bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacists' and physicians' perception of antibiotic policies in New South Wales public hospitals
Authors: Adu Ammishaddai , Simpson Judy M , Armour Carol L
Published: February 2011

Background

The potential of antibiotic policies in hospitals to improve antibiotic use depends on the compliance of practitioners with these policies. It is conceivable that the way the policies are perceived by practitioners can influence their compliance.

Objective

To determine the perception and awareness of pharmacists and physicians of their current hospital antibiotic policy.

Setting

Public hospitals in New South Wales, Australia.

Method

Pharmacists and physicians were surveyed using a structured questionnaire seeking the extent of agreement or disagreement with a series of statements about their hospital's antibiotic policy. All hospitals had at least one antibiotic policy. A simple one-stage cluster sample of 241 pharmacists and a two-stage cluster sample of 701 physicians were obtained. Factor analysis was used to identify the dimensions of perception. General linear modelling was used to investigate the effects of predictor variables on outcome variables.

Results

The response rates were 91 per cent and 77 per cent for pharmacists and physicians, respectively. The proportion of respondents who were aware of their hospital's antibiotic policy was 86 per cent (190/220) for pharmacists and 61 per cent (332/542) for the physicians. Factor analysis identified three factors related to how practitioners perceived their current hospital's antibiotic policies. These were: the usefulness of antibiotic policies (utility), how the policy was applied in the hospital (application) and the perceived problems associated with the policy (problems). Pharmacists were significantly more likely than physicians to perceive problems with antibiotic policies and how the policies were applied.

Conclusion

The level of practitioners' awareness of their hospital's antibiotic policy and pharmacists' perception of problems with such policies need to be addressed if these policies are to make a significant contribution to improved antibiotic use in hospitals.
A preliminary investigation into customers' perceptions of the image of retail pharmacies in South Africa
Authors: Truter I , van Niekerk W P
Published: February 2011

Background

The work scope of retail pharmacists in South Africa has changed considerably over the past few decades. A retail strategy is needed to adapt to these changes and challenges. One of the controllable variables of a retail strategy is store image. For a retail pharmacy, store image consists of factors relating to the pharmacist and factors relating to the pharmacy.

Objective

The primary aim of the study was to investigate the image of retail pharmacists and pharmacies in Port Elizabeth, South Africa, in an attempt to supplement knowledge regarding the business aspects of retail pharmacy and to provide a model for a further and more detailed investigation into image research.

Method

Empirical survey consisting of telephone interviews with pharmacy customers. A structured questionnaire was used to investigate the image of pharmacists and pharmacies.

Setting

The study was undertaken in Port Elizabeth, South Africa. Two hundred customers from four different pharmacies were selected using systematic random sampling.

Key findings

It was found that pharmacists and pharmacies had an exceptionally favourable image among the general public. The professional element contributed greatly to this positive image.

Conclusion

The future will require a delicate balance between the professional and business aspects of retail pharmacy, and this aspect should be investigated further. A more detailed study into customers' perceptions of the image of retail pharmacists and pharmacies is necessary to determine how the image of pharmacy as a profession is changing.
Pharmacist medication history interview of elderly patients in a teaching hospital in Nigeria
Authors: Babalola Oladipo O , Erhun Wilson O
Published: February 2011

Objective

To explore communication patterns between hospital pharmacists and elderly patients during medication history interviews.

Method

Medication history interviews conducted by four hospital pharmacists were audiotaped and videotaped. A transcript was constructed for each interview comprising the words spoken, supplemented by noted observations of non-verbal behaviour from the videotapes. Twenty transcripts were coded and analysed using the socio-linguistic model of communication.

Results

Misconception of speech events was found to be an important source of conflict in the pharmacist-patient relationship. Miscommunication occurred most frequently in the acoustic, lexicon and conception areas.

Conclusion

Pharmacists' communication skills with the elderly must be developed for effective interaction about medication use.
“I've not asked him, you see, and he's not said”: understanding lay explanatory models of illness is a prerequisite for concordant consultations
Authors: Pollock Kristian
Published: February 2011

Method

An extended qualitative analysis of a single case.

Objective

To illustrate the complexity of patients' explanatory models and their significance in underpinning experience of illness and response to disease.

Key findings

The case demonstrates how lack of professional awareness and understanding of patient models limits the capacity to provide effective health care and reduces patients' ability to cope with the experience of illness or to participate constructively in the management of disease. The distance between patients and health professionals is likely to increase, as also is the rate of “non-compliance”, if laypeople continue to become increasingly well informed outside the consulting room, but retain the traditional role of passive and acquiescent patient within it. Concordant consultations are characterised by attention to the patient's illness as well as disease. It is not enough that technical issues and disease problems should be dealt with. The patient's subjective experience of symptoms, and the personal significance of his or her illness should be set out. The interpretation of meaning should be a collaborative endeavour involving both doctor and patient. Increased professional awareness of patient models of illness and associated concerns could be an important lever in changing the culture of the consultation.

Conclusion

Concordance offers a way of developing a more equal and meaningful relationship between patients and professionals and of generating more positive outcomes in medical consultations as a result.
Delivering domiciliary pharmaceutical care from a health centre pharmacy
Authors: Coleman David J , Portlock Jane , Brown David
Published: February 2011

Aim

To develop and administer a pharmacist domiciliary visiting programme from a community pharmacy based in a health centre.

Design

Prospective cohort with peer professional intervention assessment and patient feedback questionnaires.

Subjects and setting

Total general practitioner surgery list (4,922 patients) in an urban residential area. Candidates were defined by three inclusion criteria: 65 years or older taking five or more repeat medicines (polypharmacy); any age plus polypharmacy plus significant disablement; 80 years or older taking three or more specified medications on repeat prescription.

Outcome measures

Interventions made during a programme of three visits for each patient; peer assessment of impact on patient care and cost by the three surgery GPs and three clinical pharmacists; patients' perceived worth of the service; cost of the service.

Results

One hundred patients (2 per cent) were visited over a period of six months; 74 completed the three-visit programme that involved a total of 256 visits. There were 160 interventions classified as: medicines management issues (88), health beliefs and concordance (41) or therapeutic problems, including adverse effects (31). Nineteen patients required specific and detailed collaboration with the patient's GP. There was good agreement on the utility of the pharmacist's interventions at this level with only four negative assessments out of a possible 114 (3.5 per cent). The programme was well received by patients. Talking to a pharmacist (as opposed to another health care professional) about their medicines was important to 70 of 74 patients. Sixty-one described their reaction to the visiting programme using one of three positive adjectives, “relieved,” “reassured” or “grateful”. Based on this cohort, the estimated costs to the pharmacy were £5,000 per annum, equivalent to 33 working days. Cost savings based on outcomes were not estimated.

Conclusions

This study demonstrated the feasibility of identifying candidates for domiciliary care from surgery records using carefully selected inclusion criteria. This is likely to encompass between 2 and 3 per cent of a surgery population. The visiting programme, which was well received by patients, had a favourable effect on patient care in the majority of the cohort and a very important impact in a minority (19 per cent). This success required the commitment of all members of the health centre team. It benefited from the proximity of the visiting pharmacist to medical records and prescribers.
Prescription medication use practices among non-institutionalised older persons
Authors: Thompson Sally , Stewart Kay
Published: February 2011

Objective

To investigate the prescription medication use practices of a sample of non-institutionalised older persons and to determine any differences with age (65–74 years versus 75 years and over).

Method

Data were gathered via 204 detailed in-home interviews, completed between March, 1993, and November, 1995. Respondents were identified through general practitioners (GPs). Practice patterns investigated included routines to assist with remembering when to use regular prescription medication, alterations to prescribed regimens, the borrowing and lending of prescription medication and patterns of prescription medication storage.

Setting

The study was conducted in Melbourne, Australia.

Key findings

Most respondents were found to have well-defined routines to assist with remembering when to use their prescription medication and in almost two-thirds of cases this was to use the medication with a meal. Almost a quarter of respondents said that on at least one occasion over the past few years they had intentionally used a lower dose of a medication than was prescribed and slightly less than one in 10 had intentionally used a higher dose. Less than one in 10 respondents admitted to having borrowed prescription medication on at least one occasion; almost double that number had lent medication. Most respondents stored their prescription medication appropriately, usually in the kitchen. Only 10 per cent of respondents were found to have more than three additional packs of the prescription medication they currently used. The hoarding of older medications was not uncommon; 42 per cent had prescription medication they no longer used. No differences in practice patterns were found with age.

Conclusion

Previous concerns about widespread poor quality use of medicines among non-institutionalised older persons were not generally supported by the findings of this study. However, the problems detected emphasise the need for vigilance. GPs and pharmacists could further promote the quality use of medicines among older persons through closer monitoring and review of prescription medication. Older persons need to be encouraged to discuss medicines and/or doses they feel are in some way inappropriate with their GP or pharmacist. Pharmacies should be promoted as places where unwanted or out-of-date medications can be taken for disposal.
Economic evaluation of a standard dosage system for an outpatient breast cancer chemotherapy regimen
Authors: Stringer N J , Fitzpatrick R W , Brunt A M
Published: February 2011

Objective

To develop and validate a standard dosage system for use with the cyclophosphamide, methotrexate and 5-fluorouracil (CMF) breast cancer chemotherapy regimen, and to conduct a pharmacoeconomic evaluation of the standard dosage system in the outpatient clinic.

Method

The standard dosage system was developed using data collected retrospectively from patients treated with the CMF chemotherapy regimen. The objective was to establish a standard dosage system that did not vary from individually calculated doses by more than 5 per cent, which was considered clinically to be of no significant consequence. The pharmacoeconomic evaluation involved a control and study period. Outcome measures were time taken for patients to progress through the clinic, time taken to dispense a prescription, and number of pharmacy staff involved in the process.

Setting

Two outpatient clinics in the chemotherapy unit at a large district general hospital in the West Midlands region of England.

Key findings

It is possible to develop a clinically acceptable standard dosage system for use with the CMF chemotherapy regimen. Doses of chemotherapy were pre-prepared and there was a significant reduction in the time that a prescription spent within pharmacy and the time taken to dispense the prescription. The overall time that a patient spent at the clinic was reduced significantly. As a result of implementing this system, it was possible to use pre-filled syringes in the pharmacy cytotoxic reconstitution unit, producing a drug cost saving of £20.13 per cycle for a typical CMF patient, with a projected annual saving to the Trust of almost £10,000. Furthermore, the system resulted in more efficient utilisation of staff time in the pharmacy, allowing 55.7 per cent more CMF chemotherapy cycles to be produced without additional investment.

Conclusion

This project has illustrated that a clinically acceptable standard dosage system can be developed for a chemotherapy regimen. This resulted in savings in drug costs, better utilisation of staff time in the pharmacy department, and a reduction in the overall time that a patient spends at an outpatient clinic.
Dispensing doctors and non-dispensing doctors — a comparison of their prescribing costs
Authors: Wilcock Michael
Published: February 2011

Objective

To compare and contrast the prescribing behaviour of non-dispensing doctors with that of dispensing doctors and to identify any fundamental differences in the use of specific drugs.

Method

Analysis of Prescribing Analysis and Cost (PACT) data for 10 matched pairs of dispensing and non-dispensing practices in one health authority for the year 1997/98.

Key findings

Dispensing practices issued more items per patient than non-dispensing practices. Overall, the differences in net ingredient cost per patient and per age-sex-temporary-resident-orientated prescribing unit (ASTROPU) between the two types of practices were small. Dispensing practices had the greatest potential for savings were they to increase their use of generic drugs.

Conclusion

This analysis does not support the commonly held view that prescribing costs per patient for dispensing practices are substantially greater than for patients belonging to non-dispensing practices. The main differences between the two groups of practices are that dispensing practices issue more prescriptions and have a reluctance to prescribe generically.
Shaping practice behaviour: novel training methodology
Authors: Neto Abilio C De Almeida , Kelly Fiona , Benrimoj Shalom I
Published: February 2011

Context

Some studies that have used “pseudo-patron” methods have provided the basis for criticism of pharmacists' performance and have stigmatised these methods in pharmacy research.

Objective

To test and refine the use of pseudo-patron methodology, with feedback to practitioners, as a means of implementing behaviour change.

Method

In the studies reported in this paper practice behaviour was shaped by conducting a workshop and then providing ongoing training in the form of feedback and coaching immediately after a pseudo-patron visit. The involvement of pseudo-patrons was negotiated with pharmacists and their staff and embedded within their professional development.

Results

An initial study showed that, compared with controls, pseudo-patron trained pharmacists were significantly more likely to identify off-label (not in accordance with label specifications) analgesic use (P<0.01) and were more likely to discuss the use of alternatives (P<0.02). The methodology was refined and in a subsequent study pharmacists were even more likely to identify misuse (P<0.001), assess readiness to change (P<0.001) and deliver an appropriate intervention (P<0.001).

Conclusions

The results of the studies presented in this paper demonstrate that the inclusion of pseudo-patron visits in pharmacist training is feasible and that a combination of workshops and performance feedback, including positive and corrective elements, can produce substantial protocol adherence in the natural setting. The use of pseudo-patron methods as part of a training programme is effective in shaping behaviour of pharmacists and pharmacy assistants.
Community pharmacy services for antidepressant users
Authors: Gardner D M , Murphy A L , Woodman A K , Connelly S
Published: February 2011

Objective

To evaluate the communication and barriers to communication between community-based pharmacists and antidepressant users.

Method

A survey package designed to evaluate the communication between pharmacists and antidepressant users was distributed to 50 community pharmacies. Each package included one pharmacist survey and 10 sealed antidepressant user surveys to be distributed by the pharmacy staff. The survey addressed the components of communication, level of satisfaction and barriers to effective communication.

Setting

Urban and rural community pharmacies in the Canadian Maritime provinces of Nova Scotia and New Brunswick.

Key findings

Overall, pharmacists rated the value of their communication more highly than did antidepressant users, although the difference was not statistically significant. When beginning treatment, between one-half and two-thirds of antidepressant users recalled pharmacists inquiring about past use of the antidepressant and discussing information provided by the physician, time to onset of benefits and potential side effects. The purpose of the antidepressant, target symptoms, usual duration of therapy and risk of relapse with premature discontinuation were addressed less often according to antidepressant users, and monitoring of compliance was not a common activity. Antidepressant users estimated that initial communication with the pharmacist generally lasted less than five minutes, and often less than two minutes. However, pharmacists appeared to resolve misconceptions and concerns about antidepressant use efficiently. According to pharmacists, the major barrier to effective communication was a lack of privacy.

Conclusion

Although compliance with antidepressants is low and treatment outcomes are sub-optimal, pharmacists are not using their opportunities to minimise this problem through effective communication and follow-up. Pharmacists, pharmacy administrators and regulators need to re-assess their contribution to this problem and how they can lead to its resolution in the patient's best interest.
Evaluation of mental health care interventions made by three community pharmacists — a pilot study
Authors: Ewan Marilyn A , Greene Russell J
Published: February 2011

Objective

To assess the clinical significance of drug-related interventions made by three community pharmacists (CPs) in the pharmaceutical care of 30 long-term mentally ill patients in the UK.

Method

Three CPs (“study pharmacists”) participated in a nine-month study in which they collaborated with the community mental health team (CMHT) to provide pharmaceutical care for long-term mentally ill patients in the community. In particular, they liaised with the patients' keyworkers, accompanying them on home visits. The pharmacists had previously attended a specially organised training course. Their primary tasks were to assess patient need and identify medication-related problems, intervene as appropriate and document patient outcome. An expert review panel (two specialist hospital mental health pharmacists and a consultant psychiatrist) evaluated the appropriateness of the interventions and the level of clinical significance of the interventions (using a validated four-point rating scale).

Key findings

Thirty-eight patients consented to participate in the study and 35 were contactable. Ninety-four medication-related problems were identified involving 30 patients (mean number of recorded problems per patient=3), of which full data were available for 92. Eighty-four problems (91 % n=92) were said to have had appropriate interventions, and eight (9 per cent) inappropriate interventions. In 35 per cent of problems the three reviewers agreed that the interventions were clinically significant. Inter-rater agreement for paired agreements (assessed by the kappa statistic) was fair in all cases except one, where it was poor.

Conclusions

The reviewers considered the study pharmacists to have made a valuable pharmaceutical contribution to mental health care through clinically significant interventions, although they identified cases in which further clinically significant interventions could have been made. The reviewers saw the work undertaken as providing a positive way forward in primary mental health care.
Impact of a pharmaceutical care model for non-institutionalised elderly: results of a randomised, controlled trial
Authors: Grymonpre Ruby E , Williamson Dawn A , Montgomery Patrick R
Published: February 2011

Objectives

To measure the impact of a community-based geriatric pharmaceutical care model on specific process measures.

Methods

The model was evaluated using a prospective, randomised, controlled study design. Clients who self-presented or were referred by Home Care were eligible if they were 65 years of age or older, non-institutionalised, taking two or more prescribed or non-prescribed medications, and willing to provide signed informed consent. A pharmacist conducted a comprehensive drug therapy review on test clients, then addressed issues with the client and/or the client's physician, with follow-up as required. Measurements included number of drugs, drug knowledge, adherence to therapy, cost of prescribed medicines, and number of reported symptoms obtained from a home medication history conducted by trained volunteers, the provincial prescription claims database, and response to a physician survey.

Setting

The pharmaceutical care model was situated within a community-based interdisciplinary health clinic targeting non-institutionalised elderly.

Key findings

One hundred and thirty-five clients were randomised to test (n=69) or control (n=66). A mean of 14.4 (SD 4.6) potential or actual issues were identified in test clients. Ninety-four per cent of physicians agreed with at least one of the pharmacist's recommendations but only 230 of 794 recommendations by the pharmacist (29 per cent) resulted in a change. There was no difference in overall number of prescribed or over-the-counter medications, drug costs, symptoms reported, drug knowledge or medication adherence between test and control groups post-intervention.

Future research

Further research is needed to identify barriers to changing drug use behaviour and facilitating acceptance of pharmaceutical care in the community.
Effect of verbal encouragement on patient question-asking behaviour during medication counselling
Authors: Taylor J , Gilbertson A , Semchuk W , Johnson J
Published: February 2011

Context

Empowering patients to take a more active role in health-related encounters is a goal of many advocates today. This stems from evidence that patients remain rather passive during interactions with doctors and pharmacists.

Objective

The objective of this study was to examine the effect of verbal encouragement on patient question-asking. It was hypothesised that encouragement to ask questions would elicit a freer flow of questioning.

Method

The study had two arms — intervention and control. The same prescription processing steps occurred for each group except that intervention subjects were presented with a short verbal message (to invite questioning) before the prescription was handed over to a pharmacist for filling. Any questions patients raised during subsequent medication counselling were recorded. Observations took place in one Canadian community pharmacy.

Results

A total of 127 patients were observed for study purposes (60 intervention and 67 control). A total of 141 questions were asked by 59 patients; the other 68 patients had no questions when asked. Subjects in the intervention group (one outlier removed) asked an average of 1.1 questions per encounter, while the control group asked 0.9 questions. This difference was not statistically significant.

Conclusion

The hypothesis of no difference in the rate of patient question-asking between groups was retained. This method of encouraging patients to become more involved in the counselling process proved unsuccessful.
Consumer perspectives of pharmacist-delivered healtn information and screening services
Authors: Teh Ruth , Chen Timothy , Krass Ines
Published: February 2011

Objective

Community pharmacy has been increasing its involvement in health promotion, especially information provision and screening, over the past decade. Little is known about how consumers view these services and there is a need to evaluate the level of consumer endorsement of this role. The aim of this study was to evaluate consumer attitudes towards pharmacist-delivered health information and screening services over time and with personal experiences of these services, as part of a standardised pharmacy programme.

Method

A validated instrument was administered in 1994 (n=98) and 2000 (n=58) to consumers who had not experienced a pharmacist health information and screening programme, and to a population in 2000 (n=159) who had received such a service. Comparisons of consumer attitudes were made between the unexposed 1994 and 2000 populations to test for the influence of time, and between the exposed and unexposed samples in 2000 to test for the effect of personal experience of the service.

Setting

Data were collected in seven community pharmacies in various non-metropolitan regions of New South Wales, Australia.

Key findings

Even after accounting for demographic variation between cohorts, consumers had a more positive attitude towards pharmacist screening over time, and towards both health information and screening after personal experience of these services.

Conclusion

Community pharmacists should be encouraged to participate more in health information provision and screening in order to take advantage of and further promote consumer endorsement of these pharmacist services.
SOCIOLOGICAL THEORY AND PHARMACY PRACTICE RESEARCH: (1) An introduction to sociology — and what it can do for pharmacy practice research
Authors: Bissell Paul , Traulsen Janine Morgall , Haugbølle Lotte Stig
Published: February 2011

This is the first in a series of papers seeking to demonstrate the relevance of sociological theory to the contemporary debates found in pharmacy practice research. In producing this series, we hope to stimulate a critical appreciation of sociological theorising as it might be applied to pharmacy practice research. We aim to achieve this through an exploration of the ways in which sociological theory has already been applied to areas of health care practice, in some cases providing exciting, illuminating and thought provoking insights. The examples of research which we draw upon will be supplemented by a series of questions as to how sociological theories might be more fruitfully employed in the framing of questions specific to pharmacy practice research. We will also provide an extensive reading list for those interested in finding out more.

We first feel the need to argue our “case” for greater engagement between sociology and pharmacy practice research. Why might pharmacy practice researchers find sociological theory useful in their work? After addressing this question, we attempt to define what sociology might be, draw attention to some aspects of the nature of sociological thinking and then describe what is to come in the forthcoming series of papers.
Identification of psychosocial factors which influence patient adherence with antihypertensive medication
Authors: Lennon C , Hughes C M , Mcelnay J C , Johnston G D
Published: February 2011

Focal points
Non-dispensing of NHS prescriptions in community pharmacies
Authors: Schafheutle E I , Seston E M , Hassell K , Noyce P R , Nicolson M
Published: February 2011

Focal points
Variation in the management of PONV and pain in day case surgery: implications for evidence based practice
Authors: Payne Katherine , Elliott Rachel , Mchugh Gretl , Moore Evan
Published: February 2011

Focal points
Structured medication checking workshops: student attitudes and performance
Authors: Rutter P M , Brown D , Portlock J
Published: February 2011

Focal points
Antibiotic prescribing for lower respiratory tract infections within secondary care
Authors: Woodford E M , Marriott J F , Wilson K A , Langley C A
Published: February 2011

Focal points
Compliance and adherence as pragmatic concepts: a study of TB in rural Pakistan
Authors: Rennie T W , Bates I , McKelvie W
Published: February 2011

Focal points
Developing clinical pharmacy services to prisoners in Scotland
Authors: McNulty Howard , Braddick Lyndon , Watt Carol , Shearin Pamela , Mitchell Alan
Published: February 2011

Focal points
Anonymously reported medication errors: the tip of the iceberg
Authors: Cavell Gillian F , Oborne C Alice
Published: February 2011

Focal points
Perceptions of CPD within the pharmacy profession
Authors: Bell H M , Maguire T A , Adair C G , McGartland L F
Published: February 2011

Focal points
Integrating the community pharmacist into the diabetes team: evaluation of a new care model for patients with Type 2 diabetes mellitus
Authors: Wermeille J , Bennie M , Brown I
Published: February 2011

Focal points
Pharmaceutical inspections in nursing and residential homes: an assessment of the recommendations
Authors: Schweizer A K , Curry N B , Hughes C M
Published: February 2011

Focal points
Development and validation of an instrument to measure professional self-perception and job satisfaction of Portuguese community pharmacists
Authors: Cavaco A , Ayorinde M , Pentiah E , Dias J P Sousa , Bates I
Published: February 2011

Focal points
Concordance in Muslim patients in primary care
Authors: Bashir A , Asif M , Lacey F M , Langley C A , Marriott J F , Wilson K A
Published: February 2011

Focal points
Identification of the pharmaceutical needs of patients with heart failure
Authors: McGinnes M , McGlynn S , Watson A
Published: February 2011

Focal points
The roles of informal carers in the management of medication for older care-recipients
Authors: FRANCIS SALLY-ANNE , SMITH FELICITY , GRAY NICOLA , GRAFFY JONATHAN
Published: February 2011

Objective

To document the roles of informal carers in the management of medication for older care-recipients and to relate this to carers' coping and health.

Method

Carers were identified and recruited in randomly selected community pharmacies in England. All pharmacy clients aged over 18 years who were collecting a prescription on behalf of someone aged 60 years or more, and were unpaid as a carer, were invited to participate in a home interview. Data were collected in structured interviews. Recruitment of carers in the pharmacies and home interviews were undertaken by teams of local interviewers.

Setting

Four randomly selected health authority areas in England stratified according to the proportion of the population aged over 65 years, proportion of the population from ethnic minority groups and socio-economic status.

Key findings

Carers undertook between one and 10 medication-related activities (median=6), ranging from contact with surgeries and pharmacies to clinical decision-making in the home. Different levels of involvement in, and approaches to, medication-related activities were described by carers in the context of their relationship with the care-recipient. The total number of medication-related activities was positively correlated with carer strain and negatively correlated with social functioning and mental health.

Conclusion

Support for informal carers is a priority for the British Government which recognises their important contribution to health care. In documenting the medication-related assistance provided by carers this paper identifies key considerations for the pharmacy profession in developing carer-centred pharmacy services.
Clinical medication review by a pharmacist of elderly patients on repeat medications in general practice — pharmacist interventions and review outcomes
Authors: PETTY D R , ZERMANSKY A G , RAYNOR D K , LOWE C J , FREEMANTLE N , VAIL A
Published: February 2011

Objectives

To describe the nature and rate of interventions made by a pharmacist conducting clinical medication reviews in general practice.

Method

Patients, randomly allocated to the intervention group, in a randomised controlled trial of 1,188 patients, were invited to a pharmacist-conducted medication review clinic at their general practice. Patients were seen over one year from June 1, 1999, to May 31, 2000. In the consultation an assessment was made of the patient, their clinical conditions and medication. Consultation outcomes for each patient and intervention outcomes for each medicine were evaluated.

Setting

Patients were recruited from four randomly selected general practices in Leeds, UK. Patients were eligible if aged 65 years or over and on at least one repeat medicine.

Key findings

Consultations were held with 590 patients in the intervention group (97 per cent). A recommendation for change was made in 44 per cent (258/591) of consultations. The most common outcome was a change in medication: 29 per cent of consultations (170/591). Doctor referral occurred for 28 patients (5 per cent) and nurse referral for 25 (4 per cent).

Study patients were recorded as taking 2,927 repeat medications (mode of two per patient). Interventions were made for 21 per cent of medications (603). Clinically related interventions accounted for 71 per cent (430/603). Recommendations were spread evenly across therapy groups. At the study end, 90 per cent (433/484) of recommendations remained implemented.

Conclusion

A pharmacist who clinically reviewed elderly patients, their conditions and their medications, intervened in nearly half the patients. The pharmacist was able to implement most interventions without referring the patient to a doctor or nurse.
Pharmacists in a liberalised system — results from a profession-wide survey in Iceland
Authors: ALMARSDÓTTIR ANNA BIRNA , BJÖRNSDÓTTIR INGUNN , TRAULSEN JANINE MORGALL
Published: February 2011

Background

The study reported here was part of a multi-study evaluation of new drug distribution legislation in Iceland.

Objective

The objective of this sub-study was to compare the satisfaction of community pharmacists and pharmacists in other settings with regard to their job in general, importance of the job, work hours, contact with patients, and responsibility.

Method

A questionnaire survey was constructed, pilot tested, and mailed to all pharmacists belonging to professional societies in Iceland in March 1999.

Key findings

The results show an inconsistency in whether general job satisfaction was correlated with respondents' perception of the job's importance and responsibility, more so for community pharmacists than others. Overall job satisfaction was quite high and community pharmacists felt that their contact with customers was satisfactory. However, they were more dissatisfied with their work hours, importance of their work, and responsibility than other pharmacists.

Conclusion

Community pharmacists have been affected more adversely by the legislative change than their colleagues in other work settings.
SOCIOLOGICAL THEORY AND PHARMACY PRACTICE RESEARCH: (2) An introduction to functionalist sociology: Talcott Parsons' concept of the “sick role”
Authors: BISSELL PAUL , TRAULSEN JANINE MORGALL , HAUGBØLLE LOTTE STIG
Published: February 2011

This article, the second in a series highlighting the relevance of sociological theory to pharmacy practice, provides an introduction to functionalist sociology through a discussion of the work of the influential sociologist Talcott Parsons. As we noted in the first paper,1 the discipline of sociology consists of a number of competing perspectives which seek to understand the nature of the social world: functionalism is one perspective that has had an enduring influence. Drawing on metaphors from biology, functionalist sociologists view societies as wholes or systems, which consist of interacting and self-regulating elements. Each of the elements works to maintain the whole, so ensuring the stability or order of the system. Parsons focused on one of the elements within the social system — medicine — and, specifically, on the doctor-patient relationship, in order to illustrate his ideas. In this article, we will be discussing Parsons' contribution to functionalist sociology, his depiction of the relationships between health professionals and patients and his assertion that these play an important role in sustaining order within society. We provide a critique of his ideas before assessing his relevance to the contemporary health services and pharmacy practice research agenda. A reading list is supplied at the end of the article for those who wish to follow up his ideas. As we suggested in the first paper,1 our aim for this series is to stimulate critical engagement with key sociological concepts among pharmacy practice researchers, with the hope of strengthening the inter-disciplinary explanatory capacity of this body of work.2
The emergency supply of prescription-only medicines: a survey of requests to community pharmacists and their views on the procedures
Authors: O'Neill Richard , Rowley Emma , Smith Felicity
Published: February 2011

Objectives

The provisions of the Medicines Act for the emergency supply of prescription-only medicines (POMs) represent circumstances in which pharmacists in the UK may lawfully supply a patient with a POM without having a prescription. The objectives of this research were to establish the frequency of requests for emergency supplies from doctors and patients, and the characteristics of the requests, to investigate the procedures for emergency supply from the perspective of community pharmacists and to survey their views on the subject.

Method

Data were gathered in a self-administered structured postal questionnaire. The sample comprised community pharmacists in three health authority areas in Greater London and the surrounding area.

Key findings

Over two-thirds of the 243 respondents reported receiving requests for emergency supplies of POMs from patients at least monthly. The most commonly requested items were inhalers for asthma, followed by medication for cardiovascular disease. Many pharmacists had refused to make supplies on the basis that the situation did not constitute an emergency and/or that a prescription could be obtained. They also experienced cases in which they doubted the suitability of the requested product. Over half of the respondents reported receiving at least monthly requests from doctors to dispense an emergency supply. Refusals to supply were most commonly because the requested product was a Controlled Drug and therefore disallowed. Most respondents believed that the emergency supply procedures provided an opportunity to exercise professional judgment and were an important “safety net” for patients.

Discussion

The provisions for the emergency supply of medicines are a common resort of both prescribers and patients and present pharmacists with an opportunity to exercise professional judgment. However, many pharmacists considered the procedures restrictive, believing that they should have more discretion in supplying POMs to regular patients and their representatives.

Conclusion

Professional developments as envisaged by the British government and the pharmacy profession will require greater flexibility regarding the arrangements for supply of POMs.
Community pharmacy as a performance: a participant observer's account of a day in the life of a locum
Authors: Brown Malcolm E , Bellaby Paul
Published: February 2011

Objective

To understand, from a dramaturgical viewpoint, the performance of “community pharmacy.”

Method

Participant observation supported by focus groups and semistructured interviews; the study adopted a grounded theory approach.

Setting

Fieldwork was conducted within 21 community pharmacies in East Anglia, England.

Key findings

Pharmacists identify with their setting and stage props. On the stage of community pharmacy, the pharmacist crucially converts the drug into medicine, during a complex and well-rehearsed performance. There are sometimes distractions, which make the performance sub-optimal. Other insights included what counts as error, how to manage stress, and the fact that the trust on which professional practice rests is at stake when expressive performance fails.

Conclusion

It is possible to conduct ethnography of community pharmacy and this is among the first such studies of British community pharmacy. Were the pharmacist to leave the stage and its props (the drugs), only to advise patients on medicines, the performance of community pharmacy, as we know it, might disappear.
Prescriptions Direct: a repeat prescribing scheme pilot study
Authors: Loader Jill , McCarthy Carol , Callow Katherine , Gudgeon Robert
Published: February 2011

Focal points
Safety profile of rofecoxib as used in general practice in England: results of a prescription-event monitoring study
Authors: Layton D , Riley J , Wilton L , Shakir S A W
Published: February 2011

Focal points
The influence of depression and perceived health competence on adherence in patients with heart disease
Authors: Lennon C , Hughes C M , McElnay J C
Published: February 2011

Focal points
A qualitative assessment of perceived barriers to inter-professional working between community pharmacists and general practitioners
Authors: Hughes Carmel M , McCann Siobhan
Published: February 2011

Focal points
Medicine-associated constipation in primary care
Authors: Offia A , Walker R
Published: February 2011

Focal points
An investigation of medicines returned to general practitioners and community pharmacies
Authors: Daniszewsi R , Langley C A , Marriott J F , Wilson K A , Clewes P , Wilkinson M
Published: February 2011

Focal points
The provision of diagnostic and screening services by community pharmacies
Authors: Dhoot A , Rutter P M
Published: February 2011

Focal points
Adolescents and media coverage of over-the-counter and complementary medicines
Authors: Sesselberg Tracy S , Gray Nicola J , Klein Jonathan D
Published: February 2011

Focal points
Ethical issues about shared medical records
Authors: Wilson Keith A , Jesson Jill , Patel Raksha
Published: February 2011

Focal points
Medication errors: a baseline survey of interventions recorded during the dispensing process in community pharmacies
Authors: Quinlan P , Ashcroft D M , Blenkinsopp A
Published: February 2011

Focal points
Medication errors: a baseline survey of dispensing errors reported in community pharmacies
Authors: Quinlan P , Ashcroft D M , Blenkinsopp A
Published: February 2011

Focal points
Measuring clinical competence in preregistration trainees by OSCEs
Authors: McRobbie D , Fleming G , Ortner M , Bates I , Davies J G
Published: February 2011

Focal points
Clare wants the morning-after pill: what do practitioners think?
Authors: Hope H , Dye L , Knapp P , Sowter J , Raynor D K
Published: February 2011

Focal points
A systems audit: the effectiveness of one-stop dispensing
Authors: Jones Stuart
Published: February 2011

Focal points
Supporting continuing professional development (CPD) for pharmacists: piloting a CPD portfolio development toolkit
Authors: Thompson Guy
Published: February 2011

Focal points
Developing pharmacy ward-based teams
Authors: Scanlan Justine , Stewart Ann , Fitzgerald Linda , Freeborn Stephen
Published: February 2011

Focal points
Hospital pharmacists' role in type 2 diabetes management
Authors: Tadros Labib , Barnes Edward , Ledger-Scott Margaret
Published: February 2011

Focal points
The introduction of a checking technician programme in community pharmacy and its impact on pharmacist activities
Authors: Jones W , Rutter P M
Published: February 2011

Focal points
Dispensing errors in community pharmacy: patient interview as a tool to determine attitudes
Authors: Bates Philip J
Published: February 2011

Focal points
Development of Direct Carbonate Fuel Cell Systems for Achieving Ultrahigh Efficiency
Authors: Ghezel-Ayagh Hossein , McInerney Joseph , Venkataraman Ramki , Farooque Mohammad , Sanderson Robert
Published: February 2011

FuelCell Energy, Inc. (FCE) has developed products based on its Direct FuelCell® (DFC®) technology with efficiencies near 50% based on lower heating values of natural gas. DFC is an internally reformed molten carbonate fuel cell, which operates in the 550–700°C range. The combination of the internal reforming of methane and atmospheric pressure and moderately high temperature of operation has resulted in very simple power plant system configurations. Recently, FCE has developed system concepts to further increase the net electric efficiency to beyond 60% efficiency in sub-MW and MW class power plants. One of these system concepts is the arrangement of the fuel cell stacks in series for very high utilization of fuel in the stacks. Although, in principle, the concept of fuel cell stacks in series is very simple, the implementation of the concept in the actual hardware poses challenges requiring innovative solutions. These challenges include concerns with thermomechanical issues, flow and utilization patterns within the fuel cell stacks, and management of the pressure balance between the anode and the cathode. To address these issues, various analytical tools, including system-level modeling and simulation and computational fluid dynamics (CFD), were utilized. FCE has developed a comprehensive fuel cell stack operation simulation model including hydrodynamics, kinetics, electrochemical, and heat transfer mechanisms to investigate and optimize the design for performance as well as endurance. Various system configurations were developed, which included methods for fueling the second tier stacks in the series. System simulation studies using first principle mass and energy conversation laws were performed. Parametric studies were completed. Subsequent to the system modeling results, the fuel cell stack operations were analyzed using the comprehensive stack simulation model. The CFD modeling of the fuel cell stacks was performed in support of the system simulation parametric studies. The results of the CFD modeling provided insight to the thermal and flow profiles of both first and second tier stacks in series. The net outcome of the investigation was the design of the system, which met the goals of ultrahigh efficiency and yet complied with the thermomechanical requirements of the fuel cell stack components. In this paper, FCE will describe various system options for the very high efficiency systems, the issues related to the design, and the practical solutions to overcome the issues.