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.     

NEW PATIENTS PRESENTING TO THEIR GP WITH DYSPEPSIA: DOES HELICOBACTER PYLORI ERADICATION MINIMISE THE COST OF MANAGING THESE PATIENTS?

Fifty-seven patients newly presenting to their GP with dyspepsia agreed to take part in a pharmacist-led clinic which tested and treated for Helicobacter pylori. Of these patients, 63% (36/57) tested positive and received eradication therapy. For 78% (28/36), eradication was successful with the first course of treatment, 89% (25/28) remaining symptom-free over the six-month follow-up. Eradication was successful for a further 17% (6/36) after a second attempt; again, these patients remained free of symptoms over the follow-up period. Thus, of the initial patients, 54% (31/57) were successfully treated, with no further symptoms. Such results had significant consequences on the expected direct cost of management per patient from a GP viewpoint. Using decision analysis it was found that H. pylori eradication for patients presenting with dyspepsia for the first time could result in considerable cost savings per patient in the long term.     

Qualitative insights into job satisfaction and dissatisfaction with management among community and hospital pharmacists

Background

Job satisfaction research in pharmacy has predominantly been investigated using quantitative measures that have generally overlooked satisfaction with management.

Objective

This article explores pharmacists' experiences and perceptions of management and examines the implications for job satisfaction.

Methods

Semi-structured interviews were conducted with a convenience sample of 11 community and 15 hospital pharmacists in the North West of England (n = 26). The interview schedule was composed of broad questions relating to job satisfaction and dissatisfaction, allowing for the exploration of original themes. Interviews were transcribed verbatim and entered into NVivo8. Template analysis was used to develop a hierarchical list of codes representing themes and the relationships between themes.

Results

Dissatisfaction with management emerged as a dominant aspect of pharmacists' job dissatisfaction. Of the 26 pharmacists interviewed, 24 commented on their dissatisfaction with management, whereas only 8 participants commented on positive experiences. Both hospital and community pharmacists expressed dissatisfaction with their line management, and how the organizations they worked for were managed.

Conclusions

Findings suggest that satisfaction with management is an important and significant contributor to job satisfaction overall. It would appear that pharmacists' job satisfaction is compromised by poor line management, lack of recognition, and support from management, which may lead to an increase in turnover and a reduction in job satisfaction.     

Outcome Measurement in Clinical Genetics Services: A Systematic Review of Validated Measures

Objective:  This systematic review aimed to inform researchers and policymakers about what validated outcome measures are available to evaluate clinical genetics services (CGS) and the need for new measures.
Methods:  Validated outcome measures used to evaluate CGS were identified from a systematic literature review. Subjective outcome measures were assumed to have been validated only if some form of psychometric assessment was reported.
Results:  A total of 1688 titles and abstracts were identified, and 61 articles met the inclusion criteria for the final review, which covered 67 validated outcome measures. There were 37 nongenetics-specific and 30 genetics-specific measures identified. No single validated outcome measure encompassed all potential patient benefits from using a CGS. A variety of different domains were identified, including anxiety and depression, coping, decision-making, distress, family environment, health status, knowledge, mood, perception of risk, perceived personal control, psychological impact, quality of life, satisfaction and expectations, self-esteem, spiritual well-being, and worry. Some important aspects of patient benefit from CGS are not covered by existing outcome measures.
Conclusions:  New research is necessary to develop the array of outcome measures required to quantify the benefits CGS offer patients living with the effects of genetic conditions. These need to be suitable for use in prospective evaluation studies to provide robust evidence for decision-makers to inform service development and commissioning. This includes prioritization of the existing validated outcome measures in terms of their usefulness and relevance to the measurement and valuation of patient benefits from a CGS.     

HANDLING AND ACCEPTABILITY OF THE EASI-BREATHE DEVICE COMPARED WITH A CONVENTIONAL METERED DOSE INHALER BY PATIENTS AND PRACTICE NURSES

This study compared the handling and acceptability of the Easi-Breathe^TM, a breath-actuated metered dose inhaler (MDI), with that of a conventional MDI. A total of 104 patients and 14 practice nurses took part in interviews at a central location. An additional 100 practice nurses were interviewed in a telephone study. Significantly more patients (86%) found Easi-Breathe easier than a conventional MDI to use correctly (p<0.001). Overall, more patients preferred Easi-Breathe (82% vs 18%; p<0.001), ease of use and confidence in successful dose delivery being the main reasons for their preference. Nurses thought that Easi-Breathe was easier for the vast majority of patients (97%) to use correctly, as well as being easier to teach and to use correctly in a crisis (p<0.001). Overall, 79% of nurses preferred the Easi-Breathe to the conventional MDI (p<0.001), ease of use and ease of teaching being the main reasons for their preference.     

Controlling for Systematic Selection in Retrospective Analyses: An Application to Fluoxetine and Sertraline Prescribing in the United Kingdom

BACKGROUND: Criticism has been made of observational studies in clinical practice because of their failure to control for unobserved factors that correlate with both initial treatment selection and observed outcomes. METHOD: A two-stage statistical model was applied to data obtained from a large general practitioner medical records database (DIN-LINK) to estimate the effect of initial antidepressant selection on the duration of antidepressant therapy and on the likelihood of being prescribed an average daily dose above the minimum recommended dose. The statistical model controlled for unobserved factors correlated with initial treatment selection and the observed outcomes as well as for observed confounders. RESULTS: Unobserved factors correlated with treatment selection were not a statistically significant determinant of the number of days of antidepressant therapy. However, unobserved factors correlated with treatment selection were a statistically significant determinant of the likelihood of receiving an average dose during therapy greater than the minimum recommended. After controlling for relevant confounders, those patients who began treatment with sertraline as opposed to fluoxetine had fewer days of antidepressant therapy and were more likely to receive average doses greater than the minimum recommended during therapy. CONCLUSION: Unobserved factors correlated with treatment selection can impact outcomes in observational studies and should be tested and controlled for whenever possible.     

Respiratory depression in children receiving diazepam for acute seizures: a prospective study

The aim of this study was to determine the incidence of respiratory depression following the use of diazepam in children presenting with seizures. All children presenting with seizures to a children's A & E department over a period of 9 months were studied prospectively. Respiratory depression was defined as a fall in respiratory rate or oxygen saturation, or apnoea resulting in ventilation or resuscitation with bag-and-mask oxygen. There were 130 patient episodes involving 97 children who received treatment for their seizures before admission and/or in the A & E department. Administration of diazepam resulted in 122 patient episodes. The route of administration was rectal in 91 episodes, intravenous in 12 episodes, and both rectal and intravenous in 19 episodes. Eleven children had respiratory depression in relation to diazepam administration. Eight of these children required ventilation. The overall incidence of respiratory depression following the use of diazepam was 9%. The incidence of respiratory depression following diazepam given intravenously or rectally is high. The use of diazepam as first-line therapy for children with acute seizures needs to be reviewed.     

A patient perspective of pharmacist prescribing: ‘crossing the specialisms‐crossing the illnesses’

Background

The drive for non‐medical prescribing has progressed quickly since the late 1990s and involves a range of healthcare professionals including pharmacists. As part of a commissioned research project, this qualitative element of a larger case study focused on the views of patients of pharmacist prescribers.

Objective

The aim of this study was to explore patients'' perspectives of pharmacists as prescribers.

Methods

Three pharmacists working as independent prescribers in the clinical areas of (i) hypertension, (ii) cardiovascular/diabetes management, (iii) anticoagulation were recruited to three case studies of pharmacist prescribing in Northern Ireland. One hundred and five patients were invited to participate in focus groups after they had been prescribed for by the pharmacist. Focus groups took place between November 2010 and March 2011 (ethical/governance approvals granted) were audio taped, transcribed verbatim, read independently by two authors and analysed using constant comparative analysis.

Results

Thirty‐four patients agreed to participate across seven focus groups. Analysis revealed the emergence of one overarching theme: team approach to patient care. A number of subthemes related to the role of the pharmacist, the role of the doctor and patient benefits. There was an overwhelming lack of awareness of pharmacist prescribing. Patients discussed the importance of a multidisciplinary approach to their care and recognized limitations of the current model of prescribing.

Conclusion

Patients were positive about pharmacist prescribing and felt that a team approach to their care was the ideal model especially when treating those with more complex conditions. Despite positive attitudes, there was a general lack of awareness of this new mode of practice.