An evaluation of a rural community pharmacy‐based smoking‐cessation counselling and nicotine replacement therapy initiative

Objective To evaluate the efficiency and the effectiveness of a rural community pharmacy‐based smoking‐cessation counselling and nicotine replacement therapy (NRT) initiative. Setting Community pharmacies in NHS Highland in the north of Scotland. Key findings Most clients (77%) smoked cigarettes for an average of 34 pack‐years ranging from 1 to 174 pack‐years. Almost three‐quarters (73%) of the NRT prescribed was in the form of patches. Most respondents (91%) claimed pharmacists' advice was useful, and most (65%) thought that the pharmacist was their preferred healthcare professional for smoking‐cessation advice because of ease of access. At the end of week four, 45% of clients reported that they had stopped smoking, this fell to 35% at the end of week 12, and at 44 weeks the point prevalent abstinence rate was 15.8%. Of those that did not stop, 19% reduced their smoking level. This initiative cost £525 for each quitter. Thirteen quality criteria were defined in the assessment framework of which six were achieved. Conclusions There are no established criteria for evaluating community pharmacy‐based smoking‐cessation initiatives currently available, neither are reductions in smoking levels reported. Enhancing the role of the community pharmacist to include health improvement improves the interface between healthcare and the consumer, and helps to meet the national recommendations. Community pharmacy‐based smoking‐cessation initiatives impact on smoking‐cessation targets, allow for the variety of services relevant to the needs of the population and are part of the key to making a difference. Methods A review of the literature on community pharmacy‐based smoking‐cessation initiatives informed a performance assessment framework. Data for evaluation were collected through client records, questionnaires and semi‐structured interviews of the stakeholders, and a cost‐effectiveness analysis was undertaken.     

Analysis of the information and support needs generated by a community pharmacy‐based methadone treatment programme

Background — Methadone treatment has been provided in Ireland since 1998 under the methadone protocol scheme. Two liaison pharmacists were employed by the Eastern Health Board to interface between pharmacists dispensing methadone in primary and tertiary care. Objective — To analyse and review the inquiries received and addressed by one liaison pharmacist in the first year of operation of a community pharmacy‐based methadone treatment scheme. Method — Inquiries received were recorded by the pharmacist using a standard data collection form. Using content analysis, key themes were identified and each inquiry was classified. Data were analysed using standard computer software. Key findings — Two primary categories of liaison inquiry were addressed: “patient‐related” inquiries, requiring the organisation of community pharmacy‐based methadone dispensing services for patients, and “pharmacy‐related” inquiries, which were requests from community pharmacists for information or support. Two thirds of the inquiries were “patient‐related.” The primary users of the liaison service were prescribers employed by the addiction services and community pharmacists. Conclusion — The liaison pharmacy service handled diverse inquiries, with an emphasis on the facilitation of the provision of pharmaceutical care for patients requiring community pharmacy‐based methadone dispensing services. The liaison service had a significant secondary role in the provision of support and information for community pharmacists. The study findings are of relevance to those involved in developing and introducing primary care‐based services for drug misusers.     

The feasibility of providing community pharmacy‐based services for alcohol misuse: A literature review

Objectives Excessive consumption of alcohol is a major public health concern. The use of community pharmacies and pharmacists as sources of public health information and services is gaining greater recognition. The objective of this review was to provide an overview of the evidence on the feasibility, effectiveness and acceptability of providing community pharmacy‐based services to address the excessive consumption of alcohol. Methods Electronic databases were searched for the period 1996–2007 to identify relevant evidence. Searches were also conducted of relevant pharmacy and addiction journals. Information was sought from key contacts in pharmacy and alcohol research. Studies were included if they were conducted in a community pharmacy setting. Key findings The review comprised three feasibility studies which included 14 pharmacies and 500 customers. Non‐significant reductions in alcohol consumption were reported with two studies following brief interventions by pharmacists. Between 30% and 53% of pharmacy customers were identified as having hazardous or harmful drinking behaviour. Customer opinion of the pharmacy‐based alcohol services was not reported. Conclusions There has been little empirical evaluation of the effectiveness of community pharmacy‐based services for alcohol misuse. The evidence presented in this review suggests that community pharmacy‐based screening is feasible. Organisations and individuals involved with tackling excessive alcohol consumption should consider the inclusion of community pharmacies and pharmacists as part of their strategies to address this problem. Large‐scale studies are needed to evaluate the short‐ and long‐term effects and cost‐effectiveness of community pharmacy‐based interventions to reduce excessive alcohol consumption, as well as to explore the acceptability of the service to users.     

Evaluation of patient opinions in a pharmacy‐level intervention study

Objective To explore patients' satisfaction with their community pharmacy's services and to evaluate the effects of an intervention programme in which a trained technician organised patient education activities in the pharmacy. Method We surveyed patients visiting the participating pharmacies at three stages: at the start of the intervention period (0 months, T0), at the end (after 12 months, T1), and 12 months after the intervention had been completed (24 months from baseline, T2). At each stage, 500 questionnaires were distributed by each pharmacy. Setting 28 Dutch community pharmacies: 14 intervention and 14 controls. Key findings The response rates were 54%, 44% and 43% at T0, T1 and T2, respectively. Baseline data showed that patients reported satisfaction with helpfulness, waiting time, ease of asking questions, answers to questions, and patient leaflets provided. Around two thirds (59.5%) of the patients said they would ask a pharmacy employee questions if they were concerned about side effects of their medication. Asking questions was not reported to be difficult for most patients (88.9%). The reasons most often given for experiencing difficulties with asking questions were related to lack of privacy (16.9% of all patients), waiting time of other patients (8.8%) and busy pharmacy employees (6.7%). The most frequently reported reason for being less satisfied with the answers to questions was receiving too little information (7.5%). Our analyses showed a significant improvement only on the outcome variable “helpfulness” experienced by patients between 0 (T0) and 12 months (T1), and this was found to be sustained one year later (T2). Conclusion The overall findings on patient satisfaction showed that almost two‐thirds of the respondents saw the pharmacy as a source of information about medication. Community pharmacies clearly have an important role in providing such information. Lack of privacy was the most common reason for patients reporting difficulties in asking questions about medicines and this needs pharmacists' attention. Our analysis showed that the intervention had an effect on “helpfulness” experienced by patients, which slightly increased in the intervention period (T0‐T1 differences) and appeared to have remained at the higher level one year later (T2).     

Effectiveness and acceptability of community pharmacy‐based interventions in type 2 diabetes: a critical review of intervention design,pharmacist and patient perspectives

Objective It is generally accepted that greater use could be made of community pharmacy‐based interventions. Diabetes care has been proposed as an area for enhanced community pharmacy involvement. However there is no published structured review of available evidence of either effectiveness or acceptability. This review aims to identify and assess such evidence and to synthesise findings to inform the design and delivery of future community pharmacy‐based interventions in diabetes care. Method A systematic search of published literature was conducted using a defined search strategy, electronic databases and targeted hand searching of non Index Medicus journals. The search dates were 1990–2003. The scope was international and we included only articles in the English language. Key findings Seven experimental studies which tested community pharmacy‐based interventions were reviewed. Four different primary outcomes were studied: diabetes control (three studies), adherence (two studies), medication problems (one study) and patient knowledge (one study). Six studies showed positive outcomes, and the findings were statistically significant in two. The theoretical basis of the interventions was unclear. Only one study included a cost‐effectiveness analysis, and the interventions were provided free of charge to patients in all seven studies. Nine attitudinal studies were included, five involving pharmacists and four with patients. Members of the public do not currently expect community pharmacists to become involved in discussions about diabetes treatment and its monitoring, but when such services are offered they are well used by patients. Pharmacists were positive about the provision of services for people with diabetes. Patients' experiences indicated that community pharmacists overestimate their current provision of information and advice to people with diabetes. Conclusions There is limited evidence of effectiveness of community pharmacy‐based interventions in diabetes care. Components of pharmacy‐based intervention which appear to contribute to effectiveness include: elicitation and discussion of patient beliefs about their diabetes and its treatment; discussion of how patients are using their medicines; review of haemoglobin A_1c (HbA_1c) levels; and assessing and supporting necessary lifestyle changes. Further research is needed and future interventions need to incorporate evidence from the literature on patient and pharmacist perspectives on diabetes. The findings of this review will be useful to researchers and service planners involved in developing community pharmacy‐based diabetes care.     

Impact of perceived innovation characteristics on adoption of pharmacy‐based in‐house immunization services

Objectives An in‐house immunization service in which staff pharmacists administer vaccines was conceptualized as an innovation. Prior to making adoption decisions, community pharmacies evaluated characteristics of in‐house immunization services. This study examined the impact of three specific characteristics (perceived benefit, perceived compatibility and perceived complexity) of in‐house immunization services on community pharmacies' adoption decisions. Methods A multi‐stage mixed‐mode survey design was used to collect data from key informants of community pharmacies in Washington State, USA. Key informants included pharmacy managers or pharmacists‐on‐duty who were able to answer questions related to immunization activities in their pharmacies. Perceived characteristics of in‐house immunization services and pharmacy adoption decisions were measured in 2004 and in 2006–2007, respectively. Key findings Each perceived characteristic individually predicted adoption of in‐house immunization services. When all three characteristics were included in logistic regression, perceived benefit was the only significant predictor of in‐house immunization service adoption. Conclusions Appropriate strategies, particularly promoting the benefit of in‐house immunization services, should be implemented. The proposed model and findings may be applicable to other pharmacy‐based innovative practices or other public health initiatives. We recommend that organizational leaders, researchers and practitioners consider the impact of perceived benefit and incorporate it when they design strategies to foster adoption of innovative practices. Doing this may increase the number of adopters and also increase diffusion rates for innovative services.