Community pharmacist recommendations regarding raspberry leaf for induction of labor: A mystery caller approach

Background: Raspberry leaf products are recommended by health care providers to induce labor despite insufficient efficacy and safety data. Less is known about community pharmacists’ knowledge and recommendations regarding raspberry leaf products. Objective: The primary end point was to describe New York State community pharmacist recommendations regarding raspberry leaf for labor induction. Secondary end points evaluated pharmacists’ assessment of the patient for additional information, citation of a supporting reference, provision of safety and efficacy information, recommendation of a patient-appropriate reference, and change in recommendation after learning about the obstetrician-gynecologist's recommendation. Design: Using a list of registered New York State pharmacies via a Freedom of Information Law request, a randomized representative sample of included pharmacy types (grocery store, drugstore chain, independent, and mass merchandising) was called using a mystery caller approach. Calls were conducted by one investigator throughout July 2022. Data collection included items specific to the primary and secondary outcomes. This study was approved by the associated institutional review board. Setting and participants: New York State community pharmacists from grocery store, drugstore chain, independent, and mass merchandising pharmacies were called using the mystery caller approach. Outcome measures: The primary endpoint was measured by the number of evidence-based recommendations made by pharmacists. Results: The study included 366 pharmacies. Despite insufficient efficacy and safety data, there were 308 recommendations to use raspberry leaf products (n = 308 of 366, 84.1%). Most pharmacists attempted to collect additional patient information (n = 278 of 366, 76.0%). Many pharmacists did not clearly convey safety (n = 168 of 366, 45.9%) or efficacy (n = 197 of 366, 53.8%) information. Of those who discussed safety or efficacy, many said raspberry leaf products were safe and effective (n = 125 of 198, 63.1%; n = 82 of 169, 48.5%). Pharmacists often referred or deferred the patient to another medical professional for more information (n = 92 of 282, 32.6%). Conclusion: There is an opportunity to improve pharmacists’ knowledge on the use of raspberry leaf products for the induction of labor and in making evidence-based recommendations when limited or conflicting efficacy and safety data exist.