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     

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.     

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.     

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     

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.     

Compliance and adherence as pragmatic concepts: a study of TB in rural Pakistan

□ Urine tests highlight fewer non‐compliant tuberculosis (TB) patients than do tablet counts □ Face‐to‐face interview techniques are of limited use for the purposes of investigating adherence and compliance issues □ Clinic attendance would need to have been measured for a much greater time duration to reflect compliance □ DOTS (directly observed treatment – short course) and combination formulations seem to improve compliance □ Patients who default or die while being treated have better attendance rates than those discharged (cured, resistant or sick)     

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     

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     

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     

The impact of hospital antimicrobial policy on the incidence of Clostridium difficile infection

□ An antibiotic policy specifically targeting high risk drugs for Clostridium difficile‐associated diarrhoea (CDAD) development was introduced in the study site hospital □ Despite an increased usage of antibiotics (calculated in defined daily doses) within the hospital, the policy led to a 19.7 per cent decreased incidence of CDAD □ Further improvements are predicted with improved adherence of hospital staff to the hospital antibiotic policy     

A search for socio‐economic influences in behaviour and attitudes to medicines available for self‐medication and NHS prescription

□ Variations in medicines purchased for pain relief and dyspepsia in areas with contrasting socio‐economic characteristics mirror morbidity and mortality data for the localities □ A higher overall use of medicines, both purchased and prescribed, was found in the more socially “deprived” area □ Purchasers of medicines in the “deprived” area were more frequent users of these medicines □ Purchasers of medicines in the “deprived” area were more likely to be taking concurrent prescribed medication.     

Patient-specific factors relating to medication adherence in a post-percutaneous coronary intervention cohort

Objective To explore the association between medication adherence and qualitatively characterised patient‐specific themes relating to medication adherence in patients following percutaneous coronary intervention (PCI). Methods Data‐collection questionnaires and qualitative topic guides were piloted in two patients. A validated questionnaire generated an adherence score for a convenience sample of 20 patients within 7 days of PCI. Semi‐structured qualitative interviews were subsequently carried out with all patients to explore patient‐specific themes relating to measured medication adherence. Key findings Fourteen out of 20 patients (70%) had scores indicative of good adherence. Key factors associated with good adherence included having a good relationship with the doctor, having an understanding of the condition, knowledge of the indications and consequences of non‐adherence, perceived health benefits and medications eliciting tangible symptom control. There were misconceptions of concern regarding adverse drug reactions and the importance of aspirin, both of which had a negative effect on adherence. The role of the community pharmacist was sometimes, although not always, misunderstood. Conclusion This study suggests there is an association between patients' beliefs, knowledge, understanding and misconceptions about medication and their adherence in a post‐PCI cohort. To optimise medication adherence it is vital for prescribers to remain patient‐focused and cognisant of patient‐specific themes relating to medication adherence.     

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     

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     

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     

Working alongside nursing staff to review medication in nursing homes

□ Pharmacists performed medication reviews in nursing homes using the nursing staff as a source of information □ Lack of access to medical records did hamper the review but was not the main reason for non‐implementation □ The recommendations were more likely to be implemented if further clinical information was supplied to the general practitioner □ All of the pharmacists, all of the nursing staff responding and a majority of the GPs who responded wished to see the project continue □ Future training of community pharmacists should focus on “how to review”.