An exploration of work‐related stress in Northern Ireland community pharmacy: a qualitative study

Objectives The aim of this study was, through qualitative methodology, to explore the factors which contribute to job‐related stress in community pharmacy in Northern Ireland. Methods All community pharmacists in Northern Ireland were invited to participate in one‐to‐one semi‐structured interviews. Interview schedules explored pharmacists' attitudes to job‐related stress and the situations that may contribute to stress. All interviews took place at participants' work sites between December 2007 and April 2008, were audio‐taped, transcribed verbatim, read independently by the authors and analysed using thematic analysis. Key findings Seventeen pharmacists participated in the interviews. The main themes that emerged in relation to job‐related stress were workplace issues, issues regarding professional expansion, recognition and responsibility, and a demanding public. Although there was general support for development in community pharmacy, this was tempered by concerns as to how expectations would be met and how all services would be delivered. Conclusions The themes that emerged from this work reflect what was reported from a survey conducted in 2007 and reinforce the tension between developments in practice and the ability to deliver. Developments in professional practice can be positive; however, commissioners and policy‐makers need to consider whether community pharmacists have the infrastructure in terms of environment, personnel and multi‐professional support to deliver what is required of them.     

Drug use and drug markets in the context of political conflict: The case of Northern Ireland

The focus of this article addresses drug use and drug markets in Northern Ireland against the backdrop of the most recent Irish political conflict, e.g., 1969 to the present. Between 1969 and 1999, a total of 3289 individuals had died and more than 40?000 were injured as a result of the Northern Ireland political conflict. Extrapolating the data to Britain, comparable figures would reflect 111?000 fatalities and over one million injured (Hayes and McAllister, 2000). This paper describes how the nature of the Northern Ireland political conflict contributed to low levels of drug use in the 1970s and 1980s. In 1994, the cessation of military operations by the Irish Republican Army (IRA) and subsequently by mainstream Loyalist organizations led to the possibility of widespread political and social change. Use of certain drugs, namely heroin, appeared to increase from the mid-1990s, although the effects of political conflict on drug use are less clear during the post-ceasefire era.     

Development of a community pharmacy-based model to identify and treat OTC drug abuse/misuse: a pilot study

OBJECTIVE: The aim of this study was to develop and pilot a harm-minimisation model for the identification and treatment of over-the-counter (OTC) drug abuse/misuse by community pharmacists. METHOD: Extensive consultation was conducted during the development of the model. This included an exploratory conference involving an interdisciplinary group of delegates and detailed individual consultation with a range of healthcare practitioners. Consultation with a psychologist specialising in communication skills allowed development of the communication aspects of the model. A comprehensive manual detailing the model was prepared. RESULTS: The model is designed to be used by community pharmacists in conjunction with other healthcare professionals. It focuses on the abuse/misuse of opioids, laxatives and antihistamines and can be broadly divided into three phases, namely: patient identification and recruitment, treatment/referrals and data collection/outcome measurement. Client identification is via record-keeping which is implemented alongside an information campaign promoting safe use of OTC medicines. Once identified, the pharmacist aims to recruit clients using the developed communication strategies. Treatment depends on whether the problem is misuse or abuse and on the product. Several treatment paths are available including treatment according to an agreed protocol and referring to the GP or community addiction team (CAT). Two pharmacists were recruited and trained to pilot the model. Of the clients, 18 were identified as abusing/misusing OTC products over a one-month period. The subject of inappropriate OTC use was raised with 14 of these clients. Some success was noted in that clients agreed to stop using the product and/or to try safer alternatives. As expected, some sales had to be refused, as the client was unwilling to accept the pharmacist's intervention. CONCLUSION: This study represents the first reported structured attempt by community pharmacists in the UK to address the abuse/misuse of OTC medication. Work is now ongoing to modify this model in light of the pilot study findings.     

Alcohol use,regular use,disorder and remission from use disorders in Northern Ireland: a prevalence study

Background: This study presents prevalence estimates and ages of onset for alcohol use, regular use, use disorders and remission from use disorders in Northern Ireland, and the time for transitioning between these stages.

Methods: Data on alcohol use, lifetime history, and remission from alcohol conditions as defined by the DSM-IV were collected using the Composite International Diagnostic Interview.

Results: By the age of 17 years 50% of the age cohort had started taking alcohol. By 19 years of age 67% of the cohort were regular users, and by 20 years of age 45% of the cohort were abusing alcohol. Remission from abuse/dependence was related to the number of years since commencing the use of alcohol, with women being more likely than men to move to remission sooner, and the cohort in which the person had commenced alcohol consumption also influenced the move to remission.

Conclusions: The consumption of alcohol is high within Northern Ireland with some 83% of the population consuming alcohol, and with over 90% of this group taking alcohol on a regular basis. The abuse of alcohol was particularly marked amongst students and males, with dependence showing a higher prevalence amongst those with the lowest level of educational attainment, and where the commencement of alcohol consumption was at an early age. Transitions between stages of lifetime alcohol use, regular use, and use disorders were associated with the early commencement of alcohol use, education, cohort use and being male.     

临床药师在临床合理用药中的价值分析

目的:分析临床药师在开展临床合理用药实践中的价值。方法:结合深入临床实践开展药学服务的具体内容,分析临床药师促进合理用药的价值。结果:临床药师为医师提供了合理用药的专业知识,加强了医师的药学知识积累,完善了临床药师的知识结构,为促进临床合理用药做出努力,体现了临床药师的价值。结论:临床药师对安全、有效、合理使用药物起到了有益的推进作用。     

PIVAS在临床应用中的效果分析

目的依托静脉药物配置中心（HVAS）工作平台,增强药师作用,提高合理用药水平。方法收集本院开展PIVAS前的2003年6、7月份和开展PIVAS后的2009年6、7月份门诊处方各1200张,每月600张,对其不合理用药类型、处方数、百分比等进行统计、对比分析。结果2003年6、7月份有不合理用药处方262张,比例为21．83％,2009年6、7月份有不合理用药处方68张,比例为5.67％,不合理用药处方明显减少。结论PIVAS的建立,加强了药师与临床的紧密联系,充分发挥了药师在PIVAS的重要作用。     

The role of the Danish community pharmacist: perceptions and future scenarios

In recent decades, dramatic changes of the role of the Danish community pharmacist have contributed to widespread uncertainty among professionals about the future content of their job. This case study, which is based on qualitative research interviews and documentary material, describes how key actors belonging to 10 different relevant social groups who have been influential in shaping the role of Danish community pharmacists have different perceptions of the pharmacy profession. These perceptions include: the community pharmacist as a provider of technical, standardised advice, the pharmacist as a drug expert, the pharmacist as a leader, and the pharmacist as a provider of individualised advice. Five future scenarios for the community pharmacist ranging from a role as a pharmacist with no future to a role as the provider of individualised information and future role developer are also described and analysed in the paper. The case study is theoretically based on a specific social constructivist theory, the Social Construction of Technology (SCOT).     

社区卫生服务站高血压患者不合理用药情况调查分析

目的了解社区卫生服务站高血压患者处方不合理用药情况,针对存在的问题提出改善、干预措施。方法抽取3个社区卫生服务站2009、2010年7、8月份的高血压患者处方,对处方中性别、年龄、合并症、联合用药情况等基本指标进行统计;对采取干预措施前后处方中抗高血压药物用法、用量、疗程不合理,重复用药,配伍不合理,不必要的联合用药,选药不合理情况进行对比分析。结果共抽取高血压患者处方543张,其中2009年333张,不合理处方64张占19.22%;2010年210张,不合理处方26张占12.38%。女性多于男性,年龄越大发病率逐渐增高。不合理用药原因有:根据合并症选药不合理、未考虑药物不良反应、用法用量不合理、联合用药不合理。结论组织动员社区高血压患者参与自我管理,对医师处方习惯进行有针对性的行为干预,指导患者正确认识和使用抗高血压药物,是提高高血压患者合理用药水平的有效手段。     

A cross-sectional survey of young people attending a music festival: associations between drug use and musical preference

Introduction and Aims . Drug use is becoming normalised among young Australian people involved in music sub‐cultures. We aimed to determine prevalences of illicit drug use in this population and associations between preferences for different music genres and recent use of particular illicit drugs. Design and Methods . A cross‐sectional questionnaire of young people (aged 16–29 years) attending a music festival. Results . Of 939 respondents, 46% had used illicit drugs (principally cannabis) in the past month, a significantly higher proportion than among respondents to the 2004 National Drug Strategy Household Survey (18%). Participants who favoured dance/house or rap music were more likely to have used illicit drugs recently than the remainder of the sample, while those who favoured pop or alternative music were less likely to have used drugs in the past month. Discussion and Conclusions . These data suggest that music festival attendees use illicit drugs more commonly than their age‐matched cohort in the general community, and that music festivals venues (particularly those that cater for dance/house and rap) would be appropriate places for interventions to promote safer drug use.     

Cabenuva®: Differentiated service delivery and the community Pharmacists’ roles in achieving UNAIDS 2030 target in Nigeria

The approval of the novel long-acting HIV injection; Cabenuva®- Cabotegravir and Rilpivirine injectable formulation) and the recent call by the World Health Organization for promoting community-based ART management, underscore the remarkable progress towards meeting the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95–95–95 targets by 2030.As the availability of antiretroviral therapy (ART) for the treatment of HIV/AIDS has increased in resource-limited settings, there has been a move to develop and implement alternative treatment delivery models such as Differentiated Service Delivery (DSD) in high prevalence countries to meet the global targets for HIV treatment while maintaining the quality of care. However, there is limited data on the involvement of community pharmacies in the delivery of ART within the community. Although, in western countries, several studies have documented the different roles community pharmacists can play in the management of HIV/AIDS. Community pharmacists are the most accessible and first points of health care for most clients. They are trusted, highly trained health care professionals. They should be incorporated and allowed to administer the Cabenuva® injection if the battle against the HIV pandemic is to be totally won. In this paper, we, therefore, aim to explore how the community pharmacist can be positioned in HIV service delivery regarding the administration of the Novel long-acting Cabenuva® injection formulation. It is therefore recommended that the Nigerian government embrace community pharmacy-led drug administration initiatives and embark on accredited training programmes for the profession in line with drug administration services. The government should also put in place necessary funding mechanisms for community pharmacists for the extra workload placed on them in administering injection drug formulation in their respective pharmacies.     

Factors associated with the intensity of government remunerated and unremunerated service provision in community pharmacies

BackgroundMany community pharmacies provide medication and disease state management services with and without specific remuneration. Availability of these services is often reported, however little is known about factors influencing the intensity of their provision.ObjectiveTo investigate factors associated with the intensity of provision of selected government remunerated and unremunerated community pharmacy services in Western Australia (WA).MethodsA questionnaire was mailed to a random sample of 421/628 (67%) community pharmacies in WA. The first dependent variable was intensity of government remunerated MedsCheck and Diabetes MedsCheck service frequencies per month. The second was the intensity of the sum of government unremunerated asthma screening, blood glucose testing, cholesterol testing and smoking cessation disease state management service frequencies per week. Principal Component Analysis defined attitudinal components influencing service provision. Linear regression with bootstrap confidence intervals determined variables associated with intensity of provision of the selected services. The variables were: pharmacist; pharmacy setting characteristics; and, attitudinal factors.ResultsThe questionnaire yielded a response rate of 49.2%. Attitudinal components that facilitated service provision were: general practitioners (GPs) willingness to collaborate; pharmacists are capable and ready; and pharmacists require further training. Staff capability and low return on investment were barriers to increased service provision. The intensity of government remunerated services was independently associated with pharmacies having pharmacy interns, fewer dispensary technicians, and being capable and ready to provide the services. Higher intensity of the provision of the unremunerated disease state management services was independently associated with the intensity of provision of MedsCheck and Diabetes MedsCheck services.ConclusionsImproved pharmacy workflow, achieved by the availability of pharmacy interns, and pharmacists being capable and ready, were important factors in the intensity of MedsCheck and Diabetes MedsCheck services. Intensity of the provision of government remunerated services facilitated a higher prevalence of disease state management services provision.     

Increasing prevalence of HIV, and persistent high-risk behaviours among drug users in Bangladesh: need for a comprehensive harm reduction programme

Introduction and Aims. The aim of this study was to examine trends in HIV and related risk behaviours in drug users in Bangladesh, the effects of prevention and harm reduction initiatives that have already been undertaken and to highlight immediate needs. Design and Methods. Journal publications, conference abstracts and proceedings were collected and reviewed. As there were relatively few published papers, the grey literature was also reviewed. Experts involved in the development and evaluation of current programmes or policy were contacted for official reports, policy documents or unpublished materials. The trends in injecting and sexual risk behaviours were tabulated. Results. Periodic behavioural and serosurveillance on recognised sentinel groups shows clearly that HIV prevalence among injecting drug users has been increasing steadily. In the capital city, the HIV prevalence among injecting drug users is close to the level of a concentrated epidemic (4.9%). While harm reduction strategies have brought a scope of reduction of injecting-related risk behaviours, the persistent high rates of needle sharing and high prevalence of sexual risk behaviours remains alarming. Non-injecting drug users have maintained a low prevalence of HIV but their high-risk sexual behaviours and transformation into injecting drug users with time are of concern. Discussion and Conclusions. There are substantial gaps between current needs and the ongoing prevention and harm reduction activities. There is a pressing need for a comprehensive harm reduction programme and review of any policies and laws which may impede this. [Islam MM, Conigrave KM. Increasing prevalence of HIV, and persistent high-risk behaviours among drug users in Bangladesh: need for a comprehensive harm reduction programme. Drug Alcohol Rev 2007;26:445-454]     

Update: comparison of drug use in Australia and the United States as seen in the 2001 National Household Surveys

This paper updates an earlier article by comparing the results of the 1998 and 2001 household surveys. The Australian survey showed a significant decrease in past-year use of 'any illicit drug'. The methodological changes in the US surveys prevented comparison for these years, but there were increases in use of any illicit drug between 2000 and 2001. Patterns of use of marijuana, stimulants, cocaine, ecstasy, heroin and needles are shown by age group and gender. Use by teenage girls in both countries has risen to the point that they are now using alcohol and some drugs at rates similar to boys. Over 20% of teens in both countries reported binge drinking in the past month. While Australians in their 20s had the highest rates of lifetime and past-year use, in the United States, depending on the drug, lifetime use was highest among people in their 30s or 40s, with past-year use highest among teenagers. Drug treatment services are needed not only for young people, but also for aging users. The changes in perceptions of risk from use of various drugs and availability of these drugs are related to changes in prevalence rates. [Maxwell JC. Update: comparison of drug use in Australia and the United States as seen in the 2001 National Household Surveys. Drug Alcohol Rev 2003;22:347 - 357]     

The prospect of implementing a Safer Injection Facility in San Francisco: perspectives of community stakeholders

Background

Government-sanctioned Safer Injection Facilities (SIFs) have been implemented around the world to address public health and public order concerns associated with injection drug use. The goal of this study was to investigate how community stakeholders in San Francisco's Tenderloin district respond to the idea of implementing a SIF.

Methods

Qualitative in-depth interviews were conducted with 20 purposively sampled stakeholders including representatives from neighbourhood and business associations, politicians, law enforcement, religious leaders, school officials, community activists and service providers. Data were analysed using an inductive approach.

Results

Stakeholders were concerned that implementation of a SIF would further degrade a community struggling with safety and cleanliness and questioned the efficacy of harm reduction strategies to address drug use. Stakeholders were open to dialogue about how a SIF might support neighbourhood goals, stressed the importance of respect and collaboration between stakeholders and those potentially implementing a SIF, and were interested in evidence of the impact SIFs have on communities. Government protection and political leadership would be necessary to implement a SIF.

Conclusions

Employment of a community collaborative model combined with political leadership could move the policy debate about implementation of a SIF in San Francisco forward.     

Estimating prevalence of injecting drug use: a comparison of multiplier and capture-recapture methods in cities in England and Russia

We consider the question of what method should be recommended to estimate the prevalence of injecting drug use (IDU); and compare multiplier and capture-recapture (CRC) methods of estimating prevalence of injecting drug use (IDU). The prevalence of injecting drug use in four cities (Brighton, Liverpool, London and Togliatti) was estimated using similar methods: covariate capture-recapture (CRC) and multipliers. The multipliers, generated either from a community recruited survey or historical/literature-based, were applied to a range of 'benchmarks': specialist drug treatment, arrests, accident and emergency department (A&E), syringe exchange, HIV tests and opiate overdose deaths. The CRC estimates were assumed to be 'preferred/gold standard' [2,304 (95% confidence interval 1,514 - 3,737) in Brighton, 2,910 (2,546 - 4,977) in Liverpool, 16,782 (13,793 - 21,620) in 12 London boroughs and 15,039 (12,696 - 18,515) male IDU in Togliatti]. The ranges given by the multiplier estimates obtained through the community survey varied from 200 to 770 in Brighton, 530 to 1,300 in Liverpool, 2,900 to 10,600 in London and 12,400 to 91,000 in Togliatti. Several multipliers gave implausible results, lower than the observed data collected for another benchmark, and in the three English cities all these multiplier estimates were below the lower 95% confidence interval of the CRC estimate. In Togliatti, only one multiplier estimate was close to the preferred CRC estimates, with the rest implausibly high. The multiplier estimates based on historical/literature multipliers also ranged widely from 390 to 4,800 for Brighton, from 1,645 to 2,800 in Liverpool, from 4,650 to 12,600 in the 12 London boroughs and 12,800 to 32,000 in Togliatti. In the three UK cities the mortality multiplier estimates were closest to the capture-recapture estimates. The study was a practical demonstration comparing a range of multiplier estimates with a single CRC study. In almost all the individual comparisons the multiplier estimates performed poorly. CRC methods should be preferred as the means of estimating numbers of drug users with multiplier methods being used with caution and only where CRC is not possible.