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PubMed1992

Prescribing problems and pharmacist interventions in community practice.

Interventions performed by 89 community pharmacists in 5 states to correct the prescribing problems they identified on new prescription orders were documented by trained observers. Pharmacists intervened to resolve a prescribing-related problem in 623 (1.9%) of 33,011 new prescription orders that were screened and dispensed during the study period. A panel of three expert evaluators concluded that 28.3% of the prescribing problems identified during the study could have caused patient harm if the pharmacist had not intervened to correct the problem. The rate at which pharmacists identified prescribing problems was negatively related to the number of prescriptions they dispensed per hour, suggesting that in pursuing distributive efficiency, some pharmacists may be exceeding their safe dispensing threshold. The authors recommend that the interprofessional system of oversight and verification (i.e., "checks and balances") in the delivery of pharmaceutical care in the community setting should be maintained and strengthened.

Adolescent↗
PubMed2001

Effect of vaccination by community pharmacists among adult prescription recipients.

BACKGROUND: Millions of doses of influenza vaccine are administered each year in the United States at nontraditional sites and by nontraditional vaccine providers. Pharmacists are increasingly becoming vaccine providers. OBJECTIVES: To measure association between availability of pharmacist-immunizers and immunization delivery to adult prescription recipients, and the relative contributions of various types of vaccine providers. RESEARCH DESIGN: Mailed survey in spring 1999, contrasting adults in urban Washington State, where pharmacists administer vaccines, to adults in urban Oregon, where pharmacists did not. SUBJECTS: Cluster sample based on October 1998 prescription records suggesting need for influenza vaccine, derived from 24 community pharmacies belonging to one pharmacy chain. MEASURES: Vaccination status and choice of vaccine provider. RESULTS: Influenza vaccination rates among respondents 65 years or older increased 4.7% more in Washington than in Oregon between 1997 and 1998 (P = 0.20). The net increase in influenza vaccination rate among younger respondents taking indicator medications for chronic diseases for which influenza vaccination is recommended was 10.6% (P = 0.05). Among respondents unvaccinated against influenza in 1997, the 1998 influenza vaccination rate was 34.7% in Washington, compared with 23.9% in Oregon (P = 0.01). CONCLUSIONS: Vaccine delivery by pharmacists is associated with higher rates of vaccination among those younger than 65 taking indicator medications medications for chronic diseases, as well as prescription recipients unvaccinated against influenza in the previous year.

Adult↗
PubMed2005

Differences between patients', physicians' and pharmacists' preferences for treatment products in haemophilia: a discrete choice experiment.

The provision of health care to patients with haemophilia through replacement of the deficient coagulation factor is the result of a complex interaction between patients, physicians and policy makers, each carrying their individual sets of preferences. Preferences of patients, physicians and pharmacists towards perceived viral safety, risk of inhibitor development, infusion frequency during prophylaxis, pharmaceutical dosage form, distribution modes and price were evaluated by conjoint analysis, using a discrete choice experiment. Overall 178 patients', 69 physicians and 58 pharmacists completed the study. Patients, physicians and pharmacists displayed preferences: (i) similar in direction and strength for risk of inhibitors and frequency of prophylaxis, (ii) similar in direction, but not in strength for perceived viral safety and price, with patients showing lower strength compared with physicians and pharmacists, and (iii) dissimilar in direction and/or strength for: (i) dosage form, which tested important only for pharmacists and (ii) distribution mode, which tested important for patients and physicians only. Our study provides evidence of the differences between different stakeholders in the preferences towards haemophilia replacement therapy, indicating that different opinions should be taken into account when planning optimal care.

Adolescent↗
PubMed1996

Educating the public about skin cancer prevention: a role for pharmacists.

OBJECTIVES: The incidence of skin cancer is increasing at an alarming rate. This study aimed to assess pharmacists' willingness to counsel patients about skin cancer and factors which are predictive of this. METHODS: A 30 item survey assessing skin cancer prevention counselling attitudes and behaviours, personal skin cancer prevention behaviours, and willingness to counsel on skin cancer prevention, was mailed to 300 randomly selected San Diego County pharmacists. RESULTS: Data obtained from 128 pharmacists (43% response rate) indicated that the incidence of skin cancer prevention counselling was very low, with over one-third stating that they never counsel patients on this topic. Of those that did counsel, the percentage of patients counselled on skin cancer prevention was below 5%. Bivariate analyses indicated that pharmacists who counselled on this topic differed from those that did not on knowledge of skin cancer, attitudes and beliefs about counselling patients, pharmacy setting, services offered by their pharmacies, and their personal sun protective behaviours. Multivariate analysis indicated that two variables independently predicted skin cancer prevention counselling; whether the pharmacy where the respondent was employed offered this service, and attitude about counselling. Over 90% of respondents reported they were willing to counsel patients on skin cancer prevention and other health-related topics. CONCLUSIONS: Future studies should focus on skin cancer prevention counselling barriers and environmental prompts encouraging this type of interaction between pharmacists and patients.

Communication Barriers↗
PubMed2005

Improving the outcomes of anticoagulation in rural Australia: an evaluation of pharmacist-assisted monitoring of warfarin therapy.

OBJECTIVE: The aim of this project was to assess whether rural pharmacist involvement in the management of patients receiving warfarin has the potential to lead to safer and more effective anticoagulation, and is valued and welcomed by patients and their general practitioners (GPs). METHODS: A convenience sample of rural pharmacists was trained in the use of the CoaguChek S International Normalized Ratio (INR) monitor and then conducted pharmacy-based testing for approximately 3 months. Two types of testing were performed in the pharmacy: (i) comparison testing was defined as pharmacy-based tests taken within 4 h of conventional laboratory testing or (ii) additional testing, which was a pharmacy-based test with no direct comparison laboratory test taken. Pharmacists, GPs and patients completed anonymous satisfaction surveys after the completion of the pharmacy-based testing. RESULTS: Pharmacists from 16 rural pharmacies were trained to use the CoaguChek S monitor. During the trial period, 518 INR tests were performed in the pharmacies on 137 different patients. A total of 120 tests were evaluated against results from laboratory testing. The pharmacy-based INR values were significantly correlated with the laboratory INR values (mean of 2.32+/-0.77 and 2.32+/-0.59 respectively; r=0.88, P<0.0001). A total of 398 additional pharmacy-based tests were conducted in the pharmacy and 8.5% of the additional tests resulted in a subsequent dosage change. The monitoring was well received by pharmacists, GPs and patients. CONCLUSIONS: The results of the trial were very positive. The CoaguChek S monitor in pharmacy-based testing performed accurately compared with conventional laboratory testing. Further research needs to be conducted on the impact of community pharmacy-conducted INR monitoring on patient care and outcomes.

Adult↗
PubMed2006

Factors affecting the recruitment and retention of pharmacists to practice sites in rural and remote areas of New South Wales: a qualitative study.

OBJECTIVE: To explore factors affecting recruitment and retention of pharmacists in rural/remote areas of New South Wales (NSW). DESIGN: Qualitative semistructured in-depth interviews. SETTING: Primary care--rural/remote community pharmacies. PARTICIPANTS: Purposive sample of 12 community pharmacists. MAIN OUTCOME MEASURES: Factors affecting recruitment and retention of pharmacists in rural/remote areas of NSW. RESULTS: Respondents reported a variety of personal and professional reasons for taking up rural practice, including previous rural experience and a preference for working in rural over metropolitan areas. The main factor affecting retention in rural areas was the high level of professional satisfaction and interprofessional rapport. Perceived reasons for the current under-supply of pharmacists to rural/remote areas of NSW included changing demographics of the pharmacy undergraduate degree programs and pharmacy workforce, and negative perceptions of rural pharmacy practice and rural lifestyle. CONCLUSIONS: This study identified factors believed to affect recruitment and retention of pharmacists in rural/remote areas. There appears to be considerable overlap between the factors, with different weightings of importance for different individuals. The lack of consensus for a proposed method of resolving this problem highlights its complexity and the need for further studies in this area.

Catchment Area, Health↗
PubMed1997

The role of general practitioners and pharmacists in information exchange with family carers.

As a trial of the provision of community-service information to family carers, general practitioners and pharmacists from the Western region of Melbourne were supplied with tear-off pads listing suburb-specific community services, and were encouraged to discuss service needs with carers of people with disabilities and distribute the lists to carers accordingly. One hundred and nine general practitioners and 58 pharmacists participated in pretrial and post-trial interviews assessing their knowledge of community services and frequency of discussion with carers. Before the trial, general practitioners had significantly higher self-rated knowledge of community services and reportedly discussed these with carers more often than did pharmacists. After the five-month trial period, pharmacists showed a significant increase in self-rated knowledge and frequency of discussion. General practitioners' knowledge and discussion showed a nonsignificant increase. After the trial, the two did not differ in knowledge of services; however, general practitioners maintained a higher reported frequency of discussion about services with carers. General practitioners and pharmacists appear to be well placed to act as a service link for family carers. However, additional high-intensity strategies are needed to assist them in this role.

Caregivers↗
PubMed1999

Travel advice given by pharmacists.

BACKGROUND: In 1993 more than 1 million Swiss residents traveled to a tropical or subtropical country. Although most pretravel advice is given by general practitioners, a number of travelers also seek advice from pharmacists. Little is known about the quantity and quality of travel advice given or the sources of information used by this group. METHODS: One-hundred and twenty randomly selected pharmacists from three Swiss cantons were first interviewed in a cross-sectional study on the telephone. All study participants subsequently received a pretested questionnaire, in which most of the questions asked on the phone were repeated, with additional questions regarding the sources of information used for travel advice and the cooperation of general practitioners. Included in both parts of the study were two scenarios of fictive travelers seeking health advice for destinations frequently visited by Swiss tourists (Thailand and Kenya). RESULTS: Of 136 pharmacists approached, all who said they sometimes gave travel advice, agreed to participate (88%). Fifty-six percent of them give travel advice regularly (mean 2-3 times per month). General knowledge on the main health hazards was good, but for treatment of travelers' diarrhea, only 59% spontaneously mentioned the need for increased fluid intake, whereas 100 % recommended antidiarrheal drugs. Protection from the sun was mentioned only by 10 % of the respondents, and only 8 % said that the traveler should seek advice from a medical doctor. Over 95% could name the three most important measures against mosquito bites, although up to 20% still recommend Vitamin B1 as well. On the telephone, only 19% (for Thailand) and 31% (for Kenya) gave accurate advice on malaria protection, and 13% (for Thailand) and 3% (for Kenya) could make correct recommendations about vaccination. However, more than 50% said that in practice they would consult documentation before giving any advice, with the Bulletin of the Federal Office of Health (BFOH) being the most commonly used source of information. In the questionnaire interview, where documentation was used, the accuracy of advice increased, especially for malaria protection (74% correct for Thailand and 93% for Kenya). CONCLUSIONS: The overall knowledge of Swiss pharmacists on travel medicine issues is satisfactory. Specific questions need further attention, such as treatment of travelers' diarrhea, sun protection and advice on malaria prophylaxis and vaccinations. For the latter two, clients should also consult a medical doctor. Collaboration between doctors and pharmacists, and the consistency of the advice given, are important in improving compliance. Reliable information sources are available in pharmacies and are used.

Cross-Sectional Studies↗
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↗
PubMed2000

British community pharmacists' views of physician-assisted suicide (PAS).

OBJECTIVES: To explore British community pharmacists' views on PAS, including professional responsibility, personal beliefs, changes in law and ethical guidance. DESIGN: Postal questionnaire. SETTING: Great Britain. SUBJECTS: A random sample of 320 registered full-time community pharmacists. RESULTS: The survey yielded a response rate of 56%. The results showed that 70% of pharmacists agreed that it was a patient's right to choose to die, with 57% and 45% agreeing that it was the patient's right to involve his/her doctor in the process and to use prescription medicines, respectively. Forty-nine per cent said that they would knowingly dispense a prescription for use in PAS were it to be legalized and 54% believed it correct to refuse to dispense such a prescription. Although 53% believed it to be their right to know when they were being involved in PAS, 28% did not. Most pharmacists (90%) said that they would wish to see the inclusion of a practice protocol for PAS in the code of ethics of the Royal Pharmaceutical Society of Great Britain (CE-RPSGB) in the event of a change in the law on PAS. In addition, 89% would wish to see PAS included in the Conscience Clause of the CE-RPSGB. Males were found to be significantly less likely to favour PAS than females (p < 0.05), as were those declaring an ethnic/religious background of consideration when dealing with ethical issues in practice compared with their counterparts (p < 0.00005). CONCLUSION: Pharmacists view their professional responsibility in PAS to be more obligatory than a physician's, in having to provide the means for PAS. It is worrying that a proportion of the respondents prefer to remain in ignorance of the true purpose of a prescription for PAS; a finding at odds with current developments within the pharmaceutical profession. A practice protocol for PAS and an extension of the conscience clause should be considered in the event of PAS becoming legal. Such measures would allow the efficient provision of the pharmaceutical service whilst at the same respecting the personal beliefs of those who object to cooperating in the ending of a life.

Age Factors↗
PubMed2003

Can a self-management programme delivered by a community pharmacist improve asthma control? A randomised trial.

BACKGROUND: No randomised studies have addressed whether self-management for asthma can be successfully delivered by community pharmacists. Most randomised trials of asthma self-management have recruited participants from secondary care; there is uncertainty regarding its effectiveness in primary care. A randomised controlled study was undertaken to determine whether a community pharmacist could improve asthma control using self-management advice for individuals recruited during attendance at a community pharmacy. METHODS: Twenty four adults attending a community pharmacy in Tower Hamlets, east London for routine asthma medication were randomised into two groups: the intervention group received self-management advice from the pharmacist with weekly telephone follow up for 3 months and the control group received no input from the pharmacist. Participants self-completed the North of England asthma symptom scale at baseline and 3 months later. RESULTS: The groups were well matched at baseline for demographic characteristics and mean (SD) symptom scores (26.3 (4.8) and 27.8 (3.7) in the intervention and control groups, respectively). Symptom scores improved in the intervention group and marginally worsened in the control group to 20.3 (4.2) and 28.1 (3.5), respectively (p<0.001; difference adjusted for baseline scores=7.0 (95% CI 4.4 to 9.5). CONCLUSIONS: A self-management programme delivered by a community pharmacist can improve asthma control in individuals recruited at a community pharmacy. Further studies should attempt to confirm these findings using larger samples and a wider range of outcome measures.

Administration, Inhalation↗
PubMedDate not supplied

The BC Community Pharmacy Asthma Study: A study of clinical, economic and holistic outcomes influenced by an asthma care protocol provided by specially trained community pharmacists in British Columbia.

OBJECTIVES: Despite advances in recent years, asthma morbidity and mortality have been noted to be on the increase in the past decade. The present study examined the failures and recommendations of past studies and introduced a new milieu for asthma care--the community pharmacy. The study incorporated a care protocol with the important ingredients of asthma education on medications, triggers, self-monitoring and an asthma plan, with pharmacists taking responsibility for outcomes, assessment of a patient's readiness to change and tailoring education to that readiness, compliance monitoring and physician consultation to achieve asthma prescribing guidelines. METHODS: Thirty-three pharmacists in British Columbia, specially trained and certified in asthma care, agreed to participate in a study in which experienced pharmacists would have asthma patients allocated to enhanced (pharmaceutical) care (EC) or usual care (UC). Pharmacists less experienced were clustered by geography and had their pharmacies randomized to two levels of care; each pharmacy then had patients randomized to EC versus control, UC versus control or EC versus UC depending on their pharmacy randomization. Six hundred thirty-one patients provided consent, of which 225 in EC or UC were analyzed for all outcomes. Patients were followed for one year. RESULTS: Compared with patients in the UC group, the results of those in the EC group were as follows: symptom scores decreased by 50%; peak flow readings increased by 11%; days off work or school were reduced by approximately 0.6 days/month; use of inhaled beta-agonists was reduced by 50%; overall quality of life improved by 19%, and the specific domains of activity limitations, symptoms and emotional function also improved; initial knowledge scores doubled; emergency room visits decreased by 75%; and medical visits decreased by 75%. A patient satisfaction survey revealed that the population was extremely pleased with their pharmacy services. Cost analysis reinforces the EC model, which is more cost effective than UC in terms of most direct and indirect costs in asthma patients. CONCLUSION: Specially trained community pharmacists in Canada, using a pharmaceutical care-based protocol, can produce impressive improvements in clinical, economic and humanistic outcome measures in asthma patients. The health care system needs to produce incentives for such care.

Adolescent↗
PubMed1992

Work patterns of male and female pharmacists. A longitudinal analysis 1959-1989.

A demand for better data about pharmacists as working health professionals led the authors to study the work patterns of 1,146 pharmacists over a 30-year period from 1959 to 1989. Work history data were used to determine gender-specific participation rates as a function of age, years in the work force, and date. Percent full-time (as opposed to part-time) work as a gender-specific function of age was also determined. Participation rates for males and females, widely disparate in the 1960s, have converged and are not significantly different. Graduates of the 1980s, both male and female, are remaining with pharmacy as an occupation at a significantly higher rate than earlier graduates. Percent full-time rates for women pharmacists are significantly lower than those for male pharmacists, although women have registered significant increases in percent full-time work in each decade from the 1960s to the 1980s. An unexpected finding was the overall reduced participation by graduates of the years 1970 to 1979. The findings of the study are helpful in explaining recent controversies about the adequacy of the supply of pharmacists. The form of the data bases constructed for this study could be used as a model for the study of other health professionals.

Adult↗
PubMed1980

Perceived clinical significance of consultant pharmacist recommendations in the skilled nursing facility.

In an attempt to determine if pharmacists could make significant contributions to SNF patient care in the area of disease management, the drug therapy of the residents of two SNFs was reviewed once monthly for six months by two clinical pharmacist consultants. Pharmacist-identified problems and recommendations were communicated in writing to the medical staff by means of a communication form attached to the patient's chart. Nearly 72 percent of the recommendations made were accepted by the SNF physicians. Descriptions of the cases and corresponding recommendations were distributed to review-panel physicians. These physicians were asked to agree or disagree with the pharmacists' suggestions, and to rate the clinical significance of each recommendation using a modified Likert scale. The clinical pharmacist-consultants were perceived to have had a significant input into disease management in SNF patients.

Aged↗
PubMed1984

Clinical pharmaceutical services in retail practice. I. Pharmacists' willingness and abilities to provide services.

The expansion of service levels in traditional community pharmacies in the face of structural and process impediments as well as the lack of reinforcement that would be provided by demand and reimbursement for such services requires a highly dedicated professional. As a result, this research had the goals of investigating the relationship between service provision and pharmacist willingness and competency, and characterizing pharmacists who presently do or do not provide expanded levels of service. A census of South Carolina community pharmacists was carried out using a self-administered, mail questionnaire. Analysis of the 890 responses representing 63.4 percent of the sample revealed that there is a significant relationship between pharmacists' willingness and ability and the extent to which they provide expanded levels of service. Pharmacists providing services were not only more willing and able to do so, but worked longer hours, tended to work in apothecary or independent pharmacies, held advanced degrees, and were more involved in continuing education. The results generally support the hypothesis that both willingness and competency may serve as barriers to the extension of clinical services into traditional community pharmacy settings.

Attitude of Health Personnel↗
PubMed1990

The pharmacist as a health consultant--ten years later.

Pharmacists remain a readily accessible and trusted source of information about health. In order to assess the quality of counseling on health matters and the progress of the profession in this activity over the last decade, a study similar to one reported in 1978 was conducted. We visited 46 community pharmacies and requested advice from the pharmacists concerning the proper treatment of an infant with diarrhea. Interviewers volunteered no additional information, but questions asked by the pharmacist were answered according to a predetermined hypothetical case involving an 18-month-old infant with diarrhea and vomiting. Findings include the following: approximately one-third of the pharmacists recommended a product without caution and less than 20 percent inquired about fever, nausea, vomiting, diet, or the infant's condition. We believe pharmacists should approach health counseling with an increased awareness of the harmful potential in providing inappropriate medical information.

Antidiarrheals↗
PubMed1990

Assessment of the Florida Pharmacist Self-Care Consultant Law using patient profile and prescription audit methods.

This article examines pharmacist nd physician prescribing patterns during the first two years of the Florida Pharmacist Self-Care Consultant Law. Nineteen pharmacies were audited. The mandatory patient profiles were audited for a two-year period, and the prescription files were audited for a five-year period. For the nine pharmacies maintaining patient profiles, the prescribing activities of the pharmacists almost double from the first year to the second year. However, these prescriptions made up a very small portion of the total. Pharmacist prescribing appeared to be limited to three primary drug categories: topical pediculicides (lindane shampoo), oral analgesics, and otic analgesics; these comprised 82 percent of all pharmacist-generated prescriptions.

Drug Prescriptions↗
PubMed1992

Value of community pharmacists' interventions to correct prescribing errors.

OBJECTIVE: The purpose of this analysis was to estimate the economic value created by community pharmacists who routinely screen for and correct prescribing-related problems during the course of their dispensing activities. DESIGN: Three expert judges evaluated the documented interventions of community pharmacists practicing in five states. RESULTS: The judges agreed that 28.3 percent of the identified problems could have resulted in patient harm had the pharmacist not intervened to correct the problem. The direct cost of medical care that was avoided as a result of pharmacists' intervention activities was estimated to be $122.98 per problematic prescription, or +f42.32 per each new prescription order that was screened during the study. CONCLUSIONS: Clinical pharmacy services can and do create significant value by enhancing the achievement of positive patient outcomes and by avoiding negative outcomes. Research to develop reliable methods for measuring and monitoring the value of clinical pharmacy services must continue. Mechanisms must be created to encourage and reward pharmacists who consistently provide services that add measurable value to patient care.

Community Pharmacy Services↗