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.     

Community pharmacists' views and experiences of counter-prescribing in pregnancy

Objective — To ascertain the sources of community pharmacists' knowledge base for counter-prescribing in pregnancy, whether sufficient additional information was readily accessible and, if not, to discover pharmacists' areas of concern. Method — A structured telephone interview of community pharmacists by a single researcher using a pre-piloted questionnaire to obtain both quantitative and qualitative data. Questions covered previous education about counter-prescribing in pregnancy, reference sources used, and satisfaction with available reference sources. Respondents were also asked to cite examples where they would or would not recommend a medicine in pregnancy. Setting — A random sample of 50 community pharmacies in Scotland. Key findings — From the high response rate (43 pharmacists, 86 per cent) the topic was demonstrably important to community pharmacists, most of whom perceived their knowledge base for counter-prescribing in pregnancy to be experience-gained. Thirty-four pharmacists (79 per cent) agreed there was a need for more information to be available. Ten pharmacists (23 per cent) highlighted complementary therapies as an area where they found available information inadequate. Examples of requests from pregnant women and the action taken by the pharmacist are reported. Conclusion — There is a need for an accurate, current and comprehensive data source for counter-prescribing in pregnancy. The field of complementary medicines and therapies is of particular concern to many community pharmacists. More research is required into GP referrals.     

Pharmacists' and physicians' perception of antibiotic policies in New South Wales public hospitals

Background — The potential of antibiotic policies in hospitals to improve antibiotic use depends on the compliance of practitioners with these policies. It is conceivable that the way the policies are perceived by practitioners can influence their compliance. Objective— To determine the perception and awareness of pharmacists and physicians of their current hospital antibiotic policy. Setting — Public hospitals in New South Wales, Australia. Method — Pharmacists and physicians were surveyed using a structured questionnaire seeking the extent of agreement or disagreement with a series of statements about their hospital's antibiotic policy. All hospitals had at least one antibiotic policy. A simple one-stage cluster sample of 241 pharmacists and a two-stage cluster sample of 701 physicians were obtained. Factor analysis was used to identify the dimensions of perception. General linear modelling was used to investigate the effects of predictor variables on outcome variables. Results — The response rates were 91 per cent and 77 per cent for pharmacists and physicians, respectively. The proportion of respondents who were aware of their hospital's antibiotic policy was 86 per cent (190/220) for pharmacists and 61 per cent (332/542) for the physicians. Factor analysis identified three factors related to how practitioners perceived their current hospital's antibiotic policies. These were: the usefulness of antibiotic policies (utility), how the policy was applied in the hospital (application) and the perceived problems associated with the policy (problems). Pharmacists were significantly more likely than physicians to perceive problems with antibiotic policies and how the policies were applied. Conclusion — The level of practitioners' awareness of their hospital's antibiotic policy and pharmacists' perception of problems with such policies need to be addressed if these policies are to make a significant contribution to improved antibiotic use in hospitals.     

Are health professionals ready for the new philosophy of concordance in medicine taking?

Objectives — To develop and administer a practical, valid and reliable tool to measure attitudes to concordance in medicine taking, a new concept where decisions depend on an equal partnership between patient and prescriber. Method — A postal questionnaire was devised comprising statements from the original concordance document, along with statements reflecting the orthodox model of medicine taking. There was a total of 22 statements. Respondents rated each statement on a four‐point Likert agreement scale. The questionnaire also included three scenarios of consultations involving medicine prescribing and taking, with associated statements for rating as true or false. Setting — A random sample of 207 medical, nursing and pharmacy graduates in the North of England at the time of qualification. We received 81 completed questionnaires (39 per cent) Key findings — Item analysis reduced the 22‐item scale to a 12‐item scale with good reliability (Cronbach's alpha = 0.79) and construct validity was demonstrated through correlation with responses to the scenarios. Although the typical respondent had a positive attitude towards concordance (mean = 2.3), 25 per cent of respondents had negative attitudes. Pharmacists showed the least favourable attitudes (P<0.05) Conclusions — The 12‐item Leeds Attitude Towards Concordance (LATCon) scale is a reliable and valid tool for assessing health care providers' attitudes to the new concept of concordance in medicine taking. Newly qualified doctors, nurses and pharmacists tended to hold favourable attitudes, although a significant minority — especially pharmacists — hold negative attitudes. These results have implications for undergraduate education and continuing professional education.     

Community pharmacists' attitudes to adverse drug reaction reporting

Objective — A “demonstration” scheme for adverse drug reaction (ADR) reporting by United Kingdom community pharmacists began in April, 1997. The objective of this study was to investigate community pharmacists' attitudes to and knowledge of ADR reporting and the “yellow card” scheme. Method — Structured face-to-face interview with community pharmacists, using a prepiloted questionnaire. Setting — Randomly selected community pharmacies within one demonstration scheme area. Key findings — Almost all of the pharmacists (28, 93 per cent) were aware that they were able to report ADRs but only one had done so. Just under half recalled receiving the official information pack and half of these had read it. Reasons given for not submitting reports were lack of information or time, and that most reactions seen were already well-recognised. Although most pharmacists knew that serious reactions to established drugs should be reported, fewer recognised the need to report unusual reactions to established drugs and reactions to herbal medicines. Few participants knew the reporting criteria for “black triangle” drugs. Reporting on over-the-counter (OTC) products was an area specifically identified where it was expected that community pharmacists could “add value” to the previous, yellow card, scheme. It was thus of some concern that 21 pharmacists (70 per cent) agreed that they would be unlikely to report an ADR to a product they had counter-prescribed for a patient. Few respondents had negative attitudes to the scheme. Most agreed that ADR reporting is important, and a professional role in which pharmacists should be involved. Conclusion — Community pharmacists are supportive of their involvement in ADR reporting. Their concerns about reporting need to be addressed and further publicity given to the scheme if reporting is to increase. Our findings suggest that more research is needed to identify the factors which encourage and inhibit reporting, and that further efforts may be needed to promote ADR reporting.     

Consumer attitudes towards community pharmacy services in Saudi Arabia

Objective The purpose of this study was to determine consumer attitudes towards community pharmacy and their preferences for the introduction of new services. Methods A self‐completion questionnaire was developed and 1,144 consumers in 55 community pharmacies were invited to complete it. The questionnaire covered consumers' choice of pharmacy; their perceptions of, and actual interactions with, community pharmacists; advice from pharmacists about general health and prescribed medicines; and privacy in the pharmacy. Respondents were asked for their views about five possible new services. Setting The study was based in community pharmacies in Riyadh City, Saudi Arabia. Key findings The response rate was 79.6%. Fifty‐nine per cent of respondents often or sometimes visited a particular pharmacy. One‐quarter of respondents perceived community pharmacists as having a good balance between health and business matters, while 56.1% thought pharmacists were more concerned with the business. The majority of respondents (69.7%) said they felt comfortable asking the pharmacist for advice. Just under half (44.8%) felt that pharmacists allowed them enough time to discuss their problem fully and listened well. In addition, 58.5% of respondents indicated that their pharmacists showed sensitivity to privacy by speaking more quietly across the counter. In 14.4% of situations pharmacists were reported to use a private area within the pharmacy when discussing personal or private matters. Most respondents (65.2%) indicated that their pharmacist was willing to discuss their health problems and tried to understand their feelings. Consumers' priorities for new services were: monitoring blood pressure; measuring weight, height and temperature; monitoring blood sugar; and monitoring cholesterol. Conclusion This study showed that most pharmacy customers feel comfortable seeking advice from their pharmacist. Although many pharmacists were reported to show sensitivity to a possible lack of privacy in the pharmacy, few respondents reported that their pharmacy had a private area for discussion. Customers' views on possible new services were generally positive, with the exception of patient medication records.     

Factors influencing Australian community pharmacists' willingness to participate in research projects ‐ an exploratory study

Objective To identify the factors influencing Australian community pharmacists' willingness to participate in research projects and their attitudes towards research. Method A mixed‐method survey instrument comprising demographics, previous participation in research, and perceptions about participation in research was mailed to 267 community pharmacists in New South Wales and the Australian Capital Territory. An analysis of variance test was used to identify similarities and differences between research‐ and non‐research‐active respondents. Bivariate correlations and partial least squares (PLS) regression analyses were used to identify barriers and facilitators to research participation. Key findings The overall response rate to the survey was 40%. Of these, 70% were classified as previous research participants (PRP), and 30% were classified as non‐previous research participants (NPRP). Both groups had mostly favourable attitudes towards research; however, the results revealed several differences between the PRP and NPRP groups. Three items were identified as key facilitators to participation in research for both PRP and NPRP groups ‐ having an interest in the research topic; believing that the research will benefit the customer; and a belief that community pharmacy research is important. Lack of time, either real or perceived, was identified as a key barrier to participation in research for both the PRP and NPRP groups. Conclusion Researchers should take into account pharmacists' previous research experience when recruiting pharmacists into research projects. In the case of pharmacists with research experience, emphasis should be on promoting factors that facilitate participation. In the case of pharmacists with little research experience, emphasis should be on reducing barriers to participation.     

Doctors' and pharmacists' attitudes to the use of sugar‐free and sugar‐containing medicines in the elderly

Background — Much progress has been made towards the prescribing and dispensing of sugar‐free alternatives for medicines used long‐term in children. However, older people may also take sugar‐containing medicines and those with natural teeth are at risk of dental caries. Objective — To assess the knowledge and attitudes of health professionals with regard to the use of sugar‐free medicines with prolonged oral clearance in elderly people. Method — Postal questionnaire survey of three groups of health professionals (general practitioners, community pharmacists, consultant geriatricians). Statistical analysis using factor analysis, Mann Whitney U test and Kruskal Wallis test. Setting — Five districts of north‐east England. Key findings — The overall response rate was 66 per cent (349 responses). Support for the use of sugar‐free medicines was greater among GPs than pharmacists (P=0.014). There was general agreement that, wherever possible, pharmacists should dispense sugar‐free medicines for elderly people, although more GPs (P<0.0001) and consultant geriatricians (P=0.024) agreed than pharmacists. More pharmacists than GPs believed sugar‐free medicines to be more expensive although there was general uncertainty about whether this deters doctors and pharmacists from using them. There was a good understanding of the role of sugars in medicines in the aetiology of dental disease, although respondents felt that elderly people were unaware of this link. Only 51 per cent of respondents agreed that government should subsidise sugar‐free medicines production. Ninety‐four per cent felt that the pharmaceutical industry should produce more sugar‐free products. Conclusion — Although there is support for the sugar‐free option, there is a need to raise the awareness of health professionals to barriers which currently discourage utilisation, and to encourage a more multi‐professional approach in the education of health professionals, health care providers, manufacturers and regulators with regard to sugar control in medicines use and related regulatory issues.     

Internet networking for pharmacists: an evaluation of a mailing list for UK pharmacists

Objective To analyse the content of messages to an internet mailing list for UK pharmacists and to ascertain if the list was performing a continuing professional development (CPD) function. Method For one month all messages to the main list were categorised by topic; details of the gender of the correspondent and their sector of the profession were noted. Members were surveyed using an internet questionnaire. Setting The population of subscribers to the mailing list at http:www.private‐rx.com Key findings The top three categories of e‐mails posted to the list were clinical pharmacy (20%), pharmacy politics (18%) and non‐pharmacy chat (14%). Other subjects included legal issues, the Drug Tariff, government policy, business, risk management and e‐mails of a personal and supportive nature. The survey obtained a 46% response rate. Ninety‐eight per cent of respondents found the list valuable. Respondents reported increased face to face and Internet contact with other pharmacists after joining the list. Forty‐four per cent of respondents said their practice had changed as a result of information gained from the mailing list. Qualitative data self‐reported by respondents indicated increased self‐perceived competence, confidence, knowledge and skills. Approaches to CPD had also been re‐examined. Listening to peers' views and overcoming isolation was seen as important. Conclusion Private‐Rx provided pharmacists with a rapid route for information gain, had perceived benefits and appeared to have brought about changes in practice. Internet discussion enables CPD without the restriction of time or place and reaches pharmacists who are under‐represented in formal education programmes.     

Cross-sectoral pharmacotherapeutic coherence in the Netherlands

Objectives — To measure the extent of pharmacotherapeutic coherence across sectors of Dutch health care from the hospitals' perspective, and to identify perceived markers of coherence and barriers to improvement Methods — Telephone interviews were carried out with hospital pharmacists (76), community pharmacists (5), and clinical pharmacologists (9) affiliated to pharmacies serving 120 Dutch general hospitals. Coherence between (a) hospital and general practice, (b) hospital and nursing home practice, (c) hospitals, and (d) hospital inpatient and outpatient practice was reported and assessed against a set of indicators Results — Almost all hospitals (93 per cent) had formulary agreements or prescribing policies in place and 86 per cent of these had a printed hospital drug formulary (HDF). Over 50 per cent of hospitals reported that they had established coherence with nursing home practice and/or with other hospitals. Less than half of the hospitals had established coherence with general practice. Few hospitals reported activities to review outpatient prescribing and its implications for follow-on prescribing in primary care. Reported barriers to increasing coherence could be classed into three categories: economic, organisational and social. Suggestions to enhance coherence included influencing professionals' practice through training, and greater use of regional and national policies on prescribing Conclusion — Therapeutic coherence within Dutch health care is far from ideal. The discrepancy between the actual and desired extent of coherence arises from organisational and economic barriers. To date, activities in this area have relied on professional proactivity rather than a structured approach. To move forward, (dis)incentives should be created for health care providers and professionals across all sectors, including pharmacists and prescribers     

Attitudes of community pharmacists in the Netherlands towards adverse drug reaction reporting

Objective — To gain insight into the attitude and behaviour of community pharmacists in the Netherlands with respect to the reporting of adverse drug reactions (ADRs). Method — A questionnaire survey was conducted among a stratified random sample of 200 community pharmacists from the membership list of the Royal Dutch Society for the Advancement of Pharmacy. The structured questionnaire covered knowledge of the Dutch ADR reporting system, attitudes to involvement in reporting ADRs and self‐reported behaviour. Demographic details were requested and used to assess the representativeness of responders in relation to the total population of Dutch community pharmacists. The number of self‐reported ADR reports was compared with those actually received by the nation's ADR centre. Key findings — The response rate was 73 per cent (n=147) after one reminder. Community pharmacists regarded the reporting of ADRs as an integral part of their professional duties and they did not report experiencing any major barriers to reporting. This is reflected in the frequency and number of ADR reports received by the national pharmacovigilance centre. Comparison of pharmacists' self‐reported numbers of ADR reports with actual reports received indicated that pharmacists overestimated the number of reports they made. The most frequently mentioned barriers to reporting were: the adverse effect assumed to be already known (32 per cent), the reporting procedure too time consuming (25 per cent), and uncertainty concerning the causal relationship between ADR and drug (25 per cent). Feedback was mentioned most commonly as the chief impetus for reporting, and this referred both to feedback on the report submitted and general feedback as provided in publications. Although consultation with the attending clinician before submitting a report is not compulsory in the Netherlands, 55 per cent of the pharmacists saw this as an important aspect in the reporting process. Conclusions — Community pharmacists in the Netherlands are knowledgeable about reporting ADRs and highly motivated to do so. This positive attitude towards reporting adverse events is based on the established tradition of pharmacist reporting in the Netherlands.     

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.     

A changing professional profile: ethnicity and gender issues in pharmacy employment in the United Kingdom

Objective — This research was conducted to determine whether there were significant differences between the career profiles and ambitions of United Kingdom pharmacists from different ethnic and gender sub-populations. The results were subsequently analysed to determine whether any differences found between sub-populations had varied over time. Method — The research methodology employed a postal survey and interviews, to measure parameters relating to pharmacists' current careers, career histories and career ambitions. Questionnaires were distributed to 500 ethnic minority pharmacists and 500 non-ethnic minority pharmacists; there were 1,867 valid returns. Twenty-seven ethnic minority community pharmacists working in one inner city area were interviewed. Setting — The sample for the postal survey was identified from a surname analysis of the Register of Pharmaceutical Chemists. Key findings — Ethnic minority (mainly Asian) pharmacists accounted for 15 per cent of UK pharmacists. Of pharmacists aged under 30 years, 72 per cent of white pharmacists and 50 per cent of ethnic minority pharmacists were female. Both male and female community pharmacists from ethnic minorities favoured ownership roles relative to white pharmacists in all measured age groups. Management roles were favoured by both white male and female pharmacists, while locum roles were more frequently undertaken by white female pharmacists. Family ties were found to have a relatively strong influence on the careers of ethnic minority pharmacists. Conclusion — We speculate that family involvement may have enhanced the availability of both human and financial capital for business start-up, but find indications that this influence may not persist over time. In hospital pharmacy, there were indications of underachievement and career anxiety among pharmacists from ethnic minorities, the proportion of hospital pharmacy managers from ethnic minorities being disproportionately low. Attention is drawn to some policy implications, notably for training, flexible working patterns and the need for demographic scenario planning in the profession.     

The training experience of primary care pharmacists

Objectives — To map the tasks, activities and training provision for primary care pharmacists (PCPs) and to identify perceived future training needs. Methods — Survey undertaken in 1998/1999 using a pre‐piloted, postal, self‐completion questionnaire to two samples of PCPs. Setting — PCPs in (a) the West Midlands and (b) England (outside West Midlands). Key findings — The response rate was 66 per cent. A majority (68 per cent) had worked in the role for less than two years. Eighty per cent had some form of continuing education or training for the role although only 50 per cent had a formal qualification. Over two‐thirds had contributed to the funding of their training, with one‐third providing all funding. Seventy‐four per cent of PCPs agreed that pharmacists should go through a procedure to ensure competence (accreditation) before being allowed to work for a general medical practice or primary care group. Views on the need for formal education/training prior to work differed: 82 per cent of those with formal qualifications, but only 46 per cent of those without, considered that this should be a requirement. There was general agreement that training/education had met training needs. Views on future training closely reflected previous training experiences, with a focus upon pharmaceutical roles rather than upon generic skill development and the acquisition of management skills. Conclusions — The study provides a snapshot in time of the experience of pioneer PCPs and the training available to them. PCPs will need further training or updating if they are to provide the wider roles required by the developing needs of the National Health Service. Consideration should be given to formal recognition of the training of PCPs in order to assure competence. The expectation that pharmacists should fund their own training is likely to be a barrier to uptake of training and uncertainties over funding will militate against consistency of training.     

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.     

Workcoping and homecoping: achieving a balance in part‐time community pharmacy

Objectives — (1) To explore different concepts of part‐time work by means of a study of part‐time work in community pharmacy; (2) to ascertain the complexity and diversity of part‐time work patterns; (3) to consider the strategies employed by part‐time pharmacists to make their part‐time working possible. Methods — Records of part‐time work in community pharmacy were examined. A quantitative survey was conducted by sending a postal self‐completion questionnaire to 975 pharmacists. There were 727 valid responses. Qualitative semi‐structured interviews were conducted with 33 community pharmacists, identified from the survey as working part time. The emphasis was on data representing the part‐timers' own perceptions of their work and careers. Setting — The total membership of two Midlands branches of the Royal Pharmaceutical Society of Great Britain. Key findings — Of the 230 pharmacists (31 per cent of all respondents) who worked part time, 200 (140 women; 60 men) worked in community pharmacy. There was a considerable range and variability of working patterns, the clearest division being between employed (70) and self‐employed (122) part‐timers. The strategies used to cope with work and family responsibilities by both men and women of different ages and under different circumstances were sometimes very complex. The terms “workcoping” and “homecoping” were devised to describe these strategies. Conclusions — Existing concepts of part‐time work do not fully explain the complexities revealed in this study. Many part‐time pharmacists believed they had achieved a balance which was both professionally satisfying and socially responsible. They employed strategies which enabled them to maintain this balance and keep control over their lives.     

Community pharmacy management of acute diarrhoea in adults

Objective — To study the community pharmacy management of acute diarrhoea in adults and to explore the attitudes and beliefs of community pharmacists towards the management of this common condition. Method — Data were collected over a four-week period on the incidence and presentation of acute diarrhoea in adults by pharmacy staff in 17 pharmacies who were participating in a community pharmacy research panel. A postal survey on attitudes and beliefs about the treatment of diarrhoea was sent to a random sample of 2,500 community pharmacists. Key findings — A total of 1,401 community pharmacists responded to the survey (response rate 59 per cent). Their responses suggested ambiguity in the treatment of acute diarrhoea in community pharmacy, particularly in relation to attitudes to oral rehydration and anti-motility drugs. Although the majority of pharmacists surveyed were aware of recommendations to treat adult patients with acute diarrhoea with oral rehydration, in practice many stated that they often sold an anti-motility treatment, a finding borne out by the high percentage of anti-motility sales (61 per cent) in the earlier part of the study. The decision to sell or recommend an anti-motility drug was often motivated by the patient's circumstances and their need for immediate symptomatic relief. Conclusion — This study suggests that the community pharmacy management of acute diarrhoea is characterised by ambiguity and pragmatism. Existing guidelines for the treatment of diarrhoea fail to take into account the social context in which pharmacists operate, particularly in relation to patient demand and the need for symptom relief.     

Motivations for and barriers to community pharmacy services for drug misusers

Objective — To investigate what motivated pharmacists to provide drug misuse services and, conversely, what barriers prevented service provision. Method — Telephone interviews were conducted with a purposive sample of 45 volunteering respondents to a national questionnaire survey to gain in-depth information. Setting — Forty-five community pharmacists in Scotland. Key findings — Pharmacists were found to be motivated to provide services by an awareness of the needs of the community, a desire to reduce the spread of blood-borne diseases and a desire to expand their professional services. Barriers to service provision were concerns for the effect on other customers, safety, workload and poor remuneration. Conclusion — The active encouragement of local health boards, professional endorsement, further education and remuneration might encourage pharmacists' participation in drug misuse services. This would enable the principles of harm reduction to be widely practised.