bluuebunny/crossref_metadata_2025 huggingface dataset:
Liquid medication dosing errors: a pre-post time series in India
Authors: Angalakuditi Mallik V , Sunderland V Bruce
Published: December 2005

Objective

To evaluate the influence of pharmacist intervention on the level of parental dosing measurement errors and paediatrician dosage prescribing in a clinic in India.

Setting and study design

The study was conducted at Srujan Hospital for Sick Children, India. It used a time series design with two groups of patients. Group 1 involved 175 children prescribed paracetamol and assigned to usual care. Following an educational intervention for the hospital paediatricians, including feedback on dosages prescribed for Group 1 and promotion of a dosing chart, 162 patients were recruited to the intervention group (Group 2). Parents in Group 1 received paracetamol suspension and verbal instructions from hospital staff (standard care). Parents in Group 2 were provided with a syringe with a line marking the prescribed dose and its use was demonstrated to them by the pharmacist. Data on the dosages prescribed and measurement accuracy by parents were obtained for both groups.

Main outcome measures

Measurement of correct dosages by parents, and prescribing of appropriate dosages by paediatricians.

Results

In Group 1, 85 of 175 parents (48.6%) measured the correct dose (±0.5 ml) and paediatricians prescribed appropriate dosages in 67 of 175 cases (38.2%). In Group 2, 160 of 162 parents (98.7%) measured the correct dose and paediatricians prescribed appropriate dosages in 160 of 162 cases (98.7%), showing statistically significant improvements in both indicators (P < 0.001). When the impact of prescribing and dosing correctness was combined on an individual patient basis, 76 of 175 (43.4%) were appropriate in Group 1, and 160 of 162 (98.7%) were appropriate in Group 2. There was a statistically significant improvement (P < 0.001) in appropriate dosing outcome between the two groups.

Conclusion

Pharmacist intervention through patient education, including the use of a syringe, significantly improved parents' dosing accuracy. Pharmacists' feedback resulted in a reduction in physicians' prescribing errors in a country where pharmacist involvement is currently minimal.
Health, wealth and the way we live now
Authors: Savage Imogen
Published: December 2005

The 9th Health Services Research and Pharmacy Practice Conference was hosted by the clinical and practice research group at the School of Pharmacy, Queen's University Belfast, Northern Ireland, on April 14 and 15, 2003. The opening plenary address focused on the influence that social environment has on health. Imogen Savage reports on this and on some of the other research presented at the conference.
Can a long-term continuing education course in patient counselling promote a change in the practice of Finnish community pharmacists?
Authors: Kansanaho Heli , Pietilä Kirsi , Airaksinen Marja
Published: December 2005

Objective

To assess community pharmacists' perceptions of the impact of a long-term continuing education (CE) course on their patient counselling skills.

Methods

Three focus groups were conducted with the course participants (n = 17) during the last module of the CE course. Data were analysed using computer software for qualitative analysis.

Key findings

The focus groups revealed eight preliminary categories that were further categorised into four themes related to the learning process in patient counselling skills. The first theme related to achieving the learning objectives. The second related to personal development, understanding principles of two-way communication, and problems in their implementation in practice. The third theme related to actions taken by the participants in their work place, and the fourth involved the potential conflict between the new skills gained and the traditional communication culture in the participant's pharmacy.

Conclusion

The CE course provided the community pharmacists with new skills and knowledge in patient counselling and collective in-house training. The findings show that the greatest challenge is to change the communication culture of the pharmacy. To achieve this, it may be necessary for more than one pharmacist from the same pharmacy to participate in the training process at the same time.
Interactional issues in the provision of counselling to pharmacy customers
Authors: Norris Pauline , Rowsell Bridget
Published: December 2005

Objective

To investigate issues of manner and politeness in encounters between pharmacy staff and their customers.

Method

Twelve surrogate shoppers (research assistants posing as customers) made 360 visits to pharmacies around New Zealand. This paper presents a qualitative analysis of the accounts they gave of these visits.

Setting

180 community pharmacies throughout New Zealand.

Key findings

Interactional issues were important to the shoppers. They expressed a range of concerns about wanting to feel at ease in pharmacies, to feel confident in the quality of counselling, to feel included and to understand the counselling, privacy issues, and wanting to feel genuine concern from the pharmacy staff. Lack of staff attention to these concerns jeopardised the quality of some interactions.

Conclusion

We argue that quality interactions are essential conditions for the provision of adequate counselling in pharmacies, and suggest that this is because counselling is not universally accepted as part of pharmacists' role. Pharmacists must make extra efforts to negotiate their role as medication counsellors with customers.
Evaluation of patient opinions in a pharmacy-level intervention study
Authors: Pronk M C M , Blom A Th G , Jonkers R , Bakker A
Published: December 2005

Objective

To explore patients' satisfaction with their community pharmacy's services and to evaluate the effects of an intervention programme in which a trained technician organised patient education activities in the pharmacy.

Method

We surveyed patients visiting the participating pharmacies at three stages: at the start of the intervention period (0 months, T0), at the end (after 12 months, T1), and 12 months after the intervention had been completed (24 months from baseline, T2). At each stage, 500 questionnaires were distributed by each pharmacy.

Setting

28 Dutch community pharmacies: 14 intervention and 14 controls.

Key findings

The response rates were 54%, 44% and 43% at T0, T1 and T2, respectively. Baseline data showed that patients reported satisfaction with helpfulness, waiting time, ease of asking questions, answers to questions, and patient leaflets provided. Around two thirds (59.5%) of the patients said they would ask a pharmacy employee questions if they were concerned about side effects of their medication. Asking questions was not reported to be difficult for most patients (88.9%). The reasons most often given for experiencing difficulties with asking questions were related to lack of privacy (16.9% of all patients), waiting time of other patients (8.8%) and busy pharmacy employees (6.7%). The most frequently reported reason for being less satisfied with the answers to questions was receiving too little information (7.5%). Our analyses showed a significant improvement only on the outcome variable “helpfulness” experienced by patients between 0 (T0) and 12 months (T1), and this was found to be sustained one year later (T2).

Conclusion

The overall findings on patient satisfaction showed that almost two-thirds of the respondents saw the pharmacy as a source of information about medication. Community pharmacies clearly have an important role in providing such information. Lack of privacy was the most common reason for patients reporting difficulties in asking questions about medicines and this needs pharmacists' attention. Our analysis showed that the intervention had an effect on “helpfulness” experienced by patients, which slightly increased in the intervention period (T0-T1 differences) and appeared to have remained at the higher level one year later (T2).
Development of standard therapeutic guidelines for selected common diseases for the primary health care centres of a South Indian district
Authors: Mohan N , Nagavi B G
Published: December 2005

Method

A questionnaire survey of medical officers was conducted to collect data on the most commonly-presenting diseases and doctors' treatment choices in PHCs in Mysore. Draft guidelines were developed for these conditions based on available literature, together with microbiological sensitivity data from the three district hospitals. User feedback on the draft guidelines and on guidelines in general was obtained from medical officers using a postal questionnaire.

Objective

To develop standard therapeutic guidelines for selected common diseases for the primary health care centres (PHCs) of a South Indian district and to evaluate medical officers' perceptions about the proposed guidelines and about guidelines in general.

Setting

Sample of 17 of the 93 PHCs in Mysore.

Key findings

Upper respiratory tract infection was the most commonly-presenting condition. Procaine penicillin was the most commonly-used drug and there were examples of inappropriate treatment choices. The survey produced evidence that access to medicines on the government's “essential” list was not uniform, with many patients having to purchase prescribed drugs that were not on the list. The response rate to the user feedback questionnaire was 62 per cent (31 doctors). The medical officers had positive opinions about guidelines in general and felt that the guidelines we proposed were useful and would help them to improve their prescribing habits.

Conclusions

Prescribing in primary care in India needs to be improved. The involvement of potential users of the guidelines in their development should increase their acceptability and thus their use in practice.
(6) Researching “race”, ethnicity and health: a critical review
Authors: Bissell Paul , Traulsen Janine Morgall , Haugbølle Lotte Stig
Published: December 2005

In a previous article in this series, we posed some questions about the visibility of gender and the relevance of feminism for pharmacy practice research.1 Gendered distinctions are just one of the ways in which sociologists have attempted to categorise and explain the contours of the social world. Another obvious feature of modern societies is their “racialised” or multi-ethnic composition. Recognition of this has focused attention — if somewhat belatedly — on how to account for the health and illness experiences of ethnic or “racial” groups. In this paper, we describe and critique some of the health services and social science research which has explored these issues. Our focus has mainly been the UK literature. Our aim is to raise the profile of questions around “race” and ethnicity within pharmacy practice research, which have hitherto received scant attention.
Drug and therapeutics committees — are they fulfilling their potential to improve the quality use of medicines?
Authors: Tan Ee Lyn , Day Richard O , Brien Jo-anne E
Published: December 2005

Objective

Drug and therapeutics committees (DTCs) promote the quality use of medicines (QUM). DTC functions have expanded beyond overseeing the hospital formulary. They are in a position to influence prescribing practice, within and beyond the hospital setting into community practice, and it is important to evaluate and augment the quality of their performance. A survey was conducted to document and investigate perceived and ideal DTC principal functions and the level to which DTCs were achieving these.

Method

A questionnaire was sent to 300 directors of pharmacy/chief pharmacists in Australian hospitals. Non-responses within two weeks of mail-out were followed-up. Returned questionnaires were anonymised, collated and analysed. The questionnaire asked about the DTC's functions, the extent to which DTC performance indicators were used, and barriers to the use of these indicators. Respondents were asked for their perceptions of the DTC's influence on prescribers' practices.

Key findings

The response rate was 73.3% (220) and 127 respondents had an in-house DTC. The final dataset comprised 125 responses (two incomplete questionnaires excluded). The most common principal function of DTCs was “ensuring patient safety” (83.3%). Only 16% of respondents used indicators developed specifically for DTC performance evaluation. Data collected by DTCs were primarily for accreditation. Lack of resources contributed to barriers to indicator data collection. Most respondents (92%) believed that DTCs have some influence on prescribers' practices.

Conclusion

DTCs are seen to be in a position to have an influence on the quality of medicines use. A means to enhance DTC performance can be explored if potential problems in quality are detected. Although there is a desire to use the available indicators, assistance in data collection is needed. Adequate resources and strong leadership may result in more effective DTCs with greater influence on medical practice, leading to better patient outcomes.
Use of over-the-counter medicines in children
Authors: McIntyre John , Conroy Sharon , Collier Jacqueline , Birchley Nicola , Rodgers Sarah , Neil Karen , Choonara Imti , Avery Anthony
Published: December 2005

Objective

To assess the reasons for over-the-counter (OTC) medicine use in children and the sociodemographic factors influencing this choice of self-care rather than GP consultation.

Method

Questionnaires were sent to the home address of a randomly generated list of children under 12 years of age from three GP practices in the East Midlands selected to represent bottom, middle and top tertiles of deprivation on the basis of the Jarman score. Analysis using chi-square and Mann-Whitney tests was used to identify associated factors (number of carers in the home, number of children, deprivation score, parent/carer's age, age and number of children in the house) of the responses.

Setting

Primary care setting in the East Midlands region of England.

Key findings

From 424 completed questionnaires returned (response rate 61%), 413 parents/carers had purchased OTC medicines. Fifty-one different products had been purchased, with analgesic/antipyretic and cough/cold remedies the most frequently bought. The most commonly reported reasons for parent/carer initiated medication were to avoid troubling the GP with minor childhood ailments (79% of respondents) and to have medicines available in case of future need (74%). Cost was a barrier to buying OTC medicines for the more deprived. Advice-seeking behaviour was associated with the symptom, the number of children, affluence and the age of the child.

Conclusion

Parent/carer initiated use of OTC medication is widespread, particularly for analgesic/antipyretic and cough/cold remedies. Differences in advice-seeking behaviour are associated with the presenting symptom and a variety of sociodemographic factors.
(7) The risk society
Authors: Traulsen Janine Morgall , Bissell Paul
Published: December 2005

In previous articles in this series, we have discussed classical and modern sociological theories. This article addresses risk: a field of sociological research that is the subject of current debate. One commentator has described it as “one of the most lively areas of theoretical debate in social and cultural theory in recent times”.1
Pharmacist-led medication review clinics in general practice: the views of Greater Glasgow GPs
Authors: MacRae Fiona , Lowrie Richard , MacLaren Alister , Barbour Rosaline S , Norrie John
Published: December 2005

Objectives

To ascertain general practitioners' views of a pharmacist-led medication review (PLMR) service. In particular, to quantify the percentage of GPs who perceived PLMR to be a useful service to their practices; to explore key service benefits, problems and areas for future improvement; and to quantify the percentage of GPs who believed service benefits outweighed problems.

Method

Semi-structured interviews with a purposive sample of six GPs informed the development of a self-completion postal questionnaire. The questionnaire was sent to all 258 GPs in the 82 practices where PLMR clinics were held. GP views on aspects of the PLMR process were elicited using a Likert scale. Closed questions sought views on overall service value. Free-text responses were sought on benefits, problems and areas for future improvement.

Key findings

The response rate was 84% for GPs (93% of practices were represented). Ninety-five per cent of respondents considered PLMR to be a useful service. Key perceived benefits (improved prescribing practice, raised standards of patient care and satisfaction, and increased GP knowledge and confidence) outweighed problems (space and time constraints, limited GP-pharmacist contact, occasional patient dissatisfaction). Only a minority of GPs felt that the written pharmacy referrals relating to specific patients were inappropriate. Views were divided as to whether PLMR increased or decreased practice workload. Suggestions for future improvements included increased GP-pharmacist communication and extended pharmacist roles.

Conclusion

The Glasgow model of PLMR deployed across a large Primary Care Trust by a team of pharmacists was viewed by those GPs who had received input as a useful service. The majority of GPs exposed to the service believed benefits outweighed problems.
Medically-enhanced normality: an alternative perspective on the use of medicines for non-medical purposes
Authors: Møldrup Claus , Traulsen Janine Morgall , Almarsdóttir Anna Birna
Published: December 2005

Objective

To consider public perspectives on the use of medicines for non-medical purposes, a usage called medically-enhanced normality (MEN).

Method

Examples from the literature were combined with empirical data derived from two Danish research projects: a Delphi internet study and a Telebus (telephone interview) study with a stratified random representative sample.

Results

The results of these studies indicate an acceptance of medicine usage where “enhancement” strategies are part of the rationale for medicine use. These strategies include an overall desire to enhance the quality of life, eg, to optimise economic, working and family conditions. The term “doping” does not cover or explain the use of medicines as enhancement among healthy non-athletes.

Conclusion

We recommend wider use of the term medically-enhanced normality as a conceptual framework for understanding and analysing perceptions of what is considered rational medicine use in contemporary society.
Pharmacy services and patient choice: insights into differences between patient groups
Authors: Phul Sharon , Cooper Stacey L , Cantrill Judith A
Published: December 2005

Objective

To use data from the UK electronic transmission of prescriptions (ETP) pilot to examine how and why choice and use of pharmacy services differ between patients, and how introduction of new services might impact on patient choice.

Method

Patients were invited to participate in the ETP pilot in three consortia across the UK. A postal questionnaire was distributed to 276 participating patients, and 211 (76%) were returned. Questionnaires were also completed by 64 patients who had actively chosen not to take part in the ETP pilot. Semi-structured telephone interviews were conducted with 26 questionnaire respondents who had opted to use a mail order pharmacy participating in ETP.

Key findings

54% of patients participating in ETP could have their prescription collected by pharmacy staff, but only half of these (52%) had made use of the service. Patients found it convenient to collect the prescription themselves (35%) and/or preferred to collect it themselves (34%). These patients were however still happy to use the new service offered by ETP. Reasons for using the same pharmacy centred on practical aspects, such as proximity to the GP practice (65%) and short waiting times (27%). Patients also positively rated their experiences of obtaining their prescription from their GP practice (80%) and the medication from their pharmacy (82%). Patients who were offered both ETP and mail order pharmacy but chose not to participate (n = 31) were more opposed to the mail order aspect than to ETP (70% vs 14% respectively). Patients not participating who were offered ETP without mail order pharmacy (n = 33) most frequently stated that they found the current system to be convenient (23%). Interviewees using the mail order pharmacy found not having to visit either the GP practice or pharmacy to be convenient and a repeat prescription reminder service to be advantageous.

Conclusion

The introduction of ETP and mail order to pharmacy services does have some impact on patient choice. Different aspects of pharmacy services appeal to different groups of patients. Convenience was paramount to the majority of patients in this study, but its definition differed between patients. The data will support the pharmacy profession in developments that enhance patient choice and optimise service use.
Dispensing activity in a community pharmacy-based repeat dispensing pilot project
Authors: Wilson Keith A , Jesson Jill
Published: December 2005

Objective

To measure changes in dispensing activity in a UK repeat dispensing pilot study and to estimate any associated cost savings.

Method

Patients were provided with two successive three-monthly repeat prescriptions containing all of the items on their “repeat medicines list” and valid at a study pharmacy. Pharmacists consulted with patients at the time of supply and completed a patient-monitoring form. Prescriptions with pricing data were returned by the UK Prescription Pricing Authority. These data were used to calculate dispensing activity, the cost of dispensed items and an estimate of cost savings on non-dispensed items. A retrospective identification of items prescribed during the six months prior to the project was used to provide a comparison with those dispensed during the project and thus a more realistic estimate of changes.

Setting

350 patients from two medical practices in a large English City, with inner city and suburban locations, and served by seven pharmacies.

Key findings

There were methodological challenges in establishing a robust framework for calculating changes. Based on all of the items that patients could have obtained from their repeat list, 23.8% were not dispensed during the intervention period. A correction was then made to allow for a comparison with usage in the six months prior to the study. Based on the corrected data, there was an estimated 11.3% savings in drug costs compared with the pre-intervention period. There was a marked difference in changes between the two practices, the pharmacies and individual patients. The capitation-based remuneration method was acceptable to all but one of the community pharmacists.

Conclusion

The repeat dispensing system reduced dispensing volume in comparison with the control period. A repeat dispensing system with a focus on patients' needs and their use of medicines might be cost neutral.
Pharmacists' role in improving awareness about folic acid: a pilot study on the process of introducing an intervention in pharmacy practice
Authors: Meijer Willemijn M , de Smit Denhard J , Jurgens Renate A , de Jong-van den Berg Lolkje T W
Published: December 2005

Objective

To determine whether a multiple intervention programme to improve women's awareness of folic acid was feasible in community pharmacy practice; to identify adjustments in organisation and materials that could improve feasibility; and to assess how the target group would experience the intervention.

Method

An action research study was undertaken in which four community pharmacies in the Netherlands participated. In each, a core team (one pharmacist and one to two technicians) was responsible for the organisation and implementation of the intervention. The intervention had several possible levels. As a minimum, pharmacy staff added a label about folic acid to the box of dispensed oral contraceptives (OCs) and handed out a leaflet about folic acid. The intervention was discussed during core team meetings every six weeks. Modifications were made based on the experience of the pharmacy team, on responses from pharmacy customers and on the results of a questionnaire sent to women one week after they visited the pharmacy with an OC prescription. This cycle of planning, action, observation and reflection was repeated twice.

Key findings

The minimum intervention was carried out by all four pharmacies. Other activities differed: two pharmacies introduced a maximum client age limit for handing out the leaflet; two installed an electronic information display; three worked with posters and window displays; and in two pharmacies the pharmacy technicians wore project badges and an information portfolio was placed in the public area of the pharmacy. Of the target group, 44% were positive about the label, 49% were neutral and 4% were negative. Over half (56%) of the target group stated that they appreciated the public health information given through the pharmacy.

Conclusion

Working with core teams seemed to be a successful strategy to implement practice change. By discussing and modifying the intervention during each research cycle in the core team meetings, an optimal intervention was reached that fitted in with the existing organisation within the pharmacy and possible barriers were overcome. Feedback from the target group was mainly positive and motivated the core teams to continue.
Impact of pharmacist consultation versus a decision aid on decision making regarding hormone replacement therapy
Authors: Deschamps Michelle A , Taylor Jeff G , Neubauer Shannan L , Whiting Susan , Green Kathryn
Published: December 2005

Objective

To compare the effects of pharmacist consultation versus a decision aid on women's decisional conflict regarding use of hormone replacement therapy (HRT) and subsequent satisfaction with the decision-making process.

Setting

A family medicine clinic in Canada.

Method

The study was a prospective, randomised comparative trial. Peri- and post-menopausal female patients aged 48 to 52 years were invited to participate. Volunteers (n=128) received either a private consultation with a pharmacist or a take-home decision aid. Data collection was undertaken prior to the intervention and again following an appointment with a physician to discuss HRT. Outcome measures included: perception of being informed about HRT, decisional conflict, satisfaction with the education and the decision made regarding HRT, and adherence to HRT if prescribed. Telephone follow-up occurred three and 12 months after the physician appointment.

Key findings

After discussing HRT with their physicians, 35 of 91 women (38.5%) chose HRT, 15 (16.5%) declined it and 41 (45.1%) opted to delay their decision. Both interventions significantly increased women's perception of being informed about this form of therapy and decreased decisional conflict. Satisfaction with the education and with the HRT decision was high. More postmenopausal women in the pharmacist group reached a yes/no decision than in the decision aid group. Of those initiating HRT during the study (n =18), 16.7% had discontinued it at 12 months.

Conclusion

Consultation with a pharmacist and use of a decision aid are both effective methods for decreasing decisional conflict in peri- and post-menopausal women considering HRT.
Advice provision for women: community pharmacists' attitudes and skills
Authors: McAree Deirdre P , Scott Eileen M
Published: December 2005

Objective

To assess the frequency of community pharmacists' advice-giving to women and to determine pharmacists' attitudes and perceived knowledge, confidence and embarrassment in providing such advice.

Method

A postal questionnaire was sent to a random sample of 600 Northern Ireland community pharmacists for self-completion. One reminder was sent. The questionnaire asked pharmacists to rate their knowledge on a list of women's health topics and to rate their confidence in dealing with women's health issues. Pharmacists were asked what actions they took to increase women's comfort in discussing potentially sensitive topics. They were also asked about the availability of women's health services locally. Closed response data were entered into SPSS for analysis while open question responses were collated and analysed separately.

Key findings

Pharmacy customers were predominantly female and the majority of pharmacists reported providing advice on women's health on a daily basis. Most pharmacists reported being confident and knowledgeable on women's health issues. Pharmacists had strategies to ensure that women felt comfortable discussing personal problems and they were not embarrassed dealing with such problems. Respondents felt more comfortable responding to, rather than initiating, such discussions. Personal views made it difficult for some respondents to provide advice on emergency contraception. Male pharmacists considered themselves to be less confident, less knowledgeable, more embarrassed and to have greater difficulty initiating a conversation on sensitive issues compared with female pharmacists.

Conclusion

Pharmacists on the whole were confident when dealing with requests for advice. Counselling confidence was related to counselling frequency. Initiation of conversations on women's health issues was difficult for some pharmacists. More active collaboration with the providers of other professional services available to women may enhance pharmacists' overall service provision for women customers.
(8) The work of Michel Foucault: relevance to pharmacy practice
Authors: Ryan Kath , Bissell Paul , Traulsen Janine Morgall
Published: December 2005

Michel Foucault remains a controversial figure in social theory, his ideas giving rise to both loathing and adoration in equal measure. Writing from the 1960s to the 1980s, his work spans the disciplines of history, sociology and philosophy, and defies easy categorisation and elucidation. In this paper we attempt to situate Foucault's approach within the broad sweep of sociological thought in the late 20th century. We describe some of his central ideas, before moving on to critique his work and the contribution he and his adherents have made to medical sociology. Finally, we suggest how scholars might draw on his ideas to guide their research in pharmacy practice and social pharmacy.
The evidence-based supply of non-prescription medicines: barriers and beliefs
Authors: Watson Margaret C , Bond Christine M
Published: December 2005

Context

The reclassification of prescription only medicines (POMs) to pharmacy only (P) and general sale list (GSL) status is ongoing in the UK. Pharmacy staff need support to ensure the appropriate supply of these non-prescription medicines (NPMs).

Objective

To investigate the type of evidence used in the decision to supply NPMs and the barriers associated with their supply.

Methods

A participant observation study was conducted in nine pharmacies in one area of Scotland (Grampian). In-depth interviews were conducted with one pharmacist and one medicine counter assistant (MCA) from each pharmacy to explore and compare their attitudes and beliefs towards evidence-based practice (EBP) and the supply of NPMs.

Key findings

Most consultations were product requests. Pharmacy staff had little awareness or understanding of the term EBP and no specific evidence was used in the majority of consultations. Pharmacists' attitudes towards EBP varied. Personal experience or feedback from customers were cited as evidence upon which treatment recommendations were based. Many barriers and problems were associated with the supply of NPMs. These included: lack of evidence; MCAs' self-perception of their role; questioning and communication skills; safety; and training needs. There was a gap between pharmacists' and MCAs' perceptions of who should be referred to the pharmacist. Many staff used the WWHAM mnemonic for questioning customers, but this was often used as a matter of rote rather than as a framework to engage the customer in a relevant and constructive consultation. The development of adequate communication skills to allow core information to be obtained to support decision making needs to be addressed.

Conclusion

An increased awareness of EBP and its role in quality care needs to be promoted to community pharmacists and MCAs. There is currently no formal continuing education provision or requirement for MCAs in the UK. Pharmacy staff, particularly MCAs, require continuing education on the supply of NPMs.
Antibiotic prescribing control by pharmacists within UK NHS hospitals
Authors: Woodford Eleanor Marcella , Wilson Keith Alan , Marriott John Francis
Published: December 2005

Objective

To identify the role of clinical pharmacists in antibiotic prescribing control.

Method

A self-completion postal questionnaire was sent to the chief pharmacist at 465 UK National Health Service hospitals in 2001/2002. It contained questions covering hospital demographics and the role of pharmacists in ensuring adherence with the recommendations on antibiotic prescribing contained in hospital prescribing documents.

Key findings

Fifty-four per cent of questionnaires (n=253) were completed. Of these, 93% (n=235) of the responding hospitals had at least one of the following prescribing control documents: antibiotic formulary, antibiotic policy and antibiotic guidelines. Pharmacists routinely performed clinical review of adherence with prescribing recommendations (antibiotic prescribing control) in 83% of the responding hospitals but only in approximately two-thirds of hospitals (64%) was this review performed on every ward. The antibiotic prescribing control process appeared to be thorough, with five review activities performed by pharmacists in the majority of hospitals (74%), and proactive, with pharmacists undertaking routine daily visits to all wards (or selected units) in 85% of responding hospitals. Nearly three-quarters (71%) of hospitals had performed an audit of antibiotic prescribing; the majority had done so within the past two years. Pharmacists had been involved in these audits in 92% of responding hospitals.

Conclusions

Where performed, antibiotic prescribing control appeared to be a thorough process. Key areas for service improvement are extension of antibiotic prescribing control to all wards and the standardisation of intervention documentation. Barriers preventing the provision of a comprehensive clinical pharmacy service are discussed and future strategies identified.
Consumer attitudes towards community pharmacy services in Saudi Arabia
Authors: Bawazir Saleh A
Published: December 2005

Objective

The purpose of this study was to determine consumer attitudes towards community pharmacy and their preferences for the introduction of new services.

Methods

A self-completion questionnaire was developed and 1,144 consumers in 55 community pharmacies were invited to complete it. The questionnaire covered consumers' choice of pharmacy; their perceptions of, and actual interactions with, community pharmacists; advice from pharmacists about general health and prescribed medicines; and privacy in the pharmacy. Respondents were asked for their views about five possible new services.

Setting

The study was based in community pharmacies in Riyadh City, Saudi Arabia.

Key findings

The response rate was 79.6%. Fifty-nine per cent of respondents often or sometimes visited a particular pharmacy. One-quarter of respondents perceived community pharmacists as having a good balance between health and business matters, while 56.1% thought pharmacists were more concerned with the business. The majority of respondents (69.7%) said they felt comfortable asking the pharmacist for advice. Just under half (44.8%) felt that pharmacists allowed them enough time to discuss their problem fully and listened well. In addition, 58.5% of respondents indicated that their pharmacists showed sensitivity to privacy by speaking more quietly across the counter. In 14.4% of situations pharmacists were reported to use a private area within the pharmacy when discussing personal or private matters. Most respondents (65.2%) indicated that their pharmacist was willing to discuss their health problems and tried to understand their feelings. Consumers' priorities for new services were: monitoring blood pressure; measuring weight, height and temperature; monitoring blood sugar; and monitoring cholesterol.

Conclusion

This study showed that most pharmacy customers feel comfortable seeking advice from their pharmacist. Although many pharmacists were reported to show sensitivity to a possible lack of privacy in the pharmacy, few respondents reported that their pharmacy had a private area for discussion. Customers' views on possible new services were generally positive, with the exception of patient medication records.
(9) Theories of professions and the pharmacist
Authors: Traulsen Janine Morgall , Bissel Paul
Published: December 2005

In the preceding articles in this series we have discussed various issues impacting on pharmacy as a professional group. One key issue has been the migration of increasing numbers of women and ethnic minority groups into pharmacy. We have also discussed the re-professionalisation agenda of pharmacy and where that links into the health services within the developed economies of the West. Both these issues raise questions about pharmacy as a profession, and in this article we attempt to understand issues affecting the pharmacy profession using sociological theories on the role of the professions in society. We begin with an overview of selected sociological theories of professions, followed by a focus on the pharmacy profession. Finally, we suggest research questions that are relevant today.
Internet networking for pharmacists: an evaluation of a mailing list for UK pharmacists
Authors: Cox Anthony R , Whitaker Simon , Alexander Angela M
Published: December 2005

Objective

To analyse the content of messages to an internet mailing list for UK pharmacists and to ascertain if the list was performing a continuing professional development (CPD) function.

Method

For one month all messages to the main list were categorised by topic; details of the gender of the correspondent and their sector of the profession were noted. Members were surveyed using an internet questionnaire.

Setting

The population of subscribers to the mailing list at http://www.private-rx.com

Key findings

The top three categories of e-mails posted to the list were clinical pharmacy (20%), pharmacy politics (18%) and non-pharmacy chat (14%). Other subjects included legal issues, the Drug Tariff, government policy, business, risk management and e-mails of a personal and supportive nature. The survey obtained a 46% response rate. Ninety-eight per cent of respondents found the list valuable. Respondents reported increased face to face and Internet contact with other pharmacists after joining the list. Forty-four per cent of respondents said their practice had changed as a result of information gained from the mailing list. Qualitative data self-reported by respondents indicated increased self-perceived competence, confidence, knowledge and skills. Approaches to CPD had also been re-examined. Listening to peers' views and overcoming isolation was seen as important.

Conclusion

Private-Rx provided pharmacists with a rapid route for information gain, had perceived benefits and appeared to have brought about changes in practice. Internet discussion enables CPD without the restriction of time or place and reaches pharmacists who are under-represented in formal education programmes.
Evaluation of NHS Direct “referral” to community pharmacists
Authors: Munro James , O'Cathain Alicia , Knowles Emma , Nicholl Jon
Published: December 2005

Objectives

To evaluate a pilot scheme of referrals from a nurse-led telephone helpline (NHS Direct) to community pharmacists.

Methods

A multi-method approach, including analysis of routine data from NHS Direct, postal surveys of NHS Direct callers, analysis of anonymised transcripts of calls, a postal survey of callers referred to pharmacists, and face-to-face interviews with NHS Direct nurses.

Setting

Essex, Barking and Havering.

Key findings

During the first three months of the pilot scheme, 6% (1,995/31,674) of NHS Direct calls triaged by nurses were logged as referred to pharmacists. This built on an existing foundation of informal referral to pharmacists of 4%. There was no measurable change in callers' views of the helpfulness of advice, enablement, or caller satisfaction associated with the scheme. Conditions sent to pharmacists included skin rash, cough, sore throat, stomach pain, and vomiting and/or diarrhoea. 86% (54/63) of callers referred to pharmacists during the scheme felt the referral was very or quite appropriate and 75% (48/64) attempted to contact a pharmacist. In general, those who did so found the experience a positive one: 65% (31/48) spoke to the pharmacist, and 80% (28/35) of people expressing an opinion were satisfied with the advice offered, but the lack of privacy in the pharmacy was of some concern. Although routine data indicated high usage of the scheme, nurse referral of callers to pharmacists declined over time. Their initial enthusiasm diminished due to concerns about the appropriateness of guidelines, their lack of understanding of the rationale behind some referrals, and the lack of feedback about the appropriateness of their referrals.

Conclusions

The evaluation of the pilot scheme has generated a range of recommendations for the wider national roll-out of the scheme, including revision of the guidelines and review of NHS Direct nurse training for referral to pharmacy. NHS Direct and pharmacists should consider how to strengthen the system of pharmacist feedback to NHS Direct.
(5) Feminist theory and pharmacy practice
Authors: Traulsen Janine Morgall , Haugbølle Lotte Stig , Bissell Paul
Published: December 2005

This is the fifth in a series of articles highlighting the relevance of sociological theory to pharmacy practice research. The article provides an introduction to feminist theory and research as applied to health, illness and health care. The aim is to clarify the contribution made by feminist theory in developing useful conceptual tools and theories in two major areas: the specific experiences of women's health and understanding the role of women as providers of health care. We seek to contribute to a research agenda, informed by feminist thinking, for pharmacy practice.

The focus of this article is on feminist theory as developed in the West, with particular emphasis on issues of concern for pharmacy practice research. We begin with a discussion of the historical context of feminism, including the women's movement and the women and health movement. This is followed by an overview of selected feminist theories. Feminist perspectives on the experience of health and illness are discussed in more detail, including issues of reproductive technologies, gender, health and morbidity; gender differences in the medical encounter; and finally the relevance of a feminist approach to pharmacy practice research, including research questions that are relevant today.
The Jones Morbidity Index as an aid for community pharmacists to identify poor asthma control during the dispensing process
Authors: Nishiyama T , Chrystyn H
Published: December 2005

Objective

To determine if the Jones Morbidity Index can be used in community pharmacy when asthmatic patients collect their prescriptions to identify those who have poor control.

Method

Structured questionnaires were completed by asthmatics who presented prescriptions at community pharmacies to assess their morbidity and knowledge of asthma and their attitudes towards and usage of medication.

Setting

Community pharmacies throughout the UK.

Key findings

Complete data on 306 patients were returned by 41 community pharmacists. Seventy-one patients reported using an asthma diary, 161 attended an asthma clinic and 194 had visited their doctor during the past year because of an acute exacerbation (GPV). Problems with metered dose inhaler (MDI) technique were identified in 165 patients. Patients' mean (SD) asthma knowledge score (K) (maximum 5) was 3.48 (1.32). Over the past six months they had received 0.88 (1.78) courses of oral prednisolone (P), 1.12 (1.85) courses of antibiotics (A) and 1.20 (4.51) courses of cough medicine (CM). Using the Jones Morbidity Index (JMI), 74 patients (24.2%) had low morbidity, 90 (29.4%) had medium morbidity and 142 (46.4%) had high morbidity. Comparisons between the morbidity categories revealed significant differences for P, A, GPV, “happy with” preventer (P < 0.001) and “happy with” reliever (P < 0.01) together with CM, K and compliance (P < 0.05). More patients classed as having high morbidity overused their reliever (P < 0.01) and were less compliant with their preventer (P < 0.001). There was no association between JMI and medication.

Conclusion

The JMI is a valuable tool to identify poor asthma control when patients present prescriptions at community pharmacies. More than half the asthmatics presenting their prescriptions at pharmacies had symptoms and signs indicating poor control.
Interpretation of recommended risk terms: differences between doctors and lay people
Authors: Berry Dianne C , Holden Wendy , Bersellini Elisabetta
Published: December 2005

Objectives

To examine doctors' (Experiment 1) and doctors' and lay people's (Experiment 2) interpretations of two sets of recommended verbal labels for conveying information about side effects incidence rates.

Method

Both studies used a controlled empirical methodology in which participants were presented with a hypothetical, but realistic, scenario involving a prescribed medication that was said to be associated with either mild or severe side effects. The probability of each side effect was described using one of the five descriptors advocated by the European Union (Experiment 1) or one of the six descriptors advocated in Calman's risk scale (Experiment 2), and study participants were required to estimate (numerically) the probability of each side effect occurring.

Key findings

Experiment 1 showed that the doctors significantly overestimated the risk of side effects occurring when interpreting the five EU descriptors, compared with the assigned probability ranges. Experiment 2 showed that both groups significantly overestimated risk when given the six Calman descriptors, although the degree of overestimation was not as great for the doctors as for the lay people.

Conclusion

On the basis of our findings, we argue that we are still a long way from achieving a standardised language of risk for use by both professionals and the general public, although there might be more potential for use of standardised terms among professionals. In the meantime, the EU and other regulatory bodies and health professionals should be very cautious about advocating the use of particular verbal labels for describing medication side effects.