Preliminary investigation of the problems associated with supply of palliative care medicines in primary care

□ Fax‐back was a cost effective method for administration of a self‐completion questionnaire which produced a high (76 per cent) response rate □ Problems with supply of palliative care medicines were reported by 58.5 per cent of health authorities responding to the survey □ Supply of medicines out of hours was the most common problem reported (93 per cent), with stock levels held in pharmacies and problems with specialist medicines also causing problems in over 50 per cent of respondents □ Some health authorities reported that protocols for supply of palliative medicines, or the existence of designated community pharmacies for their provision, reduced the problems reported □ Further research into effectiveness of protocols and designated palliative care pharmacies is indicated, and our study has identified those health authorities where such research could be targeted     

The use of sublingual glyceryl trinitrate and aspirin in angina patients and enhancement of coronary heart disease databases

□ Audit involving 95 per cent of community pharmacists in one LHCC □ Data were gathered using a semi‐structured questionnaire □ A list of all participating patients was sent to each GP surgery in the locality to enhance their CHD database □ Not all appropriate angina patients are receiving aspirin □ Patients' knowledge of GTN management was poor and should be improved upon by input from healthcare professionals     

Poor correlation between predicted ideal and prescribed digoxin dose: a community‐based pharmacokinetic study in the elderly

□ This study assessed if population‐based pharmacokinetics predicted measured plasma digoxin concentrations in elderly community‐managed patients □ Twenty‐seven per cent of the sample showed plasma concentrations consistent with a therapeutic level over an entire 24‐hour dosing schedule; 36 per cent showed therapeutic levels for at least some of the dosing schedule; the remainder showed digoxin concentrations not consistent with achieving a therapeutic plasma concentration for any part of the dosing schedule □ The mean daily prescribed dose of digoxin was significantly lower than that predicted from population kinetics.     

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     

A postal survey to assess the views of community pharmacists on the deregulation of emergency hormonal contraception

□ This was a postal survey undertaken before EHC was available nationally in UK community pharmacies □ The survey aimed to assess attitudes of UK community pharmacists towards the deregulation of EHC □ A response rate of 66 per cent was attained and the consensus was that community pharmacists broadly agreed with the deregulation of EHC □ Pharmacists believed that the supply of EHC through pharmacies would increase their professional status, and there would be need for GP collaboration □ Although pharmacists welcomed EHC deregulation, they had reservations about legal implications     

Concordance in Muslim patients in primary care

□ The study examined the perceptions of Muslim patients and general practitioners (GPs) about ways in which the Muslim faith may influence medicine concordance □ Fifty Muslim patients (100 per cent response) and 18 general practitioners (53 per cent response) were surveyed using self‐completion questionnaires in order to determine attitudes towards dietary requirements and medicines □ A large proportion of the Muslim patients sampled stated that they would stop taking a medicine if they found out that it was not halaal □ Pharmaceutical manufacturers also need to be sensitive towards the requirements of Muslim patients □ In specific cases, doctors should seek guidance from Islamic leaders as to the correct interpretation of Islamic law with regard to the use of medicines considered haraam     

Satisfaction with information and its relationship with adherence in patients with chronic pain

□ Due to the nature of chronic pain it would be expected that patients are highly adherent to their pain medication. However, results from this study have shown that 23 per cent of patients often or always avoid using their pain medication, 13.4 per cent often or always alter dosages, and 10.3 per cent often or always stop taking their medication for a while. This suggests intentional non‐adherence to pain medication □ Less than 50 per cent of respondents were satisfied with information provided on side effects, what to do if side effects occur, and possible interactions with other medication □ Patients' satisfaction with information about their medication was related to self‐reported adherence; greater satisfaction was associated with higher self‐reported adherence     

Patient acceptability of cyclical etidronate and calcium therapy and symptomatic response to treatment

One hundred and seventeen patients (75 per cent women) with established osteoporosis were entered into a clinical trial assessing two regimes of cyclical etidronate and calcium (Cacit). Some subjective parameters of clinical outcome were assessed prior to, and during, treatment. Patient acceptability of therapy was also examined. There was a significant reduction in pain score (median scores from a 10-point visual analogue scale at 0, 6–12 and 15–24 months were 4, 2 and 1, respectively) and in analgesic consumption (32 per cent, 51 per cent and 65 per cent of patients at 0, 6–12 and 15–24 months, respectively, were using no analgesics). Sleeping patterns improved significantly during the study but there was no change in hypnotic consumption. Sixty-four per cent of patients felt there had been an improvement in their condition and 79 per cent felt that attending the clinic had helped them come to terms with osteoporosis. Etidronate was well tolerated: 23 per cent of patients experienced mild gastrointestinal side effects; 94 per cent were prepared to continue with treatment indefinitely. However, 43 per cent felt their daily routine was interrupted by taking etidronate. The Cacit was poorly tolerated: 50 per cent of patients experienced gastrointestinal side effects, 28 per cent had to discontinue calcium because of side effects and 24 per cent felt their daily routine was altered by taking calcium. Eighty-five per cent were, however, prepared to continue with some form of calcium supplement indefinitely. In conclusion, etidronate therapy was an acceptable form of treatment in this group of patients and provided some symptomatic improvement. However, the choice of calcium supplement was less acceptable and may lead to non-compliance with treatment.     

Patient self‐eports of potential adverse drug reactions

□ A systematic questionnaire was found to be a feasible method of facilitating patients to report symptoms they perceived to be potential adverse effects of drugs □ Although 89 per cent of patients who had taken tramadol and venlafaxine reported at least one symptom in questionnaires, only 58 per cent of these claimed to have reported their symptoms to their doctor □ Only 22 per cent of symptoms reported by a sample of patients were found to be recorded in medical records and only 23 yellow card reports were submitted to the CSM for the same period □ Low reporting rates to GPs and low recording rates would appear to be contributory factors to low rates of reporting to the CSM.     

Effect of pharmaceutical pre‐assessment on post‐operative interventions

□ The study determined the extent of post‐operative interventions required for patients admitted for elective hip or knee arthroplasty □ In Phase 1, patients were pre‐assessed by nurses at admission, according to existing practice; in Phase 2, patients received pharmacist‐led pre‐assessment □ There were 131 interventions (2.05 per patient) in Phase 1 compared with 40 (0.68 per patient) in Phase 2, a reduction of approximately 70 per cent □ This study demonstrates that pharmaceutical pre‐assessment substantially reduces the number of interventions made during patients' post‐operative stay.     

Supplying emergency hormonal contraception in the pharmacy: the perspectives of service users

□ Pharmacists have been supplying emergency hormonal contraception via patient group direction in Manchester, Salford and Trafford health action zone since late 1999 □ This paper presents preliminary results of a questionnaire survey of users experiences of obtaining emergency contraception from this source □ Four hundred and thirty out of a total of 5,020 questionnaires distributed by pharmacists were completed □ Ninety‐nine per cent of service users were either very satisfied or satisfied with the manner in which their request for emergency contraception was dealt with □ Ninety‐one per cent of respondents felt either comfortable or very comfortable discussing emergency contraception with the pharmacist     

Gender and age influences on prescription and consultation frequency for multiple sclerosis patients

□ The study aimed to examine whether gender and age affects the burden of disease in secondary care in terms of number of prescribed drugs and number of consultations with the general practitioner (GP) for multiple sclerosis and control patients □ Anonymised data for 1996 was obtained for all patients (patient years at risk = 220,538) from 24 GP practices in the GP Morbidity Database who had a Read code of MS at some point from 1993 to 1996 and a randomly selected age, gender and surgery matched control group □ A total of 216 cases was identified, giving a prevalence of 97.9 per 105 (based on patient years at risk in the database for 1996; n=220,538). Sixty‐seven per cent (145/216) of cases were female. The mean age was 46.7 (range 17 to 84 years) □ Gender differences for the MS patients, but not controls were found. For example, although females in both the control and MS population had significantly more consultations than the corresponding males, only the control females had more items prescribed than control males (p=0.033) □ This study warrants further work to elucidate whether specific therapeutic areas or MS‐treated symptoms are influenced by gender     

Community pharmacy management of acute diarrhoea in adults

Objective — To study the community pharmacy management of acute diarrhoea in adults and to explore the attitudes and beliefs of community pharmacists towards the management of this common condition. Method — Data were collected over a four-week period on the incidence and presentation of acute diarrhoea in adults by pharmacy staff in 17 pharmacies who were participating in a community pharmacy research panel. A postal survey on attitudes and beliefs about the treatment of diarrhoea was sent to a random sample of 2,500 community pharmacists. Key findings — A total of 1,401 community pharmacists responded to the survey (response rate 59 per cent). Their responses suggested ambiguity in the treatment of acute diarrhoea in community pharmacy, particularly in relation to attitudes to oral rehydration and anti-motility drugs. Although the majority of pharmacists surveyed were aware of recommendations to treat adult patients with acute diarrhoea with oral rehydration, in practice many stated that they often sold an anti-motility treatment, a finding borne out by the high percentage of anti-motility sales (61 per cent) in the earlier part of the study. The decision to sell or recommend an anti-motility drug was often motivated by the patient's circumstances and their need for immediate symptomatic relief. Conclusion — This study suggests that the community pharmacy management of acute diarrhoea is characterised by ambiguity and pragmatism. Existing guidelines for the treatment of diarrhoea fail to take into account the social context in which pharmacists operate, particularly in relation to patient demand and the need for symptom relief.     

Headache experiences and medication use in primary care

□ A survey was used to examine headache experiences and medication use in an adult population sample □ Seventy per cent had experienced headaches in the previous three months □ Sixty per cent had taken medication for headache in the past three months □ Most headache sufferers self‐treated their headaches □ Only a few respondents had taken medication before headache pain started or had found their medication ineffective, but combination therapy was common.     

Obtaining accurate patient‐specific perioperative anaesthetic costs in orthopaedic anaesthesia

□ The aim of the study was to obtain perioperative patient‐specific costs associated with orthopaedic anaesthesia □ A prospective observational study design was used to determine fixed, semi‐fixed, and variable costs □ The preliminary results of the first 60 patients reports a mean total perioperative anaesthetic cost of £291 (SD: £103.9, median: £278.09, IQR: £219.3–£369.5) □ Fixed and semi‐fixed costs are a major cost component of anaesthesia; variable costs account for only 12 per cent of total cost □ The results of this study will be used in an economic evaluation examining the use of different anaesthetic techniques in orthopaedics     

Identification of psychosocial factors which influence patient adherence with antihypertensive medication

□ It is estimated that only 50 per cent of hypertensive patients adhere to medication regimens □ In this study evaluation of self‐efficacy and the theory of planned behaviour was used to identify psychosocial factors which impact on patient adherence to antihypertensives □ High self‐efficacy, intentions to comply with the medication regimen, possessing a positive attitude towards taking medication, perceiving pressure from significant others to take medication as prescribed, and perceiving control over taking medication were determinants of good adherence □ The successful identification of factors which influence adherence will allow health‐care providers to implement interventions, aimed at enhancing adherence with antihypertensive medication.     

Hay fever symptoms and over-the-counter remedies: a community pharmacy study

There is poor understanding of patients' perceptions of hay fever symptoms, the factors which motivate them to purchase particular products and what properties they deem desirable in a remedy. This study aimed to increase understanding of patients' perceptions of hay fever symptoms and to investigate their perceptions of five non-sedating oral antihistamine products and a corticosteroid nasal spray. A sample of 249 patients was recruited from community pharmacies from June to August, 1995. Of these, 139 (56 per cent) returned questionnaires, of which 124 were valid for analysis. The most common symptoms experienced were nasal and ocular. The most common early warning sign of hay fever was sneezing (75; 21 per cent). Forty-three subjects (35 per cent) indicated there was less than half an hour between the first sign of an attack and developing all symptoms, and 87 (70 per cent) reported developing all symptoms in under two hours. For 45 subjects (36 per cent) the worst period for the attack was the morning. The most common way of treating a hay fever attack was by taking a remedy at the first sign of hay fever (70; 56 per cent). Seventy-six (61 per cent) used the remedy once daily and 120 (96 per cent) once or twice daily. Eighty-five (69 per cent) used the remedy every day of the week during an attack. A reduction in sneezing was the most common indicator that the remedy was working (50; 21 per cent). The most common reason for purchasing a remedy was the pharmacist's recommendation (45; 33 per cent). The most common reason for acquiring the remedy by over-the-counter (OTC) purchase was that it was more convenient than consulting a general medical practitioner (GP) (77; 42 per cent). The most common reason for liking a particular remedy was that it gave fast relief (35; 21 per cent). The most common reason for disliking a remedy was that it was expensive (21; 28 per cent). Most patients (108; 87 per cent) were either “very” or “fairly” satisfied with their remedy. The top three most important desired properties of an “ideal” hay fever remedy were that it was fast acting, gave long lasting relief and did not cause drowsiness.     

The impact of hospital antimicrobial policy on the incidence of Clostridium difficile infection

□ An antibiotic policy specifically targeting high risk drugs for Clostridium difficile‐associated diarrhoea (CDAD) development was introduced in the study site hospital □ Despite an increased usage of antibiotics (calculated in defined daily doses) within the hospital, the policy led to a 19.7 per cent decreased incidence of CDAD □ Further improvements are predicted with improved adherence of hospital staff to the hospital antibiotic policy