Views of pharmacist prescribers,doctors and patients on pharmacist prescribing implementation

Aim The aim of this study was to explore the perspectives of pharmacist supplementary prescribers, their linked independent prescribers and patients, across a range of settings, in Scotland, towards pharmacist prescribing. Method Telephone interviews were conducted with nine pharmacist prescribers, eight linked independent prescribers (doctors) and 18 patients. The setting was primary and secondary care settings in six NHS Health Board areas in Scotland. Key findings In general, all stakeholders were supportive of pharmacists as supplementary prescribers, identifying benefits for patients and the wider health care team. Although patients raised no concerns, they had little idea of what to expect on their first visit, leading initially to feelings of apprehension. Pharmacists and doctors voiced concerns around a potential lack of continued funding, inadequate support networks and continuing professional development. Pharmacists were keen to undertake independent prescribing, although doctors were less supportive, citing issues around inadequate clinical examination skills. Conclusions Pharmacists, doctors and patients were all supportive of developments in pharmacist supplementary prescribing, although doctors raised concerns around independent prescribing by pharmacists. The ability of pharmacists to demonstrate competence, to be aware of levels of competence and to identify learning needs requires further exploration.     

秩和比法(RSR)综合评价住院药房运行效益

目的　探讨住院药房工作质量综合评定标准。方法　应用秩和比法对住院药房运行效益进行评价。结果　计算出各年度综合指数及排位。结论　此方法可操作性强,结果较客观合理,有效地促进了工作质量的管理和提高     

Clinical medication review by a pharmacist of elderly people living in care homes: pharmacist interventions

Objectives To describe the rate and nature of pharmacist interventions following clinical medication review of elderly people living in care homes. Setting Care home residents aged 65+ years, prescribed at least one repeat medication, living in nursing, residential and mixed care homes for older people in Leeds, UK. Method Analysis of data from care home residents receiving clinical medication review in the intervention arm of a randomised controlled trial. Intervention outcomes for each medicine were evaluated for each resident. Key findings Three‐hundred and thirty‐one residents were randomised to receive a clinical medication review and 315 (95%) were reviewed by the study pharmacist; 256 (77%) residents had at least one recommendation made to the general practitioner. For the 2280 medicines prescribed, there were 672 medicine‐related interventions: medicines for cardiovascular system (167 (25%)), nutrition and blood (121 (18%)), central nervous system (113 (17%)) and gastrointestinal conditions (86 (13%)) accounted for 487 (73%) of medicine‐related interventions. There were 75 non‐medicine‐related interventions. The most common interventions were ‘technical’ (225 (30%)), ‘test to monitor medicine’ (161 (22%)), ‘stop drug’ (100 (13%)), ‘test to monitor conditions' (75 (10%)), ‘start drug’ (76 (10%)), ‘alter dose’ (40 (5%)) and ‘switch drug’ (37 (5%)). Recommendations to stop a medicine were most common for CNS drugs (32 (32%)). The most common medicine to be recommended to be started was calcium and vitamin D (45 (59%)). Following a recommendation to test to monitor a medicine, 23 (14%) medicines required a change. Conclusions This study has demonstrated that clinical medication review by a pharmacist can identify medicine problems in approximately 80% of care home residents, requiring intervention in 1 in 4 of their prescribed medications.     

What is a problem drug user?

The term ‘problem drug user’ (PDU) has risen to prominence in policy and research discourse over the past 25 years or so, particularly in the UK and Europe, largely at the expense of the older ‘addiction’ and ‘dependence’ concepts. How should we understand this shift? Is it merely a change in terminological fashion or does it signify something more significant? In exploring this question, the work of the philosopher Ian Hacking is drawn on, in particular his related ideas of ‘making up people’ and ‘looping effects’. Although it first emerged in the early 1980s, it is shown how the idea of the ‘PDU’ in fact has a long and mixed genealogy which can be traced back at least as far as the 1930s, a heritage which continues to exert influence today. Following Hacking, it is argued that the invention just over 25 years ago of the ‘PDU’ constituted the creation of a new kind of person which did not exist before and which has shaped how those so labelled are governed and controlled.