bluuebunny/crossref_metadata_2025 huggingface dataset:
HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Qualitative interviews
Authors: Smith Felicity
Published: February 2011

Qualitative approaches have gained an increased prominence in health services and pharmacy practice research in recent years. Although the numbers of qualitative studies are small compared with those using survey methodology, a substantial body of work has been undertaken in pharmacy practice and related settings. The aim of this paper is to review research employing qualitative interviews in terms of the methodological issues and problems that this approach presents and to explore how these have been addressed. Study objectives, sampling procedures, data collection, processing and analysis and issues of validity, reliability and generalisability will be discussed.
Factors used by pharmacists in the recommendation of the active ingredient(s) and brand of non-prescription analgesics for a simple, tension and migraine headache
Authors: Roins Sylvia , Benrimoj Shalom I , Carroll Peter R , Johnson Lester W
Published: February 2011

The objective of this study was to determine the factors (dimensions) that are considered by community pharmacists in their recommendation of the active ingredients and brands in non-prescription analgesics for an adult with a simple, tension or migraine headache. The research was conducted in four stages: a qualitative stage, a pre-pilot study, a pilot survey and the main quantitative study. The main study was conducted across 1,500 randomly selected Australian community pharmacies (68.3 per cent usable response rate). Principal components analysis with varimax rotation was employed on a list of statements concerning pharmacists' recommendation of the active ingredient(s) and the brand. For each type of headache, a four factor solution was interpreted for reasons for recommendation of the active ingredient(s) and reasons for recommendation of the brand. All the factors extracted were meaningful and easily interpreted. The highest percentage of the total variance was explained by the clinical influences factor for simple (20.4 per cent) and tension headache (18.8 per cent) and the two clinical influences factors for migraine headache (20.3 per cent and 10.1 per cent, respectively), indicating that the clinical influences construct accounted for the highest potential influence on pharmacists' recommendation of the active ingredient(s). The highest percentage of the total variance was explained by the economic influences factor for simple (29.9 per cent), tension (28.8 per cent) and migraine headache (30.8 per cent), indicating that the economic influences construct accounted for the highest potential influence on pharmacists' brand recommendation. This research could be useful for educators, professional associations and pharmaceutical companies in pharmacy-oriented marketing strategies.
Targeted medication review: patients in the community with chronic pain
Authors: Read Rhona W , Krska Janet
Published: February 2011

Patients with chronic pain may be in need of improved pharmaceutical care because of lack of pain relief and lack of understanding of pain management, the potential for drug interaction and adverse effects. This study assessed the need for a pharmacist to review the medication of a population of patients with chronic pain in a domiciliary setting, using specific validated outcome measures to determine any benefits of pharmacist intervention.

Ninety-six patients who had rheumatoid arthritis or were taking regular nonsteroidal anti-inflammatory drugs (NSAIDs) or combination analgesics were interviewed after reviewing their medical records. Expectations of pain relief and severity of pain were assessed using McGill pain questionnaire (MPQ), visual analogue scales (VAS) and verbal descriptor scales. Twenty-eight patients required referral to their GP as a result of meeting preset criteria for poor outcome from current therapy; these patients had higher expectations of pain relief than the remaining patients and also higher pain scores. Pain scores using the MPQ and VAS were generally well correlated with each other and both showed changes in the 14 patients who were re-interviewed after pharmacist intervention. A further 59 patients required advice to optimise current therapy and 12 required referral concerning inappropriate therapy. Many patients' medicine use deviated from that prescribed, and a high proportion used alternative medicines in addition. The prescription of drugs for prophylaxis against ulceration was inappropriate in 17 patients and evidence of monitoring in patients on NSAIDs and disease-modifying antirheumatic drugs (DMARDs) was poor.
HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Focus groups and observation studies
Authors: Smith Felicity
Published: February 2011

This paper reviews research undertaken in pharmacy practice and related settings employing focus groups and observation methods. The aim of the review is to identify the main methodological considerations of these approaches to enable pharmacy practice researchers to benefit from the experiences of their colleagues when conducting their own research. The paper is in two parts. Focus groups have become increasingly prominent in pharmacy practice and health services research. They are an attractive and effective alternative to individual qualitative interviews for particular problems in pharmacy research. In this paper, the use of focus groups by researchers in pharmacy practice and related settings is reviewed. Observation studies have been applied widely to address many research questions. They are a valuable method of obtaining data, documenting actual events and activities rather than relying on self-reports of behaviours and events. Observation methods have been used both as a sole method for a research study and in combination with other methods. In the pharmacy practice literature there are examples of participant and non-participant observation studies and both quantitative and qualitative approaches. Through the experiences of pharmacy practice researchers, the methodological and ethical issues that these studies present are identified and ways in which they have been addressed are explored.
Asthma advice giving by community pharmacists
Authors: Osman L M , Bond C M , MacKenzie J , Williams S
Published: February 2011

Objective

To investigate the frequency and type of asthma-related advice provided by community pharmacists to customers, and pharmacist attitudes to advice giving and training needs.

Method

Postal questionnaire surveying the provision of advice to asthma patients in the previous month. Responses were discussed in a focus group of 13 pharmacists representing different types of community pharmacy and stratified by age and sex.

Setting

All community pharmacists in the Grampian health board area, in North East Scotland.

Key findings

Of an estimated 180 community pharmacists, 125 responded. Respondents had dispensed a median of 70 asthma medications per week to approximately 40 customers. Most had given advice no more than twice a week. In the previous month, half had checked inhaler technique and most (75 per cent) had “loaned” relief inhalers on an emergency basis. The most common areas where patients sought advice were problems with inhalers, concerns about side effects of asthma medications and using peak flow meters. In the focus group, pharmacists expressed concerns about their training in advice giving for inhaler skills and peak flow meter use and self-management plans. The 69 pharmacists who had undertaken additional training were significantly more likely to feel confident in giving asthma-related advice and to give advice more often. Sixty-one per cent of pharmacists wanted more training in advice giving.

Conclusion

At present, asthma-related advice is given infrequently. Reasons for missed opportunities for giving such advice are limited facilities in premises, lack of pharmacist knowledge of some aspects of asthma management and patient attitudes (ie, lack of awareness that pharmacists can fulfil this role).
Antibiotic use in elderly hospital inpatients before and after the introduction of treatment guidelines
Authors: McCaig D J , Hind C A , Downie G , Wilkinson S
Published: February 2011

Objective

(1) To establish the pattern of antibiotic use in elderly hospital inpatients, using data to draw up antibiotic treatment guidelines; (2) To assess the short-term and longer-term impact of the guidelines on antibiotic use and their acceptability to medical staff.

Method

Antibiotic use was assessed in relation to suitability for site and severity of infection, appropriateness of drug choice, outcome of therapy and cost, before, immediately after and 10 months after guideline introduction. Acceptability to medical staff was gauged through a questionnaire.

Setting

Geriatric hospital inpatients in long-stay, assessment and GP-supervised wards in the Grampian region of Scotland (phase 1: 324 patients; phase 2: 302 patients; phase 3: 263 patients).

Key findings

The antibiotic prescribed was appropriate for site and severity of infection in 92 per cent of patients in phase 1, but was a policy drug in only 56 per cent. After guideline introduction, adherence to policy did not improve, but use of non-policy drugs without identified reason fell from 24 per cent in phase 1 to 13 per cent in phase 3. Adjustment of antibiotic dose for renal function increased from 73 per cent in phase 1 to 86 per cent in phase 3. Duration of treatment for a single infection was significantly reduced in phase 3, but outcome and cost were unchanged after guideline introduction. Medical staff were supportive of the guidelines and felt they had changed their prescribing practices.

Conclusion

Antibiotic treatment guidelines did not have a major impact on antibiotic use, although some positive trends were observed. New ways of promoting adherence to guidelines need to be explored.
Effect of incentives on recruitment and response rate in a community-based pharmacy practice study
Authors: Kennedy Emily , Krska Janet , John Dai , Hansford Denise
Published: February 2011

Objectives

To study the feasibility of carrying out a community pharmacy-based drug utilisation study of H2 antagonists and alginate-containing preparations, and to study the effect of two methodological variations — payment of pharmacists and the free issue of medicines — on recruitment rates and response rates.

Method

Pharmacists were asked to recruit customers into the study after deciding that one of these products was appropriate for purchase. Customers were asked to provide their signed consent, their name, address and information about their general practitioner and to complete an initial questionnaire provided by the pharmacist and a second questionnaire which was sent out by the researchers two weeks later. In 20 of the pharmacies the medicines were offered free once customers had agreed to participate; in the remaining pharmacies, customers paid the normal retail price for the product. All pharmacies received incentive payments for each of the three months in the second half of the study period in which they recruited five or more customers.

Setting

Thirty-nine community pharmacies in Scotland and Wales.

Key findings

Similar numbers of customers were recruited to the study irrespective of whether free medicines were offered. Significantly more (P<0.001) customers recruited by pharmacies providing free medicines returned both the first (339/383) and second questionnaires (264) than those recruited by pharmacies not providing free medicines (269 and 208/384, respectively). Of the 608 customers who returned the first questionnaire and were subsequently issued with a second questionnaire, 77.6 per cent returned it; there was no difference in return rates between customers who received free medicines and those who did not. Incentive payments to pharmacies resulted in a small increase (14 per cent) in recruitment rate in the second half of the study and no difference in response rates from the customers recruited.

Conclusion

The study established the feasibility of undertaking drug utilisation studies with high response rates in community pharmacies. The provision of free medicines increased customer response rates, but incentive payments for pharmacists showed no clear effect on recruitment rates.
Assessing pharmaceutical services at primary care clinics in KwaZulu-Natal: an indicator-based approach
Authors: Kishuna Aarti , Smit Jennifer
Published: February 2011

Objective

To obtain baseline data on the provision of pharmaceutical services at primary care clinics

Method

Internationally used standard and objective indicators were adapted for this study and used to assess the availability and quality of key drugs, and the quality of dispensing practice in a sample of primary care clinics in 1994

Setting

The study was undertaken in three regions of the province of KwaZulu-Natal, South Africa

Key findings

It was found that the delivery of pharmaceutical services at primary care facilities was good, considering South Africa is a developing country in transition. However, some deficiencies were apparent. Recommendations for addressing these shortcomings are described. The challenge now is to maintain and improve the delivery of pharmaceutical services at primary care facilities in KwaZulu-Natal

Conclusion

The study provided baseline data against which progress in the implementation of the South African National Drug Policy (NDP) can be measured
A survey of adverse drug reaction reporting by hospital pharmacists to the Committee on Safety of Medicines — the role of pharmacy departments
Authors: Ferguson Martin , Dhillon Soraya
Published: February 2011

Objectives

To identify: (1) how adverse drug reaction (ADR) reporting by hospital pharmacists is managed, (2) the education of pharmacy personnel on ADR reporting, (3) pharmacy personnel with a specific role in ADR reporting, (4) the numbers of ADR reports sent to the Committee on Safety of Medicines (CSM) and (5) barriers to reporting

Method

Postal questionnaire survey of 250 hospital-based drug information (DI) departments

Setting

All hospital-based DI departments listed in the United Kingdom Drug Information Pharmacists' Group directory

Key findings

A total of 185 questionnaires was returned (74 per cent response). Thirty-five per cent of respondents had a procedure for the reporting of ADRs by pharmacists; 62 per cent of departments actively promoted reporting; 44 per cent of departments reviewed reports before they were sent to the CSM. DI pharmacists were frequently involved in the review of the reports and were usually the designated ADR person. Education on ADR reporting was provided by 69 per cent of departments. Few specialist pharmacists (n=9) were identified as having established a direct link with the CSM. The majority of departments had submitted five or fewer ADR reports to the CSM. The presence of a procedure, promotion of reporting, education and the presence of a designated ADR person were found to be associated with above average rates of ADR reporting (chi-square test)

Conclusion

The survey showed that the role played by pharmacy departments in the area of hospital pharmacist ADR reporting varied considerably but in most cases was insufficiently developed
The impact of professional socialisation on pharmacy students' role perceptions
Authors: Collins David M , Benson Heather A E , Occhipinti Stefano , Wright Anthony , Mcelnay James C
Published: February 2011

Objective

To evaluate pharmacy students' perceptions of the relative status of seven health professional groups: dentists, general medical practitioners (GPs), medical specialists, nurses, pharmacists, physiotherapists and social workers

Method

A 56-item questionnaire was sent to 389 pharmacy undergraduate students, from the University of Queensland, Australia, and the Queen's University of Belfast, Northern Ireland

Key findings

In comparison with their Australian counterparts, students from Northern Ireland rated pharmacists significantly higher, and GPs, medical specialists, physiotherapists, and social workers significantly lower, on a measure of overall professional status. Respondents also rated pharmacists significantly higher, and GPs, physiotherapists and social workers significantly lower, on a professional potency dimension to the status measure. However, both student groups ranked pharmacists first on a receptivity dimension to the status measure, indicating their perception of pharmacy as an empathetic profession. Medical specialists were uniformly rated highest of the professions on the potency dimension and lowest on receptivity

Conclusion

It is posited that differences between the students' perceptions of the health professionals reflect both cultural and educational differences
A good year
Authors: Blenkinsopp Alison
Published: February 2011

This final issue of the IJPP for the millennium provides both inspiration and realism about the challenges that lie ahead
Hospital doctors' perceived barriers to pharmacist prescribing
Authors: Child Damian , Cantrill Judith A
Published: February 2011

Objective

To examine the reasons behind hospital doctors' perceived barriers to pharmacist prescribing in the United Kingdom.

Method

Postal questionnaires using a combination of open and closed questions were sent to hospital doctors seeking responses to scenarios describing pharmacists writing prescriptions for drug treatment. Content analysis of the qualitative responses was undertaken to identify the major themes which represented potential barriers.

Setting

Five National Health Service teaching hospitals in Birmingham, UK.

Key findings

Completed questionnaires were received from 94/193 doctors (49 per cent). Fifty-two respondents (55 per cent) expanded on their opinions in responding to the scenarios presented. Thirty-eight respondents described potential problems or gave reasons why they believed pharmacists should not be permitted to transcribe or prescribe drug treatment. Eleven respondents spontaneously added supportive comments and the remainder were neutral. Five major themes clearly emerged: pharmacists' awareness of clinical and patient details, potential communication problems, belief that a doctor should write the initial inpatient prescription, the division of overall clinical responsibility and loss of the opportunity to review the drug treatment.

Conclusion

Potential barriers to pharmacist prescribing were identified both by doctors who agreed and by doctors who disagreed with the general concept. Some doctors had misconceptions about the division of responsibility relating to drug treatment. This study has identified important issues that the pharmacy profession will need to address if we are to be accepted as prescribers and provides a valuable starting point for further work.
The impact of social change on professions — gender and pharmacy in the UK: an agenda for action
Authors: Hassell Karen
Published: February 2011

In several countries a growing number of women are entering the pharmacy profession. This paper examines the nature of increasing female entry into the pharmacy profession in the United Kingdom, possible reasons for this, and the implications for workforce management and planning. The review forms part of a research agenda setting exercise about the pharmacy workforce commissioned by the Royal Pharmaceutical Society of Great Britain. The paper aims to provide an overview of gender-related workforce issues for researchers and commissioning bodies alike, describes what is currently known about the gender profile of the UK workforce and identifies some of the key areas that remain under-researched. Participation and activity rates, career influences, explanations around the increased entry of women into pharmacy, and the consequences of women's involvement for the profession, are all considered. Gaps are identified and priority topics for research are also suggested.
Workcoping and homecoping: achieving a balance in part-time community pharmacy
Authors: Symonds B Sue
Published: February 2011

Objectives

(1) To explore different concepts of part-time work by means of a study of part-time work in community pharmacy; (2) to ascertain the complexity and diversity of part-time work patterns; (3) to consider the strategies employed by part-time pharmacists to make their part-time working possible.

Methods

Records of part-time work in community pharmacy were examined. A quantitative survey was conducted by sending a postal self-completion questionnaire to 975 pharmacists. There were 727 valid responses. Qualitative semi-structured interviews were conducted with 33 community pharmacists, identified from the survey as working part time. The emphasis was on data representing the part-timers' own perceptions of their work and careers.

Setting

The total membership of two Midlands branches of the Royal Pharmaceutical Society of Great Britain.

Key findings

Of the 230 pharmacists (31 per cent of all respondents) who worked part time, 200 (140 women; 60 men) worked in community pharmacy. There was a considerable range and variability of working patterns, the clearest division being between employed (70) and self-employed (122) part-timers. The strategies used to cope with work and family responsibilities by both men and women of different ages and under different circumstances were sometimes very complex. The terms “workcoping” and “homecoping” were devised to describe these strategies.

Conclusions

Existing concepts of part-time work do not fully explain the complexities revealed in this study. Many part-time pharmacists believed they had achieved a balance which was both professionally satisfying and socially responsible. They employed strategies which enabled them to maintain this balance and keep control over their lives.
Development and evaluation of a survey tool to explore patients' perceptions of their prescribed drugs and their need for drug information
Authors: Duggan Catherine , Bates Ian
Published: February 2011

Objective

To explore the effect of providing information about their prescribed drugs on patients' perceptions and use of the drugs.

Method

A survey tool was administered to 501 general medical patients in their own homes during a trial to reduce discrepancies between supplies of hospital prescribed drugs and those received in the community following hospital discharge. The patient sample was randomly recruited into two cohorts: 264 in the intervention group (given information regarding drugs prescribed on discharge from hospital to take to their community pharmacy) and 237 in the comparison group. Responses to the survey were explored to assess any effects on patients of providing such information.

Setting

Domiciliary visits to general medical patients in East London.

Key findings

The survey tool was subjected to factor analysis and reliability testing. Principal components analysis (PCA) was used to extract five factors that described an intrinsic desire for information, perceived impact of the illness, perceived utility of medicines, anxiety about illness and worry about changes to medicines. Internal consistency was good, ranging from 0.8 to 0.91 (Cronbach's coefficient alpha). Interconstruct relationships between the scales, patient demographics and the two cohorts were explored. The findings indicated that the degree of patient empowerment is related to two constructs: “intrinsic desire for information” and “worry about changes to medicines.” Patients who expressed a low degree of worry about changes and a high desire for information about their drugs seemed less worried and more empowered when given additional information. Conversely, those who expressed worries about changes in their medicines and did not want information about their medicines (were happy knowing little) seemed more worried and less empowered when given additional information about those changes.

Conclusion

Further exploration of relationships between patient perceptions and information provision is needed to influence appropriately the development of pharmaceutical care between hospital and community.
Ethical awareness of community pharmacists
Authors: Hibbert Derek , Rees Judith A , Smith Ian
Published: February 2011

Objective

To explore the extent to which community pharmacists in the United Kingdom encounter and resolve ethical dilemmas in their daily work.

Method

Semi-structured interviews were carried out with a sample of community pharmacists representing a range of ages and pharmacy backgrounds. Two were from independent pharmacies and five from multiples.

Key findings

Analysis of the transcripts of the interviews showed that ethical dilemmas were a feature of community pharmacy although most of the pharmacists were not conversant with the details of the Royal Pharmaceutical Society's Code of Ethics. The examples of ethical dilemmas quoted could be classified and interpreted to demonstrate a knowledge of the basic ethical concepts and the wider legal, occupational, organisational and personal value sets which encompass ethics in the work place. Ethical dilemmas arose as a result of the pharmacist's role as supplier of prescription medicines, guardian of over-the-counter medicines and intermediary between patient and carer/doctor. Other dilemmas were related to the legal framework surrounding medicines as well as the organisational, occupational and personal values of the pharmacist.

Conclusion

The pharmacists in this study demonstrated awareness of ethical issues and their accounts indicate possession of practical skills to deal with moral uncertainty.
Group interviews with people taking long-term medication: comparing the perspectives of people with arthritis, respiratory disease and mental health problems
Authors: Smith Felicity , Francis Sally-Anne , Rowley Emma
Published: February 2011

Objective

To examine experiences of medicine use, advice and support from the perspectives of people taking medicines long term for arthritis, respiratory disease and mental health problems.

Method

Twelve group interviews were conducted, four with each of the three chronic illness groups.

Setting

Interviews were arranged through national and local voluntary organisations and conducted as part of their regular meetings.

Key findings

The most prominent issue for all the Arthritis Care groups was information about side effects. People discussed the benefits of having this information and the reasons they believed that it was not generally provided. People with respiratory disease described difficulties of obtaining information as a problem in the operation of the health service in Britain, where participants may or may not find out about different products by chance. In all these discussions there were examples of how people used their regular group meetings to inform each other. For people with mental health problems, participation in decisions concerning medicines and the attitudes of health professionals were the most prominent issues. Members of all groups, across all chronic illnesses, claimed that adequate information was not shared with them during consultations with professionals. However, different perspectives of involvement in decision-making regarding therapy were distinguishable. Pharmacy services did not feature prominently in any of the group discussions.

Conclusion

The study revealed differences between the illness groups in the emphasis participants placed on different issues. However, there were also common concerns, in particular relating to obtaining information and the attitudes of professionals. While pharmacy services were not prominent in discussions, a range of unmet needs concerning medicines were identified. This indicates that opportunities exist for pharmacists to provide more responsive services that would be valued by people taking long-term medication.
Evaluation of a new health centre pharmacy: a case study
Authors: Wilson Keith A , Jesson Jill K , Staunton Noel
Published: February 2011

Background

This case study describes the evaluation of a primary care intervention in the Isle of Wight, United Kingdom, arising from the decision to move a medical practice from its town location into a new health centre in a nearby village. The new centre incorporated a new community pharmacy within the practice.

Aim

To determine stakeholders' views on whether there was any perceived benefit resulting from the location of a pharmacy within the new health centre, over and above that of supply.

Method

The evaluation explored both process and outcome features by means of self-completion questionnaires with patients and semi-structured interviews with health centre staff. The first phase of the study was undertaken prior to the medical practice move into the new health centre in July, 1996, and the second phase 12 months after the move. An interim report was used to influence change by making recommendations to the health authority to provide support and resources for the new pharmacist.

Key findings

Prior to the move: three-quarters of medical practice patients surveyed expected to use the new pharmacy, and 55 per cent expected to receive a better service. The health centre staff and pharmacist were enthusiastic about the potential for service development in the pharmacy. The general practitioners (GPs) had the clearest ideas about possible additional services but there was no implementation strategy. Based on these findings, the evaluators made specific recommendations on action to be taken by the health authority.

After the move: 88 per cent of patients surveyed had used the pharmacy and considered that the service was better. The perception was based on matters of convenience. Health centre staff and GPs considered that the pharmacy was providing services beyond supply and had raised awareness of prescribing issues.

Conclusion

A pharmacy located within a health centre can, given appropriate support, enhance the pharmacist's contribution to primary health care over and above supply, and provide a mechanism for developing pharmaceutical support for the prescribing function. Evaluation can help to provide insight into ways of ensuring a more satisfactory outcome following organisational change.
Pharmacists and their customers: a personal or anonymous service?
Authors: Abu-Omar Sahar M , Weiss Marjorie C , Hassell Karen
Published: February 2011

Aims

To explore the existence and nature of the pharmacist-customer relationship.

Methods

A qualitative approach was adopted. Semi-structured interviews were conducted with 20 customers recruited from two pharmacies differing in type and location: Pharmacy A, a multiple chain pharmacy in a more affluent area, and pharmacy B, a small chain pharmacy.

Key findings

Customers' views differed according to the pharmacy from which they were recruited. Pharmacy B customers had a personal relationship with the pharmacist and used the pharmacy as a health care resource, while pharmacy A customers did not have a personal relationship with the pharmacist and used the pharmacy simply for medicine supply. Several pharmacy A customers had their own different local pharmacist whom they used for more personal advice and counselling. Both groups described disadvantages of multiple chain pharmacies. Consumerist behaviour was identified among customers whereby they preferred to control the provision of advice, assess it and act upon it. However, lack of information was mentioned by several interviewees, which suggested that different types of customers have different needs from the pharmacy. The pharmacist has therefore to recognise these different needs and to meet them accordingly to provide services, whether anonymous or personal, within their “extended role.” While most customers viewed pharmacists as drug experts and considered managing minor ailments to be part of their job, they were less supportive of a more extended role in the therapeutic monitoring of drug therapy. This presents a serious barrier to pharmacists wishing to extend their role into a more patient-oriented and clinical domain.

Conclusion

This study reinforces the importance of considering customers' views when policies and strategies concerning the development of the “extended role” are considered. Recognising customers' views helps the profession to adapt and respond to changing consumer behaviour. Issues identified through this in-depth exploration of public perceptions of pharmacists have implications for the extension of pharmacists' roles into areas favoured and appreciated by customers.
Evaluation of effect of pharmacy discharge planning on medication problems experienced by discharged acute admission mental health patients
Authors: Shaw Helen , Mackie Clare A , Sharkie Irene
Published: February 2011

Objective

To evaluate the effect of pharmacy discharge planning on the pharmaceutical care issues experienced by discharged mental health patients.

Method

97 patients recruited from three acute-admission psychiatric wards were randomly allocated to either an intervention group (receiving a baseline pharmaceutical needs assessment, information about medicines and then a pharmacy discharge plan sent to their community pharmacy) or a control group (no such additional pharmaceutical care). Domiciliary visits were carried out at one, four and 12 weeks post-discharge and medicine knowledge and the number and types of medication problems experienced were assessed at each visit. Community pharmacists were questioned about problems with individual prescriptions and use of the discharge plan, where relevant, after each domiciliary visit.

Key findings

There was no significant difference between the groups in baseline medicine knowledge. One week post-discharge, both groups showed significant (P<0.002) improvement in knowledge of medication from baseline and this improvement was maintained at 12 weeks. No significant difference was found between knowledge scores for the two groups on any occasion. Fewer medication problems were recorded for the intervention group. There was a trend for reduced readmissions for the intervention group, but this was not statistically significant (P = 0.065) Community pharmacists in receipt of plans were more likely to identify problems than other pharmacists.

Conclusions

Further work is needed to evaluate whether the effectiveness of pharmacy discharge planning may be improved by providing information to general practitioners and community psychiatric nurses in addition to community pharmacists, as in this study.
Lay users: smart pharmacy consumers or non-compliant patients?
Authors: Savage Imogen
Published: February 2011

Imogen Savage reports on some of the highlights from the sixth Health Services Research and Pharmacy Practice conference, held in Aberdeen from April 13–14
The development and evaluation of an extended adherence support programme by community pharmacists for elderly patients at home
Authors: Raynor D K , Nicolson M , Nunney J , Petty D , Vail A , Davies L
Published: February 2011

Objective

To devise, implement and evaluate a medication adherence support service by community pharmacists for elderly patients living at home and at risk of non-adherence.

Method

Six community pharmacists identified patients who were 65 years of age and older, prescribed four or more regular medicines and living alone. A random sample of patients was visited at home and assessed for adherence-related problems using a structured interview. The pharmacist then drew up an action plan in conjunction with the patient and general practitioner (GP), and returned for a second home visit, where the revised regime was delivered and explained. A self-reported adherence questionnaire was also administered. After two months an independent researcher visited the patients at home to assess progress.

Setting

Six community pharmacies in the city of Leeds, UK, and patients' homes.

Key findings

A total of 143 patients were recruited and 441 medicine-related problems were identified. Of these, 241 (55 per cent) required the provision of information and advice, 106 (24 per cent) required consultation with the GP and 86 (20 per cent) required changes in the presentation of the medicines. The median number of regular prescribed medicines fell from six to five (P<0.001). Overall, there was a reduction in the number of patients with one or more problems from 94 per cent to 58 per cent (P<0.001). The proportion of patients who reported non-adherence fell from 38 per cent to 14 per cent (P<0.001).

Conclusion

This study shows that community pharmacists can target patients at risk of medication non-adherence and, using a structured approach, identify problems and implement solutions. The pharmacy patient medication record is an underutilised tool for identifying patients with adherence problems. The software needs enhancing to enable pharmacists to maximise their use of these records in adherence support. An adherence support programme needs to take more account of intentional non-adherence and should be closely linked with the rest of the primary health care team.
Empathy as a communication strategy in the pharmacy — a study based on cognitive and behavioural analysis
Authors: Lilja John , Larsson Sam , Hamilton David , Issakainen Josefin
Published: February 2011

Objective

To evaluate an educational intervention that aimed to improve the level of empathy shown by pharmacy staff to their customers.

Method

Open study of the effect of the intervention on pharmacy staff attitudes and behaviour related to empathy. All members of staff in five pharmacies in and around Stockholm, Sweden, participated in a 20-hour continuing education course on communication and empathy. Participants worked in groups of between four and eight. Course outcomes were measured by questionnaires (to examine cognitive changes) and video-recordings (to examine behavioural changes). Staff (n=75) completed questionnaires before and after the course. Questionnaires used Davis's empathy scale and Rosenberg's self-esteem scale. Interactions between staff and customer were video-recorded before and after the training course in one pharmacy. Videotapes were subsequently coded by two researchers for specific behaviours that demonstrated empathic communication.

Results

The findings from both the questionnaires and the video-recordings indicated that after the course there were small increases both in the pharmacy staff's capacity to show empathy and in some aspects of the empathic behaviour they displayed.

Conclusion

Rather modest changes in empathy were found to result from the intervention and possible reasons for this are explored in the paper.
The effects of a patients' own drugs scheme on the incidence and severity of medication administration errors
Authors: Dean Bryony , Barber Nick
Published: February 2011

Background

Many UK hospitals are introducing patients' own drugs (PODs) schemes, in which patients' own medication is used during their stay. It has been suggested that these will reduce medication administration errors (MAEs), particularly those due to medication unavailability.

Objective

To explore the effects of introducing a PODs system on the incidence and severity of MAEs.

Method and setting

An observational method was used to identify MAEs before and after introducing a PODs system on one surgical and one medical ward in a teaching hospital in the United Kingdom. MAEs were classified as being due to unavailability (U-MAEs) or other reasons (O-MAEs). A validated severity assessment method was applied to the MAEs identified.

Key results

The overall MAE rate for the traditional ward pharmacy system was 4.3 per cent and for the PODs system it was 4.2 per cent (P=0.99, chi square test). There were also no significant differences in U-MAE or O-MAE rates, types of MAE or their severity. There were several potential reasons why the PODs system did not reduce U-MAEs. These included the informal use of patients' own medication in the traditional ward pharmacy system and one patient prescribed a non-formulary drug who accounted for many of the U-MAEs observed. Logistic regression analyses indicated that U-MAE rates were affected by time of day and day of week, and O-MAE rates by day of week and administering nurse.

Conclusion

It was concluded that the introduction of a PODs system had little effect on MAEs.
The effects of pharmacy commitment on the development of job satisfaction and organisational commitment
Authors: Lerkiatbundit Sanguan
Published: February 2011

Objective

To determine how professional commitment at the time of graduation affects the later development of professional commitment, job satisfaction and organisational commitment in pharmacy graduates.

Method

Sixty-one pharmacy students at Prince of Songkla university, Thailand, completed a first survey questionnaire administered two weeks before graduation and a second survey questionnaire eight months after graduation.

Results

At eight months after graduation, the level of professional commitment remained unchanged. Professional commitment at graduation was the strongest predictor of professional commitment eight months later. It was also a predictor of job satisfaction. However, its effect on job satisfaction was less than those of skill utilisation and satisfaction with workload. Professional commitment at graduation did not emerge as a significant predictor for organisational commitment, when several job factors were controlled.

Conclusion

Pharmacy commitment developed from schools seems to be stable at eight months after graduation. It is less influential than job factors in the formation of organisational commitment and job satisfaction.
Pharmaceutical needs assessment in general practice
Authors: Krska Janet , Duffus Peter R S
Published: February 2011

Objective

To develop a method of prioritising the need for pharmaceutical input into a general practice.

Method

An adaptation of health needs assessment methodology was used to study areas of potential pharmacist input into a practice. Prescribing data, information from the practice's computer system and medical records were used to identify the practice's needs for pharmacist input and changes to practice. Interviews with practice staff and direct observation were used to obtain information on current systems and suggestions for change. A summary of the needs identified and suggestions for change were used in a prioritisation process.

Setting

One UK general medical practice.

Key findings

The study identified the need for improvements to the repeat prescribing system, a greater agreement between practice partners on the use of a practice formulary and treatment protocols, and regular review and improved monitoring of patients taking long-term medication. Among patients taking repeat medication, those aged 45 or over and those taking four or more medicines were found to be at greatest risk of having potential pharmaceutical care issues which needed to be addressed. The prioritisation process resulted in pharmacist input into maintaining registers of patients taking drugs with narrow therapeutic indexes, reviewing the practice's computer-based formulary and undertaking medication review being considered of highest priority by medical staff.

Conclusion

The method enabled the identification of many areas which could benefit from pharmacist input and the prioritisation of these to plan future work.
Caring for people with schizophrenia: family carers' involvement with medication
Authors: Francis Sally-Anne , Patel Mayuri
Published: February 2011

Objective

To investigate carers' experiences of medication, and their involvement in managing medication, when caring for an adult family member with schizophrenia.

Method

In-depth, semi-structured interviews were conducted with 14 family carers who were identified through voluntary care groups of the National Schizophrenia Fellowship (NSF). Interviews were audiotape recorded and transcribed. Data were analysed by comparing transcripts to generate descriptive themes.

Setting

All but one of the carers were interviewed in their homes; the remaining carer was interviewed in the researcher's home.

Key findings

Carers acknowledged the importance of medication in stabilising their care-recipients' illness. However, they had also observed their care-recipients experiencing unexpected adverse effects of medication. As a result of these observations, carers experienced feelings of guilt and fear for having encouraged medication compliance. Not all carers were involved with their care-recipients' medication but a number of roles were described: facilitator, monitor, advocate and interventionist. Direct involvement with managing medication was identified as a source of conflict between some carers and their adult care-recipients. All carers reported unmet needs for information and support concerning their care-recipients' medication.

Conclusion

In this study, the degree of involvement that carers had with their care-recipients' medication varied. Direct involvement with medication was identified as a source of conflict between some carers and care-recipients. All carers expressed the unmet need to discuss their care-recipients' medication with a professional. Health professionals need to consider effective methods for contributing to this gap in routine service provision.
Cost implications of the delivery of pharmaceutical care services through Australian community pharmacies
Authors: Donato Ron , March Geoff , Moss John , Gilbert Andrew
Published: February 2011

Objective

To conduct a cost analysis of the Community Pharmacy Model Practices project in South Australia.

Method

As part of a prospective participatory action research programme, the cost analysis identified the main items of fixed and variable costs and of potential cost savings, and expressed them in a framework to aid decision-making.

Setting

Ten community pharmacy practices in primary care: five provided generalist medication management, two diabetes care, two asthma care, and one wound management. Services were provided to 411 pharmacy patients (median age 75; 70 per cent female) in the community, resident in a range of nursing home and hostel accommodation, or patients in hospital. There was a maximum of 11 months' observation.

Key findings

All the five medication management pharmacies, one of the asthma management pharmacies, and the wound management pharmacy, but neither of the diabetes management pharmacies, were able to generate potential resource savings greater than their total variable costs, so that net resource savings were available to make a contribution to absorbing fixed costs.

Conclusions

The provision of medication management services by community pharmacies working to a well-defined, systematic process of patient care within a primary care setting can be expected to reduce overall direct costs to the health system. Similar findings are likely with wound management in pharmacy care, but the results are less certain for asthma management and diabetes management. These results, when considered in the light of possible gains in survival and quality of life, are of significant interest to policymakers concerned with controlling health system costs.