bluuebunny/crossref_metadata_2025 huggingface dataset:
Inappropriate prescribing in an elderly population: findings from a South African public sector survey
Authors: Chetty Rangini , Gray Andy
Published: December 2005

Objective

To quantify the extent of potentially inappropriate prescribing among elderly patients seen at public sector primary health care facilities and old age homes in a South African urban setting.

Method

Cross-sectional survey of the prescription charts of patients aged 65 years or older, using a list of potentially inappropriate medicines in elderly patients, modified from that established by Beers and further developed by consensus.

Setting

A provincial government chronic prescription pharmacy servicing public sector primary health care clinics and old age homes in the Durban metropole.

Key findings

Of the 6,410 prescriptions that were reviewed, 1,926 (30.0%) included at least one medication listed as potentially inappropriate in the elderly. The median number of chronic medications prescribed per patient was 4 (range 1 to 11). Although the prevalence of potentially inappropriate prescribing in patients receiving medication at primary health care clinics (29.7%) was similar to the prevalence in those resident in old age homes (31.8%), this difference was shown to be significant upon multivariate analysis. Age was not found to be a predictor of inappropriate prescribing. An association was found between sex and inappropriate prescribing, with female sex being associated with a greater degree of potentially inappropriate prescribing.

Conclusion

This study has shown that 30% of elderly patients were prescribed at least one potentially inappropriate medicine. Women were more likely than men to be prescribed potentially inappropriate medicines.
Unused medications at home — reasons and costs
Authors: Wongpoowarak Payom , Wanakamanee Usanee , Panpongtham Khona , Trisdikoon Piti , Wongpoowarak Wibul , Ngorsuraches Surachat
Published: December 2005

Objectives

To examine types and quantities of unused medications in a sample of households and to investigate reasons for the unused medications and associated factors, including costs.

Method

A cross-sectional survey of a random sample of 931 households in the Songkhla province of Thailand. The households were visited and interviews were conducted with owners of unused medication using a structured questionnaire. Unused medications were collected, identified and quantified and their costs were calculated. Descriptive analysis of the type and amount of unused medications was conducted, including the characteristics of the owners and their reasons for having unused medications. Logistic regression analysis was used to examine factors associated with having unused medications.

Key findings

A total of 1,004 unused medication items were identified from 523 respondents who had unused medications. Oral dosage forms comprised 95.6% of all items, and totalled 14,297 doses. The median number of unused medications per household was 2. The most common therapeutic categories were musculoskeletal conditions, infections and the respiratory system. Thirty-seven per cent of all unused medications needed to be used continuously. The most frequently cited reason for having unused medications was that patients believed their symptoms or disease had resolved, and thus that the medications were no longer needed. Younger patients and those who had no chronic disease were more likely to cite this reason. The average cost of unused medications per household was 0.8 Euro.

Conclusions

This study has documented the types and quantities of unused medications and found that their costs were modest. Patients' perceptions of the need for, and effectiveness of, medication were the most frequent reasons for having unused medications. Age, gender and chronic disease were significantly associated with respondents' reported reasons for having unused medications.
An assessment of pharmaceutical inspection reports from nursing and residential homes for the elderly in Northern Ireland
Authors: Schweizer Anna K , Curry Nuala B , Hughes Carmel M
Published: December 2005

Objectives

To highlight issues currently being inspected in nursing, residential and dual-registered homes (care homes) for the elderly in Northern Ireland as part of a pharmaceutical inspection. Methods A cross-sectional survey and analysis of reports from pharmaceutical inspections in Northern Ireland care homes between January 1999 and December 2000 was undertaken, using reports provided by the four Registration and Inspection Units (R & I Units 1–4) within the region. Reports were reviewed and all recommendations made by inspectors were classified into 11 main categories. Binary logistic regression was used to examine possible relationships between the type of home (nursing, residential or dual-registered) or the R & I unit and the recommendations made by the inspectors, with corresponding odds ratios and 95% confidence intervals.

Key findings

Reports from 415 homes (one report per home) formed the final sample for analysis. Each R & I unit used different documentation to conduct a pharmaceutical inspection. Homes received the majority of recommendations from inspectors in the categories ‘Records’ (66.7% of all homes), ‘Policies and protocols’ (39.3%) and ‘Medication’ (31.8%). More recommendations in a number of categories emanated from R & I unit 4 compared with R & I unit 1 (referent). Dual-registered homes (those registered as a nursing and residential facility) were more likely to receive a recommendation in the categories ‘Storage of medicine’, ‘Order and receipt of medication’ and ‘Equipment’ than nursing or residential homes.

Conclusion

Inspections of care homes should be standardised in terms of documentation used and facilities should be given guidance on issues that are likely to result in recommendations from inspectors. In the longer-term, pharmaceutical inspections should move from a focus on structure/process measures to those that emphasise quality in prescribing.
(10) Concluding comments
Authors: Bissell Paul , Traulsen Janine Morgall
Published: December 2005

In this concluding article, we draw out some general points from the preceding articles in the series. We also seek to provide a rationale for why we think pharmacy practice researchers should engage with theory, drawing on our experience as researchers in the field. The subject of non-compliance is used as an example to illustrate how the different sociological theories discussed in the series might inform research questions in pharmacy practice research.
Responsibility, accountability and factors influencing provision of pharmacist transcription of discharge prescriptions
Authors: Hobson R J , Sewell G J
Published: December 2005

Objectives

To investigate the legal issues concerning authorisation of pharmacist transcribed discharge prescriptions and the prevalence of formal protocols for such a service, and to identify the factors influencing the decision on whether to provide a pharmacist discharge prescription transcription service (PDPTS).

Method

Postal questionnaire survey of clinical pharmacy managers. The sample included one hospital in each of the acute trusts in the UK.

Key findings

The questionnaire completion rate was 66% (135/206). Thirty-six per cent of pharmacy departments (49/135) reported that they offered a PDPTS. The majority of the pharmacy departments with a PDPTS required a medical practitioner to countersign the pharmacist-written prescription (65%) and had a formal protocol for their PDPTS (57%). Seven hospitals reported that they ‘sometimes’ asked the doctor to countersign/authorise the discharge prescription, and 10 hospitals reported that they did not ask the doctor to countersign/authorise the prescription. The most common reasons for implementing a PDPTS were to reduce delays in the discharge process (73%) and to reduce errors (50%). Among pharmacy departments with no plan to provide a PDPTS, the main reasons given for not developing this service were insufficient resources (62%) and preferentially developing other services (24%).

Conclusion

There is currently no consensus upon authorisation requirements of pharmacist-written discharge prescriptions and the legal position is unclear. The hospital pharmacy departments that ‘sometimes’ request a medical practitioner's counter-signature raise clinical governance and medico-legal issues, especially if their practice deviates from trust policy. The reasons given for implementation of a PDPTS concur with those found in previous studies.
Medication histories: does anyone know what medicines a patient should be taking?
Authors: Collins Daniel J , Nickless Gareth D , Green Christopher F
Published: December 2005

Objective

To determine and evaluate the accuracy of physician-acquired medication histories for patients admitted to the surgical and medical admission units in a large teaching hospital in the UK.

Method

The pharmacist obtained a medication history, including allergy status, by interviewing the patient. This was compared with the physician's history as documented in the medical notes and with a third source, for example general practitioner (GP) records, and then with what was prescribed on the inpatient prescription chart.

Key findings

In total, 126 medical patients and 51 surgical patients were reviewed. 102 (17%) medicines were prescribed on the inpatient chart but not documented in the medical notes; 179 (16.7%) medicines were documented in the notes but not prescribed on the prescription chart, with no explanation by the doctor; 75 (9.8%) medicines were documented in the notes by doctor with no dose; 227 (41%) medicines from pharmacist interview were not prescribed on the chart; 189 (34.1%) medicines were identified from pharmacist interview but not recorded in the notes; 113 (28.9%) medicines from pharmacist interview had a dose that was different in the notes; 45 (12.8%) medicines from pharmacist interview had a dose that was different on the chart; and 103 (21.1%) medicines from pharmacist interview had a dose different from that in the third source. A total of 51 medicines were identified from the pharmacist interviews that were not on the records of the GP or nursing home, and these accounted for approximately 5% of all medicines recorded.

Conclusion

This study supports the findings of previous studies that there are substantial numbers of discrepancies between documented sources of patients' medicines and what patients report they are taking. Furthermore our findings add to existing knowledge by highlighting the need for clearer and more complete documentation of medication histories in the patient's medical notes. The inaccuracies observed with GPs' records and in comparison with hospital records suggest that currently there is no ‘gold standard’ medication history available, other than a list of drugs taken from a patient who is perceived to be ‘reliable’.
Smoking cessation advice provided in 53 Norwegian pharmacies
Authors: Granas Anne G , Haugli Arild , Horn Anne M
Published: December 2005

Objective

To investigate the quality of the smoking cessation advice on over-the-counter (OTC) nicotine replacement treatment (NRT) provided by community and hospital pharmacies in Norway and to assess any change in customer services and pharmaceutical smoking cessation advice after a change in legislation deregulating NRT from pharmacy-only to general sale.

Method

A mystery shopper made 106 visits to 53 pharmacies in Oslo, Norway. The first visit was when NRT was a pharmacy-only medicine and the second when it had become available from any outlet as a general sales product. The pharmacies were scored on 12 observation parameters regarding customer service and pharmaceutical advice (score 0–4, total possible score was 48).

Key findings

There was considerable inter- and intra-pharmacy variation in scores. The pharmacies' total score ranged from 3 to 45. On only 14.2% of the visits was the service categorised as ‘Good’. There was no statistically significant difference in total score between the two test periods (P = 0.56), and hence no measurable difference in customer services and pharmaceutical advice as a result of increased competition after the switch to general sale. A scatter plot showed no relationship between the individual pharmacies' total score at the two visits.

Conclusions

Pharmacies' scores for the quality of their smoking cessation advice were generally low. There was no measurable change in pharmacies' customer service and pharmaceutical advice following the deregulation of NRT. There was little consistency in the total score between the first and the second visit to the same pharmacy. Improvement is needed in the smoking cessation advice provided by Norwegian pharmacies.
Consumer use of the internet for medicines information
Authors: Peterson-Clark Geraldine , Aslani Parisa , Williams Kylie A
Published: December 2005

Objective

To explore consumer opinion of the internet as a source of medicines information, the reasons consumers use this information, and the impact of this information on their use of medicines.

Method

Focus groups (n=6) were conducted in metropolitan Sydney, Australia during March to May 2003 with consumers (n=46) who had used the internet for medicines information.

Key findings

Although participants expressed some concerns about the quality of internet-based medicines information (IBMI), the convenience of access to this information outweighed these reservations. Attitudes were thus positive overall. Participants used IBMI when preparing for doctors' visits, for second opinions and additional information, for information on current issues, when deciding whether to use a medicine, for comparative information on brands and generics, and when written information was not supplied by health professionals. Most participants felt empowered by the information they found and used it to play a more active role in decision making about their therapy.

Conclusion

This study describes various issues associated with consumer use of IBMI and highlights the possible role of pharmacists to support their patients' efforts to access and interpret medicines information.
The training needs, attitudes and experience of pharmacy support staff in Northern Scotland
Authors: Smith Sarah M , Watson Margaret C
Published: December 2005

Objective

The purpose of this survey was to explore: attitudes towards training; experience of training; and training needs of support staff in hospital and community pharmacies in Northern Scotland.

Method

A postal questionnaire was sent to hospital and community pharmacies in the five regions of Northern Scotland. The intended respondents were community pharmacists, community pharmacy support staff, hospital pharmacists, and hospital pharmacy support staff.

Key findings

Data were collected from 105 (62.9%) community pharmacists, 463 (57.0%) community pharmacy support staff, 19 (90.5%) hospital pharmacists, and 88 (83.8%) hospital pharmacy support staff. Pharmacists and support staff in both settings: agreed that support staff currently receive insufficient training; were in favour of support staff receiving training; and agreed that training enhances both the confidence that support staff have in themselves and the confidence that pharmacists have in their staff. Barriers to training for support staff included: lack of availability of local relevant courses; lack of time in the working day; distance to training events; insufficient staff levels to enable staff to participate in training; and the financial cost of training. There was considerable variation in respondents' preferences for format and frequency of training.

Conclusions

Pharmacists and support staff in hospital and community sectors have positive attitudes towards training for support staff. Future training initiatives need to address barriers to training and accommodate different preferences for training format and frequency where possible.
Pictographic instructions for medications: do different cultures interpret them accurately?
Authors: Kassam Rosemin , Vaillancourt Régis , Collins John B
Published: December 2005

Objective

(1) To determine whether a range of linguistically diverse individuals of non-European descent could understand the meaning of predeveloped pictograms without any additional aids such as verbal explanations; (2) to identify appropriate modifications to the pictograms to diminish errors of interpretation; and (3) to test the notion that central pictogram elements have the same meaning irrespective of language or culture.

Setting

The study was conducted in Vancouver, Canada.

Method

This study tested a set of 16 predeveloped pictograms to determine whether they accurately communicated the intended medication administration directions to participants who neither speak nor read English, French or Spanish. Both qualitative and quantitative methods evaluated the pictograms' interpretability among 39 participants from three language groups, Cantonese, Somali and Punjabi. Standard analysis of variance tested for differences due to language groups and other demographics.

Key findings

Only four of the 16 initial pictograms tested were interpreted correctly by 70% of participants. Relaxing the criterion from 70% to 50% included seven more. Modifications of problem elements within the pictograms further improved interpretation accuracy levels by 22%, to a final accuracy of 67.15%. Quantity errors were twice as common as timing, administration route or auxiliary instruction errors.

Conclusions

Participants could identify particular pictographic symbols they found confusing or ambiguous. Basic education and time since immigration predicted interpretation accuracy better than first language or any other demographic characteristic.
Community pharmacists' attitudes to medicines management: a qualitative study
Authors: Dinnie Elizabeth , Bond Christine , Watson Margaret
Published: December 2005

Objective

To explore community pharmacists' knowledge of, and attitudes toward, medicines management, including concerns or barriers to offering medicines management services from community pharmacy premises.

Method

Focus groups held with purposively sampled pharmacists from community, practice and research sectors in Scotland. Participants were invited to discuss community pharmacists' knowledge and experience of medicines management, concerns about providing medicines management services from community pharmacy premises, and possible effects of such services on relationships with general practitioners (GPs).

Key findings

Ten pharmacists attended two focus groups. Characteristics of participants varied according to sex and employment status as well as the type and setting of the pharmacy in which they worked. Participants were familiar with the term ‘medicines management’ but understanding varied between and within groups and differences from and similarities to the term ‘pharmaceutical care’ were less clear. Concerns about the delivery of extended services included practical issues and the effect on the ‘traditional’ role of the community pharmacist. Views were mixed on whether medicines management could become a routine part of all community pharmacists' practice or whether it required specialisation. Pharmacists distinguish between ‘patients’ and ‘customers’ in relation to their differing needs. The relationship between pharmacists and GPs was influenced by the post held by the pharmacist and the setting of the pharmacy.

Conclusions

The pharmacists in this small, regional sample expressed a wide range of attitudes and opinions about the delivery of medicines management services from community pharmacies. Useful insights were given into the practicalities of providing such services on a daily basis in the current working environment, and how pharmacists might be able to provide medicines management services in other ways. Medicines management can be seen as a reprofessionalising strategy for pharmacy, making use of the pharmacist's status as an ‘expert’ to enhance the natural object, the ‘drug’ into the object of social significance, the ‘medicine’. Further research with pharmacists from other regions is needed to confirm this explanation.
The clinical autonomy of community pharmacists in England. 1. Designing and testing a survey instrument
Authors: Magirr Peter , Grimsley Mike , Ottewill Roger , Noyce Peter
Published: December 2005

Objective

To design and test an instrument for measuring variations in the extent to which community pharmacists perceive they can exercise autonomy in clinical settings.

Method

To assist with the design of the instrument a focus group comprising practising community pharmacists from a variety of backgrounds was used. The group contributed ideas for 12 scenarios, based on critical incidents in community pharmacy, which comprise the core of the instrument, and a range of responses that reflect varying degrees of autonomy. Testing involved two pilot surveys in different areas of the UK and rigorous appraisal by the research team and focus group. Various refinements were subsequently made including simplification of the scale of responses and the addition of ‘reality checks’.

Key findings

Data from the two pilots provided evidence of variations in perceived autonomy between contractors, employees and locums.

Conclusions

The instrument was deemed to meet the criteria of credibility; reliability, in terms of consistency; and criterion and construct validity and therefore was suitable for a full-scale survey which is reported in a second paper.
The clinical autonomy of community pharmacists in England. 2. Key findings
Authors: Magirr Peter , Grimsley Mike , Ottewill Roger , Noyce Peter
Published: December 2005

Objective

To investigate the perceived autonomy of community pharmacists in clinical settings and any differences between subgroups of pharmacists.

Method

A specially designed instrument, a central feature of which was 12 scenarios, was distributed by post to a systematic random sample of 2000 community pharmacists in England selected from the Royal Pharmaceutical Society of Great Britain database. Data were analysed using techniques including contingency tables, main effects binary logistic modelling and Cronbach's alpha scores.

Key findings

The response rate was 31% (626 community pharmacists). Comparison with a regional survey confirmed that the respondents were representative of the community pharmacy workforce. ‘Reality checks’ indicated that, notwithstanding variations, the scenarios were perceived as being within the experience of many respondents and of importance for clinical autonomy. Community pharmacists' perceptions of their autonomy were mainly affected by occupational status and work pattern. Contractor pharmacists were much more likely to opt for high autonomy responses than employees and locums. Similarly pharmacists who worked full-time were more likely to opt for these responses than those working part-time. Little association was found between high autonomy and gender, size of employing organisation and length of time qualified.

Conclusions

Differences in perceived autonomy may be due, in part, to the extent to which organisational and managerial constraints operate. With the moves towards an enhanced role for community pharmacists in a primary care-led NHS, these differences should be taken into account in safeguarding pharmacists' professional standing, policy making and managing service delivery.
Coping with prescription charges in the UK
Authors: Schafheutle Ellen I , Hassell Karen , Noyce Peter R
Published: December 2005

Objective

To explore cost-related behaviour in patients subject to prescription charges.

Method

A questionnaire was designed and employed to survey 244 patients with either dyspepsia or hypertension who paid for their medication, either through prescription charges or over-the-counter medication. Respondents were identified through 21 community pharmacies in the North of England. Analysis was descriptive.

Key findings

The NHS prescription charge caused over two-thirds of respondents to have to make key decisions about whether and how they could afford to have their prescriptions dispensed. The strategies used by the respondents to cope with this cost, such as (i) ones initiated by patients, (ii) those involving self-medication and (iii) ones involving the general practitioner (GP), are presented. Respondents' views about medication cost issues and the GP's involvement are also discussed.

Conclusions

This study provides further evidence that prescription charges may act as a barrier to the use of prescribed medicines, and that patients who have problems affording their medication use a number of strategies to reduce cost. These strategies suggest that such patients do not take their medication as intended, or even have them dispensed, with potentially negative impacts on health outcome. However, patients do not generally raise the challenge that prescription charges present to them, or strategies they use to cope with cost, with their GPs. This has implications for improving concordance through the Medicines Partnership programme. Awareness about patients' affordability problems needs to be raised and incorporated into concordant consultations.
Factors related to medication adherence among homeless women and children
Authors: Sleath Betsy , Calloway Michael , Selz-Campbell Laurie , Beard Ashley
Published: December 2005

Objective

The primary objective of this study was to examine factors related to medication adherence among homeless women and children. A secondary purpose was to describe the medication informational needs of homeless women.

Method

Fifty-seven women at six different shelters for homeless women in Wake County, North Carolina were interviewed during the summer of 2001.

Key findings

Fifty-eight per cent of women reported having at least one medical condition and 84% of the women had taken at least one medication during the past week. Twenty-six per cent of women said that during the last week they had not taken a medication on purpose and 30% purposively cut back on a medication. A woman with a substance abuse problem was five times more likely to purposively not take a medication. Almost half of the women who had children living with them had a child that had taken medication during the past week. The primary reasons cited for not using medications as directed were access issues. Fifty-eight per cent of the women wanted to learn more about their or their children's medications. The majority of women preferred to receive more verbal and written drug information.

Conclusions

Pharmacists need to work with local homeless shelters and the women in these shelters to help make sure that they receive needed medications and information for themselves and their children.
Using discrete choice experiments to value preferences for pharmacy services
Authors: Payne Katherine , Elliott Rachel
Published: December 2005

Objective

This paper describes the application of discrete choice experiments (DCEs), in the measurement of consumers' preferences for pharmacy services.

Patients' preferences for healthcare influence strongly their use of services. Quantifying revealed preferences for services (what services people use) is not always possible because either the service does not yet exist or the consumer has no experience of it. There is a need for tools that measure stated preference (what people say they will do) for healthcare, to allow development of new services. DCEs have been used in the valuation of preferences for healthcare services and interventions and can be applied usefully to the valuation of preferences for pharmacy services. DCEs assume that preferences are based on preferences for different attributes of a service, and that consumers are prepared to trade off one attribute against another, such as effectiveness versus side-effects. In a DCE study, respondents make hypothetical choices between scenarios of services with fixed attributes, but varying levels, revealing their strength of preference for attributes of that service. These data are analysed using regression, which generates coefficients that quantify the direction and magnitude of preferences. Marginal rates of substitution and willingness to pay for each attribute can be estimated, which provide powerful information for future service provision. For this approach to be applied in practice, key methodological issues must be handled explicitly, principally scenario design, attribute and level selection, orthogonality, level balance, minimal overlap and utility balance. A hypothetical example of a DCE designed for valuing consumers' preferences for a medication review service for the elderly is described.
Implementation of cognitive pharmaceutical services (CPS) in professionally active pharmacies
Authors: Hopp Trine R , Sørensen Ellen W , Herborg Hanne , Roberts Alison S
Published: December 2005

Objective

To investigate the implementation process of cognitive pharmaceutical services (CPS) in ‘professionally active’ pharmacies in Denmark; to describe the factors that influence the implementation process in the context of organisational theory.

Method

Twenty semi-structured interviews were conducted with pharmacy staff and owners in ‘professionally active’ pharmacies from 16 community pharmacies in Denmark.

Key findings

Fifty-one factors that influence the implementation process were identified. Based on their content and relationships, the factors were categorised into nine ‘common sense’ dimensions: network and relations with the environment; the environment's expectations and pressure for change; barriers to implementation of CPS; competence in relation to CPS; organising the pharmacy for provision of CPS; culture of the pharmacy; resources within the pharmacy; management within the pharmacy; the role of the pharmacy. Subsequently the 51 factors were categorised and described in relation to Leavitt's model of an organisation.

Conclusion

Implementation of CPS in the pharmacy is a very complex process, which is unique to the individual pharmacy. The model formed a relevant basis for describing the factors, and the theoretical analysis showed a complex interdependence of the factors identified in the study. Many interdependent factors influence the process and this has to be taken into account in designing future models for implementation of CPS. Such models should support comprehensive and flexible strategies that can be adapted to the dynamics of the individual organisation.
A cost-effectiveness analysis of a community pharmacist-initiated disease state management service for type 2 diabetes mellitus
Authors: Taylor Susan J , Milanova Tsveta , Hourihan Fleur , Krass Ines , Coleman Clare , Armour Carol L
Published: December 2005

Objective

To conduct an economic evaluation of a community pharmacy-delivered disease state management (DSM) service for type 2 diabetes mellitus.

Setting

The study was a parallel groups design, with control and intervention groups matched on demographic and diabetes-related characteristics, and was conducted in New South Wales, Australia. Three different settings were included — rural and metropolitan community pharmacy settings and hospital diabetes clinics.

Method

A cost-effectiveness analysis of the specialised service was conducted. The economic perspective adopted in the present analysis is that of the healthcare sector in general, taking into account the viewpoint of both the Commonwealth Government of Australia and the New South Wales State Government.

Key findings

Glycosylated haemoglobin (HbA1c) levels decreased by 0.46% (P = 0.02) in the intervention group compared with a change of 0.03% (P = 0.81) in the control group after 9 months. To obtain the 0.43% (95% confidence interval (CI) 0.34-0.52) reduction in HbA1c achieved by the specialised service, the cost to the healthcare sector was $A383 (Australian dollars; 95% CI $A46.16–717.46) per patient per 9 months.

Conclusion

This service has resulted in a significant reduction in HbA1c which should translate into improved health outcomes long term, since each 1% reduction in HbA1c has been associated with reductions in risk of 21% from any endpoint related to diabetes. Given the annual costs for the management of each patient with diabetes in Australia, the additional $A383 invested in the first 9 months of this service is likely to result in a saving to the healthcare system long term.
Evaluation of a pharmacist-managed repeat dispensing system: the GP perspective
Authors: Porteous Terry , Bond Christine
Published: December 2005

Objective

To evaluate a new pharmacist-managed repeat dispensing system from the perspective of participating general practitioners (GPs).

Setting

Fifteen general practices in four English health authorities, from which 36 eligible GPs received questionnaires.

Method

A new repeat dispensing system was implemented in which GPs gave patients three copies of their repeat prescription on a specially designed form. Each copy ordered a one-month supply of medication. At each monthly dispensing of the prescription, pharmacists asked patients a series of questions relating to use of their medication including information that would establish the need for continued supply. A postal questionnaire comprising closed and open questions was used to collect data on GPs' experiences of the new repeat dispensing system.

Key findings

Twenty-seven GPs (75%) completed and returned questionnaires. The system was liked by GPs and most said they would prefer to provide this system or a modified version of it for their patients. Most GPs said that medication control had either improved or remained the same for their patients. Existing communications between community pharmacists and GPs were reported to be good and in many cases improved as a result of the new system. GPs did not like having to sign all three copies of the prescription.

Conclusion

The repeat dispensing system was well received by GPs. The findings of this study have been used to inform the repeat dispensing system to be implemented by the UK government at national level.
Health-seeking behaviour: perspectives of Ghanaian women in London and Kumasi
Authors: Owusu-Daaku Frances T K , Smith Felicity J
Published: December 2005

Objective

The aim of this study was to describe and compare the perspectives of health, health-seeking behaviour and use of medicines by Ghanaian women resident in London, UK, and Kumasi, Ghana. This will enable the identification of ways in which Ghanaian women adjust to a different system and/or retain their own perspectives regarding healthcare and the use of medicines.

Method

Participants were 16 Twi-speaking Ghanaian women resident in and around London, UK, and 18 in and around Kumasi, the second largest city in Ghana, West Africa. Face-to-face semi-structured interviews were conducted in English and/or Twi, usually in respondents' own homes, audiorecorded and transcribed verbatim for analysis.

Key findings

The data uncovered similar perspectives in the two groups regarding health beliefs and behaviours. The London respondents believed they retained some of their own perspectives, describing their use of health services and medicines in the context of both their own health beliefs and their adaptation to the British system. They also drew distinctions between themselves and the indigenous British population in health-seeking behaviour, response to symptoms and use of medicines. They recognised strengths in the British system and believed they were receiving better care, when compared with services in Ghana, in particular regarding the attitude of staff, quality of services and payment for care, including medication. In contrast to perceived practices in Ghana, women in both London and Kumasi reported limited personal experiences and expressed reservations regarding the use of herbal medicines.

Conclusion

The social-cultural contexts in which Ghanaians view their health and use medicines remain apparent despite their adjustment to using the British healthcare system. In the provision of healthcare, awareness of varying perspectives of different client groups is important to promote the appropriate uptake of services and use of medicines.
Medication reviews provided by general medical practitioners (GPs) and nurses: an evaluation of their quality
Authors: Krska Janet , Ross Susan M , Watts Michelle
Published: December 2005

Objective

To train general medical practitioners (GPs) and nurses in providing medication review services in the primary care setting and to evaluate the reviews provided.

Setting

One medical practice in Scotland with five whole-time equivalent (WTE) GP partners, two practice nurses and six community-based nurses.

Method

Training for GPs was provided as a group session plus individual supported clinic sessions. Nurse training consisted of a group session only. Patients aged over 75 were invited to attend the medical practice to receive a medication review. Output measures were: number of patients with pharmaceutical care issues (PCIs) documented, changes made to repeat medicines and computer records, monitoring undertaken, number of PCIs, PCIs identifiable from notes and records but not documented (‘missed’ PCIs). A sample of GP reviews provided before training and all GP and nurse reviews during training were evaluated.

Key findings

In 45 case note reviews provided prior to training, GPs documented PCIs in 20% of patients; average 0.3 per patient, but missed 1.75 per patient. In 56 reviews provided during training, they documented PCIs in 98% of patients; average 3.0 per patient, missing 0.8 per patient. The proportion of patients with changes to drug therapy or monitoring carried out during training increased significantly compared to pre-training reviews. Nurses documented PCIs in 97% of 33 patients reviewed, average 1.5 PCIs per patient, but missed 0.8. The mean number of repeat drugs prescribed reduced from 4.73 to 4.42 per patient after nurse review, but increased after GP review from 4.07 to 4.18.

Conclusion

After training, both GPs and nurses identified PCIs appropriate to their expertise. The sustainability of this effect in the longer term is not known. Since all patients should have repeat medication reviewed regularly, involving these professionals in providing routine reviews would allow pharmacist medication review clinics to be optimised.
An introduction to adverse drug reaction reporting systems in different countries
Authors: Rabbur Reza S M , Emmerton Lynne
Published: December 2005

Objective

To review adverse drug reaction (ADR) reporting schemes in selected developed countries, with emphasis on identifying community pharmacists' roles in ADR reporting.

Setting

International comparison between eight developed countries, with respect to ADR reporting systems and developments.

Method

Review of published articles on ADR reporting by pharmacists. Health and medical sciences databases including International Pharmaceutical Abstracts, MEDLINE and ProQuest were searched for relevant publications from 1993 to 2003. Websites specific to ADR reporting schemes in the selected countries were also searched.

Key findings

ADRs impact significantly on a nation's healthcare costs. Voluntary reporting by health professionals is currently considered the cornerstone to the detection and management of ADRs and makes a valuable contribution to the safe use of medicines. ADR reporting systems are managed by national ADR or pharmacovigilance reporting centres, and differ internationally. In general, medication-related problems are reported more commonly in hospitals than in the community. Physicians are the main contributors, except in the Netherlands and Canada, where community pharmacists play the major role in ADR reporting. Time pressure, no remuneration for reporting, and confusion about what to report were identified as some of the main deterrents for reporting by pharmacists.

Conclusion

Most international reporting systems for ADRs are either hospital based, or physician based. The opportunity therefore exists to further develop reporting systems that are accessible by community pharmacists, as they are in an ideal situation to detect and report ADRs through contact with patients.
Educating Australian pharmacists about the use of online information in community pharmacy practice
Authors: Bearman Margaret , Bessell Tracey , Gogler Janette , McPhee Wendy
Published: December 2005

Objectives

Community pharmacists practice in an information technology-rich society, however many have not been educated in internet use for professional practice. The aims of this study were to investigate how community pharmacists use the internet in their practice; to develop an intervention to address their educational needs; and to examine the benefits and weakness of a flexible delivery programme.

Method

We conducted two focus groups investigating community pharmacists' internet use and education needs. We subsequently developed and provided a four-module educational course on CD ROM, ‘Advanced web skills for pharmacists: finding quality on the internet’. In total, 147 pharmacists participated. A survey was conducted to evaluate the impact of the course.

Key findings

The focus group findings provided a clear rationale for an educational intervention. One-hundred and four pharmacists completed the course. Participating pharmacists were highly positive about the learning experience, in particular the provision of education by flexible delivery. Many reported specific changes to practice. They also described the time-consuming nature of the course as the biggest barrier to further education.

Conclusions

This project demonstrates the need for community pharmacists to have access to internet education. Flexible CD ROM-based learning provided a successful delivery medium.
Improving Australian pharmacists' attitudes to internet use in community pharmacy practice
Authors: Bearman Margaret , Bessell Tracey
Published: December 2005

Objective

The internet now provides a significant part of consumers' healthcare information. While little is known about how community pharmacists regard the internet, there is some suggestion that issues of confidence and motivation may provide significant barriers to appropriate use. The objectives of this study were to measure any changes in pharmacists' attitudes towards the internet after completing a four-module educational course, ‘Advanced web skills for pharmacists: finding quality on the internet’.

Method

We developed a 30-item instrument measuring pharmacists' attitudes toward the internet. Pharmacists completed the survey upon enrolment, then again on completion of the CD ROM course and for a third time three months after completing the course.

Key findings

The instrument was completed prior to the course by 147 participating pharmacists. The numbers of responses at the end of the course and 3–4 months post-course were 104 and 88 respectively. We established a reliable measure of pharmacists' attitudes to the internet with an appropriate degree of face validity. There was a significant improvement in attitude after course completion (P <0.005) and a further significant improvement in attitude three months after course completion (P <0.01).

Conclusions

A short distance education programme in internet skills can markedly improve community pharmacists' attitudes to the internet.
The involvement of pharmacists in cardiac rehabilitation: a review of the literature
Authors: White Simon , Anderson Claire
Published: December 2005

Objective

To identify, review and evaluate the literature regarding the role of the pharmacist in cardiac rehabilitation (CR).

Method

Electronic databases searched up to October 2004 were Medline, Pharmline, Iowa Drug Information service, International Pharmacy Abstracts, Embase, Scanners and Web of Science. Reference lists of identified papers were searched and a Zetoc email alert was created to identify additional papers. Papers were included only if they referred specifically to a CR programme or CR patients, and also referred to the involvement of pharmacists or concerned pharmacy practice research. Reports were not excluded on the basis of quality, however reports that met the criteria for inclusion were allocated an evidence grade to indicate quality.

Key findings

Thirteen reports were identified, of which six reports were purely descriptive accounts of pharmacists' involvement in CR (all were from the US) and seven were evaluative reports (four from the US, two from the UK and one from Canada). Descriptions of the involvement of pharmacists in CR included providing medicines information and education to patients, and optimising drug therapy. The lack of substantial research was notable among the evaluative reports. One study found quality of life and economic benefits as a result of the involvement of a pharmacist in CR, and another found that health professionals provide most of the medicines information and education required by CR patients. However these studies were weakened by a lack of meaningful outcome measures.

Conclusion

There is insufficient evidence on which to base firm conclusions about the effectiveness of the involvement of pharmacists in CR. This has implications for pharmacy practitioners, researchers and policymakers in CR.
Effect of information leaflets and counselling on antidepressant adherence: open randomised controlled trial in a psychiatric hospital in Kuwait
Authors: Al-Saffar N , Deshmukh A A , Carter P , Adib S M
Published: December 2005

Objective

To assess the acceptability and effectiveness of two educational initiatives on patterns of antidepressant medication use in depressed Kuwaiti patients.

Setting

Patients were interviewed on three occasions at the Psychological Medicine Hospital, Kuwait.

Method

Two-hundred and seventy-eight patients attending a hospital outpatient clinic in Kuwait and receiving a single antidepressant for mild or moderate depression were randomised into a control and two treatment groups. Medication was dispensed from the pharmacy as normal. However, members of the treatment groups additionally received a patient information leaflet (PIL) written in Arabic with or without counselling from a clinical pharmacist. Medication adherence was monitored 2 months and 5 months later by self-report and tablet counting. Patient knowledge of medication and the acceptability of the educational interventions were assessed after 2 months using questionnaires.

Key findings

Patients in each of the treatment groups had an improved knowledge of the rationale behind their therapy. Clinic attendance was more likely when patients had received a PIL (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.3-3.2) or a PIL plus counselling (OR 3.2, CI 2.1–4.9). Good medication adherence at 2 and 5 months was more common in patients who were given a PIL (OR 3.0, CI 1.7-5.3) or a PIL plus counselling (OR 5.5, CI 3.2–9.6). Certain pre-existing patient attitudes to therapy and the occurrence of side-effects were not determinants of adherence.

Conclusions

Patient responses to each of these educational interventions were very positive. After 5 months, patients receiving a PIL were more likely to be adhering to their medication regimen, particularly when they had also received counselling from a clinical pharmacist.