Community pharmacists' views and beliefs about the treatment of symptoms suggestive of vaginal thrush in community pharmacies

Objective: To investigate the views and beliefs of community pharmacists about the benefits and disadvantages to the customer, pharmacy and pharmacist of treating women with symptoms suggestive of vaginal thrush. Design: Semistructured interviews.Setting: Community pharmacists from within Grampian Primary Care NHS Trust.Outcome Measures: Pharmacists' views and beliefs analysed using content analysis.Results: Of the 26 pharmacists contacted, 19 (73%) pharmacists from 16 pharmacies completed interviews. The pharmacists were generally positive towards the treatment of women with vaginal symptoms and perceived few disadvantages. Immediate access to treatment and rapid symptom relief were perceived to be the greatest advantages to the customer. The main problems were customer embarrassment, cost and the risk of masking a serious condition. Customer embarrassment was perceived to be influenced by lack of privacy and the gender of the member of staff involved in the consultation. Five pharmacists perceived vaginal thrush to be an infection that could be spread by sexual transmission. Discussion: There is a need to make pharmacists aware of the current evidence regarding the treatment of vaginal thrush, particularly that sexual partners of women with acute, uncomplicated thrush do not require treatment with an antifungal. The main difficulties that community pharmacists reported with the treatment of this condition were obtaining an accurate history and this was influenced by customer embarrassment. The gender of pharmacy staff and lack of private consultation facilities were suggested as factors that are associated with customer embarrassment and hence, the ability to obtain an accurate history.     

Community pharmacist's roles: nursing home staff and community pharmacists' views

In‐depth interviews were employed to describe the views of pharmacists and nurses on community pharmacists' roles Findings highlighted that there is a gap in appreciating the current pharmacist's roles between the two professions Collaborative work with nurses would enable community pharmacists to identify drug‐related problems in nursing home patients Pharmacists need to develop marketing strategies that mutually reward nurses, patients and pharmacists themselves Local pharmaceutical services' pilots will give pharmacists a great opportunity to overcome potential barriers to a more active role for nursing home patients     

Community pharmacists' views and experiences of counter-prescribing in pregnancy

Objective — To ascertain the sources of community pharmacists' knowledge base for counter-prescribing in pregnancy, whether sufficient additional information was readily accessible and, if not, to discover pharmacists' areas of concern. Method — A structured telephone interview of community pharmacists by a single researcher using a pre-piloted questionnaire to obtain both quantitative and qualitative data. Questions covered previous education about counter-prescribing in pregnancy, reference sources used, and satisfaction with available reference sources. Respondents were also asked to cite examples where they would or would not recommend a medicine in pregnancy. Setting — A random sample of 50 community pharmacies in Scotland. Key findings — From the high response rate (43 pharmacists, 86 per cent) the topic was demonstrably important to community pharmacists, most of whom perceived their knowledge base for counter-prescribing in pregnancy to be experience-gained. Thirty-four pharmacists (79 per cent) agreed there was a need for more information to be available. Ten pharmacists (23 per cent) highlighted complementary therapies as an area where they found available information inadequate. Examples of requests from pregnant women and the action taken by the pharmacist are reported. Conclusion — There is a need for an accurate, current and comprehensive data source for counter-prescribing in pregnancy. The field of complementary medicines and therapies is of particular concern to many community pharmacists. More research is required into GP referrals.     

Pharmacy involvement in formulary development: community pharmacists' views

A postal survey was carried out in the Eastern health and social services board in Northern Ireland to evaluate the views of community pharmacists (n= 100) on pharmacy involvement in formulary development. There was one mailing, with a response rate of 66 per cent. Most respondents (78.7 per cent) agreed or strongly agreed that pharmacist involvement in formulary development was important. Almost two thirds of responding pharmacists said they would be prepared to approach a GP in relation to such collaborative work and 27 per cent had had previous contact with GPs on the subject. Respondents considered that their input would be particularly useful in improving prescribing, providing cost advice and developing a closer working relationship with GPs. Evaluation of current levels of interprofessional liaison in relation to prescribing issues showed that 33.3 per cent of the pharmacists were already contacted by a GP regularly and 45.4 per cent contacted a GP regularly. Most (80 per cent) rated their working relationship with the GP as useful or very useful. The results suggest that community pharmacists in the Eastern health and social services board are willing to become involved in formulary development, thereby extending the use of practice formularies in general practice and integrating community pharmacy more fully into the primary health care team.     

A comparison of community pharmacists' views of over-the-counter omeprazole and simvastatin

PURPOSE: Simvastatin and omeprazole were re-classified to pharmacy status in Great Britain in summer 2004. The purpose of this study was to compare the views of community pharmacists on over-the-counter (OTC) omeprazole and simvastatin. METHODS: A pre-piloted questionnaire mailed to 2000 randomly selected community pharmacy premises, with open questions relating to pharmacists' views. Pharmacists' attitudes on aspects of supply were sought using Likert scales. Content analysis was performed on responses to the open question and Wilcoxon signed ranks test (z) used to compare responses to the attitudinal statements. RESULTS: One thousand one hundred and fifty-six questionnaires were returned (57.8%). Themes around omeprazole illustrated positive views compared to concerns relating to simvastatin. Whereas omeprazole was seen as a welcome addition, there were issues around the poor evidence base for simvastatin. Further simvastatin related concerns were in areas of cardiovascular risk assessment, adverse drug reactions and likelihood of patients not committing to therapy. For both agents, excessive cost was an issue. Nearly three-quarters of pharmacists agreed they were entirely confident about selling omeprazole (835, 73%), significantly more than simvastatin (691, 60%); (z = 9.243, p < 0.001). CONCLUSIONS: Two re-classified medicines have raised common and product-specific themes. Many themes relate to clinical governance such as evidence-based practice, risk management and continuing professional development (CPD). Views on the availability and circumstances surrounding the OTC supply differ in certain regards, for example, more believe that they should be involved in the sale of simvastatin personally than for sales of omeprazole.     

Diary cards and the assessment of cough symptoms in community pharmacies

The aim of this study is to compare cough symptom assessment and medication efficacy as recorded in a diary card with that obtained through direct questioning by a pharmacist. Clients visiting six pharmacies, purchasing a cough medication and meeting the inclusion criteria were recruited. They were asked to fill out diary cards to obtain a daily retrospective assessment of symptoms and medication efficacy. After three days the subjects returned to the pharmacy and were asked to recall their symptoms through a structured questionnaire administered by the pharmacist.48 clients were recruited to the study and of these 44 (92% completed the study. A good correlation was obtained between ratings of medication efficacy as recorded by diary cards and recall. Symptom assessment also showed a statistically significant correlation for days two and three only.For studies assessing symptoms over a 48 hour period, detailed poststudy assessments may not be required. The study provides further evidence for the viability of clinical trials conducted through community pharmacies.     

Variation in patients' and pharmacists' attribution of symptoms and the relationship to patients' concern beliefs in medications

BackgroundThe process by which symptoms are identified and characterized is related to adverse drug event reporting. Patient and pharmacist symptom attribution may differ and be related to certain patient characteristics.Objectives(1) To compare attribution of symptoms to a cause for patients and pharmacists; (2) to quantify the association between patients' concern beliefs and patient-pharmacist agreement on patients' symptom attribution to medications; and (3) to identify any associations between patients' propensity to agree with pharmacists' assessments of symptom attribution with various clinical and/or sociodemographic characteristics.MethodsAn Internet survey of Medicare beneficiaries was administered by Harris Interactive^®. The survey elicited information on health symptoms that subjects experienced and to whom they reported these symptoms. If subjects did not experience symptoms and did not report them, the reasons for not reporting were elicited. A clinical expert panel reported ratings about respondents' (1) likelihood of the symptom experienced being attributed to a medication and (2) probability of the symptom being attributed to the reason the patient stated. Frequencies of unreported symptoms for each reason/category were examined. Chi-square and Fisher's exact test analyses examined the variations between patients' and pharmacists' ratings of symptom attribution to medications and associations between attribution and patient sociodemographic and clinical characteristics, such as the number of medications used. Independent sample t tests examined how attributions were related to concern beliefs.ResultsMost patients thought their symptom(s) were the result of their disease, something other than medications or age. There was no statistically significant difference between patients' and pharmacists' symptom attribution (χ² = 1.376, P = .24). Individuals whose symptom attributions differed from pharmacists were likely to have stronger concern beliefs in medication (t = ?3.03, P < .01).ConclusionsPatients' concern about their medications may be related to their symptom attributions. Older adults may not consider these concerns when asked about their symptom attributions.     

Impact of an interactive workshop on community pharmacists' beliefs toward patient care

Background Patient assessment and documentation are less than optimal in pharmacy practice as preparing and dispensing medications is still a major part of community pharmacy practice. Pharmacists?? attitudes, specifically self-efficacy and role beliefs, toward practice have been shown to predict practice change. Objective This study will determine the impact of an interactive workshop on pharmacists?? attitudes toward assessment and documentation in routine pharmacy practice. Specific objectives included how (1) pharmacists?? role beliefs and self-efficacy toward assessment and documentation change after training and rehearsal and (2) frequently do pharmacists assess patient therapy and document patient care? Setting: ??Chat, Check and Chart: patient assessment and documentation demystified?? workshop Alberta College of Pharmacists Annual General Meeting in Calgary, Canada. Methods This study is pre?Cpost evaluation. Quantitative data on self-efficacy and role beliefs toward assessment and documentation was gathered from a validated written survey. Surveys were completed before and after the intervention. The intervention, an interactive workshop, focused on the use of three tools practice and was designed to support pharmacists in achieving the assessment and documentation required by the Alberta College of Pharmacists Standards for Practice. Main outcome measure: Pharmacists?? role beliefs and self-efficacy toward assessment and documentation in patient care. Results Of the 61 eligible pharmacists, the response rate was 61?% (37 pharmacists) with complete data. In the past 2 weeks, 54?% of pharmacists were assessing patients and 32.6?% of pharmacists were documenting greater than half the time. Prior to the workshop, pharmacists ??agreed?? (5.42?±?1.41) with their role in patient assessment and they were ??quite sure?? (4.75?±?1.10) they could assess patients. Pharmacists ??agreed?? (5.13?±?0.890) with their overall role in documentation of patient interactions and reported lower self-efficacy (3.88?±?1.32) for their ability to document patient interactions. After the interactive workshop, there were statistically significant increases in pharmacists?? self-efficacy and role beliefs in regards to both patient assessment and documentation (p?<?0.05). Conclusion This brief interactive workshop increased both self-efficacy and role beliefs towards assessment and documentation, indicating these pharmacists are likely to change future practice. Future research will assess practice uptake and implementation.     

Cross‐sectional survey of community pharmacists' views of the electronic Minor Ailment Service in Scotland

Objectives The aim was to investigate community pharmacists' views on the implementation of the electronic Minor Ailment Service (e‐MAS) in Scottish community pharmacies and to quantify the barriers and facilitators to service provision. Methods A postal cross‐sectional survey of all community pharmacies in Scotland (n = 1138) was conducted. A combination of open, closed and Likert‐type questions were used. Key findings A response rate of 49.5% was achieved. A majority of respondents (over 84%) ranked their level of implementation of e‐MAS as 4 or 5 on the five‐point scale where point 1 represented ‘not at all’ and 5 represented ‘very high’. A majority also identified opportunities to extend professional roles (83.3%), opportunities for more effective patient treatment (78.5%), opportunities to better meet patient expectations (74.4%) and financial advantage to their pharmacy (52.6%) as benefits of e‐MAS. Suspected misuse/overuse of the service by some customers (75.1%) and time required for recording each consultation or supply (61.3%) were two barriers agreed upon by the majority of the respondents. Conclusions A majority of respondents had positive views towards e‐MAS. The benefits agreed upon by the majority of the respondents relate to known facilitators of community pharmacy practice change. Major barriers, namely suspected misuse of the service by some customers and timely process for recording consultation or supply, could affect pharmacists' efficiency in service delivery and need to be addressed. These results could inform similar schemes that may be introduced locally in the UK or elsewhere.     

Older patient, physician and pharmacist perspectives about community pharmacists' roles

Objectives To investigate older patient, physician and pharmacist perspectives about the role of pharmacists in pharmacist-patient interactions. Methods Eight focus-group discussions were held in senior centres, community pharmacies and primary care physician offices. Participants were 42 patients aged 63 years and older, 17 primary care physicians and 13 community pharmacists. Qualitative analysis of the focus-group discussions was performed. Key findings Participants in all focus groups indicated that pharmacists are a good resource for basic information about medications. Physicians appreciated pharmacists' ability to identify drug interactions, yet did not comment on other specific aspects related to patient education and care. Physicians noted that pharmacists often were hindered by time constraints that impeded patient counselling. Both patient and pharmacist participants indicated that patients often asked pharmacists to expand upon, reinforce and explain physician-patient conversations about medications, as well as to evaluate medication appropriateness and physician treatment plans. These groups also noted that patients confided in pharmacists about medication-related problems before contacting physicians. Pharmacists identified several barriers to patient counselling, including lack of knowledge about medication indications and physician treatment plans. Conclusions Community-based pharmacists may often be presented with opportunities to address questions that can affect patient medication use. Older patients, physicians and pharmacists all value greater pharmacist participation in patient care. Suboptimal information flow between physicians and pharmacists may hinder pharmacist interactions with patients and detract from patient medication management. Interventions to integrate pharmacists into the patient healthcare team could improve patient medication management.     

The sale of emergency hormonal contraception in community pharmacies in the UK: the views of users

Sales of emergency hormonal contraception (EHC) in community pharmacies began in 2001 This study set out to explore the views of a small group of women purchasing EHC in community pharmacies, using qualitative techniques Users were broadly positive about pharmacy sales of EHC, citing access, convenience and confidentiality as key benefits Four out of 12 respondents made a decision to engage in unprotected intercourse because they were aware that EHC was available from the pharmacy More research is required to explore the impact of pharmacy sales of EHC on unprotected intercourse and sexually transmitted infections     

Alfuzosin for the treatment of storage symptoms suggestive of overactive bladder

Introduction: Antimuscarinics are the mainstay of overactive bladder (OAB) pharmacotherapy although other agents, such as α-adrenergic receptor antagonists, might also be effective. Alfuzosin has α1-adrenoreceptor antagonist activity and is available worldwide for the treatment of lower urinary tract symptoms resulting from benign prostate hyperplasia. Alfuzosin may relieve storage symptoms suggestive of OAB in patients with or without bladder outlet obstruction (BOO).

Areas covered: This paper reviews the available literature on the use of alfuzosin in the treatment of storage symptoms suggestive of OAB. Additionally, the role of α-adrenoreceptor antagonists in the treatment of OAB is reviewed, based on pathophysiology.

Expert opinion: Although alfuzosin is effective against storage symptoms, it does not improve them in all patients with OAB. It is likely that alternative types of therapy, such as antimuscrarinics, need to be co-administered to patients with residual storage symptoms after alfuzosin administration. Alfuzosin can decrease the risk of adverse events associated with antimuscarinics. The sequential use of alfuzosin and antimuscarinics appears to be an appropriate strategy for the treatment of storage symptoms suggestive of OAB related to BOO.     

Alfuzosin for the treatment of storage symptoms suggestive of overactive bladder

INTRODUCTION: Antimuscarinics are the mainstay of overactive bladder (OAB) pharmacotherapy although other agents, such as α-adrenergic receptor antagonists, might also be effective. Alfuzosin has α1-adrenoreceptor antagonist activity and is available worldwide for the treatment of lower urinary tract symptoms resulting from benign prostate hyperplasia. Alfuzosin may relieve storage symptoms suggestive of OAB in patients with or without bladder outlet obstruction (BOO). AreaS COVERED: This paper reviews the available literature on the use of alfuzosin in the treatment of storage symptoms suggestive of OAB. Additionally, the role of α-adrenoreceptor antagonists in the treatment of OAB is reviewed, based on pathophysiology. EXPERT OPINION: Although alfuzosin is effective against storage symptoms, it does not improve them in all patients with OAB. It is likely that alternative types of therapy, such as antimuscrarinics, need to be co-administered to patients with residual storage symptoms after alfuzosin administration. Alfuzosin can decrease the risk of adverse events associated with antimuscarinics. The sequential use of alfuzosin and antimuscarinics appears to be an appropriate strategy for the treatment of storage symptoms suggestive of OAB related to BOO.     

A model for assessment and referral of clients with bowel symptoms in community pharmacies

Background To expedite diagnosis of serious bowel disease, efforts are required to signpost patients with high-risk symptoms to appropriate care. Community pharmacies are a recognized source of health advice regarding bowel symptoms. This study aimed to examine the effectiveness of a validated self-administered questionnaire, Jodi Lee Test (JLT), for detection, triage, and referral of bowel symptoms suggestive of carcinoma, in pharmacies.

Method ‘Usual Practice’ was monitored for 12 weeks in 21 pharmacies in Western Australia, documenting outcomes for 84 clients presenting with bowel symptoms. Outcome measures were: acceptance of verbal advice from the pharmacist; general practitioner consultation; and diagnosis. Trial of the JLT involved staff training in the research protocol and monitoring of outcomes for 80 recruited clients over 20 weeks. Utility of the JLT was assessed by post-trial survey of pharmacy staff.

Results Significantly more referrals were made by staff using the JLT than during Usual Practice: 30 (38%) vs 17 (20%). Clients’ acceptance of referrals was also higher for the intervention group (40% vs 6%). Two-thirds of pharmacy staff agreed that the JLT could be incorporated into pharmacy practice, and 70% indicated they would use the JLT in the future.

Conclusion A pre–post design was considered more appropriate than a randomized control trial due to an inability to match pharmacies. Limitations of this study were: lack of control over adherence to the study protocol by pharmacy staff; no direct measure of client feedback on the JLT; and loss to follow-up. The JLT was effective in prompting decision-making by pharmacy staff and inter-professional care between pharmacies and general practice, in triage of clients at risk of bowel cancer.