bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of domiciliary pharmacy visits on medication management in an elderly population
Authors: Begley S , Livingstone C , Hodges N , Williamson V
Published: February 2011

This paper describes medication management by elderly patients living in their own homes, and the effects of patient counselling during five domiciliary pharmacy visits on patient compliance and medication management. The 190 subjects who completed the 12-month study were randomly allocated to either an intervention group (receiving counselling on the correct use and storage of their drugs during five domiciliary visits), a control (V) group (receiving visits but no counselling), or a control (NV) group (having no contact between an initial visit and the end of the study). The patients' drug knowledge, dexterity and cognitive functioning were assessed, and patients in all three groups were well matched at baseline. At each follow-up visit, patient compliance was measured using pill counts and interviews. After the initial visit, patients in the intervention group demonstrated better compliance, better drug storage practices and a reduced tendency to hoard drugs, and required fewer GP consultations, than patients in either of the control groups. The provision of the domiciliary pharmacy service was effective in detecting drug-related problems in a potentially high risk patient group. The effectiveness of such a service may be improved by increased transfer of patient information between community pharmacists and general medical practitioners.
Patients' perceptions and expectations of outpatient pharmacy services in a teaching hospital
Authors: Tam Vincent H Y , Lim Mun Moon
Published: February 2011

A six-week prospective study was carried out in a Singapore outpatient hospital pharmacy to assess patients' perceptions and expectations of pharmacy services. From a total of 1,273 self-administered questionnaires distributed, 413 evaluable responses were returned. These showed that the most important services in the patient's view were a prescription filling waiting time of less than 30 minutes, medicines being dispensed accurately and reasonable pricing. The mean acceptable waiting times for prescription filling were 9.5 minutes for up to two items, 16.8 minutes for three to five items and 23.9 minutes for six or more items. Pharmacists' competency was rated significantly higher by respondents with higher education and higher incomes than by those with lower education and incomes, while the time spent with the pharmacist was rated less sufficient by respondents with a lower income than by those with higher incomes.
Perceptions of United Kingdom pharmacy lecturers about teaching pharmaceutical care
Authors: Winit-Watjana Winit , Greene Russell J
Published: February 2011

Pharmaceutical care is now regarded as the primary mission of pharmacy practice. To help ensure that this mission is fulfilled, pharmacy students need the clinical knowledge and skills that underlie pharmaceutical care, and pharmacy academics need to be aware of this concept and its applications. A survey was conducted of British pharmacy lecturers' views on teaching pharmaceutical care. Correlations between lecturers' characteristics (sex, teaching commitment and teaching experience) and the use of computer-aided learning (CAL) in teaching pharmaceutical care were also evaluated. Self-completion questionnaires were sent to 16 heads of departments of pharmacy practice, or their equivalent, for distribution. There was a 40 per cent response rate. Perceptions varied considerably in terms of the definition of pharmaceutical care, the difference between clinical pharmacy and pharmaceutical care, the application in practice settings, drug-related problems, knowledge and skills required and the barriers to teaching pharmaceutical care. Lecturers' characteristics were not related to views on either the use of CAL generally or the potential use of CAL in teaching pharmaceutical care. Many respondents agreed that a CAL program could be used to supplement pharmaceutical care teaching. Further studies on pharmaceutical care teaching are suggested.
Supplying injecting equipment to drug misusers: a survey of community pharmacists' attitudes, beliefs and practices
Authors: Rees Lois , Harding Geoffrey , Taylor Kevin M G
Published: February 2011

A postal survey of 888 community pharmacists in one metropolitan administrative region of southern England investigated the pharmacists' involvement in the supply of injecting equipment to injecting drug misusers (IDMs). The survey response rate was 59 per cent. Of respondents, 58 per cent sold injecting equipment and almost 10 per cent supplied it via “exchange” schemes. The respondents' attitudes and beliefs towards provision of injecting equipment were measured on a five point scale. Providers of injecting equipment were significantly more likely than non-providers to have a positive attitude towards supply, to perceive greater demand for injecting equipment, and to believe that “important others,” such as the pharmacy clientele and other health professionals, would like them to make equipment available. Certain demographic variables and specific beliefs were identified which differentiated between providers and non-providers of injecting equipment. Pharmacists who did not supply injecting equipment were significantly more likely than providers to believe in negative outcomes of supply, such as theft from the pharmacy. The strong associations identified in this study, between service provision, attitudes and beliefs, have implications for shaping attitudes and encouraging pharmacists' future involvement in HIV-prevention initiatives.
Postgraduate clinical pharmacy programmes in the United Kingdom: a comparative content analysis
Authors: Quinn John , Bates Ian , Cox Roy
Published: February 2011

Hospital pharmacy in the United Kingdom has developed in the past 20 years from mainly a supply function to a more patient-orientated function. In addition, pharmacists in hospitals are interacting more with medical colleagues on drug issues, and affecting patient care directly or indirectly, through initiatives such as the formation of drug protocols/guidelines and the formation of formulary management systems. Postgraduate clinical pharmacy programmes have been developed in order to meet the needs of hospital pharmacists who have to undertake such roles. It might be expected that the 16 higher education institutions offering these programmes would differ to some extent. However, a non-judgmental, descriptive content analysis showed variation in all aspects of the programmes, namely, programme type/timescale, programme delivery/structure, choice, professional skills, research training and clinical content. The differences found were greater than was expected. On the basis of evidence obtained in this study, postgraduate clinical pharmacy programmes cannot be regarded as producing equivalent types of practitioners. Questions arise about whether these programmes meet the needs of pharmacist participants in extending their clinical role.
Hay fever symptoms and over-the-counter remedies: a community pharmacy study
Authors: Grewar J , MacDonald T M
Published: February 2011

There is poor understanding of patients' perceptions of hay fever symptoms, the factors which motivate them to purchase particular products and what properties they deem desirable in a remedy. This study aimed to increase understanding of patients' perceptions of hay fever symptoms and to investigate their perceptions of five non-sedating oral antihistamine products and a corticosteroid nasal spray. A sample of 249 patients was recruited from community pharmacies from June to August, 1995. Of these, 139 (56 per cent) returned questionnaires, of which 124 were valid for analysis. The most common symptoms experienced were nasal and ocular. The most common early warning sign of hay fever was sneezing (75; 21 per cent). Forty-three subjects (35 per cent) indicated there was less than half an hour between the first sign of an attack and developing all symptoms, and 87 (70 per cent) reported developing all symptoms in under two hours. For 45 subjects (36 per cent) the worst period for the attack was the morning. The most common way of treating a hay fever attack was by taking a remedy at the first sign of hay fever (70; 56 per cent). Seventy-six (61 per cent) used the remedy once daily and 120 (96 per cent) once or twice daily. Eighty-five (69 per cent) used the remedy every day of the week during an attack. A reduction in sneezing was the most common indicator that the remedy was working (50; 21 per cent). The most common reason for purchasing a remedy was the pharmacist's recommendation (45; 33 per cent). The most common reason for acquiring the remedy by over-the-counter (OTC) purchase was that it was more convenient than consulting a general medical practitioner (GP) (77; 42 per cent). The most common reason for liking a particular remedy was that it gave fast relief (35; 21 per cent). The most common reason for disliking a remedy was that it was expensive (21; 28 per cent). Most patients (108; 87 per cent) were either “very” or “fairly” satisfied with their remedy. The top three most important desired properties of an “ideal” hay fever remedy were that it was fast acting, gave long lasting relief and did not cause drowsiness.
Pharmacy students' experiences of the contents of pharmacy education: a phenomenological study
Authors: Rothmann J C , Gerber J J , Lubbe M S , Sieberhagen G V der M , Rothmann S
Published: February 2011

Education is high on the agenda of national priorities in South Africa. The changing health care environment in South Africa presents various opportunities and threats to the pharmacy student and his or her training institution. Although a new learner-centred education paradigm is needed to ensure the quality of education, it seems that training institutions are not yet ready to implement such a paradigm. In South Africa, little research has been carried out regarding the facilitation of professional and personal growth as experienced by the student. Twenty-six students at the Potchefstroom University for Christian Higher Education were selected randomly from a population comprising the 104 fourth year pharmacy students, after stratifying the population in terms of sex and academic performance. A qualitative measuring instrument, based on the phenomenological paradigm, was used to determine students' perceptions of the education and practice of pharmacy. Content analysis was used to analyse, quantify and interpret the research data. The students in this study felt that problems were experienced with some subjects, curriculum overload was experienced, subjects were not practically orientated, and some important topics (eg, people skills, and cultural aspects) were not included in the curriculum. Sex and academic performance influenced students' experience of some aspects of the contents of the pharmacy degree course.
No-Blame Medication Administration Error Reporting by Nursing Staff at a Teaching Hospital in Australia
Authors: McNally Karen M , Sunderland V Bruce
Published: February 2011

The medication administration error rate on a surgical ward in an Australian teaching hospital was determined using a “no-blame” self-reporting method. The self-reported error rate using the existing ward stock (WS) drug distribution system was determined over a 23-day period. After the ward underwent a number of interventions designed using failure mode and effects analysis (FMEA), a method of systems analysis employed to assess a process and identify problem areas that might lead to errors, the “no-blame” self-reported error rate was again assessed, over a 31-day period. The no-blame aspect of the study was emphasised during all education sessions prior to the study commencing. All reports, made on a simple form designed specifically for the study, were reviewed and collated by a pharmacist in a non-punitive manner. During the WS phase of the study, 182 errors were reported, compared with 170 in the FMEA phase. The error rate was 3.3 per cent of doses administered for the WS system and 2.3 per cent for the FMEA system. The difference between the two phases was found to be significant (P<0.001). These results show an error rate less than that previously found using a direct observation technique. However, used in conjunction with the disguised-observer technique, the no-blame self-reporting method may be a useful part of a continuous error detection process in hospitals.
Reducing Adverse Prescribing Discrepancies Following Hospital Discharge
Authors: Duggan Catherine , Feldman Roger , Hough Jane , Bates Ian
Published: February 2011

General medical patients from an east London teaching hospital were recruited into intervention and comparison groups. Those recruited into the intervention group were given a copy of a letter listing their drugs prescribed at discharge and asked to give it to their regular community pharmacist when they went to obtain their prescribed drugs following hospital discharge. A comparison group returned home without a letter for their community pharmacist. Recruited patients were visited in their own homes once their community supply of drugs had been obtained. The frequency of all discrepancies between the prescribed drugs were compared for both groups. A consensus panel judged the importance of the discrepancies observed. The numbers deemed as clinically significant were compared for both groups, as the effect of the intervention. The 501 patients followed up (264 in the intervention group and 237 in the comparison group) were prescribed 2,736 drugs. The number of unintentional discrepancies observed was lower for the intervention group (32.2 per cent, 454/1,408) than for the comparison group (52.7 per cent, 700/1,328) (chi-squared 117.38, P<0.001). The number of discrepancies judged to have a definite adverse effect was lower in the intervention group (1.6 per cent, 23/1,408) than in the comparison group (3.1 per cent, 41/1,328) (chi-squared 6.32, P<0.01).

Discharging 19 patients with such information to take to their community pharmacist would result in the prevention of one unintentional discrepancy having a definite adverse effect. Providing community pharmacists with a copy of patients' discharge summaries is an effective method of reducing unintentional discrepancies, with measurable patient benefit.
Serving multi-ethnic populations: measuring the cultural sensitivity of pharmacy interns in New York City
Authors: Agrawal Madhu , Sause Robert
Published: February 2011

The cultural sensitivity of pharmacy interns in New York City towards issues associated with serving multi-ethnic populations was examined and measured. Cultural sensitivity included areas such as ability to speak/understand the local language, an understanding of the health needs and problems of different cultural groups and the desire to help patients of different ethnic backgrounds. In general, the 108 pharmacy interns who answered the survey instrument appeared to recognise the importance for practising pharmacists to be sensitive to the needs of ethnic populations. The interns felt that medication compliance, pharmacist-patient relationship, patient satisfaction, patient trust and ability to understand over-the-counter directions would be greater if the pharmacist could speak the language and understand the culture of the customer population. Pharmacy interns of ethnic background and those with multilingual capabilities were found to exhibit greater cultural sensitivity. The results should be useful to educators in preparing future pharmacists for the profession.
Pharmacists' and pre-registration pharmacy graduates' views of proxy consultations
Authors: Weiss Marjorie C , Cantrill Judith A , Nguyen Huong Ly
Published: February 2011

Proxy consultations, when a customer seeks advice or requests a medicine on behalf of someone else, account for up to one-third of all visits to a community pharmacy. A combined qualitative and quantitative approach was taken to explore pharmacy staff perceptions, and management of, proxy consultations and the use of protocols. Based upon the results of 12 qualitative interviews, a postal questionnaire was designed and sent to 100 randomly selected community pharmacists and 100 pre-registration pharmacy graduates. Fifty-five pharmacists and 44 pre-registration pharmacy graduates (49.5 per cent overall) completed the questionnaire.

Respondents cited lack of information about the patient concerning their clinical condition, symptoms or medication as particular difficulties when managing proxy consultations. Respondents offered nine strategies for coping with proxy consultations, including checking the patient medication record, obtaining additional information from the proxy customer and ringing the patient directly. Eighty-six respondents (88 per cent) thought they were more cautious when selling medicines to proxy customers. Most respondents (N=69) felt that their protocols took account of proxy customers although the majority (N=91) also thought they had to be flexible when using protocols in proxy consultations. Proxy consultations are an area of practice which merit future pharmacy practice research.
Extending the role of community pharmacists: the views of GPs
Authors: Bleiker Philip , Lewis Anthony
Published: February 2011

A Questionnaire-based postal survey was used to ascertain views of general practitioners (GPs) on community pharmacists and an extension of their role. The questionnaire included attitude scales and open-ended questions. It was sent to the 368 GPs of the South and West Devon health commission area. There was an 81.2 per cent response rate. The questionnaire attained adequate internal consistency (Cronbach Alpha = 0.87). Non-responders differed from responders only in that non-responders were more likely to be in urban than rural practices. Eighty-four per cent of respondents agreed that “Pharmacists as first point of contact for many people are ideally placed to provide health education;” 19 per cent agreed that “Pharmacists should stick to dispensing and not venture into other areas of medicine;” 27 per cent would accept a pharmacist as a partner in their practice; 31 per cent felt that pharmacies should usually be located within medical practices; and 30 per cent felt that “Pharmacists are too influenced by commercial pressures to give unbiased advice about minor illness.” Eighty-one per cent of respondents agreed to pharmacists monitoring repeat prescriptions while 14 per cent agreed to pharmacists running lithium management clinics. Respondents expressed a desire for more communication and involvement of pharmacists in the primary health team. Concerns were expressed about accountability, training and the problems of favouring one pharmacy over another. We conclude that GPs have a positive attitude towards community pharmacists, their inclusion into the primary health care team and an extension of their role in relation to medicines, but there was little support for the idea of pharmacists undertaking screening and running therapeutic monitoring clinics.
Health care professionals' views on hospital pharmacist prescribing in the United Kingdom
Authors: Child Damian , Hirsch Christine , Berry Michael
Published: February 2011

The published evidence supports a multidisciplinary approach to drug therapy management. Pharmacist prescribing has already been introduced successfully in the United States, with good clinical outcome measures and high levels of doctor and patient satisfaction. In our study, questionnaires were sent to 195 doctors, 200 nurses and all 87 pharmacists working at five hospitals in Birmingham, to identify attitudes towards pharmacist-written prescriptions and pharmacist prescribing. The combined response rate was 57.5 per cent. Few doctors (4.3 per cent) and nurses (5.2 per cent) responding had any experience of prescriptions written by a pharmacist, but all of those with such experience agreed that they had found it helpful. Support for pharmacist-written prescriptions and pharmacist prescribing ranged from 43.6 per cent to 94 per cent, depending on the scenario described and the profession of the responder. Overall, a high proportion (78.7 per cent to 86.1 per cent) of doctors and nurses responding agreed that it would be useful if pharmacists were permitted to write prescriptions and prescribe drug treatment, though a majority believed that this should only include pharmacists with postgraduate education/training and routinely attached to the clinical area in question. Important issues identified as possible barriers to pharmacist prescribing in the UK include pharmacist willingness to accept this new role, education/training, familiarity with the patient, communication between health care professionals, professional and legal accountability and resource implications. If further training/education was made available for those who felt a need for it, 98.5 per cent of pharmacists stated that they would be happy to write prescriptions for existing therapy, and 95.5 per cent would also be happy to initiate/prescribe drug treatment. The future role of the hospital pharmacist in drug therapy management is explored. The perceived barriers to the introduction of pharmacist prescribing are not insurmountable. If tackled appropriately, the introduction of pharmacist-written prescriptions and pharmacist prescribing is likely to prove a valuable contribution to patient care.
Late responders and non-responders to a postal survey questionnaire: analysis of potential further response and non-response bias
Authors: Sheridan Janie , Strang John
Published: February 2011

The purpose of this study was to evaluate the effect of further mailshots on response rates to a postal survey, and to determine the extent of non-responder bias. A questionnaire on services to drug misusers was mailed to a random sample of one in four community pharmacies in England and Wales (2,654), stratified by family health services authority, followed by three further mailshots to non-responders. The remaining non-responders were contacted by telephone and asked to participate in a brief telephone interview. The addition of the fourth mailshot increased the response rate by only 4.8 per cent overall. Responses to key variables (demographics, participation in service provision) were not significantly different when comparing response to mailshots 1–3 with the fourth mailshot. Responses to the telephone survey succeeded in increasing the overall response rate to 98.4 per cent. These postal non-responders (ie, those responding to the telephone survey) were significantly different from those who responded to the postal survey in the extent of their service involvement, with postal responders being more involved in dispensing Controlled Drugs than telephone responders (50.1 per cent and 39.2 per cent, respectively) and provision of needle exchange (18.9 per cent and 9.6 per cent, respectively).

The use of additional mailshots to improve response rate may not be useful in increasing the generalisability of findings. However, persistent non-responders to postal mailshots were found to differ significantly from responders. If extrapolation to the whole population is deemed valuable, telephone follow-up of non-responders allows for the detection of any non-responder bias, and allows subsequent corrections to be made to postal survey responses.
Practice research: an international update
Authors: Savage I T
Published: February 2011

The biennial social pharmacy workshops provide a forum for practice research from around the world. This report of the 10th meeting, held in Leuven, Belgium, from August 25 to 28, is a British view of some of the work underway in other countries. Sadly, the Russian pharmacists who had intended to present work on economic aspects of rational medicines use were not, after all, able to attend. But with delegates from 13 other countries, there was still more than enough to whet the international appetite.
Potential roles of the pharmacist in chronic pain management: a multidisciplinary perspective in primary care
Authors: Read Rhona W , Krska Janet
Published: February 2011

Patients in the community with chronic pain may have poor pain control and use both prescribed and alternative therapies, often inappropriately, to try to optimise pain relief. They may benefit from management by a multidisciplinary primary care team involving a pharmacist. This study used postal questionnaires to determine community pharmacists' attitudes to involvement in pain management and the perceptions of general practitioners and physiotherapists of the current and potential roles of the pharmacist within a chronic pain care team. The three professions' views on factors which could influence chronic pain management were also determined. Sixty-three GPs (63 per cent), 59 community pharmacists (59 per cent) and 33 physiotherapists (66 per cent) responded. None of the pharmacists was currently involved in chronic pain management, but 58 (98 per cent) wanted to develop such a role, especially within pain clinics. Pharmacists and physiotherapists were more likely than GPs to identify that limited opportunity for personal involvement and expertise within a pain team reduced the likelihood of achieving optimal chronic pain management. Only 17 of the GPs had an established multidisciplinary pain care team; two of these had pharmacist involvement. All GPs and physiotherapists agreed that pharmacists had an important role to play in chronic pain management, particularly in the provision of drug information to patients and medication review.
A changing professional profile: ethnicity and gender issues in pharmacy employment in the United Kingdom
Authors: Platts Adrian E , Tann Jennifer
Published: February 2011

Objective

This research was conducted to determine whether there were significant differences between the career profiles and ambitions of United Kingdom pharmacists from different ethnic and gender sub-populations. The results were subsequently analysed to determine whether any differences found between sub-populations had varied over time.

Method

The research methodology employed a postal survey and interviews, to measure parameters relating to pharmacists' current careers, career histories and career ambitions. Questionnaires were distributed to 500 ethnic minority pharmacists and 500 non-ethnic minority pharmacists; there were 1,867 valid returns. Twenty-seven ethnic minority community pharmacists working in one inner city area were interviewed.

Setting

The sample for the postal survey was identified from a surname analysis of the Register of Pharmaceutical Chemists.

Key findings

Ethnic minority (mainly Asian) pharmacists accounted for 15 per cent of UK pharmacists. Of pharmacists aged under 30 years, 72 per cent of white pharmacists and 50 per cent of ethnic minority pharmacists were female. Both male and female community pharmacists from ethnic minorities favoured ownership roles relative to white pharmacists in all measured age groups. Management roles were favoured by both white male and female pharmacists, while locum roles were more frequently undertaken by white female pharmacists. Family ties were found to have a relatively strong influence on the careers of ethnic minority pharmacists.

Conclusion

We speculate that family involvement may have enhanced the availability of both human and financial capital for business start-up, but find indications that this influence may not persist over time. In hospital pharmacy, there were indications of underachievement and career anxiety among pharmacists from ethnic minorities, the proportion of hospital pharmacy managers from ethnic minorities being disproportionately low. Attention is drawn to some policy implications, notably for training, flexible working patterns and the need for demographic scenario planning in the profession.
Community pharmacists' attitudes to adverse drug reaction reporting
Authors: Green Christopher F , Mottram David R , Raval Dhiren , Proudlove Christine , Randall Christine
Published: February 2011

Objective

A “demonstration” scheme for adverse drug reaction (ADR) reporting by United Kingdom community pharmacists began in April, 1997. The objective of this study was to investigate community pharmacists' attitudes to and knowledge of ADR reporting and the “yellow card” scheme.

Method

Structured face-to-face interview with community pharmacists, using a prepiloted questionnaire.

Setting

Randomly selected community pharmacies within one demonstration scheme area.

Key findings

Almost all of the pharmacists (28, 93 per cent) were aware that they were able to report ADRs but only one had done so. Just under half recalled receiving the official information pack and half of these had read it. Reasons given for not submitting reports were lack of information or time, and that most reactions seen were already well-recognised. Although most pharmacists knew that serious reactions to established drugs should be reported, fewer recognised the need to report unusual reactions to established drugs and reactions to herbal medicines. Few participants knew the reporting criteria for “black triangle” drugs. Reporting on over-the-counter (OTC) products was an area specifically identified where it was expected that community pharmacists could “add value” to the previous, yellow card, scheme. It was thus of some concern that 21 pharmacists (70 per cent) agreed that they would be unlikely to report an ADR to a product they had counter-prescribed for a patient. Few respondents had negative attitudes to the scheme. Most agreed that ADR reporting is important, and a professional role in which pharmacists should be involved.

Conclusion

Community pharmacists are supportive of their involvement in ADR reporting. Their concerns about reporting need to be addressed and further publicity given to the scheme if reporting is to increase. Our findings suggest that more research is needed to identify the factors which encourage and inhibit reporting, and that further efforts may be needed to promote ADR reporting.
Counselling women about periconceptional use of folic acid: the role of the community pharmacist can be improved
Authors: De Van den Berg L T W Jong , Van Der Zee A H , Schaafsma E , de Smit D , Anderson C , Cornel M C
Published: February 2011

Objective

To assess community pharmacists' attitudes towards, and practice behaviour, relating to the periconceptional use of folic acid to prevent neural tube defects

Method

A postal questionnaire was sent to a random sample of 150 community pharmacists at the end of 1996. The questionnaire covered knowledge, attitude and behaviour regarding the use of folic acid by women of childbearing age

Setting

Two regions in the Netherlands (Northern and Western Netherlands)

Key findings

The response rate was 72 per cent. Pharmacists' attitudes towards promoting the use of folic acid by women who wish to have a child are positive. Most pharmacists reported distributing folic acid brochures in their pharmacy and many stated that they displayed posters to promote the use of folic acid. Nearly 30 per cent of pharmacists reported using an additional label on the packaging of oral contraceptives with the standard text: “If you stop using the pill because you wish to have a child, please ask your pharmacist for information about the use of folic acid before you become pregnant”. Perceived attitudes of local general practitioners seemed to influence the willingness of pharmacists to promote the use of folic acid. The results indicate a tendency for some pharmacists to be more reactive than proactive in their advice-giving on the use of folic acid

Conclusion

Compared with the findings of a similar survey two years ago, it appears that more pharmacists are actively promoting the periconceptional use of folic acid. However, further improvements could still be achieved and pharmacists could become more proactive in their information and advice-giving
Exploring community pharmacists' perceptions of their professional relationships with physicians, in Canada and the Netherlands
Authors: Reebye Rajiv N , Avery Anthony J , Van Den Bosch Wil J H M , Aslam Mohamed , Nijholt Almar , van der Bij Akke
Published: February 2011

Objective

To explore community pharmacists' levels of interaction with, and perceptions of, physicians in primary care in Canada and the Netherlands

Method

Interviews with community pharmacists

Setting

Thirty-six community pharmacies in Vancouver, Canada, and 36 in the Nijmegen and Arnhem areas of the Netherlands

Key findings

Dutch pharmacists were more likely to have “face-to-face contacts with the physician in the pharmacy setting” (P=0.008) and structured professional meetings with physicians (P<0.001). Canadian pharmacists were more likely to agree that “interaction with physicians is mainly limited to phone/fax” (P<0.001) and “the concept of pharmaceutical care is difficult to implement” (P=0.006). Qualitative analysis revealed that in both countries pharmacists had concerns about the attitudes of physicians and issues concerning territoriality. There were also many constructive comments and these enabled consideration of actions to enhance patient care

Conclusion

The findings of the study suggest four areas which could contribute to improved patient care: (1) Increasing levels of professional interaction; (2) developing a mutual understanding of roles; (3) participating in joint initiatives to benefit patients through the extended role of pharmacists; (4) conducting structured meetings between professionals with an emphasis on the care of individual patients
The demographics of pharmacy's clientele — a descriptive study of the British general public
Authors: Tully M P , Temple B
Published: February 2011

Objective

To describe the demographics of pharmacy's clientele and of those people who do not visit pharmacies

Method

A face-to-face survey was conducted of a probability sample of the population of Great Britain (≥16 years of age) on their use of pharmacies. Statistical analyses were carried out using both traditional statistical tests and chi-square automatic interaction detection (CHAID), to identify the most significant predictor variables (P<0.01)

Setting

Members of the public in private households

Key findings

Of the 1,882 people interviewed (71 per cent response rate), most (88.7 per cent) reported that they had been to a pharmacy at least once in the previous 12 months. Age and gender were the interacting predictors for respondents who had not been to a pharmacy in that time, with the proportion of women aged over 75 years who had not visited a pharmacy almost three times (30.5 per cent) that of the whole sample (11.3 per cent). Gender was the most important predictor for people who went to pharmacies every week, age the predictor for loyalty and purchase of medicines, and tenure of accommodation (with marital status and dependent children as interacting variables) the predictor for having had a prescription dispensed

Conclusions

CHAID analyses allowed us to describe specific subgroups of pharmacy users with greater precision than did traditional statistics
The new consumer — implications for pharmacy
Authors: Morgall Janine M , Almarsdóttir Anna B
Published: February 2011

In this article, we argue that the extended role of the pharmacy profession appears to be driven more by professional interests than by the interests of the consumer. We believe that a better understanding of market trends in general, as well as research into consumer needs, will ultimately give the best results for the profession. We focus on the rise of consumerism and what is referred to as the “new” or “aggressive” consumer. We argue that unless the pharmacy profession understands this widespread phenomenon, it will continue to shoot wide of its goal to increase public support and to develop an appreciation of the pharmacist's professional skills. We propose that pharmacy practice research should analyse the current situation from the consumer perspective within the context of changes in society, specifically within the health care system.
The challenges of defining pharmaceutical care on an international level
Authors: Van Mil J W Foppe , Mcelnay James , De Jong-Van Den Berg Lolkje W , Tromp F J
Published: February 2011

The objective of this article is to gain insight into the place of pharmaceutical care in health care and into the different interpretations of the term “pharmaceutical care” around the world. Based upon a literature review, communication with peers and results from an international questionnaire, the different influences on and interpretation of the terminology are outlined, and the place of pharmaceutical care within the health system is defined. The Dutch situation with regard to pharmacy and pharmaceutical care is used as an example of the national development of a definition. Different linguistic and cultural influences on the construction of the definition are discussed.

There are different definitions of pharmaceutical care, although several countries use the 1990 definition of Hepler and Strand as a working definition. The term is often used without an explanation of its content. Influences of health systems, cultures and languages across different countries on the interpretation of the term are often overlooked.

We conclude that, even after 20 years of evolution of the definition of pharmaceutical care in different cultures, for an observer it is not absolutely clear what pharmaceutical care is, and where exactly it fits into health care in different countries. The definition of social and culturally bound activities such as pharmaceutical care need rephrasing, depending on factors in the country of practice and health care system developments over time. Additionally there are conceptual language differences.
The changing face of pharmacy practice — evidence from 20 years of work sampling studies
Authors: Savage Imogen
Published: February 2011

Objectives

To determine whether the professional policy shift away from dispensing towards patient-focused care is reflected in the way community pharmacists actually use their time.

Method

Retrospective comparison, using data from five observational work sampling studies employing the same methodology. The percentage of time spent on manipulative dispensing (defined as creating labels and physically preparing prescription items) and health-related customer communication was monitored.

Setting

Fifteen independent practices (8.7 prescriptions/hour; London, England, 1993); 40 urban/rural pharmacies (7.8 prescriptions/hour; Dublin, Eire, 1985); 28 independents (9.1 prescriptions/hour; Sydney, Australia, 1985); one traditional multiple (9.6 prescriptions/hour; Nova Scotia, Canada, 1980); 20 traditional multiples (8.1 prescriptions/hour; eastern United States, 1973).

Key findings

Despite full computerisation, English pharmacists in 1993 spent as much time creating dispensing labels (8.8 per cent) as they did on health-related customer talk (7.2 per cent), and twice as much time preparing prescription items (14.2 per cent). Of their total time, 6.5 per cent was spent on simple redispensing (mostly counting tablets, pouring liquids and cutting blister strips). The time spent on extemporaneous preparation was extremely low. In Eire, pharmacists spent nearly twice as much time (5.8 per cent) on health-related talk as on counting, pouring and compounding (3.8 per cent) and in Australia nearly three times as much time (6.6 per cent vs 2.3 per cent). In Eire, two-thirds of pharmacists had qualified dispensing help of a type not found in other countries. In Australia, most products were ready to issue.

Conclusion

The proportion of pharmacist time spent on customer communication has increased three-fold since 1973. However, this has not been mirrored by a decline in time spent on manipulative dispensing. Keeping the study limitations in mind, it is suggested that, in Britain, the reprofessionalisation process may be hampered by the continued need for redispensing and the limited availability and use of trained support staff.
Community pharmacists' attitudes towards research
Authors: Rosenbloom Karen , Taylor Kevin , Harding Geoffrey
Published: February 2011

Objectives

To investigate community pharmacists' perception of Pharmacy Practice research and to identify perceived barriers preventing their participation in research.

Method

A self-completed postal questionnaire, including 29 attitudinal statements was analysed using factor analysis.

Setting

The study group comprised pharmacists working in all 651 community pharmacies in East London and Essex.

Key findings

The response rate was 60 per cent. Factor analysis revealed five factors comprising correlated statements. The majority of respondents perceived community based practice research to be important and relevant to them and to the future development of community pharmacy. Fifty-four per cent agreed that they were prepared to participate in practice research, although 66 per cent of respondents felt their daily activities precluded this. Payment for a research related activity was a major issue impacting on their likely participation, with 72 per cent of pharmacists agreeing that they would only participate if paid to do so. Pharmacists' employment status, ie, whether employee or proprietor, was also associated with willingness and ability to undertake research.

Conclusion

Community pharmacists have a positive attitude towards practice research, and under the appropriate circumstances many would be prepared to participate in research.
Impact of medication regimen reviews performed by community pharmacists for ambulatory patients through liaison with general medical practitioners
Authors: Krass Ines , Smith Carlene
Published: February 2011

Objective

To evaluate the cost and clinical benefits of the provision of medication regimen reviews (MRRs) by community pharmacists for patients identified and referred by a general practitioner using a collaborative approach.

Method

There were two cohorts of patients — 105 in stage 1 and 170 in stage 2 — from 34 GPs. The reviews were performed by 45 community pharmacists who had completed a training programme in MRR. The protocol was as follows: (1) a proforma MRR request form, including relevant clinical information and the patient's current regimen, was completed by the GP, (2) the review was conducted by the pharmacist and documented in a proforma report, (3) pharmacists and GPs met to discuss the review findings and recommendations for each patient, and (4) three months later, GPs were surveyed to verify any accepted recommendations and changes to medication regimen. A clinical panel estimated the clinical significance of the regimen changes for a subset of 141 cases.

Key findings

The patients had an average of five diagnoses, with cardiovascular disease (34 per cent) and musculoskeletal disease (15 per cent) the most common conditions. A total of 2,220 medications were prescribed, representing a mean of eight per patient. In all, 869 changes to therapy were observed at the three-month follow up: 47 per cent drug ceased; 17 per cent dose reduced; 11 per cent dose increased; and 12 per cent drug changed. Examining the impact of MRR on the mean number of medications per patient, the null hypothesis of no difference pre- and post-MRR was rejected. There was a mean reduction of one medication per patient (P<0.001). As a consequence of this reduction, the average annual cost of medications was reduced by $A240 per patient. This translated to a projected annual cost saving for medication alone of $A90 per patient after offsetting the $A150 cost (professional remuneration) of the MRR. Considering health outcomes, overall, the reviewers rated at least 40 per cent of the MRR changes as leading to a positive effect on the patient's health.

Conclusion

This study provides a good indication that MRR through GP-pharmacist collaboration in the community can lead to positive clinical benefits and reduction in health care costs.
Over-the-counter ibuprofen: how and why is it used?
Authors: Sinclair Hazel K , Bond Christine M , Hannaford Philip C
Published: February 2011

Objectives

To pilot an over-the-counter (OTC) medicine pharmacovigilance project, using ibuprofen as a model.

Method

All users of any tablet or capsule form of ibuprofen (excluding compound products) purchased from 61 participating community pharmacies, aged ≥18 years and able to give informed consent, were eligible to join the study. A postal questionnaire one week after the index purchase monitored the follow-up rate, drug usage, past medical history, concurrent medication, symptoms and health service utilisation.

Setting

Primary care: community pharmacies in Grampian, Scotland.

Key findings

A total of 443/544 (81 per cent) questionnaires were completed. The recommended daily dose of OTC ibuprofen (1,200mg) was exceeded by 35 customers (8 per cent) on at least one day and the recommended maximum daily dose that can be prescribed by a physician (2,400mg) was exceeded on five occasions. During the seven days after the index purchase, ibuprofen was used by 15 customers (4 per cent) with an active or past history of peptic ulcer, and 30 (7 per cent) with an active or past history of asthma. Thirty-eight per cent had purchased ibuprofen for a chronic condition and 32 per cent were still taking it at the end of the initial seven-day period. Twenty-eight of 412 customers (7 per cent) sought advice during the seven-day period about at least one symptom: 13 consulted their general practitioner, 12 consulted a pharmacist, two consulted both their GP and a pharmacist, and one consulted a hospital doctor. Some of these consultations (23/28, 82 per cent) might have related to an adverse reaction to ibuprofen: 11 customers (3 per cent) consulted about lower abdominal symptoms, nine about gastric symptoms and three about wheeziness.

Conclusions

This pilot study identifies instances of contraindicated and excessive use of OTC ibuprofen, indicating a need for pharmacovigilance studies of OTC medicines; it also demonstrates the feasibility of a major study.
Nurses' attitudes and beliefs about medication errors in a UK hospital
Authors: Hand Katy , Barber Nick
Published: February 2011

Objective

To investigate nurses' attitudes and beliefs about medication administration and medication system errors, and to determine the impact of these attitudes and beliefs at ward level.

Method

Semi-structured interviews with a purposive sample of nurses who had been selected initially by ward specialty and then by grade.

Setting

A teaching hospital in London, United Kingdom.

Key findings

Seventeen nurses were interviewed and their attitudes and beliefs about types of medication errors, causes of medication errors, reporting of medication errors and the responsibility for medication errors were explored. The types of errors mentioned by the nurses were consistent with those cited in the literature. Nurses believed both doctors and pharmacy staff to be sources of errors but by far the most common source of error was said to be the nurses themselves. Few of the nurses interviewed believed all errors were reported and almost all believed they were responsible for any errors which occurred when they were administering drugs. As well as blaming themselves, some also blamed the pharmacist and the doctor, if they had been involved. The nurses thought the fear of disciplinary action and having to admit to making a “silly” mistake stopped a nurse from reporting an error if it had no ill effects on the patient. They hoped anything that could harm the patient would be reported, as would any errors involving intravenous drugs, Controlled Drugs and drugs with serious side effects. They believed errors should be reported to the nurse in charge of the ward, the doctor and sometimes the ward manager, if necessary. Generally the nurses felt the patient should be informed if they might suffer any ill effects due to the error; if the error was not going to harm the patient, the nurses were divided as to whether the patient should even be told an error had occurred.

Conclusion

It was felt that medication errors should be a learning experience which could allow the nurse to reflect on her own practice. The emphasis of errors should be shifted from the nurse to the situation in which it occurred as blaming the nurse was not considered to be very constructive.