Obtaining accurate patient‐specific perioperative anaesthetic costs in orthopaedic anaesthesia

□ The aim of the study was to obtain perioperative patient‐specific costs associated with orthopaedic anaesthesia □ A prospective observational study design was used to determine fixed, semi‐fixed, and variable costs □ The preliminary results of the first 60 patients reports a mean total perioperative anaesthetic cost of £291 (SD: £103.9, median: £278.09, IQR: £219.3–£369.5) □ Fixed and semi‐fixed costs are a major cost component of anaesthesia; variable costs account for only 12 per cent of total cost □ The results of this study will be used in an economic evaluation examining the use of different anaesthetic techniques in orthopaedics     

An investigation of medicines returned to general practitioners and community pharmacies

All returned medicines were monitored in eight community pharmacies and five general medical practices over a four‐week period Returns were analysed for the type, quantity, absolute cost of the medicines, original quantity and date dispensed together with the reason for return A total of 298 items was returned to pharmacists and the reason for the return was a change or stop of therapy in 56 per cent of cases; 66 per cent of these were prescribed in a quantity of one month or greater A total of 42 items was returned to GPs and the reason for the return involved a change or stop of the therapy in 54 per cent of cases; 69 per cent of these were prescribed in a quantity of one month or greater Measures to implement a procedure to limit prescribed quantities upon initiation of therapy should help to reduce medicines wastage     

Preliminary investigation of the problems associated with supply of palliative care medicines in primary care

□ Fax‐back was a cost effective method for administration of a self‐completion questionnaire which produced a high (76 per cent) response rate □ Problems with supply of palliative care medicines were reported by 58.5 per cent of health authorities responding to the survey □ Supply of medicines out of hours was the most common problem reported (93 per cent), with stock levels held in pharmacies and problems with specialist medicines also causing problems in over 50 per cent of respondents □ Some health authorities reported that protocols for supply of palliative medicines, or the existence of designated community pharmacies for their provision, reduced the problems reported □ Further research into effectiveness of protocols and designated palliative care pharmacies is indicated, and our study has identified those health authorities where such research could be targeted     

Community pharmacist perceptions of the loss of resale price maintenance

This study was designed to elicit the views of community pharmacists on any perceived business and professional changes following the loss of resale price maintenance (RPM) A piloted, 22‐point self‐completion questionnaire containing open, closed and scaled response questions was distributed to 35 independent (<10 stores), 13 multiple group and three supermarket‐based pharmacies, and 40 responses were obtained (29 independent, eight multiple and three supermarket) Theme analysis indicated that 20 respondents felt that an increased range of services was now provided, 27 reported a decreased sales potential and 25 thought that patients now purchased more medicines The average price at which eight common over‐the‐counter medicines were offered was found to be £4.34 in independents, £4.37 in multiples and £4.22 in the supermarket pharmacies, compared with an average standard list price of £4.32 There are indications that removal of RPM may have instigated changes in community pharmacy     

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.     

Medication compliance devices in primary care: activities of community‐based nurses

Objective — To investigate the workload, training and views of community‐based nurses in relation to medication compliance devices. Method — Postal questionnaires distributed to all nurse team leaders (n=57) and community‐based nurses (n=327) in the Grampian region of Scotland. Setting — Primary care. Key findings — Responses were received from 32 team leaders (56 per cent) and 153 nurses (47 per cent). Ninety‐six nurses (63 per cent) filled a total of 212 medication compliance devices per week for patients under their care — an activity which accounted for an estimated total of 121 hours per week (mean of 1.25 hours per nurse per week, range 0.5 to 7 hours) and for which they had received no formal training. One hundred devices (47 per cent) were filled to enable carers to administer medicines. Team leaders reported several areas of concern which had been raised by their staff, particularly relating to responsibility and accountability under professional body guidelines. Conclusion — Many community‐based nurses fill medication compliance devices, an activity which clearly causes much concern. There is an urgent need to develop and evaluate multidisciplinary models of care based around the needs of individual patients requiring medication compliance devices.