bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delivering domiciliary pharmaceutical care from a health centre pharmacy
Authors: Coleman David J , Portlock Jane , Brown David 
Published: February 2011

Abstract

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

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

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

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

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

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

Abstract

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

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

Setting
The study was conducted in Melbourne, Australia.

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

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

AbstractContextEmpowering patients to take a more active role in health-related encounters is a goal of many advocates today. This stems from evidence that patients remain rather passive during interactions with doctors and pharmacists.ObjectiveThe objective of this study was to examine the effect of verbal encouragement on patient question-asking. It was hypothesised that encouragement to ask questions would elicit a freer flow of questioning.MethodThe study had two arms — intervention and control. The same prescription processing steps occurred for each group except that intervention subjects were presented with a short verbal message (to invite questioning) before the prescription was handed over to a pharmacist for filling. Any questions patients raised during subsequent medication counselling were recorded. Observations took place in one Canadian community pharmacy.ResultsA total of 127 patients were observed for study purposes (60 intervention and 67 control). A total of 141 questions were asked by 59 patients; the other 68 patients had no questions when asked. Subjects in the intervention group (one outlier removed) asked an average of 1.1 questions per encounter, while the control group asked 0.9 questions. This difference was not statistically significant.ConclusionThe hypothesis of no difference in the rate of patient question-asking between groups was retained. This method of encouraging patients to become more involved in the counselling process proved unsuccessful.
Consumer perspectives of pharmacist-delivered healtn information and screening services
Authors: Teh Ruth , Chen Timothy , Krass Ines 
Published: February 2011

AbstractObjectiveCommunity pharmacy has been increasing its involvement in health promotion, especially information provision and screening, over the past decade. Little is known about how consumers view these services and there is a need to evaluate the level of consumer endorsement of this role. The aim of this study was to evaluate consumer attitudes towards pharmacist-delivered health information and screening services over time and with personal experiences of these services, as part of a standardised pharmacy programme.MethodA validated instrument was administered in 1994 (n=98) and 2000 (n=58) to consumers who had not experienced a pharmacist health information and screening programme, and to a population in 2000 (n=159) who had received such a service. Comparisons of consumer attitudes were made between the unexposed 1994 and 2000 populations to test for the influence of time, and between the exposed and unexposed samples in 2000 to test for the effect of personal experience of the service.SettingData were collected in seven community pharmacies in various non-metropolitan regions of New South Wales, Australia.Key findingsEven after accounting for demographic variation between cohorts, consumers had a more positive attitude towards pharmacist screening over time, and towards both health information and screening after personal experience of these services.ConclusionCommunity pharmacists should be encouraged to participate more in health information provision and screening in order to take advantage of and further promote consumer endorsement of these pharmacist services.
SOCIOLOGICAL THEORY AND PHARMACY PRACTICE RESEARCH: (1) An introduction to sociology — and what it can do for pharmacy practice research
Authors: Bissell Paul , Traulsen Janine Morgall , Haugbølle Lotte Stig 
Published: February 2011

AbstractThis is the first in a series of papers seeking to demonstrate the relevance of sociological theory to the contemporary debates found in pharmacy practice research. In producing this series, we hope to stimulate a critical appreciation of sociological theorising as it might be applied to pharmacy practice research. We aim to achieve this through an exploration of the ways in which sociological theory has already been applied to areas of health care practice, in some cases providing exciting, illuminating and thought provoking insights. The examples of research which we draw upon will be supplemented by a series of questions as to how sociological theories might be more fruitfully employed in the framing of questions specific to pharmacy practice research. We will also provide an extensive reading list for those interested in finding out more.We first feel the need to argue our “case” for greater engagement between sociology and pharmacy practice research. Why might pharmacy practice researchers find sociological theory useful in their work? After addressing this question, we attempt to define what sociology might be, draw attention to some aspects of the nature of sociological thinking and then describe what is to come in the forthcoming series of papers.
The roles of informal carers in the management of medication for older care-recipients
Authors: FRANCIS SALLY-ANNE , SMITH FELICITY , GRAY NICOLA , GRAFFY JONATHAN 
Published: February 2011

Abstract

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

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

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

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

Conclusion
Support for informal carers is a priority for the British Government which recognises their important contribution to health care. In documenting the medication-related assistance provided by carers this paper identifies key considerations for the pharmacy profession in developing carer-centred pharmacy services.