The feasibility of providing community pharmacy‐based services for alcohol misuse: A literature review

Objectives Excessive consumption of alcohol is a major public health concern. The use of community pharmacies and pharmacists as sources of public health information and services is gaining greater recognition. The objective of this review was to provide an overview of the evidence on the feasibility, effectiveness and acceptability of providing community pharmacy‐based services to address the excessive consumption of alcohol. Methods Electronic databases were searched for the period 1996–2007 to identify relevant evidence. Searches were also conducted of relevant pharmacy and addiction journals. Information was sought from key contacts in pharmacy and alcohol research. Studies were included if they were conducted in a community pharmacy setting. Key findings The review comprised three feasibility studies which included 14 pharmacies and 500 customers. Non‐significant reductions in alcohol consumption were reported with two studies following brief interventions by pharmacists. Between 30% and 53% of pharmacy customers were identified as having hazardous or harmful drinking behaviour. Customer opinion of the pharmacy‐based alcohol services was not reported. Conclusions There has been little empirical evaluation of the effectiveness of community pharmacy‐based services for alcohol misuse. The evidence presented in this review suggests that community pharmacy‐based screening is feasible. Organisations and individuals involved with tackling excessive alcohol consumption should consider the inclusion of community pharmacies and pharmacists as part of their strategies to address this problem. Large‐scale studies are needed to evaluate the short‐ and long‐term effects and cost‐effectiveness of community pharmacy‐based interventions to reduce excessive alcohol consumption, as well as to explore the acceptability of the service to users.     

Development and validation of an instrument to measure professional self‐perception and job satisfaction of Portuguese community pharmacists

□ A questionnaire was developed to assess job satisfaction and professionalism, and sent to a stratified randomised sample of Portuguese community pharmacists □ The ratio of male to female between owner and employee groups was roughly equal, indicating little sex bias between these groups □ Job satisfaction and career satisfaction items could not be differentiated in the sample □ Combined job and career satisfaction scores showed significant differences between male and female pharmacy owners and employees, with the female pharmacy owner group showing the highest job and career satisfaction score     

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.     

Professional integration within health centre pharmacies

□ The National Health Service plan proposes 500 new one‐stop centres to include pharmacy □ Little is known about current activities in health centre pharmacies □ A self‐completion survey of a sample of identifiable health centre pharmacies has been carried out □ There is some evidence of integration of pharmacists within the practice team □ Increased integration will require proactive external input     

Analysis of the information and support needs generated by a community pharmacy‐based methadone treatment programme

Background — Methadone treatment has been provided in Ireland since 1998 under the methadone protocol scheme. Two liaison pharmacists were employed by the Eastern Health Board to interface between pharmacists dispensing methadone in primary and tertiary care. Objective — To analyse and review the inquiries received and addressed by one liaison pharmacist in the first year of operation of a community pharmacy‐based methadone treatment scheme. Method — Inquiries received were recorded by the pharmacist using a standard data collection form. Using content analysis, key themes were identified and each inquiry was classified. Data were analysed using standard computer software. Key findings — Two primary categories of liaison inquiry were addressed: “patient‐related” inquiries, requiring the organisation of community pharmacy‐based methadone dispensing services for patients, and “pharmacy‐related” inquiries, which were requests from community pharmacists for information or support. Two thirds of the inquiries were “patient‐related.” The primary users of the liaison service were prescribers employed by the addiction services and community pharmacists. Conclusion — The liaison pharmacy service handled diverse inquiries, with an emphasis on the facilitation of the provision of pharmaceutical care for patients requiring community pharmacy‐based methadone dispensing services. The liaison service had a significant secondary role in the provision of support and information for community pharmacists. The study findings are of relevance to those involved in developing and introducing primary care‐based services for drug misusers.     

Supply of over‐the‐counter weight‐loss products from community pharmacies

Objectives The aim was to ascertain the availability of over‐the‐counter (OTC) weight‐loss products from community pharmacies and other retail outlets in a large conurbation, and to determine the knowledge and practices of pharmacy staff in the supply of OTC weight‐loss products. Method The setting was one primary care trust in England. We used a cross‐sectional survey of 123 community pharmacies, 12 health stores and 64 supermarkets, plus telephone interview of the pharmacists. Key findings Over two‐thirds of community pharmacies (69%) and health stores (67%) but few supermarkets (8%) stocked one or more OTC weight‐loss products. In total, 73 different products were available from pharmacies, most of which (50) were claimed by manufacturers to be appetite suppressants. Seventy‐eight pharmacists were interviewed, of whom 57 stocked OTC weight‐loss products. Of these 57, only two claimed to undertake any measurements before supplying the products and 33 had no supporting materials/information about the products, although 38 claimed to provide advice. None of the 57 pharmacists had undertaken any specific training in relation to weight loss. Only 44% of all those interviewed considered OTC weight‐loss products to be useful, with even fewer (35%) considering them to be safe. Conclusions Community pharmacies are a major distributor of OTC weight‐loss products, despite the lack of evidence of their efficacy and concerns about their safety. Many pharmacists had limited knowledge of the products, placed few restrictions on their supply and viewed training in weight loss as unnecessary. Pharmacists should consider the appropriateness of supplying these products and utilize the opportunities presented to support weight reduction by more effective means.     

Using computer‐tailored smoking‐cessation advice in community pharmacy: A feasibility study

Objective Community pharmacists are in an optimal position to provide smoking‐cessation services. Computer‐based interventions that generate behavioural feedback materials designed to encourage and help smokers to quit can complement existing services and ensure that smoking‐cessation advice is reliably delivered. This study aimed to assess the feasibility of offering a system of computer‐generated individually tailored behavioural feedback for smoking cessation in community pharmacy. Method The setting was community pharmacies in North London. Pharmacists, already offering cessation advice routinely in the pharmacy, were trained to use a computer‐based system generating a feedback report containing highly tailored behavioural advice about quitting. Pharmacists' advice was structured around the report, which was printed for the participant. Pharmacists were interviewed after recruitment ended, and participants were sent a follow‐up questionnaire 4 weeks after baseline. Key findings Pharmacists felt they had benefited from taking part in the study and were more confident in their management of, and advice to, smokers. All agreed that the computer program was an acceptable and valuable tool to aid smoking‐cessation advice in pharmacies. Eleven smokers were recruited; five completed the follow‐up, four of whom reported 4‐week prolonged abstinence. Reaction to the feedback report from participants was positive. Conclusions The feedback from both pharmacists and participants demonstrates that use of this computer system to structure and standardise delivery of smoking‐cessation advice in community pharmacy is feasible and acceptable. The study suggests that the use of this system could increase pharmacists' confidence and the quality of the advice they give, leading to improved outcomes. However, a randomised controlled trial to fully evaluate the effectiveness of the system is needed.     

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     

‘At the moment it is just a couple of eccentrics doing it’: concordance in day‐to‐day practice

Objectives To assess the feasibility and acceptability of concordance in pharmacy practice through examination of communication between customers and pharmacists in two community pharmacies in consultations for over‐the‐counter medicines. Method A qualitative pilot study involving data drawn from six sources: audiotaped training session with all the pharmacists involved, observational field work in the pharmacies, audiotaped consultations with pharmacists and customers, debriefing interviews with pharmacists after the consultation, and semi‐structured interviews with customers a few days after their consultation. Setting Two community pharmacies that concentrate their services on medicine advice and dispensing, one in a deprived inner‐city area, the other in a more affluent suburban area of London. Key findings The pharmacists developed a personal understanding of concordance which informed their practice. Customers reported a high level of satisfaction with services they received from the respective pharmacists. Their accounts of the consultations verified the pharmacists' patient‐centredness in their day‐to‐day practice. Conclusion The implementation of a concordance model was possible through the development of a personalised, patient‐centred model which drew on the model of concordance but was adapted in accordance with both structural constraints as well as the personal style of the pharmacists involved.     

Are all pharmacy staff interested in potential future roles?

Objectives To determine the current perceived roles and responsibilities of pharmacy staff in community pharmacies in New Zealand, and attitudes to proposed new advanced roles for pharmacy staff. Methods Structured interviews were conducted within five community pharmacies, including at least two pharmacists, two dispensary staff and two pharmacy assistants. The interviews were structured to determine previous experience, current roles and responsibilities and the perceived future roles of pharmacy staff within a community pharmacy setting. Thematic analysis from 27 interviews identified key findings. Key findings Current roles appeared to be fairly well defined. Pharmacy assistants listed key roles as customer interactions and sales focus, noting that the dispensary was outside their area of responsibility. Technicians identified their role as being dispensary focused while pharmacists saw their role as the ‘final check’ to ensure accuracy as well as providing dispensing, counselling and managerial roles. With potential future roles, the assistants were less interested than the other groups, citing contentment with current situation and training as a barrier. Some technicians indicated an interest in furthering their roles, but many were reluctant and saw that additional training was too time consuming. Whilst pharmacists appeared to be interested in further scopes of practice, they appeared more reluctant to do this at the expense of handing dispensing responsibility to a non‐pharmacist. Conclusions Whilst there is a push for pharmacists to provide advanced clinical services, it is important to acknowledge that many staff working within community pharmacies are satisfied with their current role.     

Perceptions of CPD within the pharmacy profession

□ A questionnaire was used to determine current perceptions of continuing professional development within the pharmacy profession in Northern Ireland □ Although the majority of respondents understood the concept, few pharmacists currently practise this method of professional development □ Almost 90 per cent of responding pharmacists agreed/strongly agreed that it was essential for all practising pharmacists to participate in continuing professional development □ Lack of time, remuneration and locum cover, location and type of courses provided, and lack of understanding about continuing professional development were all identified as barriers to participation     

Impact of perceived innovation characteristics on adoption of pharmacy‐based in‐house immunization services

Objectives An in‐house immunization service in which staff pharmacists administer vaccines was conceptualized as an innovation. Prior to making adoption decisions, community pharmacies evaluated characteristics of in‐house immunization services. This study examined the impact of three specific characteristics (perceived benefit, perceived compatibility and perceived complexity) of in‐house immunization services on community pharmacies' adoption decisions. Methods A multi‐stage mixed‐mode survey design was used to collect data from key informants of community pharmacies in Washington State, USA. Key informants included pharmacy managers or pharmacists‐on‐duty who were able to answer questions related to immunization activities in their pharmacies. Perceived characteristics of in‐house immunization services and pharmacy adoption decisions were measured in 2004 and in 2006–2007, respectively. Key findings Each perceived characteristic individually predicted adoption of in‐house immunization services. When all three characteristics were included in logistic regression, perceived benefit was the only significant predictor of in‐house immunization service adoption. Conclusions Appropriate strategies, particularly promoting the benefit of in‐house immunization services, should be implemented. The proposed model and findings may be applicable to other pharmacy‐based innovative practices or other public health initiatives. We recommend that organizational leaders, researchers and practitioners consider the impact of perceived benefit and incorporate it when they design strategies to foster adoption of innovative practices. Doing this may increase the number of adopters and also increase diffusion rates for innovative services.     

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.     

Developing an R&D agenda for pharmacy workforce research

□ A consultation exercise was conducted to identify and prioritise the research agenda on the pharmacy workforce □ A two‐ound Delphi technique was employed for the main study □ People from all sectors of the profession were invited to contribute their views on what research should be carried out □ Ninety per cent of respondents agreed that the top priority for research was to “identify the levels, causes and implications of turnover among different cohorts of pharmacists” □ The need to take forward aspects of the proposed programme is now a matter of some urgency for the profession and the National Health Service     

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