Community pharmacists' attitudes to medicines management: a qualitative study

Objective To explore community pharmacists' knowledge of, and attitudes toward, medicines management, including concerns or barriers to offering medicines management services from community pharmacy premises. Method Focus groups held with purposively sampled pharmacists from community, practice and research sectors in Scotland. Participants were invited to discuss community pharmacists' knowledge and experience of medicines management, concerns about providing medicines management services from community pharmacy premises, and possible effects of such services on relationships with general practitioners (GPs). Key findings Ten pharmacists attended two focus groups. Characteristics of participants varied according to sex and employment status as well as the type and setting of the pharmacy in which they worked. Participants were familiar with the term ‘medicines management’ but understanding varied between and within groups and differences from and similarities to the term ‘pharmaceutical care’ were less clear. Concerns about the delivery of extended services included practical issues and the effect on the ‘traditional’ role of the community pharmacist. Views were mixed on whether medicines management could become a routine part of all community pharmacists' practice or whether it required specialisation. Pharmacists distinguish between ‘patients’ and ‘customers’ in relation to their differing needs. The relationship between pharmacists and GPs was influenced by the post held by the pharmacist and the setting of the pharmacy. Conclusions The pharmacists in this small, regional sample expressed a wide range of attitudes and opinions about the delivery of medicines management services from community pharmacies. Useful insights were given into the practicalities of providing such services on a daily basis in the current working environment, and how pharmacists might be able to provide medicines management services in other ways. Medicines management can be seen as a reprofessionalising strategy for pharmacy, making use of the pharmacist's status as an ‘expert’ to enhance the natural object, the ‘drug’ into the object of social significance, the ‘medicine’. Further research with pharmacists from other regions is needed to confirm this explanation.     

Measuring the impact of long-term medicines use from the patient perspective

Polypharmacy is increasing, seemingly inexorably, and inevitably the associated difficulties for individual patients of coping with multiple medicines rise with it. Using medicines is one aspect of the burden associated with living with a chronic condition. It is becoming increasingly important to measure this burden particularly that relating to multiple long-term medicines. Pharmacists and other health professionals provide a myriad of services designed to optimise medicines use, ostensibly aiming to help and support patients, but in reality many such services focus on the medicines, and seek to improve adherence rather than reducing the burden for the patient. We believe that the patient perspective and experience of medicines use is fundamental to medicines optimisation and have developed an instrument which begins to quantify these experiences. The instrument, the Living with Medicines Questionnaire, was generated using qualitative findings with patients, to reflect their perspective. Further development is ongoing, involving researchers in multiple countries.     

How professionals define medicines management: a preliminary qualitative investigation

“Medicines management” is a poorly defined concept within pharmacy practice and little is known about the understanding of the term by other health professionals Semi‐structured interviews with GPs, practice nurses and community pharmacists showed that they viewed medicines management in relation to specific tasks and activities, their own specialist training and in the context of current health priorities Three main interpretations emerged: medication focused, patient focused and a professional instigated focus An accepted understanding of terms such as like “medicines management” is essential for an effective intra‐ and inter‐professional approach to supporting people and their medicines     

A qualitative approach to the use of economic data in the selection of medicines for hospital formularies: a French survey

OBJECTIVE: Qualitative interviews were conducted with pharmacists in hospitals and clinics in the Rh?ne-Alpes region of France to determine the role of economic data when selecting medicines for formularies, to identify barriers to the use of this information and to study to what degree a healthcare establishment's financing system influences the use of this data. METHOD: A stratified sample of healthcare establishments with over 100 short-stay beds were included: (1) thirteen public and semi-private hospitals financed through annual global budgets and (2) six private clinics financed on a fee-for-service basis. Interviews were carried out between October 1999 and January 2000, and coded independently by two researchers. MAIN OUTCOME MEASURE: A multiple correspondence analysis was performed to compare the two groups of healthcare establishments. RESULTS: The influence of economic data in the decision-making process is limited, for other factors appear to have greater weight: (1) efficacy and safety of medicines (2) relations between decision-makers and the pharmaceutical industry and (3) patient quality of life. Economic data used was mainly related to medication prices and quantities consumed. This data was used in a large number of decisions and seemed to have more importance in hospitals than in clinics. Information related to resources that could be saved by the inclusion of a new medicine on formularies was seldom used and apparently considered less important in hospitals than in clinics. Pharmacoeconomic evaluations were very rarely used. Six barriers to the use of economic data were raised by the pharmacists, including: lack of time, which limits the collection and analysis of such information; insufficient health economics training, an obstacle to decision-makers' analytical capacity; and closed budgets within hospitals. CONCLUSION: Economic data concerning 'medication budgets' appears to have a greater impact in public and semi-private hospitals than in private clinics. Obstacles linked to the decision-making context itself were particularly highlighted, and it can be concluded that in order to increase the use of economic data, it is first necessary to create an environment that is more favourable to its application.     

Impact of long-term use of opioids on quality of life in patients with chronic,non-malignant pain

ABSTRACT

Objective: The use of opioids in the management of non-malignant pain remains controversial. For many physicians, pain relief stemming from opioid use is not enough unless there is also a noticeable change in quality of life (QoL) and patient functioning. The impact of long-term opioid treatment on patients’ QoL has been investigated in a limited number of trials, and these studies differ considerably with respect to their design and principal findings. This systematic review presents the results of these studies.

Design and methods: MEDLINE (1966 to November/December 2004), EMBASE (1974 to November/December 2004), the Oxford Pain Relief Database (Bandolier; 1954–1994) and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant papers by combining search terms for function with terms for opioid analgesia, non-malignant and pain. Studies were eligible for inclusion if they met all of the pre-defined criteria specifying study design, population, intervention and outcome measures.

Results: Eleven studies evaluated long-term treatment with opioids in patients with chronic, non-malignant pain and assessed QoL (?N = 2877). Six studies were randomised trials and the remaining five were observational studies. In general, the former had higher Jadad rating scores for the quality of the paper than the latter. Of the four randomised studies in which baseline QoL was reported, three showed an improvement in QoL. Similarly, of the five observational studies, a significant improvement in QoL was reported in four.

Conclusions: There is both moderate/high- and low-quality evidence suggesting that long-term treatment with opioids can lead to significant improvements in functional outcomes, including QoL, in patients with chronic, non-malignant pain. However, further methodologically rigorous investigations are required to confirm the long-term QoL benefit of opioid treatment in these patients, and to elucidate the effect of physical tolerance, withdrawal and addiction, which are all associated with long-term use of opioids, on patients’ functional status.     

Impact of long-term use of opioids on quality of life in patients with chronic, non-malignant pain

OBJECTIVE: The use of opioids in the management of non-malignant pain remains controversial. For many physicians, pain relief stemming from opioid use is not enough unless there is also a noticeable change in quality of life (QoL) and patient functioning. The impact of long-term opioid treatment on patients' QoL has been investigated in a limited number of trials, and these studies differ considerably with respect to their design and principal findings. This systematic review presents the results of these studies. DESIGN AND METHODS: MEDLINE (1966 to November/December 2004), EMBASE (1974 to November/December 2004), the Oxford Pain Relief Database (Bandolier; 1954-1994) and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant papers by combining search terms for function with terms for opioid analgesia, non-malignant and pain. Studies were eligible for inclusion if they met all of the pre-defined criteria specifying study design, population, intervention and outcome measures. RESULTS: Eleven studies evaluated long-term treatment with opioids in patients with chronic, non-malignant pain and assessed QoL (N = 2877). Six studies were randomised trials and the remaining five were observational studies. In general, the former had higher Jadad rating scores for the quality of the paper than the latter. Of the four randomised studies in which baseline QoL was reported, three showed an improvement in QoL. Similarly, of the five observational studies, a significant improvement in QoL was reported in four. CONCLUSIONS: There is both moderate/high- and low-quality evidence suggesting that long-term treatment with opioids can lead to significant improvements in functional outcomes, including QoL, in patients with chronic, non-malignant pain. However, further methodologically rigorous investigations are required to confirm the long-term QoL benefit of opioid treatment in these patients, and to elucidate the effect of physical tolerance, withdrawal and addiction, which are all associated with long-term use of opioids, on patients' functional status.