A patient‐held medication record and a patient medication profile to support the continuity of acute cancer care

□ The sharing of care of patients receiving medical oncology care is vulnerable to errors in their documented drug history □ A patient‐held medication record identified over 90 per cent of patients' medications but was ‘forgotten’ by the patient in a third of contacts with a pharmacist □ Discrepancies between the medication records of GPs, community pharmacists and the medical oncology clinic were highly prevalent □ A posted patient medication profile issued by the hospital pharmacist to both the patient's GP and their community pharmacist was associated with a significant convergence in their records (discrepancies reduced from 17 to 6 % P<0.001) □ The patient‐held record had little impact on the accuracy of practitioners' records and its value lies more in facilitating patient education than rectifying errors in documentation     

Review of computerised patient medication records to determine potential clinical interventions in community pharmacy

The potential intervention rate for cardiovascular drugs dispensed in community pharmacy was investigated by a retrospective study of 300 patient medication records (PMRs) collected from 10 community pharmacies in Sydney, Australia. A medication review protocol and operational definitions were developed for 17 types of clinical intervention and three levels of clinical significance. Spearman's correlation coefficient (r_s) was used to examine the relationship between total number of potential interventions and predictor variables. From 5,271 medications dispensed, 1,509 (28.6 per cent) potential interventions were identified. The most frequent types of potential intervention were precautions (27.6 per cent), overutilisation (17 per cent) and dose discrepancy (16.3 per cent). Of the interventions classified as being of major clinical significance, 61.3 per cent were precautions, 19.7 per cent drug interactions and 19 per cent contraindications. The cardiovascular drug classes with the highest potential intervention rate were inotropics (93.2 per cent) and anticoagulants (89.5 per cent). There was a statistically significant correlation between the number of potential interventions per patient and the total number of medications dispensed per patient (r_s=0.68, P<0.001), the total number of cardiovascular drugs dispensed per patient (r_s=0.67, P<0.001) and the number of different prescribing doctors per patient (r_s=0.29, P<0.001). This study demonstrates the potential for community pharmacists to review computerised PMRs and intervene in patients' drug therapy, thereby reducing iatrogenic problems and improving health outcomes for patients.     

Provision of a domiciliary service by community pharmacists

The potential benefits of home visits by community pharmacists to housebound people with medication difficulties were examined. Sixteen community pharmacist volunteers made initial home visits to 39 patients referred by 14 general practitioners. The medication in their possession was noted, and information about the medication recorded from the medication container label, a patient medication record provided by the referring sugery and the patients' own knowledge. In 35 cases there were discrepancies between the medicines in the patient's possession, those they were currently taking and those listed on the patient medication record. Non-adherence, medication hoarding and adverse drug reactions were found. After each visit a summary was sent to the patient's GP and dispensing pharmacist. GP intervention was requested for 25 patients and dispensing pharmacist intervention for 17. Follow-up visits to 18 patients one month later showed that 37 per cent of suggested GP interventions and 50 per cent of suggested dispensing pharmacist interventions had been acted on. Feedback was received from the visiting pharmacists during a meeting and from the GPs and dispensing pharmacists by interview. The service was valued by the patients and endorsed by the GPs and all the community pharmacists involved, indicating that community pharmacists have a potential role to play in enhancing the care of specific housebound patients through domiciliary visits.     

Reasons for community pharmacists establishing patient medication records

A survey was conducted among a sample of those pharmacists in Britain who installed a patient medication record (PMR) system during 1990 to gauge the importance of various factors that might have influenced the pharmacist's decision to acquire the system. The responses indicate that government funding influenced the developing utilisation of PMRs, but to a lesser extent than anticipated. PMRs have been installed primarily for clinical and professional reasons. Of the reasons for installing a PMR system, competition from other pharmacies was more likely to be considered important by female pharmacists, and by pharmacists working for large multiple companies, than by their male counterparts or independent contractors. The need to upgrade equipment at the end of its life span was cited as a reason for purchasing a PMR system. Future progress is likely to be very dependent on such upgrades at periodic intervals to introduce new technology into pharmacy practice.     

Pharmacy involvement in formulary development: community pharmacists' views

A postal survey was carried out in the Eastern health and social services board in Northern Ireland to evaluate the views of community pharmacists (n= 100) on pharmacy involvement in formulary development. There was one mailing, with a response rate of 66 per cent. Most respondents (78.7 per cent) agreed or strongly agreed that pharmacist involvement in formulary development was important. Almost two thirds of responding pharmacists said they would be prepared to approach a GP in relation to such collaborative work and 27 per cent had had previous contact with GPs on the subject. Respondents considered that their input would be particularly useful in improving prescribing, providing cost advice and developing a closer working relationship with GPs. Evaluation of current levels of interprofessional liaison in relation to prescribing issues showed that 33.3 per cent of the pharmacists were already contacted by a GP regularly and 45.4 per cent contacted a GP regularly. Most (80 per cent) rated their working relationship with the GP as useful or very useful. The results suggest that community pharmacists in the Eastern health and social services board are willing to become involved in formulary development, thereby extending the use of practice formularies in general practice and integrating community pharmacy more fully into the primary health care team.     

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.     

Potential roles of the pharmacist in chronic pain management: a multidisciplinary perspective in primary care

Patients in the community with chronic pain may have poor pain control and use both prescribed and alternative therapies, often inappropriately, to try to optimise pain relief. They may benefit from management by a multidisciplinary primary care team involving a pharmacist. This study used postal questionnaires to determine community pharmacists' attitudes to involvement in pain management and the perceptions of general practitioners and physiotherapists of the current and potential roles of the pharmacist within a chronic pain care team. The three professions' views on factors which could influence chronic pain management were also determined. Sixty-three GPs (63 per cent), 59 community pharmacists (59 per cent) and 33 physiotherapists (66 per cent) responded. None of the pharmacists was currently involved in chronic pain management, but 58 (98 per cent) wanted to develop such a role, especially within pain clinics. Pharmacists and physiotherapists were more likely than GPs to identify that limited opportunity for personal involvement and expertise within a pain team reduced the likelihood of achieving optimal chronic pain management. Only 17 of the GPs had an established multidisciplinary pain care team; two of these had pharmacist involvement. All GPs and physiotherapists agreed that pharmacists had an important role to play in chronic pain management, particularly in the provision of drug information to patients and medication review.     

UK postal survey of pharmacists working with general practices on prescribing issues: characteristics,roles and working arrangements

Pharmacists are increasingly undertaking more non-dispensing work within the general practice setting. A postal survey of 414 United Kingdom pharmacists working with general practitioners (GPs), resulting in 174 responses (42 per cent), indicated that the pharmacists were working with 200 surgeries. The practices with which they worked were more likely to be fundholding (P<0.001), vocational training (P<0.001), and multipartner (P<0.01) practices, when compared with national statistics. Pharmacists funded by family health services authorities (FHSAs), commissioning agencies or health boards worked fewer hours in general practice (P=0.002) than those funded by a practice. The commonest roles, each reported by more than 50 per cent of pharmacists, were PACT (prescribing analysis and cost data) analysis, challenging doctors' prescribing, formulary development, guideline and protocol development, drug information resource, and liaison with pharmaceutical advisers. Thirty-two pharmacists ran in-house clinics. This study was limited by the low response rate. However, the findings suggest that pharmacists working with GPs undertake a range of roles, some of which involve direct patient care and responsibility for practice policy.     

Role of the community pharmacist in the care of patients with chronic schizophrenia in the community

This study, using a postal questionnaire, investigated the involvement of 534 community pharmacists with patients suffering from schizophrenia. The majority of the 236 respondents regularly dispensed medication for patients with schizophrenia and almost three-quarters had been asked for advice about medication from such patients or their carers. However, the majority of respondents believed that the advice they could give to these patients was limited by their knowledge of schizophrenia (86 per cent) and of therapeutics (70 per cent). Other perceived constraints to giving advice included lack of contact with other health professionals, poor communication skills and lack of experience in dealing with the mentally ill. Respondents were significantly less confident about advising patients with schizophrenia than advising other patient groups. The results suggest that there is a need to encourage community pharmacists' participation in continuing education and to improve liaison with other community health professionals such as community psychiatric nurses.     

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.     

Evaluation of mental health care interventions made by three community pharmacists — a pilot study

Objective — To assess the clinical significance of drug‐related interventions made by three community pharmacists (CPs) in the pharmaceutical care of 30 long‐term mentally ill patients in the UK. Method — Three CPs (“study pharmacists”) participated in a nine‐month study in which they collaborated with the community mental health team (CMHT) to provide pharmaceutical care for long‐term mentally ill patients in the community. In particular, they liaised with the patients' keyworkers, accompanying them on home visits. The pharmacists had previously attended a specially organised training course. Their primary tasks were to assess patient need and identify medication‐related problems, intervene as appropriate and document patient outcome. An expert review panel (two specialist hospital mental health pharmacists and a consultant psychiatrist) evaluated the appropriateness of the interventions and the level of clinical significance of the interventions (using a validated four‐point rating scale). Key findings — Thirty‐eight patients consented to participate in the study and 35 were contactable. Ninety‐four medication‐related problems were identified involving 30 patients (mean number of recorded problems per patient=3), of which full data were available for 92. Eighty‐four problems (91 % n=92) were said to have had appropriate interventions, and eight (9 per cent) inappropriate interventions. In 35 per cent of problems the three reviewers agreed that the interventions were clinically significant. Inter‐rater agreement for paired agreements (assessed by the kappa statistic) was fair in all cases except one, where it was poor. Conclusions — The reviewers considered the study pharmacists to have made a valuable pharmaceutical contribution to mental health care through clinically significant interventions, although they identified cases in which further clinically significant interventions could have been made. The reviewers saw the work undertaken as providing a positive way forward in primary mental health care.     

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.     

Recommendations and guidance for providing pharmaceutical care services during COVID-19 pandemic: A China perspective

BackgroundThe novel coronavirus pneumonia (COVID-19), which was first detected in Wuhan City, has now became a pandemic that affecting patients around the world. Particularly, the community patient population are at high risk of infection and are facing potential failure of proper medication use during the pandemic.ObjectiveTo discuss community pharmacists’ role and the content of pharmaceutical care (PC) during the novel coronavirus pandemic to promote effective prevention and control and safe drug use of the community patient population.MethodCollect and summarize the experience Chinese community pharmacies gained from providing pharmacy services during the COVID-19 outbreak, and taking patients' PC needs into consideration, analyze and discuss the methods and strategies that community pharmacies and pharmacists shall use to provide PC during the pandemic.ResultsCommunity pharmacy management teams shall support PC services by providing adequate supply of COVID-19 related medications and preventative products, following environment regulations, and providing sufficient staff trainings. Pharmacists shall use various approaches to provide PC services in drug dispensing, consulting and referrals, chronic disease management, safe use of infusions, patient education, home care guidance and psychological support to promote the COVID-19 pandemic control and ensure safe medication use of community patients during the pandemic.ConclusionPC services in communities during the COVID-19 shall possess different properties due to disease characteristics and related change in patients' need. Community pharmacies shall work as a strong supporter of patient's medication and protective equipment supply. Community pharmacists shall be prepared to provide skilled and effective PC services for community patient population to ensure medication safety and promote the overall COVID-19 pandemic control.     

Family health services authorities and community pharmacists at the purchaser-provider interface

The views of both purchasers (family health services authorities [FHSAs]) and providers (community pharmacists) were sought on the development of community pharmaceutical services in the light of the 1992 pharmaceutical care report. Questionnaires were posted to the 480 pharmacists in charge of all community pharmacies in Wessex and to the 98 general managers of FHSAs in England and Wales. The questionnaires focused on reactions to those recommendations of the pharmaceutical care report which, if implemented, would have significant implications for the community pharmacist's workload. Both the FHSAs and community pharmacists indicated that, in their view, the skills of the community pharmacist are currently underutilised. Both groups expressed enthusiasm for the pharmaceutical care report recommendations that the following services should be provided: domiciliary services, disposal of unwanted medicines, supply of aids for disabled people, supply of compliance aids and adverse drug reaction reporting. Neither group was enthusiastic about pharmacists providing a therapeutic drug monitoring service from community pharmacies. On other areas, pharmacists were more enthusiastic about the provision of health advice, diagnostic/screening services and treatment protocols, while FHSAs favoured distribution of welfare foods, needle exchange, instalment dispensing and referral forms. Overall, both the FHSAs and community pharmacists were receptive to the principle of the development of the role of the community pharmacist within the primary health care team but expressed concerns regarding the training and workload implications.