Showing papers in "International Journal of Pharmacy Practice in 2018"

Community pharmacist-led interventions and their impact on patients' medication adherence and other health outcomes: a systematic review.

Abstract: Introduction Medication adherence can be defined as the extent to which one's medication-taking behaviour follows that mutually agreed upon by the prescribing physician. Optimal medication adherence is often deemed crucial for the success of a patient's treatment, as suboptimal adherence may lead to treatment failure and unnecessary medical expenditure. Increasing evidence has highlighted the positive contribution community pharmacist-led interventions can have on improving patients' adherence and health outcomes. Objectives To provide an overview of the published literature on community pharmacist-led interventions and their effectiveness in improving patients' adherence and health outcomes. Methods A search strategy was developed, aiming to retrieve published reports of community pharmacy interventions worldwide. Medline, EMBASE, International Pharmaceutical Abstracts, Google Scholar and ProQuest Dissertations and Theses databases were searched. Articles meeting the inclusion criteria were collated, relevant data extracted, and a risk of bias assessment undertaken. Key findings Twenty-two studies were included in the analysis, and their outcomes were reported in 26 peer-reviewed journal articles. Community pharmacist-led interventions have been shown to improve patients' adherence and contribute to better blood pressure control, cholesterol management, chronic obstructive pulmonary disease and asthma control. Studies in this review, however, did not report statistically significant effects of interventions on diabetes or depression control. Conclusion Community pharmacist-led interventions have been shown to contribute to improved adherence and better disease control. Future research should attempt to better understand which particular intervention components make the greatest contribution towards improving adherence and health outcomes, for patients with different medical conditions.

Interventions to improve the appropriate use of polypharmacy for older people: an updated Cochrane systematic review

Abstract: Publisher rights Copyright © 2014 The Cochrane Collaboration. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2014, Issue 10: Patterson SM, Cadogan CA, Kerse N, Cardwell CR, Bradley MC, Ryan C, Hughes C. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD008165. http://dx.doi.org/10.1002/14651858.CD008165.pub3.

Paediatric nurses' knowledge and practice of mixing medication into foodstuff.

Abstract: To investigate paediatric nurses' knowledge and understanding of potential drug stability issues caused by mixing medication into foodstuff. Fourteen paediatric mental health and 16 paediatric general nurses (response rate, 71%) were investigated. With the exception of one nurse, all others reported they had modified oral dosage forms, or had mixed medication with food, prior to administration. The most common foodstuffs were fruit yoghurts, diluting juice and (concentrated) fruit juices. More than half of both cohorts felt sufficiently trained in carrying out the procedure, but 27% did not feel sufficiently knowledgeable about drug stability issues. The in-depth interviews highlighted a knowledge deficit as to the nature of clinical problems that could result from performing the procedures and the associated professional liabilities. Some interviewees expressed reservations about the effectiveness of the dose when administered in this way. Co-mixing was perceived as a time-consuming process and preference was expressed for mixing the powdered dosage form into juice or a liquid rather than into solid foods. Several training issues were identified from this study, including more information about drug/food compatibilities and the need for standardised documentation around the procedures which could be implemented at the ward level. Co-mixing of medication into foodstuff is a common practice. The majority of nurses are unaware of potential drug stability/degradation issues and/or the clinical impact of these practices.

Clinical pharmacists in general practice: an initial evaluation of activity in one English primary care organisation.

Abstract: Objectives: This aim of this research was to characterise the breadth and volume of activity conducted by clinical pharmacists in general practice in Dudley Clinical Commissioning Group (CCG), and to provide quantitative estimates of both the savings in general practitioner (GP) time and the financial savings attributable to such activity. Methods: This descriptive observational study retrospectively analysed quantitative data collected by Dudley CCG concerning the activity of clinical pharmacists in GP practices during 2015. Key findings: Over the 9-month period for which data were available, the 5.4 whole time equivalent clinical pharmacists operating in GP practices within Dudley CCG identified 23 172 interventions. Ninety-five per cent of the interventions identified were completed within the study period saving the CCG in excess of £1 000 000. During the 4 months for which resource allocation data were available, the clinical pharmacists saved 628 GP appointments plus an additional 647 h that GPs currently devote to medication review and the management of repeat prescribing. Conclusions: This research suggests that clinical pharmacists in general practice in Dudley CCG are able to deliver clinical interventions efficiently and in high volume. In doing so, clinical pharmacists were able to generate considerable financial returns on investment. Further work is recommended to examine the effectiveness and cost-effectiveness of clinical pharmacists in general practice in improving outcomes for patients.

Compliance with legal requirements at community pharmacies: a cross sectional study from Pakistan

Abstract: Objectives The study evaluated the compliance of community pharmacies with legal requirements as laid down by the drug regulatory framework in Pakistan. Methods An exploratory cross sectional survey was conducted with a total of 371 randomly selected community pharmacies in three cities in Pakistan, namely Islamabad(n = 118),Peshawar(n = 120)andLahore(n = 133).Aquestionnairewas developed andfinalized by focus-group discussions and pilot testing.The questionnaire included background information and a legal requirement scale consisting of six subscales: licensing requirements,premises requirements,storage requirements, documentation requirements, narcotics section requirements and prescription checking. The data were coded, entered and analysed using SPSS software (version 16).Kruskal‐Wallis,Mann‐Whitney and chi square tests were used for analysis. Key findings The pharmacies were operating with one of the three licence types operating in Pakistan: type A (n = 96, 25.9%), type B (n = 186, 50.1%) and type C (n = 89, 24.0%).A narcotics licence was issued to 133 (35.8%) pharmacies; licences of 66 (17.8%) pharmacies were expired while the validity of 87 (23.0%) licences could not be determined. Only 113 (30.5%) pharmacies were totally clean. Eighty percent of the pharmacies had a refrigerator for storage of medicines, but only 284 (76%) of the refrigerators were in working condition.Complete medicine purchase records with warranties were available at 210 (56.6%) pharmacies. Conclusions None of the pharmacies completely complied with the legal requirements in terms of licensing, premises, storage, documentation, narcotics section, druglabellingandprescriptionchecking.Thisspeaksof poorregulationandcontrol byhealthauthoritiesonthesaleanddispensingof medicinesinPakistan.Thisstudy willserveasabaselineforpolicymakers,managers,researchersandotherstakeholders in developing designs for future interventions as well as for methods of accountability and control.

How do people conceptualise the reuse of medicines? An interview study.

Abstract: Objectives To capture people's beliefs about medicines reuse and to map the determinants of intentions to reuse medicines in the future. Methods Participants were recruited through an advert placed in the university's community newsletter reaching 15 000 households. Adults wishing to participate were interviewed using convenience sampling, with recruitment continuing until data saturation. Participants were interviewed face-to-face by two researchers using a semi-structured interview schedule based on the theory of planned behaviour (TPB). Interview transcripts were analysed by thematic analysis, with the themes classified according to the TPB. The University's research ethics committee approval was obtained. Key findings Nineteen participants were interviewed. The potential economic and environmental benefits of medicines reuse were juxtaposed with stability and safety worries. Participants trusted pharmacists to quality-assure returned medicines, but wondered if they had the time and storage space to dedicate to medicines reuse. Environmentalists were seen as the main proponents of medicines reuse with drug manufacturers, some taxpayers and parents seen as the main opponents. The physical characteristics of reused medicines, and quality assurance and logistics of reuse processes were seen to enable/obstruct engagement in medicines reuse. A working definition of medicines reuse as a behaviour was developed. Conclusions People could potentially agree to reuse medicines if their concerns are addressed and the process is well defined and managed. This is a qualitative study with a small number of participants meaning the results may not be generalisable. The themes generated will enable a structured questionnaire to be developed for quantifying broader views.

Bibliometric analysis of literature in pharmacy education: 2000–2016

Abstract: Objectives Improving pharmacy education requires continuous research to optimize education and consequently pharmacy practice. The goal of this study is to assess national and international contributions to pharmacy education research and present results in comparative bibliometric format. Methods Search strategy based on journal name and specific keywords pertaining to pharmacy education were used to retrieve the worldwide literature in pharmacy education using Scopus database during the period from 2000 to 2016. Bibliometric indicators were presented as top 10 list of countries, institutions and authors. VOSviewer was used to visualize international collaboration, while ArcMap10.1 software was used for geographical mapping of publications. Key findings A total of 5363 documents, mostly as research articles (4027; 75.1%), were retrieved. A noticeable increase in publications was seen from 2007 to 2011. The USA contributed to more than half (53.6%) of worldwide research output. Saudi Arabia had the highest percentage of international authors representing international collaboration. There was an increase in multi-authored publications with time. The American Journal of Pharmaceutical Education (AJPE) ranked first (2822, 52.6%) while the American Association of Colleges of Pharmacy (AACP) had the largest research output with 141 (2.6%) publications. The vast majority of highly cited articles were published in AJPE, and highly cited topics included the use of social media in pharmacy education and the multi-professional learning experience. Conclusion Pharmacy education research is gaining momentum and is addressing various fields in education. Research in pharmacy education should be encouraged, particularly in developing countries, where education and practice are still lagging behind.

Application of a prescribing indicators tool to assist in identifying drug-related problems in a cohort of older Australians.

Abstract: Objective Drug-related problems (DRPs) are common in older people, resulting in a disproportionate number of serious medication adverse events. Pharmacist-led interventions have been shown to be effective in identifying and reducing DRPs such as medication interactions, omission of recommended medications and use of ineffective medications. In 2008 we proposed a prescribing indicators tool to assist in identifying DRPs as part of the Australian medication review process. The objective was to apply the proposed prescribing indicators tool to a cohort of older Australians, to assess its use in detecting potential DRPs. Methods The prescribing indicators tool was applied in a cross-sectional observational study to 126 older (aged ≥65 years) English-speaking Australians taking five or more medications, as they were being discharged from a small private hospital into the community. Indicators were unmet when prescribing did not adhere to indicator tool guidelines. Key findings We found a high incidence of under-treatment, and use of inappropriate medications. There were on average 18 applicable indicators per patient, with each patient having on average seven unmet indicators. Conclusion The use of a prescribing indicators tool for commonly used medications and common medical conditions in older Australians may contribute to the efficient identification of DRPs.

Managing workplace stress in community pharmacy organisations: lessons from a review of the wider stress management and prevention literature.

Abstract: Background Workplace stress in community pharmacy is increasing internationally due, in part, to pharmacists’ expanding roles and escalating workloads. Whilst the business case for preventing and managing workplace stress by employers is strong, there is little evidence for the effectiveness of organisational stress management interventions in community pharmacy settings. Aim To identify and synthesise existing evidence for the effectiveness of organisational solutions to workplace stress from the wider organisational literature which may be adaptable to community pharmacies. Method A secondary synthesis of existing reviews. Publications were identified through keyword searches of electronic databases and the internet; inclusion and exclusion criteria were applied; data about setting, intervention, method of evaluation, effectiveness and conclusions (including factors for success) were extracted and synthesised. Findings Eighteen reviews of the stress management and prevention literature were identified. A comprehensive list of organisational interventions to prevent or manage workplace stress, ordered by prevalence of evidence of effectiveness, was produced, together with an ordered list of the benefits both to the individual and employing organisation. An evidence-based model of best practice was derived specifying eight factors for success: top management support, context-specific interventions, combined organisational and individual interventions, a participative approach, clearly delineated tasks and responsibilities, buy-in from middle management, change agents as facilitators and change in organisational culture. Conclusions This literature review provides community pharmacy organisations with evidence from which to develop effective and successful stress management strategies to support pharmacists and pharmacy staff. Well-designed trials of stress management interventions in community pharmacy organisations are still required.

The public's perception of the role of community pharmacists in Wales

Abstract: Objective To investigate the general public's perceptions of the community pharmacist's (CP) role in Wales by exploring understanding, awareness of services provided and potential interventions for promoting the role of CPs Methods Qualitative methodology using focus group (FG) discussions exploring opinions, facilitated by a moderator (pharmacist) and an assistant Topics discussed included the following: what a CP does; reasons for visiting; from whom they seek advice on medicines or lifestyle issues; use of traditional and newer services and promotion of services The groups, totalling 32 participants, represented non-users and users of pharmacy services, that is pupils from a local secondary school (x1 group), people from the local community (x3) and patients plus carers from a Parkinson's disease group (x1) FG discussions were recorded and transcribed verbatim, and analysis was undertaken to identify themes Key findings Traditional dispensing and supply of medicines roles were clearly recognised, but poor awareness of the newer services emerged, particularly in public health roles CP's professionalism was acknowledged, but there was confusion over where they ‘fit’ within the National Health Service or with General Practitioners, with concerns or misconceptions raised over the impact of commercialism on professionalism Conclusions Based on these findings, the public is accepting of the extended role of CPs and would engage with CPs for a wider range of services However, there is a lack of awareness of what public health services are available Considerable work is needed to increase public awareness, during the strategic development of these services in Wales

Assessment of counselling for acute diarrhoea in German pharmacies: a simulated patient study.

Abstract: OBJECTIVES The aim of this study was to assess the quality of counselling provided for acute diarrhoea and to evaluate the role of the patient's approach and different user groups in determining the outcome of counselling. METHODS The simulated patient methodology was used in all 21 community pharmacies in a north-eastern German city. Four different scenarios related to self-medication of acute diarrhoea were developed and used in all the pharmacies (a total of 84 visits). The assessment form, completed immediately postvisit by the simulated patient, included 9 objective items scored using dichotomous scales to produce a scale from 0 to 9. After evaluating the data, every pharmacy received individual performance feedback to encourage behavioural changes and improve the quality of the counselling provided. KEY FINDINGS Overall, the quality of counselling was poor (mean score of 3.3/9 (37%)). The most common information provided was about dosage (87% of interactions), while the least common information given was about side effects (4% of interactions). The main effect was seen when comparing the product and symptom requests (F(1,60) = 24.748, P < 0.001, ωp2 = 0.277). There was no effect resulting from different user groups (F(1,28) = 0.237, P = 0.630, ωp2 = -0.026) and no interaction between the type of request and different user groups (F(1,28) = 3.395, P = 0.076, ωp2 = 0.073). CONCLUSIONS This study highlighted the current deficits in appropriate counselling provided by community pharmacies in Germany.

Community pharmacist-led clinical services: physician's understanding, perceptions and readiness to collaborate in a Midwestern state in the United States.

Abstract: OBJECTIVES Many pharmacists are actively enhancing their role in the delivery of health care by offering a variety of pharmacist-led clinical services. The delivery of these services within community pharmacies can contribute to overcoming the cost and accessibility challenges currently facing U.S. health care, especially when pharmacist-physician collaborative efforts are utilized. The study purpose was to identify general and family practice physicians' awareness of pharmacists' delivery of clinical services, uncover their perceived barriers to collaboration with community pharmacists, and collect their input on how to overcome such barriers in order to better understand how pharmacist-led clinical services can be integrated, improved and more widely utilized as a healthcare delivery mechanism. METHODS Semi-structured interviews were performed at the physicians' place of practice to assess (1) family practice and internal medicine physicians' knowledge of pharmacists' education, clinical training, and role in the healthcare team; (2) their perceptions and barriers towards pharmacist-delivered clinical services and physician-pharmacist collaboration; and (3) their recommendations to improve physician-pharmacist collaboration. The data were analysed qualitatively to identify and categorize themes. KEY FINDINGS Thirteen physicians were interviewed. While nearly all physicians were aware of pharmacists' level of education, most were not aware of the level of clinical training pharmacists receive. Only half of the physicians were able to provide a definition or example of collaborative practice agreements, although most recognized value and benefit when the definition and examples were provided to them. The commonly perceived barriers for collaboration were concern over loss of communication, hesitancy to relinquish control and lack of confidence in pharmacists' clinical judgement. CONCLUSION The study results emphasize the need to develop strategies to improve collaborative relationships between physicians and pharmacists. To encourage collaboration, pharmacists must take a proactive approach to increasing awareness of their clinical knowledge and training, the benefits and value of collaborative practice and the opportunities for it.

Ethical responsibilities of pharmacists when selling complementary medicines: a systematic review.

Abstract: The widespread sale of complementary medicines in community pharmacy raises important questions regarding the responsibilities of pharmacists when selling complementary medicines. This study reviews the academic literature that explores a pharmacist's responsibilities when selling complementary medicines. International Pharmaceutical Abstracts, Embase, PubMed, Cinahl, PsycINFO and Philosopher's index databases were searched for articles written in English and published between 1995 and 2017. Empirical studies discussing pharmacists' practices or perceptions, consumers' expectations and normative studies discussing ethical perspectives or proposing ethical frameworks related to pharmacists' responsibilities in selling complementary medicines were included in the review. Fifty-eight studies met the inclusion criteria. The majority of the studies discussing the responsibilities of pharmacists selling complementary medicines had an empirical focus. Pharmacists and consumers identified counselling and ensuring safe use of complementary medicines as the primary responsibilities of pharmacists. No formal ethical framework is explicitly employed to describe the responsibilities of pharmacists selling complementary medicines. To the degree any ethical framework is employed, a number of papers implicitly rely on principlism. The studies discussing the ethical perspectives of selling complementary medicines mainly describe the ethical conflict between a pharmacist's business and health professional role. No attempt is made to provide guidance on appropriate ways to resolve the conflict. There is a lack of explicit normative advice in the existing literature regarding the responsibilities of pharmacists selling complementary medicines. This review identifies the need to develop a detailed practice-specific ethical framework to guide pharmacists regarding their responsibilities when selling complementary medicines.

Pharmacy-based management of influenza: lessons learned from research.

Abstract: Recently, several jurisdictions have pursued legislative and regulatory changes to allow pharmacy-based influenza management models in which pharmacists can initiate appropriate antiviral therapy in community pharmacy settings. While studies have been published in Canada, Japan, New Zealand, Norway and the United States, concerns have been expressed over pharmacist training, the accuracy of rapid influenza diagnostic tests, and the potential impact on antimicrobial resistance, among others. Studies have demonstrated that pharmacists provide safe and effective influenza management, with high rates of patient satisfaction, while maintaining or improving antimicrobial stewardship.

Current state of pharmacovigilance in the Arab and Eastern Mediterranean region: results of a 2015 survey.

Abstract: OBJECTIVES This study describes the current state of pharmacovigilance systems in Arab and Eastern Mediterranean countries. METHODS A descriptive cross-sectional study was conducted between May and September 2015. Data were gathered from a standardized online survey sent to pharmacovigilance leadership identified as the official national contact for the WHO Programme for International Drug Monitoring. In countries with no specified pharmacovigilance programme or leadership, Ministry of Health officers responsible for drug safety policies were invited to participate in the survey. The survey measured three domains of pharmacovigilance performance using indicators that were defined and assigned scores a priori: 10 structural, 10 process, and seven impact indicators. Total scores were assigned to each domain of indicators, and countries were compared depending on their total performance score. KEY FINDINGS Complete responses were received from 20 countries (of 24 total), representing an 83% response rate. Approximately 20% (n = 4) of respondents reported not having any pharmacovigilance programme in their country. In total, across the three primary pharmacovigilance performance domains, the mean score for the 20 countries in the survey was 28.9 [standard deviation(SD): 13.8] with a range from 4 to 48 (maximum possible score: 48). In the structural performance domain, which assessed the existence of key pharmacovigilance structures, systems and policies in each country, the mean score among respondents was 13.1 (SD: 5.7) and the scores ranged from 2 to 19 (maximum possible score: 19). In the process performance domain, which assessed the constellation of activities undertaken by pharmacovigilance programmes (including the collection, collation, analysis and evaluation of adverse drug event reports), the mean score among respondent countries was 9.1 (SD: 5.4) and the scores ranged from 0 to 17 (maximum possible score: 17). Finally, in the impact domain, which measured the scope of national efforts at promoting risk minimization and increasing awareness in use of potentially unsafe pharmaceutical products, the mean score was 6.8 (SD: 3.6) and scores ranged from 0 to 12 (maximum possible score: 12). CONCLUSIONS The findings suggest wide disparities in pharmacovigilance systems in the region, underscoring the need for a multistakeholder effort in bolstering programme development and the necessity to build collaboration regionally and internationally to enhance capacity, improve public and healthcare provider awareness and assist in the development of pharmacovigilance systems still in their nascent stage.

Impact of test anxiety on pharmacy students' performance in Objective Structured Clinical Examination: a cross-sectional survey.

Abstract: Objective: To assess the association between test-related anxiety and pharmacy students’ performance in the Objective Structured Clinical Examination (OSCE). Methods: A cross-sectional survey was conducted among Year-5 Doctor of Pharmacy (PharmD) students enrolled at a public university in Saudi Arabia. Students completed Test Anxiety Inventory (TAI), a 20-item validated questionnaire used to assess test-related anxiety, prior to the commencement of a summative OSCE. TAI has two subscales: TAI-Emotionality (TAI-E) and TAI-Worry (TAI-W). The overall maximum possible total score (TAI-T) is 80, with a minimum possible score of 20. Key findings: All 25 students, 10 males and 15 females completed the survey. The overall mean scores for TAI-E, TAI-W and TAI-T were 20.2, 19.6 and 50.2, respectively. There were no statistically significant differences between males and females with respect to the TAI-E score (P = 0.43), TAI-W score (P = 0.25) and TAI-T score (P = 0.34). Females had higher marks in the OSCE compared with males (P = 0.01), however. After adjusting for gender, multiple linear regression analysis showed a statistically significant negative association between TAI-W score and marks obtained in OSCE (P = 0.02; 95% CI = −0.42, −0.03). Conclusion: Assessment-related worry may negatively affect students’ scores in performance-based examination and could lead to overall underperformance.

Pharmacist awareness and views towards counterfeit medicine in Lebanon.

Abstract: Background Pharmacists, as healthcare professionals, have patients' well-being and safety as their primary concern. However, the safety and efficacy of treatments may be compromised by the availability of counterfeit medicine (CFM) which could have serious consequences for public health. Objectives To assess pharmacist awareness and views towards CFM in Lebanon. Methods The study used convenience sampling and selected pharmacists based on their willingness to participate and used a questionnaire as a tool to determine their experiences and views towards CFM. The questionnaires were completed in different regions in Lebanon. Key findings A total of 223 pharmacists participated in the study, and all were able to define CFM, however were inconsistent in their definitions. The majority reported identifying CFM by the medicine's effect (67.7%), followed by cost (66.8%). Almost 43% reported knowing of pharmacists who dispensed CFM. Additionally, participants reported that they believed that pharmacists who dealt with CFM were unprofessional (89.2%) and unethical (86.5%), and that they did it for the ‘easy money’ (87.9%) and large profit (86.5%). Conclusion The study highlighted the need for additional CFM awareness campaigns with an emphasis on the role that pharmacists have in protecting patients from using CFM. In addition, there is a need for an official CFM definition that distinguishes between the different types of counterfeiting. Furthermore, the Lebanese Ministry of Public Health and regulatory authorities should control and secure the supply chain of medicine in the country and enforce the law.

Transfer of care – a randomised control trial investigating the effect of sending the details of patients' discharge medication to their community pharmacist on discharge from hospital

Abstract: Objective: There is substantial evidence demonstrating that transferring patients between care providers is a high-risk area for medicines management. This study aimed to investigate the effect of sending patients’ hospital discharge letters to their nominated community pharmacists on the number of discrepancies between the patient’s general practitioner (GP) records and the discharge letter and between the patient’s self-described medication regime and the discharge letter. Methods: In a randomised, controlled trial, 33 participants in two groups, control and intervention, had their discharge letter sent to either their GP only or their GP and nominated community pharmacy after hospital discharge. At least 3 weeks after hospital discharge, the participant’s current GP’s medication record and their self-described medication regime was obtained. Discrepancies between their GP medication record and their discharge letter and between the participant’s self-described medication regime and their discharge letter were counted. The number of discrepancies (relative to the number of drugs pre- scribed) in the intervention group was compared with the control group for each of the above two categories, using the chi-squared test to determine the statistical significance of any differences between the two groups. Results: The intervention group had statistically fewer discrepancies than the control group for both data sets: GP records compared with the discharge letters (P < 0.0005); participants’ self-described medication regimes compared with the discharge letters (P < 0.00005). Conclusions: Sending a copy of patients’ discharge letters to their community pharmacists could be beneficial in reducing post-discharge prescribing discrepancies and improving patient understanding of the changes made to their medicines.

Community pharmacists' perceptions of barriers to communication with migrants.

Abstract: Objectives Effective communication by pharmacists is essential to ensure patient safety in terms of provision and use of medications by patients. Global migration trends mean community pharmacists increasingly encounter patients with a variety of first languages. The aim of this study was to explore community pharmacists' perceptions of communication barriers during the provision of care to A8 (nationals from central/Eastern European states) migrants. Methods A qualitative face-to-face interview study of purposively sampled community pharmacists, North East Scotland. Key findings Participants (n = 14) identified a number of barriers to providing optimal care to A8 migrants including: communication (information gathering and giving); confidentiality when using family/friends as translators; the impact of patient healthcare expectations on communication and the length of the consultation; and frustration with the process of the consultation. Conclusions Several barriers were specific to A8 migrants but most seemed pertinent to any group with limited English proficiency and reflect those found in studies of healthcare professionals caring for more traditional UK migrant populations. Further research is needed using objective outcome measures, such as consultation recordings, to measure the impact of these perceived barriers on pharmacist-patient consultations. Language and cultural barriers impact on the quality of pharmacist-patient communication and thus may have patient safety and pharmacist training implications.

Reducing medication errors in critical care patients: pharmacist key resources and relationship with medicines optimisation.

Abstract: Background Medication errors are the most common type of medical errors critical care patients experience. Critical care units utilise a variety of resources to reduce medication errors; it is unknown which resources or combinations thereof are most effective in improving medication safety. Objectives To obtain UK critical care pharmacist group consensus on the most important interventions/resources that reduce medication errors. To then classify units that participated in the PROTECTED UK study to investigate if there were significant differences in the reported pharmacist prescription intervention type, clinical impact and rates according to unit resource classification. Methods An e-Delphi process (three rounds) obtained pharmacist consensus on which interventions/resources were most important in the reduction of medication errors in critical care patients. The 21 units involved in the PROTECTED UK study (multicentre study of UK critical care pharmacist medicines interventions), were categorised as high-, medium- and low-resource units based on routine delivery of the final Top 5 interventions/ resources. High and low units were compared according to type, clinical impact and rate of medication interventions reported during the PROTECTED UK study. Key findings Consensus on the Top 5 combined medication error reduction resources was established: advanced-level clinical pharmacist embedded in critical care being ranked most important. Pharmacists working on units with high resources made significantly more clinically significant medicines optimisations compared to those on low-resourced units (OR 3.09; P = 0.035). Conclusions Critical care pharmacist group consensus on the most important medication error reduction resources was established. Pharmacists working on high-resourced units made more clinically significant medicines optimisations.

What can community pharmacy learn from the experiences of transition to practice for novice doctors and nurses? A narrative review.

Abstract: Objectives In the absence of literature reporting the transition experiences of novice community pharmacists, peer-reviewed evidence on the transition experiences of novice doctors and nurses was identified and reviewed. Specific objectives included identifying the challenges to transition and their perceived impact, before considering the implications for novice community pharmacists. Methods The electronic databases MEDLINE, EMBASE, CINAHL, PsycINFO and ScienceDirect were searched for full peer-reviewed original research papers published 1990-March 2015, reporting the transition experiences of novice doctors and nurses. A narrative review following coding of themes was undertaken to synthesise findings with transferability. Key findings Twenty-five papers using qualitative and quantitative methods were retrieved from nursing (18) and medicine (6). Challenges were categorised into three themes: personal experiences (where acquiring professional accountability, failing to meet expectations, and emotional, cognitive and physical demands of the job heightened stress), social experiences (where support and acceptance at work were hindered by organisational culture, hierarchy or interpersonal conflict) and challenges from job-related experiences (high workloads, task complexity, staffing, rotations and shift patterns). Challenging transitions were perceived by novice practitioners and their peers as impeding learning, impairing performance and having negative implications for patient care. Conclusions While some of these findings may be transferable to community pharmacy settings, contextual differences exist: relative isolation from professional peers, commercially driven private-sector settings, full and immediate acquisition of professional accountability and the lack of clinical career pathways or formalised support. Given these differences, is it appropriate that 'day-one' community pharmacists are fully and immediately accountable? Empirical research exploring transition to practice in the community pharmacy setting is needed.

Factors associated with self-medication in Spain: a cross-sectional study in different age groups.

Abstract: Objective The identification of factors which may influence a patient's decision to self-medicate. Methods Descriptive, cross-sectional study of the adult population (at least 16 years old), using data from the 2009 European Health Interview Survey in Spain, which included 22 188 subjects. Logistic regression models enabled us to estimate the effect of each analysed variable on self-medication. Key findings In total, 14 863 (67%) individuals reported using medication (prescribed and non-prescribed) and 3274 (22.0%) of them self-medicated. Using logistic regression and stratifying by age, four different models have been constructed. Our results include different variables in each of the models to explain self-medication, but the one that appears on all four models is education level. Age is the other important factor which influences self-medication. Self-medication is strongly associated with factors related to socio-demographic, such as sex, educational level or age, as well as several health factors such as long-standing illness or physical activity. Conclusions When our data are compared to those from previous Spanish surveys carried out in 2003 and 2006, we can conclude that self-medication is increasing in Spain.

Critical care pharmacy workforce: UK deployment and characteristics in 2015.

Abstract: Objective Clinical pharmacists reduce medication errors and optimize the use of medication in critically ill patients, although actual staffing level and deployment of UK pharmacists is unknown. The primary aim was to investigate the UK deployment of the clinical pharmacy workforce in critical care and compare this with published standards. Methods An electronic data entry tool was created and distributed for UK critical care pharmacy services to record their critical care workforce deployment data. Key findings Data were received for 279 critical care units in 171 organizations. Clinical pharmacist input was identified for 98.6% of critical care units. The median weekday pharmacist input to critical care was 0.045 whole time equivalents per Level 3 (ICU) bed with significant interregional variation. Weekend services were sparse. Pharmacists spent 24.5% of time on the multidisciplinary team ward round, 58.5% of time on independent patient review and 17% of time on other critical care professional support activities. There is significant variation in staffing levels when services are stratified by highest level of competence of critical care pharmacist within an organization (P = 0.03), with significant differences in time spent on the multi-disciplinary ward round (P = 0.010) and on other critical care activities (P = 0.009), but not on independent patient review. Conclusions Investment in pharmacy services is required to improve access to clinical pharmacy expertise at weekends, on MDT ward rounds and for other critical care activities.

Flourishing: positive emotion regulation strategies of pharmacy students

Abstract: OBJECTIVES The aim of this study was to investigate whether flourishing students use different emotion regulation strategies from moderately mentally healthy and languishing students. METHODS Registered pharmacy students (779) at the North-West University in South Africa completed the emotion regulation profile and Mental Health Continuum - Short Form. The data were analysed using a latent class analysis in Mplus 7.31. KEY FINDINGS Three latent classes were revealed comprising languishing (14.2%), moderately mentally healthy (47.5%) and flourishing students (38.3%). Students who flourished were more likely to use adaptive positive emotion regulation strategies (savouring the moment, behavioural display, capitalising). Students who languished were inclined to use maladaptive emotion regulation strategies (inattention, fault finding, external attribution). CONCLUSION Flourishing students increase or maintain their positive emotions and refrain from decreasing their positive emotions.

Waiter, there is a drug in my soup - using Leximancer® to explore antecedents to pro-environmental behaviours in the hospital pharmacy workplace.

Abstract: Objective/s The aim of this study was to explore Queensland hospital pharmacists’ and pharmacy technicians’ knowledge and understanding of the impact of pharmaceuticals on the environment, and the handling of pharmaceutical waste. Methods This study followed a mixed methods research design. Purposive sampling techniques were used to recruit 64 hospital pharmacists and pharmacy technicians working in five public and private hospitals, in metropolitan and regional Queensland, Australia. Both quantitative and qualitative data were collected. Qualitative data were analysed using both text analytics software and manual coding techniques. Descriptive statistics were used to present the quantitative data. Key Findings Lack of environmental knowledge regarding the impact of pharmaceuticals on the environment, and lack of understanding of systems thinking concepts (that all living things are part of the one environment or system, and therefore any negative impacts on the environment will ultimately have negative impacts on human health) were the key findings of this research. Interviewees expressed concern, but most expressed minimal personal concern, about the impact of pharmaceuticals entering the environment. Most interviewees were unsure as to best practice methods for the disposal of pharmaceutical waste, and by complying with hospital policy assumed appropriate disposal occurred. Conclusion Before the pharmacy profession can take up a leadership role in the more sustainable use of pharmaceuticals, pharmacists and pharmacy technicians require environmental information regarding the negative impacts of pharmaceuticals on the environment, and education on systems thinking to enable them to understand that any negative impacts on the environment will ultimately have negative impacts on human health.

An underutilised resource for Antimicrobial Stewardship: a 'snapshot' of the community pharmacists' role in delayed or 'wait and see' antibiotic prescribing

Abstract: Various strategies have been implemented in primary care to address the inappropriate use of antibiotics, with varying degrees of success. One such intervention is delayed or 'wait and see' prescribing, where the prescriber indicates to wait a few days before dispensing the antibiotic. The aim of this study was to explore community pharmacists' perceptions and practice experiences with delayed antibiotic prescribing. An online survey was advertised in two professional pharmacy organisations' e-newsletters for community and internship pharmacists in Queensland, Australia, from January to April 2016. We received 120 responses. 103 (86%) worked in a community pharmacy. Sixty per cent of the respondents would not dispense the delayed antibiotic prescription if a patient presented to the pharmacy within 24 h of seeing a doctor. Instead, they would advise the patient to wait and fill the prescription if they are not improving. The concept of delayed or a 'wait and see' antibiotic prescription was well received by the participating community pharmacists. These healthcare professionals are well placed to be effective stewards of antibiotics and can play an important role in collaboration with other healthcare professionals to optimise the quality use of antibiotics in primary care.

Polypharmacy and use of potentially inappropriate medications in long-term care facilities: does coordinated primary care make a difference?

Abstract: Objectives Polypharmacy is both common and harmful for frail residents of long-term care facilities (LTCF). We aimed to study rates of polypharmacy and potentially inappropriate medications (PIMs) before and after the implementation of a new model of coordinated primary care in LTCF, ‘Care by Design (CBD)’. Methods This was an observational before/after study in 10 LTCFs in Halifax, NS, Canada. Chart reviews were conducted for 529 LTCF residents for whom medication use was available. Both regularly scheduled and PRN medications were included but topical, inhaled and other non-systemic agents were excluded. Polypharmacy was defined as the concomitant use of more than 10 medications. PIMs were identified using Beers Criteria. Key findings Mean age of LTCF residents was older pre- versus post-CBD (85.7 versus 82.1 years; P = 0.0015). The burden of polypharmacy was high, but decreased significantly from 86.8% pre-CBD to 79.5% post-CBD (P = 0.046). The mean number of medications per resident decreased from 16.7 (SD 5.6) pre- to 15.5 (SD 6.2) post-CBD (P = 0.037). Residents with dementia were taking fewer medications both overall and following the implementation of CBD (mean 15.9, SD 0.6 pre-CBD versus 14.4, SD 0.4 post-CBD; P = 0.04). PIM rates were high and showed no change with CBD (86.2% versus 81.1%, P = 0.16). Conclusions Polypharmacy was the norm of this sample of LTCF residents. Implementation of coordinated care through the CBD model was associated with a small decrease in polypharmacy but not overall use of PIMs. Further targeted efforts are required to substantially reduce both polypharmacy and PIMs in clinical practice.

Antimicrobial use in a critical care unit: a prospective observational study.

Abstract: Objective The purpose of this study was to describe antimicrobial utilization, consumption, indications and microbial resistance in a medical-surgical-trauma intensive care unit (ICU) of a teaching hospital to identify potential targets for antimicrobial stewardship. Methods This was a 30-day prospective observational study enrolling adults admitted to the ICU for at least 24 h and having received antimicrobial therapy. Primary endpoints included utilization as percentage use of antimicrobials by class and agent, consumption measured as days of therapy per 1000 patient days (DOT/1000PD), indications for use and prescriber. Secondary endpoints included reasons for modifications to therapy and microbial resistance. Key findings Eighty-three patients were screened and 61 enrolled, receiving 133 courses of antimicrobial therapy, mainly intravenously and prescribed by ICU staff. The most frequently prescribed agents were piperacillin/tazobactam (20%), cefazolin (17%) and vancomycin (13%). The indications for therapy were empirical (50%), directed (27%) and prophylactic (23%). Overall consumption was 1368.54 DOT/1000PD and was mainly attributed to empirical therapy (734.25). Prolonged durations were noted for carbapenems and for surgical prophylaxis. There were 86 therapy modifications involving indication (36), efficacy (25), safety (18) and route (7). Suboptimal or excessive dosing were common contributors to efficacy and safety modifications, respectively. Infections due to microorganisms with notable resistance included methicillin-resistant Staphylococcus aureus (5), Pseudomonas aeruginosa (1) and Streptococcus pneumoniae (1). Conclusions Antimicrobial utilization and consumption based on DOT/1000PD were prospectively determined providing a comparator for other ICUs. Potential targets identified for antimicrobial stewardship initiatives include empirical therapy, treatment duration, dosing and route.

The impact of closed-loop electronic medication management on time to first dose: a comparative study between paper and digital hospital environments.

Abstract: Closed-loop electronic medication management systems (EMMS) are recognised as an effective intervention to improve medication safety, yet evidence of their effectiveness in hospitals is limited. Few studies have compared medication turnaround time for a closed-loop electronic versus paper-based medication management environment. Objective To compare medication turnaround times in a paper-based hospital environment with a digital hospital equipped with a closed-loop EMMS, consisting of computerised physician order entry, profiled automated dispensing cabinets packaged with unit dose medications and barcode medication administration. Method Data were collected during 2 weeks at three private hospital sites (one with closed-loop EMMS) within the same organisation network in Queensland, Australia. Time between scheduled and actual administration times was analysed for first dose of time-critical and non-critical medications located on the ward or sourced via pharmacy. Key findings Medication turnaround times at the EMMS site were less compared to the paper-based sites (median, IQR: 35 min, 8–57 min versus 120 min, 30–180 min, P < 0.001). For time-critical medications, 77% were administered within 60 min of scheduled time at the EMMS site versus 38% for the paper-based sites. Similar difference was observed for non-critical medications, 80% were administered within 60 min of their scheduled time at the EMMS site versus 41% at the paper-based facilities. Conclusion The study indicates medication turnaround times utilising a closed-loop EMMS are less compared to paper-based systems. This improvement may be attributable to increased accessibility of medications using automated dispensing cabinets and electronic medication administration records flagging tasks to nurses in real time.

Public risk perception of non-prescription medicines and information disclosure during consultations : a suitable target for intervention?

Abstract: This work was supported by the Chief Scientist Office, Scottish Executive Health Department (CZH/4/376). The views expressed in this paper are those of the authors and may not represent the views of the funding organisation.