bluuebunny/crossref_metadata_2025 huggingface dataset:
Reconstitution of Ambisome injection in one regional health authority
Authors: Chandhok Mani , Taylor Kevin M G , Craig Duncan Q M
Published: February 2011

Ambisome is a lyophilised liposomal formulation of amphotericin B which requires a prolonged and elaborate reconstitution procedure prior to administration by intravenous infusion. In this study a questionnaire survey was used to ascertain the level of usage of Ambisome in hospitals within the North Thames (West) regional health authority, England, and details of the reconstitution procedure employed.

Eight hospitals indicated that they currently had patients being treated with Ambisome or had in the recent past. A number of different guidelines, based on the product's data sheet, were used in the region. Reconstitutions of Ambisome performed in three hospitals during the study period were monitored by the investigator. When possible, samples of the reconstituted product were sized by photon correlation spectroscopy. The observational study suggests that significant deviation from the reconstitution guidelines occurred in practice. However, the sizing data, although indicating that liposome size may increase slightly on storage and be influenced to some extent by the reconstitution procedure, suggest that within limits the final product is not greatly influenced by reconstitution variables.
Location of community pharmacies: A rational approach using geographic information systems
Authors: Hirschfield A , Wolfson D J , Swetman S
Published: February 2011

The role played by community pharmacies in primary and community care and the extent to which they meet patient and customer needs has come under close scrutiny in Great Britain recently following publication of reports from the National Audit Office and House of Commons Public Accounts Committee.1,2 Spatial variations in the provision of pharmaceutical services and their physical accessibility to different sections of the community are issues at the forefront of the current debate. This paper reports on recent research, being undertaken in the North West region, to develop a systematic approach to the analysis of community pharmacy location drawing on the fields of geodemographics (ie, neighbourhood classifications) and geographical information systems (GIS).

Comprehensive information is being assembled about individual pharmacies, the services they provide, the types of residential neighbourhood in which they are located, their advice-giving role, and their proximity to general practitioners, other health care outlets and residential homes. Data sources include the pharmaceutical register, the family health services authorities (FHSAs) and surveys of pharmacists and health care professionals. This is being augmented with digitised boundary information including the road network and small area statistics on demographic structure, social conditions and deprivation.

These data are being utilised within a computerised system to identify how well the current distribution of pharmacies accords with expectations and alternative resource deployment scenarios. Particular attention is being paid to the identification of gaps in provision and areas of over-provision.
Consumer and professional views of pharmacy
Authors: Savage I T
Published: February 2011

With 116 participants from 21 countries, the 8th Social Pharmacy Workshop, held at Humboldt university in former East Berlin in June, was a truly international event. This year, there were participants from Bulgaria, Czech Republic, Slovakia and Slovenia, and a large British contingent, which matched that of the host country. We publish here a summary of some of the research presented.
Where has all the money gone? Therapeutic areas making major contributions to general practitioner prescribing costs
Authors: Dunn Christopher D R , Beswick D Trevor
Published: February 2011

A “top down” analysis was used to identify the therapeutic areas making major contributions to the greater than £22m increase in general practitioner prescription costs in the former South Western regional health authority (RHA) between the years ending August, 1992, and August, 1993. The analysis used PACTLINE and level 3 PACT to identify the British National Formulary (BNF) chapters and sections most responsible for cost increases. In support of this analysis, a “bottom up” analysis was also carried out. This involved empirically selecting therapeutic areas that might have made significant contributions, then calculating, using levels 2 and 3 PACT, the extent of the contribution.

Despite the different approaches, several classes of agents were identified by both methods. The top down analysis indicated that just six therapeutic areas had contributed almost £11m to the total increase of £22m+: they accounted for over 100 per cent of the “excess” growth in the four high growth rate BNF chapters (1, 3, 4 and 6). As various authoritative guidelines have recently been published concerning the use of many of the drugs in these therapeutic areas, the bases exist for a detailed evaluation of whether or not the large increases in their use can be justified.

Analysis of prescriptions dispensed for medicines in chapter 2, which served as a control because of a large increase in prescription numbers but a below average increase in costs, supported the contention that the increased use of generic products and/or some sort of price control (eg, their inclusion in the Drug Tariff) can release considerable resources to be exploited, allowing the introduction of newer and more expensive drugs even in situations of tightly-controlled budgets.
Hygiene compliance in contact lens wearers presenting to an ophthalmic casualty department
Authors: Wakelin Susan E
Published: February 2011

Poor compliance with contact lens care regimens is a factor considered important in the development of potentially sight-threatening microbial keratitis. The purpose of this study was to highlight particular areas of non-compliance in contact lens care. One hundred and sixty contact lens wearers, who presented to an ophthalmic casualty department over a period of six months, were surveyed using a self-administered questionnaire. Of the 142 patients who used daily wear lenses, 29 (20 per cent) did not clean/disinfect their contact lenses after every use. Soft contact lens wearers used a wide variety of care regimens, some of which would be ineffective in disinfecting the lenses. The care of the lens case was a particular problem, with only 10 patients (7 per cent) using a regular and effective method of case cleaning. Seventy-three patients (50 per cent) either rarely or never discarded their contact lens solutions 28 days after opening. Of the 128 patients wearing non-disposable lenses, 43 (34 per cent) either rarely or never used enzymatic cleaning tablets to remove protein from their lenses. Tap water, a potential source of microbial contamination, was used for rinsing contact lenses before or after cleaning by 36 patients (25 per cent). The results highlight specific areas where there was deviation from recognised standards of practice for contact lens care. There is a need for contact lens wearers to be re-educated in the care of their lenses. Since pharmacies are a major source of contact lens care products, pharmacy staff could have an important role to play in the counselling of contact lens wearers to help prevent serious ocular pathologies.
Evaluation of a presentation skills course for pharmacists
Authors: Hargie Owen D W , Morrow Norman C
Published: February 2011

As the role of the pharmacist develops, expands and changes, it is crucial that those involved in the provision of education and training programmes address areas of current need. One such area is that of delivering presentations to groups, since this is a task which pharmacists are increasingly expected to perform. This paper describes a communication skills training (CST) course for pharmacists, targeting on the area of presentation skills. Starting with a brief overview of the content of the course, where five specific presentation strategies are elaborated, the article goes on to describe the key instructional techniques used. Programme evaluation was through analysis of a post-course questionnaire designed to assess the perceived effects of the training on participants. Against the stated criteria the course achieved an overall 85 per cent score. Strategies for introducing, structuring and concluding a presentation, and for defining new terms scored highest in terms of skill use outcome whereas techniques for engaging audience participation obtained the lowest scores. The implications of these results are discussed, together with recommendations as to how this type of training can be optimised.
A preliminary investigation of the interactions between UK and US community pharmacists and their prescription clients
Authors: Evans Stuart W , John David N
Published: February 2011

Similar periods of time were spent recording pharmacist-client interactions in each of five pharmacies in North Carolina, United States, and South Wales, United Kingdom. All interactions involving prescription medicines were transcribed and analysed, 63 from the UK pharmacies and 60 from the US. The mean time spent by the US pharmacists counselling their clients (122.7 seconds) was almost twice as long as that spent by UK pharmacists (69.1 seconds). Pharmacists in the US offered significantly more items of information to their clients (11.2 items per interaction) than their UK counterparts (6.5 items per interaction). Although pharmacists from both countries asked their clients similar numbers of questions, UK pharmacists asked significantly more leading questions. Over 95 per cent of questions asked by pharmacists from both the UK and the US were the closed type. Although US pharmacists have been shown to offer more advice to their clients than those in the UK, the study did not assess the quality of advice given nor ascertain the opinion of those who received this advice.
Frequency of counselling on prescription medicines in community pharmacy
Authors: Krska J , Kennedy E J , Milne S A , McKessack K J
Published: February 2011

Forty five community pharmacists set standards for counselling patients receiving prescription medicines. Replying to a postal questionnaire describing 10 hypothetical scenarios, they identified four priority counselling situations: drugs with a complex dosage regimen, significant interactions, changed or new therapy and uncommon or difficult to use formulations. They estimated their counselling frequency for such situations as 62 per cent.

Fourteen of the pharmacists later allowed a researcher to observe their counselling practice and 267 of their patients participated in a survey of expectations and experiences. The patients completed questionnaires before and after receiving their medicines and were observed collecting them. Eighty one per cent expected verbal information from the pharmacist while 41 per cent reported receiving it and 33 per cent were observed receiving it. They particularly expected to receive advice about how, how often and when to use their medicines and these were the aspects they were counselled most frequently about, though less often than they expected. Many also expected advice on what the medicine was for and any possible side effects, but this was offered less frequently as part of the pharmacist's standard advice. The vast majority (81.5 per cent) felt that the time spent on counselling was adequate, even when this was no time at all, and 62 per cent felt the information given was adequate. After feedback of these results to eight of the 14 pharmacists, seven said they would attempt to improve the frequency and nature of their counselling, to complete the audit cycle.

These results show that questionnaires completed by patients in pharmacies provide reliable data comparable to that from observational studies. Well designed questionnaires could, therefore, be used as a self-audit tool by community pharmacists.
Analysis of a “Medidump” campaign in Australia
Authors: Longmore Robert B , Sunderland V Bruce , Sansom Lloyd N
Published: February 2011

The Australian Commonwealth Department of Health, Housing and Community Services organised a campaign to collect unwanted medicines on a national basis. A representative sample of the returned medicines was analysed. Of the 6,556 items examined, the majority were tablets or capsules. There was a high level of prescription items, with cardiovascular (17.0 per cent), central nervous system (15.7 per cent) and respiratory (14.0 per cent) medications the main therapeutic categories returned. Some individual items occurred in high frequency, more than 100 items each of salbutamol, glyceryl trinitrate, frusemide, theophylline, beclomethasone dipropionate and aspirin being returned. The date of dispensing was only recorded for 45.1 per cent of the sample, and of these 37.6 per cent had been dispensed in the past year.

Of the 5,860 items that could be evaluated, 38.9 per cent were unopened and 55.7 per cent had 80 per cent or more of the medication unused. Of the 4,359 items bearing a pharmacy label, 36.4 per cent were unopened and 53.9 per cent had 80 per cent or more of the medication unused. Approximately 55 per cent of cardiac and respiratory drugs and antibiotics were more than three-quarters unused and 45 per cent, 38 per cent and 47 per cent, respectively, of items in these therapeutic groups were returned unopened. Although the number of labelled items returned in each of these categories was lower than the total items returned, the percentages of items returned unopened were substantially the same. Some caution must be adopted in interpreting these results as they are based on medications that have been disposed of, and do not represent total medication usage.
Time for customer contact in pharmacies with and without a dispensing technician
Authors: Savage I T
Published: February 2011

Dispensary workload is widely perceived by pharmacists as limiting the time available for customer contact. This study compared pharmacist work patterns at two neighbouring independent pharmacies, one without (A) and one with (B) a trained dispensing technician, using fixed interval activity sampling. Pharmacists were observed at work over two weeks; six half-day observation sessions (A = 1,181 observations; B=1,348) could be matched for incoming dispensing workload. Data on 505 prescription issues and 74 over-the-counter events (advice requests, advised sales, and health information) were collected. Pharmacy B dispensed a greater proportion of antibiotics (19 per cent v 11 per cent, P<0.02) but there were no other significant differences. Pharmacists at site B spent 20 per cent less of their time on dispensary activities, 14 per cent more of their time on the counter and had 6 per cent more time to rest and read, but they did not spend significantly longer talking to customers about medicines and health. Skilled dispensing help released over an hour of pharmacist time per day, but these savings were linked to prescription workload, which is unpredictable. The pharmacists could not plan to give this extra time to their customers because they did not know when it would be available, or when it would be needed.
Family health services authorities and community pharmacists at the purchaser-provider interface
Authors: Hunt A J , Sheppard C , Lupton C , Brown D
Published: February 2011

The views of both purchasers (family health services authorities [FHSAs]) and providers (community pharmacists) were sought on the development of community pharmaceutical services in the light of the 1992 pharmaceutical care report. Questionnaires were posted to the 480 pharmacists in charge of all community pharmacies in Wessex and to the 98 general managers of FHSAs in England and Wales. The questionnaires focused on reactions to those recommendations of the pharmaceutical care report which, if implemented, would have significant implications for the community pharmacist's workload. Both the FHSAs and community pharmacists indicated that, in their view, the skills of the community pharmacist are currently underutilised. Both groups expressed enthusiasm for the pharmaceutical care report recommendations that the following services should be provided: domiciliary services, disposal of unwanted medicines, supply of aids for disabled people, supply of compliance aids and adverse drug reaction reporting. Neither group was enthusiastic about pharmacists providing a therapeutic drug monitoring service from community pharmacies. On other areas, pharmacists were more enthusiastic about the provision of health advice, diagnostic/screening services and treatment protocols, while FHSAs favoured distribution of welfare foods, needle exchange, instalment dispensing and referral forms.

Overall, both the FHSAs and community pharmacists were receptive to the principle of the development of the role of the community pharmacist within the primary health care team but expressed concerns regarding the training and workload implications.
Factors influencing the choice of drug therapy in primary and secondary health care
Authors: Cossens M J , Davies G , Bose D , Horne R
Published: February 2011

A prescribing decision model incorporating drug characteristics, professional opinions and past experience was used to predict the choices made by prescribers when selecting a non-steroidal anti-inflammatory drug (NSAID) for inclusion in a formulary. Thirty general practitioners (GPs) and 14 hospital doctors (HDs), most practising within the South East Thames regional health authority, were asked to select either ibuprofen, diclofenac or indomethacin, based on the needs of a described population, and then to answer a questionnaire.

Looking at the relative importance of factors influencing the choice of treatment, there was generally a high degree of agreement between HDs and GPs. However, the majority of HDs ranked efficacy as the most important drug characteristic whereas GPs were generally more concerned with side effects. Fundholding GPs ranked cost more highly than did their non-fundholding counterparts, and GPs working in single handed practices were more influenced by specialists and company representatives than were GPs working in groups. The decision model correctly predicted the drug choice of all the HDs and of 76 per cent of the GPs. These values were considerably better than the 33 per cent that would be predicted based on chance alone.

Although various limitations of this type of study are noted, it is hoped that the model could be developed as a valuable tool to assist in understanding complex prescribing issues.
A national, one-day, consumer-oriented telephone drug information project in Australia
Authors: Allen Karen M , Alderman Christopher P
Published: February 2011

The design and execution of a nationwide, one-day telephone drug information service for the general public are described and data collected during the project analysed.

The Australian public was provided with access to a toll-free telephone service on September 4, 1992, for seeking direct information about medication from a team of pharmacists and medical practitioners based at a temporary telecommunications centre in Melbourne. Details of the project had been agreed by a multidisciplinary steering group. Over 2,000 calls were connected to the centre, averaging 167 calls per hour (range nine to 215). Calls were processed through central triage lines prior to referral to appropriate personnel. Information was gathered from 1,650 calls using a standard data collection form, and the details of a sample of 895 of these were analysed using Epi-info 5.01a (public domain) software for epidemiology and disease surveillance.

The success of this project, as well as that of other similar telephone information services in other countries, indicates a high level of interest among the public. In the future, information gained in this type of data collection process may be of benefit to clinicians in assisting them to provide information to patients about their drug therapy.
Empiric therapy for treatment of infection and the influence of antibiotic guidelines on outcomes
Authors: English Sue , Scott Eileen
Published: February 2011

The appropriateness of empiric therapy, how closely prescribers adhered to hospital guidelines for use of antimicrobial drugs and how relevant these guidelines proved in providing cover for the infecting pathogen were assessed from a retrospective survey of culture and sensitivity reports issued during a one-month period in a district general hospital. Blood, stool, pus, sputum and mid-stream urine specimens were reviewed. Urine specimens from a fundholding general practice unit were also included. Catheter specimens of urine and specimens from other body sites were excluded. Of 290 specimens sent for culture, 99 (34 per cent) were positive. One hundred patients, of whom 54 (19 per cent of the total) were subsequently demonstrated to have a positive culture, had been treated empirically. In 38 per cent of cases the pre-report empiric treatment was considered appropriate for the isolated pathogen, while 46 per cent of patients had negative cultures and 16 per cent had positive cultures but had been given unsuitable antibiotics. In hospitalised patients, 73 per cent of antibiotic treatments were prescribed according to hospital guidelines, although this was the case for only 45 per cent of community-based patients. Hospital guidelines were a relevant and useful aid to rational prescribing in that 75 per cent of organisms isolated were sensitive to guideline antibiotics. The guidelines were least appropriate for urine specimens from hospital. This reflects the range of organisms encountered and the emergence of resistant strains, reinforcing the need for regular updating and amending of prescribing recommendations.
Evaluation of ward pharmacy activity and effects of a change in non-stock ward supply
Authors: Deshmukh A A , Eggleton A G , Monteath A J
Published: February 2011

An activity sampling technique was used to compare the work patterns of clinical pharmacists at hospital ward level within six specialties at the West Suffolk hospital, UK. Significant differences were found between specialties for the activities of prescription and clinical monitoring, stock control and the transcription of prescriptions, travel, annotation, intervention with a doctor or nurse, information to a patient and unproductive time (P<0.05).

On the psycho-geriatric and long-stay geriatric wards, a substantial proportion of pharmacist activity was found to be devoted to stock control and transcription. Two new systems of drug supply were then introduced to these wards and the activity sampling procedure was used to evaluate the effect of the change. It was found that a system employing a technician top-up service significantly reduced the proportion of time the pharmacist spent on stock control and transcription (P<0.0001) and increased the time spent on clinical monitoring (P<0.05). An estimate based on “total contact time” per occupied bed showed that this new method of supply was achieved at little or no increase in cost, and was arguably a more effective use of pharmacist and technician skills.
Non-prescription drug use by elderly patients
Authors: McElnay James C , McCallion C Rosaleen
Published: February 2011

Non-prescription drug use by patients aged 65 and over in Northern Ireland was assessed. Sixteen community pharmacists collected data on 515 elderly patients who purchased non-prescription drugs, using a short structured interview. The patients most commonly purchased oral analgesics (17.5 per cent), cough preparations (14.8 per cent) and laxatives (11.5 per cent). Almost one quarter (23.9 per cent) were already taking a prescribed medication for the same condition. Only one half of the latter patients (49.6 per cent) discussed nonprescription drug use with their general medical practitioner.

Patients' main reasons for the purchase of non-prescription medicines were: symptoms were not severe enough to visit their doctor, convenience of the pharmacy and the product had been used before. Patients who presented to their pharmacist with either gastrointestinal or pain symptoms were found to be twice as likely as patients with other symptoms to be taking a prescribed drug for the same condition(s) (P<0.001). Since elderly patients are more susceptible to adverse drug reactions, health care professionals must endeavour to obtain a complete medication history from them.
Perceptions of preregistration graduates about the UK pharmacy undergraduate course
Authors: Mudhar M S , Wilson K A , Irwin W J
Published: February 2011

This study reports on the perceptions of recent graduates of their undergraduate pharmacy course. Questionnaires were sent to 952 graduates undertaking their preregistration training in the period 1992–3. Of the total response of 695 (73 per cent), 55 per cent were in community pharmacy, 38 per cent in hospital and the remainder in various joint posts. Their opinions on the usefulness of course topics indicated that pharmacognosy and some topics within pharmaceutical chemistry were significantly regarded as of little use (P<0.05), while the vocationally-oriented topics were the most useful. The only topics thought to require significantly more extensive teaching (P<0.05) were responding to symptoms and clinical pharmacy. Pharmacognosy and some topics within pharmaceutical chemistry were considered to require less teaching. The remainder were considered to be given sufficient time. Problem-solving, and small group tutorials and seminars were considered very useful forms of learning by 73 per cent and 63 per cent of respondents, respectively. Clinically-oriented topics were considered significantly beneficial (P<0.05) and useful for inclusion within the new four-year framework.

The study suggests that changes in course design should not include undergraduate specialisation, the graduates' branch of pharmacy having no influence on their opinion of the usefulness of clinical pharmacy and pharmacy practice topics. It also suggests that some science-based topics need to be made more relevant to pharmacy and that clinical and practice-based topics should have a major role in an extended course.
An audit of responding to symptoms in community pharmacy
Authors: Krska Janet , Kennedy Emily J
Published: February 2011

A two-stage audit of community pharmacists' service in response to symptoms was carried out using a previously piloted method. Pharmacists from up to 46 pharmacies completed questionnaires indicating the advice they thought should be given in each of 12 scenarios that could present to community pharmacies. The six scenarios with the highest consensus response were later enacted in the same pharmacies by researchers. Three were used in the first stage and three in the second. Meetings were held between the stages to discuss the results and suggest ways of improving them. The consensus advice, determined by the questionnaire responses, was given on only 27 per cent of all visits — 18 per cent in the first stage and 35 per cent in the second. This was mainly due to non-drug advice being omitted. “Appropriate” products were recommended in 90 per cent of first stage visits but only 74 per cent of second stage visits. “Acceptable” advice was provided in 75 per cent of all visits, with little difference between the two stages. Questioning of the researchers was “good” in 35 per cent of first stage visits and 43 per cent of second stage visits. Inadequate questioning was significantly related to inappropriate advice being given. Inappropriate advice was given on 25 per cent of all visits, with equal frequency by both pharmacists and assistants. Participating pharmacists identified many problems that could contribute to a less than ideal service but most were outside their control, such as television advertising of products and customer expectations. The use of protocols, implementation of staff training and the audit were considered to have had a positive effect on the response to symptoms service. Most participants considered that the method used was acceptable and suggested a similar method should be used on a regular basis to monitor the service.
Threatening and violent incidents in community pharmacies: (2) Implications for pharmacists and community pharmacy services
Authors: Smith Felicity , Weidner Derek
Published: February 2011

This paper reports the second stage of a study into threatening and violent incidents in community pharmacies. The first stage, an investigation of the frequency and nature of incidents, found that a high proportion of practising pharmacists had been threatened and/or assaulted while at work (see p136). The implications of security issues for pharmacists, and how these affect the services they are prepared to offer, are addressed in this paper. Data were collected in semi-structured interviews with pharmacists who had reported one or more threatening or violent incidents.

Many respondents described serious events with lasting psychological effects, including anxiety about their own safety and changed attitudes towards clients. Pharmacists' concerns about personal safety influenced them in their decisions regarding the services they offered. Pharmacists felt vulnerable at opening and closing times and believed that services to intravenous drug users increased the risks of an event; many incidents did actually occur at these times and involve this group of people. Concerns about safety and security affected late-night and out-of-hours dispensing, services to IV drug users and domiciliary visits. More surprisingly, pharmacists also reported effects on their general dispensing and advice-giving activities.

The role of pharmacists in primary health care is becoming more prominent as the Government promotes community based care and encourages individuals to take more responsibility for their own health. Concerns about safety and security could hamper the continuation and development of professional services. The profession must acknowledge the potential impact of these issues in its aspirations and recommendations regarding its future primary care role.
Review of computerised patient medication records to determine potential clinical interventions in community pharmacy
Authors: Hannaoui A , Krass I , Benrimoj S I
Published: February 2011

The potential intervention rate for cardiovascular drugs dispensed in community pharmacy was investigated by a retrospective study of 300 patient medication records (PMRs) collected from 10 community pharmacies in Sydney, Australia. A medication review protocol and operational definitions were developed for 17 types of clinical intervention and three levels of clinical significance. Spearman's correlation coefficient (rs) was used to examine the relationship between total number of potential interventions and predictor variables. From 5,271 medications dispensed, 1,509 (28.6 per cent) potential interventions were identified. The most frequent types of potential intervention were precautions (27.6 per cent), overutilisation (17 per cent) and dose discrepancy (16.3 per cent). Of the interventions classified as being of major clinical significance, 61.3 per cent were precautions, 19.7 per cent drug interactions and 19 per cent contraindications. The cardiovascular drug classes with the highest potential intervention rate were inotropics (93.2 per cent) and anticoagulants (89.5 per cent). There was a statistically significant correlation between the number of potential interventions per patient and the total number of medications dispensed per patient (rs=0.68, P<0.001), the total number of cardiovascular drugs dispensed per patient (rs=0.67, P<0.001) and the number of different prescribing doctors per patient (rs=0.29, P<0.001). This study demonstrates the potential for community pharmacists to review computerised PMRs and intervene in patients' drug therapy, thereby reducing iatrogenic problems and improving health outcomes for patients.
An audit of sodium valproate assays
Authors: Bowhay Stephen
Published: February 2011

Several authors have questioned the usefulness of serum valproic acid analysis in the routine management of patients with epilepsy. This audit assesses the current practice in a Scottish NHS Trust laboratory for requesting sodium valproate assays and the impact of an intervention on the number and “appropriateness” of the assays. A literature search suggested that assays are only of benefit in patients who are poorly controlled despite optimal dosage, where there is suspected toxicity or where compliance is questioned. A retrospective data collection covering a two-year period was performed, followed by a 12-month prospective collection. All sodium valproate assays requested were studied and the reason for requesting them, the assay result and the dose recorded. Throughout both periods the number of other assays was also recorded. Sodium valproate assays were considered “appropriate” if the reason they were requested was poor control, suspected toxicity or doubts about compliance. An arbitrary dose of 2000mg/day was chosen as optimal dosage. Between the two data collection periods an intervention was introduced, namely, the use of two new interpretation comments which reflected the results of the literature search and were used on most of the sodium valproate assays reported. Following the intervention there was a significant fall in the number of valproate assays performed (P = 0.046), an increase in the number of assay results outside the “target range” (P<0.001), a change in the distribution of reasons for the requests (P = 0.030) and an increase in the number of “appropriate” assays (P<0.001).
Preliminary investigation of patient information leaflets as package inserts
Authors: Bandesha G , Raynor D K , Teale C
Published: February 2011

In the United Kingdom, patient information leaflets (PILs) are now supplied with all medicines licensed or re-licensed since January, 1994. This means that, by 1998, all medicines will come with one of these detailed leaflets inside the pack. In a preliminary investigation of the impact of these leaflets, 117 elderly inpatients were questioned on their experience of PILs prior to admission. Ninety-one (78 per cent) said they had received a PIL and 57 (49 per cent) had read one. The main reasons for not reading a leaflet were the perceived difficulty in understanding and being put off by excessive information. Of the patients who had read a leaflet, 23 (40 per cent) reported difficulty in reading the small print and 26 (46 per cent) said they had difficulty understanding the content. Thirteen patients (23 per cent) reported having to seek help with reading a leaflet. Forty-two of those who had read a leaflet rated it as helpful. Eleven patients said they had asked for advice from their doctor or pharmacist as a result of reading a leaflet. Nine patients said the leaflet had caused some anxiety, with two stopping their medicine as a result. The move to universal PILs in patient packs is a major development in the provision of information to patients about medicines. This study suggests that elderly patients have problems relating to understanding the content of PILs and reading the size of print used in these leaflets.
Influencing prescribing in primary care: a collaboration between clinical pharmacology and clinical pharmacy
Authors: Wood Kay M , Mucklow John C , Boath Elizabeth H
Published: February 2011

A study was carried out to determine whether the standard of prescribing in primary care can be improved by a therapeutics advisory service provided by a consultant clinical pharmacologist and a clinical pharmacist.

Audit, feedback, peer review, guidelines, target setting and small group teaching were used to influence behaviour in two fundholding practices: a four partner semi-rural practice in Staffordshire (practice A) and a five partner urban practice in Shropshire (practice B), both of whom paid for the therapeutics advisory service from their practice funds. The main outcome measures were changes in prescribing and disease management.

Practices A and B showed a 62 per cent and 28 per cent compliance, respectively, with recommendations for making financial savings. Blood pressure control improved in both practices, with the proportion of patients with blood pressure readings less than 160/90 mmHg rising from 47 per cent to 65 per cent in practice A, and from 53 per cent to 72 per cent in practice B, over the study period. After an intervention, the percentage of patients with non-valvular atrial fibrillation who were anticoagulated rose from 24 per cent to 57 per cent at practice B. Adherence to guidelines on the use of omeprazole by the two practices occurred in 41 per cent and 42 per cent of prescriptions, respectively, after one year, improving to 58 per cent and 56 per cent after a further year.

The approach of peer group audit, education and clinical pharmacy support was well accepted by the GPs, and early results show it may have led to an improvement in the standard of prescribing.
Pharmacists' quality of learning in a diploma/MSc course in pharmacy practice
Authors: Kostrzewski Andrzej , Dhillon Soraya
Published: February 2011

A rapid expansion of postgraduate courses in pharmacy practice has raised the issue of quality. An understanding of how pharmacists approach their learning is one factor that influences learning outcomes. It would, therefore, be of value to identify pharmacists' approaches to learning. This paper describes the approaches to learning on a postgraduate diploma/MSc course in pharmacy practice. The Approaches to Study Inventory was administered to a total of 103 pharmacists over a period of three years. Overall, the pharmacists demonstrated a high meaning orientation and low reproducing orientation, indicating a high quality of learning. This was supported by a consistently low negative attitude score. The surface approach increased significantly in 1993 and 1994 compared with 1992. This is difficult to interpret but may have been due to increased workload. The use of this instrument in combination with other methods of evaluation has allowed a good database to be built up for designing the future of the pharmacy practice course.
Diarrhoea management by pharmacy staff in retail pharmacies in Hanoi, Vietnam
Authors: Duong Dat , Le Truyen , Binns Colin William
Published: February 2011

A survey was conducted in a sample of 29 pharmacies in the Badinh district of Hanoi, Vietnam, to determine the knowledge and behaviour of pharmacy staff in dealing with cases of acute diarrhoea in children. The survey found that antibiotics and antidiarrhoeal drugs were suggested in the majority of cases (45 per cent and 69 per cent, respectively) while oral rehydration salts (ORS) were suggested in only one case. In about 80 per cent of the observed cases in which antibiotics were supplied, one to four tablets were given, enough for only one to two days. The advice given by pharmacy staff to purchasers was poor. Only about half the pharmacy staff asked for information about the stool, age of the child and frequency of diarrhoea, while questions about medicines that had already been taken, feeding and health status were rarely asked. In about 10 per cent of the cases, no questions at all were asked. The mean cost of the treatment was $ 0.53 (95 per cent CI = 0.37–0.68). Constraints of knowledge, time and finance could be the reasons for this inappropriate management of childhood diarrhoea.
Design of a computer program for automatic capture of adverse drug interaction and contraindication data detected during prescription labelling
Authors: Balon D , Stevens R G
Published: February 2011

This article describes the design of a computer program for the automatic recording and analysis of all potentially harmful incidents identified during prescription labelling after reference to data held in patient medication records (PMRs). Information extracted from the British National Formulary (BNF) is incorporated into the program, which provides warnings of potential drug/drug interactions and drugs contraindicated for patients belonging to particular age groups or suffering from specific clinical conditions or allergies. Individual clinical patient data are stored in patient profiles within the PMRs. Access to the monitoring software is provided by a purpose-built labelling program. Unlike other systems, the program requires the pharmacist to enter information about the action taken in response to any warnings generated before it permits the labelling procedure to continue. Data relating to the warnings and the action taken by the pharmacist are captured automatically and stored for later analysis.
Detection of hazardous drug/drug interactions in a community pharmacy and subsequent intervention
Authors: Stevens Robert G , Balon Derek
Published: February 2011

The interaction data in the British National Formulary were used to create a program which automatically recorded all potentially harmful drug/drug interactions from patient medication records. The program was used in a project pharmacy for 29 months to detect and record major drug/drug interactions.

Analysis of the data from approximately 58,000 prescriptions showed that one in every 80 was written for a drug which interacted with a previously prescribed drug and might have caused a major harmful event. Many of the apparent interactions referred to previously prescribed drugs which were not currently part of the patient's drug regimen. Elimination of non-concurrent pairs still left one potentially hazardous prescription in every 180. Examination of these potential problems and consultation with both prescribers and patients indicated that few changes of prescriptions were required.
Changing medication: general practitioner and patient perspectives
Authors: Wood Kay M , Boath Elizabeth H , Mucklow John C , Blenkinsopp Alison
Published: February 2011

This study, carried out in one fundholding general practice with 9,680 patients, assessed the acceptability to patients and general practitioners of three types of prescribing changes to repeat medication: generic substitution, therapeutic substitution, and changing delivery device. Patients' opinions were sought via a postal questionnaire, face-to-face semi-structured interviews and telephone interviews. Prescribers' views were sought via face-to-face interviews with five GPs and an asthma clinic doctor. The interviews assessed the acceptability of the changes to the patients, and the attitudes of prescribers towards identifying the need for change and carrying it out. Of 78 patients who returned the postal questionnaire following a change from branded to generic medicine, 14 (18 per cent) were “happy” with the change, 48 (62 per cent) were “not bothered” and 12 (15 per cent) were “unhappy” (four did not answer the question). Of 25 patients, interviewed face-to-face, whose prescription for ranitidine had been changed to cimetidine, 21 (84 per cent) were not concerned about the change. Of 15 patients, interviewed by telephone, who were asked to change their asthma delivery device, eight had refused to be changed, one had reverted back and the remaining six were happy with their new delivery device. Interviews with the prescribers showed that they had expected a higher level of resistance and complaints from patients than had proved to be the case. Simple changes to patients' repeat medication are feasible and have a high level of acceptance provided the proposed change is appropriately communicated to the patient.
An investigation into adverse drug reaction monitoring by United Kingdom hospital pharmacy departments
Authors: Green Christopher F , Mottram David R , Rowe Philip , Brown Adrian M
Published: February 2011

Prior to the nationwide introduction of the Committee on Safety of Medicines “yellow card” adverse drug reaction reporting for hospital pharmacists, a study was carried out to investigate the activities undertaken by hospital pharmacists in adverse drug reaction (ADR) reporting. A survey of 200 United Kingdom hospitals was conducted and 172 (86 per cent) questionnaires were returned. Local ADR reporting schemes were in operation in 26 (15.1 per cent) surveyed hospitals. The majority used locally designed cards to report ADRs. The most common reasons for the lack of a local ADR scheme (n=141) were staffing, the fact that a scheme had never been considered, time factors and the lack of perceived need to operate a scheme. Of these 141 departments, 80.1 per cent said they would consider implementing schemes in their hospital. With the inclusion of pharmacists in the CSM “yellow card” scheme, there is an incentive for them to become officially and further involved in the management and reporting of ADRs. Local ADR reporting schemes encourage pharmacovigilance and could allow pharmacists to take a leading role in this area of clinical practice.
HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Survey research: (2) Survey instruments, reliability and validity
Authors: Smith Felicity
Published: February 2011

Social surveys are an important tool in health services research. They have been used in a high proportion of pharmacy practice research studies and in a wide range of settings. Extensive hand searches of published studies has enabled a review of the issues and problems that survey methods present when applied in pharmacy practice and an exploration of how they have been addressed by researchers. It is hoped that the review will enable pharmacy practice researchers to benefit from the experience of their colleagues when conducting their own research. This is the second part of a two-part review of surveys in pharmacy practice research. The first part (IJPP, 1997;5:152) focused on research questions, study design, sampling frames and procedures, response and non-response. This second part discusses the development of survey instruments and the issues of validity, reliability and generalisability.
Pharmacy research: the place of work measurement
Authors: Rutter Paul M , Brown David , Jones Ian F
Published: February 2011

In this review, work measurement techniques involved in establishing what pharmacists do and how they perform their various duties are described. Initially, a comprehensive literature search was undertaken using Medline, Pharmline and Bath Information and Data Services (BIDS). Seven methods of work measurement were found to have been used in pharmacy research. Each method is explained and its applicability to pharmacy research evaluated. Work measurement studies have proved to be of value in analysing individual jobs and quantifying institutional staffing levels. By understanding both the advantages and disadvantages of each method, the pharmacist researcher should be able to choose the most appropriate method for his or her own investigation.
Patient Education in 20 Dutch Community Pharmacies: Analysis of Audiotaped Patient Contacts
Authors: Blom Lyda , Jonkers Ruud , Kok Gerjo , Bakker Albert
Published: February 2011

The level of patient education activity in Dutch community pharmacies was examined. A total of 200 hours' audiotapes of pharmacy patient contacts were collected in a selective sample of 20 community pharmacies. All pharmacists involved were selected on the basis of their interest in developing patient education in their pharmacies. The outcome measure was the percentage of patient contacts which included the provision of oral drug information. Both pharmacists and technicians participated in the audiotapes and their behaviour at the counter was compared. The results demonstrated that the provision of oral drug information was concentrated on contacts where patients collected drugs, and the contents of the information mainly concerned drug instructions. The pharmacists provided significantly more frequent oral drug information than the technicians. No differences were found in the frequency of provision of oral drug information to female and to male patients, or to patients and to relatives collecting the drug. Mostly the oral drug information was given without patients' questioning. The effects of these kind of activities on patients' drugs use are questioned because it is known that efforts to increase patient compliance should meet the educational principles of individualisation. Therefore, the development of patient instruction into patient education remains a challenge to pharmacists in the future.