Children's over‐the‐counter medicines pharmacoepidemiological (COPE) study

Objective To quantify the extent and types of minor ailments in children that were presented at community pharmacies and the types of over‐the‐counter (OTC) medicines purchased in response to these ailments. Method Data on all requests and sales of OTC medicines for children (aged 16 years and under) and consultations for minor ailments in children were recorded in eight community pharmacies for one week every month over a 12‐month period. Participants were members of the public who consulted the pharmacists or other pharmacy staff in the community pharmacies. Key findings A total of 976 consultations was recorded with 61.5% requesting an OTC medicine by name and 38.5% by symptom presentation. An average of 10.2 consultations was made per pharmacy per week. Requests for treatment were usually made within five days of symptom occurrence (86%). Most of the consultations were made by mothers (75%), although 17% were by fathers. The most commonly purchased OTC medicine was paracetamol. There were five requests for aspirin and one was for a 2‐year old child. A total of 62 cases (6%) was referred back to the child's primary care physician (general practitioner). Conclusions Symptoms related to cough and cold were the most common problems in children presenting to community pharmacies for treatment. Paracetamol was the most widely used OTC medicine in children. Pharmacy staff do question the request for OTC medicines such as aspirin, to ensure its safe use. Community pharmacies play an important role as the first port of call for advice on minor ailments in children and have an opportunity to provide health promotion to carers of children.     

Over‐the‐counter ibuprofen: how and why is it used?

Objectives — To pilot an over‐the‐counter (OTC) medicine pharmacovigilance project, using ibuprofen as a model. Method — All users of any tablet or capsule form of ibuprofen (excluding compound products) purchased from 61 participating community pharmacies, aged ≥18 years and able to give informed consent, were eligible to join the study. A postal questionnaire one week after the index purchase monitored the follow‐up rate, drug usage, past medical history, concurrent medication, symptoms and health service utilisation. Setting — Primary care: community pharmacies in Grampian, Scotland. Key findings — A total of 443/544 (81 per cent) questionnaires were completed. The recommended daily dose of OTC ibuprofen (1,200mg) was exceeded by 35 customers (8 per cent) on at least one day and the recommended maximum daily dose that can be prescribed by a physician (2,400mg) was exceeded on five occasions. During the seven days after the index purchase, ibuprofen was used by 15 customers (4 per cent) with an active or past history of peptic ulcer, and 30 (7 per cent) with an active or past history of asthma. Thirty‐eight per cent had purchased ibuprofen for a chronic condition and 32 per cent were still taking it at the end of the initial seven‐day period. Twenty‐eight of 412 customers (7 per cent) sought advice during the seven‐day period about at least one symptom: 13 consulted their general practitioner, 12 consulted a pharmacist, two consulted both their GP and a pharmacist, and one consulted a hospital doctor. Some of these consultations (23/28, 82 per cent) might have related to an adverse reaction to ibuprofen: 11 customers (3 per cent) consulted about lower abdominal symptoms, nine about gastric symptoms and three about wheeziness. Conclusions — This pilot study identifies instances of contraindicated and excessive use of OTC ibuprofen, indicating a need for pharmacovigilance studies of OTC medicines; it also demonstrates the feasibility of a major study.     

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.     

Basing pharmacy counselling on the perspective of the angina pectoris patient

Aim of the study: A participatory action research study design was developed and tested in 40 Danish internship pharmacies as part of a 3-year study supported by the Research Centre for Quality in Medicine Use. The aim of the study was to create a foundation for improving the quality of counselling practice in pharmacies by comparing the pharmacy staff's views on, knowledge of and behaviour towards a specific patient group with the knowledge, perceptions and medication use of the same patients. Method: Pharmacy students in their fourth year collected data for the study. In 1999, the students carried out 123 qualitative interviews with angina pectoris patients and collected 569 questionnaires from pharmacy staff in 40 internship pharmacies. Results: The results indicate that discrepancies exist between the patients' and pharmacy staff's perspectives on important issues such as knowledge about medicines (patients)/provision of information about medicines (pharmacy staff), experienced side effects (patients)/information about side effects (pharmacy staff), knowledge on prevention and lifestyle (patients)/information on lifestyle and prevention (pharmacy staff) and expectations of pharmacies (patients)/initiatives started in pharmacies (pharmacy staff). Conclusion: The study gives reason to believe that angina pectoris patients might benefit if pharmacies provided more information on the relationship between lifestyle factors and angina pectoris, the possible side effects of medicines and the function of medicines.     

Virtual pharmacist interventions on abuse of over-the-counter medications during COVID-19 versus traditional pharmacist interventions

ObjectivesThis study aimed to investigate the frequency, nature, and clinical significance of pharmacist interventions on over-the-counter (OTC) medicines with abuse potential across community pharmacies with and without virtual care.MethodsIn this prospective observational study, a trained research team observed the dispensary teams of 12 community pharmacies in the United Arab Emirates (UAE), 6 of which were operating virtual pharmacy care. A standardized data collection form was used to include information about dispensing of OTC medicines and pharmacist interventions on those with abuse/misuse potential. The clinical significance of the interventions was evaluated by a multidisciplinary committee.ResultsThe frequency of pharmacist interventions on OTC medicines with abuse potential across pharmacies with and without virtual services was 83.2% versus 91.0%, respectively, whereas the frequency of pharmacist interventions on OTC medicines with misuse potential across pharmacies with and without virtual services was 79.8% versus 41.2%, respectively. The proportions of clinically significant interventions across pharmacies with and without virtual services were 19.7% versus 10.5%, respectively. Cough medicines were dispensed significantly more across pharmacies with virtual care than across pharmacies without virtual care (25.6% vs. 9.7%, respectively; P = 0.04). Asking the patient to seek the advice of an addiction specialist (adjusted odds ratio = 4.11; P = 0.001) versus refusing to sell the drug was more likely to be associated with pharmacies with virtual services than with pharmacies operating traditional pharmacy services.ConclusionVirtual pharmaceutical care is a potential approach to reduce the abuse/misuse of OTC medicines but needs some improvements regarding detection of these cases. The UAE is the first country in the region to implement and regulate virtual pharmacy practice.     

Cost implications of the delivery of pharmaceutical care services through Australian community pharmacies

Objective — To conduct a cost analysis of the Community Pharmacy Model Practices project in South Australia. Method — As part of a prospective participatory action research programme, the cost analysis identified the main items of fixed and variable costs and of potential cost savings, and expressed them in a framework to aid decision-making. Setting — Ten community pharmacy practices in primary care: five provided generalist medication management, two diabetes care, two asthma care, and one wound management. Services were provided to 411 pharmacy patients (median age 75; 70 per cent female) in the community, resident in a range of nursing home and hostel accommodation, or patients in hospital. There was a maximum of 11 months' observation. Key findings — All the five medication management pharmacies, one of the asthma management pharmacies, and the wound management pharmacy, but neither of the diabetes management pharmacies, were able to generate potential resource savings greater than their total variable costs, so that net resource savings were available to make a contribution to absorbing fixed costs. Conclusions — The provision of medication management services by community pharmacies working to a well-defined, systematic process of patient care within a primary care setting can be expected to reduce overall direct costs to the health system. Similar findings are likely with wound management in pharmacy care, but the results are less certain for asthma management and diabetes management. These results, when considered in the light of possible gains in survival and quality of life, are of significant interest to policymakers concerned with controlling health system costs.     

Pharmacy support staff involvement in,and attitudes towards,pharmacy‐based services for drug misusers

Objective This study aimed to examine involvement of pharmacy support staff in delivering services to drug misusers; to quantify their participation in related training; and to examine relationships between attitudes, practice experience and training. Methods The setting was a random sample of 10% of UK community pharmacies (n = 1218) using a postal questionnaire with two reminders. Pharmacy managers were used as gate‐keepers to access pharmacy support staff, which included dispensary technicians and medicines counter assistants. Key findings Six hundred and ninety (56.7%) pharmacies responded, and 1976 completed questionnaires were returned from 610 (50.1%) pharmacies. A further 80 (6.6%) opted out. Three‐fifths of staff had no input into decisions about whether their pharmacy provided services for drug misusers. One‐third working in pharmacies that provide services were uncertain or negative about whether their pharmacy should do so. Staff were more involved in needle exchange (91%) and decisions to sell needles (95%) than supervising consumption of therapies (64%) or handing out dispensed medicines to drug misusers (73%), suggesting managers perceive needle exchange and sales as appropriate roles. Three‐quarters of those working in pharmacies that provide services had not received any training to do so. Those who had undertaken training and who worked in pharmacies that provided services had significantly more positive attitudes compared to those had not undertaken training but also worked in pharmacies that provided services, or those who had undertaken training but did not provide services. Conclusions Pharmacy support staff were involved extensively in drug‐misuse services but the majority had not been trained to do so. Attitudes were more positive in those who were involved in service provision and had undertaken training. The findings suggest a need for more extensive training and for further exploration of the views of managers on appropriate roles, particularly the clinical versus supply nature of needle exchange. This is timely given the recent publication of guidelines by the National Institute of Health and Clinical Excellence (NICE) on needle exchange.     

Pharmacists solving problems in asthma management — experiences from a one‐year intervention programme in Finland

Objective — To study the effect of an intervention provided by community pharmacists on detection and resolution of problems in asthma patients' self‐management and to study patients' opinions about the perceived usefulness of the pharmacists' input. Method — A one‐year intervention study was conducted with scheduled visits and follow‐ups at baseline, four, eight and 12 months. Study patients (n=28) acted as their own controls. Setting — Four communities and community pharmacies in different parts of Finland. Key findings — At study baseline, all patients had at least one documented problem, the most commonly reported being problems with medication, side effects, problems with inhalation devices and not using asthma medicines according to the physician's instructions. On average, patients had five “intervention” consultations with the pharmacist during the one‐year study. After the intervention, half of the patients reported that their problems had been resolved. The most useful areas of advice were considered by the patients to be instructions about changing asthma medication according to asthma symptoms and management of asthma symptoms. Twenty‐five of the 28 patients reported that they were satisfied with the education and counselling provided by pharmacists, a higher number than for physicians or nurses. Conclusion — The findings from this small longitudinal study indicate that community pharmacists can improve asthma patients' treatment by consultations during which they identify and address problems in self‐management of asthma.     

Effect of incentives on recruitment and response rate in a community-based pharmacy practice study

Objectives — To study the feasibility of carrying out a community pharmacy-based drug utilisation study of H₂ antagonists and alginate-containing preparations, and to study the effect of two methodological variations — payment of pharmacists and the free issue of medicines — on recruitment rates and response rates. Method — Pharmacists were asked to recruit customers into the study after deciding that one of these products was appropriate for purchase. Customers were asked to provide their signed consent, their name, address and information about their general practitioner and to complete an initial questionnaire provided by the pharmacist and a second questionnaire which was sent out by the researchers two weeks later. In 20 of the pharmacies the medicines were offered free once customers had agreed to participate; in the remaining pharmacies, customers paid the normal retail price for the product. All pharmacies received incentive payments for each of the three months in the second half of the study period in which they recruited five or more customers. Setting — Thirty-nine community pharmacies in Scotland and Wales. Key findings — Similar numbers of customers were recruited to the study irrespective of whether free medicines were offered. Significantly more (P<0.001) customers recruited by pharmacies providing free medicines returned both the first (339/383) and second questionnaires (264) than those recruited by pharmacies not providing free medicines (269 and 208/384, respectively). Of the 608 customers who returned the first questionnaire and were subsequently issued with a second questionnaire, 77.6 per cent returned it; there was no difference in return rates between customers who received free medicines and those who did not. Incentive payments to pharmacies resulted in a small increase (14 per cent) in recruitment rate in the second half of the study and no difference in response rates from the customers recruited. Conclusion — The study established the feasibility of undertaking drug utilisation studies with high response rates in community pharmacies. The provision of free medicines increased customer response rates, but incentive payments for pharmacists showed no clear effect on recruitment rates.     

Evaluation of a practice‐based research design using an asthma care model

Objective — To evaluate a quasi‐experimental research design using a practice‐based model in community pharmacy by comparing baseline characteristics of the control and intervention samples used. Methods — An asthma care model was chosen to trial the use of a quasi‐experimental design. Two geographically separate areas were selected as intervention and control areas. Pharmacists from the intervention area were trained and provided with resources to set up asthma specialty practices and recruit intervention patients. Control area pharmacists were not offered training but were requested to recruit patients with asthma to act as a control sample to data being collected from the intervention population. The research design aimed to establish equivalence between the two groups. In both cases, data were gathered using an “asthma file,” which consisted of a patient demographics and asthma information form and a series of previously validated questionnaires to examine humanistic outcomes. Setting — Community pharmacies in two non‐urban areas of New South Wales, Australia. Key findings — Nine of 15 intervention pharmacies recruited 52 patients into the study and 11 of 20 control pharmacies recruited 50 patients. No apparent differences existed between the two samples with respect to the humanistic parameters of asthma‐related quality of life, asthma general knowledge and perceived control of asthma. In terms of asthma severity and disease‐specific parameters, such as asthma‐related hospitalisations, no statistically significant differences were found. Control and intervention groups were thus found to be equivalent for the purposes of the study. Conclusion — The data support the use of the quasi‐experimental research method employed in the study.