General medical practitioners' attitudes towards the use of patient medication records

A survey was conducted to ascertain general medical practitioners' (GPs') attitudes to community pharmacists' use of patient medication records (PMRs) and to assess whether GPs envisage a role for family health service authorities (FHSAs) in maintaining records of patients' data. The survey questionnaire was sent by post to all 1,257 GPs in contract with Avon and Devon FHSAs. A total of 811 questionnaires was returned, an overall response rate of 64.5 per cent. A majority (59 per cent) of GPs considered that community pharmacists should keep patient medication records and there was strong support for pharmacists holding PMRs for the elderly and confused, and also for patients with diabetes, asthma, epilepsy, and those patients who had experienced major adverse drug reactions or allergies. Some GPs, however, remained unconvinced of the usefulness of a pharmacy PMR. Seventy four per cent of respondents considered that patients should keep their own medication records. In contrast, only 4 per cent were in agreement with patient medication data being stored by FHSAs. The community pharmacist's role in maintaining PMRs received less support from doctors in dispensing practices than from their non-dispensing counterparts. Some 80 per cent of respondents were in favour of pharmacists providing PMR system-generated patient information leaflets with dispensed medicines. Most GPs considered that such leaflets had a positive effect on patient compliance. Recently registered GPs were found to be more supportive than their older colleagues of community pharmacists recording patients' clinical conditions and providing information leaflets.     

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]     

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.     

Supplying injecting equipment to drug misusers: a survey of community pharmacists' attitudes,beliefs and practices

A postal survey of 888 community pharmacists in one metropolitan administrative region of southern England investigated the pharmacists' involvement in the supply of injecting equipment to injecting drug misusers (IDMs). The survey response rate was 59 per cent. Of respondents, 58 per cent sold injecting equipment and almost 10 per cent supplied it via “exchange” schemes. The respondents' attitudes and beliefs towards provision of injecting equipment were measured on a five point scale. Providers of injecting equipment were significantly more likely than non-providers to have a positive attitude towards supply, to perceive greater demand for injecting equipment, and to believe that “important others,” such as the pharmacy clientele and other health professionals, would like them to make equipment available. Certain demographic variables and specific beliefs were identified which differentiated between providers and non-providers of injecting equipment. Pharmacists who did not supply injecting equipment were significantly more likely than providers to believe in negative outcomes of supply, such as theft from the pharmacy. The strong associations identified in this study, between service provision, attitudes and beliefs, have implications for shaping attitudes and encouraging pharmacists' future involvement in HIV-prevention initiatives.     

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.     

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.     

Treatment satisfaction and quality of support in outpatient substitution treatment: opiate users’ experiences and perspectives

Abstract

Aims: Patient-reported outcomes have become an important source of information to guide service provision. Although opiate substitution treatment (OST) is an evidence-based and widely available intervention for opiate dependent individuals, evaluation studies have primarily focused on objective outcome indicators rather than on clients’ perspectives and personal experiences. This study aims to assess opiate users’ satisfaction with various aspects of substitution treatment and their subjective experiences and expectations regarding the provision of psychosocial support. Methods: The study sample consisted of 77 opiate-dependent individuals who had been involved in OST for at least three months in some cities in Belgium. Qualitative interviews were used to explore clients’ subjective experiences, in addition to some quantitative measures. Findings: About half of the respondents recently received some form of psychosocial support and they were generally satisfied about these services. However, the number of persons who wanted psychosocial support clearly outnumbered those actually receiving these services. Respondents stressed the importance of building trusting relationships with OST staff. Also, the need for more flexible and individualised support was emphasised. Conclusions: Compared with other stakeholders’ perspectives or traditional outcome indicators, service users’ subjective experiences shed an alternative light on the impact of opiate dependence and OST on individuals’ daily lives. This information should be incorporated in individual treatment planning and when designing and evaluating OST services.     

Attitudes Toward Evidence-Based Pharmacological Treatments Among Community-Based Addiction Treatment Programs Targeting Vulnerable Patient Groups

ABSTRACT

A national sample of addiction treatment Program Directors (N = 296) were assessed regarding their attitudes about pharmacological treatment for addiction disorders. Multivariable analyses indicate that directors who worked in organizations affiliated with research institutions and who had more professional experience had significantly more positive attitudes about a range of pharmacological therapies. Also, directors in organizations serving higher percentage homeless clients and clients with severe and persistent mental illness had more negative attitudes toward use of buprenorphine. Community-based organizations providing addiction treatment to specific vulnerable client groups exhibit more negative attitudes about pharmacological evidence-based practices and may underutilize those practices.     

Referral of clients by community pharmacists: views of general medical practitioners

Community pharmacists have been shown to advise approximately 15 per cent of clients who present to them with minor ailments to consult another health professional, usually their general medical practitioner. The clients that pharmacists refer may or may not be those that GPs most wish to see. There may be other clients or symptoms that GPs believe should be referred to them. This study investigated GPs' views on community pharmacists' referral practices, looking at which symptoms they believed should be referred, the level of agreement between them and how their recommendations compared with the referral practices of community pharmacists established by the author in an earlier study. Questionnaires were posted to a random sample of GPs in Greater London, asking them to indicate the referral advice they felt appropriate for each of 62 symptom groups, recommending either direct referral, no referral or referral only in some cases. The symptom groups were derived from the symptoms presented to the pharmacists in the earlier study. Respondents were generally positive about the pharmacist's role, indicating that for many symptom groups they felt it appropriate for the pharmacist to be a first port of call. Although the variation between responses suggested that there should be local liaison regarding practice, on the whole the GPs' recommendations were in line with the pharmacists' existing practices.     

Gaps in pharmaceutical care for patients with mental health issues: A cross-sectional study

Background

Mental health issues such as depression and anxiety are often underdiagnosed and undertreated. Medications are a primary method of managing mental health problems, and pharmacists therefore have a vital role in supporting patients and providing them with information about the safety and efficacy of mental health medications. However, the potential role of pharmacists in managing mental health issues in Jordan has not been well established.

Aim

This study aimed to assess Jordanian pharmacists’ attitudes and actual practices related to the provision of mental health services.

Method

This was an exploratory cross-sectional study that used a self-report questionnaire among a convenience sample of 347 pharmacists in Amman, the capital of Jordan.

Results

The participating pharmacists had positive attitudes towards providing care for patients with mental health problems. However, their actual practices did not resonate with their enthusiasm, particularly in terms of the long-term follow-up of disease symptoms and medication side effects and adherence. The participating pharmacists showed an eagerness to collaborate with their colleagues, but their level of actual cooperation was lower than desired. The most reported barrier to providing care for patients with mental health problems was the lack of education on mental health issues (71.5%), followed by the lack of privacy in pharmacy settings (53.9%).

Conclusion

To be effectively involved in the provision of care to mental health patients, pharmacists should receive adequate education/training related to mental health issues, and pharmacies should be redesigned to provide private areas for patient counseling.

     

An audit of the supply of emergency hormonal contraception through patient group direction

This abstract reports on an innovative semi‐covert audit of community pharmacists' supply of emergency hormonal contraception (EHC) via patient group directions Two women researchers were trained to request EHC in 10 community pharmacies; they were told to tell the pharmacist that this was a result of unprotected sexual intercourse and they recorded their experiences of the consultation on a structured form following supply of EHC In 100 per cent of cases, pharmacists asked about the date of the last menstrual cycle, whether the last menstrual cycle was normal, whether they were taking any other medication, whether experiencing any other conditions and whether they had taken EHC before, and explained how EHC worked In 70 per cent of cases, pharmacists provided information about STIs, and long term contraception; in 80 per cent of cases, they provided condoms and in 100 per cent of cases supplied EHC; neither women experienced judgmental of negative attitudes Although we should be cautious about generalising from this small sample, on the evidence of this evaluation it appears that the service is being provided appropriately     

Asthma advice giving by community pharmacists

Objective — To investigate the frequency and type of asthma-related advice provided by community pharmacists to customers, and pharmacist attitudes to advice giving and training needs. Method — Postal questionnaire surveying the provision of advice to asthma patients in the previous month. Responses were discussed in a focus group of 13 pharmacists representing different types of community pharmacy and stratified by age and sex. Setting — All community pharmacists in the Grampian health board area, in North East Scotland. Key findings — Of an estimated 180 community pharmacists, 125 responded. Respondents had dispensed a median of 70 asthma medications per week to approximately 40 customers. Most had given advice no more than twice a week. In the previous month, half had checked inhaler technique and most (75 per cent) had “loaned” relief inhalers on an emergency basis. The most common areas where patients sought advice were problems with inhalers, concerns about side effects of asthma medications and using peak flow meters. In the focus group, pharmacists expressed concerns about their training in advice giving for inhaler skills and peak flow meter use and self-management plans. The 69 pharmacists who had undertaken additional training were significantly more likely to feel confident in giving asthma-related advice and to give advice more often. Sixty-one per cent of pharmacists wanted more training in advice giving. Conclusion — At present, asthma-related advice is given infrequently. Reasons for missed opportunities for giving such advice are limited facilities in premises, lack of pharmacist knowledge of some aspects of asthma management and patient attitudes (ie, lack of awareness that pharmacists can fulfil this role).     

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.     

Non-prescribed use of opioid substitution medication: Patterns and trends in sub-populations of opioid users in Germany

BackgroundNon-prescribed use of opioid substitution medication (NPU) appears to represent a relevant source of opioids among European drug users. Little is known about the prevalence of NPU in Germany and possible differences between subgroups of opioid users. The present study examines NPU and other drug use patterns among drug consumption room (DCR) clients, opioid substituted DCR clients, and patients recruited in opioid substitution treatment (OST) practices.MethodsCross-sectional data was collected in 2011 from 842 opioid users in 10 DCRs and 12 OST practices across 11 German cities. Structured interviews comprised indicators for socio-demographics, health status, drug use, motives for NPU, and the availability and price of illicit substitution medication. Group differences were examined with one-way ANOVAs, chi-square tests, or t-tests, and factors for NPU were included in a multivariate model. Over-time comparisons were performed with similar data collected in 2008.ResultsLifetime, 30-day and 24-h NPU prevalence for the total sample was 76.5%, 21.9%, and 9.3%, respectively, with methadone being the most frequently used substance. NPU, poly-drug use and injection drug use were more common among DCR clients, especially among DCR clients not in OST. The three groups featured distinct socio-demographic characteristics, with substituted patients being more socially integrated, while few differences in health parameters emerged. Motives for NPU were mostly related to potential shortcomings of OST, such as insufficient dosages, difficulties with transportation, and lack of access. NPU prevalence was found to be higher than in 2008, while injection rate of substitution medication was similarly low. Main factors associated with NPU were not being in OST, past 24-h use of other drugs, and younger age.ConclusionAlthough diverted methadone or buprenorphine are rarely used as main drugs, NPU is prevalent among opioid users, particularly among DCR clients not in OST. OST reduces NPU if opioid users’ needs are met.     

Counselling women about periconceptional use of folic acid: the role of the community pharmacist can be improved

Objective — To assess community pharmacists' attitudes towards, and practice behaviour, relating to the periconceptional use of folic acid to prevent neural tube defects Method — A postal questionnaire was sent to a random sample of 150 community pharmacists at the end of 1996. The questionnaire covered knowledge, attitude and behaviour regarding the use of folic acid by women of childbearing age Setting — Two regions in the Netherlands (Northern and Western Netherlands) Key findings — The response rate was 72 per cent. Pharmacists' attitudes towards promoting the use of folic acid by women who wish to have a child are positive. Most pharmacists reported distributing folic acid brochures in their pharmacy and many stated that they displayed posters to promote the use of folic acid. Nearly 30 per cent of pharmacists reported using an additional label on the packaging of oral contraceptives with the standard text: “If you stop using the pill because you wish to have a child, please ask your pharmacist for information about the use of folic acid before you become pregnant”. Perceived attitudes of local general practitioners seemed to influence the willingness of pharmacists to promote the use of folic acid. The results indicate a tendency for some pharmacists to be more reactive than proactive in their advice-giving on the use of folic acid Conclusion — Compared with the findings of a similar survey two years ago, it appears that more pharmacists are actively promoting the periconceptional use of folic acid. However, further improvements could still be achieved and pharmacists could become more proactive in their information and advice-giving     

Pharmacists' provision of methadone to intoxicated clients in community pharmacies, Victoria, Australia

This paper concerns pharmacists dispensing methadone to intoxicated clients, drawing on both questionnaire and focus-group data from a 1996 evaluation of the community-based methadone programme in Victoria, Australia. The questionnaire was sent to registered community methadone pharmacies in Victoria (N = 188). The response rate was 84% and 148 questionnaires were analysed. Pharmacists were asked how they would respond to clients who presented intoxicated for their methadone dose. Results indicated that 32% of pharmacists said that they would provide a client who presented intoxicated with his or her usual methadone dose. The analyses suggested that pharmacists who were male and those pharmacists whose number of methadone clients exceeded 10 were more likely to dispense methadone to an intoxicated client than female pharmacists and those pharmacists with less than 10 clients. Pharmacists who would withhold the methadone dose were more likely to inform the client's prescribing doctor at the time (74%) than pharmacists who would provide the usual or modified dose (41%). In order to understand the social processes underlying provision of methadone to intoxicated clients this theme was later taken up in a focus group with pharmacists. Reasons given by pharmacists to explain the dispensing of methadone to intoxicated clients were: insufficient communication between prescribers and pharmacists; a down playing of the pharmacological dangers; personal beliefs and values; a fear of retribution from the client if thedose was refused; difficulty in recognizing intoxication; lack of education and training. The results raise concerns about the basis on which pharmacists make decisions about providing methadone to intoxicated clients. [Koutroulis GY, Kutin JJ, Ugoni AM, Odgers P, Muhleisen P, Ezard N, Lintzeris N, Stowe A, Lanagan A. Pharmacists' provision of methadone to intoxicated clients in community pharmacies, Victoria, Australia. Drug Alcohol Rev 2000;19:299-308]     

Exploring the dissonance between business and public health policy: pharmacy and the provision of opioid pharmacotherapies and clean needles in rural settings

Objective To ascertain, by interview of rural community pharmacists, how well public health policies relating to the provision of clean needles and opioid pharmacotherapies fit with the imperatives of business. Previous research investigating the provision of opioid pharmacotherapies focused predominantly on metropolitan community pharmacists and their experience with servicing methadone clients. Furthermore, there had been no exploration as to whether dissonance exists between community pharmacy business imperatives and the public health policy underpinning these programmes. Method Fifteen rural community pharmacists were interviewed in three focus groups. Experienced interviewer and researcher EH facilitated all three focus group interviews. The questioning path was developed following review of the literature. Thematic analysis identified common themes and issues within the qualitative data collected. Setting All three focus group interviews were conducted in rural South Australia. Key findings Professional obligation played a key role in motivating rural community pharmacists to be involved with service provision. Dissonance existed between the sense of fulfilment by participating in a major public health initiative and the recognition of the mainly negative financial impacts. Financial gain was limited, due to difficulty in fee collection, and inadequate remuneration. Other difficulties included lack of support from allied health services, and restricted access to training due to geographical isolation. Conclusion Some of the difficulties experienced in the servicing of opioid‐dependent clients and its clash with business imperatives are universal and not specific to a rural environment. For the provision of opioid pharmacotherapy services to have fruitful business outcomes and simultaneously deliver effective services, appropriate remuneration and support programmes are needed. Future initiatives should aim at improving pharmacist communications with allied health services and prescribing doctors, as well as greater training opportunities to address problems associated with geographical isolation. Training on realistic outcomes of opioid treatment, the philosophy of treatment, and whether the role should include reducing client doses to assist clients become ‘drug free’ were identified as relevant training issues.     

Involvement and practice of community pharmacists in maternal and child health services: A systematic review

IntroductionCommunity pharmacists are pivotal in the provision of Maternal and Child Health (MCH) services, yet level of involvement, practice and barriers and facilitators in providing these services is largely unknown.ObjectiveThe objective of this review is to summarize available evidence on the involvement and practice of community pharmacists in MCH services.MethodsSeven electronic databases (PubMed, CINAHL, ProQuest Health, Cochrane library, Scopus, Embase, and Web of Science) were searched for articles published in English since inception of the database to November 30, 2019. Papers were included if they assessed involvement and practices of community pharmacists in maternal and child health services. Full articles identified and included for the final analysis were assessed for quality using the Mixed Method Appraisal Tool (MMAT) (2018) by all authors and data were extracted by one author and cross-checked by all authors.ResultA total of 2830 articles were identified. Following the assessment against the inclusion criteria, 14 full text articles were included for the final analysis. In eight studies, community pharmacists were reported to have involvement in maternal health services, in terms of providing breastfeeding guidance, counselling about the benefit of vitamins during pregnancy, provision of emergency contraception advice, and responding to illness symptoms such as back pain. In three studies, community pharmacists were providing advice in managing acute diarrhea in children. Medication use services and counselling about medication for children were also reported in three studies. Perceived consumer attitudes, problem with insurance coverage, lack of time among pharmacists and lack of incentives for the services provided were reported by pharmacists as the main barriers to service provision.ConclusionCommunity pharmacists were involved in various MCH services in community pharmacy settings. However, the extent of practices was not as per the joint International Pharmaceutical Federation (FIP)/World Health Organization (WHO) guidelines on good pharmacy practice in some services such as management of diarrhea.