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Biomedical subjects

C M Bond

Publications and source records attributed to C M Bond.

29 records · Page 2Linked to original sources
PubMed1998

Over-the-counter emergency contraception: a feasible option.

BACKGROUND: The high number of unintended pregnancies and terminations in Britain indicates that women who could use emergency contraception do not. Knowledge of access to sources of emergency contraception is limited. Oral administration of combined oestrogen-progestogen is safe and does not require routine physical administration, and there are proposals to re-regulate this from a prescription-only medicine to a pharmacy medicine, available over the counter in community pharmacies under the supervision of a pharmacist. OBJECTIVES: We aimed to demonstrate that the availability of combined, oral oestrogen-progestogen under the supervision of the community pharmacist would be safe and effective. METHOD: Guidelines were developed by a multidisciplinary group incorporating pharmacists, GPs, a pharmacologist and a consultant in family planning. The guidelines were based on published evidence, where possible. CONCLUSION: Guidelines have been developed to accompany the provision of combined, oral oestrogen-progestogen which demonstrate that over-the-counter availability could be a safe and effective method of reducing the number of unwanted pregnancies in Britain.

Contraceptives, Oral↗
PubMed1998

Training pharmacists and pharmacy assistants in the stage-of-change model of smoking cessation: a randomised controlled trial in Scotland.

OBJECTIVE: To evaluate a training workshop for community pharmacy personnel to improve their counselling in smoking cessation based on the stage-of-change model. DESIGN: A randomised controlled trial of community pharmacies and pharmacy customers. SETTING: All 76 non-city community pharmacies registered in Grampian, Scotland, were invited to participate. Sixty-two pharmacies (82%) were recruited. SUBJECTS: All the intervention pharmacy personnel were invited to attend the training; 40 pharmacists and 54 assistants attended. A total of 492 customers who smoked (224 intervention, 268 controls) were recruited during the 12-month recruitment period (overall recruitment rate 63%). MAIN OUTCOME MEASURES: The perceptions of customers and pharmacy personnel of the pharmacy support and self-reported smoking cessation rates for the two groups of customers at one, four, and nine months. RESULTS: The intervention customer respondents were significantly more likely to have discussed stopping smoking with pharmacy personnel, 85% (113) compared with 62% (99) of the controls (p < 0.001). The former also rated their discussion more highly; 34% (45) of the intervention customers compared with 16% (25) of the controls rated it as "very useful" (p = 0.048). Assuming non-responders had lapsed, one-month point prevalence of abstinence was claimed by 30% of intervention customers and 24% of controls (p = 0.12); four months' continuous abstinence was claimed by 16% of intervention customers and 11% of controls (p = 0.094); and nine months' continuous abstinence was claimed by 12% of intervention customers and 7% of controls (p = 0.089). These trends in outcome were not affected by potential confounders (sex, age, socioeconomic status, nicotine dependence, and type of nicotine replacement product used) or adjustment for clustering. CONCLUSIONS: The intervention was associated with increased and more highly rated counselling, and a trend toward higher smoking cessation rates, indicating that community pharmacy personnel have the potential to make a significant contribution to national smoking cessation targets.

Adolescent↗
PubMed1998

Comparison of buccal and oral prochlorperazine in the treatment of dizziness associated with nausea and/or vomiting.

The dizziness inherent in vertiginous disorders is often accompanied by nausea and/or vomiting. While prochlorperazine is effective in relieving nausea and vomiting, its low bioavailability following first pass metabolism in the liver and metabolism in the intestinal wall, compounded by the likelihood of regurgitation in the nauseous patient, may limit the therapeutic value of the oral preparation. A buccal preparation achieves higher plasma concentrations by direct absorption into the systemic circulation. In this randomised, double-blind, double-dummy trial in patients with vestibular disorders, in keeping with previous pharmacokinetic studies, buccal prochlorperazine achieved a significantly faster onset of effect compared with oral prochlorperazine (p = 0.04), and was significantly better in reducing the frequency of nausea (p = 0.02) and severity of vomiting (p = 0.05) at 24-36 hours. The frequency of vomiting was also reduced by buccal prochlorperazine compared with oral prochlorperazine, but this difference was only of borderline significance (p = 0.07). Buccal prochlorperazine was well tolerated and well rated by both patients and investigators, having no more adverse effects on the buccal mucosa than placebo and causing less drowsiness and sedation compared with the oral preparation. No advantages were reported for the oral preparation over buccal prochlorperazine. Buccal prochlorperazine is therefore safe and effective, and suitable for the treatment of dizziness associated with nausea and/or vomiting in patients suffering from vertiginous disorders.

Administration, Oral↗
PubMed1997

The cost of medicines in the United Kingdom. A survey of general practitioners' opinions and knowledge.

Prescribing costs in general practice continue to grow. Their importance is underlined by the amount of information concerned with costs that general practitioners (GPs) receive, and by the existence of target budgets. In 1986 and 1991, surveys showed that GPs agreed that cost should be borne in mind when choosing medicines, but that their knowledge of drug prices was often inaccurate. This study assessed the current knowledge and attitudes of GPs in the UK in respect of prescribing costs, and examined the influence of various developments in general practice since 1986 on the accuracy of drug price estimation. 1000 randomly selected GP principals (500 in Scotland and 125 in each of 4 English health regions) were sent a postal questionnaire. The GPs' level of agreement with 5 statements concerned with prescribing costs, and the accuracy of their estimates of the basic price of 31 drugs, were analysed. Most GPs (71%) agreed that prescribing costs should be taken into account when deciding on the best treatment for patients. Fundholders were more likely than non-fundholders: (i) to agree that prescribing costs could be reduced without affecting patient care; (ii) to agree that providing more information on costs would lower the cost of prescribing; and (iii) to comment that cost guidelines had changed their prescribing habits. Fundholders were less likely than non-fundholders to reject the principle of fixed limits on prescribing costs. Overall, one-third of the price estimates given were accurate (within 25% of the actual cost). For the most expensive drugs in the survey [those priced over 10 pounds sterling (Pound) per pack], half of the price estimates were accurate. There were significant differences between non-fundholders' and fundholders' estimates of the price of less expensive drugs (those priced at less than 10 pounds per pack). Use of a formulary or computer-displayed drug price information did not affect the accuracy of price estimates. It may be that GPs who were more knowledgeable and concerned about costs were more likely to become fundholders. It is also possible that the expansion of fundholding, or other mechanisms that give GPs responsibility for resource allocation, might improve accurate cost awareness in prescribing. Clinical and economic review of repeat prescribing is recommended.

Cost-Benefit Analysis↗
PubMed1996

Over the counter drugs. The interface between the community pharmacist and patients.

Pharmacists play an important part in primary health care, and their accessibility is a key factor. Their NHS payments relate predominantly to the dispensing of prescribed medicines; to recognise the service element of their advisory role, an NHS funded professional fee could be built into the cost structure for pharmacy medicines. The increased number of medicines available over the counter has highlighted the need for training for counter assistants; it will become compulsory in July 1996, and some family health services authorities are providing this. The shift to care in the community could mean that pharmacists will have an even greater role in the primary health care team. Encouraging the public to seek advice from the community pharmacist may lead to a greater proportion of visits to doctors resulting from referrals from the pharmacist. Joint development by pharmacists and doctors of guidelines for advice on, and recommendation of, over the counter medicines is needed.

Community Pharmacy Services↗
PubMed1995

Multi-disciplinary guideline development: a case study from community pharmacy.

There is increasing interest in the role of clinical guidelines to encourage appropriate care. However, if guidelines are to achieve this, they need to be scientifically valid in the sense that, when followed, they lead to the health gains projected from them. Multi-disciplinary involvement in guideline development is desirable and is likely to promote validity. However, there are difficulties inherent in multidisciplinary guideline development relating to professional hierarchies and mutual ignorance of different professionals' skills and modus operandi which have not previously been addressed in the literature. In this paper, we describe in detail the processes involved in the multidisciplinary development of guidelines for community pharmacy management of dyspepsia and discuss the practical issues and problems encountered.

Community Pharmacy Services↗
PubMed1993

Hormone replacement therapy: a study of women's knowledge and attitudes.

Hormone replacement therapy can successfully treat menopausal symptoms. A postal questionnaire was used to investigate the knowledge of and attitudes to hormone replacement therapy of an age-stratified, computer-generated, representative sample of 1500 women living in the Grampian region of Scotland. A response rate of 78% was achieved. Comparisons were made between women of differing age, educational background and their current or past experience of hormone replacement therapy. The questionnaire also assessed their knowledge of osteoporosis, including the possible beneficial role of hormone replacement therapy. The results showed that women had a poor knowledge of the potential risks and benefits of oestrogen, lack of knowledge being greatest in the less educated and older women. The majority of women agreed with the view that because the menopause is brought on by diminished hormone levels, it should be viewed as a medical condition and treated as such, and also that a woman who experiences distressing menopausal symptoms should take hormone replacement therapy. Despite this, relatively few postmenopausal women were currently taking hormone replacement therapy (9%) or had taken the treatment in the past (7%), although many had experienced menopausal symptoms for over six months. The most common reason for postmenopausal women never having taken hormone replacement therapy was that they had never considered the treatment (70%) and had not discussed it with a doctor (79%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Change in the established prescribing habits of general practitioners: an analysis of initial prescriptions in general practice.

The aim of this study was to describe the types of drugs prescribed by general practitioners in a sample of initial (rather than repeat) prescriptions, the additions and deletions made to a doctor's repertory and the factors influencing these changes. The method used here enabled repeat prescriptions to be excluded as these are an inaccurate reflection of the current habits of the prescriber. A total of 201 (74%) of the principal general practitioners in the Grampian region participated. Data were obtained by substituting special prescription pads containing duplicate forms which allowed additional data to be recorded at the time of prescribing, including perceived influences that had resulted in changes from established choices of drug therapy. A sample of 100 forms were collected on seven occasions from each doctor over a one year sample period. Prescribers on average selected a preparation that they had only started to use within the last 12 months (that is newly adopted to their repertory) in 5.4% of initial prescriptions. These changes mostly involved antibiotics and analgesics and were occasioned mainly by the influence of the 'limited list' regulations, pharmaceutical company representatives and hospital specialists. We conclude that general practitioners were not unduly influenced by commercial sources of information, and that their prescribing habits were stable and conservative. The paper presents a case for the separate analysis of initial and repeat prescriptions as an essential step in producing more informative data on prescribing.

Drug Prescriptions↗
PubMed1985

Limited list: limited effects?

During the first month after the limited National Health Service drug list came into effect 17 cooperative general practitioners recorded the actions taken when a now prohibited drug would formerly have been prescribed. An average of 6% of direct surgery contacts with patients and 8% of indirect contacts with patients were affected by the new regulations, but in 2% and 4% of cases respectively the patient received the same pharmacological substance under a different (generic or approved) name. Where a real change in pharmacological constitution or formulation had been required four fifths of these substitutes were considered by the doctors to result in less effective treatment. In 1% of contacts no drug was issued or recommended where one would formerly have been given.

Drug Prescriptions↗