The pharmacists were given about two weeks to use the database during their daily practices.
The database consisted of two search features – either a search by indication or search by product name.
Feedback on the pharmacists’ experience with the database was obtained using an online self-administered questionnaire.
Findings on the challenges that pharmacists faced when recommending probiotics and their feedback on the database were recently published in Clinical Therapeutics.
“The probiotics e-reference database provides a centralised platform where health care professionals can access detailed information on both probiotic products and associated clinical studies.
“This database enables health care professionals to avoid the tedious process of manually linking information on the efficacy of probiotics obtained from various resources to a corresponding product, hence allowing HCPs to address probiotic-related inquiries more efficiently,” said the researchers from Watson’s, the National University of Singapore, and Singapore General Hospital.
A total of 13 pharmacists were included in the beta-testing of the online probiotics database. All of them were in full time practice.
Common consumer queries
Out of the 13 pharmacists, most (61.5 per cent) said they had received between five and 10 queries related to probiotics per week.
Another 23.1 per cent said they received between 11 and 15 queries, while the remaining two received less than five and between 16 and 20 queries each week respectively.
All said they were approached for recommendations on the types of probiotics suitable for managing a condition.
The other common queries were 1) the uses of a specific product and 2) the suitability of a product for a specific population, such as children, vegetarian, Muslims, pregnant, and breastfeeding women.
Top three challenges
Despite regularly receiving consumer queries on probiotics, more than half of the pharmacists (53.8 per cent) rated their knowledge on probiotics as “weak”, while the remainder rated their amount level of knowledge as “fair”.
The biggest challenge faced when making a recommendation was in ascertaining the indications and corresponding clinical evidence available for each probiotic strain or mixture of probiotic strains.
The next most common challenge was differentiating between the wide range of probiotic products available.
More than half also said that available references on probiotics did not provide adequate product-specific information.
Creation of the database
The database was created by compiling existing clinical studies and probiotic products.
When compiling clinical studies, the researchers conducted a PubMed search for systematic reviews, meta-analyses, randomised controlled trials, follow-up studies, and case-control studies published between January 2008 and December 2019.
A total of 584 study excerpts were found.
The information extracted into the database were the probiotic indication, usage of the probiotics – for treatment of prevention, age groups, strain, dose, and duration of probiotic use, and efficacy.
It was found that the top three most studied conditions were gastrointestinal problems (15.8 per cent), followed by irritable bowel syndrome (13.4 per cent), and eczema (11.3 per cent).
The three conditions with the least amount of studies found were bad breath (0.9 per cent), traveller’s diarrhoea (0.9 per cent), oral candida (0.7 per cent), and lactose intolerance (0.5 per cent).
To compile information on the probiotic products, the researchers collected information from the physical stores of the three local pharmacy chains, outpatient pharmacies of two public hospitals, and local websites of two major supplement retailers.
They then went on to extract information on the product’s brand name, probiotic strain(s) and other ingredients used, product strength, dosage regimen, dosage form, marketed indications, suitability for different demographics, and storage conditions.
Only oral probiotics that stated the genus, species of the probiotics were included in the database.
A total of 449 probiotic products were identified – with 146 (32.5 per cent) and 303 (67.5 per cent) found in physical pharmacy stores and local websites of major supplement retailers respectively.
The probiotic products were then matched to the relevant studies based on its genus, species, and strains.
Interestingly, four in five products contained a combination of probiotic ingredients, while only one in five contained only one probiotic ingredient.
However, only 19.5 per cent of the combination probiotic products had supporting evidence, while most of the single-strain probiotic products (94.1 per cent) had supporting clinical evidence.
All participants said that the database has helped to resolve the challenges faced initially when making product recommendations to customers.
Second, the database was said to be user-friendly, with all agreeing or strongly agreeing that it was simple and intuitive to navigate the database interface.
However, there were mixed reaction on the comprehensiveness of the database, especially when it comes to the amount of information shown on the search results page.
Four disagreed that the summary of the products and/or studies provided on the search results page had sufficient detail to effectively assist them in shortlisting potential probiotics for customers.
Another five agreed with the statement, while the remaining four took a neutral position.
The feedback turned positive when it came to the details page, where nine in 10 agreed that the information provided was comprehensive.
Overall, all of them said they were satisfied with the database and would use it again to complement their practice.
To improve the robustness of the database, the researchers have plans to include information from more literature databases, pharmacies, and online stores.
Future updates will also consider the quality of the clinical studies included in the database to ensure credibility and accuracy of the information.
“While there are areas for improvement, this study provides an indication of the usefulness of the database in assisting health care professionals to develop relevant and evidence-based recommendations on probiotics for consumers,” the researchers concluded.
Source: Clinical Therapeutics
Development of a Probiotics E-Reference Database for Health Care Professionals
Authors: A.D.Y. Goh et al