The provision of current and future sexual health services from community pharmacies in Grampian, Scotland

Objective Community pharmacies play a vital role in promoting, maintaining and improving the health of the local community. This study explored community pharmacists?? activities and attitudes towards the provision of sexual health services (SHS) in North East Scotland, as well as their needs with regard to the delivery of current and future SHS. Setting North East Scotland. Methods A questionnaire was conducted of community pharmacists working in community pharmacies in Grampian (n = 128). Main outcome measures Self-reported provision of sexual health services; attitudes towards current and future sexual health services; previous training and perceived training needs; respondent demographics. Results In total, 73% (94/128) of community pharmacists responded. The average number of SHS/products per pharmacy was six out of a possible 13 (range: 4?C10). Respondents expressed positive attitudes towards the provision of current and future SHS. However, they also reported that they had received little or no sexual health training but that they would like to receive training in all areas of sexual health. Barriers to the provision of sexual health included workload, lack of training and the need for payment for additional services. Conclusion Community pharmacists already provide a limited range of sexual health services. Community pharmacists, their staff and their premises could be used in strategies to reduce unplanned pregnancies, the incidence of sexually transmitted infections and to promote respectful and responsible sexual behaviour.     

Pharmacy under the spotlight: New Zealand pharmacists' perceptions of current and future roles and the need for accreditation

Objectives The aim was to determine New Zealand pharmacists' views on the range of services outlined in the Ten Year Vision for Pharmacists document and the need for accreditation to provide these services. Methods A national postal survey of practising pharmacists registered with the Pharmacy Council of New Zealand (n= 1892) was carried out, with two follow‐ups. Key findings The response rate was 51.8% (n= 980 usable surveys). Findings indicated that the majority of pharmacists believe they should continue to undertake traditional clinical and technical roles (median 98.5%, range 92.7–99.3%). Less than one‐third of respondents felt these activities required pharmacists to be accredited. A lower proportion, but still the majority, of respondents thought that pharmacy should undertake selected enhanced or collaborative roles (median 74.85%, range 64–92.5%). However, there was a greater emphasis on accreditation for these roles, with more than two‐thirds of respondents suggesting a need for accreditation. Conclusions There is a high level of support for the retention of current clinical and technical roles. A lack of need for additional accreditation suggests that pharmacists believe their training is adequate. There is a positive, but more tempered view regarding enhanced or collaborative services. There is recognition of a greater need for accreditation for enhanced and collaborative services. This suggests a cautious optimism about new services and a perceived need for pharmacists to learn more about these programmes.     

A community pharmacy-based cardiovascular screening service: views of service users and the public

Objectives To determine whether pharmacy‐based cardiovascular disease (CVD) screening reached the desired population, the local population's awareness of pharmacy screening and the views of service users and the general public about CVD screening. Methods Pharmacy staff, located in one English Primary Care Trust providing a CVD screening service, issued questionnaires to service users who had undergone screening. Face‐to‐face street surveys were conducted with members of the general public within the vicinity of each participating pharmacy. Key findings A total of 259 people were screened within the first 6 months of service provision, 97 of whom (37.4%) completed the evaluation questionnaire. In addition, 261 non‐service users participated in street surveys. Most respondents among both service users and non‐users had at least one risk factor for cardiovascular disease, including smoking and lack of exercise. Responses to statements regarding CVD screening showed a high level of agreement with the need for screening in both groups. However, significantly more service users (90.7%) agreed that a pharmacy was a good place for screening compared to the non‐users (77.4%; P < 0.005). Likewise significantly fewer service users agreed that screening should be only carried out by doctors (10.3 compared to 25.3% of non‐users; P < 0.005). The overall majority of service users 96 (99.7%) had a positive experience of the screening service, agreeing that they were given enough time and pharmacists made them feel at ease. Only 9% of non‐users were aware of the pharmacy service and, although the majority (78.4%) were willing to be screened at a pharmacy, this was significantly lower among males than females (69.9 compared to 82.7%; P < 0.005). Perceived concerns about confidentiality and lack of privacy were among barriers identified to taking up screening. Conclusion Pharmacy‐based CVD screening is acceptable to the public. Its uptake could be improved through increased awareness of the service and by addressing concerns about privacy and confidentiality in promotional activities.     

Involvement and practice of community pharmacists in maternal and child health services: A systematic review

IntroductionCommunity pharmacists are pivotal in the provision of Maternal and Child Health (MCH) services, yet level of involvement, practice and barriers and facilitators in providing these services is largely unknown.ObjectiveThe objective of this review is to summarize available evidence on the involvement and practice of community pharmacists in MCH services.MethodsSeven electronic databases (PubMed, CINAHL, ProQuest Health, Cochrane library, Scopus, Embase, and Web of Science) were searched for articles published in English since inception of the database to November 30, 2019. Papers were included if they assessed involvement and practices of community pharmacists in maternal and child health services. Full articles identified and included for the final analysis were assessed for quality using the Mixed Method Appraisal Tool (MMAT) (2018) by all authors and data were extracted by one author and cross-checked by all authors.ResultA total of 2830 articles were identified. Following the assessment against the inclusion criteria, 14 full text articles were included for the final analysis. In eight studies, community pharmacists were reported to have involvement in maternal health services, in terms of providing breastfeeding guidance, counselling about the benefit of vitamins during pregnancy, provision of emergency contraception advice, and responding to illness symptoms such as back pain. In three studies, community pharmacists were providing advice in managing acute diarrhea in children. Medication use services and counselling about medication for children were also reported in three studies. Perceived consumer attitudes, problem with insurance coverage, lack of time among pharmacists and lack of incentives for the services provided were reported by pharmacists as the main barriers to service provision.ConclusionCommunity pharmacists were involved in various MCH services in community pharmacy settings. However, the extent of practices was not as per the joint International Pharmaceutical Federation (FIP)/World Health Organization (WHO) guidelines on good pharmacy practice in some services such as management of diarrhea.     

Utility and value of a medicines information service provided by pharmacists: a survey of health professionals

Objectives Many health professionals lack the time and skills to search for and appraise information on medicines. A solution might be to use others skilled in evidence appraisal, who make recommendations or provide information tailored to patients' needs. The objectives of this study were to assess how advice provided to health professionals by the northwest of England regional medicines information centre is used, whether it is useful for patient care and to measure satisfaction with the service. Methods A questionnaire was designed and sent to health professionals who contacted the centre between September 2008 and March 2009. Enquirers contacting the centre more than once were sent a questionnaire only in response to their first enquiry during the study period. Non‐responders were sent a reminder. Key findings Questionnaires were sent to 672 enquirers; 68% were returned. Nearly all respondents used the advice provided. Of the 430 respondents who provided data on how they used the information, 81% used it to manage a current patient and 29% to plan the care of future patients; nearly all considered it useful. Where data were given (n = 366), half used it to check if current or proposed management was appropriate, 45% to make changes to therapy and 35% to advise another health professional. In addition to patient care, one‐quarter (n = 105/430) of respondents used the information for continuing professional development and 16% (n = 69/430) for training or teaching. Conclusions Health professionals value the enquiry‐answering service and use the advice provided for patient care, continuing professional development and educating patients and other health professionals. The service is responsive, supporting the care of patients needing immediate and future management.     

The General Practitioner-Pharmacist Collaboration (GPPC) study: a randomised controlled trial of clinical medication reviews in community pharmacy

Objectives There are conflicting results in studies of pharmacists undertaking medication reviews for older people. With increasing promotion and funding for ‘medication reviews’ there is a need for them to be standardised, and to determine their effectiveness and the feasibility of providing them from a community pharmacy. The objective was to determine whether involvement of community pharmacists undertaking clinical medication reviews, working with general practitioners, improved medicine‐related therapeutic outcomes for patients. Methods A randomised controlled trial was carried out in people 65 years and older on five or more prescribed medicines. Community pharmacists undertook a clinical medication review (Comprehensive Pharmaceutical Care) and met with the patient's general practitioner to discuss recommendations about possible medicine changes. The patients were followed‐up 3‐monthly. The control group received usual care. The main outcome measures were Quality of Life (SF‐36) and Medication Appropriateness Index. Key findings A total of 498 patients were enrolled in the study. The quality‐of‐life domains of emotional role and social functioning were significantly reduced in the intervention group compared to the control group. The Medication Appropriateness Index was significantly improved in the intervention group. Only 39% of the 44 pharmacists who agreed to participate in the study provided adequate data, which was a limitation of the study and indicated potential barriers to the generalisability of the study. Conclusion Clinical medication reviews in collaboration with general practitioners can have a positive effect on the Medication Appropriateness Index. However, pharmacist withdrawal from the study suggests that community pharmacy may not be an appropriate environment from which to expand clinical medication reviews in primary care.     

The development of the tumor vascular-disrupting agent ASA404 (vadimezan,DMXAA): current status and future opportunities

Importance of the field: Targeting tumor vasculature with antiangiogenic agents improves outcomes achieved with chemotherapy in some cancers, but toxicity limits their applicability. Tumor vascular-disrupting agents (tumor-VDAs) induce an acute collapse in tumor vascular supply; ASA404 (vadimezan, 5,6-dimethylxanthenone-4-acetic acid [DMXAA]) is the tumor-VDA most advanced in clinical development. Recent randomized trials of ASA404 in combination with chemotherapy suggested a survival advantage in NSCLC comparable to that achieved with bevacizumab, but with little additional toxicity. Phase III trials in advanced NSCLC have completed accrual, and a review of this exciting agent is timely.

Areas covered in this review: This review focuses on the development of ASA404 to date, its mechanisms of action, the current body of clinical research and potential avenues for therapeutic use. It includes all completed clinical trials since it entered clinical testing in 1995 through to 2009.

What the reader will gain: This review will help the reader to understand why ASA404 is unique among tumor-VDAs; the clinical trial methodology required to evaluate such agents; and its remarkable potential clinical utility.

Take home message: ASA404 is a tumor-VDA that offers considerable potential to improve outcomes in cancer patients in combination with existing treatments.     

Inhibitors of propagation of coagulation (factors VIII, IX and XI): a review of current therapeutic practice

The management of patients with congenital haemophilia who develop alloantibodies against factors of the propagation phase of blood coagulation, commonly known as inhibitors, is the most important challenge facing haemophilia caregivers at present, as this complication not only compromises the efficacy of replacement therapy but also consumes an enormous amount of economic resources. Development of inhibitors further complicates the clinical course of severe haemophilia, with a prevalence of up to 30% in patients with haemophilia A (factor VIII deficiency) and up to 5% in those with haemophilia B (factor IX deficiency) and haemophilia C (factor XI deficiency). While the short-term goal of treatment of patients who develop alloantibodies is the control of bleeding, the eradication of the inhibitor is the main long-term goal. The management of severe bleeding episodes and the eradication of the autoantibody are also the mainstays of treatment of patients with acquired haemophilia, a rare but life-threatening haemorrhagic condition characterized by the development of inhibitory autoantibodies against coagulation factor VIII. The most recent options available for treating patients with congenital haemophilia complicated by inhibitors and acquired haemophilia because of autoantibodies against factor VIII are summarized in this review article.     

Low detection rates, negative attitudes and the failure to meet the "Health of the Nation" alcohol targets: findings from a national survey of GPs in England and Wales

The appropriateness of the primary care setting to undertake the health promotional activities needed to meet 'Health of the Nation' alcohol targets has been acknowledged in UK government policy and the scientific literature. However, the latest data suggest these targets are not being met. A 20% random sample of all general practitioners in England and Wales were surveyed by postal questionnaire to examine their work in detecting alcohol misuse and their attitudes towards the work. Four mailing waves produced a 44% response rate. GPs had identified a mean of 3.2 patients per month drinking above recommended 'sensible' guidelines. These patients were mostly male (73%) and above 40 years of age (45%), with nearly half (45%) already dependent drinkers. Most GPs perceived alcohol misuse patients as a difficult group with whom to work. None the less, over half the respondents believed general practice was an appropriate setting for the detection of the problem. However, most did not feel trained or supported in this area of their work. More emphasis needs to be placed on the valuable contribution GPs can make with the larger number of patients who are drinking regularly above 'sensible' levels but not yet suffering adverse affects. Our findings point towards not an unwilling profession, but a profession lacking confidence. The provision of support and basic training are major factors in how GPs perceive alcohol misusers and their own role in this work. Twenty years after the Maudsley Alcohol Pilot Project research it is disappointing that, despite greater recognition by GPs of their potential impact, lack of training and lack of support are still so central to their continued low levels of therapeutic commitment.     

Timing of drotrecogin alfa (activated) initiation in treatment of severe sepsis: a database cohort study of hospital mortality,length of stay,and costs

ABSTRACT

Introduction: For patients with critical conditions including severe sepsis, minimizing the time from presentation to treatment is important to improving outcomes. Understanding the factors influencing high hospital mortality and resource utilization in severe sepsis continues to interest clinicians and researchers. This study examined the associations between timing of drotrecogin alfa (activated) (DrotAA) initiation and hospital mortality, length-of-stay, and costs.

Methods: We conducted a cohort study of adult patients (N = 1179) with intensive care unit stays from November 2001 to June 2003 who received DrotAA in US hospitals with data in the Solucient ACTracker database. We defined evident severe sepsis (ESS) as concurrent antibiotic plus ventilator and/or vasopressor use. We characterized the interval between ESS and DrotAA initiation as Same-day, Next-day, or Day 2+. We compared group characteristics and created multivariate models of hospital mortality, length-of-stay, and costs.

Results: Forty-three percent of patients received Same-day DrotAA, 30% Next-day, and 27% Day 2+. Same-day and Next-day patients had more organ dysfunctions at ICU admission than Day 2+ patients (1.1 ± 0.9 and 1.2 ± 0.8 vs. 1.0 ± 0.8; p = 0.021 and p < 0.001, respectively), but from ESS to DrotAA initiation, organ dysfunctions for Day 2+ patients had increased more (+0.0 and +0.4 vs. +0.6, respectively; all p < 0.0001). Increased mortality was observed with administration later than Same-day, although only for the Day 2+ group did the association remain significant (?p < 0.05) after adjusting for clinical and demographic factors. Only Next-day initiation was associated with significantly decreased costs (?p = 0.0145).

Conclusions: Timing of DrotAA initiation is associated with clinical and economic outcomes in severe sepsis. The potential impact of this timing on hospital mortality, length-of-stay, and costs deserves further study.