bluuebunny/crossref_metadata_2025 huggingface dataset:
Survey of the needs of patients in a private nursing home: a pharmacist's view
Authors: Deshmukh A A , Sommerville H
Published: February 2011

Validated data collection instruments were used to assess the health status and existing drug therapy of 79 patients (16 male, 63 female; mean age 84 [±9] years) in two private nursing homes in Norfolk. The homes had already been found to be above average standard in terms of medicines supply, storage and administration. The most common symptoms of long term chronic disease were associated with neurological, cardiovascular, arthritic, psychiatric or diabetic diagnoses. Fifty nine patients had some memory impairment; 77 suffered from additional health problems which could arise from inappropriate therapy or dosing. All patients received most of their medicines from nursing staff. The mean (±SD) number of items received per day was 7.1 (±3.4). Of drugs prescribed for regular use, 79 per cent were given in accordance with the wishes of the prescriber. In contrast, only 21 per cent of medicines prescribed for use when necessary (prn) were given as intended. Thirty three per cent of prn medicines, some prescription only, had been given in the absence of any GP knowledge or instruction. Although there were written procedures for drug administration, there was only 58 per cent compliance with these guidelines. Drug administration charts proved to be an incomplete record of pre-existing drug allergy, topical application, self-medication and drugs used in routine nursing procedures, eg, bladder washouts.
A pharmaceutical advisory service in a private nursing home: provision and outcome
Authors: Deshmukh A A , Sommerville H
Published: February 2011

A survey of pharmaceutical care in two private nursing homes in Norfolk identified concerns relating to the extent and nature of patient therapy as well as its administration and documentation (see p83). With the support of medical and nursing staff, relevant policy documents were reviewed by the investigating pharmacist and then implemented. A laxative policy was also introduced. During the next five months, monthly medication reviews were made for the 60 patients (eight male, 52 female; mean age 84 [±9] years) who remained from the original survey. Recommendations concerning individual drug therapy were subsequently evaluated. Of the 44 recommendations for changes in prescribing and administration of drugs that were accepted by the medical/nursing staff, 37 produced positive outcomes for the patient. Compared with the baseline data, there were significant increases in the number of patients who were free of possible drug induced problems (P<0.05) or no longer constipated (P<0.005) and a significant increase in the proportion of medicines administered in accordance with the prescriber's wishes (P<0.05). The accuracy and completeness of drug administration records had improved and guidelines for nurse prescribing had been rationalised. The mean daily number of items taken by patients had fallen by 1.5. Based on these data, provision of pharmaceutical care to private nursing homes should produce significant cost savings and improve patient care.
Subject-centred learning outcomes of structured work-based learning in a community pharmacy training programme
Authors: Rees J A , Collett J H , Mylrea S , Crowther I
Published: February 2011

Second-year pharmacy students were divided into two cohorts, one of which participated in structured work-based learning (WBL) activities in a summer vacation training programme (VTP) in a community pharmacy work placement. Assessment methods were developed to measure quantitatively any change in knowledge and knowledge-based transferable skills. Results from the assessments showed that participation in structured WBL activities increased the students' knowledge and knowledge-based transferable skills.
General practitioner prescribing and community pharmacist recommendation for the sale of aciclovir topical cream
Authors: Gaunt Rebecca , Whitfield Michael , Ghalamkari Hooman , Millar Michael
Published: February 2011

A questionnaire survey of 50 general medical practitioners (GPs) and 50 community pharmacists in Bristol was undertaken to compare GPs' prescribing behaviour and the recommendations of community pharmacists for the sale of aciclovir topical cream. The participants' stated advice about prescribing or recommending the sale of aciclovir topical cream for a series of case studies illustrated by colour photographs was examined. In only one of the nine cases was a significant difference found between prescribing/recommendation of aciclovir cream, with pharmacists being more prepared than the GPs to recommend the cream for a cold sore at the scabbing stage. Pharmacists reported receiving a greater amount of information about the drug from the manufacturer than did the GPs. Some GPs were shown to be confused about the licensing laws regulating the over-the-counter sale of aciclovir cream. This is likely to lead to inappropriate advice from GPs for patients to visit community pharmacists for the purchase of the cream.
Communication and interaction between customers and pharmacy personnel in two Norwegian pharmacies — an observational study
Authors: Strømme Helge Knudsen , Haugli Arild
Published: February 2011

During the summer of 1993, a social anthropologist carried out non-participating observations in two pharmacies in Oslo, Norway, in order to describe the communication and interaction between the customers and the pharmacy staff. The ways the personnel encountered their customers varied in a striking way. Few indicators could be relied upon in predicting staff behaviour. Informational interaction did occur between customers and staff, but this practice did not seem to be systematic with regard to rules or routines. In the cases of customer-initiated questioning, the customer seemed to be taken good care of. The observations made in this study highlight three important features of pharmacy: a lack of control of admission, the transactional nature of the interaction between customer and staff and a lack of systematic approach for serving customers with particular needs. The quality and content of the information and interaction did not seem to be dependent on the physical layout of the pharmacy. It also seemed more dependent on the personal characteristics of the staff member concerned than on his or her formal competence, and dependent on when, during opening hours, the interaction took place. These features should be taken into account when more standardised routines are implemented for serving pharmacy customers.
Infant weaning and community pharmacy — the pharmacist's perspective
Authors: McCallion C Rosaleen , Scott Eileen M , Doherty Marie
Published: February 2011

Community pharmacists' awareness of the COMA report on “Weaning and the weaning diet” and their knowledge of its recommendations was assessed in a questionnaire distributed to all (n=81) community pharmacists in the Western Health and Social Services Board in Northern Ireland. Sources of information and adequacy of training on childhood nutritional issues were determined. A knowledge score was computed for each pharmacist depending on their responses to questions based on key issues in the COMA report. Completed questionnaires were returned by 48 pharmacists (59 per cent). The COMA report had been read by 14.5 per cent of respondents while 12.5 per cent knew of its recommendations. Others had heard of it but not read it (52 per cent) or had never heard of it (21 per cent). The mean knowledge score was 66 per cent (±17.5). Scores ranged from 18 per cent to 90 per cent, indicating wide variability in pharmacists' knowledge of key recommendations for weaning. Only 29 per cent of pharmacists felt that they were adequately trained to give advice on weaning; 50 per cent felt that they did not have sufficient knowledge and 21 per cent were unsure. Pharmacists indicated that, on average, parents approached them weekly about a weaning topic, which emphasises the need for them to be well informed about current weaning recommendations.
Pharmacy practice research, ethical issues and local research ethics committees
Authors: Jesson Jill
Published: February 2011

Pharmacy practice research projects carried out in a community setting will often require approval from a local research ethics committee. This article discusses the processes, and problems, involved in seeking ethical approval, and sets out a framework for incorporating ethics committee approval into the design of a project.
Oral counselling on dispensed medication: a survey of its extent and associated factors in a random sample of community pharmacies
Authors: Aslanpour Zoe , Smith Felicity J
Published: February 2011

To establish the current rate of oral counselling on dispensed medications, a random sample of 50 community pharmacists from the greater London area was selected. A non-participant observational method was used to obtain the required information. It was found that most pharmacist characteristics, including age, experience and employment status (proprietor, manager or locum) did not affect the rate of provision of oral counselling. However, the rate varied according to sex, with female pharmacists advising more patients. The rate of counselling was also influenced by the patient's age, the type of prescription (National Health Service or private), whether the prescription was a repeat or for new medication and the therapeutic category of the medicine. During the study, the collection of 1,472 prescription items was observed. Overall, counselling was provided for 39 per cent of patients. Counselling was given for around 70 per cent of new prescription items and for 20 per cent of repeat items.
“One simple question should be enough”: consumers' perceptions of pharmacy protocols
Authors: Morris Caroline J , Cantrill Judith A , Weiss Marjorie C
Published: February 2011

Little research in the United Kingdom has addressed consumers' views about over-the-counter (OTC) medicine purchase. In this study, qualitative telephone interviews were conducted with 40 consumers recruited via two community pharmacies. Consumers' views and spontaneous comments regarding their expectations when making their most recent OTC medicine purchase, their awareness of the need for questioning and their willingness to answer questions about minor ailments were explored. Although the majority of consumers had a degree of awareness of why pharmacy staff might require information, 25 (62.5 per cent) expected to make their most recent purchase without being questioned. Consumers' attitudes to unsolicited questioning appeared to be affected by their perception of whether questioning was necessary. In addition, the majority of consumers seemed to view decisions about medicine purchase as their sole responsibility, rather than perceiving pharmacists to have a professional role. The results also suggested a wide variation in the needs and preferences of individual consumers.
Ethnic minority pharmacy practice
Authors: Platts Adrian E , Tann Jennifer , Chishti Zahid
Published: February 2011

Community pharmacy in Britain practised by members of ethnic minorities is characterised by a large number of independent proprietors. We examined and compared the career paths of ethnic minority (largely Asian) and British white pharmacists, concluding that there are a number of qualitative and quantitative differences. We considered the number and distribution of pharmacies owned by ethnic minority pharmacists and the relationship to ethnic residential areas. Linkages between pharmacies and local communities were also examined. We suggest that the British ethnic minority-owned pharmacy currently fulfils a role for patients who feel less confident in a pharmacy owned or managed by a British white pharmacist and that this, at present, enables the small pharmacy business to remain viable in a competitive environment. Whether or how long this will remain the case will depend on a number of factors, including remuneration packages and changing attitudes among successive generations of British Asian pharmacists.
Residents' views and experiences of pharmacy questioning and advice relating to non-prescription medicine purchases
Authors: John David Neale , Evans Stuart Wyn
Published: February 2011

Questionnaires were sent to a sample of 2,190 Cardiff residents asking their experiences of, and attitudes to, the questioning and provision of advice associated with non-prescription medicine sales from pharmacies. Eight hundred and ten questionnaires (37 per cent) were returned. A total of 585 respondents had made such a purchase in the previous six months, and 486 of the 585 (83 per cent) had bought their most recent medicine for their own use. Of the 486, 157 had not used the medicine on a previous occasion. Seventy-three of the 157 respondents (46.5 per cent) stated that pharmacy staff had selected the medicine for them and it was found that such respondents were more likely to have been questioned (P < 0.001) and advised (P < 0.001) than those for whom pharmacy staff had no influence on the medicine purchase.

Over 90 per cent of the 810 respondents believed that it was a good idea to be asked questions when purchasing non-prescription medicines and fewer than seven per cent resented such questioning. Only 16 respondents (2 per cent) indicated that they never wanted advice regarding non-prescription medicines, even for those medicines that they had not previously used. The majority of respondents expressed positive opinions of community pharmacists.
A stability and validation study of 1%w/w menthol in aqueous cream
Authors: Gallagher Peter , Jones Sean
Published: February 2011

In this study an analytical method for the determination of menthol in aqueous cream was developed, together with the complete validation of the production process and stability testing of 18 months' retained reference samples. Cream packed in 500ml plastic screw cap containers was tested and studied. Up to now there has only been a small scale (1.40kg) manual manufacture of 1%w/w menthol in aqueous cream without any formal quality control analysis and testing carried out on the product.

The purpose of this work was to enable large scale manufacture of the product, which would require development of an analytical method and validation of the mixing and filling processes. Stability testing of stored reference samples was carried out concurrently.

A stability-indicating, gas-liquid chromatographic method, with the use of an internal standard, was developed and validated for the product. Stability testing of samples stored at 25C ± 1C showed no significant degradation over 18 months. Validation of the manufacturing process by a sequential sampling technique showed the process to be satisfactory and workable at all stages.

The current formulation in use is 1%w/w menthol triturated directly into aqueous cream BP.
Wiltshire pharmacy health promotion training initiative: a telephone survey
Authors: Anderson Claire , Alexander Angela
Published: February 2011

A telephone survey of 40 pharmacists before and after attendance on a health promotion course in Wiltshire, conducted using semi-structured questionnaires, indicated that training led to changes in knowledge and perceived changes in attitude and practice. The value of the increased knowledge was recognised by participants, in particular when talking to patients and other health professionals. The change in attitude, towards a more holistic view of health, is seen by the authors as a positive benefit of training, as it may be of value to the pharmacists. Changes in practice were evident despite recognised constraints.

Recommendations for future health promotion training schemes are: training should be ongoing; joint working with other health care professionals is needed fully to achieve training objectives; the role of the pharmacist should be promoted; and this currently unremunerated role should be recognised by Wiltshire health authority for its potential contribution towards the health care of the population, and receive appropriate funding.
Health promotion by community pharmacists: consumers' views
Authors: Anderson Claire
Published: February 2011

As part of the evaluation of the Barnet family health services authority high street health scheme (HSHS), 592 consumers were interviewed in six pharmacies. The objectives were to investigate whether the consumers came to the pharmacies for advice on general health matters, saw pharmacists as a reliable source of advice about staying healthy, read health promotion leaflets and had heard of HSHS.

The general medical practitioner's (GP's) surgery was felt to be the most convenient place to get advice about staying healthy, and the GP the best person from whom to get it. The pharmacist was rated second in each case, above the media, although only 90 (15 per cent) of respondents had ever asked the pharmacist for general health advice. Only 237 (40 per cent) thought that it was the “usual” job of the pharmacist to give advice about general health, 112 (19 per cent) thought that it was not, and 243 (41 per cent) did not know. Those who had taken away leaflets to read (178, 30 per cent) were significantly more likely to be frequent visitors to the pharmacy, to have chronic illnesses, to think the media was the most convenient place to get advice, to have previously asked the pharmacist for advice about staying healthy and to think it was usual job of the pharmacist to give advice about staying healthy. Only 65 (11 per cent) had heard of the HSHS.

Many consumers do not currently perceive that there is a role for community pharmacists in health promotion, and the profession needs to think again about some of the presumptions that have been made in the past.
An observational study of the prescribing and administration of intravenous drugs in a general hospital
Authors: Hartley G M , Dhillon S
Published: February 2011

The prescribing and administration of intravenous drugs on two surgical and one medical ward were studied to determine the number, type and causes of errors occurring. The errors were classified for potential to harm the patient and for implications for the system of supply, preparation and administration. Of the 154 patients, 46.7 per cent were prescribed intravenous drugs. Of the 178 prescriptions for intravenous drugs, 14 per cent failed to conform to the local policy on prescribing and 11.2 per cent were considered to be clinically inappropriate. Preparation and administration were observed for 41.5 per cent of all scheduled intravenous doses during the 39-day study period. Excluding wrong time errors, the intravenous error rate was 26.9 per cent. Most errors were omissions (12.5 per cent of all observations), of which 45 per cent were due to lack of venous access and 22.5 per cent due to improper use of the drug chart. The latter also caused two errors of extra dosing. Fifty-two per cent of doses were given at the wrong time. Of the 254 errors, 4.7 per cent were classed as of major consequence for the patient, 17.3 per cent classed as moderate and 77.9 per cent as minor. Although the majority of errors observed were of minor consequence for the patient, the intravenous medication error rate could be reduced by using knowledge of the causes observed to change or reinforce the existing system of intravenous drug supply, preparation and administration.
Pictograms in pharmacy
Authors: Dowse R , Ehlers M S
Published: February 2011

This review examines the use of pictograms in health care. Well designed pictograms are simple, clear, graphic symbols able to convey their intended meaning to all patients, including those who are illiterate, elderly or visually impaired. Although some research on the effectiveness of pictograms has not supported the hypothesis that pictograms are beneficial for the acquisition and comprehension of information, most studies investigating health-related applications of pictograms have shown them to be of benefit in the comprehension and recall of instructions on prescription and over-the-counter medicines. However, the success of pictograms as a communication aid in pharmacy depends first on a rigorous design process, followed by well-designed, randomised, controlled trials using an appropriate method of evaluation. The final stage is to investigate the optimal way of using pictograms in practice and to assess their effect on behavioural outcomes, such as compliance. We discuss methodological issues associated with the design process of pictograms, the evaluation of pictograms in practice, reasons for their use in pharmacy and their potential in improving medication compliance. We also report on the positive and negative aspects of various pictograms that have been developed and tested in pharmacy.
UK postal survey of pharmacists working with general practices on prescribing issues: characteristics, roles and working arrangements
Authors: Martin Richard M , Lunec Susan G , Rink Elizabeth
Published: February 2011

Pharmacists are increasingly undertaking more non-dispensing work within the general practice setting. A postal survey of 414 United Kingdom pharmacists working with general practitioners (GPs), resulting in 174 responses (42 per cent), indicated that the pharmacists were working with 200 surgeries. The practices with which they worked were more likely to be fundholding (P<0.001), vocational training (P<0.001), and multipartner (P<0.01) practices, when compared with national statistics. Pharmacists funded by family health services authorities (FHSAs), commissioning agencies or health boards worked fewer hours in general practice (P=0.002) than those funded by a practice. The commonest roles, each reported by more than 50 per cent of pharmacists, were PACT (prescribing analysis and cost data) analysis, challenging doctors' prescribing, formulary development, guideline and protocol development, drug information resource, and liaison with pharmaceutical advisers. Thirty-two pharmacists ran in-house clinics. This study was limited by the low response rate. However, the findings suggest that pharmacists working with GPs undertake a range of roles, some of which involve direct patient care and responsibility for practice policy.
Role of consumer attributes in predicting the impact of medicines deregulation on National Health Service prescribing in the United Kingdom
Authors: Payne Katherine , Ryan-Woolley Bernadette M , Noyce Peter R
Published: February 2011

This study aimed to identify the key variables that determine consumers' preference for over-the-counter (OTC) purchase, rather than obtaining a National Health Service prescription, of a deregulated medicine. An empirical approach, using a convenience sample of 628 consumers, was taken to explore the impact of consumer characteristics and preferences on the decision to purchase rather than obtain a prescription. The study focused on four groups of deregulated medicines: intravaginal imidazoles, aciclovir cream, oral H2-antagonists and intranasal steroid sprays. A postal questionnaire, designed for self-completion, was distributed at point of sale, or dispensing, by community pharmacists. Two main groups of respondents were compared: those who had purchased OTC on this occasion and those who had obtained a product on prescription. Of the initial 23 variables included in the primary cross-tabulations, a total of 18 were statistically significant (P<0.05). A CHAID analysis identified four key factors that were found to influence respondents' decision to purchase OTC: stated preference for OTC purchase, knowledge of OTC availability, liability for prescription charges and not currently using other medicines on prescription. These key attributes should prove a valuable tool in the design of a predictive model to quantify the impact of deregulation on NHS prescribing. This model should, in turn, be a useful indicator of the likely effect on the demand for OTC sales of medicines and associated advice-giving from community pharmacists and their staff.
Mass media health information available to young adults in the United Kingdom: (1) Daily newspapers and magazines
Authors: Gray Nicola J , Cantrill Judith A , Noyce Peter R
Published: February 2011

Consumers are increasingly challenging community pharmacists with mass media advertisements and news items. This has the potential to produce conflict as professional judgment, editorial priorities and advertising practices are inevitably not aligned. To explore the characteristics and distribution of health information in publications read by young adults (15- to 24-year-olds) in the United Kingdom, four newspapers and 29 magazines were surveyed over an eight-week period in January/February 1997. Nine hundred health items were found in 84 newspaper issues and 80 magazine issues. Newspapers commonly included health information in the form of advertisements and news items; magazines included features and readers' letters. Descriptions of disease treatment and states were the most common subjects. Although conventional therapies were featured more often than alternative options, there was a considerable number of advertisements and features for alternative therapies, especially in newspapers. Most therapeutic areas were included, but the central nervous system was the most prevalent. One hundred and ninety-six newspaper items (40.2 per cent), and 193 magazine items (46.8 per cent) referred to a specific drug or medicine. The drug properties most often described were indication and formulation. Side effects were more likely to be included in magazine items. There was a notable lack of references to professional information sources. Community pharmacists must be aware of the characteristics of this information to help consumers to make better informed self care decisions.
Drug-related problems and pharmacy interventions in community practice
Authors: Westerlund Tommy , Almarsdóttir Anna Birna , Melander Arne
Published: February 2011

Objectives

(1) To document types and number of drug-related problems identified by community pharmacy personnel in Sweden; (2) to determine relationships among the types and number of problems identified and the gender, age and number of prescribed drugs in patients; and (3) to document the interventions made by pharmacy personnel with patients and prescribers.

Method

Random samples of pharmacists, prescriptionists and pharmacy technicians were drawn nationwide in Sweden; 144 (63 per cent) of the employees fulfilling the inclusion criteria agreed to take part. The participants documented drug-related problems, interventions and patient variables on a data collection form, and tallied the number of patients they served on another form.

Setting

One hundred and sixteen community pharmacies and 12 outpatient hospital pharmacies.

Key findings

One problem or more was identified among 2.5 per cent of the patients. The median number of problems identified per 100 patients was greater for pharmacists (6.1) than for prescriptionists (2.6) and pharmacy technicians (1.1). About one in three problems was presented to the participants by their patients, while two thirds were detected by the pharmacy staff. One in four problems was related to dosage, and one in five to uncertainty about the aim or function of the medication. Problems were over-represented among children and the younger middle-aged and under-represented in the elderly. Patient medication counselling was the most common type of intervention. When contacted, the physician nearly always approved the recommendation made by the pharmacy staff.

Conclusion

The results led to suggestions as to how pharmacy practitioners can augment pharmaceutical care through drug-related problem detection.
HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Triangulation
Authors: Smith Felicity
Published: February 2011

There are many examples of studies in which pharmacy practice researchers have combined different types of data, methods and approaches within a single research project. Although a common practice in research across many disciplines, concerns have been expressed over combining methods underpinned by different philosophical assumptions and conceptual frameworks. The choice of methods made by pharmacy researchers is generally governed by practical considerations of the research and data requirements for fulfilling research objectives rather than these theoretical concerns. This review of the pharmacy practice research literature demonstrates how a wide variety of methods have been combined for different purposes and in a variety of study designs.
Patient drug information and consumer choice of pharmacy
Authors: Whitehead P , Atkin P , Krass I , Benrimoj S I
Published: February 2011

Objective

The purpose of this study was to investigate whether there is an association between the level of drug information provided in community pharmacies and business performance as measured by consumer satisfaction and consumer loyalty.

Method

After an initial qualitative phase and a pilot survey, a questionnaire was administered to 253 consumers in 10 high and low information provision pharmacies.

Setting

The study took place in community pharmacies in the Sydney metropolitan and Newcastle areas of New South Wales, Australia.

Key findings

There was no significant difference in the summed consumer scores of behavioural intention or consumer satisfaction between the two pharmacy types. However, this study showed that up to 41 per cent of consumers (n=182) currently patronising low provider pharmacies indicated a preference for a high information provider pharmacy given equivalent convenience and no preformed loyalties to a particular pharmacist. This represents a potential net shift of 24 per cent of consumers from low information provider pharmacies to high provider pharmacies.

Conclusion

This study provides initial evidence to show that the level of provision of drug information has the potential to increase consumer patronage and loyalty to a community pharmacy. The full implications of this should become more apparent as the number and convenience of high provider pharmacies increases and more low provider consumers are exposed to this type of pharmacy.
Reassessing the MAI: elderly people's opinions about medication appropriateness
Authors: Volume Carlyn I , Burback Lisa M , Farris Karen B
Published: February 2011

Objectives

To identify the criteria that the elderly use to assess the appropriateness of their medications, rank the identified criteria in terms of importance, and compare elderly people's and clinicians' ratings of the importance of medication appropriateness index (MAI) criteria

Methods

A qualitative method was used to understand why elders' rankings of appropriateness criteria may or may not differ from clinicians'. Five focus groups with 38 elderly people were completed and content analysed. The participants also completed a written ranking of 10 criteria, indicating them as being of high importance, moderate importance or low importance

Key findings

Overall, the group discussion cited indication, effectiveness and drug-drug interactions as most important. The written ranking of the MAI criteria suggested drug-drug interactions and correct directions as being most important. Elderly people appeared to have difficulty ranking the criteria of indication and effectiveness, as there was some evidence that they took these criteria for granted. Differences among focus group participants appeared to be due to their varied medication use experience

Conclusion

These findings suggest that drug-drug interactions may be ranked highly important and practicality ranked moderately important when elderly patients' opinions are sought about medication appropriateness. Further research should be conducted to assess whether the MAI is accountable to patient viewpoints
Analysis of data from focus groups: Group interaction — the added dimension
Authors: Smith Felicity
Published: February 2011

This is the first article in an occasional series in which researchers will share their experiences of methodological issues. Some articles will draw attention to particular aspects of the research process while others will describe how methodological problems were resolved. In this article, the author discusses how interaction between members of a focus group influences the data obtained and should attract special attention when the data are analysed.
Attitudes of hospital pharmacists to adverse drug reactions and the “yellow card” scheme: a qualitative study
Authors: Green Christopher F , Mottram David R , Brown Adrian M , Rowe Philip H
Published: February 2011

Objective

To elicit the views of hospital pharmacists towards adverse drug reaction (ADR) reporting.

Method

Qualitative, semi-structured interviews were conducted on a face to face basis using a prepiloted questionnaire. Analysis was carried out using Winmax Pro, content analysis and comparison of interpretation by two independent reviewers.

Setting

All major hospitals in one Committee on Safety of Medicines/Medicines Control Agency (CSM/MCA) regional monitoring centre in England.

Key findings

It was considered that introduction of reporting had been poorly publicised and promoted. Only 42 per cent of those interviewed had submitted more than one “yellow card” report and a similar percentage had reported none. The CSM/MCA has a poor image in terms of accessibility and its perceived opinion of pharmacists' role in reporting. Feedback from the CSM/MCA was satisfactory and Current Problems in Pharmacovigilance was highly regarded. Several factors appear to be dissuading pharmacists from participation in the scheme, including lack of clinical knowledge, pressure of work and a lack of time. The absence of a fee did not appear to be a deterrent to reporting; in fact, a fee was considered inappropriate. Initial schemes for education and training were perceived as having been successful. However, ongoing training needs had not been fully addressed.

Conclusion

While hospitals pharmacists acknowledge ADR reporting as part of their professional role, it is not yet considered as part of their daily practice and requires more vigorous promotion. Further investigation and quantitative work are required to investigate fully this aspect of pharmacy practice.
The effect of pharmaceutical review of repeat prescriptions in general practice
Authors: Granås Anne Gerd , Bates Ian
Published: February 2011

Objectives

To investigate how a community pharmacist can affect the quality of repeat prescribing, and to develop a model for general practitioner (GP) and pharmacist co-operation.

Methods

Repeat prescriptions with three or more items were reviewed by a community pharmacist and randomly allocated to a trial or control group. Drug-related problems (DRPs) were discussed at joint meetings with the GP and the pharmacist. A modified Delphi technique was used to evaluate the clinical significance of the DRPs identified by the pharmacist.

Setting

The repeat prescription review and meetings took place in a GP surgery in an inner city location between November, 1995, and October, 1997.

Key findings

The pharmacist reviewed 511 repeat prescriptions, representing 3,018 prescribed items. Ninety repeat prescriptions (36.3 per cent) in the trial group and 86 repeat prescriptions (34.1 per cent) in the control group were identified as having DRPs. The GP agreed with 92.3 per cent of the interventions in the trial group, while only 12.8 per cent of the interventions in the control group were routinely resolved by the GP. The difference in interventions dealt with between the trial and the control group is statistically significant (X2=94.14, P<0.001). The absolute risk reduction (ARR) was 26 per cent, and the prescription number needed to treat (NNT) was 3.8. For every 19 prescriptions reviewed, an intervention that results, or potentially results, in clinical improvement in patient care was made by the pharmacist.

Conclusion

The pharmacist significantly reduced the number of DRPs associated with repeat prescriptions compared with routine surgery procedure. Pharmacist review of repeat prescriptions is an effective method of solving DRPs, reducing risk and making significant clinical improvements to patient care.
HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Evaluation of pharmaceutical services: (2) Methods and measures
Authors: Smith Felicity
Published: February 2011

Numerous studies have been undertaken to evaluate pharmaceutical services. These include both the evaluation of existing practice and assessments of innovative services in both hospital and community settings. Evaluation requires employment of methods and measures to ensure that relevant data on the effects of a programme are obtained. To evaluate a service from different perspectives (eg, acceptability to health professionals or patients, uptake, clinical outcomes or resource implications), a number of methods may be required. The outcomes may also be wide-ranging. Measures must be selected which provide a true reflection of the extent to which these outcomes are, or are not, achieved. Designs and frameworks used in the evaluation of pharmacy services have been discussed previously,1 this paper reviews the methods and measures that have been employed.
Arguments for theory-based Pharmacy Practice research
Authors: Nosrgaard Lotte S , Morgall Janine M , Bissell Paul
Published: February 2011

The aim of this discussion paper is to argue for the relevance of theory use in Pharmacy Practice research and to stimulate debate about the quality and relevance of research carried out in this field. A general definition of the concept of “theory” is provided, and the paper discusses the advantages of theory-based Pharmacy Practice research. The number and range of theories useful for Pharmacy Practice research are enormous and varied, originating from such fields as sociology, psychology, anthropology, pedagogy and health economics. The paper describes how methods that follow specific theories can serve different purposes. We suggest that engaging with theory provides richer and deeper insights into human behaviour and its social context, which can ultimately contribute to dynamism and diversity in Pharmacy Practice research. Examples are presented from projects carried out in the school of pharmacy in Copenhagen and the school of pharmacy and pharmaceutical sciences at the University of Manchester in order to illustrate the different functions of theory in Pharmacy Practice research.
Motivators and barriers to the implementation of pharmacist-run prescription monitoring and review services in two settings
Authors: Tully M P , Seston E M , Cantrill J A
Published: February 2011

Objectives

To assess the strong motivators and barriers to the implementation of prescription monitoring and review services by community pharmacists either in pharmacies or in general practitioner (GP) surgeries.

Method and setting

A systematic review was used to develop questionnaire statements for a two-part postal Delphi survey to a purposive sample of 120 community pharmacists working in Britain. Responses were analysed, a repeat questionnaire was mailed (including feedback of individual and group response), and respondents re-ranked the statements. The main outcome measure was attainment of consensus as to whether the statements represented motivators or barriers. This was defined as 75 per cent of respondents giving a score of ≥5 (a strong motivator/barrier) or ≤3 (not a motivator/barrier) on a seven-point scale.

Key results

Eighty-four pharmacists (70 per cent) responded to both questionnaires. Consensus was attained that 23 of 24 statements were strong motivators and 14 of 23 statements were strong barriers. There were high levels of agreement that providing a prescription monitoring and review service would improve perceptions of pharmacists, help develop relationships with patients and give pharmacists professional fulfilment. The key barriers to the implementation of these services were their time-consuming nature, locum difficulties, the prohibitive cost and unwillingness of pharmacy owners or GPs to fund services.

Conclusions

The study suggests that these community pharmacists were motivated to participate in prescription monitoring and review schemes by a complex set of personal, professional and altruistic reasons. However, if such services are to be generally successful, adequate remuneration structures, internal rivalries and the structure and culture of the profession itself also need to be considered.
Social constructivist analysis of a patient medication record experiment — why a good idea and good intentions are not enough
Authors: Nørgaard Lotte S , Sørensen Ellen W , Morgall Janine M
Published: February 2011

Objective

To explain the limited success of a local patient medication record (PMR) experiment in pharmacy practice in Denmark from a social constructivist perspective and to promote a discussion among pharmacy practice researchers of how on-going social constructivist analysis can be used to manage experiments in pharmacy practice.

Method

A secondary social constructivist analysis of data collected during and after a local experiment on the development and use of PMRs. Data were analysed using three specific social constructivist concepts. The data consisted of 93 qualitative interviews with elderly medicine users with a PMR, 10 qualitative interviews with representatives from health professionals participating in the experiment, and documentary evidence from a research report.

Key findings

Eight relevant social groups were identified in the PMR experiment. The groups attached different meanings to the same PMR, such as: threat; totally useless; important tool for preventing drug-related problems, promoting interdisciplinary co-operation and carrying out pharmaceutical care; unnecessary interference in private affairs; security; good checklist. The relevant social groups also had different opinions about responsibility, duty to inform patients about the PMR, and need for and co-ordination of the PMR.

Conclusion

The analysis supports an important social constructivist point, namely, that the outcome of a technological development is not given a priori; rather, it is driven by the interests of various social groups. Ongoing identification and assessment of these social groups is recommended to focus future experiments.
Student assessment of postgraduate clinical pharmacy programmes in the United Kingdom (1): validation of the course experience questionnaire
Authors: Quinn John , Bates Ian , Cox Roy
Published: February 2011

Background

Confirming the validity of the previously published course experience questionnaire (CEQ), a tool in general use in higher education, will enable its specific use in the evaluation of postgraduate clinical pharmacy programmes. The postgraduate clinical pharmacy programmes of interest may have unique aspects to them which may affect validity of the CEQ, for example, the dual emphasis on learning experience through both a formal class environment and workplace practice activities.

Objective

To validate the course experience questionnaire (CEQ), a tool used for student evaluation of higher education provision.

Method

A UK postal survey, using the CEQ, of graduates from clinical pharmacy postgraduate programmes. Cases were subject to exploratory factor analysis and compared with previous, non-pharmacy samples.

Setting

Graduates from 11 different postgraduate clinical pharmacy programmes in the UK since 1990 were surveyed. A total of 511 questionnaires were distributed and 364 (72 per cent) were returned.

Key findings

Factor analysis showed that the sample exhibited similar key constructs to other higher education samples. An important finding was a split in the “good teaching” construct in this postgraduate sample. This split reflects the type of teaching delivery common in postgraduate clinical pharmacy programmes.

Conclusions

The validation of this important evaluation tool for use in higher education means that comparisons can now be made between institutions and programmes, providing evidence for the quality of provision of these programmes from the student's perspective.
Work patterns and uptake of continuing education in a two-year cohort of New Zealand pharmacy technicians
Authors: Elmey V A , Beresford R A
Published: February 2011

Objective

To investigate the current practice, continuing education uptake and future work intentions of pharmacy technicians in New Zealand.

Method

Postal questionnaire survey of all 148 technicians certificated through the Open Polytechnic of New Zealand who started training in 1991 and 1992. Responses were obtained from 83 (56 per cent) of the target population.

Key findings

While most technicians regularly performed the duties for which they had been trained, some were also performing more demanding tasks, such as unit dose dispensing and deliveries for rest homes. A smaller number were engaged in more managerial tasks while fewer still were working beyond the confines of their legally defined role by undertaking extemporaneous compounding and preparing Controlled Drugs. Many felt restricted within their current role and wished to see it extended. Perhaps for that reason, most had undertaken some form of continuing education/professional development, not all of them with the support of their pharmacist employer(s).

Conclusions

While pharmacy technicians' aspirations and activities might be perceived by some as threatening the traditional role of pharmacists, technicians could also assist pharmacists to move further from the dispensary into the new age of counselling and other forms of patient management and care.
Pharmacist integration into the discharge process: a qualitative and quantitative impact assessment
Authors: Cattell Richard , Conroy Clare , Sheikh Adel
Published: February 2011

Objective

To determine whether a discharge pharmacist can improve the timeliness of patient discharge.

Method

Following a pilot phase on an acute admissions ward to assess the suitability of data collection forms (DCFs), patients were assigned to have their discharge medication organised either by a pharmacist (intervention group) or by the existing system (control group). Information relating to a variety of prescription processing times, together with data on clinical interventions and use of patient's own drugs (PODs), was recorded for each group.

Setting

Sixty-eight patients were recruited from one surgical ward and one medical ward at Bristol Royal Infirmary.

Key findings

Median discharge prescription processing time (time from discharge decision to patient discharge) was significantly less in the intervention group than in the control group (322 versus 460 minutes, P=0.0056). The median discharge prescription dispensing time was significantly greater with the existing system than when prescriptions were transcribed by the discharge pharmacist (240 versus 177 minutes, P=0.005). A cost-saving of £6 per patient by the reuse of PODs was calculated for the intervention group. No PODs were documented in the control group.

Conclusion

Our study demonstrates that integration of a pharmacist into the discharge system improves the timeliness of discharge, benefiting hospital bed management. Significant reductions in drug wastage and release of medical time are also apparent with this modified discharge process.