Estimating problem drinking among community pharmacy customers: what did pharmacists think of the method?

Objectives Community pharmacists have successfully been involved in brief interventions in many areas of health, and also provide services to substance misusers. There has been recent interest in community pharmacists providing screening and brief interventions (SBI) to problem drinkers. The aim of this study was to develop a method for measuring prevalence of risky drinking among community pharmacy customers and to explore acceptability of this method to participating pharmacists. Methods Forty‐three pharmacies (from 80 randomly selected) in New Zealand agreed to participate in data collection. On a set, single, randomly allocated day during one week, pharmacies handed out questionnaires about alcohol consumption, and views on pharmacists providing SBI, to their customers. At the end of the data collection period semi‐structured telephone interviews were carried out with participating pharmacists. Key findings Pharmacists were generally positive about the way the study was carried out, the support and materials they were provided with, and the ease of the data collection process. They reported few problems with customers and the majority of pharmacists would participate again. Conclusions The method developed successfully collected data from customers and was acceptable to participating pharmacists. This method can be adapted to collecting data on prevalence of other behaviours or medical conditions and assessing customer views on services.     

Pharmacist-delivered asthma management services—what do patients think?

BackgroundEvaluating pharmacy services from the perspective of the end user—patients—is imperative for ensuring the sustainability of services.ObjectivesThis study evaluated patient feedback regarding an evidence-based community pharmacist-delivered Pharmacy Asthma Service (PAS), in terms of overall satisfaction, satisfaction with PAS delivery, and perceived impact, and explored determinates of satisfaction.MethodsAll patients who received the 12-month PAS (n = 143) were invited to provide feedback via a project-specific patient evaluation survey upon completion of the final consultation. The survey included a mix of 5-point Likert-type scale items, multiple-choice questions, and free-text response questions. Overall satisfaction was determined by a single 5-point Likert-type scale question. Satisfaction with service delivery and overall impact were assessed using a 4-item and 8-item Likert-type scale, respectively, and a summative score computed for each section. Patient PAS data including demographics and management outcomes were then cross tabulated against overall satisfaction, satisfaction with PAS delivery, and impact.ResultsFeedback was received from 71% (n = 101) of patients who completed the PAS. The results indicated high overall patient satisfaction, with 86% of respondents very satisfied with the service. Patients identified positive impacts of the PAS including improved understanding and management of asthma and allergic rhinitis. Similarly, almost all patients were satisfied with service delivery including the pharmacist’s knowledge and their ability to assist (98%) and the privacy of the pharmacy setting (91%). Patients who had controlled asthma at the end of the trial had higher levels of overall satisfaction (χ² = 9.584, df = 5, P = 0.048) and reported greater overall impact on asthma and allergic rhinitis management (U = 1593.5, P = 0.004).ConclusionThe diffusion of health services within community pharmacy practice is dependent upon patient receptivity and how the services align with patient needs. The positive satisfaction received indicates that the PAS would be welcomed by patients with asthma in future.     

Sleep health management in community pharmacy: Where are we and where should we be heading?

BackgroundPoor sleep health is now recognised as a significant risk factor for chronic diseases and is associated with considerable comorbidity and mortality. Community pharmacists are primary care clinicians with an integral role in sleep health promotion and chronic sleep disorder management; however, it is unclear to what extent this is currently being undertaken or what the perspectives of Australian community pharmacists regarding their role in sleep health are.ObjectivesTo explore community pharmacists’ current sleep health practice and perspectives on the potential future of sleep health care in community pharmacy.MethodsQualitative semi-structured interviews were carried out with a maximally varied, convenience-based purposive sample of community pharmacists. Interviews were audio-recorded, transcribed verbatim and subjected to, in sequence; an inductive analysis followed by a deductive approach where the inductively derived thematic structure was used as a framework.ResultsTwenty-five community pharmacists from two Australian states were interviewed. Insomnia and obstructive sleep apnea (OSA) were the most frequently encountered sleep disorders in community pharmacy presentations. Four key themes were derived from the data: 1) Preparedness, 2) Approach, 3) Capabilities and 4) What needs to change? All participants reported that their sleep health knowledge was insufficient and emphasized the need for more education and training. Although some were engaged in providing OSA services, none of the participants offered services for insomnia or other sleep disorders. Time/task pressures, low health system/health care professional sleep health recognition/awareness and the lack of standardised pharmacy-specific sleep health management guidelines were commonly cited barriers for sleep health service provision.ConclusionCommunity pharmacists commonly manage day-to-day sleep health; however, most expressed a need for increased sleep health recognition/awareness by the health system, targeted education/training for pharmacists and support for the future provision of community pharmacy-delivered sleep health services. With the appropriate implementation strategies, community pharmacists could utilise their availability and accessibility to improve the future of primary care sleep health management.     

What free services do pharmacists offer? Investigating the provision of unfunded pharmacy services in community pharmacies

BackgroundGlobally, pharmacists report to be providing free or partially subsidised patient-focused services in order to meet healthcare needs of their communities. Budget cuts to pharmacy contracts are reported to challenge the provision of such services. Limited information exists identifying the types of unfunded services provided in community pharmacies.ObjectivesTo identify the types of services which pharmacists report to provide that are not reimbursed by the government, insurance companies or paid for by the patient.MethodsSemi-structured focus group discussions with pharmacists were conducted stimulating narratives from community pharmacists across New Zealand about the types of unfunded pharmacy services they provide. Discussions were audio recorded and transcribed verbatim. Inductive coding of the data was carried out using QSR International Nvivo 11 for Windows. A semantic thematic analysis was carried out.ResultsTwenty-four pharmacists took part in the focus groups across five regions in both the North and South Islands of New Zealand. Key themes identified from focus groups were: ‘Standalone unfunded services’, ‘Services funded elsewhere’ and ‘Leakages from the current funding model’. Pharmacists reported that unfunded patient-focused services accounted for 15%–50% of their daily activities. Pharmacists stated that they believed these services often led to reduction of disease progression, hospitalisations and improved quality of life. Pharmacists also stated that given budget cuts, these services are not sustainable.ConclusionsPharmacists report to offer many professional services without remuneration. In some cases, these services make up a substantial part of the pharmacist's time. Further budgetary constraints and increased competition may put these services at risk of being lost. Findings from this study can be applied to unfunded pharmacy services elsewhere, as worldwide pharmacy faces many similar challenges, particularly where there are budget cuts and decreasing revenue in other jurisdictions.     

Osteonecrosis of the jaw: what do bisphosphonates do?

Osteonecrosis of the jaw is a new disease, partly caused by bisphosphonates. It is commonly assumed that the bisphosphonates somehow cause cell death (osteocyte necrosis) within the jawbone, which makes it prone to chronic infection. In this article, an alternative pathogenetic theory is suggested, based on the normal effect of bisphosphonates. According to the new theory, the bone is alive until it is injured and infected, and the reduced resorptive ability due to bisphosphonates hinders the formation of a fresh bone surface for re-establishment of bone cell coverage. The theories are compared, based on the recent, very scarce literature. None of them can be completely refuted, but the demonstration of living osteocytes within the lesion and the number of necessary assumptions speak against the theory of a primary, bisphosphonate-induced necrosis.     

Osteonecrosis of the jaw: what do bisphosphonates do?

Osteonecrosis of the jaw is a new disease, partly caused by bisphosphonates. It is commonly assumed that the bisphosphonates somehow cause cell death (osteocyte necrosis) within the jawbone, which makes it prone to chronic infection. In this article, an alternative pathogenetic theory is suggested, based on the normal effect of bisphosphonates. According to the new theory, the bone is alive until it is injured and infected, and the reduced resorptive ability due to bisphosphonates hinders the formation of a fresh bone surface for re-establishment of bone cell coverage. The theories are compared, based on the recent, very scarce literature. None of them can be completely refuted, but the demonstration of living osteocytes within the lesion and the number of necessary assumptions speak against the theory of a primary, bisphosphonate-induced necrosis.     

APOM‐project: managing change to the customer in community pharmacy practice

In 1994, a Ph.D.study started regarding pharmacy, organization and management (APOM) in the Netherlands. This article describes the final phase of the study in community pharmacy practice: managerial problems in change to the customer and the difference between supported pharmacy managers and independent ones. It appeared that pharmacy managers experienced problems with the formulation and use of aims, norms, and measurements. Although many organizations operating in the pharmaceutical sector are a good source for new ideas, they lack to have the proper support for these problems. The difference between supported and independent pharmacy managers was minimal in the change to the customer. Pharmacy managers are in need of microinstrumentalization: aims, norms, and monitor instruments for customer activities applicable at their own pharmacy. Moreover, pharmacy managers will have to learn how to deal with the tension between money and care in order to improve the 'grip' on their organization.     

Pharmacovigilance of over-the-counter products based in community pharmacy: a feasible option?

PURPOSE: With the increasing range of potent medicines available for sale 'over-the-counter' (OTC) in community pharmacies, this feasibility study set out to develop and validate a method for the pharmacovigilance of OTC medicine, using ibuprofen as a model. METHOD: A trained network of community pharmacies (n=61) in Grampian, Scotland, tested different methods for recruiting people buying ibuprofen for their own use (pilot 1) and then used the 'best' method to test two methods of follow-up (pilot 2). RESULTS: Recruitment rates-method 1 (pharmacy staff inserted the patient information sheet and recruitment questionnaire in the shop bag of eligible subjects): 18% (41/227) of questionnaires issued; method 2 (staff explained the study and asked eligible subjects to complete the questionnaire outwith the pharmacy): 31% (61/194); method 3 (staff explained the study and asked eligible subjects to complete the questionnaire in the pharmacy): 52% (100/192). A further 200 subjects were recruited in pilot 2. The majority of recruits (n=402) were female (75%), mean age 43 years (range 18-84 years), 73% drank alcohol, 72% were non-smokers, and 56% were in the two most affluent socio-economic categories. There was a strong association between the drug dose data collected prospectively and that collected retrospectively. The average response to postal follow-up was 80% (315/392) at 1 week and 79% (308/390) at 2 months. CONCLUSION: The study has confirmed the support of pharmacy personnel in undertaking research and indicated the feasibility of a major pharmacovigilance project of OTC medicines.     

Long-acting β-agonists in asthma management: what is the current status?

Large surveillance studies or phase IV clinical studies of long-acting β-agonists (LABA) compared with placebo in asthma patients using variable (from nil to regular) doses of inhaled corticosteroids (ICS) have raised the issue of mortality risk in patients with asthma taking regular LABA. There have been a number of meta-analyses and systematic reviews that have examined the risk of LABA in asthma patients, and the general conclusion is that LABA added to ICS reduces asthma-related hospitalizations compared with ICS alone and there is no statistical increase in mortality. However, LABA without ICS do increase mortality risk in asthma. All reviews and analyses show a greater number of LABA deaths, but not all are statistically significant. A recent meta-analysis found LABA with concomitant ICS had a higher mortality rate in asthma than ICS alone. The flaw in the study is the higher doses of ICS in the control arms, but the implicit message remains: the essential need for enough ICS to control airway inflammation. We suggest that the pragmatic solution is to have LABA only available in the same device as ICS for asthma treatment. We do not think that a study comparing the safety of LABA plus ICS versus ICS alone in asthma is necessary. If such a study is conducted, the measurement of morbidity from increased doses of ICS is an essential design consideration. Furthermore, the critical focus in asthma management should not be forgotten - education of health professionals and the community of the critical role of ICS, and the need for good communication between health professionals and the asthma patient to facilitate good asthma control. The same arguments apply to the asthma-with-chronic obstructive pulmonary disease overlap syndrome in older patients. There is an urgent need to provide medical practitioners with the capability to diagnose the overlap syndrome.     

Marketing activity in the community pharmacy sector – A scoping review

Background

Community pharmacy ownership requires engaging with marketing strategies to influence consumer behaviour. There is a plethora of information from trade journals, expert opinion, and published discussion surrounding this issue. Despite this, evidence relating to the efficacy of marketing activity within the pharmacy sector is scant.

Pharmacists’ perspectives of the current status of pediatric asthma management in the U.S. community pharmacy setting

International Journal of Clinical Pharmacy - Objective To explore community pharmacists’ continuing education, counseling and communication practices, attitudes and barriers in relation to...     

Drug-resistant tuberculosis: what do we do now?

Drug-resistant tuberculosis (TB) represents a threat to TB control programmes. Erratic and inappropriate use of currently available medications, HIV-TB co-infection, and concern about transmission of drug-resistant strains in the general population all contribute to a worrying picture. What do we do now? In the last few years, there has been considerable progress in the understanding of mechanisms of action and resistance to antituberculosis agents, and in establishing the value of directly observed therapy in preventing treatment failure. However, a limited effort has been devoted to the development of new active compounds or of rapid diagnostic tests, and their relevance to global tuberculosis control has been questioned.     

The management of urinary infections: what have we learned in the past decade?

User-friendly, cost-effective practices to manage urinary infection should become routine. The vast majority of inflections are relatively easy to treat and many of these can be prevented with appropriate interventions. Additional research is urgently needed to compare various clinical strategies and determine which is most acceptable to patients at a reasonable cost with satisfactory health outcomes.