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.     

Perceptions of pharmacists as providers of immunizations for adult patients

Pharmacists have been involved with patient care at the Family Medicine Center, affiliated with the Medical University of South Carolina, for over 20 years. In 1999, to add to existing clinical services, pharmacists administered immunizations (influenza and pneumonia) to over 400 adult patients during clinic visits in designated patient care rooms. A few months after the immunization period, both health care providers and immunized patients were asked to respond to a survey regarding their opinions of pharmacist-administered immunizations. Response rates were 71% for health care providers and 16% for all immunized patients. Most (90%) of the health care respondents felt comfortable with pharmacists providing immunizations and thought it was appropriate for pharmacists to provide this service. However, 35% of the providers did not agree that pharmacists should provide immunizations in local pharmacies. Most (97%) of the immunized patients felt comfortable with their provider but did not recall that a pharmacist had administered the immunization. In addition, 64% questioned the qualifications of a pharmacist to administer immunizations, and only 43% felt comfortable having a community pharmacist administer a vaccine. By extrapolation of these data, one can determine that patients do not regard pharmacists as qualified providers of immunizations. Further study of patient perception of pharmacists in this role is being conducted.     

Perceptions of patients on Medicare Part D medication therapy management services

ObjectivesTo determine patients’ perceptions and expectations about medication therapy management (MTM) services pertaining to the core elements of an MTM service in the community pharmacy setting, and to develop educational strategies and outreach programs aimed at increasing patients’ knowledge of MTM services and the expanded role of pharmacists in the community pharmacy setting.DesignMulticenter, cross-sectional, anonymous study.SettingFour regional community chain pharmacies in Maryland and Delaware in January and February 2006.Patients81 patients who were 18 years of age or older and able to complete the survey.InterventionSurvey containing 14 questions administered within pharmacies, two of which had patient care centers that were providing clinical services.Main outcome measurePatients’ perceptions and expectations regarding MTM services.Results49 of 81 patients (60%) had never heard of MTM services. A total of 65 patients (80%) had never had or received a medication therapy review, 63 (78%) never had or received a personal medication record, and 70 (86%) never had or received a medication action plan. Some 56% of participants (n = 45) thought that pharmacist provision of medication therapy reviews, personal medication records, medication action plans, recommendations about medications, and referral to other health care providers was very important. At least 70% of participants (n = 57) thought that having one-on-one consultation sessions with pharmacists to improve communication and relationships with their pharmacists and to improve their medication use and overall health was very important. More than 50% of participants indicated that they would like to receive brochures or talk to their pharmacist to learn more about MTM services.ConclusionPatients have very limited knowledge of the core elements of an MTM service in the community pharmacy setting. Patients reported that pharmacist provision of MTM services was important, but they were concerned about privacy and pharmacists’ time. Patients are also supportive of and believe that MTM services can improve communication and relationship with their pharmacist and improve medication use. Patients appear to prefer receiving brochures and talking to pharmacists to learn more about MTM services. This survey identified a key opportunity for pharmacists to inform patients about MTM services.     

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.     

Perspectives on privacy in the pharmacy: The views of opioid substitution treatment clients

BackgroundMany pharmacists practise in settings in which protecting privacy can be difficult. To address this, some community pharmacies are rearranging their retail space to provide private areas for clinical consultations. Such facilities are deemed particularly important when dealing with clients who have sensitive medical conditions, such as opioid dependence.ObjectiveTo explore Opioid Substitution Treatment (OST) patients’ perceptions of privacy in a community pharmacy setting, with a particular focus on the layout of the community pharmacy.MethodsWe conducted semi-structured interviews with OST clients. Recruitment and the interviews were conducted at state government drug and alcohol clinic. The interviews were audio recorded and transcribed verbatim. The data were analysed in NVivo using the framework approach.ResultsWe interviewed fourteen OST clients. Most participants were concerned about privacy and considered that the pharmacy layout could enhance or hinder privacy. However, they disagreed about exactly which pharmacy layout was most privacy-protecting. In addition, a small group of clients interviewed who had a very positive relationship with pharmacists believed that the relationship contributed to their confidence that their privacy was protected.ConclusionsThere is little consensus amongst consumers about how to protect privacy in the community pharmacy. The range of views expressed by clients in this study may reflect the lack of consensus about the nature of privacy in health ethics. Attention to the meaning of and rationales for privacy protections may be helpful when designing pharmacy layouts to meet the needs of a broad range of consumers. An enclosed or screened private area which can be used as a consultation area for all private pharmacy discussions, including for OST dosing, could be a solution to addressing these varying views on privacy in the pharmacy. Further attention to enhancing the pharmacist and client relationship may assist in reducing sensitivity about privacy.     

Pharmacy customers' views and experiences of using pharmacies which provide drug misuse services

This study aimed to determine whether pharmacy customers are deterred from using a pharmacy that offers services to drug misusers. If patients are deterred, what are their specific concerns? The study was qualitative and three different groups were interviewed about their views on pharmacies providing services to drug misusers (i) pharmacy customers, (ii) local community councils and (iii) local drug forums. This paper focuses on pharmacy customer interview results. Interviews were conducted in 10 pharmacies, five in Aberdeen and five in Glasgow, both areas of high drug misuse. The pharmacy customers were attending pharmacies with high, medium and low involvement with drug misusers and were located in city centre, suburban and rural locations. Pharmacy customers were generally supportive of pharmacies offering services to drug misusers. However, their support was often qualified by a wish to see a private area provided for methadone consumption. Pharmacy customers were more knowledgeable of the rationale for and supportive of needle exchange services compared to methadone maintenance and supervised consumption. The results of the study demonstrate that the majority of pharmacy customers are supportive of drug misuse services, provided there is adequate privacy in the pharmacy. These results should be used to encourage more pharmacists to provide drug misuse services.     

Health promotion by community pharmacists: consumers' views

As part of the evaluation of the Barnet family health services authority high street health scheme (HSHS), 592 consumers were interviewed in six pharmacies. The objectives were to investigate whether the consumers came to the pharmacies for advice on general health matters, saw pharmacists as a reliable source of advice about staying healthy, read health promotion leaflets and had heard of HSHS. The general medical practitioner's (GP's) surgery was felt to be the most convenient place to get advice about staying healthy, and the GP the best person from whom to get it. The pharmacist was rated second in each case, above the media, although only 90 (15 per cent) of respondents had ever asked the pharmacist for general health advice. Only 237 (40 per cent) thought that it was the “usual” job of the pharmacist to give advice about general health, 112 (19 per cent) thought that it was not, and 243 (41 per cent) did not know. Those who had taken away leaflets to read (178, 30 per cent) were significantly more likely to be frequent visitors to the pharmacy, to have chronic illnesses, to think the media was the most convenient place to get advice, to have previously asked the pharmacist for advice about staying healthy and to think it was usual job of the pharmacist to give advice about staying healthy. Only 65 (11 per cent) had heard of the HSHS. Many consumers do not currently perceive that there is a role for community pharmacists in health promotion, and the profession needs to think again about some of the presumptions that have been made in the past.     

Diabetes care in Norwegian pharmacies: a descriptive study

OBJECTIVE: To describe Norwegian pharmacies' involvement in diabetes care, to investigate pharmacists' views on future services and to investigate whether the recommendations in the Norwegian diabetes declaration for pharmacies have been implemented. Setting Hospital and community pharmacies in Norway. METHOD: All 543 pharmacies in Norway, of which 511 were community pharmacies and 32 were hospital pharmacies, received a link to a web-based questionnaire. One pharmacist from each pharmacy was asked to complete the questionnaire. The questionnaire covered subjects ranging from the diabetes declaration and the pharmacists' views on which services the pharmacy should offer in the future, to demographic characteristics. RESULTS: In total 358 (66%) questionnaires were completed. The diabetes declaration was read by 37% of the pharmacists. Almost all pharmacies complied with the declarations' recommendations regarding glucose monitoring services. Twenty four percent of the pharmacies could offer medication reviews, and roughly 10% could offer screening for undiagnosed diabetes. Counseling on lifestyle issues was the least implemented recommendation. Eighty one percent of the pharmacists reported a wish to expand their services towards diabetes patients. Services in regard to glucose monitoring had the highest score, however the views on which services should be offered varied a great deal. Already performing a service increased the chance of the pharmacist being positive towards offering it. CONCLUSION: Norwegian pharmacists report that they are involved in a wide range of diabetes related services, although only 37% report to have read the diabetes declaration. The pharmacists generally wish to actively support patients with diabetes, and further research should concentrate on identifying the areas where their involvement is most productive.     

Community pharmacy services for antidepressant users

Objective — To evaluate the communication and barriers to communication between community‐based pharmacists and antidepressant users. Method — A survey package designed to evaluate the communication between pharmacists and antidepressant users was distributed to 50 community pharmacies. Each package included one pharmacist survey and 10 sealed antidepressant user surveys to be distributed by the pharmacy staff. The survey addressed the components of communication, level of satisfaction and barriers to effective communication. Setting — Urban and rural community pharmacies in the Canadian Maritime provinces of Nova Scotia and New Brunswick. Key findings — Overall, pharmacists rated the value of their communication more highly than did antidepressant users, although the difference was not statistically significant. When beginning treatment, between one‐half and two‐thirds of antidepressant users recalled pharmacists inquiring about past use of the antidepressant and discussing information provided by the physician, time to onset of benefits and potential side effects. The purpose of the antidepressant, target symptoms, usual duration of therapy and risk of relapse with premature discontinuation were addressed less often according to antidepressant users, and monitoring of compliance was not a common activity. Antidepressant users estimated that initial communication with the pharmacist generally lasted less than five minutes, and often less than two minutes. However, pharmacists appeared to resolve misconceptions and concerns about antidepressant use efficiently. According to pharmacists, the major barrier to effective communication was a lack of privacy. Conclusion — Although compliance with antidepressants is low and treatment outcomes are sub‐optimal, pharmacists are not using their opportunities to minimise this problem through effective communication and follow‐up. Pharmacists, pharmacy administrators and regulators need to re‐assess their contribution to this problem and how they can lead to its resolution in the patient's best interest.     

Pharmacists and their customers: a personal or anonymous service?

Aims — To explore the existence and nature of the pharmacist‐customer relationship. Methods — A qualitative approach was adopted. Semi‐structured interviews were conducted with 20 customers recruited from two pharmacies differing in type and location: Pharmacy A, a multiple chain pharmacy in a more affluent area, and pharmacy B, a small chain pharmacy. Key findings — Customers' views differed according to the pharmacy from which they were recruited. Pharmacy B customers had a personal relationship with the pharmacist and used the pharmacy as a health care resource, while pharmacy A customers did not have a personal relationship with the pharmacist and used the pharmacy simply for medicine supply. Several pharmacy A customers had their own different local pharmacist whom they used for more personal advice and counselling. Both groups described disadvantages of multiple chain pharmacies. Consumerist behaviour was identified among customers whereby they preferred to control the provision of advice, assess it and act upon it. However, lack of information was mentioned by several interviewees, which suggested that different types of customers have different needs from the pharmacy. The pharmacist has therefore to recognise these different needs and to meet them accordingly to provide services, whether anonymous or personal, within their “extended role.” While most customers viewed pharmacists as drug experts and considered managing minor ailments to be part of their job, they were less supportive of a more extended role in the therapeutic monitoring of drug therapy. This presents a serious barrier to pharmacists wishing to extend their role into a more patient‐oriented and clinical domain. Conclusion — This study reinforces the importance of considering customers' views when policies and strategies concerning the development of the “extended role” are considered. Recognising customers' views helps the profession to adapt and respond to changing consumer behaviour. Issues identified through this in‐depth exploration of public perceptions of pharmacists have implications for the extension of pharmacists' roles into areas favoured and appreciated by customers.     

Nursing and residential care for the elderly in Northern Ireland: the contribution of the pharmacist

Aim of the study: To gain more detailed information on the current pharmaceutical service provision in nursing and residential homes in Northern Ireland and to assess the views of care staff on future pharmacy services. Method: A structured questionnaire was developed and mailed to all nursing and residential homes (n=586) in Northern Ireland on two occasions. Results: A response rate of 68% (n=396) was obtained. The most frequent services currently provided by community pharmacists were the supply of medication and the collection of unwanted, discontinued or outofdate medicines. The majority of respondents also reported receiving advice on safekeeping, correct administration of medicines, advice on more appropriate formulations and advice on patient medication records from the community pharmacist. Over a third of all the respondents received advice on compliance devices. A similar proportion stated that their care staff were trained by the pharmacist on broad medication management issues.Over 90% of all homes strongly supported staff training by pharmacists on the recognition of medicationrelated problems as a future service. Over 70% of all respondents thought additional guidelines and advice for missed dosages and the use of home remedies would be beneficial. A review of patient medication records to assess drugdrug interactions and possible adverse drug reactions by pharmacists was supported by over 65% of all respondents. Conclusions: This work has demonstrated that those responsible for care in nursing and residential facilities strongly support further involvement by the pharmacist in these care facilities; pharmacy policy makers must ensure that such services are developed to meet the needs of these vulnerable elderly residents.