Community pharmacists' attitudes towards research

Objectives — To investigate community pharmacists' perception of Pharmacy Practice research and to identify perceived barriers preventing their participation in research. Method — A self‐completed postal questionnaire, including 29 attitudinal statements was analysed using factor analysis. Setting — The study group comprised pharmacists working in all 651 community pharmacies in East London and Essex. Key findings — The response rate was 60 per cent. Factor analysis revealed five factors comprising correlated statements. The majority of respondents perceived community based practice research to be important and relevant to them and to the future development of community pharmacy. Fifty‐four per cent agreed that they were prepared to participate in practice research, although 66 per cent of respondents felt their daily activities precluded this. Payment for a research related activity was a major issue impacting on their likely participation, with 72 per cent of pharmacists agreeing that they would only participate if paid to do so. Pharmacists' employment status, ie, whether employee or proprietor, was also associated with willingness and ability to undertake research. Conclusion — Community pharmacists have a positive attitude towards practice research, and under the appropriate circumstances many would be prepared to participate in research.     

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.     

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.     

Are health professionals ready for the new philosophy of concordance in medicine taking?

Objectives — To develop and administer a practical, valid and reliable tool to measure attitudes to concordance in medicine taking, a new concept where decisions depend on an equal partnership between patient and prescriber. Method — A postal questionnaire was devised comprising statements from the original concordance document, along with statements reflecting the orthodox model of medicine taking. There was a total of 22 statements. Respondents rated each statement on a four‐point Likert agreement scale. The questionnaire also included three scenarios of consultations involving medicine prescribing and taking, with associated statements for rating as true or false. Setting — A random sample of 207 medical, nursing and pharmacy graduates in the North of England at the time of qualification. We received 81 completed questionnaires (39 per cent) Key findings — Item analysis reduced the 22‐item scale to a 12‐item scale with good reliability (Cronbach's alpha = 0.79) and construct validity was demonstrated through correlation with responses to the scenarios. Although the typical respondent had a positive attitude towards concordance (mean = 2.3), 25 per cent of respondents had negative attitudes. Pharmacists showed the least favourable attitudes (P<0.05) Conclusions — The 12‐item Leeds Attitude Towards Concordance (LATCon) scale is a reliable and valid tool for assessing health care providers' attitudes to the new concept of concordance in medicine taking. Newly qualified doctors, nurses and pharmacists tended to hold favourable attitudes, although a significant minority — especially pharmacists — hold negative attitudes. These results have implications for undergraduate education and continuing professional education.     

Doctors' and pharmacists' attitudes to the use of sugar‐free and sugar‐containing medicines in the elderly

Background — Much progress has been made towards the prescribing and dispensing of sugar‐free alternatives for medicines used long‐term in children. However, older people may also take sugar‐containing medicines and those with natural teeth are at risk of dental caries. Objective — To assess the knowledge and attitudes of health professionals with regard to the use of sugar‐free medicines with prolonged oral clearance in elderly people. Method — Postal questionnaire survey of three groups of health professionals (general practitioners, community pharmacists, consultant geriatricians). Statistical analysis using factor analysis, Mann Whitney U test and Kruskal Wallis test. Setting — Five districts of north‐east England. Key findings — The overall response rate was 66 per cent (349 responses). Support for the use of sugar‐free medicines was greater among GPs than pharmacists (P=0.014). There was general agreement that, wherever possible, pharmacists should dispense sugar‐free medicines for elderly people, although more GPs (P<0.0001) and consultant geriatricians (P=0.024) agreed than pharmacists. More pharmacists than GPs believed sugar‐free medicines to be more expensive although there was general uncertainty about whether this deters doctors and pharmacists from using them. There was a good understanding of the role of sugars in medicines in the aetiology of dental disease, although respondents felt that elderly people were unaware of this link. Only 51 per cent of respondents agreed that government should subsidise sugar‐free medicines production. Ninety‐four per cent felt that the pharmaceutical industry should produce more sugar‐free products. Conclusion — Although there is support for the sugar‐free option, there is a need to raise the awareness of health professionals to barriers which currently discourage utilisation, and to encourage a more multi‐professional approach in the education of health professionals, health care providers, manufacturers and regulators with regard to sugar control in medicines use and related regulatory issues.     

Attitudes of community pharmacists in the Netherlands towards adverse drug reaction reporting

Objective — To gain insight into the attitude and behaviour of community pharmacists in the Netherlands with respect to the reporting of adverse drug reactions (ADRs). Method — A questionnaire survey was conducted among a stratified random sample of 200 community pharmacists from the membership list of the Royal Dutch Society for the Advancement of Pharmacy. The structured questionnaire covered knowledge of the Dutch ADR reporting system, attitudes to involvement in reporting ADRs and self‐reported behaviour. Demographic details were requested and used to assess the representativeness of responders in relation to the total population of Dutch community pharmacists. The number of self‐reported ADR reports was compared with those actually received by the nation's ADR centre. Key findings — The response rate was 73 per cent (n=147) after one reminder. Community pharmacists regarded the reporting of ADRs as an integral part of their professional duties and they did not report experiencing any major barriers to reporting. This is reflected in the frequency and number of ADR reports received by the national pharmacovigilance centre. Comparison of pharmacists' self‐reported numbers of ADR reports with actual reports received indicated that pharmacists overestimated the number of reports they made. The most frequently mentioned barriers to reporting were: the adverse effect assumed to be already known (32 per cent), the reporting procedure too time consuming (25 per cent), and uncertainty concerning the causal relationship between ADR and drug (25 per cent). Feedback was mentioned most commonly as the chief impetus for reporting, and this referred both to feedback on the report submitted and general feedback as provided in publications. Although consultation with the attending clinician before submitting a report is not compulsory in the Netherlands, 55 per cent of the pharmacists saw this as an important aspect in the reporting process. Conclusions — Community pharmacists in the Netherlands are knowledgeable about reporting ADRs and highly motivated to do so. This positive attitude towards reporting adverse events is based on the established tradition of pharmacist reporting in the Netherlands.     

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.     

A survey of adverse drug reaction reporting by hospital pharmacists to the Committee on Safety of Medicines — the role of pharmacy departments

Objectives — To identify: (1) how adverse drug reaction (ADR) reporting by hospital pharmacists is managed, (2) the education of pharmacy personnel on ADR reporting, (3) pharmacy personnel with a specific role in ADR reporting, (4) the numbers of ADR reports sent to the Committee on Safety of Medicines (CSM) and (5) barriers to reporting Method — Postal questionnaire survey of 250 hospital-based drug information (DI) departments Setting — All hospital-based DI departments listed in the United Kingdom Drug Information Pharmacists' Group directory Key findings — A total of 185 questionnaires was returned (74 per cent response). Thirty-five per cent of respondents had a procedure for the reporting of ADRs by pharmacists; 62 per cent of departments actively promoted reporting; 44 per cent of departments reviewed reports before they were sent to the CSM. DI pharmacists were frequently involved in the review of the reports and were usually the designated ADR person. Education on ADR reporting was provided by 69 per cent of departments. Few specialist pharmacists (n=9) were identified as having established a direct link with the CSM. The majority of departments had submitted five or fewer ADR reports to the CSM. The presence of a procedure, promotion of reporting, education and the presence of a designated ADR person were found to be associated with above average rates of ADR reporting (chi-square test) Conclusion — The survey showed that the role played by pharmacy departments in the area of hospital pharmacist ADR reporting varied considerably but in most cases was insufficiently developed     

Community pharmacists' views and experiences of counter-prescribing in pregnancy

Objective — To ascertain the sources of community pharmacists' knowledge base for counter-prescribing in pregnancy, whether sufficient additional information was readily accessible and, if not, to discover pharmacists' areas of concern. Method — A structured telephone interview of community pharmacists by a single researcher using a pre-piloted questionnaire to obtain both quantitative and qualitative data. Questions covered previous education about counter-prescribing in pregnancy, reference sources used, and satisfaction with available reference sources. Respondents were also asked to cite examples where they would or would not recommend a medicine in pregnancy. Setting — A random sample of 50 community pharmacies in Scotland. Key findings — From the high response rate (43 pharmacists, 86 per cent) the topic was demonstrably important to community pharmacists, most of whom perceived their knowledge base for counter-prescribing in pregnancy to be experience-gained. Thirty-four pharmacists (79 per cent) agreed there was a need for more information to be available. Ten pharmacists (23 per cent) highlighted complementary therapies as an area where they found available information inadequate. Examples of requests from pregnant women and the action taken by the pharmacist are reported. Conclusion — There is a need for an accurate, current and comprehensive data source for counter-prescribing in pregnancy. The field of complementary medicines and therapies is of particular concern to many community pharmacists. More research is required into GP referrals.     

Asthma advice giving by community pharmacists

Objective — To investigate the frequency and type of asthma-related advice provided by community pharmacists to customers, and pharmacist attitudes to advice giving and training needs. Method — Postal questionnaire surveying the provision of advice to asthma patients in the previous month. Responses were discussed in a focus group of 13 pharmacists representing different types of community pharmacy and stratified by age and sex. Setting — All community pharmacists in the Grampian health board area, in North East Scotland. Key findings — Of an estimated 180 community pharmacists, 125 responded. Respondents had dispensed a median of 70 asthma medications per week to approximately 40 customers. Most had given advice no more than twice a week. In the previous month, half had checked inhaler technique and most (75 per cent) had “loaned” relief inhalers on an emergency basis. The most common areas where patients sought advice were problems with inhalers, concerns about side effects of asthma medications and using peak flow meters. In the focus group, pharmacists expressed concerns about their training in advice giving for inhaler skills and peak flow meter use and self-management plans. The 69 pharmacists who had undertaken additional training were significantly more likely to feel confident in giving asthma-related advice and to give advice more often. Sixty-one per cent of pharmacists wanted more training in advice giving. Conclusion — At present, asthma-related advice is given infrequently. Reasons for missed opportunities for giving such advice are limited facilities in premises, lack of pharmacist knowledge of some aspects of asthma management and patient attitudes (ie, lack of awareness that pharmacists can fulfil this role).     

Counselling women about periconceptional use of folic acid: the role of the community pharmacist can be improved

Objective — To assess community pharmacists' attitudes towards, and practice behaviour, relating to the periconceptional use of folic acid to prevent neural tube defects Method — A postal questionnaire was sent to a random sample of 150 community pharmacists at the end of 1996. The questionnaire covered knowledge, attitude and behaviour regarding the use of folic acid by women of childbearing age Setting — Two regions in the Netherlands (Northern and Western Netherlands) Key findings — The response rate was 72 per cent. Pharmacists' attitudes towards promoting the use of folic acid by women who wish to have a child are positive. Most pharmacists reported distributing folic acid brochures in their pharmacy and many stated that they displayed posters to promote the use of folic acid. Nearly 30 per cent of pharmacists reported using an additional label on the packaging of oral contraceptives with the standard text: “If you stop using the pill because you wish to have a child, please ask your pharmacist for information about the use of folic acid before you become pregnant”. Perceived attitudes of local general practitioners seemed to influence the willingness of pharmacists to promote the use of folic acid. The results indicate a tendency for some pharmacists to be more reactive than proactive in their advice-giving on the use of folic acid Conclusion — Compared with the findings of a similar survey two years ago, it appears that more pharmacists are actively promoting the periconceptional use of folic acid. However, further improvements could still be achieved and pharmacists could become more proactive in their information and advice-giving     

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.     

Workcoping and homecoping: achieving a balance in part‐time community pharmacy

Objectives — (1) To explore different concepts of part‐time work by means of a study of part‐time work in community pharmacy; (2) to ascertain the complexity and diversity of part‐time work patterns; (3) to consider the strategies employed by part‐time pharmacists to make their part‐time working possible. Methods — Records of part‐time work in community pharmacy were examined. A quantitative survey was conducted by sending a postal self‐completion questionnaire to 975 pharmacists. There were 727 valid responses. Qualitative semi‐structured interviews were conducted with 33 community pharmacists, identified from the survey as working part time. The emphasis was on data representing the part‐timers' own perceptions of their work and careers. Setting — The total membership of two Midlands branches of the Royal Pharmaceutical Society of Great Britain. Key findings — Of the 230 pharmacists (31 per cent of all respondents) who worked part time, 200 (140 women; 60 men) worked in community pharmacy. There was a considerable range and variability of working patterns, the clearest division being between employed (70) and self‐employed (122) part‐timers. The strategies used to cope with work and family responsibilities by both men and women of different ages and under different circumstances were sometimes very complex. The terms “workcoping” and “homecoping” were devised to describe these strategies. Conclusions — Existing concepts of part‐time work do not fully explain the complexities revealed in this study. Many part‐time pharmacists believed they had achieved a balance which was both professionally satisfying and socially responsible. They employed strategies which enabled them to maintain this balance and keep control over their lives.