Showing papers in "International Journal of Pharmacy Practice in 2011"

The case for qualitative research

Abstract: Qualitative as well as quantitative methods are needed in pharmacy practice research

The Delphi and nominal group techniques in health services research

Abstract: This review examines two methodologies that are being increasingly used in health services research (HSR): the Delphi and nominal group techniques. The Delphi is a survey technique for decision making among isolated respondents while the nominal group technique (NGT) is a highly controlled small group process for the generation of ideas. Typical applications of the techniques are for the development of consensus guidelines or standards in areas where research based evidence is absent or inconclusive. We discuss methodological issues associated with these techniques, namely, sample size and composition, response rates, anonymity, feedback and consensus, and reliability and validity. We also illustrate the range of applications of the techniques in HSR, including pharmacy practice. Although not widely used to date, both methodologies are potentially valuable additions to the practice researcher's toolbox.

Responsible self‐medication: perceived risks and benefits of over‐the‐counter analgesic use

Abstract: Objectives This study examines awareness of the potential risks associated with over-the-counter (OTC) use of paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) among Australian consumers to better understand patterns of usage of these products. Methods We employed two self-reported cross-sectional surveys (conducted in 2001 and 2009) using computer-aided telephone interviewing. Both survey samples were weighted to match national population proportions; data were collected for 3702 respondents (study 1, 2001, n = 1901; study 2, 2009, n = 1801). The inclusion criteria were age over 18 years and willingness to participate in the survey. Key findings Self-reported regular use (once or more per month) of OTC analgesics declined between 2001 (67.5%) and 2009 (55.0%; P < 0.05). In 2009 42.0% of regular OTC analgesic users were purchasing NSAIDs outside the pharmacy setting (compared with none in 2001). Stated awareness of potential risks has increased slightly among regular paracetamol users (from 49.0% in 2001 to 52.0% in 2009) and regular NSAID users (from 25.0% in 2001 to 41.0% in 2009). Regular OTC analgesic users were considered to be using the product appropriately if there were no contraindications, warnings, precautions or potential drug interactions to the analgesic that they had used. In 2001, significantly more people were using paracetamol appropriately than were using NSAIDs appropriately (98.3 compared with 79.3%; P < 0.05). Corresponding figures for 2009 were 96.4 and 69.1% (P < 0.5). Conclusions Increasing consumer awareness of the need to consider potential risks prior to taking OTC analgesics is a positive sign. However, this has not translated to an increase in appropriate use of OTC NSAIDs; since ibuprofen has become available outside the pharmacy setting in Australia fewer people are using NSAIDs appropriately according to the label. The quality use of medicines, in particular OTC NSAIDs, is becoming increasingly reliant on product labelling and the ability of consumers to understand and self-assess risk.

Drug‐related problems and pharmacy interventions in community practice

Abstract: Objectives — (1) To document types and number of drug-related problems identified by community pharmacy personnel in Sweden; (2) to determine relationships among the types and number of problems identified and the gender, age and number of prescribed drugs in patients; and (3) to document the interventions made by pharmacy personnel with patients and prescribers. Method — Random samples of pharmacists, prescriptionists and pharmacy technicians were drawn nationwide in Sweden; 144 (63 per cent) of the employees fulfilling the inclusion criteria agreed to take part. The participants documented drug-related problems, interventions and patient variables on a data collection form, and tallied the number of patients they served on another form. Setting — One hundred and sixteen community pharmacies and 12 outpatient hospital pharmacies. Key findings — One problem or more was identified among 2.5 per cent of the patients. The median number of problems identified per 100 patients was greater for pharmacists (6.1) than for prescriptionists (2.6) and pharmacy technicians (1.1). About one in three problems was presented to the participants by their patients, while two thirds were detected by the pharmacy staff. One in four problems was related to dosage, and one in five to uncertainty about the aim or function of the medication. Problems were over-represented among children and the younger middle-aged and under-represented in the elderly. Patient medication counselling was the most common type of intervention. When contacted, the physician nearly always approved the recommendation made by the pharmacy staff. Conclusion — The results led to suggestions as to how pharmacy practitioners can augment pharmaceutical care through drug-related problem detection.

Extended adherence support by community pharmacists for patients with hypertension: a randomised controlled trial

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<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.

Pictograms in pharmacy

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

Reducing Adverse Prescribing Discrepancies Following Hospital Discharge

Abstract: General medical patients from an east London teaching hospital were recruited into intervention and comparison groups. Those recruited into the intervention group were given a copy of a letter listing their drugs prescribed at discharge and asked to give it to their regular community pharmacist when they went to obtain their prescribed drugs following hospital discharge. A comparison group returned home without a letter for their community pharmacist. Recruited patients were visited in their own homes once their community supply of drugs had been obtained. The frequency of all discrepancies between the prescribed drugs were compared for both groups. A consensus panel judged the importance of the discrepancies observed. The numbers deemed as clinically significant were compared for both groups, as the effect of the intervention. The 501 patients followed up (264 in the intervention group and 237 in the comparison group) were prescribed 2736 drugs. The number of unintentional discrepancies observed was lower for the intervention group (32.2 per cent, 454/1408) than for the comparison group (52.7 per cent, 700/1328) (chi-squared 117.38, P < 0.001). The number of discrepancies judged to have a definite adverse effect was lower in the intervention group (1.6 per cent, 23/1408) than in the comparison group (3.1 per cent, 41/1328) (chi-squared 6.32, P < 0.01). Discharging 19 patients with such information to take to their community pharmacist would result in the prevention of one unintentional discrepancy having a definite adverse effect. Providing community pharmacists with a copy of patients' discharge summaries is an effective method of reducing unintentional discrepancies, with measurable patient benefit.

Collaboration in chronic care: unpacking the relationship of pharmacists and general medical practitioners in primary care

Abstract: Objectives The objective of this research was to gain deeper understanding of the expectations, experiences and perceptions of Australian general medication practitioners (GPs) and pharmacists around collaboration in chronic illness (asthma) management in the primary care setting. Methods A qualitative research methodology utilising a semi-structured interview guide, based on theory and an empirical approach, was used to fulfill the objectives of this study. Face-to-face interviews with pharmacists (n = 18) and GPs (n = 7) were recorded, transcribed and coded for concepts and themes. Relationships between concepts and themes were examined and used to describe the nature of collaborative relationships in the primary care setting. Key findings A relationship between GPs and pharmacists currently exists although there is minimal collaboration and there are several areas of practice and patient care in which the two professional groups are mismatched. At the same time, this research uncovered key aspects of the GP–pharmacist relationship, which could be used to develop more collaborative relationships in the future. The findings from this study were evaluated in light of the Collaborative Working Relationships model and published literature. Conclusions A model for the development of GP–pharmacist relationship has been postulated which articulates the dynamic nature of professional relationship in primary care and highlights a pathway to more collaborative practice. Future research should focus on further developing this model.

The General Practitioner-Pharmacist Collaboration (GPPC) study: a randomised controlled trial of clinical medication reviews in community pharmacy.

Abstract: Objectives There are conflicting results in studies of pharmacists undertaking medication reviews for older people. With increasing promotion and funding for ‘medication reviews’ there is a need for them to be standardised, and to determine their effectiveness and the feasibility of providing them from a community pharmacy. The objective was to determine whether involvement of community pharmacists undertaking clinical medication reviews, working with general practitioners, improved medicine-related therapeutic outcomes for patients. Methods A randomised controlled trial was carried out in people 65 years and older on five or more prescribed medicines. Community pharmacists undertook a clinical medication review (Comprehensive Pharmaceutical Care) and met with the patient's general practitioner to discuss recommendations about possible medicine changes. The patients were followed-up 3-monthly. The control group received usual care. The main outcome measures were Quality of Life (SF-36) and Medication Appropriateness Index. Key findings A total of 498 patients were enrolled in the study. The quality-of-life domains of emotional role and social functioning were significantly reduced in the intervention group compared to the control group. The Medication Appropriateness Index was significantly improved in the intervention group. Only 39% of the 44 pharmacists who agreed to participate in the study provided adequate data, which was a limitation of the study and indicated potential barriers to the generalisability of the study. Conclusion Clinical medication reviews in collaboration with general practitioners can have a positive effect on the Medication Appropriateness Index. However, pharmacist withdrawal from the study suggests that community pharmacy may not be an appropriate environment from which to expand clinical medication reviews in primary care.

Attitudes of community pharmacists in the Netherlands towards adverse drug reaction reporting

Abstract: Objective — To gain insight into the attitude and behaviour of community pharmacists in the Netherlands with respect to the reporting of adverse drug reactions (ADRs). Method — A questionnaire survey was conducted among a stratified random sample of 200 community pharmacists from the membership list of the Royal Dutch Society for the Advancement of Pharmacy. The structured questionnaire covered knowledge of the Dutch ADR reporting system, attitudes to involvement in reporting ADRs and self-reported behaviour. Demographic details were requested and used to assess the representativeness of responders in relation to the total population of Dutch community pharmacists. The number of self-reported ADR reports was compared with those actually received by the nation's ADR centre. Key findings — The response rate was 73 per cent (n=147) after one reminder. Community pharmacists regarded the reporting of ADRs as an integral part of their professional duties and they did not report experiencing any major barriers to reporting. This is reflected in the frequency and number of ADR reports received by the national pharmacovigilance centre. Comparison of pharmacists' self-reported numbers of ADR reports with actual reports received indicated that pharmacists overestimated the number of reports they made. The most frequently mentioned barriers to reporting were: the adverse effect assumed to be already known (32 per cent), the reporting procedure too time consuming (25 per cent), and uncertainty concerning the causal relationship between ADR and drug (25 per cent). Feedback was mentioned most commonly as the chief impetus for reporting, and this referred both to feedback on the report submitted and general feedback as provided in publications. Although consultation with the attending clinician before submitting a report is not compulsory in the Netherlands, 55 per cent of the pharmacists saw this as an important aspect in the reporting process. Conclusions — Community pharmacists in the Netherlands are knowledgeable about reporting ADRs and highly motivated to do so. This positive attitude towards reporting adverse events is based on the established tradition of pharmacist reporting in the Netherlands.

Patient compliance: the pharmacist's role

Abstract: Pharmacists can influence patients' compliance with prescribed medicines not only by educating and informing patients but also by helping to simplify their medication regimens. This article discusses the measurement of compliance and looks at ways of improving it.

Community pharmacists' attitudes to adverse drug reaction reporting

Abstract: Objective — A “demonstration” scheme for adverse drug reaction (ADR) reporting by United Kingdom community pharmacists began in April, 1997. The objective of this study was to investigate community pharmacists' attitudes to and knowledge of ADR reporting and the “yellow card” scheme. Method — Structured face-to-face interview with community pharmacists, using a prepiloted questionnaire. Setting — Randomly selected community pharmacies within one demonstration scheme area. Key findings — Almost all of the pharmacists (28, 93 per cent) were aware that they were able to report ADRs but only one had done so. Just under half recalled receiving the official information pack and half of these had read it. Reasons given for not submitting reports were lack of information or time, and that most reactions seen were already well-recognised. Although most pharmacists knew that serious reactions to established drugs should be reported, fewer recognised the need to report unusual reactions to established drugs and reactions to herbal medicines. Few participants knew the reporting criteria for “black triangle” drugs. Reporting on over-the-counter (OTC) products was an area specifically identified where it was expected that community pharmacists could “add value” to the previous, yellow card, scheme. It was thus of some concern that 21 pharmacists (70 per cent) agreed that they would be unlikely to report an ADR to a product they had counter-prescribed for a patient. Few respondents had negative attitudes to the scheme. Most agreed that ADR reporting is important, and a professional role in which pharmacists should be involved. Conclusion — Community pharmacists are supportive of their involvement in ADR reporting. Their concerns about reporting need to be addressed and further publicity given to the scheme if reporting is to increase. Our findings suggest that more research is needed to identify the factors which encourage and inhibit reporting, and that further efforts may be needed to promote ADR reporting.

Impact of medication regimen reviews performed by community pharmacists for ambulatory patients through liaison with general medical practitioners

Abstract: Objective — To evaluate the cost and clinical benefits of the provision of medication regimen reviews (MRRs) by community pharmacists for patients identified and referred by a general practitioner using a collaborative approach. Method — There were two cohorts of patients — 105 in stage 1 and 170 in stage 2 — from 34 GPs. The reviews were performed by 45 community pharmacists who had completed a training programme in MRR. The protocol was as follows: (1) a proforma MRR request form, including relevant clinical information and the patient's current regimen, was completed by the GP, (2) the review was conducted by the pharmacist and documented in a proforma report, (3) pharmacists and GPs met to discuss the review findings and recommendations for each patient, and (4) three months later, GPs were surveyed to verify any accepted recommendations and changes to medication regimen. A clinical panel estimated the clinical significance of the regimen changes for a subset of 141 cases. Key findings — The patients had an average of five diagnoses, with cardiovascular disease (34 per cent) and musculoskeletal disease (15 per cent) the most common conditions. A total of 2,220 medications were prescribed, representing a mean of eight per patient. In all, 869 changes to therapy were observed at the three-month follow up: 47 per cent drug ceased; 17 per cent dose reduced; 11 per cent dose increased; and 12 per cent drug changed. Examining the impact of MRR on the mean number of medications per patient, the null hypothesis of no difference pre- and post-MRR was rejected. There was a mean reduction of one medication per patient (P<0.001). As a consequence of this reduction, the average annual cost of medications was reduced by $A240 per patient. This translated to a projected annual cost saving for medication alone of $A90 per patient after offsetting the $A150 cost (professional remuneration) of the MRR. Considering health outcomes, overall, the reviewers rated at least 40 per cent of the MRR changes as leading to a positive effect on the patient's health. Conclusion — This study provides a good indication that MRR through GP-pharmacist collaboration in the community can lead to positive clinical benefits and reduction in health care costs.

Pharmacist use of social media.

Abstract: Introduction The rapid emergence and exploding usage of social media (also called Web 2.0) present pharmacists with new professional, ethical and time management challenges. Objectives To describe social media use among pharmacists in West Virginia, USA. Methods A survey was administered during the West Virginia Pharmacist Association 102nd Annual Convention held in October 2009. The meeting participants were pharmacists practising in the different regions of West Virginia. All conference attendees were eligible to participate. Results The survey was completed by all 50 pharmacists in attendance, yielding a response rate of 100%. Social media use was found to be common among West Virginia pharmacists, with the most frequently used applications including: YouTube (74%), Wikipedia (72%), Facebook (50%), and blogs (26%). However, there were some tools that pharmacists barely used such as Bebo, Hi5, Flickr and Friendster. Given the widespread use of Facebook by respondent pharmacists, it is noteworthy that they indicated the main purposes for using it were for chatting, uploading pictures and keeping touch with friends rather than for professional and educational purposes. Discussion Presently, pharmacists utilize social media primarily for personal purposes. As social media becomes more sophisticated and widely adopted in the healthcare arena, it is probable that pharmacists will also increasingly utilize it for professional and educational purposes.

The role of the community pharmacist - a survey of public opinion in Northern Ireland

Abstract: Data from a survey of 906 members of the public (570 females, 336 males; age range 13–90 years) with regard to opinions on, and use of present and proposed community pharmacy services are presented. It was shown that the majority of people (67.7 per cent) visit pharmacies at least once a month. Females visit pharmacies more frequently than males (P<0.05). Respondents who were less than 25 years old were more likely than older age groups to purchase non-prescription medicines from pharmacies although they were less likely to use the same pharmacy (P<0.05). Proximity to a person's home was the major deciding factor for patronising a particular pharmacy (43.7 per cent). The major factor determining choice of non-prescription medicines was previous use (34.7 per cent), with pharmacist's advice (29.3 per cent) the second most frequent response. For a range of common minor ailments, respondents were more likely to seek their doctor's advice or self-treat the condition than seek advice from the pharmacist. With respect to extended role activities, 93.4 per cent felt that the pharmacist had a role to play in health education, the provision of individualised advice being the most frequently noted method for this (34.6 per cent). Health screening services were highly supported (90.6 per cent), as was the maintenance of patient medication records (93.6 per cent). A greater proportion of the younger age group (<25 years old) than the older age groups supported the provision of health screening services (P<0.05). In response to a question on services that the public would like to see provided by community pharmacists, the most popular responses were: giving more advice on the treatment of minor ailments and the provision of a private consultation area within the pharmacy. Overall, the results show a positive response to the current and future use of community based pharmaceutical services.

Community pharmacy in the United Arab Emirates: characteristics and workforce issues

Abstract: Objectives To determine the characteristics and workforce issues of community pharmacy practice in the United Arab Emirates (UAE). Methods Data collection was by anonymous cross-sectional survey. Questionnaires were distributed by hand to 700 community pharmacies to collect information about the participating pharmacists, pharmacy characteristics, the types of products and professional pharmacy services available to patients, and the barriers to offering professional services. Key findings A total of 344 pharmacists (49%) responded. Most were male (64%), had been in practice for less than 10 years (mean = 9.3, 95% confidence interval (CI) = 8.4–10.0) and were trained in India (35%) or Egypt (15%). The pharmacies were open for business 7 days/week (mean = 6.8, 95% CI = 6.7–8.8) with an average working day of 13 h (mean = 12.9, 95% CI = 12.7–13.2) and were mostly owned by independent non-pharmacists (70%). The pharmacies employed on average 2.6 full-time-equivalent (FTE) pharmacists (95% CI = 2.3–2.8) with 74% employing 1.8 FTE pharmacy assistants (95% CI = 1.7–2.0) and 47% employing trainee pharmacists (mean = 1.8 FTE, 95% CI = 1.6–2.0). Around three-quarters of the pharmacies dispensed fewer than 100 prescriptions (75%) and responded to fewer than 100 requests for over-the-counter medicines (69%) per day. Most pharmacists encountered limited immediate access to up-to-date resources. Conclusions This is the first study to explore the characteristics of community pharmacy practice in the UAE. The study provides baseline data which are critical to inform the development of strategies to improve the quality of community pharmacy services in the UAE.

Impact of domiciliary pharmacy visits on medication management in an elderly population

Abstract: This paper describes medication management by elderly patients living in their own homes, and the effects of patient counselling during five domiciliary pharmacy visits on patient compliance and medication management. The 190 subjects who completed the 12-month study were randomly allocated to either an intervention group (receiving counselling on the correct use and storage of their drugs during five domiciliary visits), a control (V) group (receiving visits but no counselling), or a control (NV) group (having no contact between an initial visit and the end of the study). The patients' drug knowledge, dexterity and cognitive functioning were assessed, and patients in all three groups were well matched at baseline. At each follow-up visit, patient compliance was measured using pill counts and interviews. After the initial visit, patients in the intervention group demonstrated better compliance, better drug storage practices and a reduced tendency to hoard drugs, and required fewer GP consultations, than patients in either of the control groups. The provision of the domiciliary pharmacy service was effective in detecting drug-related problems in a potentially high risk patient group. The effectiveness of such a service may be improved by increased transfer of patient information between community pharmacists and general medical practitioners.

A randomised controlled trial of a pharmaceutical care programme in high-risk diabetic patients in an outpatient clinic

Abstract: Objective — To determine the impact of a pharmaceutical care programme (PCP) in diabetic patients. Design — Randomised controlled study of high-risk diabetic patients. Setting — Outpatient clinic at Fremantle hospital (FH), Western Australia. Method — Patients over 18 years of age who could communicate freely in English and fulfilled pre-determined criteria for being high-risk for the development of diabetic complications, were randomly assigned to the PCP or control groups in a ratio of 2:1. In the PCP arm, a clinical pharmacist reviewed and monitored all aspects of the patients' drug therapy in collaboration with other health care professionals at six-weekly intervals for six months. The control patients received usual outpatient care. Main outcome measures — Glycosylated haemoglobin (HbA1c), quality of life (QOL), patient satisfaction with health care providers and changes in drug therapy during the PCP. Results — Seventy-three patients were recruited into the study, of whom 48 (66 per cent) were randomised to the PCP. There were no significant differences between the PCP (cases) and the control groups for demographic variables. The mean (±SD) HbA1c for the cases was 8.4±1.4 per cent at the beginning and 8.2±1.5 per cent at the end of the study period (P>0.05). There was similarly no change in the control group (8.5±1.6 per cent to 8.1±1.6 % P>0.05). There were no significant changes in QOL for cases or controls over the period of the study. During the PCP, there was a significant increase in patient satisfaction with the care provided by the clinical pharmacist (P=0.007) and the provision of drug information (P=0.036). The clinical pharmacist facilitated 39 drug interventions in the 48 cases. A high level of complementary medicine usage was found in the PCP group (16.7 per cent). Conclusions — PCPs provide patients with important medication information and result in changes to drug therapy. However, in diabetic patients under specialist care, a six-month PCP did not lead to an improvement in glycaemic control. The role for pharmacist intervention in primary care now needs to be evaluated.

Is 15 per cent very common? Informing people about the risks of medication side effects

Abstract: Objectives — To assess the general public's interpretation of the verbal descriptors for side effect frequency recommended for use in medicine information leaflets by a European Union (EU) guideline, and to examine the extent to which differences in interpretation affect people's perception of risk and their judgments of intention to comply with the prescribed treatment. Method — Two studies used a controlled empirical methodology in which people were presented with a hypothetical, but realistic, scenario about visiting their general practitioner and being prescribed medication. They were given an explanation that focused on the side effects of the medicine, together with information about the probability of occurrence using either numerical percentages or the corresponding EU verbal descriptors. Interpretation of the descriptors was assessed. In study 2, participants were also required to make various judgments, including risk to health and intention to comply. Key findings — In both studies, use of the EU recommended descriptors led to significant overestimations of the likelihood of particular side effects occurring. Study 2 further showed that the “overestimation” resulted in significantly increased ratings of perceived severity of side effects and risk to health, as well as significantly reduced ratings of intention to comply, compared with those for people who received the probability information in numerical form. Conclusion — While it is recognised that the current findings require replication in a clinical setting, the European and national authorities should suspend the use of the EU recommended terms until further research is available to allow the use of an evidence-based approach.

An assessment of dispensing practices in private pharmacies in Dar-es-Salaam, Tanzania.

Abstract: Objectives To assess medicine dispensing practices in private pharmacies in Dar-es-Salaam, Tanzania and recommend interventions to improve practice. Methods A cross-sectional survey and observational study of dispensing practices among 70 pharmacies in metropolitan Dar-es-Salaam, Tanzania. Key findings There were 1479 dispensing encounters recorded across the 70 pharmacies. This translated to 1573 medicines dispensed. Of the medicines dispensed, 16% were anti-infectives; 45% of the dispensed medicines were requested by the client, 32% were recommended by the dispenser and only 23% were on prescriptions. The main reasons for pharmacy consultations were coughs (62%), general pain (62%) and 'flu and colds. Malaria constituted 21% of the private pharmacy visits. Of the cough encounters, 30% received antibiotics. In addition, oral antibiotics were given to 81% of the clients with diarrhoea and to 95% of those with eye and ear problems. Of the 628 clients who requested specific medicines without a prescription, only 29% were asked questions on why the medicines were required. Of the clients who bought antibiotics, 20% bought incomplete doses. In total, 1180 clients were interviewed. Of these, 35% could not repeat the instructions given to them by the dispenser. Of the 70 dispensers who gave dosage instructions, only 20% gave them according to guidelines. Conclusion In Tanzania, an overwhelming proportion of medicines sold in pharmacies are dispensed without a prescription. The majority of medicines dispensed without a prescription are either requested by the client or recommended by the dispenser. When dispensing medicines, dispensers seldom give dosage instructions; when they do, the instructions are often not consistent with guidelines. A high proportion of clients seeking management of coughs and colds or for diarrhoea from private pharmacies receive antibiotics. Interventions that build the capacity of dispensers, improve the rational use of antibiotics and the management of diarrhoea in private pharmacies in Tanzania are necessary to provide consistent quality services to a populace that relies heavily on the private sector for their medications needs.

Impact of a pharmaceutical care model for non-institutionalised elderly: results of a randomised, controlled trial

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.

Prescription errors detected by Swedish pharmacists

Abstract: Prescription errors identified and dealt with by personnel at 36 Swedish community and hospital pharmacies during March, 1992, were analysed. During the study period, the participating pharmacies handled 76,956 prescriptions for 41,908 patients. All prescription errors, even minor ones, were registered. In total 32,132 errors were detected and reported, corresponding to an overall rate of 42 per cent. The most common error was omission of the purpose of the therapy. This type of error was found in 20,517 prescriptions (64 per cent of all noted errors). Most detected errors did not require any special intervention by the dispensing pharmacist. Errors of commission, which are potentially harmful to the patient, totalled 338 or 1 per cent of the errors. The most common of these was that the dosage form stated was incorrect. The pharmacists were able to resolve almost three-quarters of the errors that required intervention and dispense the elucidated or amended prescription.

British pharmacy professionals' beliefs and participation in continuing professional development: a review of the literature.

Abstract: Objectives Continuing professional development (CPD) has potential to be useful in pharmacy revalidation but past uptake and attitudes to CPD in Great Britain (GB) need to be mapped. This review examines published literature to chart the participation and beliefs of pharmacy professionals towards CPD in GB in a decade that had seen a formal transition from continuing education to CPD. Methods A comprehensive review of the published literature was conducted to identify studies of the uptake of, or attitudes towards, CPD cross different sectors of pharmacy in GB from 2000 to 2010. Key findings Twenty-two studies were included and analysed, including 13 research papers, six conference papers, two news items reporting survey outcomes and one commissioned study. Eight barriers to CPD were identified as: time, financial costs and resource issues, understanding of CPD, facilitation and support for CPD, motivation and interest in CPD, attitudes towards compulsory CPD, system constraints, and technical problems. Pharmacy professionals on the whole agreed with the principle of engaging with CPD but there was little evidence to suggest widespread and wholehearted acceptance and uptake of CPD, essential for revalidation. Conclusions If CPD is to succeed, people's beliefs and attitudes must be addressed by recognising and modifying perceived barriers through a combination of regulatory, professional, work-related and personal channels. A number of recommendations are made. Direct experience of effective CPD in the absence of perceived barriers could impact on personal development, career development and patient benefit thus strengthening personal beliefs in the value of CPD in an iterative manner.

Role of the community pharmacist in the care of patients with chronic schizophrenia in the community

Abstract: This study, using a postal questionnaire, investigated the involvement of 534 community pharmacists with patients suffering from schizophrenia. The majority of the 236 respondents regularly dispensed medication for patients with schizophrenia and almost three-quarters had been asked for advice about medication from such patients or their carers. However, the majority of respondents believed that the advice they could give to these patients was limited by their knowledge of schizophrenia (86 per cent) and of therapeutics (70 per cent). Other perceived constraints to giving advice included lack of contact with other health professionals, poor communication skills and lack of experience in dealing with the mentally ill. Respondents were significantly less confident about advising patients with schizophrenia than advising other patient groups. The results suggest that there is a need to encourage community pharmacists' participation in continuing education and to improve liaison with other community health professionals such as community psychiatric nurses.

An observational study of the prescribing and administration of intravenous drugs in a general hospital

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

Preventing drug‐related morbidity: determining valid indicators

Abstract: Focal points The study involved used a two-round Delphi questionnaire survey of a total of 17 general practitioners and pharmacists, to assess the face and content validity and develop consensus for 31 indicators for preventable drug-related morbidity (PDRM) Consensus that an indicator represented a PDRM was achieved for 15 indicators Combining these results with that from previous work has identified 34 PDRM indicators suitable for use in the UK This study has highlighted the difficulty of identifying the process of care needed to prevent specific drug-related morbidities The results of operationalising these indicators will help focus an intervention to facilitate improvements in medicines usage in UK primary care

When do medication administration errors happen to hospital inpatients

Abstract: The aim of this study was to determine when medication administration errors (MAEs) are most likely to occur. MAEs were identified by observing nurses preparing and administering medication on a care of the elderly ward during two eight-day periods. The exposure of individual patients to MAEs was also determined. A total of 119 MAEs was identified during the observation of 2,170 opportunities for error, representing an error rate of 5.5 per cent (95 per cent confidence interval, 4.5 per cent to 6.4 per cent). The omission of drugs that were not available on the ward was the predominant type of error. Of the 56 study patients, 35 experienced at least one MAE during the study period. Errors occurred at an average rate of at least 0.3 errors per patient day. The MAE rate was significantly higher on weekdays (6.4 per cent) than during weekends (4.0 per cent) and higher during pharmacy opening hours (7.8 per cent) than when the pharmacy was closed (4.6 per cent). Patients were at greatest risk of MAEs in the first 48 hours of admission and in the first 48 hours after prescribing. A multidisciplinary approach is required to design safer systems.

The effect of pharmaceutical review of repeat prescriptions in general practice

Abstract: Objectives — To investigate how a community pharmacist can affect the quality of repeat prescribing, and to develop a model for general practitioner (GP) and pharmacist co-operation. Methods — Repeat prescriptions with three or more items were reviewed by a community pharmacist and randomly allocated to a trial or control group. Drug-related problems (DRPs) were discussed at joint meetings with the GP and the pharmacist. A modified Delphi technique was used to evaluate the clinical significance of the DRPs identified by the pharmacist. Setting — The repeat prescription review and meetings took place in a GP surgery in an inner city location between November, 1995, and October, 1997. Key findings — The pharmacist reviewed 511 repeat prescriptions, representing 3,018 prescribed items. Ninety repeat prescriptions (36.3 per cent) in the trial group and 86 repeat prescriptions (34.1 per cent) in the control group were identified as having DRPs. The GP agreed with 92.3 per cent of the interventions in the trial group, while only 12.8 per cent of the interventions in the control group were routinely resolved by the GP. The difference in interventions dealt with between the trial and the control group is statistically significant (X2=94.14, P<0.001). The absolute risk reduction (ARR) was 26 per cent, and the prescription number needed to treat (NNT) was 3.8. For every 19 prescriptions reviewed, an intervention that results, or potentially results, in clinical improvement in patient care was made by the pharmacist. Conclusion — The pharmacist significantly reduced the number of DRPs associated with repeat prescriptions compared with routine surgery procedure. Pharmacist review of repeat prescriptions is an effective method of solving DRPs, reducing risk and making significant clinical improvements to patient care.

Nurse prescribing from the community nurse's perspective

Abstract: Background — Since 1994, district nurses and health visitors in the United Kingdom have been able to prescribe from a limited formulary. Items which are prescribed by these nurses are wound care products, incontinence appliances and medicinal preparations such as paracetamol and emollients. There is a planned expansion of prescribing by nurses, in terms of both the range of products and drugs that are prescribable and the types of nurses eligible for training for this new role. Objective — To investigate patterns of nurse prescribing among community nurses in three primary care trusts in the United Kingdom. Methods — Postal survey to 164 community nurses who were qualified to prescribe. Responses were received from 129 (79 per cent) with 35 nurses identifying themselves as not prescribing and excluded from the sample; 93 (72 per cent) of the questionnaires were entered on a database for analysis. Key findings — Prescribing costs for district nurses ranged from £7.65 to £18,053 (median £2,023.64) and for health visitors from £0.73 to £2,556 (median £42.77) for a 12-month period. Nineteen per cent (n=28) of community nurses had decided not to prescribe even though they were trained to do so. Infrastructures and mechanisms to support nurses with nurse prescribing have been slow to emerge. Nurses perceived that their ability to prescribe was benefiting their patients and that they were providing better care. Community nurses cautiously welcomed the proposed extension of nurse prescribing. Conclusions — Nurse prescribing has allowed community nurses more autonomy in managing a patient's total care. Our findings suggest that around one-quarter of nurses qualified to prescribe are not doing so. With the imminent extension of nurse prescribing for other nurses, action is needed by primary care trusts to put structures in place to ensure that nurses take on board this extension and challenge to their role.

The cost‐effectiveness of intensive pharmaceutical intervention in assisting people to stop smoking

Abstract: Objective — To assess the cost-effectiveness of intensive pharmaceutical intervention in assisting people to stop smoking. Method — A randomised control trial was used to evaluate training of pharmacy personnel based on the “stage of change” model. All 76 non-city community pharmacies registered in Grampian were invited to participate. All intervention personnel were invited to attend the training. Control and intervention groups then recruited clients over a 12-month period. Detailed records were kept of the costs borne by the health service, pharmacies and clients. The effectiveness of the training was assessed by comparing the smoking cessation rates of the two groups at one, four and nine months. Setting — Community pharmacies in the Grampian region of Scotland. Key findings — Sixty-two pharmacies (82 per cent) were recruited. The training was undertaken by 94 participants (40 pharmacists, 54 assistants). A total of 492 clients (224 intervention, 268 controls) was recruited. Assuming that non-responders had lapsed, intervention subjects tended to be more likely than control subjects to report not smoking at each follow up. As reported previously, one-month point prevalence was 29.9 per cent intervention and 23.6 per cent control (P=0.12); four months' continuous abstinence was achieved by 16.1 per cent in the intervention group and 10.9 per cent of controls (P<0.094) and nine months' continuous abstinence by 12.0 per cent in the intervention group and 7.4 per cent of controls (P<0.089). The cost of producing one additional successful attempt to quit smoking by using intensive rather than standard pharmaceutical support was £300. Conclusion — The intervention was associated with higher smoking cessation rates, confirming that community pharmacy personnel have the potential to make a significant, cost-effective contribution to smoking cessation.