Pharmacist and general practitioner ambivalence about providing written medicine information to patients—A qualitative study

BackgroundWritten medicine information is an important aspect of patient education, increasing patient knowledge and satisfaction. It can play an important role in promoting education, communication, and improving health literacy. In Australia, standardized, comprehensive written medicine information is available for all medicines. Patients' want such written information, however they report it is generally not supplied or there is limited interaction between healthcare professionals and patients when provided.ObjectiveA qualitative study was conducted to explore the opinions and attitudes of healthcare professionals toward the use of written medicine information in practice.MethodThe study involved focus groups with 32 general practitioners (4 groups), 29 community pharmacists (4 groups) and 7 hospital pharmacists (1 group) in Sydney and rural New South Wales. All discussions were transcribed verbatim and analyzed using thematic content analysis.FindingsAcross the groups, professionals were aware of patients' needs for medicine information, but provision to patients in practice appeared the exception rather than the rule. Common reasons for non-provision were lack of time, possible creation of patient anxiety, low literacy, and perceived length and complexity of the information. Many desired more balanced information for patients on both benefits and risks. Most felt current materials were not useful information-sharing tools; some perceived that it undermined their relationship with patients. Improvement strategies proposed included increased consultation times and improved quality of the information.ConclusionParticipants were ambivalent about supplying written medicine information to their patients and concerned about its impact on the patient-provider relationship. This contributed to limited provision, despite the information being available for all medicines. A tailored approach to meet individual patient information preferences, together with efforts to support professionals as facilitators of information may increase written medicine information utilization as an information-sharing tool to improve health literacy and patient engagement.     

Labetalol (‘Trandate’) in hypertension: A multicentre study in general practice

Summary

A study was carried out in 1286 hypertensive patients seen in general practice to evaluate the effectiveness of labetalol given for periods of up to 24 months. Initial dosage was 300?mg per day. The results showed that blood pressure was readily controlled and maintained by labetalol alone in the majority of patients. Pulse rate, vision andfundi were unchanged. There was little difference between the supine and upright blood pressures, confirming the clinical finding that postural hypotension was not a problem. The incidence of side-effects leading to withdrawal was small (7.2%), most side-effects being minor and transient. No drug interactions with concomitant therapy were apparent and the incidence of bronchospasm was very low. The incidence of myocardial infarction and cerebrovascular accident in the population studied was lower than expected.     

“In-loop” carbonylation—A simplified method for carbon-11 labelling of drugs and radioligands

Transition-metal mediated carbonylation with ¹¹C-labelled carbon monoxide ([¹¹C]CO) is a versatile method for introducing ¹¹C (t_1/2 = 20.3 min) into drugs and radioligands for subsequent use in positron emission tomography (PET). The aim of the current study was to perform the ¹¹C-carbonylation reaction on the interior surface of a stainless-steel loop used for high performance liquid chromatography (HPLC). In the experimental setup, cyclotron produced ¹¹C-labelled carbon dioxide ([¹¹C]CO₂) was converted to [¹¹C]CO by reduction over heated Molybdenum and swept into an HPLC loop pre-charged with the appropriate reaction mixture. Following a 5 min reaction, the radiochemical purity (RCP) and the trapping efficiency (TE) of the reaction mixture was determined. After optimization, [¹¹C]N-Benzylbenzamide was obtained in quantitative radiochemical yield (RCY) following a 5 min reaction at room temperature. The methodology was further applied to label [¹¹C]benzoic acid (RCP≥99%, TE>91%), [¹¹C]methyl benzoate (RCP≥99%, TE>93%) and [¹¹C]phthalide (RCP≥99%, TE>88%). A set of pharmaceuticals was finally radiolabelled using non-optimized conditions. Excellent yields were obtained for the histamine-3 receptor radioligand [¹¹C]AZ13198083, the oncology drug [¹¹C]olaparib and the dopamine D2 receptor radioligand [¹¹C]raclopride, whereas a moderate yield was observed for the high-affinity dopamine D2 receptor radioligand [¹¹C]FLB457. The presented “in-loop” process proved efficient for diverse ¹¹C-carbonylations, providing [¹¹C]amides, [¹¹C]esters and [¹¹C]carboxylic acids in moderate to excellent RCYs. Based on the advantages associated with performing the radiolabelling step as an integrated part of the purification system, this methodology may become a valuable addition to the toolbox of methodologies used for ¹¹C-carbonylation of drugs and radioligands for PET.     

A contribution to a new test method for dandruff-inhibiting and “keratolytic” action of drugs

Summary Free cholesterol in lipids from the scalp and hair is predominantly a constituent of epidermal lipids. Therefore, a reduction in cholesterol content induced by a drug indicates a reduction in cell turnover in the epidermis. As, according to the literature, increased cell turnover in the epidermis results in formation of dandruff, a reduction in the proportion of cholesterol should indicate inhibition of the formation of dandruff. Conversely, an increase in free cholesterol should generally indicate a keratolytic effect. So unequivocal an interpretation has not so far been possible in persons with dandruff, as it was not known whether free cholesterol was increased or decreased. In addition, this interpretation was not possible after use of antimicrobial substances, as in vitro investigations had failed to exclude microbial esterification of cholesterol on the scalp. The present investigation has shown that correlation of free cholesterol level with cell turnover is permissible in patients with dandruff, even if antimicrobial drugs are being tested.     

Predictors of treatment outcomes for substance‐abusing women: A retrospective study

This study examined whether client characteristics at admission predict Retention, Abstinence, and utilization of Required Services and Specialized Services for pregnant women in outpatient and residential substance abuse treatment. Retrospective data were collected with the Psychosocial History (PSH), a structured clinical interview that is an expansion of the Addiction Severity Index, designed specifically to assess substance abusing women. The PSH was administered at intake for 183 pregnant women admitted to outpatient (n = 133) or residential (n = 50) treatment. Factor analysis reduced predictors to five factors with composite scores, and multiple regression procedures determined client characteristics that predict treatment outcomes. The findings suggest the complexity of predicting treatment outcomes for pregnant women. Significant predictors were composites of variables that encompassed all aspects of women's personal and family lives including medical and psychiatric needs, family and parenting issues, housing, victimization, and clients’ perceived needs for treatment and assistance in all of these areas. The results suggest the need for a holistic approach to substance abuse treatment and continued exploration of a broad range of psychosocial assessments at intake in order to develop substance abuse treatment programs that effectively address multiple aspects of women's lives.     

Are incorrectly used drugs more frequently involved in adverse drug reactions? A prospective study

OBJECTIVES: The aims of this study were to identify and evaluate the frequency of drugs involved in adverse drug reactions (ADRs) for which recommendations of the Summary of Product Characteristics (SPC) had not been respected and to compare the percentages of drugs suspected of being the cause of ADRs when correctly and incorrectly used. METHODS: All ADRs reported to the Regional Pharmacovigilance Centre of Tours (RPC) over a period of 5 months were analysed to identify drugs used "incorrectly" defined by drug use beyond the recommendations of the SPC, i.e. drugs used when contra-indicated and/or drugs used for an off-label indication, and/or drugs used at an inappropriate dose, and/or inappropriate duration of treatment, and/or drugs used in the presence of a potentially or definitely interacting drug. RESULTS: Included in the study were 182 ADRs involving 182 patients. Of 642 drugs, 169 (26%) were incorrectly used and for 81 patients (44.5%) ADRs involved at least one "incorrectly" used drug. These included 10% (64 of 642) drug interactions, 7.3% (47 of 642) off-licence indications, 5% (32 of 642) inadequate dosage, 3% (20 of 642) incorrect duration of treatment and 1% (6 of 642) contraindications. "Correctly" used drugs appeared to be less often the cause of the ADRs than "incorrectly" used drugs (59.4% versus 75%, P=0.0001). CONCLUSION: "Incorrectly" used drugs were more often causally linked to ADR than correctly used drugs. A meaningful number of ADRs could probably be avoided if SPC guidelines for a safe and effective drug use are carefully adhered to.     

A treatment algorithm for attention deficit hyperactivity disorder in cocaine‐dependent adults: A one‐year private practice study with long‐acting stimulants,fluoxetine, and bupropion

A subgroup of adults in private treatment for cocaine dependence in remission reported a therapeutic effect from cocaine during the initial phases of cocaine addiction and, also, met DSM‐IV criteria for ADHD. We report evidence that study subjects probably medicated their ADHD symptoms with cocaine and describe a 1‐year treatment algorithm featuring long‐acting stimulants that was effective in the management of their ADHD and cocaine dependence. Nineteen stable patients in full remission from all substance dependence were entered into an open label, prospective, treatment trial for ADHD. The treatment schedule consisted of the progressive introduction—and discontinuation of ineffective medication—of each of several medications in the following order: fluoxetine, bupropion, pemoline, sustained‐release methylphenidate, dextroamphetamine spansules, and methamphetamine gradumets. Treatment of ADHD was successful. Several treatment regimens, especially those including long‐acting stimulants, alone or in combination with other agents, were highly effective. All but 1 of the 19 subjects had a fully effective response for at least 1 full year. Mean UTAH scale scores were 7.4 before any medications were administered and 1.6 at the end of the study. Treatment proved successful in suppressing ADHD symptoms, with minimal cocaine slips or side effects.     

A controlled study of benzydamine oral rinse (‘Difflam’) in general practice

Summary

Fifty-two patients suffering from presumed viral pharyngeal infection or tonsillitis were treated with either benzydamine or placebo oral rinse as a gargle at 3-hourly intervals in a randomized double-blind study. Patients on the active preparation experienced faster resolution of pain and dysphagia and at 7 days 88% were symptom-free compared with 38% on placebo.     

Implementing a multiple‐isolator unit for centralized preparation of cytotoxic drugs in a cancer center pharmacy

Previous attempts to conduct economic evaluation of pharmacy services are almost exclusively from the US and the UK. Studies from the US concentrate largely on the drug cost savings realised by pharmacists. Few detail the costs of service provision and even fewer give an estimate of service benefits other than decreased drug expenditure. UK evaluation to date focuses on quantifying pharmacists' interventions, but there is no clear indication of the quality or the impact of these. This article proposes a model for economic evaluation and discusses the factors which make evaluation results useful to decision makers. The costs and outcomes, that need to be considered for economic evaluation, are discussed and the example of a pharmacist led anticoagulation clinic is used. The nature of modern health care systems demands that services are effective and, increasingly, costeffective. If pharmacy as a profession is to develop, decision makers must decide that pharmaceutical care delivered by pharmacists is a costeffective use of health care resources. Politics, education and cost pressures will mean that decision makers are likely to put more weight on the results of economic evaluation in future. If pharmacists do not start to provide good quality data about the costs and outcomes of pharmacy services then other evaluators will.     

A multi-centre pilot study of tri-potassium di-citrato bismuthate (‘De-Nol’) in general practice

Abstract

A multi-centre uncontrolled assessment of tri-potassium di-citrato bismuthate in the treatment of 161 ambulatory peptic ulcer patients (26 gastric, 114 duodenal, and 21 'indefinable’) was carried out under the conditions of general practice. The intensity of pain and vomiting were assessed before and after a 28-day course of treatment, as was the degree of overall symptomatic relief.

Full or great symptomatic relief was reported in 96.3% of patients, many of whom had failed previously to respond adequately to antacid or other forms of treatment.     

What influences the information exchange during self-medication consultations in community pharmacies? A non-participant observation study

BackgroundAlthough pharmaceutical staff consider guideline-compliant information exchange during self-medication consultations as crucial, they have not fully integrated it into practice. It is unclear what prevents pharmaceutical staff from implementing their positive intentions into their actual everyday practice. To improve the information exchange during the current consultation practice, a deeper understanding of its implementation is needed.ObjectivesThe aim was to evaluate the factors influencing information exchange during self-medication consultations in German community pharmacies.MethodsWe performed a non-participant observation of real-life consultations with post-consultation interviews of pharmaceutical staff in 10 pharmacies. The information exchanged during self-medication consultations was evaluated via 7 guideline-recommended information parameters in 2 stages of information exchange: (a) ‘information gathering’ and (b) ‘provision of information’. Directly after each observed consultation, pharmaceutical staff's opinion about the consultation, the customer's interest and their own performance was questioned. Factors associated with the observed extent of information exchange were analysed by Poisson regression analysis.ResultsIn the 379 self-medication consultations with 46 pharmaceutical staff members, 454 different customer enquiries were addressed, and 483 medications were dispensed. In median, 2 predefined information parameters (First-/Third quartile: 1/4) were fulfilled during an enquiry and 2 parameters (First-/Third quartile: 1/3) were fulfilled for a dispensed medication. Pharmaceutical staff were satisfied with 85% of their consultations and perceived 76% of them as easy to handle. In both information stages, information exchange increased when ‘customers were perceived to be interested in counselling’ (p < 0.001) and decreased when customers had a ‘specific medication request’ (p < 0.001).ConclusionsInformation exchange in pharmacies needs to be better integrated into daily practice. Strategies to encourage information exchange should also include pharmaceutical staffs’ perception of their own counselling technique. Ongoing patient-centred trainings should facilitate strategies to engage uninterested customers or costumers with specific medication requests in consultations.     

Electrointraperitoneography: A new method for testing the pharmacological effects of drugs at the intestine level—Preliminary note

A recent and nontraumatizing method, electrointraperitoneography (EIG), has been used in the anesthetized rat in order to test its usefulness for the pharmacological study of drug effects on the electrical activity of the intestine. The results show that such a study is possible for different drugs. Advantages and disadvantages of the method are discussed.