bluuebunny/crossref_metadata_2025_split huggingface dataset:
The community pharmacist as a member of a primary health care team in South Africa — perceptions of pharmacists, doctors and nurses
Authors: Gilbert Leah 
Published: February 2011

AbstractThe growing emphasis on primary health care (PHC) has drawn increased attention to disease prevention and health promotion activities from many health professionals, among them pharmacists. This paper explores the role of the community pharmacist as a member of the PHC team in South Africa, through the perceptions of pharmacists, nurses and doctors. Data were collected by survey and interviews. The results reveal a scenario where pharmacists are eager to engage in PHC activities, whereas nurses and doctors are more cautious in their support. Although they see pharmacists as health professionals, and are of the opinion that they should play a part in the PHC team, doctors and nurses strongly protect their own domains when it comes to allocation of potential tasks. This raises some difficulties with regard to the effective implementation of PHC. Based on the South African reality and a literature review, suggestions are made to develop models of PHC centres which would potentially overcome some of the problems raised.
Mass media health information available to young adults in the United Kingdom: (2) Television and radio
Authors: Gray Nicola J , Cantrill Judith A , Noyce Peter R 
Published: February 2011

Abstract
In order to examine health information given in television and radio broadcasts popular with young adults (15- to 24-year-olds) in the United Kingdom, three terrestrial television channels and six radio stations were surveyed over eight weeks, using methodology described previously. One hundred and eighty-seven health items were found during 54 hours of television and 58 hours of radio broadcasting. Television commonly included health information within programme storylines and advertisements; radio included advertisements and news items. Descriptions of disease treatment and states were the most common subjects on television, but radio also covered substance misuse and sexual health issues. The central nervous system was the most prevalent therapeutic area. Ninety-two television items (56.8 per cent) and 15 radio items (60.0 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 reported on the radio, and hazards were a major issue within items about substance misuse. As with the first part of this study, which reported on health information given in the press (p180), references to contacting any professional sources for further information were rare, and certainly do not lead young consumers to expect to be questioned about the appropriateness of products when subsequently purchasing them. This study challenges community pharmacy to reconsider how it best continues to discharge its consumer protection role in an era of increasing consumer empowerment.
A review of factors that influence the use of community pharmacies as a primary health care resource
Authors: Hassell Karen , Noyce Peter R , Rogers Anne 
Published: February 2011

Abstract
This review paper provides an analysis of a range of pharmacy practice, health services and sociological literature relevant to understanding how the public in the United Kingdom use and view community pharmacies as a primary health care resource. Papers published between 1980 and 1997 inclusive were identified, based on on-line searches of databases, and hand searches of a published literature index, relevant journals, and bibliographies of published papers. Papers included in the review are those which report findings on any aspect of consumers' views and use of community pharmacies. No attempt is made to evaluate the adequacy of the findings since the level of reporting in most short papers does not allow for this type of evaluation. Instead, the review paper “maps out” what is currently known about pharmacy utilisation. Key variables that have been used to explain pharmacy use, including a number of demographic and organisational factors, are identified, as well as factors associated with need and demand issues. The paper summarises the main empirical findings, and provides a view of where further work could add to a greater understanding of the relationship between the delivery of pharmaceutical services and primary health care. Potential strategies that could positively influence consumer demand for community pharmacy services are discussed.
Referrals made by different health care professionals to community pharmacists for domiciliary visits
Authors: Foulsham Russell , Goodyer Larry 
Published: February 2011

AbstractObjectiveTo examine the suitability of referrals made by health professionals to a pharmacist for a domiciliary visiting service.MethodGeneral practitioners (GPs), district nurses and social services carers were contacted to request that they refer patients who they thought might benefit from a home visit by a pharmacist, using a referral form agreed by an expert panel. Information gathered by the visiting pharmacist during the patient interview was compared with the reason for referral by the health care worker.SettingAll GPs, district nurses and social services carers who cared for housebound patients in the Kenton and Stanmore areas of the London Borough of Harrow.Key findingsNinety patients were visited. Of these, 47 had been referred by GPs, 29 by nurses and 14 by social services. The highest level of incorrectly stated referrals (22 per cent of their referrals) came from nurses. Nurses tended to refer patients for an explanation of the purpose of their medicines, and GPs because patients were taking more than three medications. Six patients, five of whom were referred by GPs, appeared not to have any problems that could be helped by a visit.ConclusionThere may be a need to raise awareness among social services carers about potential medication problems and the role that could be played by community pharmacists in helping these patients. When GPs make referrals, the criterion of patients taking more than three medications may not be sufficiently sensitive; this should be expanded to ensure that the GP has additional clinically related suspicions that there are adherence issues. Generally, little difference was found between the appropriateness of referrals from the three agencies.
Cross-sectoral pharmacotherapeutic coherence in the Netherlands
Authors: Fijn R , Brouwers J R B J , De Van den Berg L T W Jong 
Published: February 2011

AbstractObjectivesTo measure the extent of pharmacotherapeutic coherence across sectors of Dutch health care from the hospitals' perspective, and to identify perceived markers of coherence and barriers to improvementMethodsTelephone interviews were carried out with hospital pharmacists (76), community pharmacists (5), and clinical pharmacologists (9) affiliated to pharmacies serving 120 Dutch general hospitals. Coherence between (a) hospital and general practice, (b) hospital and nursing home practice, (c) hospitals, and (d) hospital inpatient and outpatient practice was reported and assessed against a set of indicatorsResultsAlmost all hospitals (93 per cent) had formulary agreements or prescribing policies in place and 86 per cent of these had a printed hospital drug formulary (HDF). Over 50 per cent of hospitals reported that they had established coherence with nursing home practice and/or with other hospitals. Less than half of the hospitals had established coherence with general practice. Few hospitals reported activities to review outpatient prescribing and its implications for follow-on prescribing in primary care. Reported barriers to increasing coherence could be classed into three categories: economic, organisational and social. Suggestions to enhance coherence included influencing professionals' practice through training, and greater use of regional and national policies on prescribingConclusionTherapeutic coherence within Dutch health care is far from ideal. The discrepancy between the actual and desired extent of coherence arises from organisational and economic barriers. To date, activities in this area have relied on professional proactivity rather than a structured approach. To move forward, (dis)incentives should be created for health care providers and professionals across all sectors, including pharmacists and prescribers
Cost-effective prescribing in general practice: Patients' attitudes to financially motivated prescribing changes
Authors: Russell David , Luthra Manjo , Plastow Liz , Airdrie Ruth , Marshall Martin 
Published: February 2011

Abstract

Objectives
To assess the patient acceptability of a personalised letter suggesting a change of repeat medication to a generic or cheaper equivalent brand, to determine the resulting cost savings and to investigate patients' attitudes to cost-effective prescribing.

Method
Patients identified from their records as receiving a predefined group of repeat prescriptions for medication that could be prescribed more cheaply were sent a letter from their own general practitioner asking them to consider changing their prescription. They were given the option to agree to the change, to refuse or to discuss the change with their doctor. Qualitative semi-structured interviews were conducted with a purposeful sample of those who agreed and those who refused the suggested change.

Setting
Two fundholding practices in the south west of England with a combined list size of 15,500.

Key findings
The letter was sent to 323 patients, of whom 252 responded (78 per cent). One hundred and eighty-two patients (72.2 per cent) agreed to the suggested change, 37 (14.7 per cent) refused and 33 (13.1 per cent) wished to discuss the suggestion with their doctor. Eleven of the last group subsequently agreed to change, resulting in a total of 193 (76.6 per cent) agreeing to the change and 59 (23.4 per cent) refusing to change. Four months after the change was made, four patients (2 per cent) had reverted to their previous prescription. The changes resulted in an annual saving to the practice of £10,038 (1.1 per cent of total prescribing budget). The total cost of conducting the changes (including staff time) was £1,800.

Conclusion
Changing repeat medication to equivalent generics or cheaper brands can result in significant cost savings in general practice, and a short personalised letter is an effective and acceptable way of achieving the change.
Clinical decision making — an application of judgment analysis and its potential for pharmacy
Authors: Weiss Marjorie C , Scott David 
Published: February 2011

Abstract

Objectives
To explore the methodological use of judgment analysis in understanding clinical decision-making among United Kingdom(UK) general practitioners (GPs), and to consider how it might be applied to pharmacy.

Method
Written cases, with clinical and social patient information, were developed for sore throat and dyspepsia. Decision models were created relating social and clinical information to: (1) GPs' perceptions of severity (sore throat); (2) the likelihood of an ulcer diagnosis (dyspepsia).

Setting
Two counties in southern England.

Key findings
Of the 47 practices contacted, 17 (36 per cent) participated with 24 general practitioners completing the sore throat series and 24 different GPs completing the dyspepsia series. Twenty GPs (42 per cent) had decision models incorporating social factors. These GPs were no more likely to prescribe on paper or in practice than those with decision models without social factors.

Conclusion
Judgment analysis has yet to be applied to the decision-making of practising pharmacists. Potential applications include pharmacists' decisionmaking in the area of minor ailment management or the decision when to intervene when monitoring prescriptions. The influence of social factors, such as patient demand, social class or a distressing patient circumstance on pharmacists' decision-making are aspects of decision-making particularly worthy of future investigation.
Extended adherence support by community pharmacists for patients with hypertension: a randomised controlled trial
Authors: Blenkinsopp A , Phelan M , Bourne J , Dakhil N 
Published: February 2011

Abstract

Objective
To determine the effects of a patient-centred intervention by community pharmacists on adherence to treatment for hypertension.

Study design
Randomised controlled trial.

Method
Randomisation was at pharmacy level. Pharmacists in the intervention group used a structured, brief questioning protocol to identify patients' medication-related problems and their information needs relating to hypertension and its treatment. Advice, information and referral to the general practitioner (GP) were provided by the pharmacist, based on patients' responses. Pharmacists in the control group provided usual care. The intervention was delivered three times at approximately two-month intervals. Blood pressure measurements were collected retrospectively from GP medical records. Patients completed feedback questionnaires at baseline and post-study. The questionnaire comprised a self-reported adherence measure and explored satisfaction with pharmaceutical services.

Setting
Twenty community pharmacy sites (11 intervention and nine controls) in one health authority area in England.

Outcome measures
Control of blood pressure; patient satisfaction with pharmaceutical services; self-reported adherence.

Results
In total, 180 patients (101 intervention and 79 control) from 43 general medical practices completed the trial. Patients whose blood pressure was uncontrolled prior to the study were more likely to become controlled in the intervention group (P&lt;0.05). Most of the effect on self-reported adherence was seen after the first intervention. Patient satisfaction was high prior to the study and was increased in the intervention group after the study. The increase was statistically significant for five items relating to communication between pharmacist and patient.

Conclusion
A simple intervention delivered by community pharmacists produces positive effects on blood pressure control, self-reported adherence and on patient satisfaction with pharmaceutical services.
Surveys of drug-related therapy problems of patients using medicines for allergy, asthma and pain
Authors: Nilsson J LARS G , Andersson Åsa , Kälvemark Sofia , Lieberman-Ram Helen , Ullenius Birgitta , Wendel Ann , Åberg Åsa 
Published: February 2011

Abstract

Objective
To determine the incidence of drug-related therapy problems (DRTPs) among patients obtaining medicines for allergy, asthma or pain.

Method
Problem detection interventions at the pharmacies were carried out as project-like activities. Pharmacy staff members used open-ended questions to detect all DRTPs in patients presenting prescriptions for medicine for allergy, asthma and pain and in people buying over-the-counter (OTC) medicines for allergy. The data were collected under regular health care conditions and the study can therefore be considered as a survey of the epidemiology of DRTPs among the selected groups of patients.

Setting
Swedish community pharmacies during two one-year nationwide disease management programmes on allergy and pain.

Key findings
Of the 44,504 patients with prescriptions registered in the study, 13,895 (31 per cent) with DRTPs were detected. Of 1,135 people buying OTC medicines for hay fever/pollen allergy, 144 (13 per cent) with DRTPs were detected.

Conclusion
The study indicates that about one-third of patients with prescriptions have DRTPs. Only a fraction of all DRTPs are apparently discovered in the regular dispensing process at the pharmacies. Pharmacy staff need to use more active interventions, such as dialogue with open-ended questions, to efficiently identify and help patients with DRTPs.
Concordance: what is the relevance for pharmacists?
Authors: Stevenson Fiona A 
Published: February 2011

Abstract
Non-adherence (or non-compliance) to prescribed medicines has long been regarded as problematic. The concept of concordance, rather than seeking ways to persuade people to take their medicines, instead focuses on the need to adopt a different model of the patient-prescriber relationship. Much of the discussion about concordance thus far has related to the relationship between doctors and patients. In this article, the role of the pharmacist and ways in which pharmacists could usefully engage with the concordance model, both as part of the primary health care team and as independent practitioners, are considered.
Concordance was developed as an ideal to which to aspire and needs to make the transition into practice. It is however important to note that if the move towards concordance is to happen and be successful it will require the support, enthusiasm and commitment of patients and health care professionals generally.
Does the concordance concept serve patient medication management?
Authors:   PCOPR Investigatne Research Team, Chewning Betty , Boh Larry , Wiederholt Joe , Kreling Dave , van Koningsveld Richard , Wilson Dale , Bell Carolyn , Boh Dawn , Nowlin Nancy , Douglas Jeff 
Published: February 2011

AbstractObjectivesTo assess how people with arthritis evaluate and calibrate their complex medication regimens. Building on these findings, to explore how the concept of concordance helps to describe a patient-provider partnership model which can aid optimum medication regimen selection, calibration and management of chronic conditions.MethodA longitudinal study of 689 patients diagnosed with osteoarthritis (OA) or rheumatoid arthritis (RA) was conducted to identify patient perceptions, decision-making and behaviour related to their medication management. Face to face interviews with the Brief Medication Questionnaire, health quality of life questionnaires (AIMS2 and SF-36) and telephone interviews were conducted in waves centered around patient visits every six months for two years. Data about medication regimens were abstracted from the clinic medication profile record for each visit.SettingThree rheumatology clinics in the United States: a university clinic, a private clinic and a Veterans Administration clinic.Key findingsAbout half of the patients in the sample had complex regimens with eight or more medications at any one time. The majority of physicians altered patients' medication orders every six months. The majority of patients reported that they evaluated the effectiveness and side effects of individual medicines based largely on symptoms. There were 248 reported deviations in the scheduled medications at baseline and the majority (61 per cent) were intentional, largely based on symptoms.ConclusionProviders and patients each had unique expertise and were engaged in a dynamic process of calibrating patients' ever-changing regimens. In the absence of a perfect static regimen for patients, the concept of concordance productively reflects the partnership and mutual respect needed for ongoing medication regimen selection, calibration and management for a long-term condition.
Changing pharmacists' and pharmacist assistants' practice in dealing with direct requests for non-prescription analgesics
Authors: SIGRIST T , BENRIMOJ S I , HERSBERGER K , LANGFORD J 
Published: February 2011

AbstractObjectivesTo design, implement and evaluate an intervention to improve pharmacists' and pharmacist assistants' practice in dealing with non-prescription analgesics.MethodDirect request situations, rather than symptom presentation situations, were targeted. A sample of 27 pharmacies (14 intervention, 13 control) was recruited in the French speaking Canton of Neuchâtel, Switzerland. Intervention pharmacies participated in a training programme developed at the University of Sydney based on psycho-social and behavioural conceptual frameworks and communication skills. A pseudo-patient technique was used to assess the effect of training on the frequency and quality of pharmacists' and pharmacist assistants' verbal interaction with their patients. The pseudo-patient visits were followed-up by the provision of immediate feedback to the intervention group, a form of ongoing training. A scoring system was developed for the consultation with the pseudo-patient and 189 interactions were audio-taped and analysed. One-way analysis of variance was used to compare the mean total scores obtained in the intervention and the control groups, at each time point (seven pseudo-patient visits in each pharmacy). The study period was two months.Key findingsThere were significant differences (P&lt;0.05) between the scores obtained in the intervention and control groups. Pharmacists' and pharmacist assistants' practice changed pre- and post-intervention. Interactions involving C-list (pharmacy only) medicines showed a greater change than those involving D-list (not restricted to pharmacies) medicines.ConclusionThe results indicate that the training programme and the pseudopatient methodology facilitated a more comprehensive questioning process and increased the provision of personalised advice to individual patients.
Pharmacists solving problems in asthma management — experiences from a one-year intervention programme in Finland
Authors: NÄRHI ULLA , AIRAKSINEN MARJA , ENLUND HANNES 
Published: February 2011

Abstract

Objective
To study the effect of an intervention provided by community pharmacists on detection and resolution of problems in asthma patients' self-management and to study patients' opinions about the perceived usefulness of the pharmacists' input.

Method
A one-year intervention study was conducted with scheduled visits and follow-ups at baseline, four, eight and 12 months. Study patients (n=28) acted as their own controls.

Setting
Four communities and community pharmacies in different parts of Finland.

Key findings
At study baseline, all patients had at least one documented problem, the most commonly reported being problems with medication, side effects, problems with inhalation devices and not using asthma medicines according to the physician's instructions. On average, patients had five “intervention” consultations with the pharmacist during the one-year study. After the intervention, half of the patients reported that their problems had been resolved. The most useful areas of advice were considered by the patients to be instructions about changing asthma medication according to asthma symptoms and management of asthma symptoms. Twenty-five of the 28 patients reported that they were satisfied with the education and counselling provided by pharmacists, a higher number than for physicians or nurses.

Conclusion
The findings from this small longitudinal study indicate that community pharmacists can improve asthma patients' treatment by consultations during which they identify and address problems in self-management of asthma.
Analysis of Elliptical Rolling Contact Joints in Compression
Authors: Montierth Jacob R. , Todd Robert H. , Howell Larry L. 
Published: February 2011

AbstractThis paper presents elliptical rolling contact joints in compression as an alternative to circular rolling contact and conventional revolute joints where high quality force transmission—low friction and backlash—with variable output are desired. Parameters specific to the joint and its position are defined in terms of relative link angles and elliptical surface geometry. These relationships allow elliptical rolling contact joints to be incorporated in vector loop summations used in kinematic analysis. Notably, elliptical rolling contact is developed as the more general case of which circular rolling contact is a subset. Elliptical rolling contact joints are shown to offer several benefits over circular rolling contact, including reduced Hertz contact stresses, variable output velocity, maximum use of contact interface by distributing small rotations across surfaces of small curvature, reduced forces on constraining members, and no-slip pure rolling provided by either connecting links or flexures, without the need for gear teeth or friction.