 3: ‘Conflicting Advice from Authorities’. Parents lacked confidence in advice from pharmacy staff because they believed cough medicines were available for purchase for under six year olds from supermarkets. They also felt that packaging displaying images of toddlers was inappropriate. Some staff thought that manufacturers were trying to save money by not recalling cough medicines that were not labelled according to the latest MHRA guidance. Discussion Parents may not be willing to accept the refusal to sell a cough medicine if they know that the product can be purchased from a supermarket or if packaging with images of toddlers is on display. This evaluation suggests that research is required in order to inform policy on how pharmacies, and other retailers, sell cough medicines responsibly without undermining the advice of pharmacy staff and to ensure that children under six years are not placed at risk. References

1. Anon. (2005) Changing role of pharmacies. Parliamentary Office of Science and Technology. Postnote No. 246. http://www.parliament.uk/documents/post/postpn246.pdf. Accessed on 25/04/2011
2. Anon. Children’s over the counter cough and cold medicines – new advice from the Medicines & Healthcare Regulating Agency (February 2009). http://www.mhra.gov.uk/Safetyinformation/Safetywarningsalertsandrecalls/Safetywarningsandmessagesformedicines/CON038908. Accessed on 25/04/2011.