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.     

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.     

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.     

Community pharmacists' attitudes to medicines management: a qualitative study

Objective To explore community pharmacists' knowledge of, and attitudes toward, medicines management, including concerns or barriers to offering medicines management services from community pharmacy premises. Method Focus groups held with purposively sampled pharmacists from community, practice and research sectors in Scotland. Participants were invited to discuss community pharmacists' knowledge and experience of medicines management, concerns about providing medicines management services from community pharmacy premises, and possible effects of such services on relationships with general practitioners (GPs). Key findings Ten pharmacists attended two focus groups. Characteristics of participants varied according to sex and employment status as well as the type and setting of the pharmacy in which they worked. Participants were familiar with the term ‘medicines management’ but understanding varied between and within groups and differences from and similarities to the term ‘pharmaceutical care’ were less clear. Concerns about the delivery of extended services included practical issues and the effect on the ‘traditional’ role of the community pharmacist. Views were mixed on whether medicines management could become a routine part of all community pharmacists' practice or whether it required specialisation. Pharmacists distinguish between ‘patients’ and ‘customers’ in relation to their differing needs. The relationship between pharmacists and GPs was influenced by the post held by the pharmacist and the setting of the pharmacy. Conclusions The pharmacists in this small, regional sample expressed a wide range of attitudes and opinions about the delivery of medicines management services from community pharmacies. Useful insights were given into the practicalities of providing such services on a daily basis in the current working environment, and how pharmacists might be able to provide medicines management services in other ways. Medicines management can be seen as a reprofessionalising strategy for pharmacy, making use of the pharmacist's status as an ‘expert’ to enhance the natural object, the ‘drug’ into the object of social significance, the ‘medicine’. Further research with pharmacists from other regions is needed to confirm this explanation.     

Professional practices and experiences with complementary medicines: a cross‐sectional study involving community pharmacists in England

Objective As retailers of complementary medicines (CMs), pharmacists are well placed to advise consumers on the safe and effective use of these products; where CMs are available in pharmacies, pharmacists should be well informed about such products. This study explored the extent to which CMs are available in community pharmacies in England, and examined pharmacists' experiences, professional practices and training with regard to these products. Method A cross‐sectional study was conducted, involving a structured questionnaire posted to community pharmacists. Coded follow‐up mailings were sent to non‐responders after 2 and 4 months, and a reminder telephone call made after 3 months. Setting All community pharmacists in six areas (Devon, Cornwall, Bradford, Leeds, Manchester, Stockport) of England (total n = 1337). Key findings The response rate was 66.5%. Overall, 92% of respondents reported that CMs (excluding vitamins/minerals) are sold in the pharmacy in which they practise, 81% had received requests from patients/consumers for specific CMs in the previous year, and 58% had recommended CMs. Around 70% of respondents rarely/never asks about CMs use when counter‐prescribing conventional medicines or when receiving reports of suspected adverse drug reactions (ADRs) associated with conventional medicines. In total, 40% of respondents had undertaken training in complementary/alternative medicine (CAM). Pharmacists who had undertaken training were more likely to ask patients/consumers specifically about use of CMs when counter‐prescribing conventional over‐the‐counter (OTC) medicines (37.0% versus 23.4%, respectively; χ² = 17.4; P = 0.0003) and when receiving reports from patients/customers of suspected ADRs associated with conventional (prescribed or OTC) medicines (35.6% versus 23.8%, respectively; χ² = 13.0; P = 0.0003). Conclusion CMs are widely available in pharmacies in England, and pharmacists interact with users of these products. An opportunity exists for pharmacists to embrace a professional role as expert advisors on CMs. However, pharmacists' training, professional practices and competence with respect to CMs first need to improve.     

Investigation of patients' demand for community pharmacies: relationship between pharmacy services and patient satisfaction

We performed an investigation on the patients' demand for community pharmacy based on the analysis of questionnaire responses on community pharmacy services from the patients at 32 pharmacies in Tokyo and Osaka. In the previous study, we developed seven evaluation indices for pharmacy services, and showed that the functions most sought by patients in the "ideal pharmacies" were "Attitude of pharmacy/pharmacist", "Convenient hours" and "Information management". The objective of this study is to determine the relationship between these pharmacy functions and patient satisfaction by analyzing responses from the same questionnaire survey. Overall satisfaction score with the "pharmacy used today" was employed as the dependent variable, while the six factors derived from the 26-item evaluation scale in the questionnaire by factor analysis were used as the independent variables. As a result of analysis, it was found that four variables had a significant positive correlation with patient satisfaction, one had a significant inverse correlation, and one showed no significant correlation (p < 0.05). These results suggest that: attitude of the pharmacists such as general attitude and specialized activities of pharmacy/pharmacist such as providing information and explanations, and convenience of hours are not only judged to be important by patients, but also influence their satisfaction; comfortable facilities and availability of OTC drugs, while rated relatively low by patients in terms of importance, do influence their satisfaction; and convenience of location does not influence patient satisfaction. It was also indicated that insufficient inventories of prescribed medications have an impact upon patient satisfaction. This investigation offers evidence to provide patient-based pharmacy services.     

Identifying caring behaviors of pharmacists through observations and interviews.

OBJECTIVE: To identify caring behaviors of community pharmacists demonstrated in the pharmacist-patient interaction. DESIGN: Qualitative research. SETTING: Five community pharmacies in the Greater Chicago area. PARTICIPANTS: 8 pharmacists identified as "caring pharmacists" by corporate managers and 13 pharmacy technicians. INTERVENTIONS: Observations of pharmacy personnel interacting with patients and interviews of 2 pharmacists. MAIN OUTCOME MEASURES: Caring behaviors. RESULTS: Four categories of caring behaviors emerged from the observation field notes: physical behaviors (leaning toward patient, smiling, looking patient in eye), relationship behaviors (greeting patients, knowing name, making small talk), task behaviors-nonpharmacy (explaining receipt and money transaction), and task behaviors-pharmacy (providing information, calling physician, asking about allergies and explaining interactions). In interviews, pharmacists said that a caring pharmacist was about "being for the patient," and both noted that caring pharmacists greet the patient, inquire about the patient's health and family, and are sincerely interested in the patient. Mentors and family members are important in developing caring pharmacists, the pharmacists said. CONCLUSION: Specific caring behaviors identifiable among pharmacists and pharmacy technicians. These behaviors can be modeled by pharmacy managers and should be taught in pharmacy schools.     

Older patient, physician and pharmacist perspectives about community pharmacists' roles

Objectives To investigate older patient, physician and pharmacist perspectives about the role of pharmacists in pharmacist-patient interactions. Methods Eight focus-group discussions were held in senior centres, community pharmacies and primary care physician offices. Participants were 42 patients aged 63 years and older, 17 primary care physicians and 13 community pharmacists. Qualitative analysis of the focus-group discussions was performed. Key findings Participants in all focus groups indicated that pharmacists are a good resource for basic information about medications. Physicians appreciated pharmacists' ability to identify drug interactions, yet did not comment on other specific aspects related to patient education and care. Physicians noted that pharmacists often were hindered by time constraints that impeded patient counselling. Both patient and pharmacist participants indicated that patients often asked pharmacists to expand upon, reinforce and explain physician-patient conversations about medications, as well as to evaluate medication appropriateness and physician treatment plans. These groups also noted that patients confided in pharmacists about medication-related problems before contacting physicians. Pharmacists identified several barriers to patient counselling, including lack of knowledge about medication indications and physician treatment plans. Conclusions Community-based pharmacists may often be presented with opportunities to address questions that can affect patient medication use. Older patients, physicians and pharmacists all value greater pharmacist participation in patient care. Suboptimal information flow between physicians and pharmacists may hinder pharmacist interactions with patients and detract from patient medication management. Interventions to integrate pharmacists into the patient healthcare team could improve patient medication management.     

Pharmacist–patient communication in Swedish community pharmacies

BackgroundIt is important that pharmacists counsel patients about their prescribed medicines, as it leads to improved therapeutic outcome, increases compliance, and decreases confusion and insecurity. Studies have shown that the number of patients getting any pharmaceutical counseling varies greatly. Swedish pharmacists claim that the focus of the dialog with the patient has switched from pharmaceutical counseling to economy and regulations.ObjectiveThe aim of this study was to determine the content and time disposition of the patient–pharmacist communication during dispensing of prescribed medicines at Swedish community pharmacies.MethodNon-participant observations and audio recordings were used as data-collecting methods. The content of the dialog was categorized into 2 deductively decided main categories–medicinal and non-medicinal issues–and 12 inductively decided subcategories.ResultsA total of 282 pharmacy encounters were observed and recorded, of which 259 fully coincided with the inclusion criteria. After categorizing the content of each encounter the results showed that there was little or no dialog regarding medicinal issues during the pharmacy encounter in Swedish community pharmacies. Forty percent of the dialog concerns non-medical issues and almost half of the encounter was silent.ConclusionMedicines are an essential treatment method in healthcare, and pharmaceutical expertise is available to patients who enter a community pharmacy. The results of this study show that today's pharmacy encounter is not focused on improving the use of medication, possibly resulting in the patient not gaining the most benefit from his or her treatment.     

OTC hearing aids: An opportunity for collaborative working relationships between pharmacists and audiologists

In 2017, the United States Food and Drug Administration Reauthorization Act created a new category of hearing aids to be sold over the counter (OTC), disrupting how nearly 30 million persons with hearing loss will seek and purchase hearing aids. Laws and regulations do not require a medical evaluation or an appointment with an audiologist prior to purchasing OTC hearing aids. However, it is likely that patients will approach pharmacists with questions about OTC hearing aids when considering these devices available at the community pharmacy. The objective of this commentary is to discuss the opportunity for collaborative working relationships between pharmacists and audiologists in the context of OTC hearing aids. The most relevant barriers to pharmacist/audiologist collaboration are turf concerns, lack of trust, and distance between practice sites. OTC hearing aids can positively impact hearing health care across the nation with successful collaboration between the professions of pharmacy and audiology.     

Pharmaceutical care program for patients with reactive airways disease.

A pharmaceutical care program for patients with reactive airways disease (RAD) is described. A pharmaceutical care program for patients with RAD was developed and implemented at 36 CVS pharmacies. The impact on patient outcomes, pharmacist job satisfaction, and other variables is currently being evaluated in a controlled trial with more than 1100 patient enrollees. Guiding the program are the beliefs that pharmacists must have clinically relevant, patient-specific data to provide appropriate care; that pharmacists must have adequate training to provide pharmaceutical care; that the program must be sensitive to organizational barriers, particularly time demands; and that there must be ongoing support for the program. The program has five components: (1) computer display of patient-specific data for patients enrolled in the study, (2) distribution of tailored patient education materials, (3) use of a resource guide to facilitate the implementation of pharmaceutical care, (4) strategies to reinforce and facilitate the program, and (5) pharmacist training. While developed for community pharmacies, the program is applicable to most ambulatory care pharmacy practices. A pharmaceutical care program for patients with RAD was developed for use in community pharmacies.