South Australian rural community pharmacists and the provision of methadone,buprenorphine and injecting equipment

Objective To explore how the provision of opioid substitution treatment (OST) services and/or sterile injecting equipment impacts on community pharmacists. This will assist in identifying strategies to improve the provision of maintenance pharmacotherapy treatment programmes in South Australia. Setting Rural South Australia. Method Analysis of data obtained from earlier focus‐group interviews enabled compilation of key issues for the development of a semi‐structured questionnaire. Fifty‐one potential participants were contacted. Twenty‐five rural South Australian community pharmacists were interviewed through a 15–20‐min semi‐structured telephone questionnaire. Interview responses were manually recorded. Thematic analysis of the transcribed data by one researcher enabled determination of key issues. Key findings Fifty‐one potential pharmacies were contacted and 25 pharmacists were interviewed. All 25 pharmacists had experience in the provision of OST services, 22 sold sterile injecting equipment and 10 offered needle exchange. Exploration of service issues in the context of rural pharmacy practice found that the geographical closeness of a small community may improve rapport with local prescribers, as indicated by 15 of 25 pharmacists. Access to other allied health services was described by 13 of the 25 as difficult. Servicing OST clients can have a negative impact on pharmacy business, is not profitable for rural pharmacies and only seven of the 25 felt adequately remunerated for the provision of their services. Client debt was an identified issue and the practice of withholding doses because of lack of payment was supported by 10 participants and not supported by an equal number. Mentored practice was highlighted as a potential area for future training, as was managing clients' debts. In addition, pharmacy structural changes to provide a private dosing area would preserve confidentiality during supervised dosing. Conclusion Access to allied health services in regional areas could be better coordinated. Financial incentives for South Australian pharmacies, without increasing the cost of treatment for clients, requires further exploration.     

Motivations for and barriers to community pharmacy services for drug misusers

Objective — To investigate what motivated pharmacists to provide drug misuse services and, conversely, what barriers prevented service provision. Method — Telephone interviews were conducted with a purposive sample of 45 volunteering respondents to a national questionnaire survey to gain in-depth information. Setting — Forty-five community pharmacists in Scotland. Key findings — Pharmacists were found to be motivated to provide services by an awareness of the needs of the community, a desire to reduce the spread of blood-borne diseases and a desire to expand their professional services. Barriers to service provision were concerns for the effect on other customers, safety, workload and poor remuneration. Conclusion — The active encouragement of local health boards, professional endorsement, further education and remuneration might encourage pharmacists' participation in drug misuse services. This would enable the principles of harm reduction to be widely practised.     

Managing obesity in pharmacy: the Australian experience

Objective To explore pharmacists’ opinions about the provision of weight management services in community pharmacy and their attitudes towards the establishment of an accredited training course in weight management in pharmacy. Setting Interviews were conducted with practising pharmacists on site in various community pharmacies in metropolitan Sydney, Australia. Method In-depth, semi-structured interviews with twenty practising pharmacists were conducted. Of the twenty interviewed pharmacists, sixteen were involved in the provision of one or more pharmacy based weight management programs in their pharmacies. Interviews were audio-recorded, transcribed and analysed using the grounded theory approach. Main outcome measure The data were thematically analysed to identify facilitators and perceived barriers to the provision of high quality services, and pharmacists’ willingness to undertake training and accreditation. Results Participants clearly perceived a role for pharmacy in weight management. Key facilitators to provision of service were accessibility and the perception of pharmacists as trustworthy healthcare professionals. The pharmacists proposed collaboration with other healthcare professionals in order to provide a service incorporating diet, exercise and behavioural therapy. A program that was not-product-centred, and supported by ethical marketing was favoured. Appropriate training and accreditation were considered essential to assuring the quality of such services. Barriers to the provision of high quality services identified were: remuneration, pharmacy infrastructure, client demand and the current marketing of product-centred programs. Conclusion Australian pharmacists believe there is a role for pharmacy in weight management, provided training in accredited programs is made available. A holistic, evidence-based, multi-disciplinary service model has been identified as ideal.     

Weight management in community pharmacy: what do the experts think?

Background The increasing prevalence of obesity and overweight adults creates a significant public health burden and there is great potential for pharmacists to be involved in the provision of weight management services, other than the mundane supply of commercial products. In order to provide optimal services that can be integrated into the healthcare system, a best practice model for weight management services in community pharmacy should be in place. We sought experts’ and key stakeholders’ opinions on this matter. Objectives (1) To identify components of a best practice model of a weight management service feasible in Australian community pharmacy. (2) To identify the role of pharmacists and the training requirements to up-skill pharmacists to competently provide weight management services. (3) To elicit any practical suggestions that would contribute to successful implementation of weight management services in pharmacy. Setting Australian primary care sector. Method Semi-structured interviews were conducted with a purposive sample of 12 participants including Australian experts in obesity and representatives of main Australian professional organisations in pharmacy. Interviews were digitally recorded, transcribed verbatim and thematically analysed using the framework approach. Main outcome measure Recommended components of pharmacy-based weight management services and training requirements. Results Participants perceived two potential roles for pharmacists involved in weight management: health promotion and individualised service. Multi-component interventions targeting all three areas: diet, physical activity and behaviour change were emphasised. Physical assessment (e.g. weight, waist circumference measurements), goal setting, referral to allied healthcare professionals and on-going support for weight maintenance were also proposed. Participants suggested pharmacists should undergo formal training and identified various training topics to improve pharmacists’ knowledge, attributes and skills to acquire competencies necessary for delivery of this service. Some physical and financial barriers in providing these services were also identified including infrastructure, pharmacists’ time and cost-effectiveness. Conclusion Pharmacists are well-positioned to promote healthy weight and/or implement weight management interventions. Furthering pharmacists’ role would involve training and up-skilling; and addressing key practice change facilitators such as pharmacy layout and remuneration. This study provides some insight into the design and implementation of a best practice model for pharmacy-based weight management services in Australia.     

Evaluation of online training for the provision of opioid substitution treatment by community pharmacists in New Zealand

Introduction and Aims. The role of community pharmacists in the provision of opioid substitution treatment (OST) is pivotal and integral to addiction treatment. An online training program for pharmacists in OST management was piloted in New Zealand in 2010, following recognition of the difficulty in recruitment and retention of community pharmacists to provide OST services. Our aim was to evaluate the OST online training that was made available for any community pharmacist in New Zealand and to establish the feasibility and acceptability of this format of training for community pharmacists. The evaluation explored participants' attitudes, skills and knowledge both pre‐ and post‐training in OST. Design and Methods. All pharmacists registering to participate in the training program were asked to complete an evaluation questionnaire immediately before (pre) and immediately after (post) completing the training. Participants were also invited to participate in a brief 10 min structured telephone interview about their training experience. Results. In the first 4 months 190 pharmacists commenced the training; 101 completed both evaluations. Improvements in the confidence and skills of pharmacists were demonstrated through both the quantitative and qualitative analyses. Statistically significant changes in attitudes were also demonstrated. Overall the OST training was well received and the online format was feasible and highly acceptable. Discussion and Conclusion. Online training is an appropriate and economical method of improving pharmacists' clinical skills with respect to this client group, and has the potential to reach a wider audience of pharmacists. Further research is required to investigate OST client experiences in community pharmacy.[Walters C, Raymont A, Galea S, Wheeler A. Evaluation of online training for the provision of opioid substitution treatment by community pharmacists in New Zealand. Drug Alcohol Rev 2012;31:903–910]     

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.     

Development,implementation and evaluation of a pilot project to deliver interventions on alcohol issues in community pharmacies

Objective The aim was to evaluate the feasibility and acceptability of the provision of brief interventions on alcohol misuse in community pharmacies. The objectives were to: train community pharmacists to initiate discussion of alcohol consumption with targeted pharmacy clients and screen, intervene or refer as appropriate; and to explore with pharmacists and clients the feasibility, acceptability and perceived value of screening and delivering the intervention. Setting Eight community pharmacies in Greater Glasgow. Method After a two‐day training course for pharmacists (n = 9) and one day for pharmacy assistants (n = 13), the eight pharmacies recruited clients over 3 months. Standardised protocols were prepared to screen clients for hazardous or harmful drinking using the Fast Alcohol Screening Tool (FAST) and to guide the intervention. Clients were recruited from specific target groups and via posters highlighting the service. Following completion of the recruitment phase, pharmacists and clients were followed up by the research team, using a combination of focus groups and semi‐structured telephone interviews. Key findings During the study period 70 clients were recruited, 30 screened as drinking hazardously (42.9%) and 7 (10%) screened positive for harmful drinking. Interventions commonly included explanation of sensible drinking and units in clients' preferred drinks (n = 33), feedback on screening and risks to health (n = 27) and discussion of pros and cons of current drinking pattern and link with presenting issue (n = 23). Of the 40 clients agreeing to be followed up, 19 could be contacted and most were generally positive about the experience. On follow‐up the pharmacists were positive and felt the project worthwhile and, importantly, noted no strong negative reactions from clients. Conclusion This project has been successful in training community pharmacists to discuss alcohol with 70 clients. Further work is required to test the generalisability of our findings and to measure the impact on alcohol consumption.     

The provision of current and future sexual health services from community pharmacies in Grampian, Scotland

Objective Community pharmacies play a vital role in promoting, maintaining and improving the health of the local community. This study explored community pharmacists?? activities and attitudes towards the provision of sexual health services (SHS) in North East Scotland, as well as their needs with regard to the delivery of current and future SHS. Setting North East Scotland. Methods A questionnaire was conducted of community pharmacists working in community pharmacies in Grampian (n = 128). Main outcome measures Self-reported provision of sexual health services; attitudes towards current and future sexual health services; previous training and perceived training needs; respondent demographics. Results In total, 73% (94/128) of community pharmacists responded. The average number of SHS/products per pharmacy was six out of a possible 13 (range: 4?C10). Respondents expressed positive attitudes towards the provision of current and future SHS. However, they also reported that they had received little or no sexual health training but that they would like to receive training in all areas of sexual health. Barriers to the provision of sexual health included workload, lack of training and the need for payment for additional services. Conclusion Community pharmacists already provide a limited range of sexual health services. Community pharmacists, their staff and their premises could be used in strategies to reduce unplanned pregnancies, the incidence of sexually transmitted infections and to promote respectful and responsible sexual behaviour.     

Factors associated with the intensity of government remunerated and unremunerated service provision in community pharmacies

BackgroundMany community pharmacies provide medication and disease state management services with and without specific remuneration. Availability of these services is often reported, however little is known about factors influencing the intensity of their provision.ObjectiveTo investigate factors associated with the intensity of provision of selected government remunerated and unremunerated community pharmacy services in Western Australia (WA).MethodsA questionnaire was mailed to a random sample of 421/628 (67%) community pharmacies in WA. The first dependent variable was intensity of government remunerated MedsCheck and Diabetes MedsCheck service frequencies per month. The second was the intensity of the sum of government unremunerated asthma screening, blood glucose testing, cholesterol testing and smoking cessation disease state management service frequencies per week. Principal Component Analysis defined attitudinal components influencing service provision. Linear regression with bootstrap confidence intervals determined variables associated with intensity of provision of the selected services. The variables were: pharmacist; pharmacy setting characteristics; and, attitudinal factors.ResultsThe questionnaire yielded a response rate of 49.2%. Attitudinal components that facilitated service provision were: general practitioners (GPs) willingness to collaborate; pharmacists are capable and ready; and pharmacists require further training. Staff capability and low return on investment were barriers to increased service provision. The intensity of government remunerated services was independently associated with pharmacies having pharmacy interns, fewer dispensary technicians, and being capable and ready to provide the services. Higher intensity of the provision of the unremunerated disease state management services was independently associated with the intensity of provision of MedsCheck and Diabetes MedsCheck services.ConclusionsImproved pharmacy workflow, achieved by the availability of pharmacy interns, and pharmacists being capable and ready, were important factors in the intensity of MedsCheck and Diabetes MedsCheck services. Intensity of the provision of government remunerated services facilitated a higher prevalence of disease state management services provision.     

Continuation of opioid replacement program delivery in the aftermath of cyclones in Queensland,Australia: A qualitative exploration of the perspectives of pharmacists and opioid replacement therapy staff

BackgroundCyclones can significantly impact on communities and their healthcare services. Community members with chronic diseases, including opioid dependence, who rely on these healthcare services are placed at an increased risk of treatment disruption during a disaster event. Disruptions to the continuity of the opioid replacement therapy (ORT) service can potentially lead to relapse, withdrawal, and risky behaviours in clients with potential repercussions for the community.ObjectiveTo explore the effects of Queensland (QLD) cyclones on opioid treatment programs within Queensland community and hospital pharmacies from three perspectives.MethodQualitative research methods were used. Participants comprised five community pharmacists, four Queensland opioid treatment program (QOTP) employees, and five public hospital pharmacists. Participants were identified as they had worked in Townsville, Rockhampton, Mackay, or Yeppoon in a community impacted by a cyclone and involved with ORT supply. Interviews were recorded and data were analysed by two methods - manual coding and the text analytics software Leximancer®.ResultsThe two themes that emerged from the manual coding process were ‘disaster preparedness’ and ‘continuity of service’. The key themes from the Leximancer® analysis aligned with the two manual coding themes with no new themes identified. Primary dosing site closures in disaster-affected areas led to increased pressures on hospitals and other community pharmacy dosing sites to supply ORT doses to clients. However, a lack of dosing information available to pharmacists and strict legislative requirements made continuity of ORT supply during these cyclones difficult.ConclusionContinuation of ORT services during and in the aftermath of a cyclone event is complex. This research highlighted a need for a coordination of efforts and shared dosing information between QOTP employees, community pharmacists, and hospital pharmacists. To improve continuity of ORT services, it is essential that these stakeholders engage with each other in preparing for and responding to future events.     

New Zealand community pharmacist attitudes toward opioid-dependent clients

Aim: To survey New Zealand community pharmacists to explore levels of training, attitudes towards providing services for drug users, and associations with current and past practice.

Methods: Postal survey of 898 randomly selected community pharmacists. Questions included demography, training and a 20-question attitude scale. Principle component analysis was conducted to identify the main attitude factors. Multiple linear regressions were used to model the effect of different independent variables on the factors.

Findings: Twenty-six percent of respondents had previously undertaken training about the management of opioid misuse. Four principal factors explained 57% of the variance within the attitude questions. These were attitudes towards: 'the general results of dispensing methadone to opioid misusers'; 'the effect of opioid-dependent clients on a pharmacy'; 'reducing harm associated with drug use'; and 'engaging with drug users'. Training (having it or wanting to have it) was positively associated with the four attitude factors.

Conclusions: The results of this study indicate that attitudes towards various aspects of service provision to drug misusers may not be as simple as previously perceived.     

Linking pharmacists to the delivery of public health services

Objective

To describe components fundamental to the process of linking pharmacy to the delivery of public health services in a sustainable way.

New Zealand community pharmacist attitudes toward opioid-dependent clients

Aim: To survey New Zealand community pharmacists to explore levels of training, attitudes towards providing services for drug users, and associations with current and past practice.

Methods: Postal survey of 898 randomly selected community pharmacists. Questions included demography, training and a 20-question attitude scale. Principle component analysis was conducted to identify the main attitude factors. Multiple linear regressions were used to model the effect of different independent variables on the factors.

Findings: Twenty-six percent of respondents had previously undertaken training about the management of opioid misuse. Four principal factors explained 57% of the variance within the attitude questions. These were attitudes towards: ‘the general results of dispensing methadone to opioid misusers’; ‘the effect of opioid-dependent clients on a pharmacy’; ‘reducing harm associated with drug use’; and ‘engaging with drug users’. Training (having it or wanting to have it) was positively associated with the four attitude factors.

Conclusions: The results of this study indicate that attitudes towards various aspects of service provision to drug misusers may not be as simple as previously perceived.     

Dispensing opioid substitution treatment: practices, attitudes and intentions of community-based pharmacists

INTRODUCTION AND AIMS: Community-based pharmacists (CPs) play a pivotal role in the provision of opioid substitution treatment (OST). This study examined practices, experiences, attitudes and intentions of a sample of South Australian pharmacists involved with the provision of OST. DESIGN AND METHODS: A random sample, stratified by geographic location, of 50 SA CPs were administered a telephone survey. The survey included pharmacist and pharmacy details, current practices, problems experienced, attitudes towards and future intentions in relation to the provision of OST. RESULTS: Pharmacists indicated high levels of support for the OST programme and most (98%) intended to continue providing OST. Sixty-four per cent of all pharmacists, and significantly more rural pharmacists (90%), indicated that they were willing to take on additional clients. Metropolitan pharmacists dosed greater numbers of OST clients (median = 7) than rural pharmacists (median = 4). There was a strong positive correlation between number of regular clients seen and problems experienced by pharmacists. Seventy per cent of pharmacists reported detecting no diversion of pharmacotherapy medication. DISCUSSION AND CONCLUSIONS: Despite reports to the contrary, pharmacists appear to be generally positively predisposed to providing OST. Policies aimed at retaining pharmacists, particularly in resource poor rural areas, could consider embracing a shared-care approach between general practitioners and pharmacists.     

Perceived factors influencing the development of primary care‐based pharmaceutical care in Scotland

Objective — To obtain the views of key pharmacists in Scotland (potential policy‐makers and innovative practising pharmacists) on a systematic approach to pharmaceutical care and on the factors important in its development. Method — Semi‐structured interviews, based on factors identified from the literature as resources required for, or barriers to, pharmaceutical care development. Key findings — All 16 interviewees agreed with the systematic approach and identified community pharmacies as the key locus for the delivery of pharmaceutical care in primary care. Many expressed similar views in relation to remuneration, the need for training, physical resources, relationships with general practitioners to facilitate access to clinical information from medical records, repeat dispensing systems and improvements to existing computer systems to support the necessary documentation. Divergent opinions were expressed on the need for registration of patients with community pharmacies, on the use of dispensing technicians and on what specific literature and information from medical records would be required to support pharmaceutical care. While all agreed that there was insufficient evidence available of the benefits of pharmaceutical care, many felt that its development should nonetheless be progressed. Conclusion — Many of the views expressed are similar to those identified among community pharmacists in similar studies. Planning of future services needs to involve community pharmacists if indeed they are key to pharmaceutical care provision.