Supply of over‐the‐counter weight‐loss products from community pharmacies

Objectives The aim was to ascertain the availability of over‐the‐counter (OTC) weight‐loss products from community pharmacies and other retail outlets in a large conurbation, and to determine the knowledge and practices of pharmacy staff in the supply of OTC weight‐loss products. Method The setting was one primary care trust in England. We used a cross‐sectional survey of 123 community pharmacies, 12 health stores and 64 supermarkets, plus telephone interview of the pharmacists. Key findings Over two‐thirds of community pharmacies (69%) and health stores (67%) but few supermarkets (8%) stocked one or more OTC weight‐loss products. In total, 73 different products were available from pharmacies, most of which (50) were claimed by manufacturers to be appetite suppressants. Seventy‐eight pharmacists were interviewed, of whom 57 stocked OTC weight‐loss products. Of these 57, only two claimed to undertake any measurements before supplying the products and 33 had no supporting materials/information about the products, although 38 claimed to provide advice. None of the 57 pharmacists had undertaken any specific training in relation to weight loss. Only 44% of all those interviewed considered OTC weight‐loss products to be useful, with even fewer (35%) considering them to be safe. Conclusions Community pharmacies are a major distributor of OTC weight‐loss products, despite the lack of evidence of their efficacy and concerns about their safety. Many pharmacists had limited knowledge of the products, placed few restrictions on their supply and viewed training in weight loss as unnecessary. Pharmacists should consider the appropriateness of supplying these products and utilize the opportunities presented to support weight reduction by more effective means.     

Barriers to the provision of needle‐exchange services: a qualitative study in community pharmacies

Objective To investigate the attitudes of pharmacists to the provision of needle‐exchange services (NES) at community pharmacies and, if barriers exist, explore means by which they may be overcome. Setting Twenty‐one community pharmacies across Grampian in North East Scotland during May and June 2005. Method Semi‐structured face‐to‐face interviews conducted with 24 pharmacists. Key findings Newly identified barriers included the negative influence of security staff, a local policy against NES provision and a lack of awareness of other services available for drug users. Conclusion Training packages for all health professionals working with drug users and awareness training for security staff are required if the identified barriers are to be overcome. ‘Hands‐on’ training and experience of NES for pharmacists and their staff should be available. Suggestions made by pharmacists for NES provision in general practitioner surgeries or community hospitals and the development of automated services should be considered.     

Public knowledge and awareness of cardiovascular disease and its risk factors: a cross‐sectional study of 1000 Jordanians

Objective To assess the level of the current knowledge and understanding of cardiovascular disease (CVD) among Jordan's general public, their behaviour towards CVD and the factors associated with different CVD knowledge levels. Methods The data in the present study were collected using an interview‐administered questionnaire. One thousand members of the general public were interviewed face to face. CVD knowledge was computed as a continuous variable. Key findings The present study reports limited public knowledge and awareness of CVD. Participants were more likely to have better CVD knowledge scores if they were non‐smokers, always or often paid attention to their diet, reported having an ‘about right’ weight, occupied a very high socioeconomic level, held a university degree and had positive family history of CVD. Participants indicated that the community pharmacists had to play a role in helping patients manage their prescribed medicines; however, they did not recognise the community pharmacists' role in other areas of CVD prevention and management. Conclusion The present study reports that the general public in Jordan has limited knowledge and awareness of CVD. In planning to positively impact CVD prevention and management, community pharmacists must develop and promote effective and accessible services.     

Pharmacists' perceptions of their role in asthma management and barriers to the provision of asthma services

Objectives Few studies have explored pharmacists' perceptions of their potential role in asthma management. This study aimed to investigate community pharmacists' perceptions of their role in the provision of asthma care, to compare the perceptions of metropolitan and regional pharmacists with regards to their role, to identify barriers to the provision of asthma management services and to explore their level of inter‐professional contact. Methods A 29‐item questionnaire was mailed to a convenience sample of community pharmacists. Items included pharmacists' perceptions of their role in asthma management, barriers to pharmacy asthma services and inter‐professional contact. The setting was community pharmacies in metropolitan and rural New South Wales, Australia. Key findings Seventy‐five pharmacists (63% male, 69% in metropolitan pharmacies) returned completed questionnaires (response rate 89%). Pharmacists perceived their role in asthma management along three major dimensions: ‘patient self‐management’, ‘medication use’ and ‘asthma control’. Regional pharmacists described a broader role than metropolitan pharmacists. Most participants perceived time and patient‐related factors to be the main barriers to optimal asthma care with pharmacist's lack of confidence and skills in various aspects of asthma care less important barriers. Almost 70% indicated that they would like more inter‐professional contact regarding the care of patients with asthma. Conclusions Community pharmacists perceived a three‐dimensional role in asthma care with regional pharmacists more likely to embrace a broader role in asthma management compared to metropolitan pharmacists. Pharmacists identified time and patient‐related factors as the major barriers to the provision of asthma services. Future research should explore barriers and facilitators to expansion of the pharmacist's role in asthma management in a holistic way.     

The provision of current and future Healthy Weight Management (HWM) services from community pharmacies: a survey of community pharmacists' attitudes, practice and future possibilities

Objectives The extent to which community pharmacists contribute to the management of the global obesity epidemic is unclear. Local, regional and national obesity management schemes need to be informed by existing services which will be influenced by health professionals' attitudes and willingness to engage in service provision. The purpose of this study was to derive an accurate account of community pharmacists' activities and attitudes towards the provision of current and future Healthy Weight Management (HWM) services. Methods A postal survey was developed and disseminated to all 128 community pharmacies in Grampian, north‐east Scotland. Key findings The response rate was 64.8% (83/128). A range of HWM services was already being provided. The most common services offered were the supply of weight‐loss medication (n = 69, 84.1%) and advice about its use (n = 68, 84.0%). Other services commonly offered were dietary advice (n = 59, 72.8%), physical activity advice (n = 53, 66.3%) and body mass index (BMI) calculation (n = 56, 68.3%). Most pharmacists were confident in measuring weight (n = 78, 93.9%), height (n = 78, 93.9%) and BMI (n = 78, 93.9%). Many pharmacists perceived a need for HWM services in their local area (n = 56, 67.5%) as well as a need to extend these services within their pharmacies (n = 48, 57.9%). Barriers to the provision of HWM services included workload (n = 77, 92.8%) and the need for additional reimbursement (n = 63, 75.9%) and additional staff (n = 49, 59.7%). The pharmacists' perceived training needs included estimation of body fat (n = 67, 81.7%), one‐to‐one consultation skills (n = 60, 73.2%), advice on weight‐loss products (n = 52, 63.4%), measurement of blood cholesterol (n = 51, 63%) and advice on weight‐loss drugs (n = 49, 60.5%). Conclusions Community pharmacies could be an ideal setting for the provision of HWM services. The barriers to service provision need to be addressed. Furthermore, the development of appropriate undergraduate and postgraduate training is required to equip pharmacists and their staff with appropriate knowledge and skills to deliver these services effectively.     

‘At the moment it is just a couple of eccentrics doing it’: concordance in day‐to‐day practice

Objectives To assess the feasibility and acceptability of concordance in pharmacy practice through examination of communication between customers and pharmacists in two community pharmacies in consultations for over‐the‐counter medicines. Method A qualitative pilot study involving data drawn from six sources: audiotaped training session with all the pharmacists involved, observational field work in the pharmacies, audiotaped consultations with pharmacists and customers, debriefing interviews with pharmacists after the consultation, and semi‐structured interviews with customers a few days after their consultation. Setting Two community pharmacies that concentrate their services on medicine advice and dispensing, one in a deprived inner‐city area, the other in a more affluent suburban area of London. Key findings The pharmacists developed a personal understanding of concordance which informed their practice. Customers reported a high level of satisfaction with services they received from the respective pharmacists. Their accounts of the consultations verified the pharmacists' patient‐centredness in their day‐to‐day practice. Conclusion The implementation of a concordance model was possible through the development of a personalised, patient‐centred model which drew on the model of concordance but was adapted in accordance with both structural constraints as well as the personal style of the pharmacists involved.     

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.     

Views of the Scottish general public on community pharmacy weight management services: international implications

Background Obesity has reached pandemic levels, with more than 1.5 billion adults being affected worldwide. In Scotland two-thirds of men and more than half of women are either overweight or obese, placing Scotland overall third behind the United States of America and Mexico. All community pharmacies in Scotland are contracted to provide public health services such as smoking cessation and there is increasing interest in their contribution to weight management. Researching this area in Scotland may provide valuable information to facilitate the development of community pharmacy services in other parts of the UK and internationally. Objectives To describe the views of the Scottish general public on the provision of weight management services via community pharmacies. Setting General public in Scotland. Methods A cross-sectional postal questionnaire survey of 6,000 randomly selected members of the Scottish general public aged 18?years and over. Main outcome measures Views on community pharmacy led weight management services. Results Questionnaires were returned by 20.6% (n?=?1,236). Over half 60.1% (n?=?751) agreed or strongly agreed that they had easy access to pharmacy services in general and around one-third agreed (35%; n?=?438) that it was more convenient to obtain weight management advice from a pharmacist than it is to make an appointment with a GP. Most respondents however lacked awareness of the types of health services available through community pharmacy (13.2%; n?=?162) and would not feel comfortable speaking to a pharmacist or medicines counter assistant about weight related issues (25%; n?=?320). Concerns over privacy (47.3%; n?=?592) and perceived lack of pharmacists?? specialist knowledge (open comments) were identified as potential barriers to service uptake by the general public. Conclusion Overall, respondents appear to be receptive to the idea of accessing weight management services through community pharmacy but a perceived lack of privacy, poor knowledge of pharmacists?? skill level and of public health services available to them may explain the reluctance in the uptake of such services to date. The general public??s views expressed in this study may help to shape future community pharmacy led weight management service provision.     

Are community pharmacists prepared to work extended opening hours?

A 5 per cent cross‐sectional sample of the Royal Pharmaceutical Society's membership was targeted with a self‐completion questionnaire Community pharmacy respondents were asked questions on their views on current pharmacy opening hours and their willingness to work extended opening hours Around one fifth of the community pharmacists sampled believed that patients should have access to at least one community pharmacy 24 hours a day Only 3.4 per cent of community pharmacists sampled were prepared to work at any time over a 24‐hour period With the introduction of more 24‐hour health care services (eg, NHS Direct), there may need to be a change in the attitudes of community pharmacists towards working extended opening hours     

“Each one has their own role”: Exploratory study on consumers’ perceptions about nutritionists services provided in community pharmacies

Obesity and overweight have grown to epidemic proportions in the past decades. To tackle this rising threat to health systems, lifestyle changes and nutritional education have been promoted through specialized programs and nutritional primary health care services. Community pharmacies adjustment to a new paradigm of pharmacy services means that they are not just a place for buying and selling medicines, but increasingly a space for diverse health care services. One such service addresses the weight problems of community pharmacy users through the provision of nutrition consultation services. In Portugal, these consultations are provided by nutritionists, many times under formal agreements with nutritional supplements commercial brands. Methods: The aim of this exploratory study was to characterize the experience of people attending nutrition consultations at two different pharmacies and to understand their perception of the role community pharmacists may have in weight management. To conduct this study, interviews were performed following an interview guide comprised of sociodemographic characterization questions and open-answer questions. Results: Ten people participated in the study, seven females and three males. The average self-reported BMI of the sample was 29.4Kg/m2. The results showed that there is a general satisfaction with nutrition consultations, with all respondents agreeing that community pharmacies are a right place to have these consultations. Accessibility and low cost were found to be the biggest advantages in having nutrition consultations at a pharmacy. On the other hand, these participants felt that the biggest disadvantage was the price of nutritional supplements. Lack of motivation was also seen as a major impediment to continue with the nutrition consultations. When participants were asked about what role community pharmacists may have in weight management, 50% of participants disagreed with the idea of pharmacists providing the service on their own. Conclusion: the results of this study indicate that the degree of satisfaction of those attending the nutrition consultations is high, especially because of pharmacies’ accessibility and proximity, hinting at the idea of efficiency as an important factor driving the demand for new health care services. Pharmacists were viewed as having a gatekeeper role, but the nutrition service provision should be exclusively provided by nutritionists, in an example of successful multidisciplinary practice within the community pharmacy setting. Future studies should focus on the effect these consultations have on the loss or maintenance of weight, including the comparison with service provision in the traditional settings.     

Encouraging safe medication disposal through student pharmacist intervention

ObjectivesTo (1) determine the public's current method of medication disposal, (2) identify the public's knowledge of the environmental impact of inappropriate medication disposal, (3) determine whether student-facilitated education improves the public's awareness of safe medication disposal, and (4) determine whether the public recognizes student pharmacists as a public health information resource for issues such as safe disposal of medications.DesignCross sectional.SettingAlbany, NY, pharmacies during August and September 2009.Participants242 patrons at 13 Albany College of Pharmacy and Health Sciences Community Pharmacy Advanced Pharmacy Practice Experience (CPAPPE) sites (2 mass merchandiser, 5 community chain, and 6 grocery store pharmacies).InterventionNine-question baseline and five-question postintervention anonymous surveys were administered to a convenience sample of store patrons 18 years of age or older.Main outcome measuresMedication disposal practices before and after education, beliefs on the environmental importance of inappropriate disposal practices, and perceptions of student pharmacists as sources of information.ResultsStudents from CPAPPE sites completed 242 educational interventions. Respondents were primarily women (72%). At baseline, 12.8% of patients disposed of medication appropriately. Respondents frequently flushed medications down the toilet (27.2%) or incorrectly dumped medications in the trash (34.6%). Only 30.9% had received previous advice on safe medication disposal. Posteducation survey results indicated that 80.1% of respondents were willing to change their disposal methods. Increased numbers of respondents viewed inappropriate medication disposal as a moderate to substantial problem (from 57.2% preeducation to 83.9% posteducation). Of participants, 59.7% strongly agreed that student pharmacists were a good resource for information on safe medication disposal.ConclusionAdditional public education on safe medication disposal is needed. Student pharmacists produced positive outcomes toward reducing this environmental and potential public health risk.     

South Australian rural community pharmacists and the provision of methadone,buprenorphine and injecting equipment

Objective To explore how the provision of opioid substitution treatment (OST) services and/or sterile injecting equipment impacts on community pharmacists. This will assist in identifying strategies to improve the provision of maintenance pharmacotherapy treatment programmes in South Australia. Setting Rural South Australia. Method Analysis of data obtained from earlier focus‐group interviews enabled compilation of key issues for the development of a semi‐structured questionnaire. Fifty‐one potential participants were contacted. Twenty‐five rural South Australian community pharmacists were interviewed through a 15–20‐min semi‐structured telephone questionnaire. Interview responses were manually recorded. Thematic analysis of the transcribed data by one researcher enabled determination of key issues. Key findings Fifty‐one potential pharmacies were contacted and 25 pharmacists were interviewed. All 25 pharmacists had experience in the provision of OST services, 22 sold sterile injecting equipment and 10 offered needle exchange. Exploration of service issues in the context of rural pharmacy practice found that the geographical closeness of a small community may improve rapport with local prescribers, as indicated by 15 of 25 pharmacists. Access to other allied health services was described by 13 of the 25 as difficult. Servicing OST clients can have a negative impact on pharmacy business, is not profitable for rural pharmacies and only seven of the 25 felt adequately remunerated for the provision of their services. Client debt was an identified issue and the practice of withholding doses because of lack of payment was supported by 10 participants and not supported by an equal number. Mentored practice was highlighted as a potential area for future training, as was managing clients' debts. In addition, pharmacy structural changes to provide a private dosing area would preserve confidentiality during supervised dosing. Conclusion Access to allied health services in regional areas could be better coordinated. Financial incentives for South Australian pharmacies, without increasing the cost of treatment for clients, requires further exploration.     

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.     

Evaluation of community pharmacy service mix: evidence from the 2004 National Pharmacist Workforce Study.

OBJECTIVES: To describe the mix of pharmacy services being offered in different types of community pharmacy practices and to identify factors associated with a community pharmacy offering pharmacy services. DESIGN: Cross-sectional study. SETTING: Community pharmacies (independent, chain, mass merchandiser, and supermarket pharmacies). PARTICIPANTS: Pharmacists practicing full-time or part-time who worked in community pharmacies and responded to the 2004 National Pharmacist Workforce Survey. INTERVENTION: Mailed survey from the 2004 National Pharmacist Workforce Survey, which included core content questions for all sampled pharmacists and supplemental surveys that included workplace questions for a selected subsample of pharmacists. MAIN OUTCOME MEASURES: Type and frequency of pharmacy services being offered in a community pharmacy, including dispensing and product-related services (e.g., specialty compounding), and pharmacist care services (e.g., immunizations, smoking cessation, health screening, medication therapy management, wellness screening, nutritional support, and disease management services). RESULTS: Four pharmacist care services were reported as being offered at more than 10% of community pharmacy practices: immunizations, smoking cessation, health screening, and diabetes management. The number of pharmacist care services offered at a community pharmacy was positively associated with having at least three pharmacists on duty, innovativeness of the pharmacy, status as an independent pharmacy, and status as a supermarket pharmacy. More than one half of the community pharmacy practices did not offer any of the eight pharmacist care services included in a pharmacy service index. CONCLUSION: Pharmacy services were reported at relatively few community pharmacies, and were associated with pharmacy innovativeness, pharmacist staffing levels, and pharmacy setting. Some community pharmacies are offering pharmacy services as part of their business strategy, while others are dedicated to dispensing services. Continued study of pharmacy service availability in community pharmacies is needed to improve our understanding of our capacity to deliver such services, including medication therapy management services.