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.     

A preliminary investigation into customers' perceptions of the image of retail pharmacies in South Africa

Background — The work scope of retail pharmacists in South Africa has changed considerably over the past few decades. A retail strategy is needed to adapt to these changes and challenges. One of the controllable variables of a retail strategy is store image. For a retail pharmacy, store image consists of factors relating to the pharmacist and factors relating to the pharmacy. Objective — The primary aim of the study was to investigate the image of retail pharmacists and pharmacies in Port Elizabeth, South Africa, in an attempt to supplement knowledge regarding the business aspects of retail pharmacy and to provide a model for a further and more detailed investigation into image research. Method —Empirical survey consisting of telephone interviews with pharmacy customers. A structured questionnaire was used to investigate the image of pharmacists and pharmacies. Setting — The study was undertaken in Port Elizabeth, South Africa. Two hundred customers from four different pharmacies were selected using systematic random sampling. Key findings — It was found that pharmacists and pharmacies had an exceptionally favourable image among the general public. The professional element contributed greatly to this positive image. Conclusion — The future will require a delicate balance between the professional and business aspects of retail pharmacy, and this aspect should be investigated further. A more detailed study into customers' perceptions of the image of retail pharmacists and pharmacies is necessary to determine how the image of pharmacy as a profession is changing.     

Public perceptions of community pharmacists in Benin City,Nigeria

Objective — To determine public perceptions of community pharmacists and pharmacies in Benin City, Nigeria. Method — A self‐completion questionnaire was distributed to a stratified random sample of 1,500 households. Data were collected using a 22‐item, Likert‐type scale which was shown to have 0.77 reliability. The neutral point was assumed to be 66 on the scale of 22 to 110. Scores above 66 were interpreted as positive perception. Results — The response rate was 68.3 per cent (1,025/1500). Almost two‐thirds (64 per cent) of respondents perceived the community pharmacist as a health care provider, and 70 per cent agreed that community pharmacists are needed, especially in the area of medicinal product selection (76 per cent). However, 52 per cent believed pharmacists are profit motivated and only 43 per cent said they would be willing to pay for pharmacist consultation. Respondents reported difficulty in differentiating between pharmacists and pharmacy attendants, with only 58 per cent reporting that they could tell the difference. The pharmacists scored 76.37 ± 27.63, with 60 per cent of respondents scoring them above 66. Conclusion — This study found that community pharmacists received a moderately positive rating from the public. There is a need for community pharmacists to carve out a more distinct professional identity for themselves.     

Consumer attitudes towards community pharmacy services in Saudi Arabia

Objective The purpose of this study was to determine consumer attitudes towards community pharmacy and their preferences for the introduction of new services. Methods A self‐completion questionnaire was developed and 1,144 consumers in 55 community pharmacies were invited to complete it. The questionnaire covered consumers' choice of pharmacy; their perceptions of, and actual interactions with, community pharmacists; advice from pharmacists about general health and prescribed medicines; and privacy in the pharmacy. Respondents were asked for their views about five possible new services. Setting The study was based in community pharmacies in Riyadh City, Saudi Arabia. Key findings The response rate was 79.6%. Fifty‐nine per cent of respondents often or sometimes visited a particular pharmacy. One‐quarter of respondents perceived community pharmacists as having a good balance between health and business matters, while 56.1% thought pharmacists were more concerned with the business. The majority of respondents (69.7%) said they felt comfortable asking the pharmacist for advice. Just under half (44.8%) felt that pharmacists allowed them enough time to discuss their problem fully and listened well. In addition, 58.5% of respondents indicated that their pharmacists showed sensitivity to privacy by speaking more quietly across the counter. In 14.4% of situations pharmacists were reported to use a private area within the pharmacy when discussing personal or private matters. Most respondents (65.2%) indicated that their pharmacist was willing to discuss their health problems and tried to understand their feelings. Consumers' priorities for new services were: monitoring blood pressure; measuring weight, height and temperature; monitoring blood sugar; and monitoring cholesterol. Conclusion This study showed that most pharmacy customers feel comfortable seeking advice from their pharmacist. Although many pharmacists were reported to show sensitivity to a possible lack of privacy in the pharmacy, few respondents reported that their pharmacy had a private area for discussion. Customers' views on possible new services were generally positive, with the exception of patient medication records.     

Supporting patients with mental illness: Deconstructing barriers to community pharmacist access

Objectives

To discuss the barriers faced by individuals with mental health conditions attempting to access their community pharmacists and to propose solutions toward deconstructing those barriers.

Evaluation of community pharmacy service mix: evidence from the 2004 National Pharmacist Workforce Study.

OBJECTIVES: To describe the mix of pharmacy services being offered in different types of community pharmacy practices and to identify factors associated with a community pharmacy offering pharmacy services. DESIGN: Cross-sectional study. SETTING: Community pharmacies (independent, chain, mass merchandiser, and supermarket pharmacies). PARTICIPANTS: Pharmacists practicing full-time or part-time who worked in community pharmacies and responded to the 2004 National Pharmacist Workforce Survey. INTERVENTION: Mailed survey from the 2004 National Pharmacist Workforce Survey, which included core content questions for all sampled pharmacists and supplemental surveys that included workplace questions for a selected subsample of pharmacists. MAIN OUTCOME MEASURES: Type and frequency of pharmacy services being offered in a community pharmacy, including dispensing and product-related services (e.g., specialty compounding), and pharmacist care services (e.g., immunizations, smoking cessation, health screening, medication therapy management, wellness screening, nutritional support, and disease management services). RESULTS: Four pharmacist care services were reported as being offered at more than 10% of community pharmacy practices: immunizations, smoking cessation, health screening, and diabetes management. The number of pharmacist care services offered at a community pharmacy was positively associated with having at least three pharmacists on duty, innovativeness of the pharmacy, status as an independent pharmacy, and status as a supermarket pharmacy. More than one half of the community pharmacy practices did not offer any of the eight pharmacist care services included in a pharmacy service index. CONCLUSION: Pharmacy services were reported at relatively few community pharmacies, and were associated with pharmacy innovativeness, pharmacist staffing levels, and pharmacy setting. Some community pharmacies are offering pharmacy services as part of their business strategy, while others are dedicated to dispensing services. Continued study of pharmacy service availability in community pharmacies is needed to improve our understanding of our capacity to deliver such services, including medication therapy management services.     

Barriers to the provision of needle‐exchange services: a qualitative study in community pharmacies

Objective To investigate the attitudes of pharmacists to the provision of needle‐exchange services (NES) at community pharmacies and, if barriers exist, explore means by which they may be overcome. Setting Twenty‐one community pharmacies across Grampian in North East Scotland during May and June 2005. Method Semi‐structured face‐to‐face interviews conducted with 24 pharmacists. Key findings Newly identified barriers included the negative influence of security staff, a local policy against NES provision and a lack of awareness of other services available for drug users. Conclusion Training packages for all health professionals working with drug users and awareness training for security staff are required if the identified barriers are to be overcome. ‘Hands‐on’ training and experience of NES for pharmacists and their staff should be available. Suggestions made by pharmacists for NES provision in general practitioner surgeries or community hospitals and the development of automated services should be considered.     

Community pharmacy as a performance: a participant observer's account of a day in the life of a locum

Objective — To understand, from a dramaturgical viewpoint, the performance of “community pharmacy.” Method — Participant observation supported by focus groups and semistructured interviews; the study adopted a grounded theory approach. Setting — Fieldwork was conducted within 21 community pharmacies in East Anglia, England. Key findings — Pharmacists identify with their setting and stage props. On the stage of community pharmacy, the pharmacist crucially converts the drug into medicine, during a complex and well‐rehearsed performance. There are sometimes distractions, which make the performance sub‐optimal. Other insights included what counts as error, how to manage stress, and the fact that the trust on which professional practice rests is at stake when expressive performance fails. Conclusion — It is possible to conduct ethnography of community pharmacy and this is among the first such studies of British community pharmacy. Were the pharmacist to leave the stage and its props (the drugs), only to advise patients on medicines, the performance of community pharmacy, as we know it, might disappear.     

Barriers to the implementation of advanced clinical pharmacy services at Portuguese hospitals

Background In some countries, such as Portugal, clinical pharmacy services in the hospital setting may be implemented to a lower extent than desirable. Several studies have analysed the perceived barriers to pharmacy service implementation in community pharmacy. Objective To identify the barriers towards the implementation of advanced clinical pharmacy services at a hospital level in Portugal, using medication follow-up as an example. Setting Hospital pharmacies in Portugal. Methods A qualitative study based on 20 face-to-face semi-structured interviews of strategists and hospital pharmacists. The interview guide was based on two theoretical frameworks, the Borum’s theory of organisational change and the Social Network Theory, and then adapted for the Portuguese reality and hospital environments. A constant comparison process with previously analysed interviews, using an inductive approach, was carried out to allow themes to emerge. Themes were organised following the Leavitt’s Organizational Model: functions and objectives; hospital pharmacist; structure of pharmacy services; environment; technology; and medication follow-up based on the study topic. Main outcome measure Barriers towards practice change. Results Medication follow-up appeared not to be a well-known service in Portuguese hospital pharmacies. The major barriers at the pharmacist level were their mind-set, resistance to change, and lack of readiness. Lack of time, excessive bureaucratic and administrative workload, reduced workforce, and lack of support from the head of the service and other colleagues were identified as structural barriers. Lack of access to patients’ clinical records and cumbersome procedures to implement medication follow-up were recognised as technological barriers. Poor communication with other healthcare professionals, and lack of support from professional associations were the major environmental barriers. Conclusion Few of the barriers identified by Portuguese hospital pharmacists were consistent with previous reports from community pharmacy. The mind-set of pharmacists and predetermined attitudes are recognised as barriers that can give rise to new perceived barriers.     

Community pharmacy management of acute diarrhoea in adults

Objective — To study the community pharmacy management of acute diarrhoea in adults and to explore the attitudes and beliefs of community pharmacists towards the management of this common condition. Method — Data were collected over a four-week period on the incidence and presentation of acute diarrhoea in adults by pharmacy staff in 17 pharmacies who were participating in a community pharmacy research panel. A postal survey on attitudes and beliefs about the treatment of diarrhoea was sent to a random sample of 2,500 community pharmacists. Key findings — A total of 1,401 community pharmacists responded to the survey (response rate 59 per cent). Their responses suggested ambiguity in the treatment of acute diarrhoea in community pharmacy, particularly in relation to attitudes to oral rehydration and anti-motility drugs. Although the majority of pharmacists surveyed were aware of recommendations to treat adult patients with acute diarrhoea with oral rehydration, in practice many stated that they often sold an anti-motility treatment, a finding borne out by the high percentage of anti-motility sales (61 per cent) in the earlier part of the study. The decision to sell or recommend an anti-motility drug was often motivated by the patient's circumstances and their need for immediate symptomatic relief. Conclusion — This study suggests that the community pharmacy management of acute diarrhoea is characterised by ambiguity and pragmatism. Existing guidelines for the treatment of diarrhoea fail to take into account the social context in which pharmacists operate, particularly in relation to patient demand and the need for symptom relief.