bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frequency of counselling on prescription medicines in community pharmacy
Authors: Krska J , Kennedy E J , Milne S A , McKessack K J 
Published: February 2011

Abstract
Forty five community pharmacists set standards for counselling patients receiving prescription medicines. Replying to a postal questionnaire describing 10 hypothetical scenarios, they identified four priority counselling situations: drugs with a complex dosage regimen, significant interactions, changed or new therapy and uncommon or difficult to use formulations. They estimated their counselling frequency for such situations as 62 per cent.
Fourteen of the pharmacists later allowed a researcher to observe their counselling practice and 267 of their patients participated in a survey of expectations and experiences. The patients completed questionnaires before and after receiving their medicines and were observed collecting them. Eighty one per cent expected verbal information from the pharmacist while 41 per cent reported receiving it and 33 per cent were observed receiving it. They particularly expected to receive advice about how, how often and when to use their medicines and these were the aspects they were counselled most frequently about, though less often than they expected. Many also expected advice on what the medicine was for and any possible side effects, but this was offered less frequently as part of the pharmacist's standard advice. The vast majority (81.5 per cent) felt that the time spent on counselling was adequate, even when this was no time at all, and 62 per cent felt the information given was adequate. After feedback of these results to eight of the 14 pharmacists, seven said they would attempt to improve the frequency and nature of their counselling, to complete the audit cycle.
These results show that questionnaires completed by patients in pharmacies provide reliable data comparable to that from observational studies. Well designed questionnaires could, therefore, be used as a self-audit tool by community pharmacists.
Analysis of a “Medidump” campaign in Australia
Authors: Longmore Robert B , Sunderland V Bruce , Sansom Lloyd N 
Published: February 2011

Abstract
The Australian Commonwealth Department of Health, Housing and Community Services organised a campaign to collect unwanted medicines on a national basis. A representative sample of the returned medicines was analysed. Of the 6,556 items examined, the majority were tablets or capsules. There was a high level of prescription items, with cardiovascular (17.0 per cent), central nervous system (15.7 per cent) and respiratory (14.0 per cent) medications the main therapeutic categories returned. Some individual items occurred in high frequency, more than 100 items each of salbutamol, glyceryl trinitrate, frusemide, theophylline, beclomethasone dipropionate and aspirin being returned. The date of dispensing was only recorded for 45.1 per cent of the sample, and of these 37.6 per cent had been dispensed in the past year.
Of the 5,860 items that could be evaluated, 38.9 per cent were unopened and 55.7 per cent had 80 per cent or more of the medication unused. Of the 4,359 items bearing a pharmacy label, 36.4 per cent were unopened and 53.9 per cent had 80 per cent or more of the medication unused. Approximately 55 per cent of cardiac and respiratory drugs and antibiotics were more than three-quarters unused and 45 per cent, 38 per cent and 47 per cent, respectively, of items in these therapeutic groups were returned unopened. Although the number of labelled items returned in each of these categories was lower than the total items returned, the percentages of items returned unopened were substantially the same. Some caution must be adopted in interpreting these results as they are based on medications that have been disposed of, and do not represent total medication usage.
Time for customer contact in pharmacies with and without a dispensing technician
Authors: Savage I T 
Published: February 2011

AbstractDispensary workload is widely perceived by pharmacists as limiting the time available for customer contact. This study compared pharmacist work patterns at two neighbouring independent pharmacies, one without (A) and one with (B) a trained dispensing technician, using fixed interval activity sampling. Pharmacists were observed at work over two weeks; six half-day observation sessions (A = 1,181 observations; B=1,348) could be matched for incoming dispensing workload. Data on 505 prescription issues and 74 over-the-counter events (advice requests, advised sales, and health information) were collected. Pharmacy B dispensed a greater proportion of antibiotics (19 per cent v 11 per cent, P&lt;0.02) but there were no other significant differences. Pharmacists at site B spent 20 per cent less of their time on dispensary activities, 14 per cent more of their time on the counter and had 6 per cent more time to rest and read, but they did not spend significantly longer talking to customers about medicines and health. Skilled dispensing help released over an hour of pharmacist time per day, but these savings were linked to prescription workload, which is unpredictable. The pharmacists could not plan to give this extra time to their customers because they did not know when it would be available, or when it would be needed.
Family health services authorities and community pharmacists at the purchaser-provider interface
Authors: Hunt A J , Sheppard C , Lupton C , Brown D 
Published: February 2011

Abstract
The views of both purchasers (family health services authorities [FHSAs]) and providers (community pharmacists) were sought on the development of community pharmaceutical services in the light of the 1992 pharmaceutical care report. Questionnaires were posted to the 480 pharmacists in charge of all community pharmacies in Wessex and to the 98 general managers of FHSAs in England and Wales. The questionnaires focused on reactions to those recommendations of the pharmaceutical care report which, if implemented, would have significant implications for the community pharmacist's workload. Both the FHSAs and community pharmacists indicated that, in their view, the skills of the community pharmacist are currently underutilised. Both groups expressed enthusiasm for the pharmaceutical care report recommendations that the following services should be provided: domiciliary services, disposal of unwanted medicines, supply of aids for disabled people, supply of compliance aids and adverse drug reaction reporting. Neither group was enthusiastic about pharmacists providing a therapeutic drug monitoring service from community pharmacies. On other areas, pharmacists were more enthusiastic about the provision of health advice, diagnostic/screening services and treatment protocols, while FHSAs favoured distribution of welfare foods, needle exchange, instalment dispensing and referral forms.
Overall, both the FHSAs and community pharmacists were receptive to the principle of the development of the role of the community pharmacist within the primary health care team but expressed concerns regarding the training and workload implications.
Factors influencing the choice of drug therapy in primary and secondary health care
Authors: Cossens M J , Davies G , Bose D , Horne R 
Published: February 2011

Abstract
A prescribing decision model incorporating drug characteristics, professional opinions and past experience was used to predict the choices made by prescribers when selecting a non-steroidal anti-inflammatory drug (NSAID) for inclusion in a formulary. Thirty general practitioners (GPs) and 14 hospital doctors (HDs), most practising within the South East Thames regional health authority, were asked to select either ibuprofen, diclofenac or indomethacin, based on the needs of a described population, and then to answer a questionnaire.
Looking at the relative importance of factors influencing the choice of treatment, there was generally a high degree of agreement between HDs and GPs. However, the majority of HDs ranked efficacy as the most important drug characteristic whereas GPs were generally more concerned with side effects. Fundholding GPs ranked cost more highly than did their non-fundholding counterparts, and GPs working in single handed practices were more influenced by specialists and company representatives than were GPs working in groups. The decision model correctly predicted the drug choice of all the HDs and of 76 per cent of the GPs. These values were considerably better than the 33 per cent that would be predicted based on chance alone.
Although various limitations of this type of study are noted, it is hoped that the model could be developed as a valuable tool to assist in understanding complex prescribing issues.
A national, one-day, consumer-oriented telephone drug information project in Australia
Authors: Allen Karen M , Alderman Christopher P 
Published: February 2011

Abstract
The design and execution of a nationwide, one-day telephone drug information service for the general public are described and data collected during the project analysed.
The Australian public was provided with access to a toll-free telephone service on September 4, 1992, for seeking direct information about medication from a team of pharmacists and medical practitioners based at a temporary telecommunications centre in Melbourne. Details of the project had been agreed by a multidisciplinary steering group. Over 2,000 calls were connected to the centre, averaging 167 calls per hour (range nine to 215). Calls were processed through central triage lines prior to referral to appropriate personnel. Information was gathered from 1,650 calls using a standard data collection form, and the details of a sample of 895 of these were analysed using Epi-info 5.01a (public domain) software for epidemiology and disease surveillance.
The success of this project, as well as that of other similar telephone information services in other countries, indicates a high level of interest among the public. In the future, information gained in this type of data collection process may be of benefit to clinicians in assisting them to provide information to patients about their drug therapy.
Empiric therapy for treatment of infection and the influence of antibiotic guidelines on outcomes
Authors: English Sue , Scott Eileen 
Published: February 2011

AbstractThe appropriateness of empiric therapy, how closely prescribers adhered to hospital guidelines for use of antimicrobial drugs and how relevant these guidelines proved in providing cover for the infecting pathogen were assessed from a retrospective survey of culture and sensitivity reports issued during a one-month period in a district general hospital. Blood, stool, pus, sputum and mid-stream urine specimens were reviewed. Urine specimens from a fundholding general practice unit were also included. Catheter specimens of urine and specimens from other body sites were excluded. Of 290 specimens sent for culture, 99 (34 per cent) were positive. One hundred patients, of whom 54 (19 per cent of the total) were subsequently demonstrated to have a positive culture, had been treated empirically. In 38 per cent of cases the pre-report empiric treatment was considered appropriate for the isolated pathogen, while 46 per cent of patients had negative cultures and 16 per cent had positive cultures but had been given unsuitable antibiotics. In hospitalised patients, 73 per cent of antibiotic treatments were prescribed according to hospital guidelines, although this was the case for only 45 per cent of community-based patients. Hospital guidelines were a relevant and useful aid to rational prescribing in that 75 per cent of organisms isolated were sensitive to guideline antibiotics. The guidelines were least appropriate for urine specimens from hospital. This reflects the range of organisms encountered and the emergence of resistant strains, reinforcing the need for regular updating and amending of prescribing recommendations.
Evaluation of ward pharmacy activity and effects of a change in non-stock ward supply
Authors: Deshmukh A A , Eggleton A G , Monteath A J 
Published: February 2011

Abstract
An activity sampling technique was used to compare the work patterns of clinical pharmacists at hospital ward level within six specialties at the West Suffolk hospital, UK. Significant differences were found between specialties for the activities of prescription and clinical monitoring, stock control and the transcription of prescriptions, travel, annotation, intervention with a doctor or nurse, information to a patient and unproductive time (P&lt;0.05).
On the psycho-geriatric and long-stay geriatric wards, a substantial proportion of pharmacist activity was found to be devoted to stock control and transcription. Two new systems of drug supply were then introduced to these wards and the activity sampling procedure was used to evaluate the effect of the change. It was found that a system employing a technician top-up service significantly reduced the proportion of time the pharmacist spent on stock control and transcription (P&lt;0.0001) and increased the time spent on clinical monitoring (P&lt;0.05). An estimate based on “total contact time” per occupied bed showed that this new method of supply was achieved at little or no increase in cost, and was arguably a more effective use of pharmacist and technician skills.
Non-prescription drug use by elderly patients
Authors: McElnay James C , McCallion C Rosaleen 
Published: February 2011

Abstract
Non-prescription drug use by patients aged 65 and over in Northern Ireland was assessed. Sixteen community pharmacists collected data on 515 elderly patients who purchased non-prescription drugs, using a short structured interview. The patients most commonly purchased oral analgesics (17.5 per cent), cough preparations (14.8 per cent) and laxatives (11.5 per cent). Almost one quarter (23.9 per cent) were already taking a prescribed medication for the same condition. Only one half of the latter patients (49.6 per cent) discussed nonprescription drug use with their general medical practitioner.
Patients' main reasons for the purchase of non-prescription medicines were: symptoms were not severe enough to visit their doctor, convenience of the pharmacy and the product had been used before. Patients who presented to their pharmacist with either gastrointestinal or pain symptoms were found to be twice as likely as patients with other symptoms to be taking a prescribed drug for the same condition(s) (P&lt;0.001). Since elderly patients are more susceptible to adverse drug reactions, health care professionals must endeavour to obtain a complete medication history from them.
Perceptions of preregistration graduates about the UK pharmacy undergraduate course
Authors: Mudhar M S , Wilson K A , Irwin W J 
Published: February 2011

AbstractThis study reports on the perceptions of recent graduates of their undergraduate pharmacy course. Questionnaires were sent to 952 graduates undertaking their preregistration training in the period 1992–3. Of the total response of 695 (73 per cent), 55 per cent were in community pharmacy, 38 per cent in hospital and the remainder in various joint posts. Their opinions on the usefulness of course topics indicated that pharmacognosy and some topics within pharmaceutical chemistry were significantly regarded as of little use (P&lt;0.05), while the vocationally-oriented topics were the most useful. The only topics thought to require significantly more extensive teaching (P&lt;0.05) were responding to symptoms and clinical pharmacy. Pharmacognosy and some topics within pharmaceutical chemistry were considered to require less teaching. The remainder were considered to be given sufficient time. Problem-solving, and small group tutorials and seminars were considered very useful forms of learning by 73 per cent and 63 per cent of respondents, respectively. Clinically-oriented topics were considered significantly beneficial (P&lt;0.05) and useful for inclusion within the new four-year framework.The study suggests that changes in course design should not include undergraduate specialisation, the graduates' branch of pharmacy having no influence on their opinion of the usefulness of clinical pharmacy and pharmacy practice topics. It also suggests that some science-based topics need to be made more relevant to pharmacy and that clinical and practice-based topics should have a major role in an extended course.
An audit of responding to symptoms in community pharmacy
Authors: Krska Janet , Kennedy Emily J 
Published: February 2011

Abstract
A two-stage audit of community pharmacists' service in response to symptoms was carried out using a previously piloted method. Pharmacists from up to 46 pharmacies completed questionnaires indicating the advice they thought should be given in each of 12 scenarios that could present to community pharmacies. The six scenarios with the highest consensus response were later enacted in the same pharmacies by researchers. Three were used in the first stage and three in the second. Meetings were held between the stages to discuss the results and suggest ways of improving them. The consensus advice, determined by the questionnaire responses, was given on only 27 per cent of all visits — 18 per cent in the first stage and 35 per cent in the second. This was mainly due to non-drug advice being omitted. “Appropriate” products were recommended in 90 per cent of first stage visits but only 74 per cent of second stage visits. “Acceptable” advice was provided in 75 per cent of all visits, with little difference between the two stages. Questioning of the researchers was “good” in 35 per cent of first stage visits and 43 per cent of second stage visits. Inadequate questioning was significantly related to inappropriate advice being given. Inappropriate advice was given on 25 per cent of all visits, with equal frequency by both pharmacists and assistants. Participating pharmacists identified many problems that could contribute to a less than ideal service but most were outside their control, such as television advertising of products and customer expectations. The use of protocols, implementation of staff training and the audit were considered to have had a positive effect on the response to symptoms service. Most participants considered that the method used was acceptable and suggested a similar method should be used on a regular basis to monitor the service.
Threatening and violent incidents in community pharmacies: (2) Implications for pharmacists and community pharmacy services
Authors: Smith Felicity , Weidner Derek 
Published: February 2011

Abstract
This paper reports the second stage of a study into threatening and violent incidents in community pharmacies. The first stage, an investigation of the frequency and nature of incidents, found that a high proportion of practising pharmacists had been threatened and/or assaulted while at work (see p136). The implications of security issues for pharmacists, and how these affect the services they are prepared to offer, are addressed in this paper. Data were collected in semi-structured interviews with pharmacists who had reported one or more threatening or violent incidents.
Many respondents described serious events with lasting psychological effects, including anxiety about their own safety and changed attitudes towards clients. Pharmacists' concerns about personal safety influenced them in their decisions regarding the services they offered. Pharmacists felt vulnerable at opening and closing times and believed that services to intravenous drug users increased the risks of an event; many incidents did actually occur at these times and involve this group of people. Concerns about safety and security affected late-night and out-of-hours dispensing, services to IV drug users and domiciliary visits. More surprisingly, pharmacists also reported effects on their general dispensing and advice-giving activities.
The role of pharmacists in primary health care is becoming more prominent as the Government promotes community based care and encourages individuals to take more responsibility for their own health. Concerns about safety and security could hamper the continuation and development of professional services. The profession must acknowledge the potential impact of these issues in its aspirations and recommendations regarding its future primary care role.
Review of computerised patient medication records to determine potential clinical interventions in community pharmacy
Authors: Hannaoui A , Krass I , Benrimoj S I 
Published: February 2011

Abstract
The potential intervention rate for cardiovascular drugs dispensed in community pharmacy was investigated by a retrospective study of 300 patient medication records (PMRs) collected from 10 community pharmacies in Sydney, Australia. A medication review protocol and operational definitions were developed for 17 types of clinical intervention and three levels of clinical significance. Spearman's correlation coefficient (rs) was used to examine the relationship between total number of potential interventions and predictor variables. From 5,271 medications dispensed, 1,509 (28.6 per cent) potential interventions were identified. The most frequent types of potential intervention were precautions (27.6 per cent), overutilisation (17 per cent) and dose discrepancy (16.3 per cent). Of the interventions classified as being of major clinical significance, 61.3 per cent were precautions, 19.7 per cent drug interactions and 19 per cent contraindications. The cardiovascular drug classes with the highest potential intervention rate were inotropics (93.2 per cent) and anticoagulants (89.5 per cent). There was a statistically significant correlation between the number of potential interventions per patient and the total number of medications dispensed per patient (rs=0.68, P&lt;0.001), the total number of cardiovascular drugs dispensed per patient (rs=0.67, P&lt;0.001) and the number of different prescribing doctors per patient (rs=0.29, P&lt;0.001). This study demonstrates the potential for community pharmacists to review computerised PMRs and intervene in patients' drug therapy, thereby reducing iatrogenic problems and improving health outcomes for patients.
An audit of sodium valproate assays
Authors: Bowhay Stephen 
Published: February 2011

Abstract
Several authors have questioned the usefulness of serum valproic acid analysis in the routine management of patients with epilepsy. This audit assesses the current practice in a Scottish NHS Trust laboratory for requesting sodium valproate assays and the impact of an intervention on the number and “appropriateness” of the assays. A literature search suggested that assays are only of benefit in patients who are poorly controlled despite optimal dosage, where there is suspected toxicity or where compliance is questioned. A retrospective data collection covering a two-year period was performed, followed by a 12-month prospective collection. All sodium valproate assays requested were studied and the reason for requesting them, the assay result and the dose recorded. Throughout both periods the number of other assays was also recorded. Sodium valproate assays were considered “appropriate” if the reason they were requested was poor control, suspected toxicity or doubts about compliance. An arbitrary dose of 2000mg/day was chosen as optimal dosage. Between the two data collection periods an intervention was introduced, namely, the use of two new interpretation comments which reflected the results of the literature search and were used on most of the sodium valproate assays reported. Following the intervention there was a significant fall in the number of valproate assays performed (P = 0.046), an increase in the number of assay results outside the “target range” (P&lt;0.001), a change in the distribution of reasons for the requests (P = 0.030) and an increase in the number of “appropriate” assays (P&lt;0.001).