Barriers to the use of patient safety information sources by community pharmacies

BackgroundWhen patient safety information is communicated across a regulatory jurisdiction or country, the potential to enhance the safety of community pharmacy practice is significant. While there currently exists a number of sources for patient safety information (e.g., websites, safety bulletins, online tools), knowledge of the barriers that may inhibit the use of such information sources within community pharmacies is limited.ObjectiveThis research explores community pharmacy manager use of Canadian patient safety information sources and the barriers that may limit the use of such sources.MethodsA qualitative research study design using semi-structured interviews was conducted with 15 community pharmacy managers in the Halifax Regional Municipality of Nova Scotia, Canada. The study explored how pharmacists access and engage a variety of information sources, including corporate intranets, websites, and tools provided by third party data base repositories. Interview data were analyzed using thematic analysis.ResultsFive general barriers were identified: lack of time to access information sources and its contents; too many sources of available information; too much information not relevant to community pharmacy practice; complexity navigating online information sources; and lack of community pharmacy involvement in source design.ConclusionWhile pharmacies do use safety information sources to enhance practice safety, their ability to incorporate this information is inhibited by their general lack of time available to access and read safety information, lack of knowledge about where to get this information, and lack of tailored information for the community pharmacy context. Future initiatives should address increasing information awareness of available sources, consolidating and reducing information overload of such sources, and packaging information to better fit with pharmacists’ needs.     

10 ways to improve medication safety in community pharmacies

Data sourcesNot applicable.SummarySince at least the time of Hippocrates, health care providers have recognized their responsibility to protect patients from potential harm resulting from the care they provide. In pharmacy, such harm typically results from a violation of any of the “5 rights” of safe medication use. However, a memorable adage stops short of providing operational guidance to improve medication safety. Specific actionable recommendations are needed to identify changes that, if implemented, would significantly improve the safety of medication delivery and use.ConclusionMost threats to medication safety result from weaknesses or failures in one or more of the key system elements identified by the Institute for Safe Medication Practices. Pharmacists should be advocates for implementing targeted recommendations to strengthen their practice systems and improve medication safety.     

Pharmacist–patient communication in Swedish community pharmacies

BackgroundIt is important that pharmacists counsel patients about their prescribed medicines, as it leads to improved therapeutic outcome, increases compliance, and decreases confusion and insecurity. Studies have shown that the number of patients getting any pharmaceutical counseling varies greatly. Swedish pharmacists claim that the focus of the dialog with the patient has switched from pharmaceutical counseling to economy and regulations.ObjectiveThe aim of this study was to determine the content and time disposition of the patient–pharmacist communication during dispensing of prescribed medicines at Swedish community pharmacies.MethodNon-participant observations and audio recordings were used as data-collecting methods. The content of the dialog was categorized into 2 deductively decided main categories–medicinal and non-medicinal issues–and 12 inductively decided subcategories.ResultsA total of 282 pharmacy encounters were observed and recorded, of which 259 fully coincided with the inclusion criteria. After categorizing the content of each encounter the results showed that there was little or no dialog regarding medicinal issues during the pharmacy encounter in Swedish community pharmacies. Forty percent of the dialog concerns non-medical issues and almost half of the encounter was silent.ConclusionMedicines are an essential treatment method in healthcare, and pharmaceutical expertise is available to patients who enter a community pharmacy. The results of this study show that today's pharmacy encounter is not focused on improving the use of medication, possibly resulting in the patient not gaining the most benefit from his or her treatment.     

Consumer satisfaction with opioid treatment services at community pharmacies in Australia

OBJECTIVE: To explore consumer satisfaction with, and experiences of, a range of issues associated with the delivery of opioid substitution treatment at community pharmacies in New South Wales, Australia. SETTING: 50 community pharmacies providing opioid substitution treatment in New South Wales. METHOD: Self-completion survey completed by 508 clients during supervised dosing. MAIN OUTCOME MEASURE: Satisfaction with opioid substitution treatment delivery at community pharmacies. RESULTS: Sixty-one percent of participants reported being satisfied with their treatment programme. Participants expressed a high level of satisfaction with most aspects of opioid substitution treatment delivery at their pharmacy (aggregate mean = 8.1/10; 10 = excellent). However, participants were less satisfied with the level of privacy afforded at the pharmacy. Thirty-four percent reported that they were made to wait longer than other customers, and 25% reported that the pharmacy staff did not treat them the same as other customers. However, 87% reported that they felt welcomed by the pharmacy staff. Twenty-three percent of clients were currently in debt to the pharmacy for nonpayment of dispensing fees. The mean amount of current debt was $71.75, equivalent to approximately 2 weeks of pharmacy dispensing fees. CONCLUSION: Community pharmacies providing opioid substitution treatment in New South Wales appear to be providing a level of service that is satisfactory to the clients of those services. However, many participants were concerned about a lack of privacy, the high cost of treatment, and being treated differently to other customers.     

Cardiovascular risk screening program in Australian community pharmacies

Objective To assess the suitability of Australian community pharmacies as cardiovascular disease risk profile screening centres and evaluate whether community pharmacists can play an important role in detecting, educating and referring screened individuals at high risk of cardiovascular disease. Setting 14 Australian community pharmacies. Method Opportunistic cardiovascular disease risk profiling for members of the public aged greater than 30 years with no existing cardiovascular diseases was performed. All major cardiovascular risk factors were measured. Exercise habits, existing conditions and therapy, and family history were also assessed. The results were used to calculate each subject’s 10-year risk of developing cardiovascular events, based on Framingham Risk Equations (New Zealand tables). Each subject’s knowledge of cardiovascular risk factors was assessed using a multiple-choice questionnaire. Written educational materials and verbal counselling were provided. Referral to a doctor for further assessment was recommended as appropriate. The screened individuals were followed up via mailed out questionnaire. A random sample of individuals at elevated risk was phoned to assess for outcomes of the screening and referral process. Main outcome measures Risk of developing cardiovascular disease and knowledge of cardiovascular risk factors. Results A total of 655 individuals (71.4% female) were screened for cardiovascular disease risk factors. Ages ranged from 30 to 90 years (median: 54 years) and 14.2% were smokers. Of the individuals screened, 28.1% had a 10-year risk of developing cardiovascular disease greater than 15%, including 6.9% who had a 10-year risk above 30%. The median calculated 10-year risk of developing cardiovascular disease was 9.5%. Approximately one-third of the individuals had elevated blood pressure, and almost two-thirds were either overweight or obese. The mean total serum cholesterol was 5.31 mmol/l, with 40% of individuals having a level above 5.5 mmol/l and 20% having a high-density lipoprotein cholesterol level below 1.0 mmol/l. There was a statistically significant improvement in the knowledge of cardiovascular disease risk factors at follow-up. Almost half of the contacted high-risk subjects reported lifestyle changes or started drug therapy following re-testing by their general practitioner. Conclusion A pharmacy-based cardiovascular disease risk profile screening and education program has the potential to identify and refer many undiagnosed individuals at high risk of cardiovascular events, and help contain the burden of heart disease.     

Investigation on safety climate for preventing dispensing errors in community pharmacies

We investigated consciousness of the prevention of dispensing errors with the pharmacists and clerical staffs which work in community pharmacies and analyzed the structure of those subconscious to examine preventive measures of dispensing errors. Questionnaire survey was performed for all pharmacists and clerical staffs working in community pharmacies where each is affiliated with four pharmacy groups. The questionnaire consisted of 38 questions about "atmospheres for the prevention of dispensing errors" in the pharmacy along their attributions. And data were analyzed by occupation to confirm the difference. As a result of factor analysis, five factors such as "the posture of the boss", "information exchange", "the order of the pharmacy" were extracted from the pharmacists. Moreover, in the case of the clerical staffs, five similar factors have been extracted besides "a sense of responsibility to duties" replaced "the order of the pharmacy". As a result of structural equation modeling, the pass model with high goodness of fit to which "measures for dispensing error prevention" and "consciousness to the dispensing error of a pharmacy" were assumed to be a subordinate concept respectively by each occupational category. It became clear that a suggestion of the concrete preventive measures drafting was provided even from the investigation of the consciousness level.     

Direct observation of telephone communication between community pharmacies and prescribers in New Zealand

Background Phone calls between pharmacists and prescribers play an important role in resolving potential errors and other issues. Despite their importance in patient care, and sometimes causing frustration for pharmacists, there is little research on these calls. Objective To quantify how long calls between pharmacists and prescribers are, how often phone calls occur, why calls are made, and who is called. Method An observational study was conducted with 130.5 h observed in 11 community pharmacies over 8 weeks in Dunedin, New Zealand, recording information about all incoming and outgoing calls. Data captured included information on length, date, time, reason for call, pharmacy staff involved, health professionals involved, and the place being called. We also surveyed pharmacists’ perceptions of this communication. Results Data on 95 phone calls was captured. The mean length was 110 s (95% CI 88–133), at an average of 0.7 calls per hour. The most frequent reasons for calling were clarifications and dose inquiries. Conclusion Calling prescribers is perceived as a frustrating; however the frequency of calls we observed was low, but some were long. The amount of time spent for pharmacist interventions may be reduced using alternative communication methods but these need further study.     

Medicines use review service in community pharmacies in Spain: REVISA project

International Journal of Clinical Pharmacy - Background Community pharmacy services play an important role in controlling some factors related to medicine use and patients can benefit from these...     

Directly observed hepatitis C treatment with opioid substitution therapy in community pharmacies: A qualitative study

BackgroundThe hepatitis C virus (HCV) will only be eliminated through successful engagement with people who inject drugs (PWID), however some of this population experience socioeconomic and individual issues that can lead to poor HCV treatment adherence. A key sub-group of (PWID) are those who receive opioid substitution therapy (OST). In Australia, OST is most often delivered under direct supervision by a community pharmacist every day or multiple times a week. This regular interaction could be an ideal opportunity to enhance direct-acting antiviral (DAA) treatment adherence under directly observed therapy (DOT) by the pharmacist.AimThe aim of this study was to explore the perspectives of OST patients with a lived experience of HCV to understand whether or not dispensing DAAs in the same way as, or simultaneously with OST would benefit HCV treatment.MethodsData collection occurred from June to August 2017. Semi-structured interviews were conducted with a sample of PWID living with HCV and on OST programs (n = 12) in Melbourne, Australia. Interviews were voice recorded and transcribed in verbatim. Interpretive phenomenology guided analysis of the data.ResultsThemes reported by participants that provide insight into the suitability of DOT of DAAs include: Adherence and non-adherence to DAA treatment; Mixed views towards DOT of DAAs; Experiences and perceptions of OST providers; and Perceived stigma in the pharmacy.ConclusionsCommunity pharmacies offering OST may be an effective place for DOT of HCV treatment, but is likely only to benefit people who face significant challenges to adherence. We suggest that a positive pharmacist-patient relationship, high OST adherence, and commitment to reducing stigma in the pharmacy would be necessary for the intervention to be effective. Further research is needed to evaluate the expanded-role of community pharmacies in improving DAA adherence and eliminating HCV.