Preliminary investigation of patient information leaflets as package inserts

In the United Kingdom, patient information leaflets (PILs) are now supplied with all medicines licensed or re-licensed since January, 1994. This means that, by 1998, all medicines will come with one of these detailed leaflets inside the pack. In a preliminary investigation of the impact of these leaflets, 117 elderly inpatients were questioned on their experience of PILs prior to admission. Ninety-one (78 per cent) said they had received a PIL and 57 (49 per cent) had read one. The main reasons for not reading a leaflet were the perceived difficulty in understanding and being put off by excessive information. Of the patients who had read a leaflet, 23 (40 per cent) reported difficulty in reading the small print and 26 (46 per cent) said they had difficulty understanding the content. Thirteen patients (23 per cent) reported having to seek help with reading a leaflet. Forty-two of those who had read a leaflet rated it as helpful. Eleven patients said they had asked for advice from their doctor or pharmacist as a result of reading a leaflet. Nine patients said the leaflet had caused some anxiety, with two stopping their medicine as a result. The move to universal PILs in patient packs is a major development in the provision of information to patients about medicines. This study suggests that elderly patients have problems relating to understanding the content of PILs and reading the size of print used in these leaflets.     

Public perceptions of community pharmacists in Benin City,Nigeria

Objective — To determine public perceptions of community pharmacists and pharmacies in Benin City, Nigeria. Method — A self‐completion questionnaire was distributed to a stratified random sample of 1,500 households. Data were collected using a 22‐item, Likert‐type scale which was shown to have 0.77 reliability. The neutral point was assumed to be 66 on the scale of 22 to 110. Scores above 66 were interpreted as positive perception. Results — The response rate was 68.3 per cent (1,025/1500). Almost two‐thirds (64 per cent) of respondents perceived the community pharmacist as a health care provider, and 70 per cent agreed that community pharmacists are needed, especially in the area of medicinal product selection (76 per cent). However, 52 per cent believed pharmacists are profit motivated and only 43 per cent said they would be willing to pay for pharmacist consultation. Respondents reported difficulty in differentiating between pharmacists and pharmacy attendants, with only 58 per cent reporting that they could tell the difference. The pharmacists scored 76.37 ± 27.63, with 60 per cent of respondents scoring them above 66. Conclusion — This study found that community pharmacists received a moderately positive rating from the public. There is a need for community pharmacists to carve out a more distinct professional identity for themselves.     

Factors related to medication adherence among homeless women and children

Objective The primary objective of this study was to examine factors related to medication adherence among homeless women and children. A secondary purpose was to describe the medication informational needs of homeless women. Method Fifty‐seven women at six different shelters for homeless women in Wake County, North Carolina were interviewed during the summer of 2001. Key findings Fifty‐eight per cent of women reported having at least one medical condition and 84% of the women had taken at least one medication during the past week. Twenty‐six per cent of women said that during the last week they had not taken a medication on purpose and 30% purposively cut back on a medication. A woman with a substance abuse problem was five times more likely to purposively not take a medication. Almost half of the women who had children living with them had a child that had taken medication during the past week. The primary reasons cited for not using medications as directed were access issues. Fifty‐eight per cent of the women wanted to learn more about their or their children's medications. The majority of women preferred to receive more verbal and written drug information. Conclusions Pharmacists need to work with local homeless shelters and the women in these shelters to help make sure that they receive needed medications and information for themselves and their children.     

The development and evaluation of an extended adherence support programme by community pharmacists for elderly patients at home

Objective —To devise, implement and evaluate a medication adherence support service by community pharmacists for elderly patients living at home and at risk of non‐adherence. Method — Six community pharmacists identified patients who were 65 years of age and older, prescribed four or more regular medicines and living alone. A random sample of patients was visited at home and assessed for adherence‐related problems using a structured interview. The pharmacist then drew up an action plan in conjunction with the patient and general practitioner (GP), and returned for a second home visit, where the revised regime was delivered and explained. A self‐reported adherence questionnaire was also administered. After two months an independent researcher visited the patients at home to assess progress. Setting — Six community pharmacies in the city of Leeds, UK, and patients' homes. Key findings — A total of 143 patients were recruited and 441 medicine‐related problems were identified. Of these, 241 (55 per cent) required the provision of information and advice, 106 (24 per cent) required consultation with the GP and 86 (20 per cent) required changes in the presentation of the medicines. The median number of regular prescribed medicines fell from six to five (P<0.001). Overall, there was a reduction in the number of patients with one or more problems from 94 per cent to 58 per cent (P<0.001). The proportion of patients who reported non‐adherence fell from 38 per cent to 14 per cent (P<0.001). Conclusion — This study shows that community pharmacists can target patients at risk of medication non‐adherence and, using a structured approach, identify problems and implement solutions. The pharmacy patient medication record is an underutilised tool for identifying patients with adherence problems. The software needs enhancing to enable pharmacists to maximise their use of these records in adherence support. An adherence support programme needs to take more account of intentional non‐adherence and should be closely linked with the rest of the primary health care team.     

Evaluation of drug information for cardiology patients.

1. Cardiologists and pharmacists at the University Hospital of Wales collaborated to write 20 individual leaflets incorporating guidelines for a range of drugs used in the treatment of cardiology patients. The Plain English Campaign advised on the intelligibility and presentation of the information. 2. One hundred and twenty-five patients from the Regional Cardiology Unit, University Hospital of Wales were randomly allocated to receive usual verbal counselling about their drug treatment with or without an individualised drug information wallet. Two weeks after discharge from hospital patients completed a postal questionnaire to determine their satisfaction with the information about their drug treatment and their understanding of it. Forty-nine questionnaires were returned from the leaflet group and 52 from the control group. 3. The provision of written guidelines resulted in significant improvements in patients' satisfaction with their drug treatment (chi 2 = 33.3, P less than 0.001) and their understanding of it (P less than 0.001, Mann-Whitney test). Overall, patients who received leaflets were more likely to be aware of the potential side effects of their drugs but less likely to be apprehensive about them. Succinct guidelines concerning drug therapy can be assimilated by cardiology patients and provide them with a permanent record for future reference.     

Glaucoma patient receipt of information and instruction on how to use their eye drops

Objectives The objectives of the study are: (a) to describe the sources of glaucoma patient's medication information and instruction, and (b) to examine the influence of patient characteristics on the sources of medication information and instruction obtained. Setting Four geographically distinct ophthalmology practices in the US. Method A survey assessing receipt of information and instruction on how to use eye drops was completed by 324 patients. Multivariable logistic and ordinal regression were used to analyse the data. Key findings Fifteen per cent of patients stated that no‐one gave them information about their glaucoma medications, and 20% of patients stated that no‐one showed them how to use their glaucoma medications. Ophthalmologists were the individuals most likely and ophthalmic technicians were the second‐most likely to give the patients information and instruction on how to use their medications. Fourteen per cent of patients stated that pharmacists gave them information about their eye drops. Patients very rarely reported pharmacists or primary care physicians showing them how to use their glaucoma medications. Fourteen per cent of patients reported going to the internet for information. Younger patients were significantly more likely to receive information about glaucoma and glaucoma medications from the internet than older patients. Conclusion Patients are receiving information about glaucoma medications from numerous sources, yet almost one out of five glaucoma patients reported receiving no instruction on the instillation of their eye drops. Pharmacists have the opportunity to educate glaucoma patients about using their medications by giving them information and showing them how to administer the medications correctly.     

Community pharmacy services for antidepressant users

Objective — To evaluate the communication and barriers to communication between community‐based pharmacists and antidepressant users. Method — A survey package designed to evaluate the communication between pharmacists and antidepressant users was distributed to 50 community pharmacies. Each package included one pharmacist survey and 10 sealed antidepressant user surveys to be distributed by the pharmacy staff. The survey addressed the components of communication, level of satisfaction and barriers to effective communication. Setting — Urban and rural community pharmacies in the Canadian Maritime provinces of Nova Scotia and New Brunswick. Key findings — Overall, pharmacists rated the value of their communication more highly than did antidepressant users, although the difference was not statistically significant. When beginning treatment, between one‐half and two‐thirds of antidepressant users recalled pharmacists inquiring about past use of the antidepressant and discussing information provided by the physician, time to onset of benefits and potential side effects. The purpose of the antidepressant, target symptoms, usual duration of therapy and risk of relapse with premature discontinuation were addressed less often according to antidepressant users, and monitoring of compliance was not a common activity. Antidepressant users estimated that initial communication with the pharmacist generally lasted less than five minutes, and often less than two minutes. However, pharmacists appeared to resolve misconceptions and concerns about antidepressant use efficiently. According to pharmacists, the major barrier to effective communication was a lack of privacy. Conclusion — Although compliance with antidepressants is low and treatment outcomes are sub‐optimal, pharmacists are not using their opportunities to minimise this problem through effective communication and follow‐up. Pharmacists, pharmacy administrators and regulators need to re‐assess their contribution to this problem and how they can lead to its resolution in the patient's best interest.     

Validation of a “desire for information” scale

Objective — To validate a scale to measure patients' desires for information about their prescribed drugs. Methods — Both quantitative and qualitative methods were used. Standardised bedside interviews were conducted with general medical patients in three hospitals over an eight‐month period. The validity of the scale was explored by interfacing qualitative data from patients' perspectives and their scores to the scale. Setting — General medical wards at three teaching hospitals in London. Key findings — A total of 630 patients were recruited for interview; 50.2 per cent were male and 49.8 per cent female. The mean age for the population was 60 years. More than half (54 per cent) of the study population was retired, and the majority (82 per cent) described their cultural background as white. Through a factor analytic approach, the primary 12‐item scale was refined to six items (designated F1), measuring “extent of information desired”. A second extracted factor (designated F2) measured “inhibited desire for information”, but was not considered reliable. The responses to semi‐structured interviews gave valuable insights into the types of information sought: low‐scorers declared no need for detailed information as this would sometimes even worry or frighten them, while high‐scorers worried about not receiving enough information and requested specific details that would help them in their self care. Conclusion — Interfacing qualitative responses to semi‐structured and open questions and the quantitative scores contributed to the validation of a new six‐item scale and gave insights into the types of information patients seek. By developing a tool to identify patients' desires for information, pharmacists will be able to identify and meet the drug information needs of patients in an appropriate and timely way.     

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

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

Evaluation of mental health care interventions made by three community pharmacists — a pilot study

Objective — To assess the clinical significance of drug‐related interventions made by three community pharmacists (CPs) in the pharmaceutical care of 30 long‐term mentally ill patients in the UK. Method — Three CPs (“study pharmacists”) participated in a nine‐month study in which they collaborated with the community mental health team (CMHT) to provide pharmaceutical care for long‐term mentally ill patients in the community. In particular, they liaised with the patients' keyworkers, accompanying them on home visits. The pharmacists had previously attended a specially organised training course. Their primary tasks were to assess patient need and identify medication‐related problems, intervene as appropriate and document patient outcome. An expert review panel (two specialist hospital mental health pharmacists and a consultant psychiatrist) evaluated the appropriateness of the interventions and the level of clinical significance of the interventions (using a validated four‐point rating scale). Key findings — Thirty‐eight patients consented to participate in the study and 35 were contactable. Ninety‐four medication‐related problems were identified involving 30 patients (mean number of recorded problems per patient=3), of which full data were available for 92. Eighty‐four problems (91 % n=92) were said to have had appropriate interventions, and eight (9 per cent) inappropriate interventions. In 35 per cent of problems the three reviewers agreed that the interventions were clinically significant. Inter‐rater agreement for paired agreements (assessed by the kappa statistic) was fair in all cases except one, where it was poor. Conclusions — The reviewers considered the study pharmacists to have made a valuable pharmaceutical contribution to mental health care through clinically significant interventions, although they identified cases in which further clinically significant interventions could have been made. The reviewers saw the work undertaken as providing a positive way forward in primary mental health care.     

General medical practitioners' attitudes towards the use of patient medication records

A survey was conducted to ascertain general medical practitioners' (GPs') attitudes to community pharmacists' use of patient medication records (PMRs) and to assess whether GPs envisage a role for family health service authorities (FHSAs) in maintaining records of patients' data. The survey questionnaire was sent by post to all 1,257 GPs in contract with Avon and Devon FHSAs. A total of 811 questionnaires was returned, an overall response rate of 64.5 per cent. A majority (59 per cent) of GPs considered that community pharmacists should keep patient medication records and there was strong support for pharmacists holding PMRs for the elderly and confused, and also for patients with diabetes, asthma, epilepsy, and those patients who had experienced major adverse drug reactions or allergies. Some GPs, however, remained unconvinced of the usefulness of a pharmacy PMR. Seventy four per cent of respondents considered that patients should keep their own medication records. In contrast, only 4 per cent were in agreement with patient medication data being stored by FHSAs. The community pharmacist's role in maintaining PMRs received less support from doctors in dispensing practices than from their non-dispensing counterparts. Some 80 per cent of respondents were in favour of pharmacists providing PMR system-generated patient information leaflets with dispensed medicines. Most GPs considered that such leaflets had a positive effect on patient compliance. Recently registered GPs were found to be more supportive than their older colleagues of community pharmacists recording patients' clinical conditions and providing information leaflets.     

Knowledge of and attitudes to medicines in the Southampton community.

A 1 in 200 sample of the Southampton electorate was sent a postal questionnaire in January, 1984. Of the 740 adults surveyed, 443 (59.9%) returned completed questionnaires. One hundred and eighty-eight (42.4%) of those replying had been prescribed a medicine within the previous month. Two hundred and seventy-five respondents (62%) felt that not enough was explained about medicines by doctors or pharmacists. Consistent with this, was the fact that 37% were unaware of safe methods of disposal of leftover medicines. In addition, 112 of 154 (72.7%) people currently taking a prescribed medicine knew of no side-effects which could result from this. Eighty-three per cent of respondents thought an information leaflet would be helpful. Of nine items which previous authors had suggested should be included, seven were thought to be important by more than 75% of those replying. Although 54% of people wanted detailed information, 43% stated a preference for short, summarized points. We conclude that most patients need to have more information about prescribed medicines and they would welcome written leaflets. However, further work is necessary to determine the best format for such leaflets.     

Community pharmacists' attitudes towards research

Objectives — To investigate community pharmacists' perception of Pharmacy Practice research and to identify perceived barriers preventing their participation in research. Method — A self‐completed postal questionnaire, including 29 attitudinal statements was analysed using factor analysis. Setting — The study group comprised pharmacists working in all 651 community pharmacies in East London and Essex. Key findings — The response rate was 60 per cent. Factor analysis revealed five factors comprising correlated statements. The majority of respondents perceived community based practice research to be important and relevant to them and to the future development of community pharmacy. Fifty‐four per cent agreed that they were prepared to participate in practice research, although 66 per cent of respondents felt their daily activities precluded this. Payment for a research related activity was a major issue impacting on their likely participation, with 72 per cent of pharmacists agreeing that they would only participate if paid to do so. Pharmacists' employment status, ie, whether employee or proprietor, was also associated with willingness and ability to undertake research. Conclusion — Community pharmacists have a positive attitude towards practice research, and under the appropriate circumstances many would be prepared to participate in research.