The counter and consultation room work explored in the Netherlands

OBJECTIVE: To determine the frequency and nature of conversations at the counter and of private consultations at three Dutch community pharmacies. METHODS: In a purposive and convenience sample of three Dutch community pharmacies two work categories were investigated: counter work and consultation room work with self-reporting tally. The study took 6 weeks: 2 weeks at each pharmacy. MAIN OUTCOME MEASURE: The number of care related conversations and consultations emerging in the counter work and consultation room work. RESULTS: About 43% of all counter conversations consisted of the provision of pharmaceutical information and 72% of the consultations in the separate consultation room dealt with care related activities. However, only 18 consultations were held in this latter room: 0.4% of all reported conversations. CONCLUSION: The proportion of care related work at the counter and in the consultation room did have significant substance. There are however serious possibilities to change pharmaceutical care for the better. It is suggested that standard procedures at the counter may help increasing care related work. The presence of a separate consultation room may increase the number of consultations held in private, when combined with raising patient awareness of its existence.     

The general pharmacy work explored in The Netherlands

OBJECTIVE: To determine the frequency and nature of general pharmacy work at three Dutch community pharmacies. METHODS: In a purposive and convenience sample of three Dutch community pharmacies the general work was investigated. Multi-dimensional work sampling (MDWS) was used. The study took six weeks: two weeks at each pharmacy. MAIN OUTCOME MEASURE: The number of care related items emerging in the general work. RESULTS: Care related work represented 34% of all pharmacy activities. CONCLUSION: Although care related work was present at all three studied pharmacies, this part of the work still needs serious attention of Dutch pharmacists in order to advance pharmaceutical care. It is suggested that an efficient pharmacy organization in combination with robotization, task specialization, and interior design can expand the care related work at the pharmacy.     

Drug information resources at community pharmacies in Amman,Jordan

Objectives The aim of this study was to investigate the drug information resources available in community pharmacies in Amman, Jordan. Methods A total of 156 private community (retail) pharmacies in different parts of Amman, the capital of Jordan, were recruited by personal contact. Pharmacists at the sample pharmacies completed a self‐administered questionnaire that consisted of two sections. The first section elicited the drug information resources available in their pharmacies. The second section presented five mock medicines information scenarios and asked respondents to identify the most suitable information resource to be used from a given list. Answers then were coded and entered into SPSS for Windows for statistical analysis. Key findings All pharmacies had at least one reference book, but most were outdated. The Monthly Index of Medical Specialties (MIMS) was the most commonly found (n =101; 64.7%), and 40.4% (n = 63) had internet access. Only 19.2% (n = 30) of the respondents reported getting medicines information directly from pharmaceutical companies, usually through pharmaceutical representatives. Most pharmacists could identify appropriate information resources for drug dosing and side effects but did not fare well for medicine identification, drug interactions and primary research evidence. Conclusions The quality of drug information resources in private community pharmacies in Amman is far from optimal. This will affect the quality of information provided to patients and prescribers and have an adverse effect on the role that pharmacists can play in the health system in Jordan.     

“Each one has their own role”: Exploratory study on consumers’ perceptions about nutritionists services provided in community pharmacies

Obesity and overweight have grown to epidemic proportions in the past decades. To tackle this rising threat to health systems, lifestyle changes and nutritional education have been promoted through specialized programs and nutritional primary health care services. Community pharmacies adjustment to a new paradigm of pharmacy services means that they are not just a place for buying and selling medicines, but increasingly a space for diverse health care services. One such service addresses the weight problems of community pharmacy users through the provision of nutrition consultation services. In Portugal, these consultations are provided by nutritionists, many times under formal agreements with nutritional supplements commercial brands. Methods: The aim of this exploratory study was to characterize the experience of people attending nutrition consultations at two different pharmacies and to understand their perception of the role community pharmacists may have in weight management. To conduct this study, interviews were performed following an interview guide comprised of sociodemographic characterization questions and open-answer questions. Results: Ten people participated in the study, seven females and three males. The average self-reported BMI of the sample was 29.4Kg/m2. The results showed that there is a general satisfaction with nutrition consultations, with all respondents agreeing that community pharmacies are a right place to have these consultations. Accessibility and low cost were found to be the biggest advantages in having nutrition consultations at a pharmacy. On the other hand, these participants felt that the biggest disadvantage was the price of nutritional supplements. Lack of motivation was also seen as a major impediment to continue with the nutrition consultations. When participants were asked about what role community pharmacists may have in weight management, 50% of participants disagreed with the idea of pharmacists providing the service on their own. Conclusion: the results of this study indicate that the degree of satisfaction of those attending the nutrition consultations is high, especially because of pharmacies’ accessibility and proximity, hinting at the idea of efficiency as an important factor driving the demand for new health care services. Pharmacists were viewed as having a gatekeeper role, but the nutrition service provision should be exclusively provided by nutritionists, in an example of successful multidisciplinary practice within the community pharmacy setting. Future studies should focus on the effect these consultations have on the loss or maintenance of weight, including the comparison with service provision in the traditional settings.     

我国药事服务费概念初探

目的：科学界定药事服务费概念和内涵。方法：通过文献调查法和网页搜索了解各国调剂费的实施经验,结合公立医院改革目标总结归纳我国药事服务费定义。结果和结论：药事服务费是医院药房和社会药店提供药品和药学服务收取的费用,包含药房运营成本和药师基本药学服务价值。设立药事服务费在医改背景下具有现实意义。     

‘At the moment it is just a couple of eccentrics doing it’: concordance in day‐to‐day practice

Objectives To assess the feasibility and acceptability of concordance in pharmacy practice through examination of communication between customers and pharmacists in two community pharmacies in consultations for over‐the‐counter medicines. Method A qualitative pilot study involving data drawn from six sources: audiotaped training session with all the pharmacists involved, observational field work in the pharmacies, audiotaped consultations with pharmacists and customers, debriefing interviews with pharmacists after the consultation, and semi‐structured interviews with customers a few days after their consultation. Setting Two community pharmacies that concentrate their services on medicine advice and dispensing, one in a deprived inner‐city area, the other in a more affluent suburban area of London. Key findings The pharmacists developed a personal understanding of concordance which informed their practice. Customers reported a high level of satisfaction with services they received from the respective pharmacists. Their accounts of the consultations verified the pharmacists' patient‐centredness in their day‐to‐day practice. Conclusion The implementation of a concordance model was possible through the development of a personalised, patient‐centred model which drew on the model of concordance but was adapted in accordance with both structural constraints as well as the personal style of the pharmacists involved.     

The CombiConsultation for patients with diabetes,COPD and cardiovascular diseases: Evaluation of interventions and personal health-related goals

BackgroundThe CombiConsultation is a consultation with the community pharmacist for patients with diabetes, COPD and/or cardiovascular disease (CVD), aligned with the annual or quarterly consultation with the practice nurse (PN) or general practitioner (GP). The consultation is focused on the personal health-related goals of the patient.ObjectivesTo assess the number and types of personal health-related goals, drug-related problems (DRPs) and interventions identified by pharmacists during a CombiConsultation and to investigate which patients can benefit most from such consultation.MethodTwenty-one Dutch community pharmacies and associated GP practices were included in the CombiConsultation study. CombiConsultations were performed, involving patients with diabetes, COPD and/or (at risk of) CVD. The pharmacists set health-related goals together with the patients and identified DRPs. The number and types of personal health-related goals, DRPs and interventions were analysed. Associations between patient characteristics and the identification of at least one DRP were analysed by multivariate regression analysis.ResultsIn 834 patients (49% men, mean age: 70 years), 939 DRPs were identified, mostly (potential) side effects (33%), undertreatment (18%) and overtreatment (14%). In 71% of the patients, one or more DRPs were found, with a median of one DRP per patient. Pharmacists proposed 935 recommendations, of which 72% were implemented. DRPs were found more often in patients using a higher number of drugs for chronic conditions. A total of 425 personal health-related goals were set, of which 53% were (partially) attained.ConclusionThe CombiConsultation can be used as a compact health service contributing to safe and effective use of medication for patients with diabetes, COPD and/or (at risk of) CVD, also in patients under 65 or with less than 5 medications in use. The output of the CombiConsultation reflects its characteristics.     

Actual and Perceived Provision of Pharmaceutical Care in Danish Community Pharmacies: The Pharmacists’ Opinions

Objective: The study explores characteristics of community pharmacies with respect to implementing pharmaceutical care activities. The article addresses the provision of pharmaceutical care at reality level, perceived level and policy level. Method: A cross-sectional questionnaire was sent to all Danish community pharmacies to investigate the provision of pharmaceutical care (n=288). The respondents were pharmacists. Pharmaceutical care activities were operationalised by detecting and identifying medicine-related problems, setting goals to solve medicine-related problems, and documenting efforts to solve them. A non-respondent analysis was also performed. Main outcome measure: The identification of medicine-related problems (from self-report) was used as a proxy measure of pharmaceutical care activities and compared to pharmacies’ self-reported provision of pharmaceutical care. Results: The survey response rate was 75.7. The characteristics of pharmacies that detected medicine-related problems differed from those of pharmacies with only a perceived provision of pharmaceutical care. Pharmacies that actually detected medicine-related problems focused on external cooperation regarding their pharmacy activities. Conclusion: The profiles of the perceived providers of pharmaceutical care and the respondents that detected medicine- related problems were distinct, thus indicating two separate groups of pharmacies. Pharmaceutical care has only been implemented in Denmark to a limited extent. This may be explained in part by the top-down implementation strategy conceived by the proprietor organisation.     

Studying the impact of a medication use evaluation by the community pharmacist (Simenon): Drug-related problems and associated variables

BackgroundA medication use review (MUR) aims to optimize medication use, patient knowledge and can improve health outcomes. This pharmaceutical care service is not yet available in Belgium.ObjectivesTo describe drug-related problems (DRPs) detected during a MUR, subsequent interventions proposed by pharmacists and evolution of DRPs until follow-up and to identify patient-related variables associated with the number of reported DRPs.MethodsBelgian community pharmacists provided a MUR to older polymedicated ambulatory patients and registered DRPs, interventions and resolution at follow-up using the PharmDISC classification. The relationship between 14 patient-related variables and the number of reported DRPs was investigated with univariate analysis. A prediction model was developed with significant variables using negative binomial regression analysis.ResultsAcross 56 pharmacies, 453 patients received a MUR and 1196 DRPs were registered (median 3DRPs/patient, range 0–10). Only for 11.7% of patients no problems were identified. The top-3 causes were interaction (15.2%), inappropriate timing or frequency (13.5%) and adverse effect (11.9%). The top-3 recommended interventions by pharmacists were transmission of information (25.1%), in-depth patient counselling (15.0%) and therapy stop (8.2%). After six weeks, 42.6% of DRPs were resolved; data was missing for 33.3%. A higher number of chronic drugs, female gender and living alone were associated with more DRPs. The prediction model found that per additional chronic drug, the number of problems increases by 4.3% (95% CI: 2.0–6.6%). Male gender decreases DRPs by 22.1% (95% CI: 10.4–32.0%). Living alone provided no additional predictive value in the prediction model. Confounding process- and pharmacist-related variables also influenced the number of reported DRPs.ConclusionA MUR appears an effective strategy to detect and resolve DRPs. The number of chronic medications and female gender predict a higher number of DRPs. These findings are a starting point for evidence-based eligibility criteria for a MUR service in Belgium.     

Pharmaceutical care in Denmark: perceived importance of medicine‐related problems and participation in postgraduate training

Objective: To investigate the readiness of Danish community pharmacists to provide pharmaceutical care. Special focus was on information provided to patients on medicinerelated problems and participation in postgraduate training.Method: National crosssectional survey distributed to all Danish community pharmacies (N = 288). Response rate 75.7%; nonresponders were interviewed by telephone to establish their reasons for not participating.Main outcome measures: Prioritisation of information to patients regarding medicinerelated problems. Postgraduate courses selected by pharmacists during the past three years. Results: In accordance with the profile of Danish community pharmacists, respondents were primarily female and half were below 45 years of age. The main reason given for not responding was lack of time. The prioritisation of information to patients regarding medicinerelated problems resulted in three clusters of answers. The overall topics of the clusters were: information related to the technicalpractical use of medicines; information related to pharmacotherapeutic aspects of medicine use; and information related to the function of the medicine. The clusters accounted for 61.9% of the total variance. The most frequently attended postgraduate courses were on quality assurance and specific diseases. Conclusion: The patient information prioritised by Danish community pharmacists is primarily of a technicalpractical nature. The postgraduate training pursued is primarily technical without much focus on the philosophy of pharmaceutical care. These factors contribute to the lack of proper readiness of pharmacists to practice pharmaceutical care.     

The views of pharmacists supplying emergency hormonal contraception through a patient group direction

Patient group directions (PGD) to supply emergency hormonal contraception (EHC) in community pharmacies have been operating for several years, predating the deregulation of the product to a pharmacy medicine This study explored attitudes of community pharmacists involved in PGD supply towards the scheme; a short self‐completion questionnaire was distributed to 98 community pharmacies, in Manchester, Salford and Trafford and a response rate of 63 per cent was achieved Most respondents thought a private room or area was necessary to provide an EHC service; 78 per cent of pharmacies had regular locums working in pharmacy, but only a third of all the locums were trained to supply EHC Sixty per cent of respondents admitted that there were days when their pharmacy could not supply the EHC service One cause of dissatisfaction among the pharmacists offering the scheme was the lack of personal remuneration     

Recognizing and Addressing Limited PHarmaceutical literacy: Development of the RALPH interview guide

Background

In the context of medication use, pharmaceutical literacy skills are crucial for appropriate and safe use of medication. Recognition of patients with inadequate pharmaceutical literacy in daily pharmacy practice is difficult. No instrument is yet available to support pharmacists herein. The aim of this study was therefore to develop an interview guide for pharmacists to Recognize and Address Limited PHarmaceutical literacy (RALPH).