bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacy practice research in the United Kingdom: which issues should shape future developments?
Authors: Cotter Siobhan M , Mays Nicholas
Published: February 2011

Pharmacy practice research (PPR) is a developing area of research in the United Kingdom. To date, most studies have been carried out in secondary care, although efforts have been made recently to encourage studies in primary care. The quality of PPR is variable and there have been few well-performed studies. It is likely that this has resulted from the relative novelty of PPR and the inexperience of the researchers. Studies have usually been performed on services at a single site and have been carried out in isolation from fellow researchers or university departments with appropriate expertise. Initiatives have been taken within pharmacy to improve the quality of PPR but the resources that are available, and hence the potential for improvement, are limited. In contrast, health services research (HSR) is a relatively well-established area of research in which related topics in the broader areas of health care are considered. Comparable methods could be employed to examine PPR and HSR topics. It is suggested that substantial improvements may be made in the quality of PPR by fostering long-term collaborative ventures between PPR and HSR.
Pharmacist intervention in an elderly care facility
Authors: Bellingan M , Wiseman I C
Published: February 2011

The effectiveness of a pharmacist-initiated drug regimen review (DRR) in reducing the incidence of drug-related problems (DRPs), such as drug interactions, additive adverse effects and duplicate therapy, in the elderly was investigated. The medication profiles of 85 patients aged over 65 years, in an elderly care facility in South Africa, were evaluated for potential DRPs. It was found that 77 per cent of the patients were receiving one or more drugs at a dose exceeding the recommended geriatric dose. Some 68 per cent were receiving six or more drugs. Potential drug interactions and duplicate therapy were identified in 64 per cent and 34 per cent, respectively. A total of 85 pharmacist-initiated recommendations was presented to seven medical practitioners over a period of 16 weeks. Of these, 66 (77.7 per cent) met with the approval of the prescribers. Statistical interpretation of results showed that the incidence of all DRPs declined significantly post-recommendation. The cost benefit of the study was clearly illustrated by a 41 per cent reduction in the incidence of polypharmacy (P<0.01).
The Delphi and nominal group techniques in health services research
Authors: Cantrill J A , Sibbald B , Buetow S
Published: February 2011

This review examines two methodologies that are being increasingly used in health services research (HSR): the Delphi and nominal group techniques. The Delphi is a survey technique for decision making among isolated respondents while the nominal group technique (NGT) is a highly controlled small group process for the generation of ideas. Typical applications of the techniques are for the development of consensus guidelines or standards in areas where research based evidence is absent or inconclusive. We discuss methodological issues associated with these techniques, namely, sample size and composition, response rates, anonymity, feedback and consensus, and reliability and validity. We also illustrate the range of applications of the techniques in HSR, including pharmacy practice. Although not widely used to date, both methodologies are potentially valuable additions to the practice researcher's toolbox.
Dyspepsia treatment guidelines in general practice — an observational study
Authors: McKenzie J , Timoney A , Kirby-Jones S
Published: February 2011

An observational study of prescribing for dyspepsia, in Glasgow, used Scottish Prescribing Analysis (SPA) and Prescribing Information for Scotland Computer Programme (PRISMS) data to monitor the implementation of a set of locally produced guidelines on dyspepsia. The main outcomes measured were the proportion of cimetidine prescribed generically, the ratio of prescriptions for cimetidine and ranitidine, the number of prescriptions for omeprazole per 1,000 patients per month and the total number of prescriptions for tripotassium dicitratobismuthate (De-Nol) per month. The results suggest that the dyspepsia guidelines have been successfully implemented as there has been an increase in the proportion of cimetidine prescribed generically, an increase in the use of cimetidine as the H2 antagonist of choice and an increase in the use of the recommended triple therapy regimen to eradicate Helicobacter pylori infection from patients with peptic ulcer disease. This study shows that consensus guidelines on a common clinical condition can be widely accepted in primary care if appropriately designed, developed and implemented. Their implementation can be followed from routine prescription information.
Assessment of the appropriateness of extemporaneous preparations prescribed in Swedish primary care
Authors: Lindblad Åsa Kettis , Isacson Dag , Eriksson Carin
Published: February 2011

Extemporaneous preparations are drugs that are compounded for individual patients or made in larger batches for stock-keeping. This study aimed to assess the prescribing of extemporaneous preparations in Swedish primary care, both therapeutically and pharmaceutically. An analysis of the extent to which alternative commercial drugs were available at the time of the prescription was also conducted.

Information was taken from the Swedish diagnosis and therapy survey for the time period October, 1986, to September, 1988, inclusive. This survey collects from a random sample of physicians the details of all prescriptions they write during one week, as well as the corresponding diagnoses. The present study analysed the 1,043 extemporaneous prescriptions written during that period.

The majority (62 per cent) were considered to be therapeutically appropriate in that they formed recommended treatment for the diagnosis in question according to the medical literature. Another 15 per cent were neither recommended nor questioned in the consulted sources; 20 per cent were designated as controversial because they were recommended in some sources and questioned in others. About 3.5 per cent were considered to be therapeutically inappropriate, ie, the literature suggested that their use should be abandoned. One per cent were pharmaceutically inappropriate. Many preparations probably could have been replaced by commercial alternatives, about half differing from available commercial alternatives only by strength and/or vehicle. Whether substitutions could have been made in practice would depend on the clinical picture in the individual patient case.
Threatening and violent incidents in community pharmacies: (1) An investigation of the frequency of serious and minor incidents
Authors: Smith Felicity , Weidner Derek
Published: February 2011

The incidence of threatening and violent behaviour in community pharmacy is of concern to pharmacists and their staff, who, if they have not experienced events themselves, will be aware of anecdotal reports and will have their own perceptions about their vulnerability and risks. The frequency of serious and more minor incidents, when and where they occur, is unknown. The concerns of pharmacists may have wide-ranging implications for pharmacy practice and the services pharmacists are prepared to offer. This study was conducted in two stages: a postal survey of all community pharmacies in six family health services authorities in and around London, followed by semi-structured interviews with pharmacists who had reported a threat and/or an assault while at work. This first paper reports an investigation of the frequency and nature of events, pharmacists' perceptions of crime and of their own safety, and the association of these findings with demographic and other variables. The second paper addresses the implications for pharmacists and community pharmacy services.

Fifty-one per cent of respondents reported that they or their staff had at some time been threatened with violence and 31 per cent had been assaulted. Incidents involving knives or firearms comprised about one-fifth of all cases. Approximately one-third of events related to robbery of drugs, supply of prescriptions or non-dispensing pharmacy services and would thus be peculiar to community pharmacy. Therefore the possession of drugs on the premises and other aspects of the professional role of pharmacists places them at increased risk over other retail businesses. Significant minorities of pharmacists did not feel safe in the pharmacy on their own, or undertaking certain everyday activities. Events and concerns were more common in areas with a high Jarman score. Only weak associations were found between whether or not pharmacists reported incidents and personal and other business characteristics.
Insights into the choice between self-medication and a doctor's prescription: a study of hay fever sufferers
Authors: SCHAFHEUTLE E I , CANTRILL J A , NICOLSON M , NOYCE P R
Published: February 2011

Self-medication plays an increasingly important role in the health care systems of many countries. In the United Kingdom (UK) this is reflected in the current policy of deregulating increasing numbers of prescription-only medicines (POM) to pharmacy medicines (P). The purpose of the work described in this paper was to explore factors affecting clients' choice to self-medicate or to contact their doctor for the treatment of a minor ailment, namely, hay fever. Structured qualitative interviews were conducted with 36 clients recruited through community pharmacies. The main themes investigated were clients' reasons for choosing their particular management option and their attitudes towards the increasing number of OTC medicines and towards self-medication. For clients who obtained the medicine through their doctor, the most common reason for doing so was cost. For clients who obtained their medicine over the counter, the incentive to self-medicate was convenience. Payment for or exemption from prescription charges was a major factor. Many clients mentioned potential risks involved in self-medication and the need for appropriate information. However, clients drew differing conclusions on these issues, reflecting either a negative or a positive attitude towards self-medication.
Comparison of attitudes of general medical practitioners and community pharmacists to prescribing matters
Authors: Holden John D , Wolfson David J
Published: February 2011

In order to compare the attitudes of general medical practitioners (GPs) and community pharmacists to a broad range of issues concerning prescribing, a questionnaire was mailed in April, 1994, to all GPs and community pharmacists in contract with a local family health services authority (St Helens and Knowsley), an area covering 350,000 people. Replies were received from 60 per cent of the GPs and 84 per cent of the pharmacists. There was general agreement between the doctors and the pharmacists in their attitudes towards prescribing, and agreement that the quality of prescribing was a legitimate subject of concern for local health authorities. The role of community pharmacists was the main area of disagreement, with the GPs generally being more conservative while the pharmacists favoured a wider role. The professions shared a concern to improve the quality of prescribing, and about one third believed that a substantial amount of prescribing was of poor quality. A substantial minority of each profession had little contact with the opposite numbers from the other profession: 43 per cent of doctors had met a pharmacist fewer than four times in 1993.

We present evidence of general agreement between the professions on a wide range of issues concerning the quality of prescribing in the community. However, if UK pharmacists are to achieve the wider role they and the government desire, the concerns of GPs need to be addressed.
Researching change — methods for community practice research
Authors: Savage I T
Published: February 2011

Most of us wonder what pharmacy practice will look like as the millenium comes round. But how can we study what is happening in our profession? “Researching change” was the theme of the 9th Social Pharmacy Workshop, held at the University of Wisconsin-Madison in America, from August 10 to 14. This report summarises some of the research methods discussed at the conference.
Implementation of a patient-orientated pharmacy service
Authors: Eadon H J , Batty R , Beech E F
Published: February 2011

In 1994, the clinical pharmacy service at Harefield hospital was reorganised: the inpatient population was divided into five groups based on the directorate system and each group allocated to a pharmacist. Each pharmacist became responsible for the provision of a clinical pharmacy service to their group of patients, irrespective of the ward on which the patients were resident. This was a major change from the previous system where pharmacists visited a number of wards and saw all the patients on those wards. The effect of the reorganisation on pharmacists' activities, customers' satisfaction, pharmacists' job satisfaction and the supply of inpatient medication was measured. The change had minimal impact on the majority of parameters measured but significantly increased the time taken by pharmacists to carry out their rounds. The extra time commitment may be justified by the opportunities this method of organisation offers for the development of total pharmaceutical care.
A study of the appropriateness of prescribing in nursing homes
Authors: Lunn Jennifer , Chan Kelvin , Donoghue John , Riley Brian , Walley Tom
Published: February 2011

A study carried out in five nursing homes and 13 general practitioner practices in the North West National Health Service region investigated medicine use in the homes and assessed the extent of inappropriate prescribing using consensus derived criteria. A review of the medical and nursing records of 101 residents showed that they were using a total of 714 items (mean 7.1; range 0 to 15), of which 659 were medicines, including 51 dressings, and 55 were other items such as stoma products. When criteria for inappropriate prescribing were developed and applied, 54 (53 per cent) residents were judged to have one or more inappropriate prescriptions. Medicines most frequently associated with inappropriate prescribing were those for the cardiovascular system (57 per cent of inappropriate prescriptions) and the central nervous system (17 per cent); diuretics accounted for 41 per cent of all inappropriate prescriptions. However, these results may not be representative of the true level of inappropriate prescribing. Of the eight GPs who filled in a questionnaire, five had a system for regularly reviewing drug treatment for nursing home residents; all considered that nursing home residents could benefit if pharmacists were to support GPs by offering advice about individual residents' drug treatment.

Elderly residents in nursing homes are at high risk of inappropriate prescribing. A role for pharmacists in the monitoring of individual residents' prescriptions, in academic detailing or in guideline development could help in improving the quality of prescribing for nursing home residents.
Role of pharmacies and general practitioners in the management of dermatological conditions
Authors: Kilkenny Monique , Yeatman Josephine , Stewart Kay , Marks Robin
Published: February 2011

Interviewers in the three community pharmacies in Maryborough, Central Victoria, Australia, collected data over four weeks from 830 people obtaining 1,011 skin related products. At the same time, the general practitioners in the area recorded all patients seen with skin related conditions, the management they required and the diseases for which they were treated. Over 70 per cent of the products obtained were non-prescription items, the sources of recommendation for these being pharmacy staff (39 per cent), family (27 per cent), medical practitioner (19 per cent) and other sources (15 per cent). Purchasers of one-third of the OTC products had already sought advice at some stage from their medical practitioner; 57 per cent of these products were subsequently bought on advice from sources other than their medical practitioner. For 34 per cent of the OTC purchases the consumers had described their symptoms to pharmacy staff, and in one third of these the consumer had at some stage seen a medical practitioner about the condition. Of those who described symptoms within the pharmacy, 55 per cent were seen only by a pharmacy assistant, the remainder being seen at some stage by the pharmacist. More consumers with inflammatory skin diseases purchased an OTC product from a pharmacy than visited their GP. All people with suspected neoplasms consulted a GP rather than a pharmacist. Education programmes are required to ensure that pharmacists have adequate knowledge of the conditions for which OTC skin products are available. Public education is required to ensure that consumers who seek advice for skin disease in the pharmacy do so from the person in that environment who is appropriately qualified to give it.
Pharmacists' perceptions and experiences of pharmacy protocols: a step in the right direction?
Authors: Cantrill J A , Weiss M C , Kishida M , Nicolson M
Published: February 2011

A postal questionnaire to 300 pharmacists in Lancashire, investigating community pharmacists' perceptions of the usefulness of medicine sales protocols, was completed by 138 (46 per cent). Almost all of the respondents (96 per cent) stated that they used protocols in their place of work. Of the 95 respondents who indicated the frequency with which customers were unwilling to answer questions, 94 per cent stated this frequency was at least one in every 10 customers. Examples of customers who were sometimes unwilling to answer questions included some who had used the medicine previously, some with a condition of a sensitive nature and some purchasing on behalf of a third party. Although the majority of respondents were positive towards the impact and future development of protocols, 37 felt protocols required modification and greater flexibility. Comments suggested that protocols could both enhance the professional image of pharmacy and be professionally restrictive. Protocols should be developed which reflect both the patient, as well as the professional, perspective.
Identification and costs of prescriber-defined repeat prescribing
Authors: Davidson William , Collett John H , Jackson Clive , Rees Judith A
Published: February 2011

The use of different definitions of repeat prescribing has, understandably, resulted in different published values of both numbers of prescriptions and their costs. One possible way of determining the number of repeat prescriptions would be to allow prescribers to self-identify prescriptions at source. However, the cost of repeat prescription items only becomes a tangible cost if, and when, the patient has the prescription dispensed. The aim of this work was to allow prescribers from six general practices in one family health services authority to self-identify repeat prescriptions. Only those prescriptions presented for dispensing were analysed and costed. Out of a total of nearly 54,000 prescription items, 29.4 per cent were identified as repeats; they accounted for 32.2 per cent of the total cost of the prescriptions. Overall, the average cost of repeat prescription items was higher than that for new prescription items.

The approach used in this work is a novel method of identifying, quantifying and determining the extent and costs of repeat prescribing in a study population. The limitations of the method are discussed.
In vitro evaluation of the complexation of non-steroidal anti-inflammatory drugs with caffeine
Authors: Gerber Jan J , Villiers Melgardt M , Toongsuwan Siriporn , Liebenberg Wilna
Published: February 2011

The complexation of five non-steroidal anti-inflammatory drugs (NSAIDs) with caffeine was evaluated. Mixtures were prepared by powder mixing, trituration in a mortar with a pestle and recrystallisation from a common solvent. The properties of the mixtures and the recrystallised materials, evaluated by differential scanning calorimetry (DSC) and dissolution rate measurements, differed significantly (P<0.05). Disappearance of peaks in DSC thermograms, or lowering of melting points of the NSAIDs in NSAID-caffeine co-precipitates were ascribed to the complexation of caffeine with the NSAIDs. The dissolution rate of ketoprofen was not affected by the addition of caffeine but the dissolution rates of ibuprofen, mefenamic acid, naproxen and indomethacin were significantly enhanced (P0.05) after being co-precipitated, or mixed in a mortar or V-blender, with caffeine. Higher dissolution rates, because of the complexation of caffeine and the drugs in solution, could translate into changed bioavailability and different pharmacokinetic parameters.

Less gastrointestinal irritation and quicker onset of required blood levels might improve the efficacy of NSAIDs, a factor that, if confirmed, should be considered when prescribing these drugs to patients.
Opinions and practices with regard to confidentiality in French hospital pharmacies
Authors: Auguste V , Guerin C , Hazebroucq G
Published: February 2011

During the past 10 years, the profession of hospital pharmacy has undergone radical changes in France. These include changes in laws and regulations, the development of activities related to clinical pharmacy and direct contact with patients. Situations now arise where the pharmaceutical team has access to personal data and is confronted with problems concerning confidentiality.

An inquiry designed to highlight the problems and study pharmaceutical practice was conducted by interviewing 15 hospital pharmacists. The interviewees represented a variety of grades and came from hospitals of different sizes, with different specialisations. Although the small number of interviewees did not allow us to draw quantitative conclusions, their replies were of great interest. The work shows the need to revise present practice in order to preserve confidentiality. Such revision calls for collective discussion and decisions, based on the pre-eminence of ethics respecting the individual. This investigation forms a preliminary phase for a more ambitious larger scale investigation.
HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Survey research: (1) Design, samples and response
Authors: Smith Felicity
Published: February 2011

Social survey methodology is the most widely used approach by pharmacy practice researchers, accounting for a higher proportion of published papers than any other. Survey techniques have been used to address a range of research objectives in a variety of populations and settings.

Extensive hand searches of published survey research have enabled a review of the issues and problems that social survey research presents when applied in pharmacy settings, and an exploration of how they have been addressed. This review is in two parts. This first part focuses on the research questions that have been addressed by survey methods, design of the studies, sampling frames and procedures, response rates and management of non-response. A second paper will discuss the development of survey instruments, and the issues of validity, reliability and generalisability.
Drug pushers or health care professionals: the public's perceptions of pharmacy as a profession
Authors: Varnish John
Published: February 2011

This study explores the extent to which consumers view pharmacy as a fully fledged profession that commands and fulfils a legitimate role in the primary health care team, or alternatively as just another retailer in the high street who happens to sell drugs instead of newspapers.

The data were generated through the use of five focus groups involving a total of 23 participants. These group discussions were tape-recorded and transcribed. The resulting data were analysed using the definitions of “professions” and “professionalisation” as found in the sociological literature. The results may be seen by the profession as very encouraging. While there are a few grey areas in the lay public's understanding of pharmacy, the overall feelings expressed were ones of recognition of the profession, understanding of its area of expertise, and support for the role it is playing.
Reviewing Repeat Prescribing — General Practitioners and Community Pharmacists Working Together
Authors: Goldstein Ruth , Hulme Helen , Willits Judy
Published: February 2011

In the United Kingdom, patients receiving medication to treat chronic conditions frequently obtain treatment via repeat prescriptions. This reduces the workload of general practitioners (GPs) but increases the potential for patients to receive inappropriate and unnecessary medication over long periods of time. The aim of this project was to determine the potential role that community pharmacists could fulfil in reviewing and rationalising medication received on repeat prescriptions. Volunteer pharmacists and general practitioners in two health authorities in England formed 47 GP-pharmacist partnerships. Each GP identified up to 50 patients receiving six or more “repeat” medicines. Pharmacists reviewed GP notes and record systems to identify potential problems. Discussions addressing the identified problems and possible solutions were held between the GP-pharmacist partners. Three months later the pharmacists revisited the surgeries to review GP notes to determine whether changes had occurred. On completion of the project, focus groups were held with participating GPs and pharmacists to ascertain their views on the project. In total, repeat prescriptions for 1,564 patients were investigated which resulted in 13,194 medicines being reviewed. The pharmacists identified 9,762 potential “problems” of which the most common were: drugs no longer required, inappropriate quantity ordered, and unsatisfactory directions. The GPs agreed with 58 per cent of identified problems and acted upon 56 per cent of these (32 per cent of the original total). In general, the involvement of pharmacists was beneficial in terms of rationalising prescribing and reducing possible drug interactions and adverse drug reactions resulting from multiple supplies of potentially inappropriate and unnecessary medication. Furthermore, pharmacists were able to rationalise patients' supplies to help improve the actual management of medication in terms of ordering and collecting supplies and coping with complex daily regimens.
Personal learning outcomes of structured work-based learning in a summer vacation work placement in community pharmacy
Authors: Rees J A , Collett J H , Crowther I , Mylrea S
Published: February 2011

If work-based learning is to become an acceptable and accredited part of an undergraduate course, it is essential to incorporate assessment methods in order to measure the students' learning outcomes. Learning outcomes can be subject based or personal. The development of intra- and interpersonal skills by students as a result of work-based learning would lend credit to such learning. This paper describes the methods used to assess the development of students' personal learning outcomes as a result of participation in structured work-based learning activities in a vacation training programme in community pharmacy. Overall, quantitative and qualitative results show that, during work-based learning, the students were able to develop personal skills such as communication, teamworking, motivation, confidence, professional attitudes and decision making. The development of some of these skills would be difficult to achieve in the academic environment.
Preliminary findings from an economic analysis of nurse prescribing
Authors: Ferguson Brian , Luker Karen , Smith Kirsteen , Austin Lynn , Hogg Cath
Published: February 2011

A study was carried out to examine the economic and qualitative aspects of nurse prescribing for patients, carers, nurses and other health care professionals. The design was a case study, without controls or randomisation, and involved patients, nurses, general practitioners and other health care professionals in GP fundholding practices, one in each region of England, that were designated by the Department of Health as demonstration sites for nurse prescribing. This paper reports the data from the economic analysis. The main outcome measures were changes in the frequency and cost of prescribing compared with a range of scenarios, and the impact on health professionals' time.

There was no evidence to suggest that prescribing costs in the eight demonstration sites increased more than they would have done in the absence of nurse prescribing. It is relatively safe to conclude that the impact on prescribing costs in those sites was neutral. The range of uncertainty around the first-year costs in the demonstration sites is nevertheless high, in the order of £240,000.

Further work is required to identify the economic impact of nurse prescribing with a larger sample of practices, to assess whether prescribing costs will be contained (preferably in relation to a control sample) and whether notional time savings are cash-releasing. Research is also needed to shed light on questions of appropriateness and effectiveness of prescribing.
Shared care: a study of patients' experiences with erythropoietin
Authors: Ashcroft Darren M , Clark Christine M , Gorman Sean P
Published: February 2011

A study was carried out to evaluate the impact of a shared care scheme on patients receiving erythropoietin treatment. A structured, self-administered questionnaire was given to adult patients receiving recombinant human erythropoietin. Completed questionnaires were received from 86 of 119 patients (72 per cent). Thirty respondents reported problems with administration. Reports of pain were significantly higher from those patients receiving Eprex than those using Recormon (P = 0.01, χ2 test). Doses were missed occasionally by 27 patients (31 per cent) and frequently by two patients. Supply problems had resulted in missed doses for 15 respondents (17 per cent). Eleven patients claimed that their general practitioner (GP) had not been aware of dosage adjustments initiated at the hospital. Thirty respondents (35 per cent) stated that they would like to speak to a pharmacist about their treatment.

In conclusion, the shared care scheme was effective and practical for most patients. However, some difficulties were identified. Problems involved administration, concordance, supply, and communication of dosage adjustments. Furthermore, there was a general lack of information about the treatment among many patients.
Medicines counter assistants: roles and responsibilities in the sale of deregulated medicines
Authors: Ward Paul R , Bissell Paul , Noyce Peter R
Published: February 2011

The work reported here aimed to quantify the involvement of medicines counter assistants (MCAs) in the United Kingdom in the sale of deregulated medicines and to provide insights into their role and experiences in this process. Non-participant observation for five days in each of 10 community pharmacies was used in conjunction with interviews and focus groups with MCAs working in these pharmacies. It was found that MCAs dealt with 84 per cent of the deregulated medicines requested, without the formal involvement of a pharmacist. MCAs dealt with 96 per cent of requests for aciclovir, and 100 per cent of requests for cetirizine, Canesten Combi, famotidine, hydrocortisone cream and topical ibuprofen without the intervention of a pharmacist. MCAs viewed themselves as front-line health care workers carrying out an important role in consumer care. However, in instances where difficulties were encountered during an MCA-consumer interaction, MCAs knew and appreciated that they had the backup of a pharmacist to whom to refer. MCAs identified a number of dilemmas which impinged on their ability to ask questions and provide advice to consumers requesting deregulated medicines. Given these findings, the current role, workload and experiences of MCAs merit more attention than has hitherto been accorded in pharmacy practice and health services research.
The long-term learning effect of training in stage of change for smoking cessation: a three-year follow up of community pharmacy staff's knowledge and attitudes
Authors: Sinclair Hazel K , Bond Christine M , Lennox A Scott
Published: February 2011

Objective

A randomised controlled trial has already demonstrated that a training workshop on smoking cessation counselling for pharmacists and their assistants, based on the stage of change model, had a positive effect on the knowledge and attitudes of pharmacy personnel for at least a year, and was associated with increased and more useful counselling, and higher smoking cessation rates. An extension of the study aimed to monitor the duration of the training effect and so help to determine the optimum time span for refresher training. This paper reports the results of two further annual follow-ups.

Method

A previously developed and validated self-completion questionnaire assessing knowledge and attitudes was re-administered to intervention and control personnel at 24 and 36 months. One hundred and thirty-four questionnaires were completed at 24 months (85 per cent response rate) and 124 (83 per cent) at 36 months.

Setting

Community pharmacies in Grampian, Scotland, United Kingdom.

Key findings

The training had a significant effect on knowledge for at least three years, since at both 24 and 36 months the intervention pharmacy teams had a significantly greater knowledge and understanding of the model than the controls (24 months, P=0.0001; 36 months, P=0.031). At 24 months, the intervention pharmacy teams were significantly more confident in their ability to counsel smokers (P=0.021) and were more positive about the outcome of smoking cessation counselling provided in community pharmacies (P=0.043). These attitudinal differences were no longer statistically significant at 36 months.

Conclusion

This study has demonstrated the long-term benefit of the stage of change training over a three-year period, for both community pharmacists and their staff, on knowledge and attitudes.
National and local guidance on services for drug misusers: do they influence current practice?— results of a survey of community pharmacists in South East England
Authors: Sheridan Janie , Strang John , Lovell Selena
Published: February 2011

Objective

To investigate levels of awareness of national and local guidance about services for drug misusers and their effect on pharmacy practice.

Method

A postal survey in 1997 to collect data on current involvement in services for drug misusers, awareness of and receipt of key documents pertaining to drug misuse, effects of guidelines and protocols on practice, and influences on decisions to provide services.

Setting

A random one in two sample (n=1,582) of community pharmacies in the South East of England (North and South Thames regions).

Key findings

A 65.1 per cent response rate was achieved. Just over half (54.7 per cent) were dispensing Controlled Drugs for the management of dependence, 47.2 per cent were selling clean injecting equipment and 15.5 per cent were offering a needle exchange service. Most respondents were unaware of key government documents, with the exception of “Health of the nation,” and only a small minority had received copies. The most influential factors on current position on service provision were “personal experience,” “local need” and “Royal Pharmaceutical Society of Great Britain (RPSGB) policy.” New local guidelines and initiatives mainly related to supervised consumption of methadone in pharmacies and pharmacy needle exchange.

Conclusion

Community pharmacies are substantially and increasingly involved in providing*** primary care services for drug misusers. However, there is a disturbing lack of awareness of key government initiatives, possibly due to the lack of dissemination of such documents. RPSGB policy as a key influencing factor points to an opportunity for the profession to take a more influential position.
The cost-effectiveness of intensive pharmaceutical intervention in assisting people to stop smoking
Authors: Sinclair Hazel K , Silcock Jonathan , Bond Christine M , Lennox A Scott , Winfield Arthur J
Published: February 2011

Objective

To assess the cost-effectiveness of intensive pharmaceutical intervention in assisting people to stop smoking.

Method

A randomised control trial was used to evaluate training of pharmacy personnel based on the “stage of change” model. All 76 non-city community pharmacies registered in Grampian were invited to participate. All intervention personnel were invited to attend the training. Control and intervention groups then recruited clients over a 12-month period. Detailed records were kept of the costs borne by the health service, pharmacies and clients. The effectiveness of the training was assessed by comparing the smoking cessation rates of the two groups at one, four and nine months.

Setting

Community pharmacies in the Grampian region of Scotland.

Key findings

Sixty-two pharmacies (82 per cent) were recruited. The training was undertaken by 94 participants (40 pharmacists, 54 assistants). A total of 492 clients (224 intervention, 268 controls) was recruited. Assuming that non-responders had lapsed, intervention subjects tended to be more likely than control subjects to report not smoking at each follow up. As reported previously, one-month point prevalence was 29.9 per cent intervention and 23.6 per cent control (P=0.12); four months' continuous abstinence was achieved by 16.1 per cent in the intervention group and 10.9 per cent of controls (P<0.094) and nine months' continuous abstinence by 12.0 per cent in the intervention group and 7.4 per cent of controls (P<0.089). The cost of producing one additional successful attempt to quit smoking by using intensive rather than standard pharmaceutical support was £300.

Conclusion

The intervention was associated with higher smoking cessation rates, confirming that community pharmacy personnel have the potential to make a significant, cost-effective contribution to smoking cessation.
Health Services Research Methods In Pharmacy
Authors: Smith Felicity
Published: February 2011

The aim of this paper is to review the methodologies employed by health service and pharmacy practice researchers in the evaluation of pharmacy services. The review is in two parts. Part 1 discusses the application of different study designs and frameworks in the evaluation of existing and innovative services and interventions; part 2, to be published in a later issue, will address the methods and measures employed in the evaluation process. The studies included in this review were selected to give examples of different study objectives, designs and frameworks and their application in pharmacy settings. Although many of the issues regarding study design and evaluation frameworks may be relevant to clinical trials comparing the efficacy of alternative drug therapies, the focus of this paper is on pharmacy services.
Patient awareness of the adverse effects of aspirin and non-aspirin non-steroidal anti-inflammatory drugs
Authors: Wynne H A , Dorward M
Published: February 2011

Objective

To determine the extent to which patients reported having been informed about the adverse effects of aspirin and non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs)

Method

Questionnaire survey of 26 patients who had suffered an acute gastrointestinal bleed while taking aspirin, and 100 patients who had suffered an acute gastrointestinal bleed while taking a non-aspirin NSAID

Setting

Admissions to three United Kingdom hospitals. Patients were identified from endoscopy clinic records

Key findings

Five (19 per cent) of the aspirin-treated patients and 45 (45 per cent) of the non-aspirin NSAID-treated patients remembered having been informed of potential adverse effects, an odds ratio of 3.4 (95 per cent confidence interval 1.2–9.8, P<0.05). Five (19 per cent) of the aspirin-treated patients recalled having been advised what to do should adverse symptoms develop, whereas 44 (44 per cent) of the non-aspirin NSAID-treated patients did so, an odds ratio of 3.3 (95 per cent CI 1.2–9.5, P<0.05). Three (12 per cent) of aspirin-treated patients reported having been given an information leaflet, whereas 29 (29 per cent) of non-aspirin NSAID-treated patients did so, an odds ratio of 3.1 (95 per cent CI 0.9–11.2, P=0.08)

Conclusion

Our results suggest that aspirin-treated patients are less informed about their drug than are patients taking non-aspirin NSAIDs, in spite of the risk of gastrointestinal bleeding with which aspirin is associated
Developing and evaluating a model for pharmaceutical care in Australian community pharmacies
Authors: March Geoff , Gilbert Andrew , Roughead Elizabeth E , Quentrell Neil
Published: February 2011

Objective

To develop and evaluate a medication management service. The service was based on the principles of pharmaceutical care and targeted patients at risk of medication misadventure, primarily elderly patients, in five community pharmacies.

Methods

In phase one, pharmacists defined the service in consultation with consumers, medical practitioners and professional pharmacy organisations. Agreed characteristics of the service were: patient selection criteria, a structured patient care process, systematic documentation, a quality assurance process and a complementary relationship with services of other health professionals. Implementation and evaluation of the service occurred in the second phase. The service was provided over an 11-month period to 205 patients.

Key findings

Of the patients who received the service, 179 (87 per cent) had one or more medication or health-related problems. Pharmacists identified a total of 526 problems. Follow-up was available for 432 problems and 75 per cent of these problems were well managed by the end of the study. Of the 115 consumers surveyed, 74 responded. Eighty-five per cent of respondents believed the service had made a “significant” or “great” contribution to their health and 64 per cent thought that their knowledge of their medication had improved. Health economic evaluation indicated that net cost benefits were delivered to the health system. The net annual cost savings per patient ranged from $A40 to $A311.

Conclusion

Pharmacists were able to apply the principles of pharmaceutical care to meet the needs of at-risk consumers in the community. Further development of this service delivery model is under way and would appear to offer substantial advantages to consumers and the health system.
Adverse drug reaction monitoring by United Kingdom hospital pharmacy departments: impact of the introduction of “yellow card” reporting for pharmacists
Authors: Green Christopher F , Mottram David R , Rowe Philip H , Brown Adrian M
Published: February 2011

Objective

To assess the impact of the introduction of hospital pharmacist “yellow card” adverse drug reaction (ADR) reporting on the operation of local schemes.

Method

Prepiloted postal questionnaire sent to hospitals in 1998 following up a previous survey two years earlier.

Setting

Clinical services managers for 200 hospital pharmacies that had been randomly selected for the previous survey.

Key findings

One hundred and fifty usable questionnaires (75 per cent) were returned. Twenty-eight departments (18.9 per cent), compared with 26 departments (15.1 per cent) in 1996, operated ADR reporting schemes. Of a total of 440 local ADR reports made to participating departments, 70.0 per cent (312) were forwarded to the Committee on Safety of Medicines, a significantly higher percentage than the 14.9 per cent in the previous study (P=0.001). Only eight hospitals (5.4 per cent) had schemes for monitoring newly marketed or “black triangle” drugs. Ninety-four departments (62.3 per cent) had supported education and training activities. Of the hospitals without a scheme, 15 (12.5 per cent) said they had definite plans to introduce one in their hospital, 40 (33.3 per cent) had probable plans to introduce one and 65 (54.2 per cent) had no such plans.

Conclusion

Pharmacists' involvement in the CSM yellow card scheme appears to have had little impact on local initiatives. In areas where these local schemes have been implemented and educational activities provided, drug information pharmacists appear to have a significant role. From the results of this study, even in hospitals with local or in-house schemes, gross under-reporting of ADRs remains a major problem.
Motivations for and barriers to community pharmacy services for drug misusers
Authors: Matheson Catriona , Bond Christine M
Published: February 2011

Objective

To investigate what motivated pharmacists to provide drug misuse services and, conversely, what barriers prevented service provision.

Method

Telephone interviews were conducted with a purposive sample of 45 volunteering respondents to a national questionnaire survey to gain in-depth information.

Setting

Forty-five community pharmacists in Scotland.

Key findings

Pharmacists were found to be motivated to provide services by an awareness of the needs of the community, a desire to reduce the spread of blood-borne diseases and a desire to expand their professional services. Barriers to service provision were concerns for the effect on other customers, safety, workload and poor remuneration.

Conclusion

The active encouragement of local health boards, professional endorsement, further education and remuneration might encourage pharmacists' participation in drug misuse services. This would enable the principles of harm reduction to be widely practised.
Qualitative insights into general practitioners' views on the appropriateness of their long-term prescribing
Authors: Cantrill Judith A , Dowell Janey , Roland Martin
Published: February 2011

Objective

To explore factors which may contribute to inappropriate long-term prescribing in United Kingdom general practice.

Methods

Nine previously validated indicators of the appropriateness of long-term prescribing were applied to a sample of patients, each under the care of one of 22 general practitioners from 10 practices. The GPs were then interviewed, using as the basis for the discussion specific examples of their prescribing that had been identified as potentially inappropriate. The interview transcripts were studied repeatedly to identify key themes in the reasons or explanations for apparently inappropriate prescribing.

Setting

General practices in three health authorities in England and one health board in Scotland.

Key findings

In total, 227 instances of potentially inappropriate prescribing, relating to 101 patients, were discussed with the 22 GPs. Four key themes emerged from the interview data. One common theme was that of perceived patient preference to continue with long-term therapy. A second theme was cases where the prescribing was “historical,” ie, the drug had been started a long time before, or by another doctor. Within this context, many doctors expressed great reluctance to change a drug when there was no obvious clinical need to do so, even though they would not initiate the drug regimen within their current practice. A third theme was that “hospital-led” prescribing was perceived to pose frequent and sometimes potentially difficult problems. Fourth, many GPs expressed their unease with the process of repeat prescribing which is operated in many UK practices.

Conclusions

This study has reinforced the fact that there are a number of internal and external factors which can impact on a GP's decision to continue apparently inappropriate long-term prescribing.