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     

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     

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     

Anonymously reported medication errors: the tip of the iceberg

□ Errors reported to an anonymous medication error reporting scheme are presented □ Human error accounts for almost half the misadventures reported □ Reporting rates are low compared with rates identified by direct observation □ Low reporting rates limit the opportunities for risk reduction strategies     

SIGN guidelines and the management of sore throat in community pharmacy

□ Scottish Intercollegiate Guidelines Network guidance on the management of sore throat recommends analgesia and refer to the role of the community pharmacist in advising symptomatic relief □ Advice given to 749 patients from 65 community pharmacies; 49 patients (6.5 per cent) were referred to their general practitioner □ Paracetamol, drug of choice from SIGN guideline, was recommended to 219 patients (29 per cent); a preparation for symptomatic relief either alone or in combination with an analgesic was advised for 590 patients (79 per cent) and of these, 315 patients (42 per cent) were recommended lozenges with anaesthetic and antibacterial action □ Compliance with SIGN guidelines was observed regarding choice of analgesic □ Evidence is required for choice of symptomatic relief.     

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.     

Concordance in Muslim patients in primary care

□ The study examined the perceptions of Muslim patients and general practitioners (GPs) about ways in which the Muslim faith may influence medicine concordance □ Fifty Muslim patients (100 per cent response) and 18 general practitioners (53 per cent response) were surveyed using self‐completion questionnaires in order to determine attitudes towards dietary requirements and medicines □ A large proportion of the Muslim patients sampled stated that they would stop taking a medicine if they found out that it was not halaal □ Pharmaceutical manufacturers also need to be sensitive towards the requirements of Muslim patients □ In specific cases, doctors should seek guidance from Islamic leaders as to the correct interpretation of Islamic law with regard to the use of medicines considered haraam     

The use of sublingual glyceryl trinitrate and aspirin in angina patients and enhancement of coronary heart disease databases

□ Audit involving 95 per cent of community pharmacists in one LHCC □ Data were gathered using a semi‐structured questionnaire □ A list of all participating patients was sent to each GP surgery in the locality to enhance their CHD database □ Not all appropriate angina patients are receiving aspirin □ Patients' knowledge of GTN management was poor and should be improved upon by input from healthcare professionals     

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     

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     

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     

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     

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 postal survey to assess the views of community pharmacists on the deregulation of emergency hormonal contraception

□ This was a postal survey undertaken before EHC was available nationally in UK community pharmacies □ The survey aimed to assess attitudes of UK community pharmacists towards the deregulation of EHC □ A response rate of 66 per cent was attained and the consensus was that community pharmacists broadly agreed with the deregulation of EHC □ Pharmacists believed that the supply of EHC through pharmacies would increase their professional status, and there would be need for GP collaboration □ Although pharmacists welcomed EHC deregulation, they had reservations about legal implications     

An investigation into adverse drug reaction monitoring by United Kingdom hospital pharmacy departments

Prior to the nationwide introduction of the Committee on Safety of Medicines “yellow card” adverse drug reaction reporting for hospital pharmacists, a study was carried out to investigate the activities undertaken by hospital pharmacists in adverse drug reaction (ADR) reporting. A survey of 200 United Kingdom hospitals was conducted and 172 (86 per cent) questionnaires were returned. Local ADR reporting schemes were in operation in 26 (15.1 per cent) surveyed hospitals. The majority used locally designed cards to report ADRs. The most common reasons for the lack of a local ADR scheme (n=141) were staffing, the fact that a scheme had never been considered, time factors and the lack of perceived need to operate a scheme. Of these 141 departments, 80.1 per cent said they would consider implementing schemes in their hospital. With the inclusion of pharmacists in the CSM “yellow card” scheme, there is an incentive for them to become officially and further involved in the management and reporting of ADRs. Local ADR reporting schemes encourage pharmacovigilance and could allow pharmacists to take a leading role in this area of clinical practice.     

Attitudes of hospital pharmacists to adverse drug reactions and the “yellow card” scheme: a qualitative study

Objective — To elicit the views of hospital pharmacists towards adverse drug reaction (ADR) reporting. Method — Qualitative, semi-structured interviews were conducted on a face to face basis using a prepiloted questionnaire. Analysis was carried out using Winmax Pro, content analysis and comparison of interpretation by two independent reviewers. Setting — All major hospitals in one Committee on Safety of Medicines/Medicines Control Agency (CSM/MCA) regional monitoring centre in England. Key findings — It was considered that introduction of reporting had been poorly publicised and promoted. Only 42 per cent of those interviewed had submitted more than one “yellow card” report and a similar percentage had reported none. The CSM/MCA has a poor image in terms of accessibility and its perceived opinion of pharmacists' role in reporting. Feedback from the CSM/MCA was satisfactory and Current Problems in Pharmacovigilance was highly regarded. Several factors appear to be dissuading pharmacists from participation in the scheme, including lack of clinical knowledge, pressure of work and a lack of time. The absence of a fee did not appear to be a deterrent to reporting; in fact, a fee was considered inappropriate. Initial schemes for education and training were perceived as having been successful. However, ongoing training needs had not been fully addressed. Conclusion — While hospitals pharmacists acknowledge ADR reporting as part of their professional role, it is not yet considered as part of their daily practice and requires more vigorous promotion. Further investigation and quantitative work are required to investigate fully this aspect of pharmacy practice.     

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