Identification of the pharmaceutical needs of patients with heart failure

□ An extensive evidence‐base exists to support the treatment of heart failure □ A systematic identification of the pharmaceutical care of heart failure patients is needed to develop a model of pharmaceutical care □ Pharmaceutical care issues may be identified from a number of sources □ Care issues may be based on evidence or accepted “best practice”     

Delivering pharmaceutical care: what does it involve?

□ Implementing pharmaceutical care plans requires pharmacists to interact with both patients and health care professionals □ The actions involved in implementation for the majority of drug classes require contact with other health care professionals □ Requests for monitoring make up a substantial proportion of these contacts □ Authorising pharmacists to make requests directly to appropriate staff may enhance pharmaceutical care without increasing general practitioners' workload.     

Medianes management and the individual patient

□ For medicines management to fulfil its aim of partnership with patients, the individual patient's perspective needs to be examined □ Study uses discursive analysis of in depth interviews of hypertensive patients to highlight individual patients' experience of hypertension □ Findings suggest that patients may consider condition and care differently than health care professional □ Evaluation of medication may not be completely explained by the clinical paradigm of risk/benefit □ Concordance may be more difficult to achieve in the early stages of treatment.     

Patients' perspectives on medicines and pharmacy: views of patients with Type 2 diabetes

□ The study was conducted to inform the design of pharmaceutical care support to patients with Type 2 diabetes – a recognised health care priority and a target for new pharmacy initiatives □ Interviews in an outpatient clinic revealed an apparent lack of patient‐pharmacist communication and low patient expectations □ Some patients felt a lack of feedback about the results of clinic checks and what they meant for disease control □ Patient information leaflets were not consistently seen as meeting patients' needs for information and advice □ Patients' experiences can be used to develop the role of community pharmacy services within the health care team effort     

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.     

Integrating the community pharmacist into the diabetes team: evaluation of a new care model for patients with Type 2 diabetes mellitus

□ Diabetes is a major public health issue affecting 3 per cent of the population □ Integration of the pharmacist into the multidisciplinary care of patients with chronic conditions is supported by the profession and the government □ Community pharmacists engaging with their established customers and access to relevant data can, through use of a systematic process, identify the pharmaceutical needs of this patient group □ The model of care proposed is feasible in a primary care setting, resulting in acceptance of pharmaceutical care issues general practitioners and an improvement in patient care     

Futile and inappropriate prescribing: an assessment of the issue in a series of patients admitted to a specialist palliative care unit

□ Palliative care patients are often subjected to polypharmacy, some of which is futile or inappropriate □ Rationalisation of medication does not occur due to patients being seen by several specialists and prescribers fearing the reaction of a patient whose drug rationalisation may remind the patient of his/her own mortality □ Patients raised no objections to having medication withdrawn after the reasons why had been carefully communicated to them □ Health care professionals need to do regular medication review as part of their role to achieve favourable outcomes for patients     

Pharmaceutical information exchange between primary and secondary health care professionals and cancer patients

□ No single professional takes overall responsibility for the pharmaceutical aspects of cancer patient care □ Information given to cancer patients by health care professionals (HCPs) varies depending on the priority of the professional □ Cancer patients primarily approach primary care HCPs for help and advice for their medication □ Training and support must be available to enable HCPs to address individual cancer patients' information needs.     

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     

Do increasing levels of income deprivation have an effect on the prescribing of OTC medication?

□ People who are on a low income frequently visit their general practitioner to obtain medication that is also available over the counter, because it will be dispensed at no cost to them □ This activity reduces the amount of time available for the GP to treat more serious illnesses □ This leads to inequity when compared with the service provided in more affluent areas □ Pharmacists should be more involved in the provision of free health care to these patients     

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     

Laxative prescribing during pregnancy in primary care

□ Hormonal changes, mechanical pressure and concurrent medication all contribute to altered bowel habit during pregnancy □ It has been suggested that pregnant women are more likely to receive laxatives than the baseline population □ A retrospective case control study using a primary care prescribing database was undertaken to compare laxative prescribing before and during pregnancy with that in matched controls □ Prescribing rate of laxatives increased during pregnancy compared with before becoming pregnant but this was not different to controls □ Pregnant women were more likely to receive a laxative if they were using antibacterials, preparations for haemorrhoids or drugs for nausea and vertigo.     

Action learning as an improved method for continuing professional development for pharmacists providing women's health care advice

□ A self‐selected set of pharmacists participated in a formal women's health care advice programme □ The tools (continuing education needs assessment grid and job competency wheels) proved useful in identifying training needs and assisted the implementation of identified training solutions □ Regular meetings of the set were an essential component of the process □ Motivation and encouragement by peers should not be underestimated □ Action learning in association with an organised programme is a successful and appropriate means of facilitating CPD     

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     

The association of psychosocial and diabetes factors to diabetes knowledge

□ In diabetes a good knowledge of the disease state and its treatment is likely to enhance self‐management □ The questionnaire‐based study aimed to determine factors associated with decreased diabetes knowledge to help target patients who may be at risk of poor self‐management □ Factors predictive of increased knowledge about diabetes were lower age, Type 1 diabetes, a longer duration of diabetes, a higher occupational status, higher generalised self‐efficacy and a lower serum triglyceride level □ Patients who fall outside those parameters may be at greater risk of poor management, through having poor knowledge of diabetes □ Diabetes education should be a routine aspect of diabetes care, targeted at those in greatest need.     

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.     

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”     

Clinical medication review by a pharmacist of patients on repeat prescriptions in general practice

□ The government proposes an extension to pharmacists' role to medicine management, including services such as medication review □ We found that pharmacist‐conducted clinical medication review identified medication related problems in nearly half of the patients seen and a quarter of medicines reviewed □ Pharmacist‐conducted clinical medication review is effective in identifying clinical issues related to patients' repeat medication and recommendations are accepted by general practitioners □ There are education and training issues for pharmacy if this model is to be accepted more widely. The pharmacist will need to be part of the primary health care team with access to medical records