Showing papers in "Pharmacy World & Science in 2008"

The knowledge and attitude of the Turkish community pharmacists toward pharmacovigilance in the Kadikoy district of Istanbul

Abstract: Objective We investigated the knowledge and attitudes of community pharmacists towards pharmacovigilance and adverse drug reactions (ADRs) in Kadikoy district of Istanbul (Turkey). Setting The community pharmacies in Kadikoy. Kadikoy is one of the biggest districts of Istanbul and has the largest number of pharmacies. Kadikoy district was divided into two regions, the central and the peripheral. Method Between December 2005 and June 2006 we conducted a survey about the knowledge and attitude of community pharmacists (n = 219) using a face-to-face questionnaire. The questionnaire consisted of questions about the sociodemographic characteristics of the pharmacists, their knowledge of pharmacovigilance and their attitudes towards ADR reporting. Main outcomes measured The knowledge of pharmacovigilance practice, ADR reporting compliance rates, reasons for not reporting ADR and perceptions of the Turkish community pharmacists on pharmacovigilance practice were evaluated. Results Although all 411 pharmacies in the Kadikoy district were visited, only 53% of the community pharmacists (n = 219) consented to participate in the study. Of those that did respond, only 17.2% of the pharmacists had any knowledge about ‘pharmacovigilance’. Sixty-five percent of the pharmacists stated that patients reported an ADR to them during the previous 12 months, and 21% of pharmacists reported to the concerned organizations. Our survey showed that only 7% actually reported an ADR to the national pharmacovigilance center. On the other hand, 89% of the pharmacists believed that the role of the pharmacist in ADR reporting was essential. Conclusion The results show that Turkish community pharmacists have poor knowledge about pharmacovigilance. There is an urgent need for educational programs to train them about pharmacovigilance and ADR reporting.

Evaluation of frequently used drug interaction screening programs.

Abstract: Objective Drug-drug interaction (DDI) screening programs are an important tool to check prescriptions of multiple drugs. The objective of the current study was to critically appraise several DDI screening programs. Methods A DDI screening program had to fulfil minimal requirements (information on effect, severity rating, clinical management, mechanism and literature) to be included into the final evaluation. The 100 most frequently used drugs in the State Hospital of Baden, Switzerland, were used to test the comprehensiveness of the programs. Qualitative criteria were used for the assessment of the DDI monographs. In a precision analysis, 30 drugs with and 30 drugs without DDIs of clinical importance were tested. In addition, 16 medical patient profiles were checked for DDIs, using Stockley’s Drug Interactions as a reference. Main outcome measure Suitability of DDI screening program (quality of monographs, comprehensiveness of drug list, statistical evaluation). Results Out of nine programs included, the following four fulfilled the above mentioned criteria: Drug Interaction Facts, Drug-Reax, Lexi-Interact and Pharmavista. Drug Interaction Facts contained the smallest number of drugs and was therefore the least qualified program. Lexi-Interact condenses many DDIs into one group, resulting in less specific information. Pharmavista and Drug-Reax offer excellent DDI monographs. In the precision analysis, Lexi-Interact showed the best sensitivity (1.00), followed by Drug-Reax and Pharmavista (0.83 each) and Drug Interaction Facts (0.63). The analysis of patient profiles revealed that out of 157 DDIs found by all programs, only 18 (11%) were detected by all of them. No program found more than 50% of the total number of DDIs. A further evaluation using Stockley’s Drug interactions as the gold standard revealed that Pharmavista achieved a sensitivity of 0.86 (vs Drug Interaction Facts, Lexi-Interact and Drug-Reax with a sensitivity of 0.71 each) and a positive predictive value of 0.67. Conclusion None of the four DDI screening programs tested is ideal, every program has its strengths and weaknesses, which are important to know. Pharmavista offers the highest sensitivity of the programs evaluated with a specificity and positive predictive value in an acceptable range.

Adherence to anti-diabetic drug therapy and self management practices among type-2 diabetics in Nigeria.

Abstract: Objective To describe the pattern of anti-diabetic drug prescribing; ascertain the level of glycemic control, adherence with prescribed anti-diabetic medications, and diabetes self management practices among patients with type-2 diabetes in a tertiary care setting in Nigeria. Setting University College Hospital (UCH); a 900 bed teaching hospital with medical residents located in Ibadan, southwestern Nigeria. Method The study consisted of two phases. A cross-sectional review of randomly selected 200 case notes of type 2 diabetic patients that attended the Endocrinology clinic over 3 month; and crosssectional interviews, with a pre-tested Adherence and Self-Management Monitoring Tool (ASMMT), of 200 consecutive patients that presented their drug prescriptions at the satellite pharmacy unit over a 4 week period at a 900-bed teaching hospital located in Ibadan, South-Western Nigeria. Results Oral Hypoglycemic Agents (OHA) were prescribed for 86% (171) of cohorts while insulin and OHA was prescribed in 14% (29). About 70.8% (121) of patients on OHA were on combination therapy. The most frequently prescribed OHA combination was glibenclamide and metformin (95.8%). Glibenclamide was prescribed as twice daily regimen in 69% of cohorts. The most frequently documented side effect was hypoglycemia (60.3%). Only 44% (88) of cohorts had adequate glycemic control; of these, 93% (82) were adjudged adherent with prescribed anti-diabetic drugs. Interviews with the structured ASMMT revealed that 59% of patients were non-adherent with the previous anti-diabetic drugs due to lack of finance (51.7%); side effects (34.5%); perceived inefficacy of prescribed anti-diabetic drugs leading to self-medication with local herbs (13.8%). Only 20% of non-adherent patients claimed disclosure to physicians during consultation. The identified factors for non-disclosure were lack of privacy during consultation (58%); and short consultation time (42%). The knowledge and practice of critical components of diabetes self-management behaviours were generally low among the cohort studied. However, it was significantly higher among patient judged adherent with their prescribed anti-diabetic medications (P < 0.05). Conclusion Majority of patients with type 2 diabetes in an ambulatory tertiary care setting in Nigeria are managed with OHA combinations, mainly glibenclamide and metformin. While the current prescribing strategy achieved glycemic control in about one third of patients, majority are still not meeting the recommended blood glucose targets due to poor adherence with prescribed drug regimen, and poor knowledge and practice of successful self-management.

Analysis and quantification of self-medication patterns of customers in community pharmacies in southern Chile.

Abstract: Background Self-medication refers to using drugs which have not been prescribed, recommended or controlled by a licensed health care specialist. Marketing, in Chile only admitted for over-the-counter medications, influences the practice of self-medication and extends it to prescription drugs. Thus, a complex self-medication process is started, due to reuse of a previous prescription, using drugs purchased directly at the pharmacy or drugs coming from family first-aid kits. The purpose of this study is to determine the frequency of self-medication, the type of medications involved, the dosages used, and the reasons for this practice. Methods An observation-based cross-sectional study was carried out at three pharmacies belonging to a pharmacy chain in the city of Valdivia (southern Chile). In addition, a previously validated form was used. Customers who requested over-the-counter medications were surveyed to identify the patterns that foster the self-medication practice. Results Of 909 surveyed customers, 75% self-medicate. Of these, 31% stated that they commonly self-medicate due to suffering from light symptoms, such as headaches (19%), the common cold (8.8%), sore muscles (6.7%), and bone pains (5.3%). The group of medications most requested in this study was nonsteroidal anti-inflammatory drugs (NSAIDs) (33%), with diclofenac sodium being the most used (14%). Influence from other people did not exceed 20% and reusing prior prescriptions reached 46%. There were significant differences when assessing consumer knowledge, reading of information leaflets, and opinions about self-medication at each surveyed pharmacy (P < 0.001). Conclusion Most consumers at the surveyed pharmacies use medications without proper knowledge of their benefits, treatment method, and duration. Drug dispensing at community pharmacies should include active pharmacist involvement to divulge the sensible use of drugs.

Community pharmacists' attitudes towards medicines use reviews and factors affecting the numbers performed.

Abstract: Objective of the study Medicines use review and prescription intervention (‘MUR services’) is the first advanced service within the NHS community pharmacy contract and is a structured review that is undertaken by a pharmacists with patients on multiple medicines. The objective of this study was to investigate factors that influence the number of Medicines use reviews (MURs) performed by community pharmacists and to explore community pharmacists’ attitudes towards the service. Setting This study was conducted with pharmacists who were employed by one UK community pharmacy chain. Method A questionnaire was developed to investigate factors that influence the number of MURs performed and pharmacists’ attitudes towards MURs. It consisted of a series of attitudinal statements together with brief demographic data. Questionnaires were distributed to a sample of 280 pharmacists accredited to provide the service during April and May 2006. Main outcome measure Factors affecting the number of MURs performed and community pharmacists’ attitudes towards MURs. Results Sixty per cent (167/280) of pharmacists returned a completed questionnaire. Twenty-seven per cent of respondents had not performed any MURs, 43% had conducted one to 14 reviews and 31% had conducted 15 or more. Job title affected the number of reviews performed; respondents categorised as ‘Store based’ pharmacists performed significantly more MURs than those working as ‘Locums’ but not significantly more than ‘Managing’ pharmacists. Pharmacists reporting access to an accredited consultation area performed significantly more MURs than those who did not. Those working more than 20 h per week performed significantly more MURs than those working less. Gender, time since qualification, the pharmacy size and those having or currently undertaking a clinical diploma were not found to be associated with the number of MURs performed. Most respondents reported that MURs were an opportunity for pharmacist to use their professional skills in an extended role and patients would benefit from the service. However they reported concerns about GPs opinion of the service, lack of time and support staff to conduct MURs and were unhappy about consultation areas. Conclusion This study demonstrates that pharmacists perceive MURs to be an opportunity for an extended role and of value to patients. However, this study has identified perceived barriers, including the availability of a consultation area suitable for performing MURs, time to perform MURs and support staff. The number of MURs performed by pharmacists appears to be affected by the pharmacists’ job title, their working hours and the presence of a consultation area. Additional support for ‘locum’ pharmacists was also highlighted and may be needed.

Societal perspectives on the role of community pharmacists and over-the-counter drugs in Jordan

Abstract: Objective The aim of this study is to investigate the Jordanian population’s attitudes towards the role of community pharmacist and their use of and their perceptions of OTC drugs. Setting The interviews were carried out in four urban centers in Jordan with the target sample being 1,000 members of the general public. Method This project used the survey methodology administered by structured interviews to general public in four main urban centers in Jordan. The target sample was 1,000. The questionnaire was divided into four sections that measured the knowledge, attitude and practice of the Jordanian population regarding the use of community pharmacy services and OTC drugs. Main outcome measure Perceptions on the professional role of the community pharmacist and the use of OTC drugs as expressed by a sample of the general public in Jordan. Results A total of 1,085 members of the public were interviewed. Proximity to home was the main reason to visit the same pharmacy (26.2%). More than half of the interviewed sample (56.8%) stated that they would always follow the directions on the packet of the OTC product. Males were more likely to increase the dose of the preparation if it did not work within the recommended period of time, while females were more likely to decrease the dose or stop the product (P < 0.05). More than 60% of participants mentioned that they bought antimicrobials from pharmacies without prescriptions. The majority of participants (62.7%) reported that they would seek advice from a pharmacist when the condition was not serious enough to visit the doctor. Conclusions The public in Jordan think highly of the pharmacy profession despite their confusion and uncontrolled consumption of OTC drugs. The findings of this study indicate that drug authorizing bodies in Jordan must be more proactive in promoting appropriate self-medication use and improving pharmaceutical services.

Exploring patients’ perspectives of pharmacist supplementary prescribing in Scotland

Abstract: Aim The aim of this study was to explore patients’ perspectives and experiences of pharmacist supplementary prescribing (SP) in Scotland. Method A survey in primary and secondary care in Scotland. Pharmacist supplementary prescribers (n = 10) were purposively selected across Scotland. All pharmacists distributed questionnaires to 20 consecutive patients as they attended appointments during October to December 2006. Reminders were mailed to all 20 patients by each pharmacist 2 weeks after initial distribution. Main outcome measures The questionnaire contained items on: attitudes towards pharmacist SP derived from earlier qualitative research; consultation satisfaction derived from a validated scale developed initially for general practitioners, with the term ‘doctor’ being replaced by ‘pharmacist prescriber’; and demographics. Closed and Likert scales were used as response options. Results One pharmacist withdrew. The patient response rate was 57.2% (103/180). The median age was 67 years (interquartile range 56.5–73 years), with 53.4% being female. Most (76, 73.8%) consulted with the pharmacist in a general practice setting. Patients reported positive consultation experiences with 89.3% agreeing/strongly agreeing that they were satisfied with the consultation, 78.7% thought the pharmacist told them everything about their treatment and 72.9% felt the pharmacist was interested in them as a person. Most patients were positive in their attitudes, agreeing that they would recommend a pharmacist prescriber to others and that they had trust in the pharmacist. However, 65% would prefer to consult a doctor. Conclusion Most patient respondents were satisfied with, and had a positive attitude towards, pharmacist prescribing consultations. However, most patients would still elect to see a doctor given the choice.

Off-label drug use among hospitalised children: identifying areas with the highest need for research.

Abstract: Objective of the study To analyse the off-label use of drugs on a paediatric ward in Germany, and to identify domains of pharmacotherapy with the highest need for research concerning off-label use in children. Setting A prospective observational study was conducted on a paediatric ward in Duesseldorf in Germany between January and June 2006. Method Data about patients, diagnoses and prescribed drugs were collected from the prescription records and the discharge letters. Diagnoses were classified in groups by means of the International Classification of Diseases. Drugs were grouped according to the Anatomical Therapeutic Chemical Classification system. We compared the off-label prescriptions with those on the list of paediatric needs and priority list established by the European Medicines Agency (EMEA). Main outcome measure Off-label use was defined due to age, indication, route of application and dose. Results The study included 417 patients. We analysed 1,812 prescriptions representing 211 different drugs. In total, 253 patients (61%) received at least one off-label prescription. Of all analysed prescriptions, 553 (31%) were off-label. The percentage of off-label prescriptions among the five most frequently prescribed drug groups were as follows: 60% cardiovascular drugs (CV: 129/216), 42% anti-infectives (AI: 190/449), 30% drugs for respiratory system (RS: 100/335), 25% drugs for alimentary tract and metabolism (AM: 67/269) and 3% analgesics and antipyretics (AA: 8/264); with 17 drugs, the cardiovascular drugs also showed the highest number of different off-label prescribed drugs due to age: AI: 14; AM: 11; RS: 5; AA: 1. In addition, there was a nearly complete overlap between the identified off-label prescriptions in cardiovascular drugs and those listed by the EMEA to be prioritized for urgent research in Europe. ConclusionCardiovascular drugs are a domain of pharmacotherapy, with a large need for research in paediatrics. The results of our study can guide the researcher to future trials on off-label prescriptions such as cardiovascular drugs, especially due to the fact that the identified off-label prescribed drugs in this group are also mentioned by the EMEA to be prioritized for paediatric research.

Drug-related problems: evaluation of a classification system in the daily practice of a Swiss University Hospital

Abstract: Aim To evaluate the Pharmaceutical Care Network Europe (PCNE) classification system as a tool for documenting the impact of a hospital clinical pharmacology service. Setting Two medical wards comprising totally 85 beds in a university hospital. Main outcome measure Number of events classified with the PCNE-system, their acceptance by the medical staff and cost implications. Methods Clinical pharmacy review of pharmacotherapy on ward rounds and from case notes were documented, and identified drug-related problems (DRPs) were classified using the PCNE system version 5.00. Results During 70 observation days 216 interventions were registered of which 213 (98.6%) could be classified: 128 (60.1%) were detected by reviewing the case notes, 33 (15.5%) on ward rounds, 32 (15.0%) by direct reporting to the clinical pharmacist (CP), and 20 (9.4%) on non-formulary prescriptions. Of 148 suggested interventions by the CP 123 (83.0%) were approved by the responsible physician, 12 ADR reports (8.1%) were submitted to the local pharmacovigilance centre and 31 (20.9%) specific information given without further need for action. An evaluation of the DRPs showed that direct drug costs of €2,058 within the study period or €10,731 per year could be avoided. Conclusion We consider the PCNE system to be a practical tool in the hospital setting, which demonstrates the values of a clinical pharmacy service in terms of identifying and reducing DRPs and also has the potential to reduce prescribing costs.

Returned medicines in community pharmacies of Barcelona, Spain.

Abstract: Objective To monitor the amount of unused drugs and the cost to the public health system. Setting A random sample of community pharmacies in Barcelona, Spain. Method The drugs were collected from 38 community pharmacies over a period of 7 consecutive working days (excluding Sundays). A questionnaire was designed to evaluate each returned medicine. The resulting data were analyzed and evaluated. Main outcome measure The number of drugs collected at the pharmacy, the characteristics of the clients and the reasons why they returned the drugs, and finally the economic value of the drugs returned and the cost to the public health system. Results A total of 227 clients (54.6% women, 64 ± 20 years-old) returned 1,176 packages to the pharmacy. The number of packages collected in one return ranged from 1 to 121. The number of packages collected per pharmacy ranged from 0 to 188. In more than half of the cases (52.4%) the patients returned their drug in person and in 32.2% of the cases a relative returned it on their behalf. The main reason (28.2%) why drugs were returned was the expiry date. In 24.9% of the cases the patient's condition had improved and there was no further need for the drug. In 20.8% the patient had died. The estimated total cost of the collected drugs was €8,539.9. Over 75% of this amount (€6,463.9) had been paid by the public health system. Conclusion This study confirms the importance of analyzing the return of unwanted medicines to reduce unnecessary health expenditure. It also highlights the inadequacies of the Spanish health system in the areas of prescription, dispensing and use of medicines. Establishing strategies to reduce the wastage of unused medicines is necessary.

Barriers to pharmaceutical care in Argentina

Abstract: Objective To identify the perceived barriers to implementing pharmaceutical care in Argentina. Method A semi-structured questionnaire was designed to carry out a cross-sectional descriptive study. The questionnaires were distributed in different continuing professional development events for pharmacists during November–December 2005. Results Ninety completed questionnaires were collected with the following distribution: 16.7% at the national congress of hospital pharmacy, 18.9% after a conference, 64.4% during two courses related to pharmaceutical care. The surveyed pharmacists work for community pharmacies (76.7%), hospital/institutional pharmacies (20.0%) and primary care centers (2.2%). The most important barriers mentioned were lack of time, lack of specific training and lack of communication skills. Conclusion The opinions of Argentinian pharmacists from different places and professional practice settings were obtained. In all work settings, “lack of time” is the main barrier to overcome for implementing pharmaceutical care.

People's views on the level of agreement of generic medicines for different illnesses.

Abstract: Objectives The present study aims to investigate (1) what is the influence of illness labels (flu, asthma and angina pectoris) upon the level of agreement with the prescription of generic medicines, and (2) the influence of socio-demographic factors on lay beliefs about generic medicines, in general, and for different illness labels. Method This was a cross-sectional design in which the participants were Portuguese, men and women, aged over 18 years old, and recruited from the general population (non-patients). The participants completed an anonymous self-administered questionnaire which included measures of lay beliefs about generic medicines in general (GMS), level of agreement with the prescription of a generic medicines for different illnesses, and socio-demographic factors. Main outcome measure Level of agreement with the use of generic medicines for flu, asthma and angina pectoris. Results Participants seemed to have well-defined beliefs about generics concerning their efficacy and similarity with brand medicines. Beliefs about the efficacy of generic medicines were significantly different according to the three age groups (18–25 years, mean = 3.84 (0.56); 26–37 years, mean = 3.80 (0.61); >38 years, mean = 3.72 (0.66); F = 4.4; P = 0.01), and level of education attained (9 years, mean = 3.60 (0.69); 12 years, mean = 3.78 (0.57); graduate, mean = 3.93 (0.54); F = 32.2; P = 0.000). Although participants have a moderate level of agreement with the prescription of generic medicines for the three different illnesses, their agreement significantly decreased when the illness was perceived as more serious. The lay beliefs about generics seemed to moderate the level of agreement with the prescription of a generic medicine. Conclusions Lay beliefs about generic medicines may influence the level of agreement with the prescription of a generic medicine in a general population sample. These results raise important questions concerning the need to consider illness perceptions of lay people and their relationship with perceptions of treatment for different conditions.

Attitudes of pharmacy students toward people with mental disorders, a six country study.

Abstract: Objective To compare and contrast the extent to which pharmacy students in Australia, Belgium, Finland, India, Estonia and Latvia hold stigmatising attitudes toward people with schizophrenia and severe depression. Method Data were collected as part of the International Pharmacy Students Health Survey, a census survey of third-year pharmacy students studying at eight universities in six countries. Respondents (n = 642) indicated how strongly they endorsed six stigmatising statements about patients with schizophrenia and severe depression. Coded data were analysed using the Statistical Package for the Social Sciences (Version 14.0). Results Between 52.5% (95% CI 46.2–58.9%) of students in Australia and 65.1% (95% CI 56.9–73.3) in Finland agreed that people with schizophrenia are a danger to others. Between 30.3% (95% CI 24.5–36.1%) of students in Australia and 60.0% (95% CI 48.5–71.5) in Estonia and Latvia agreed that people with schizophrenia are difficult to talk to. Between 9.8% (95% CI 4.0–15.6%) of students in Belgium and 43.8% (95% CI 35.3–52.3%) in Finland agreed that people with severe depression have themselves to blame. Conclusion Sub-optimal attitudes toward people with schizophrenia and severe depression were common among pharmacy students in all countries. New models of pharmacy education are required to address the attitudes and misconceptions among pharmacy students.

Medication persistence among patients with asthma/COPD drugs

Abstract: Objective To determine medication possession ratio (MPR) of patients with asthma/COPD drugs. Method Individual patient’s volumes of asthma/COPD drugs (ATC-code R03) for 2000–2004 were obtained from a pharmacy record database. For each patient the MPR was calculated as the percentage of the treatment time that the patient had drugs available. Main outcome measure Medication possession ratio (MPR). Results A total of 1,812 patients, 20 years and older, with dispensed asthma/COPD drugs were registered in the database, 928 patients (51%) had acquired drugs less than once per year (68% for 20–29 years old) during the 5-year study. Only 13% of the patients had steroids and steroid combinations available to allow continuous treatment. Eight percent of the patients 20–29 years old had MPR ≥ 80% of all the included drugs and 5% when only steroids and steroid combinations were considered. About 25% of the patients had acquired 80% of the total volume of asthma/COPD drugs. Conclusion The majority of the patients, and particularly those in the youngest age group used asthma/COPD drugs only sporadically. This may indicate undermedication which is likely to have a negative impact on patient outcome.

Clinical outcomes from the use of Medication Report when elderly patients are discharged from hospital

Abstract: Objective The objective of this study was to investigate whether a Medication Report also can reduce the number of patients with clinical outcomes due to medication errors. Method A prospective intervention study with retrospective controls on patients at three departments at Lund University Hospital, Sweden that where transferred to primary care. The intervention group, where patients received a Medication Report at discharge, was compared with a control group with patients of the same age, who were not given a Medication Report when discharged from the same ward one year earlier. For patients with at least one medication error all contacts with hospital or primary care within 3 months after discharge were identified. For each contact it was evaluated whether this was caused by the medication error. We also compared medication errors that have been evaluated as high or moderate clinical risk with medication errors without clinical risk. Main outcome measures Need for medical care in hospital or primary care within three months after discharge from hospital. Medical care is readmission to hospital as well as visits of study population to primary and out-patient secondary health care. Results The use of Medication Report reduced the need for medical care due to medication errors. Of the patients with Medication Report 11 out of 248 (4.4%) needed medical care because of medication errors compared with 16 out of 179 (8.9%) of patients without Medication Report (p = 0.049). The use of a Medication Report significantly reduced the risk of any consequences due to medication errors, p = 0.0052. These consequences included probable and possible care due to medication error as well as administrative procedures (corrections) made by physicians in hospital or primary care. Conclusions The Medication Report seems to be an effective tool to decrease adverse clinical consequences when elderly patients are discharged from hospital care.

Polypharmacy in elderly hospitalised patients in Slovakia

Abstract: Objective The aims of the present study were to: analyse the prevalence of polypharmacy in a group of older patients; evaluate the influence of hospital stay on the number of drugs taken; assess the most frequently prescribed pharmacological classes; identify risk factors that predisposed the patient to polypharmacy. Setting The study was carried out in the Department of Internal Medicine of a non-university general hospital. Method In the retrospective study, 600 patients aged 65 years or more were enrolled. They were hospitalised in the period from 1st December 2003 to 31st March 2005. Each person taking six or more medications per day was considered to be a patient with polypharmacy. Particular sociodemographic and clinical characteristics, as well as comorbid conditions, were evaluated as factors potentially influencing the prevalence of polypharmacy. Main outcome measure The number and type of medications taken at the time of hospital admission and discharge were recorded and compared for each patient. Results Polypharmacy on admission and at discharge was observed in 362 (60.3%) and 374 (62.3%) patients, respectively. Hospitalisation led to a significant increase in the number of medications. The spectrum of medications used corresponded to the proportions of diagnoses in the evaluated group, in which cardiovascular diseases were most prevalent. According to the multivariate analysis using a logistic regression model, diabetes mellitus (odds ratio (OR) 2.40; 95% confidence interval (CI): 1.64–3.50), heart failure (OR 2.14; 95% CI: 1.46–3.14), dementia (OR 2.12; 95% CI: 1.26–3.57), living alone (OR 2.00; 95% CI: 1.28–3.10), arterial hypertension (OR 1.63; 95% CI: 1.08–2.44) and cerebrovascular disease (OR 1.58; 95% CI: 1.03–2.44) significantly increased the risk of the presence of polypharmacy. Conclusion Our study confirmed a relatively high prevalence of polypharmacy in Slovak elderly patients. Polypharmacy risk rose especially with the increased prevalence of diseases of advancing age (diabetes mellitus, heart failure, arterial hypertension, dementia and cerebrovascular diseases). The increasing numbers of medications in inpatients indicate the need for the careful re-evaluation of pharmacotherapy during the stay in hospital.

Minimising treatment-associated risks in systemic cancer therapy

Abstract: Aim of the review To review the consequences of drug-related problems (DRP) in systemic cancer therapy and identify specific contributions of the pharmacist to minimise treatment-associated risks. Method Searches in PubMed, Embase and the Cochrane Library were conducted. Bibliographies of retrieved articles were examined for additional references. Only papers in English between 1980 and 2007 were included. Results In systemic cancer therapy there is an enormous potential for DRP due to the high toxicity and the complexity of most therapeutic regimens. The most frequently reported DRP can be classified into adverse effects, drug–drug interactions, medication errors, and non-adherence. Pharmacists have enhanced efforts to assure quality and safety in systemic cancer therapy together with other health care providers. In consequence, oncology pharmacy has evolved as a novel specialist discipline. The endeavour to merge and co-ordinate individual activities and services of the pharmacist has led to pharmaceutical care concepts which aim at offering novel solutions to the various DRP. Conclusion Pharmaceutical care for cancer patients should be developed within research projects and integrated into disease management programs in order to ensure broad implementation.

Adverse-drug-reaction related admissions to a hospital in Scotland.

Abstract: Aims To apply established methods to identify ADR-related admissions and to determine the proportion which was preventable and which were caused by non-prescription medicines (NPMs). Methods This prospective, observational study screened all acute hospital admissions (n = 1,101) by ward pharmacists over a 2-week period. Suspected ADR-related admissions were reported to the researcher and established criteria were used to evaluate probability, causality and preventability of the ADR-related admissions. Results Of the 1,101 emergency admissions which occurred during the study period, 30 were categorised as ADR-related, equating to a prevalence of 2.7% (95% CI, 1.8–3.7%). Three (9.7%) of the 30 admissions were associated with NPMs. The ADR was the dominant reason for admission in 56.7% (n = 17/30) and only 13.3% (n = 4/30) of all reported admissions were assessed as unavoidable. Conclusion The proportion of ADR-related admissions was lower than in previous studies in the UK. A substantial proportion of ADRs was associated with NPMs, highlighting the need for greater awareness amongst patients, prescribers and other health care professionals regarding possible serious adverse effects caused by these medicines.

A discussion paper on self-care and its implications for pharmacists

Abstract: Self-care is what people do to themselves to establish and maintain health, prevent and deal with illness. It includes nutrition, lifestyle, self-medication, hygiene, socio-economic and environmental factors. Self-care has been with us for thousands of years, but today there is an opportunity for pharmacists to assist patients with self-care. Society is better educated than ever before and now has access to accurate, understandable and objective, up-to-date information about drug therapies. Moreover, there is a general trend to take back control from physicians and other care-givers, and for patients to make decisions about their own care. Additional drugs are becoming available OTC and some information may require professional interpretation. On a parallel plane, the pharmacist is being recognized as a trustworthy source of information and advice. When these trends interact, there becomes a golden opportunity for pharmacists to demonstrate their worth to their patients. This report provides the perspectives from numerous sources as to the future role of the pharmacist in self-care.

Overcoming obstacles for adherence to phosphate binding medication in dialysis patients: a qualitative study.

Abstract: Objective The aim of this study was to explore obstacles to adherence to phosphate binding medication and to describe the measures taken by dialysis patients to overcome these obstacles. Setting A Swedish renal unit. Method Ten patients undergoing dialysis were interviewed. The interviews were semi-structured and were analysed according to qualitative content analysis. Main outcome measure Statements about barriers and the ways to overcome these. Results Non user-friendly drug compound, feeling of discomfort, forgetfulness, polypharmacy and patient ignorance were identified as obstacles to adherence to phosphate binding medication. Measures taken by the patients to handle obstacles were identified as using a dispensing aid, consuming extra water and exercising routines. Conclusion Dialysis patients identify obstacles that impede patient adherence to prescribed phosphate binding medication. The patients overcame most obstacles by self-management but not always in concordance with treatment requirements. Our findings imply that the ways the patient conquer each barrier need to be considered when strategies for self-management are promoted.

Medicine-taking behaviour and drug-related problems in adolescents of a Swedish high school.

Abstract: Objectives To examine (1) which over-the-counter (OTC) and prescription drugs adolescents most frequently use and for which ailments or diseases, and (2) which DRPs adolescents have experienced, as well as if and by whom these problems were resolved. Setting A high school in Helsingborg, Sweden. Methods A self-completion questionnaire was designed and used in students with a median age of 17 in late 2005 and early 2006. To enable students to identify DRPs they may have experienced, the questionnaire contained a list of DRPs in lay language. The questionnaires were distributed by the teachers to be completed by the students in the classroom. Main outcome measures: Self-reported prevalence of OTC and prescription drug use and experienced drug-related problems. Results A total of 245 students (99%) took part, 138 females and 107 males. OTCs had been used occasionally by 37.7% of the girls and 62.6% of the boys, while 10.9% and 6.5% respectively were daily users. Analgesics were the most frequently used OTCs. DRPs had been experienced by 31.1% of the female and 19.6% of the male students, the most common of which was therapy failure (too little or no effect), accounting for 46.5% of the girls’ and 38.1% of the boys’ OTC DRPs. Eighty-five percent of the problems with OTCs had been resolved, half of them by the teenagers themselves. Prescription drugs had been used occasionally by 31.9% of the female and 29.0% of the male students, while 28.3% and 26.2% respectively reported using such drugs on a daily basis. Antibiotics were the most frequently taken prescription drugs. DRPs related to prescribed drugs were reported by 32.6% of the girls and 10.3% of the boys. The most common DRPs were side effects, accounting for 34.8% of the girls’ problems, and therapy failure, experienced by 28.6% of the boys. All the boys’ DRPs were reported to be resolved, but only 75% of those of the girls. Physicians were stated to have resolved the problems in 41.4% of the cases. Conclusions There is a need to develop the interface between pharmacy practitioners and adolescents, as the study has demonstrated frequent use of OTCs and prescription drugs as well as a high prevalence of DRPs in adolescents. The reasons for therapy failure, which was the most common problem, should be further explored and measures taken by pharmacists and physicians to minimise it.

Pharmacist-initiated general practitioner referral of patients with suboptimal asthma management

Abstract: Objective To assess the impact of an intervention initiated by community pharmacists, involving the provision of educational material and general practitioner (GP) referral, on asthma knowledge and self-reported asthma control and asthma-related quality of life (QOL) in patients who may have suboptimal management of their asthma, as evidenced by pharmacy dispensing records. Setting Community pharmacies throughout Tasmania, Australia. Methods Forty-two pharmacies installed a software application that data mined dispensing records and generated a list of patients with suboptimal asthma management, as indicated by having three or more canisters of inhaled short-acting beta-2-agonists dispensed in the preceding 6 months. Identified patients were randomised to an intervention or control group. At baseline, intervention patients were mailed intervention packs consisting of a letter encouraging them to see their GP for a review, educational material, asthma knowledge, asthma control and asthma-related QOL questionnaires, and a letter with a dispensing history to give to their GP. Pharmacists were blinded to the control patients’ identities for 6 months, after which time intervention patients were sent repeat questionnaires, and control patients were sent intervention packs. Main outcome measures Asthma knowledge, asthma control and asthma-related QOL scores. Results Thirty-five pharmacies completed the study, providing 706 intervention and 427 control patients who were eligible to receive intervention packs. Intervention patients’ asthma control and asthma-related QOL scores at 6 months were significantly higher compared to the control patients (P < 0.01 and P < 0.05, respectively) and to the intervention patients’ baseline scores (P < 0.001 and P < 0.05, respectively). Symptom-related QOL was significantly higher compared to the control patients (P < 0.01) and activities-related QOL significantly improved compared to baseline (P < 0.05). No significant change was observed in asthma knowledge. Conclusion The results suggest that community pharmacists are ideally placed to identify patients with suboptimal asthma management and refer such patients for a review by their GP. This type of collaborative intervention can significantly improve self-reported asthma control and asthma-related QOL in patients identified as having suboptimal management of their asthma. A larger trial is needed to confirm the effects are real and sustained.

A system for monitoring quality standards in the provision of non-prescription medicines from Australian community pharmacies.

Abstract: There is a growing trend, globally, for consumers to self-medicate with non-prescription medications for common ailments. Pharmacists and pharmacy assistants are thought to be in a unique position to support consumers’ purchases of these medicines through the application of knowledge and skills, in an environment in which safety and quality remains paramount. Standards of practice have been developed by the profession to address the provision of these medicines, using a consumer-focused and risk management approach. The application of these standards has been monitored since 2002, by the Quality Care Pharmacy Support Centre (QCPSC), created as a joint venture between the University and the Pharmacy Guild of Australia. The establishment of the QCPSC has allowed the development of a system to monitor and improve the application of standards for the provision of non-prescription medicines to consumers in community pharmacies in Australia. This system is unique in two aspects. The first is the use of pseudo-patient methodology, also called “mystery shoppers”, “pseudo-customers” and “simulated patients”, for the purpose of both assessment and quality improvement. The second unique aspect is the capturing of data based on assessments of behaviour in practice environments. To date, the centre has conducted 14,738 standards maintenance assessment (SMA) visits, involving over 4,200 pharmacies across all states and territories in Australia. The data generated by such a system create a feedback mechanism for policy decision-making in the area of Quality Use of Medicines (QUM) for non-prescription medicines, which is of critical importance to the health and safety of consumers.

Exploring the supply of non-prescription medicines from community pharmacies in Scotland

Abstract: Objective The objectives of this study were to: (1) explore pharmacy support staff (PSS) opinions of and attitudes towards the supply of non-prescription medicines (NPMs); (2) assess whether NPM supply is compliant with professional and good practice guidelines. Methods This exploratory study was conducted in community pharmacies in Grampian, Scotland, and comprised non-participant observation of NPM consultations, semi-structured interviews with, and a questionnaire of, PSS. Guideline compliance was assessed by a consensus group of practising community pharmacists. Main outcome measures The percentage of consultations which achieved compliance with professional guidelines was calculated. A total score was also calculated for each consultation to assess compliance with good practice guidelines. Results Fifty-seven support staff from 21 pharmacies participated in at least one component of the study. In total, 195 observed consultations were evaluable. Fifty-four participants completed a questionnaire and 95 post-consultation interviews were completed. Most consultations involved product requests and were for self-treatment. Overall, interviewees were satisfied or very satisfied with 78 (83.0%) and 14 (14.9%) of all consultations, respectively. Participants’ self-reported scores for the quality of consultation were high indicating that they perceived their consultations to be appropriate. Most PSS were aware of good practice guidelines and thought their use was important/very important, yet few consultations were fully guideline compliant. Non-product consultations were more guideline compliant than product consultations. Just over one third (35.6%) of consultations established whether other medication was being used by the intended recipient of the NPM. Few PSS (21.2%) had read the professional guidelines and as such, compliance with these guidelines was extremely low. The percentage of guideline compliant consultations were 6.6% (n = 5) (sufficient information gathered), 13.2% (n = 10) (adequate advice/information provision), 46.1% (n = 35) (personal involvement of pharmacist), 21.1% (n = 16) (particular care of specific patient groups) and 28.9% (n = 22) (pharmacist involvement with specific NPMs). Conclusion Few consultations for NPMs in this study were fully guideline compliant. The reasons for non-compliance with good practice and professional guidelines need to be explored. Although failure to comply with professional guidelines could be due to PSS’s lack of awareness, this does not explain non-compliance with good practice guidelines.

Views, attitudes and self-assessed training needs of Scottish community pharmacists to public health practice and competence

Abstract: Objective To assess the education and training needs of community pharmacists to support the delivery of an expanded public health role. Setting Community pharmacy in Scotland. Method Two focus groups of community pharmacists (n = 4 in each) in geographically distinct regions of Scotland explored issues of public health function, competencies and education and training. Findings from thematic analysis were used to develop a draft postal questionnaire. Following piloting, pharmacist managers from a random sample of 500 community pharmacies in Scotland were contacted by telephone to ascertain the number of pharmacists working in each pharmacy in the following 14-day period. A survey pack containing questionnaires for each identified pharmacist working in the study period was sent by post to the pharmacist manager in each pharmacy. The questionnaire contained items on: demographics; views and attitudes towards: public health; competencies for public health practitioners; and education and training needs. One postal reminder was sent 2 weeks later. Main Outcome Measures Main themes identified from focus group discussions; questionnaire response rate; views and attitudes towards public health competencies and education and training. Results Four hundred and fifteen managers agreed to participate, providing 904 potential participants. The response rate was 25% (223/904). Most (n = 179, 80%) were aware of the term ‘pharmaceutical public health’. While a majority saw the importance of public health to their practice (n = 177, 79%) agreeing/strongly agreeing, they were less comfortable with the term ‘specialist’. Respondents viewed competencies relating to health promotion (n = 192, 86%) more relevant than surveillance (n = 70, 31%), risk management (n = 29, 13%) and strategic developments (n = 12, 5%). Responses indicated a desire for education and training with more than half (n = 121, 54%) agreeing/strongly agreeing that they had a need now, with 69% (n = 153) expressing a future need. Conclusion Results should be interpreted with caution due to the response rate. However, this research highlights the self assessed gap in competence related to pharmaceutical public health for community pharmacists in Scotland.

Addressing the workforce crisis: the professional aspirations of pharmacy students in Ghana.

Abstract: Objective A lack of skilled health professionals, and net migration from developing to more developed countries, are widely recognised as barriers to the delivery of effective health care. However, few studies have investigated this issue from the perspective of pharmacists, although they are increasingly viewed as a potentially valuable and underexploited health care resource. The objectives of this study were to examine the professional aspirations and perceived opportunities of final year pharmacy students in a developing country; and consider what developments may encourage them to remain in, and contribute to, health care in their home country. Method Final year pharmacy students from the Faculty of Pharmacy, KNUST, Kumasi, Ghana, were randomly selected and invited to participate in in-depth interviews. These were audio-recorded (with permission of respondents) and transcribed verbatim to enable a qualitative analysis. Main outcome measure: professional aspirations, and perceived opportunities and barriers to their achievement in Ghana and abroad. Results Participants viewed themselves, and wished to be viewed by others, as health professionals. They described a commitment to applying their clinical knowledge and to education beyond their first degree. However, they identified significant barriers to the achievement of professional aspirations in Ghana, which would diminish their opportunities to contribute to health care. Whilst most students expressed the expectation or desire to travel at some point, usually early, in their career, they all demonstrated a commitment to their country and stated a wish to return. Conclusion Overall the study highlighted prospective pharmacists in Ghana as ambitious, committed potential health professionals. The study indicates that a lack of attention by policy makers and professional bodies to ways of exploiting the contribution of pharmacists to public health, may represent a lost potential human resource for health in developing countries.

Influencing the use of antibiotics in a Chinese pediatric intensive care unit

Abstract: Objectives To demonstrate the effectiveness of an intervention in antibiotics prescribing, and evaluate the use of antibiotics in the pediatric intensive care unit (PICU) at the Beijing Children’s Hospital. Methods Our interventions included (1) educating the pediatricians on antibiotics prescribing, (2) applying an antimicrobial spectrum chart, and (3) controlling the prescription of specific antibiotics with the use of a guideline. Nine hundred clinical records, including clinical information and antibiotic usage data, were selected retrospectatively from the PICU admissions during the pre- and post-intervention periods. Results In this 5-year survey, the mean rate of antibiotic prescribing was greater than 95% in the PICU. More than 76% of the prescriptions were started empirically. The most frequently used antibiotics were third-generation cephalosporins. After the intervention, we found a reduction in the rate of antibiotic cost/patient/day (P < 0.05); a decrease in the prescription rate of third-generation cephalosporins and macrolides (P < 0.01); an increase in the prescription rate of β-lactam/β-lactamase inhibitors and second-generation cephalosporins (P < 0.01); a reduction in the empiric treatment (P < 0.01); and a significant reduction in the incidence rates of bacterial resistance for imipenem-, cefepime-, and ceftazidime-resistant Pseudomonas aeruginosa (P < 0.05), and cefepime-resistant Escherichia coli and Klebsiella pneumoniae (P < 0.01). Conclusion Our interventions led to a significant reduction of broad-spectrum antibiotic prescribing associated with the significant reduction in bacterial resistance in the PICU. The implementation of the antibiotics guideline appeared to be effective.

Post-discharge medication reviews for patients with heart failure: a pilot study

Abstract: Background Medication misadventure is greatest at times of change such as the transition from hospital to community. Patients with heart failure are prone to medication misadventure due to polypharmacy, inappropriate medication use and frequent readmissions. Objective To identify the barriers encountered when implementing a Liaison Pharmacist facilitated post-discharge medication management service for patients with heart failure. Method A Liaison Pharmacist contacted the patient’s General Practitioner (GP), sent them a medication discharge summary and organised an appointment for the patient with the GP approximately 2 days post-discharge to make a Home Medicines Review (HMR) referral. The patient’s community pharmacist was also contacted, sent a medication discharge summary and requested to engage an accredited pharmacist to undertake the HMR. The Liaison Pharmacist arranged for the HMR report to be sent to the outpatient department clinic to enable assessment of outcomes at the outpatient department follow-up 12 weeks post-discharge. Main outcome measure: GP HMR referral rates. Results 90 patients were offered the service. Fifty-nine patients (66%) agreed to have their GP contacted with 56 GPs agreeing to order a HMR and 41 patients having an HMR post-discharge. Barriers to the implementation of a HMR post-discharge included: patient withdrawal, low GP awareness of the HMR process and conducting the HMR in a timely manner. Conclusion This study provides evidence for the feasibility of a post-discharge pharmacy service for patients with heart failure although barriers to implementation have been identified.

Practical evaluation of the drug-related problem management process in Swiss community pharmacies.

Abstract: Objective To develop and evaluate a coding system integrated into pharmaceutical software to routinely report and assess the process of community pharmacists’ interventions related to medical prescriptions. Setting A convenient sample of 20 Swiss community pharmacies. Method Pharmacists documented their interventions concerning all drug-related problems (DRPs) related to medical prescriptions during four consecutive weeks in 2005. The coding system assesses each step of the DRP management process; that is, the type of problem, possible negative outcomes, pharmaceutical decisions, and individuals involved. In order to be comprehensive, the management process of technical problems related to prescriptions and clinical DRPs was analysed separately. Main outcome measure DRP intervention rate and characterization of each step of the process. Results Of 38,663 prescriptions, 287 clinical DRPs required interventions. This corresponds to a mean intervention rate of 0.77% per pharmacy (SD = 0.61%). There was a large variability among pharmacies (0–2.6%). Most of the clinical DRPs were associated with dosage problems (n = 91) and drug–drug interactions (n = 45). The most frequent potential negative outcomes reported were quantitative inefficacy (n = 101) and quantitative safety (n = 94). Two-thirds of clinical DRPs required a prescription modification (n = 186), the most frequent being a change in dosage or drug regimen. In 110 interventions (38%), physicians were immediately contacted to take part in the decision. In 122 interventions (43%), pharmacists managed the interventions alone. However, in 55 interventions (19%), pharmacists managed the DRPs with the patient. From these 287 clinical interventions, 134 different codes were reported. Seven hundred and thirty-six technical problems related to prescriptions required intervention, which corresponded to a mean intervention rate of 1.90% per pharmacy. The main type of problem was a discrepancy with the medication record (n = 208). There were 494 instances that required a prescription modification. Pharmacists resolved 45% of all technical problems by themselves. Conclusion The developed coding system could describe the management process for DRPs. The observed intervention rate and the frequency of steps involved were comparable to those previously observed for pharmacists’ interventions. Data regarding the entire process used to manage drug-related problems can be useful in improving medication safety, education, and collaborative care.

Social pharmacy strengthening clinical pharmacy: why pharmaceutical policy research is needed in Pakistan?

Abstract: Pakistan has a population of more than 160 million and is the sixth most populous country in the world. Drugs are the most common form of treatment modality; however, inappropriate use of medicines is a crucial issue in the country. In Pakistan, recently there is a surge of number of pharmacy schools, the pharmacy degree (B. Pharm) has been changed to Pharm D and there is a lot of rhetoric about "clinical pharmacy". However, whether this change has brought any significant improvement in drug use situation; it is still a moot question for academics and policy makers. Authors feel that before embarking upon on clinical pharmacy at an institutional level, it is important that basic pharmacy system should be in place. Thus, a strong culture in social pharmacy or pharmaceutical policy research will not only be helpful to establish clinical pharmacy practice, but it would also be supportive enough to provide manpower to the country's proposed drug regulatory authority.