bluuebunny/crossref_metadata_2025 huggingface dataset:
Public views on an extended role for community pharmacy
Authors: Williamson V K , Winn S , Livingstone C R , Pugh A L G
Published: February 2011

The acceptability to the general public of an extended role for community pharmacy was investigated using a social survey methodology. Within one locality, a sample of 133 respondents was drawn from four population groups who were likely to be extensive users of community pharmacy services: active elderly people, mothers of young children, carers of people with disabilities and people in full-time employment. The evidence from the interview survey was supplemented by discussions with community groups representative of the same sections of the population. The results indicate that there is considerable public support for the development of a range of new services in community pharmacies, with a majority of respondents supporting the provision of more information on prescribed medicines, opportunity to discuss minor symptoms with the pharmacist, medicine delivery services, and the holding of patient medication records. There is less support for discussing health promotion with the pharmacist, while cost was found to be a major obstacle to the acceptability of diagnostic testing. Elderly people found all aspects of the extended role less acceptable than did other respondent groups. It is concluded that there is a need to market unfamiliar services, and, if an extended role is to be developed effectively, the nature of the relationship between the roles of the community pharmacist and the GP needs to be demonstrated more clearly to service users.
Assessment of chronic disease status in the community pharmacy
Authors: Mcelnay J C , Grainger-Rousseau T-J
Published: February 2011

From a therapeutic viewpoint, it would be useful if the community pharmacist had information on a patient's chronic illnesses when dispensing medicines. This study determined the concordance of pharmacists' and patients' impressions of chronic illness with those charted by general practitioners.

A total of 657 patients presenting prescriptions to a health centre pharmacy were interviewed to obtain details of age, sex, prescriber and chronic illness. Details of 66 patients (who attended one GP and with self-reported chronic illness) together with their patient medication records for the previous 12 months were given to two groups of five community pharmacists, qualified for <10 years (Group I) and >25 years (Group II). Each pharmacist gave an intuitive assessment of the chronic illnesses being treated in each patient. These were compared with the GP's charted diagnoses and were placed into three categories: (i) agreement, (ii) partial agreement or (iii) non-agreement. The results (mean±sem) obtained for categories (i), (ii), (iii) respectively were: Group I 36.7±3 per cent, 43.7±5.8 per cent, 19.7±4.8 per cent and Group II 33.6±3.6 per cent, 40.6±3.8 per cent, 25.7±1.9 per cent. Patient (or their representative) assessments for (i), (ii) and (iii) were 56.1 per cent, 31.8 per cent and 12.1 per cent, respectively. The results make it clear that if there is to be a high level of concordance between pharmacy-held and GP-charted information on chronic illnesses there must be collaboration between the two professions in this regard.
Community pharmacists as immunisation advocates: A pharmacoepidemiologic experiment
Authors: Grabenstein J D , Hartzema A G , Guess H A , Johnston W P
Published: February 2011

To determine if advocacy of influenza immunisation by community pharmacists would affect vaccine acceptance among patients at risk of influenza, a randomised, placebo-controlled trial was conducted in three pharmacies. Patients receiving certain medications for heart or lung disease or diabetes, or receiving non-steroidal anti-inflammatory drugs and who were at least 65 years old, were randomly assigned to receive either messages explaining the risk of influenza and availability of vaccine or recommending household poison prevention measures. All patients were surveyed by mail regarding behaviour and opinions related to influenza and influenza vaccine.

Of 125 previously unvaccinated recipients of vaccine-advocacy letters, 39 were vaccinated (31.2 per cent), compared with 24 of 134 control subjects (17.9 per cent), a difference of 13.3 per cent (P=0.013). Unvaccinated patients were 1.74 times more likely to be vaccinated after receiving vaccine recommendations and information than were control patients. In this setting, community pharmacists increased vaccine acceptance by advising patients of their personal risk and describing where to be vaccinated.
Effect of tobramycin, amiloride and sodium deoxycholate on the in vitro activity of ciprofloxacin against Pseudomonas aeruginosa
Authors: Shaffer K N , Jones D S
Published: February 2011

The effects of sodium deoxycholate, tobramycin and amiloride on the inhibitory effect (minimum inhibitory concentration) of ciprofloxacin against Pseudomonas aeruginosa (strain PAO 511 and two clinical isolates, one from a burn infection and the other from a cystic fibrosis respiratory tract infection) were examined in vitro. The method used was a macrodilution technique in Mueller-Hinton broth at 37C. Marked enhancement of ciprofloxacin activity was observed in the presence of 4.15mg/ml sodium deoxycholate, 0.4μg/ml tobramycin and 50μg/ml amiloride. It is suggested that these observations may be clinically important in the treatment of localised Pseudomonas aeruginosa infections, eg, within the respiratory tract of cystic fibrosis patients.
Community pharmacists' attitudes to their advice-giving role and to the deregulation of medicines
Authors: Bond C M , Sinclair H K , Winfield A J , Taylor R J
Published: February 2011

The attitudes of pharmacists towards their advisory role and to the further deregulation of medicines have been surveyed using a postal questionnaire distributed to a randomly selected 20 per cent (227) of all community pharmacies in Scotland (response rate 90 per cent). Half the pharmacists thought that their role had changed since the publication of the Nuffield report in 1987, 81 per cent that their role was restricted by the range of drugs available for over-the-counter sale, and 93 per cent that they would like to see their role extended by the further deregulation of medicines; fifty eight per cent agreed that there should be a nursing formulary and 74 per cent that a corresponding pharmacists' formulary should be established. Pharmacists were also asked to suggest target preparations for deregulation: ninety per cent suggested at least one preparation, with chloramphenicol eye ointment and drops being the most frequently cited.
Practice research: Strategies for stability studies on hospital pharmaceutical preparations
Authors: Mehta A C
Published: February 2011

This article describes the various tests that should be considered in the chemical stability testing of drugs prepared in hospital pharmacy. The requirement for a stability indicating analytical method to carry out such tests is emphasised.
“Why do you ask?” A study of questioning behaviour in community pharmacist-client consultations
Authors: Morrow Norman , Hargie Owen , Donnelly Helen , Woodman CATHERINE
Published: February 2011

This article reports the results of an analysis of recorded community pharmacist-client interactions. The results showed that 98 per cent of all pharmacist questions asked were closed, over two thirds of which were of the Yes/No variety. Twenty four per cent were leading in nature and almost all of these were subtle leads. Pharmacists asked, on average, four questions per consultation as compared with a mean of 2.5 for clients. Only 2 per cent of all pharmacist questions addressed the psychosocial dimensions of practice, the vast majority being concerned with purely clinical matters. The findings are discussed within the context of a communication audit approach to community pharmacy practice, directed to effecting improvements in the quality of interviewing performance in pharmacist-client consultations.
Counterprescribing for ophthalmic conditions: a survey of community pharmacists
Authors: Hardy N , Hodgkins P , Luff A , Moughtin S , Elkington A
Published: February 2011

All 123 community pharmacies in the Southampton area were telephoned and the pharmacist invited to answer questions on the management of patients with ophthalmic conditions. Of those approached, 95 per cent (n=117) agreed to participate. The mean number of patients seeking advice on eye conditions was 14 per pharmacist per week. All but one pharmacist stated that they discussed the condition with the patient, and 97 per cent (n=114) examined the eye. Fifty-one per cent (n=60) did not feel qualified to touch the eye or lids while the remainder were prepared on occasion to carry out a contact examination. Only 6 per cent (n=7) had a pen-torch to aid examination. The most commonly counterprescribed products were Brolene drops and ointment, Otrivine-Antistin drops and artificial tear preparations. Sixty per cent (n=70) of pharmacists had no information available on the diagnosis and treatment of eye conditions and 88 per cent (n=103) said they would welcome more information. Ninety-six per cent (n = 112) routinely advised the patient to consult their general practitioner if the condition failed to resolve, the remainder advising attendance at the casualty department of the eye hospital. The study shows that community pharmacists are regularly consulted by patients with ocular pathology. Locally produced guidelines and education could lead to improved patient care.
Pharmaceutical care
Authors: Kielgast Peter J
Published: February 2011

To what extent has the concept of pharmaceutical care been taken up outside the United States?
Self assessment of health status and symptoms by cancer patients
Authors: Malone Margaret , Harris Adrian L , Luscombe David K
Published: February 2011

A study was carried out to assess the value and feasibility of using a short questionnaire to evaluate overall health status and common symptoms in cancer patients attending an outpatient clinic.

A cancer specific questionnaire (CSQ) was developed to assess the impact of cancer on overall health, appetite, energy, mood and pain. Patient ratings were compared with the doctor rating made at the same time. A pilot study was carried out in 20 patients to identify any practical problems associated with administration of the CSQ. Thirty patients deemed to be clinically stable were asked to complete the CSQ on two separate occasions to assess its reliability. Three hundred patients were recruited to the main study.

In the pilot study, the CSQ was found to be comprehensible and practical to use. Subjects required between two and five minutes to complete the CSQ. No statistically significant difference in any of the categories of the CSQ (chi-squared test, P>0.05) was found in the 30 patients who completed the CSQ on two occasions.

In the main study, the majority (72 per cent) of patients considered their overall health status as fair to good. Appetite was rated as normal in 63 per cent of patients. Only 22 per cent of patients considered their energy status as normal. Fifty-two per cent of the patients rated their mood as normal. Fifty-seven per cent of patients had some degree of pain. There was no statistically significant difference (ehi-squared, P>0.05) between doctor and patient ratings made on the same occasion in any category. Assessments matched closely in cases where there was no impairment in the category assessed. However, when there was some impairment doctor and patient agreement fell to less than 50 per cent.

The data obtained were useful in the identification of problems but did not provide sophisticated qualitative information regarding the nature of the symptoms. The information obtained from the patient could provide a focus for further discussion during the medical consultation.
Does a high workload decrease ward pharmacists' clinical monitoring?
Authors: Barber N D , Blackett A , Batty R
Published: February 2011

In Britain prescriptions are written on proforma charts kept by the patient's bed. Pharmacists generally visit wards daily to initiate supply of drugs and monitor prescription charts. We wished to compare this service across all acute hospitals in a British regional health authority.

Pharmacists (n=210) at 31 hospitals monitored 10,337 beds in 489 wards. The median beds/pharmacist ratio was 57 (first quartile 33, third quartile 68). The median time to check 100 prescription charts was 2 hours 49 minutes (first quartile 2 hours 21 minutes, third quartile 3 hours 27 minutes) and related to the ward specialty (Spearman's rs=0.78, P=0.013). Analysis of the 19 district general hospitals showed a positive correlation between time to monitor 100 beds and prescription monitoring incidents (PMIs)/100 beds/week (P=0.002) and a negative correlation between beds/pharmacist and PMIs/100 beds/week (P=0.003). Increasing a ward pharmacist's workload may lead to a decrease in their monitoring of appropriate prescribing. It is suggested that these measures may have some value as indicators of workload, clinical effectiveness and efficiency.
Therapeutic drug monitoring in community pharmacy — a feasibility study
Authors: Maguire T A , McElnay J C
Published: February 2011

A study was carried out to examine the feasibility of providing a community pharmacy based theophylline therapeutic drug monitoring service for asthma patients. Twenty-two patients attending 12 general practitioners (GPs) participated in the study. Their serum theophylline concentrations were measured and via the use of patient medication records an estimate of compliance with the prescribed dosage regimen was made. If the latter was satisfactory and the serum theophylline concentration was not within the target range of 10–20 μg/ml agreed with GPs, a computer program using Bayesian kinetic principles was used to calculate an appropriate dosage adjustment. This dosage adjustment was made after agreement was obtained from each patient's GP. Patients found to be non-compliant were counselled. Follow-up assessments were carried out after three and nine months; compliance was also assessed at 12 months. Eighteen per cent of patients had serum concentrations within the target range at the beginning of the study; this improved significantly (P<0.05, chi-squared) to 72 per cent and 68 per cent at three and nine months, respectively. Compliance data also improved significantly (P<0.01) over the study period, from a baseline of 59 per cent compliant to a final figure of 86 per cent. Both outcome measures indicate the value of the community pharmacy based monitoring service.
Pharmacokinetics and pharmacoepidemiology
Authors: Leufkens H G M , Zuidema J
Published: February 2011

Pharmacokinetic methodology should be included in pharmacoepidemiology and postmarketing surveillance
Reasons consumers do not ask for advice on non-prescription medicines in pharmacies
Authors: Taylor J
Published: February 2011

Reports in the literature indicate that consumers may hesitate to ask for advice when considering the purchase of non-prescription products in community pharmacies. Consumers observed purchasing products in 11 pharmacies without asking for advice were surveyed to ascertain why they did not do so. Of the 151 consumers who completed questionnaires, 145 indicated they had not wanted advice, mainly because they had used the product before or had received advice elsewhere on what to purchase. Only six consumers indicated that in fact they had wanted advice, but had hesitated to ask for it. Their main reason for not asking was that the pharmacist appeared too busy.
Nursing sisters' satisfaction with the pharmacy service — a survey
Authors: Newton S A , Black M
Published: February 2011

A questionnaire was sent to all nursing sisters in Hammersmith and Queen Charlotte's special health authority, a provider of specialist hospital services in London. They were asked for their overall impression of the pharmacy service and staff, for their opinions of specific services and for suggestions for improving the service. Eighty-six per cent of respondents thought the service was good, very good or excellent and 92 per cent thought the service was either the same or better than that of other hospitals in which they had worked.

Just under half the suggestions received were for service improvements related to supply of drugs stocked on the ward. The other main areas commented on were drug delivery, discharge medication and the pharmacy on-call service. The survey provided useful information about the pharmacy service and has enabled the department to implement some of the changes suggested as well as look at the feasibility of other improvements. It is intended to repeat this survey annually.
A community-based pharmaceutical care model for the elderly: report on a pilot project
Authors: Grymonpre Ruby E , Williamson Dawn A , Huynh Dieu H , Desilets Lynn M
Published: February 2011

This paper describes the development and pilot evaluation of a pharmacy consultation service for the elderly. The service is a comprehensive, community-based pharmaceutical care model which identifies drug-related problems in the elderly population. Eligible clients were 55+ years of age, taking two or more items of medication and non-institutionalised. The pharmaceutical care model involved home medication histories, drug therapy review, and consultation with physicians and individual clients. The service was evaluated through therapeutic outcomes monitoring, follow-up interviews with clients and questionnaires mailed to physicians. The 20 pilot clients had a mean age of 77 ± 7 years. They took a mean of 8.6 ±3.7 prescription drugs and 9.2 ± 7.9 non-prescription drugs. Potential and actual problems identified which could have adversely affected desired therapeutic outcomes included adverse drug reactions, untreated indications, suboptimal regimens, and improper drug selection. Sixteen of the 20 pilot clients participated in follow-up interviews. A reduction in the number of non-current labels was the only statistically significant difference noted between baseline and follow-up interviews. However, changes consistent with pharmacy recommendations were noted for almost all other drug-related problems identified. Questionnaires relating to 16 clients were completed by 15 physicians. Although the physicians agreed with 79 per cent of the recommendations, only 31 per cent of recommendations resulted in a change to the drug regimen. The majority of physicians surveyed rated the service as somewhat useful to very useful. The need for pharmaceutical review in this population is demonstrated by the number of drug-related problems identified. Although the model led to numerous positive outcomes, further research is required to evaluate the effectiveness of this proposed strategy.
General medical practitioners' perceived use of drug information sources with special reference to drug information centres
Authors: Clark J C , Gerrett D
Published: February 2011

This study reports the current perceived use of available sources of drug information for general medical practitioners. The sample frame, of 463 GPs practising in Derbyshire, England, on January 1, 1990, provided a 74 per cent response rate to a pre-piloted questionnaire. Two printed sources, the Monthly Index of Medical Specialities and the British National Formulary (BNF) plus one personal service, fellow colleagues, were by far the most frequently used. The estimated average minimum number of days per year on which personal information services were consulted was 28.51 days compared with 63.83 days for non-personal, printed sources. Thus, if GPs are to be guided by independent sources then the BNF must be considered a prime vehicle. Drug information centres (DICs) were ranked last with 56 per cent of GPs having consulted such a source within the previous year. Use of DICs could not be predicted from GPs' characteristics or demographic data. Interviews with 101 of 106 randomly selected GPs generally confirmed questionnaire findings. However, only 41 per cent perceived themselves as users of DICs. Collation of queries from two local centres showed 25 per cent were known to be users. From interviews, discrepancies were seen to arise from accessing DICs outside the sample frame boundary plus confusion of DICs with poisons centres and hospital pharmacy departments. Thus, for use of DICs, questionnaire techniques may be unreliable unless source definition is considered. If using DICs, GPs very significantly had lower concurrent use of community pharmacists, GP colleagues and hospital consultants for general drug information
Dimensions of pharmacists' preferences for cough and cold products
Authors: Emmerton Lynne , Gow David J , Benrimoj Shalom I
Published: February 2011

In Australia, purchases of cough and cold products have been found to involve pharmacists' recommendation more frequently than other minor health problems, but little information exists to explain pharmacists' preferences for cough and cold products. This report undertakes the preliminary step of identifying the underlying dimensions of preferences of this product group, using principal factor analysis of a range of potential influences on preference. Qualitative methods and review of the literature were used to develop a list of 42 influences on pharmacists' preferences for these products. A mail survey of 1,200 community pharmacists followed (response 66 per cent). Factor analysis reduced the 42 influences to seven factors, namely, advertising (variance explained, 13.65 per cent), non-scientific [product] (6.96 per cent), non-scientific [social] (4.70 per cent), financial (3.31 per cent), experience/economics (2.86 per cent), clinical (2.15 per cent) and restriction/ingredients (1.61 per cent) influences. These factors indicate the dimensions of preference and may be further analysed using multiple regression to determine their relative influence in explaining preference for specific products, enabling assessment of the appropriateness of product selection and the development of marketing strategies.
Costing inpatient drug treatment
Authors: Jenkins D , Cairns C , Dobson L , Barber N
Published: February 2011

The aim of this study was to examine costs of charted drugs by using three data capture techniques. Data were manually extracted retrospectively from drug charts for a stratified sample of 200 inpatient stays at each of two London hospitals — a teaching hospital (St George's) and a district general hospital (Kingston). Specialties where costing was not feasible were excluded. These were: intensive care, oncology, dermatology and paediatrics. Three costs were calculated: nonstock drugs administered (the capability of traditional pharmacy computer systems), drugs prescribed (the data captured by a basic computerised prescribing system) and drugs administered (the data captured by a drug administration recording system). Pharmaceuticals not prescribed on the drug chart, such as anaesthetics, contrast media and disinfectants, were not included.

At St George's 2,739 and at Kingston 2,843 prescription entries were recorded, amounting to costs of £2,940 and £2,327, respectively, for drugs administered. A range of £0.01 to £171 per patient (median £4.67) at St George's and £0.00 to £122.66 (median £2.88) at Kingston demonstrates a skewed distribution, with most patients incurring low costs. Non-stock drugs accounted for 21 per cent of the cost of drugs administered at St George's and 15 per cent at Kingston. Twenty-four patients incurred costs above £50, their non-stock drugs being a mean of 21 per cent of their total costs. The cost of drugs administered at both hospitals was found to be 95 per cent of the cost of drugs prescribed.

Computerised prescribing and drug administration recording systems would significantly improve cost allocation. However, it is unlikely that the expense could be justified on the basis of the low value of drugs received by most patients.
Therapeutic drug and biochemical monitoring in a community pharmacy: Part 1
Authors: Hawksworth Gillian M , Chrystyn Henry
Published: February 2011

A therapeutic drug and biochemical monitoring service within the primary health care sector could provide positive patient outcomes. We have evaluated the possibility of measurements being made by a community pharmacist. Simultaneous blood samples were taken from a finger prick and vein of 55 patients attending a hospital outpatient clinic. The plasma drug concentrations (digoxin, carbamazepine, phenytoin and theophylline) and biochemical parameters (creatinine, potassium and urea) of these finger prick and venous samples were measured in a community pharmacy using the Ames Seralyzer and Clinimate systems. Similar measurements of the venous samples were made by the biochemistry department of a local hospital. There was no significant difference between the concentrations of the two samples (finger prick and venous) measured in the community pharmacy or between the community pharmacy measurements and those carried out by the hospital biochemistry department. External and internal quality control by the community pharmacist was satisfactory. Interpretation of the measured drug concentrations showed that optimal dosing was achieved in only 58.3, 33.3, 50.0 and 28.3 per cent of patients prescribed carbamazepine, digoxin, phenytoin and theophylline, respectively. Interpretation of biochemical concentrations showed that 38.9 per cent of the patients monitored were either hypo- or hyper-kalaemic; 80 per cent of the monitored patients taking renally excreted drugs required a change in their drug management. Although the patients in this study were attending a hospital outpatient clinic, the results highlight the potential benefit of a therapeutic drug and biochemical monitoring service within the primary health care sector.
Therapeutic drug and biochemical monitoring in a community pharmacy: Part 2
Authors: Hawksworth Gillian M , Chrystyn Henry
Published: February 2011

Opportunistic blood samples, at appropriate times post-dose, were taken from patients presenting prescriptions at a community pharmacy. Measurement and interpretation of carbamazepine (19 patients), digoxin (23), phenytoin (13) and theophylline (51) plasma concentrations indicated that 63.1 per cent (12 patients), 47.8 (11), 84.6 (11) and 58.6 (30), respectively, of the patients could benefit from a change to their therapeutic management to provide plasma concentrations with the highest probability of efficacy and the smallest possibility of side effects. Changes in the therapeutic management of 22 out of 46 patients (47.8 per cent) were necessary because of their plasma potassium concentrations. Of these, 13 (28.3 per cent of the total) were hypokalaemic and their medication included diuretics with no potassium assistance. Nine patients (19.6 per cent) were hyperkalaemic and were taking either a potassium sparing diuretic or potassium supplements with their diuretics. Thirty three (70.2 per cent) of the 47 patients whose creatinine clearance was determined required a change to their therapy. These patients had some degree of renal impairment and, according to the British National Formulary, a dosage adjustment was justified. We have previously shown (in part 1) that accurate measurements of these therapeutic drugs and biochemical parameters can be made in a community pharmacy from plasma samples. The study reported here shows that community pharmacists can use clinical pharmacokinetic and therapeutic knowledge to recommend optimal therapeutic regimens. Liaison between community pharmacists and general practitioners could provide a therapeutic drug and biochemical monitoring service with patient and economic benefits.
Prescription errors detected by Swedish pharmacists
Authors: Claesson Cecilia B , Burman Kerstin , Nilsson J Lars G , Vinge Ellen
Published: February 2011

Prescription errors identified and dealt with by personnel at 36 Swedish community and hospital pharmacies during March, 1992, were analysed. During the study period, the participating pharmacies handled 76,956 prescriptions for 41,908 patients. All prescription errors, even minor ones, were registered. In total 32,132 errors were detected and reported, corresponding to an overall rate of 42 per cent. The most common error was omission of the purpose of the therapy. This type of error was found in 20,517 prescriptions (64 per cent of all noted errors). Most detected errors did not require any special intervention by the dispensing pharmacist. Errors of commission, which are potentially harmful to the patient, totalled 338 or 1 per cent of the errors. The most common of these was that the dosage form stated was incorrect. The pharmacists were able to resolve almost three-quarters of the errors that required intervention and dispense the elucidated or amended prescription.
Customer feedback as a tool for improving pharmacy services
Authors: Airaksinen Marja , Ahonen Riitta , Enlund Hannes
Published: February 2011

The quality of pharmacy services can be assessed by using both profession-based measures and customer feedback. The aim of this population-based survey (n=848) in Finland was to evaluate how well the existing service level matched customer expectations and to examine whether pharmacy-specific quality dimensions derived from recent service quality models were found in population-based data. The survey indicated that the Finns seemed to be very satisfied with the professional competence and trustworthiness of pharmacy personnel. The highest dissatisfaction was experienced with queuing times, privacy and time for customer-pharmacist interaction (40 per cent). Pharmacies also seem to have various opportunities to extend their services beyond traditional dispensing, especially in the field of patient counselling and diagnostic screening. The importance of customer-based feedback through surveys will grow in the future when trying to develop pharmacy services. This study shows that theoretical models of service quality dimensions are suitable for processing the data although the methodology needs further development.
The pharmacist's contribution to clinicians' ward rounds: analysis by the stages in the drug use process
Authors: Fletcher P J , Barber N D
Published: February 2011

Hospital pharmacists are increasingly becoming an integral part of the clinical team, with many pharmacists now attending clinicians' ward rounds. This exploratory study observed five pharmacists attending ward rounds in hospitals in South East England, each on two or three occasions. The pharmacists volunteered to take part in the study and consent was obtained from the clinicians in charge. Each round was observed, tape recorded and transcribed. The verbal contributions of each member of the team to the discussions of drugs were analysed and categorised using the stages of the drug use process.

The rounds involved 109 patients and there were 269 separate conversations involving medication. Of these, 135 were patient-specific drug discussions where therapy was reviewed; the pharmacists made proposals to start, stop or alter therapy in nearly half of these discussions. There was no review of therapy in 38 per cent of patients in the study, ranging from 0 per cent on a medical round, to 75 per cent on a surgical round. The pharmacists were particularly involved in selecting the most appropriate dose, stopping drug therapy, and monitoring drugs. The clinicians were more involved in initiating drug therapy. All doctors questioned expressed their satisfaction with the pharmacists and their contribution to the ward rounds.
Provision of a domiciliary service by community pharmacists
Authors: Schneider Julia , Barber Nicholas
Published: February 2011

The potential benefits of home visits by community pharmacists to housebound people with medication difficulties were examined. Sixteen community pharmacist volunteers made initial home visits to 39 patients referred by 14 general practitioners. The medication in their possession was noted, and information about the medication recorded from the medication container label, a patient medication record provided by the referring sugery and the patients' own knowledge. In 35 cases there were discrepancies between the medicines in the patient's possession, those they were currently taking and those listed on the patient medication record. Non-adherence, medication hoarding and adverse drug reactions were found. After each visit a summary was sent to the patient's GP and dispensing pharmacist. GP intervention was requested for 25 patients and dispensing pharmacist intervention for 17. Follow-up visits to 18 patients one month later showed that 37 per cent of suggested GP interventions and 50 per cent of suggested dispensing pharmacist interventions had been acted on. Feedback was received from the visiting pharmacists during a meeting and from the GPs and dispensing pharmacists by interview. The service was valued by the patients and endorsed by the GPs and all the community pharmacists involved, indicating that community pharmacists have a potential role to play in enhancing the care of specific housebound patients through domiciliary visits.
White and ethnic minority pharmacists' professional practice patterns and reasons for choosing pharmacy
Authors: Hassell Karen
Published: February 2011

The growing number of women in pharmacy practice has led to a wealth of research looking at their role and impact on the profession. While anecdotal evidence supports the view that pharmacy is also an increasingly popular profession for a large number of ethnic minority groups, there is no empirical pharmacy practice research to support the claim. A small scale postal survey was conducted to determine and compare the practice environments and reasons for embarking on a pharmacy career of white and ethnic minority pharmacists (classified using the 1991 United Kingdom census classification scheme). The sample comprised graduates of one UK school of pharmacy over a 10 year period. While the data are not generalisable, and despite small numbers in the ethnic minority group, the results indicate that ethnic minority status may contribute to different practice patterns. Ethnic minority pharmacists might be more likely to practise in community pharmacy, and to be under-represented in management positions although over-represented as owners/partners of community pharmacies. There is also some evidence to suggest that ethnic minority pharmacy graduates might have more difficulty than white pharmacy graduates in obtaining preregistration posts.
Savings at ward level through simplification of dose schedules
Authors: Wallenius Kari , Tuovinen Kati , Naaranlahti Toivo , Enlund Hannes
Published: February 2011

The magnitude of possible savings to be made by changing drug dose frequency was investigated. First, the time, labour cost and material cost involved in administering three different dosage forms on the oncology ward of a university hospital was measured. On average, administering a single oral dose took 0.6 minutes, an injection 4.8 minutes and an infusion 10.9 minutes. The dose frequencies on three wards (oncology, surgical and internal medical) were then noted. For oral medications the frequencies were similar, 39 to 53 per cent of the doses being administered three times daily, but for parenteral drugs there was a large variation in dose frequency. The total time spent on drug dosing activities in one month was 82.7 hours on the oncology ward, 74.8 hours on the surgical ward and 65.8 hours on the medical ward. The time spent giving doses of the most frequently ordered thrice daily oral drug varied from 4.0 to 5.2 hours per month on each ward. The annual costs of drug dosing, related to drug acquisition costs, varied from 5.8 per cent to 30.1 per cent. The magnitude of theoretical savings at the hospital level, made by changing the most popular intravenous antibiotic (currently administered three times a day) to a once a day alternative could mean savings of about 60,000 ECU per year. However, in practice, this kind of calculation is applicable only to the most frequently used medications.
Developing community pharmacy services wanted by local people: information and advice about prescription medicines
Authors: Livingstone Carina R , Pugh Anthony L G , Winn Sandra , Williamson Valerie K
Published: February 2011

An extended information service on prescription medicines was evaluated in four community pharmacies over a period of 11 months, including a three-month pilot phase. Written patient information leaflets (PILs) and structured verbal advice designed according to the preferences of local people were provided by the pharmacist to patients prescribed any of three study drugs — amoxycillin, atenolol or ibuprofen. A total of 1,614 PILs were issued. Data were collected from a sample of 311 recipients about their perception and recall of the information service. Altogether, 64 per cent remembered receiving the study leaflet and 56 per cent remembered receiving some verbal information from the pharmacist. More than 80 per cent of service recipients supported the provision of both verbal and written information by the pharmacist. In the main study period (n=203), the types of information respondents could recall receiving most frequently were when to take the medicine (67 per cent), the name of the medicine (53 per cent) and side effects (41 per cent). Sixty seven per cent (40) of those receiving amoxycillin, 61 per cent (43) taking atenolol and 38 per cent (28) taking ibuprofen recognised a side effect of their medicine given in both the leaflet and verbal advice. For all three drugs, side effects were recognised most frequently when included in both the written and verbal information. Support for this aspect of the pharmacist's extended role has been demonstrated in practice and the feasibility of service implementation is discussed.
Comparison of attitudes and beliefs about self-care and personal responsibility for health held by consumers and pharmacists in Thailand
Authors: Charupatanapong N , Chairojkanjana K , Tanapaisalkit A
Published: February 2011

The 16-item Krantz Health Opinion Survey (KHOS) and the 18-item Multidimensional Health Locus of Control (MHLC) were used to measure Thai consumers' and pharmacists' attitudes and beliefs about self-care and personal responsibility for health. A face-to-face interview was conducted with 193 consumers at Silpakorn university pharmacy, Thailand, and with 34 pharmacists who worked occasionally at the pharmacy. All subjects were asked to indicate their responses to each of the 34 statements on a continuous measure ranging from strong disagreement to strong agreement. The KHOS results showed that Thai pharmacists had more favourable attitudes than Thai consumers towards receiving health care information and were more actively involved in their health care. The MHLC results showed that Thai consumers believed more than Thai pharmacists that their health was under the control of “powerful others”. Out of five demographic variables (sex, age, marital status, education and income), education was found to be the best predictor of Thai consumers' attitudes and beliefs. However, none of these variables could be used to predict Thai pharmacists' attitudes and beliefs.
Health promotion in community pharmacy
Authors: Moore S M , Cairns C J , Harding G , Craft M
Published: February 2011

In this study, health promotion activity in community pharmacies and pharmacists' perceptions of the barriers to increasing health promotion activity were investigated. A stratified sample (30) was investigated using a structured interview. Health promotion activities were undertaken in all pharmacies in the study. The number of times advice was given or a query dealt with was estimated to be around 1,400 per week for this sample. Health promotion activity was 2.5 times more likely to be reactive than proactive. Other issues were identified which suggest that pharmacists' activities in this field tend to be passive and product orientated. Barriers identified included remuneration issues, space, time, training and insufficient liaison with other health professionals and health promotion units.
Pharmacy involvement in formulary development: community pharmacists' views
Authors: Hughes Carmel M , McFerran Geraldine
Published: February 2011

A postal survey was carried out in the Eastern health and social services board in Northern Ireland to evaluate the views of community pharmacists (n= 100) on pharmacy involvement in formulary development. There was one mailing, with a response rate of 66 per cent. Most respondents (78.7 per cent) agreed or strongly agreed that pharmacist involvement in formulary development was important. Almost two thirds of responding pharmacists said they would be prepared to approach a GP in relation to such collaborative work and 27 per cent had had previous contact with GPs on the subject. Respondents considered that their input would be particularly useful in improving prescribing, providing cost advice and developing a closer working relationship with GPs. Evaluation of current levels of interprofessional liaison in relation to prescribing issues showed that 33.3 per cent of the pharmacists were already contacted by a GP regularly and 45.4 per cent contacted a GP regularly. Most (80 per cent) rated their working relationship with the GP as useful or very useful. The results suggest that community pharmacists in the Eastern health and social services board are willing to become involved in formulary development, thereby extending the use of practice formularies in general practice and integrating community pharmacy more fully into the primary health care team.
Clinical evaluation of community pharmacists' interventions
Authors: Caleo Sue , Benrimoj Shalom , Collins David , Lauchlan Roberta , Stewart Kay
Published: February 2011

Pharmacists' clinical interventions with prescriptions listed on the Australian Pharmaceutical Benefits Scheme were investigated in a pilot study set up in 30 pharmacies — 10 each from the states of New South Wales, Queensland and Victoria — stratified by city or rural location. Clinical interventions were self-reported by the 29 participating pharmacies for a period of four weeks. A total of 89,326 prescription items was dispensed in the pharmacies over the 675 recording days. There were 1,273 clinical interventions recorded from 1,053 prescription forms. Clinical interventions were divided into two main categories: reactive and proactive. The mean of the total clinical intervention rate was 1.5 per cent (SD=1.4 per cent), comprising 1.2 per cent (SD=1.2 per cent) reactive interventions and 0.3 per cent (SD=0.3 per cent) proactive interventions. A random sample of 50 proactive interventions that resulted in a change in a patient's therapy was evaluated by a clinical expert panel to determine the most likely adverse outcome avoided as a result of the pharmacist's intervention. This study provides evidence of community pharmacists' interventions with prescriptions and demonstrates that pharmacists increase the efficiency and effectiveness of patients' drug regimens and also, potentially, their welfare and quality of life.
Leading edge practitioners in community pharmacy: approaches to innovation
Authors: Tann Jennifer , Blenkinsopp Alison , Allen Judy , Platts Adrian
Published: February 2011

Despite the recommendations of the Nuffield (1986) and Pharmaceutical Care (1992) reports, implementation of the “wider role” in pharmacy practice has been piecemeal. While individual pharmacists have successfully introduced innovations in tasks and working methods, others have not. The paper explores the hypothesis that innovation is related to a set of (largely) generic characteristics possessed by those who promote professional change, together with enabling elements in the work environment. The hypothesis is explored by the identification of leading edge practitioners (LEPs) by key stakeholders in pharmaceutical service delivery and tested using critical incident analysis, an extended interview schedule and a psychometric test (KAI). LEPs were found to initiate more actions, to be more patient-centred, to be effective “soft” networkers, more focused on staff development and more effective influencers. There are wide implications for both providers and purchasers of pharmaceutical care, together with those who have a responsibility for training and development.
Use of non-prescription advice offered to the public by community pharmacists
Authors: Evans Stuart W , John David N , Bloor Michael J , Luscombe David K
Published: February 2011

A study was undertaken to establish whether members of the public use the specific advice offered by community pharmacists relating to minor ailments and non-prescription medicines. Conversations between pharmacists and clients discussing symptoms and researcher-client interviews were recorded and transcribed. Ninety-eight clients who had sought advice either for themselves or someone in their care were interviewed by telephone using a structured instrument. While pharmacists offered a mean of 13.7 information items per client, only 3.3 were later recalled (24 per cent). Clients were more likely to recall procedural advice (P<0.001) and repeated items of information (P<0.01). Over three-quarters of the medicines sold (76.5 per cent) were reported to have been used within the dose range specified by the manufacturer (or recommended by a pharmacist if different). Ten clients were directly referred by the pharmacist to a general practitioner; seven had visited their GP before the interview. A further 30 clients were conditionally referred. Forty-six clients reported the resolution of symptoms on interview and a further 34 reported symptom improvement. All clients, when asked, reported being satisfied with their pharmacy visit.
When do medication administration errors happen to hospital inpatients?
Authors: Ho Catherine Y W , Dean Bryony S , Barber Nicholas D
Published: February 2011

The aim of this study was to determine when medication administration errors (MAEs) are most likely to occur. MAEs were identified by observing nurses preparing and administering medication on a care of the elderly ward during two eight-day periods. The exposure of individual patients to MAEs was also determined.

A total of 119 MAEs was identified during the observation of 2,170 opportunities for error, representing an error rate of 5.5 per cent (95 per cent confidence interval, 4.5 per cent to 6.4 per cent). The omission of drugs that were not available on the ward was the predominant type of error. Of the 56 study patients, 35 experienced at least one MAE during the study period. Errors occurred at an average rate of at least 0.3 errors per patient day. The MAE rate was significantly higher on weekdays (6.4 per cent) than during weekends (4.0 per cent) and higher during pharmacy opening hours (7.8 per cent) than when the pharmacy was closed (4.6 per cent). Patients were at greatest risk of MAEs in the first 48 hours of admission and in the first 48 hours after prescribing. A multidisciplinary approach is required to design safer systems.