Do Finnish women using hormone replacement therapy need more information about risks

Objective In 1998, the Women’s Health Initiative (WHI) in 2002 and the Million Women Study (MWS) in 2003 have shown a need for re-evaluation of the benefits and adverse reactions of hormone replacement therapy (HRT). Consequently the authorities in Europe and USA have issued new recommendations against the use of HRT. The aim of this study was to examine women’s perceptions of HRT since the publication of the Women’s Health Initiative study and the Million Women Study, and the kind of sources women use to obtain information about HRT. Method The data was collected with questionnaire survey in the autumn 2003 among 315 women using HRT. Results One third of the respondents (35%) had experienced fears concerning HRT use, and more than half (52%) reported that the debate in the media had markedly influenced them; they have experienced fears or worries, considered discontinuation or discussed with the physician. Whereas the most common source of information concerning the benefits of HRT was the physician (74%), the most common source of information concerning the risks of HRT was the media (78%). Conclusion This study shows that women using HRT should get more information about the risks from health care professionals. Physicians and pharmacists have an opportunity to alleviate fears and to help women to critically evaluate the information they get from the media. Such discussions are also important to women who have been using HRT for years.     

Professional practices and experiences with complementary medicines: a cross‐sectional study involving community pharmacists in England

Objective As retailers of complementary medicines (CMs), pharmacists are well placed to advise consumers on the safe and effective use of these products; where CMs are available in pharmacies, pharmacists should be well informed about such products. This study explored the extent to which CMs are available in community pharmacies in England, and examined pharmacists' experiences, professional practices and training with regard to these products. Method A cross‐sectional study was conducted, involving a structured questionnaire posted to community pharmacists. Coded follow‐up mailings were sent to non‐responders after 2 and 4 months, and a reminder telephone call made after 3 months. Setting All community pharmacists in six areas (Devon, Cornwall, Bradford, Leeds, Manchester, Stockport) of England (total n = 1337). Key findings The response rate was 66.5%. Overall, 92% of respondents reported that CMs (excluding vitamins/minerals) are sold in the pharmacy in which they practise, 81% had received requests from patients/consumers for specific CMs in the previous year, and 58% had recommended CMs. Around 70% of respondents rarely/never asks about CMs use when counter‐prescribing conventional medicines or when receiving reports of suspected adverse drug reactions (ADRs) associated with conventional medicines. In total, 40% of respondents had undertaken training in complementary/alternative medicine (CAM). Pharmacists who had undertaken training were more likely to ask patients/consumers specifically about use of CMs when counter‐prescribing conventional over‐the‐counter (OTC) medicines (37.0% versus 23.4%, respectively; χ² = 17.4; P = 0.0003) and when receiving reports from patients/customers of suspected ADRs associated with conventional (prescribed or OTC) medicines (35.6% versus 23.8%, respectively; χ² = 13.0; P = 0.0003). Conclusion CMs are widely available in pharmacies in England, and pharmacists interact with users of these products. An opportunity exists for pharmacists to embrace a professional role as expert advisors on CMs. However, pharmacists' training, professional practices and competence with respect to CMs first need to improve.     

The development of a sleep disorder screening program in Australian community pharmacies

Objective To develop, pilot and determine the feasibility of a sleep-specific screening and awareness program in community pharmacies. Setting The screening was piloted in five Australian community pharmacies. Method The Pharmacy Tool for Assessment of Sleep Health was constructed by drawing on known relationships between sleep disorders, and lifestyle factors, medical conditions and medications. Four validated instruments were used in the screening tool: the Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Multivariable Apnea Prediction Index (MAPI) and International Restless Legs Syndrome Study Group Screening Criteria (IRLS). These instruments were used to predict the participant’s risk of a sleep disorder and the results were compared with reported lifestyle, medical and medication factors. On-site training of consenting pharmacists was provided, followed by an eight week client recruiting and screening period. Feedback was elicited from participating pharmacists and clients. Main outcome measure The feasibility of, and trends found from, the developed screening tool and protocol. Results Of 167 clients who requested or were invited to participate by pharmacists, 84 (50.3%) were screened. Analysis of collected data indicated that 33.3%, 21.4% and 27.4% of participants were at risk of having or developing insomnia, obstructive sleep apnea (OSA) and restless legs syndrome (RLS) respectively, while 38.1% were not at risk of any of the screened disorders. OSA odds increased 12.8 times (95% CI: 3.2–50.4) with diabetes and 4.9 times (1.2–20.9) with opioid use, while shift workers were 8.4 times (1.6–43.2) more likely to have insomnia. Participants and pharmacists reported the screening protocol and instrument was user friendly and feasible. Conclusion The development and pilot of this screening tool was successful. The prevalence of sleep disorders in the sampled population was high but generally consistent with previous studies on the general population. Furthermore, associations found may form a foundation for a clinical algorithm to identify those at a higher risk of having or developing a sleep disorder. Further work is required to validate this screening tool in the community pharmacy context.     

The knowledge and attitude of the Turkish community pharmacists toward pharmacovigilance in the Kadikoy district of Istanbul

Objective We investigated the knowledge and attitudes of community pharmacists towards pharmacovigilance and adverse drug reactions (ADRs) in Kadık?y district of Istanbul (Turkey). Setting The community pharmacies in Kadikoy. Kadikoy is one of the biggest districts of Istanbul and has the largest number of pharmacies. Kadikoy district was divided into two regions, the central and the peripheral. Method Between December 2005 and June 2006 we conducted a survey about the knowledge and attitude of community pharmacists (n = 219) using a face-to-face questionnaire. The questionnaire consisted of questions about the sociodemographic characteristics of the pharmacists, their knowledge of pharmacovigilance and their attitudes towards ADR reporting. Main outcomes measured The knowledge of pharmacovigilance practice, ADR reporting compliance rates, reasons for not reporting ADR and perceptions of the Turkish community pharmacists on pharmacovigilance practice were evaluated. Results Although all 411 pharmacies in the Kadikoy district were visited, only 53% of the community pharmacists (n = 219) consented to participate in the study. Of those that did respond, only 17.2% of the pharmacists had any knowledge about ‘pharmacovigilance’. Sixty-five percent of the pharmacists stated that patients reported an ADR to them during the previous 12 months, and 21% of pharmacists reported to the concerned organizations. Our survey showed that only 7% actually reported an ADR to the national pharmacovigilance center. On the other hand, 89% of the pharmacists believed that the role of the pharmacist in ADR reporting was essential. Conclusion The results show that Turkish community pharmacists have poor knowledge about pharmacovigilance. There is an urgent need for educational programs to train them about pharmacovigilance and ADR reporting.     

Drug information resources at community pharmacies in Amman,Jordan

Objectives The aim of this study was to investigate the drug information resources available in community pharmacies in Amman, Jordan. Methods A total of 156 private community (retail) pharmacies in different parts of Amman, the capital of Jordan, were recruited by personal contact. Pharmacists at the sample pharmacies completed a self‐administered questionnaire that consisted of two sections. The first section elicited the drug information resources available in their pharmacies. The second section presented five mock medicines information scenarios and asked respondents to identify the most suitable information resource to be used from a given list. Answers then were coded and entered into SPSS for Windows for statistical analysis. Key findings All pharmacies had at least one reference book, but most were outdated. The Monthly Index of Medical Specialties (MIMS) was the most commonly found (n =101; 64.7%), and 40.4% (n = 63) had internet access. Only 19.2% (n = 30) of the respondents reported getting medicines information directly from pharmaceutical companies, usually through pharmaceutical representatives. Most pharmacists could identify appropriate information resources for drug dosing and side effects but did not fare well for medicine identification, drug interactions and primary research evidence. Conclusions The quality of drug information resources in private community pharmacies in Amman is far from optimal. This will affect the quality of information provided to patients and prescribers and have an adverse effect on the role that pharmacists can play in the health system in Jordan.     

Opinion comparison concerning future information technology in Finnish community pharmacies

Objective To compare the opinions of community pharmacy owners, managers and personnel concerning the key features of the future information technology system needed in Finnish community pharmacies. Setting The study was targeted to the pharmacists working in community pharmacies as managers (owners and staff pharmacists with M.Sc. degree) or personnel responsible for dispensing and patient counselling (pharmacists with B.Sc. degree). Method A national cross-sectional survey to all of Finnish community pharmacy owners (n = 580) and staff pharmacists (B.Sc. and M.Sc. degrees, n = 1709) working in community pharmacies, was conducted in order to determine differences in opinions between these occupation groups with different professional duties. The response rates were 53% for pharmacy owners (n = 308) and 22% for staff pharmacists (n = 373). Main outcome measure The main outcome measure was the perceived importance of 89 potential features for a new IT system ranked by using a five-point Likert scale. Results The responding community pharmacy managers and staff pharmacists had differences in their ranking of more than half (52%) of the potential features listed in the survey questionnaire. The features related to the pharmacy’s internal processes, such as financial management, sales and marketing management and stock holding, were ranked significantly higher by the managers, while the personnel prioritized the features supporting pharmaceutical service provision and personnel management. The managers and personnel shared their opinion on the importance of features supporting drug information and patient counselling, medication safety and interprofessional collaboration. Conclusion The managers and staff pharmacists have different views of the importance of IT features, reflecting their different professional duties in the community pharmacy. A high priority was given for the features familiar to the users and needed in their daily practice. This indicates the need for involving different occupation groups in planning the new IT systems for community pharmacies.     

Effect of incentives on recruitment and response rate in a community-based pharmacy practice study

Objectives — To study the feasibility of carrying out a community pharmacy-based drug utilisation study of H₂ antagonists and alginate-containing preparations, and to study the effect of two methodological variations — payment of pharmacists and the free issue of medicines — on recruitment rates and response rates. Method — Pharmacists were asked to recruit customers into the study after deciding that one of these products was appropriate for purchase. Customers were asked to provide their signed consent, their name, address and information about their general practitioner and to complete an initial questionnaire provided by the pharmacist and a second questionnaire which was sent out by the researchers two weeks later. In 20 of the pharmacies the medicines were offered free once customers had agreed to participate; in the remaining pharmacies, customers paid the normal retail price for the product. All pharmacies received incentive payments for each of the three months in the second half of the study period in which they recruited five or more customers. Setting — Thirty-nine community pharmacies in Scotland and Wales. Key findings — Similar numbers of customers were recruited to the study irrespective of whether free medicines were offered. Significantly more (P<0.001) customers recruited by pharmacies providing free medicines returned both the first (339/383) and second questionnaires (264) than those recruited by pharmacies not providing free medicines (269 and 208/384, respectively). Of the 608 customers who returned the first questionnaire and were subsequently issued with a second questionnaire, 77.6 per cent returned it; there was no difference in return rates between customers who received free medicines and those who did not. Incentive payments to pharmacies resulted in a small increase (14 per cent) in recruitment rate in the second half of the study and no difference in response rates from the customers recruited. Conclusion — The study established the feasibility of undertaking drug utilisation studies with high response rates in community pharmacies. The provision of free medicines increased customer response rates, but incentive payments for pharmacists showed no clear effect on recruitment rates.     

Pharmacists solving problems in asthma management — experiences from a one‐year intervention programme in Finland

Objective — To study the effect of an intervention provided by community pharmacists on detection and resolution of problems in asthma patients' self‐management and to study patients' opinions about the perceived usefulness of the pharmacists' input. Method — A one‐year intervention study was conducted with scheduled visits and follow‐ups at baseline, four, eight and 12 months. Study patients (n=28) acted as their own controls. Setting — Four communities and community pharmacies in different parts of Finland. Key findings — At study baseline, all patients had at least one documented problem, the most commonly reported being problems with medication, side effects, problems with inhalation devices and not using asthma medicines according to the physician's instructions. On average, patients had five “intervention” consultations with the pharmacist during the one‐year study. After the intervention, half of the patients reported that their problems had been resolved. The most useful areas of advice were considered by the patients to be instructions about changing asthma medication according to asthma symptoms and management of asthma symptoms. Twenty‐five of the 28 patients reported that they were satisfied with the education and counselling provided by pharmacists, a higher number than for physicians or nurses. Conclusion — The findings from this small longitudinal study indicate that community pharmacists can improve asthma patients' treatment by consultations during which they identify and address problems in self‐management of asthma.     

A clinical knowledge measurement tool to assess the ability of community pharmacists to detect drug-related problems

Introduction Drug‐related problems (DRPs) are associated with significant morbidity and mortality, with most DRPs thought to be preventable. Community pharmacists can detect and either prevent or resolve many of these DRPs. A survey‐based clinical knowledge measurement tool was designed and validated to estimate a community pharmacist's clinical knowledge and ability to detect and appropriately resolve DRPs. Methods Nine clinical cases with seven multiple‐choice statements (63 statements in total) were constructed, based on scenarios that were found to occur frequently in Australian community pharmacies. The statements aimed to assess a pharmacist's ability to identify, gather relevant information about and make appropriate recommendations to resolve, a DRP. The survey was pilot tested with 18 academics at three Australian pharmacy schools, resulting in the removal of 23 statements. The survey was then administered to undergraduate pharmacy students (28 fourth‐year, 41 third‐year and 42 first‐year students) and to 433 Australian community pharmacists who were participating in an intervention documentation trial. The pharmacists' resultant survey scores were correlated against their actual rate of documenting clinical interventions. Results The tool had relatively good internal consistency. Significant differences were seen between the three groups of students (P < 0.01). Community pharmacists with additional clinical qualifications had a significantly higher score than other participating pharmacists (P < 0.01). A moderate, but significant, correlation was seen between the pharmacists' survey score and their clinical intervention rate in practice during the trial (P < 0.01). Conclusion The clinical knowledge measurement tool appeared to estimate a pharmacist's ability to detect and resolve DRPs within the community pharmacy environment.     

Exploring the impact of evolving health policy on independent pharmacy ownership in England

Objective To study the impact of policy and contractual changes on community pharmacy ownership in England. Setting North West of England. Method Twenty nine male pharmacists were interviewed between September 2007 and February. 2008. The study involved semi-structured face to face interviews with theoretically sampled respondents. Data were analysed using the constant comparative method. Main outcome measure English community pharmacists’ opinions and experiences. Results Practice ownership attracted some respondents to pharmacy as a career. Respondents considered that a combination of legislative and policy changes in combination with contractual alterations had decreased the profitability of independent pharmacy businesses. Additionally, it seemed that community pharmacy corporate groups were able to out bid individual pharmacists for community pharmacy businesses. A proportion of respondents had sold community pharmacy businesses recently, in some cases in response to contractual and policy changes. Some considered that the declining proportion of independent pharmacies was likely to limit patient choice as well as affecting the profession. Some felt this made pharmacy a less attractive career choice. Conclusion It seems that recent policy and contractual changes have favoured the multiple community pharmacy sector in England, resulting in a declining proportion of independent community pharmacies. Policy makers must consider the far reaching consequences of this for pharmacists, the profession and patient choice.     

Characteristics of Australia's community pharmacies: National Pharmacy Database Project

Objective To report the characteristics of community pharmacies in Australia and analyse them for their association with pharmacists' consultation time. Setting A large representative sample of community pharmacies in Australia in 2002. Method Questionnaires were mailed by an independent survey group to managers and owners in a national sample of pharmacies stratified into six zones. Questionnaires were returned by 1131 of 1532 pharmacies contacted (73.8%). The data were analysed using the general linear model (GLM) for univariate analysis. Key findings: Male pharmacists comprised 76.3% of pharmacy owners and 39.5% were aged = 51 years. Most pharmacies (81.1%) had one or two pharmacist owners, and 51.3% of pharmacies were members of marketing groups. Medicines accounted for approximately 75% of annual sales and occupied a minority of the average total area of 187.2 m². Pharmacies opened for an average of 55.5 h per week. Pharmacists spent 18.8% of their time on patient consultation. This was significantly related to pharmacies with forward pharmacy dispensing areas (P < 0.001), which were owner or partner operated (P < 0.002) and had high numbers of customers (P < 0.004). Holding national accreditation status and belonging to a banner group may be additional factors. Conclusions Ownership of community pharmacies in Australia is dominated by pharmacists in contrast to the minority pharmacist ownership in the USA and England. Owners and managers of pharmacies were mainly male and older than other staff. Pharmacists working in pharmacies with a forward dispensing area, designed to facilitate patient consultation, were significantly more likely to provide increased consultation time for patients. Owner‐ or partner‐operated pharmacies, and pharmacies with high numbers of customers were also significantly associated with patient consultation time. The strength of association between membership of marketing groups and national accreditation with consultation time requires more evidence.     

Refinement of an osteoporosis risk‐assessment questionnaire for use in community pharmacy

Objective To explore the influence of bone mineral density (BMD) tests in osteoporosis risk categorisation in community pharmacies, and to develop a simple tool for pharmacists to use as a pre‐BMD test screen. Method A secondary data analysis was conducted on the responses of 193 participants to a risk‐assessment questionnaire, used in previous osteoporosis research that included a BMD test. To explore the impact of the BMD test on pharmacists' categorisation of risk, the researchers made an independent assessment based on responses of the questionnaire. The influence of risk factors on BMD scores/bone status was explored using multiple and logistic regression respectively. Key findings A total of responses of 193 participants were available for study, with 113 in the BMD group and 80 from the non‐BMD group. In the BMD group, both researchers and pharmacists identified a similar proportion of patients in the moderate/high‐risk category when BMD results were incorporated in the risk assessments (X² = 0.78, degrees of freedom (df) = 1, 0.3 < P < 0.5). A statistically significant difference in risk categorisation was found between the pharmacists and researchers in the non‐BMD group (X² = 23.9, df = 1, P < 0.001). Risk factors identified to be significantly affecting BMD and of use for identifying patients at high risk for osteopenia/osteoporosis were age, weight, postmenopause and absence of hormone replacement therapy (HRT). These four factors were used to construct a simple risk index to guide pharmacists' initial risk categorisation. Conclusion The findings of this study suggested that BMD testing may increase the effectiveness of risk assessments and enhance the screening procedures in the community pharmacy. The simple risk index could serve as a pre‐BMD test screen, with a BMD test recommended when necessary. A refined risk‐assessment questionnaire could serve to guide pharmacists in directing individualised counselling and advice for at‐risk patients, through identification of modifiable risk factors and conditions.