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     

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”     

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.     

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.     

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.     

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     

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     

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.     

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”     

The views of general practitioners on the reuse of patients' own drugs

□ The quality of patient care could potentially improve through patients' own drugs (POD) schemes □ POD schemes need to be promoted to primary care professionals     

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.     

A consensus model for delivery of structured pharmaceutical care for the patient with type 2 diabetes mellitus by Scottish community pharmacists

Objective To generate a model of pharmaceutical care for the patient with type 2 diabetes mellitus in primary care, from a consensus determined among community pharmacists in Scotland. Setting Community pharmacists within Scotland already involved in providing structured pharmaceutical care. Method The Delphi questionnaire was based on a validated multidisciplinary model of care for the patient with type 2 diabetes mellitus in primary care comprising 47 items under five themes: assessment, treatment plan, treatment administration, patient monitoring, confirmation/review. Seventy participants already participating in a pharmaceutical care model schemes initiative to encourage pharmaceutical care from community pharmacies and with an interest in diabetes mellitus were sent an initial questionnaire. Thirty‐seven participants agreed to enter two further rounds; response rates were 22/37 (59%) and 18/22 (82%). Final round cut‐off defining consensus was 80% scoring 6–7 from a seven‐point Likert scale. Key findings A model emerged from the achieved consensus. There was an early consensus achieved on the core functions that participants were already delivering to the patient with diabetes mellitus. These are functions that have been highlighted and delivered in previous studies within this disease state: receiving and sharing patient information, individualising treatment, identifying unsatisfactory treatment and monitoring and prescribing analgesia. Conclusions For service development and linked continued professional development a well‐defined service model for delivering pharmaceutical care to patients is required. This study proposes such a model based on consensus among a self‐selected group of community pharmacists leading diabetes pharmacy practice in Scotland.     

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.     

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.     

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     

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.     

Antibiotic prescribing for lower respiratory tract infections within secondary care

□ A systematic content analysis of the treatment guidelines for lower respiratory tract infection was performed on antibiotic formularies and policies obtained from hospital management units within the West Midlands and university hospitals from the rest of the United Kingdom □ Analysis of antibiotic formularies and policies demonstrated considerable variation between prescribing guidelines with regard both to the agents and dosages used □ A proportion of hospitals in the West Midlands and university hospitals from the rest of the UK gave no guidance regarding drug dosages, which may result in wide variations in therapy □ These findings have important consequences for quality of patient care, drug budget management and antibiotic resistance     

一例类固醇性糖尿病的病例分析及药学监护

目的:探讨类固醇性糖尿病的发生原因、治疗方法及药学监护。方法:临床药师结合相关文献,对一例住院过程中出现血糖升高的患者进行原因分析,为患者提供药学监护。结果和结论:患者出现类固醇性糖尿病,与其长期使用糖皮质激素类药物,近期加大用药剂量有关。各类降糖药均可用于治疗类固醇性糖尿病,但应根据血糖值采取合理的降糖方式,并遵循类固醇性糖尿病临床特点用药。临床药师在临床治疗中及时发现药品不良反应并提供药学监护,可提高患者用药的安全性和有效性。