Compliance,concordance and the revolving door of care: caring for elderly people with mental health problems

□ The project involved community pharmacists receiving specialised training, becoming integrated into the community mental health teams and providing pharmaceutical care when making joint domiciliary visits with the key workers. □ Community pharmacists, psychiatrists and key workers all wanted the project to develop into a service and had similar views about the general benefits of the study. However, they had contrasting expectations of the project, based on their own perspectives on compliance, concordance and models of care □ The key workers valued the provision of monitored dosage systems for patients with confusion or memory problems. But the pharmacists felt that they were being expected to organise compliance aids; they recognised that it was their role to assess complaince and that other measures could be taken before organising an MDS □ The psychiatrists stated that involuntary non‐compliance with medication, arising from confusion, memory and physical problems, was a major issue and the project had made improvements in this area; they wanted to keep patients in the community and particularly valued reductions in morbidity, relapses and the “revolving door of care”     

A randomised,controlled study to quantify the benefits of community pharmacist interventions on the prescribing of cardiovascular drugs in general practice

□ The impact of a one‐off medication review by a specially trained community pharmacist, with recommendations to the patient's general practitioner was studied □ No differences were observed in any of the physiological or biochemical monitoring indicators □ There was greater improvement post‐intervention in some key quality prescribing indicators (eg, prescribing of antiplatelet and beta blocker or ACE inhibitor post‐MI); others showed equal improvement in both groups (diabetic patients on ACE inhibitor) □ A single review of medication records by a practice‐based pharmacist, with a dependence on the general practitioner to implement change may have limited benefit.     

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.     

A novel approach for teaching aseptic processing to pharmacy undergraduates

□ Aseptic processing is a fundamental skill required of pharmacy graduates □ Traditional one‐to‐one teaching is not possible with the expanding numbers of undergraduates □ An original computer‐aided learning package was written to aid teaching aseptic processing to pharmacy undergraduates □ The students valued the CAL package as an aid in preparation for practical exercises, but would have preferred more feedback on the questions asked □ Funds have been secured to enable improvements in the CAL package, allowing assessment of questions and better interactivity.     

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     

From compliance to concordance: meeting the needs of patients?

□ Compliance has come under increasing criticism as a means by which to organise health care interactions and interest has been expressed in a new model termed concordance □ This research set out to explore the relevance of compliance and concordance to a group of Pakistani people with Type 2 diabetes and the health professionals involved in their care □ Both patients and health professionals remained wedded, to some degree, to traditional notions of compliance with health care instructions □ However, some patients expressed a desire for greater understanding of the practical problems of living with Type 2 diabetes and integrating the regimen into their lives □ On the basis of these findings, it may be more appropriate to link concordance to an approach which seeks to sensitively elicit patients narratives as a basis for shared understanding.     

Continuation of treatment of drug misusers between primary and secondary care in the South West

□ This study established the extent to which hospitals in the South West region have guidelines or protocols in place to ensure that continuation of care is provided to drug misusers □ An internet‐based questionnaire, using open and closed questions, was designed to explore the issue of continuous care policies for drug misusers within secondary care □ Formalised hospital‐wide policies, guidelines or protocols on continuous care for drug misusers were found to be lacking within the South West; however, several measures taken at ward level or on an individual case basis ensured continuation of care □ Regional‐wide guidelines within the South West to promote the continuous care of drug misusers when they are taken into and discharged from hospital need to be developed in liaison with primary care service providers.     

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     

Educational strategies to promote evidence‐based community pharmacy practice: a cluster randomised controlled trial

□ Cluster randomised controlled trial of educational strategies in community pharmacy □ Comparison of educational outreach visits and continuing professional development as strategies for implementing guidelines for the sale of over‐the‐counter (OTC) medicines □ Outcome measures derived using simulated patients visits □ Neither educational strategy produced significant change in the sale of OTC medicines □ Further research required to identify effective and efficient educational strategies in community pharmacy.     

Does social environment affect arthritis patients' ability to remain on methotrexate treatment?

□ Drug toxicity is still a major limiting factor for methotrexate treatment continuation □ Treatment discontinuation within 12 months of start of methotrexate in this UK cohort was 20% (SE 2%) □ The monitoring of tolerance to methotrexate has implications for the dispensing of the drug in primary care □ Although social circumstances may have a role in arthritis patients' psychosocial health status, continuation rates of methotrexate in “affluent” and “deprived” patients were similar at the end of the first and second years of treatment □ The reasons for lower socio‐economic groups being discontinued on lower methotrexate doses warrant further study     

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     

Training needs analysis for pharmacy technicians in Northern Ireland

□ No structured post‐qualification training programme for pharmacy technicians is available in Northern Ireland and research was conducted to assess current training needs □ A number of research strategies was employed during the training needs analysis including: observational visits, surveys, in‐depth interviews and focus groups □ Details relating to the current role, deployment, qualifications held and post‐qualification training of technicians were obtained during the research □ The need for a structured post‐qualification training programme was highlighted and a number of suitable areas for inclusion in such a programme were identified (eg, supervisory skills, communication skills, medicines management, aseptic technique and information technology) □ It is recommended that a training programme is introduced and that resources are provided to allow this to happen     

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     

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     

Validity and reliability of the kidney disease questionnaire in patients receiving continuous ambulatory peritoneal dialysis

□ No specific health‐elated quality of life (HRQL) measure exists for patients receiving continuous ambulatory peritoneal dialysis (CAPD) □ This study assessed evaluated the use of the kidney disease questionnaire (KDQ) which has been specifically designed for haemodialysis patients in those undergoing CAPD □ Confirmatory factor analysis was used to assess the validity and reliability of the KDQ which was administered by interview to 41 CAPD patients □ Many of the items in the five dimensions of the KDQ demonstrated high factor loadings, thus indicating good representation of the associated dimension; good reliability scores were also reported □ The KDQ may be a useful measure of HRQL in CAPD patients     

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.