Community-based Pharmacy Research Articles

Stigmatizing attitudes and low levels of knowledge but high willingness to participate in HIV management: A community-based survey of pharmacies in Pune, India

BackgroundThe World Health Organization (WHO) recommends that the role of pharmacists in low-income settings be expanded to address the increasing complexity of HIV antiretroviral (ARV) and co-infection drug regimens. However, in many such settings including in India, many pharmacists and pharmacy workers are often neither well trained nor aware of the intricacies of HIV treatment. The aims of our study were; to determine the availability of ARVs, provision of ARVs, knowledge about ARVs, attitudes towards HIV-infected persons and self-perceived need for training among community-based pharmacies in an urban area of India.MethodsWe performed a survey of randomly selected, community-based pharmacies located in Pune, India, in 2004-2005 to determine the availability of ARVs at these pharmacies, how they were providing ARVs and their self-perceived need for training. We also assessed knowledge, attitudes and perceptions on HIV and ARVs and factors associated with stocking ARVs.ResultsOf 207 pharmacies included in the survey, 200 (96.6%) were single, private establishments. Seventy-three (35.3%) pharmacies stocked ARVs and 38 (18.4%) ordered ARVs upon request. The reported median number of ARV pills that patients bought at one time was 30, a two week supply of ARVs (range: 3-240 pills). Six (2.9%) pharmacy respondents reported selling non-allopathic medicines (i.e. Ayurvedic, homeopathy) for HIV. Ninety (44.2%) pharmacy respondents knew that ARVs cannot cure HIV, with those stocking ARVs being more likely to respond correctly (60.3% vs. 34.8%, p = 0.001). Respondents of pharmacies which stocked ARVs were also more likely to believe it was a professional obligation to provide medications to HIV-infected persons (91.8% vs. 78.8%, p = 0.007) but they were also more likely to believe that HIV-infected persons are unable to adhere to their medicines (79.5% vs. 40.9%, p < 0.01). Knowledge of the most common side effects of nevirapine, abnormal liver enzyme profile and skin rash, was reported correctly by 8 (3.9%) and 23 (11.1%) respondents, respectively. Seven (3.4%) respondents reported that they had received special training on HIV, 3 (1.5%) reported receipt of special training on ART and 167 (80.7%) reported that they believed that pharmacy staff should get special training on ART.ConclusionThere is a high willingness to participate in HIV management among community-based pharmacies but there is a tremendous need for training on HIV therapies. Furthermore, stigmatizing attitudes towards HIV-infected persons persist and interventions to reduce stigma are needed, particularly among those that stock ARVs.

IMPROVING CARDIOVASCULAR HEALTH AT THE POPULATION LEVEL: A 39 COMMUNITY CLUSTER-RANDOMISED TRIAL OF THE CARDIOVASCULAR HEALTH AWARENESS PROGRAM (CHAP): PS.3.03

Objective: Cardiovascular disease (CVD) is a major cause of death and disability. Effective population-based strategies to reduce CVD morbidity and mortality are needed. We conducted a community cluster-randomized trial to evaluate the effectiveness of a pharmacy-based Cardiovascular Health Awareness Program (CHAP) on cardiovascular disease morbidity. Design and Method: Thirty-nine mid-sized communities in Ontario, Canada were stratified by location and population size and were randomized to receive CHAP (n = 20) or no intervention (n = 19). In CHAP communities, residents 65 years of age or older were invited to attend volunteer-run cardiovascular risk assessment and education sessions held in community-based pharmacies over a 10-week period. Automated blood pressure readings and self-reported risk factor data were collected and shared with session participants and their family physicians and pharmacists. The primary trial endpoint was a composite of hospital admissions for acute myocardial infarction, stroke and congestive heart failure among all community residents aged 65 years and older. Analysis was by intention to treat. The study was registered at controlled-trials.com, number ISRCTN50550004. Results: All 20 intervention communities successfully implemented CHAP. A total of 1 265 3-hour long sessions were held in 90% (129/145) of pharmacies during the 10-week campaign. A total of 27 358 CVD assessments were performed on 15 889 unique participants with the assistance of 577 peer-volunteers. Adjusting for hospital admission rates in the year prior to intervention, CHAP was associated with a 9% relative reduction in our composite endpoint (rate ratio 0.91 [95% CI 0.86–0.97], p = 0.002). There were statistically significant reductions favouring the intervention communities in hospital admissions for acute myocardial infarction (rate ratio 0.87 [95% CI 0.79 – 0.97], p = 0.008) and congestive heart failure (rate ratio 0.90 [95% CI 0.81 – 0.99], p = 0.029), but not for stroke (rate ratio 0.99 [95% CI 0.88–1.12], p = 0.89). Conclusions: A collaborative, multipronged community-based health promotion and prevention program targeted at older adults can reduce cardiovascular morbidity at the population level.

Pharmacy students' views of managed care pharmacy and PBMS: should there be more exposure to managed care in the pharmacy curriculum?

New accreditation standards implemented in 2007 have required schools of pharmacy to evaluate their existing curricula. An issue frequently encountered is the limited amount of content in the pharmacy curriculum specific to managed care and the role and function of pharmacy benefit management companies (PBMs). To determine pharmacy student knowledge and opinions about managed care pharmacy, including the function of PBMs in the delivery of health care, in a college of pharmacy, and to explore tendencies in communication between pharmacy interns and patients in the community setting. Students from all 4 PharmD years (n = 663) in 1 college of pharmacy were invited to complete an online survey consisting of 19 questions on demographics, students' views and understanding of PBMs, and interest in working at a PBM in their career. Follow-up in-person and online focus group sessions with representatives from each pharmacy class year were conducted to collect information from students regarding views and understanding of managed care pharmacy. Focus group data were analyzed using a constant comparative method by 2 independent researchers. Of 374 respondents, 332 (88.8%) answered all of the survey questions and were included in the analysis. Most students (72.0%) indicated that they understand little or nothing about the functions of PBMs; 84.3% rated the amount that they had been taught about PBMs in pharmacy school as "inadequate" or "very inadequate;" and 45.2% indicated little or no interest in a PBM career. Yet, 34.7% (99 of 285) of students with past or current community pharmacy work experience rated the percentage of time that PBMs directly affected their practice worksite during a shift at 50% or greater. Focus group emerging themes confirmed survey data findings that students feel uninformed about managed care but regularly communicate with patients about managed care issues. Focus group findings also suggest that students may perceive managed care to be a "masculine," "uncaring" field. In an exploratory survey conducted at 1 pharmacy school, students perceived themselves as generally uninformed about managed care issues, yet more than one-third believed that dealing with PBMs constituted a significant portion of their work day as community-based pharmacy interns. Managed care understanding is necessary for all pharmacy students because most graduates will practice in community settings. Patients are exposed to managed care and their pharmacy benefit primarily at the point of medication procurement and medication counseling. As a result, pharmacists provide many patients with managed care and pharmacy benefit education. Schools of pharmacy may wish to evaluate and consider increasing the amount of curriculum content specific to managed care and PBMs.

Correlates of quality of life of pre-obese and obese patients: a pharmacy-based cross-sectional survey

BackgroundThe correlates of quality of life (QOL), as measured by the OSQOL questionnaire were investigated in a convenience sample of overweight patients recruited in pharmacies.MethodsA convenience sample of patients with a Body Mass Index ≥ 28 kg/m2 were recruited in community-based pharmacies. Baseline characteristics and QOL dimensions (1-Physical state, 2-Vitality-desire to do things, 3-Relations with others, 4-Psychological state) were reported in self-completed questionnaires from which the risk of obtaining a low QOL was assessed for each dimension.ResultsQOL was inadequate for all dimensions in the 494 patients included in the study (median age = 61, 48% women, 21% professional persons/top executives). Older pre-obese and obese patients were more likely to report impaired physical functioning (OR = 2.02, 95%CI = [1.10-3.70]), but were less severely affected socially (OR = 0.32, 95%CI = [0.15-0.69]). Pre-obese and obese professional persons and top executives showed better physical capabilities (OR = 0.35, 95%CI = [0.15-0.81]) and increased vitality (OR = 0.47, 95%CI = [0.23-0.95]). Overall, men's psychological state was better than females' (OR = 0.46, 95%CI = [0.25-0.82]). A body-mass index ≥ 35 kg/m2 was significantly associated with poorer QOL scores on physical, relational and psychological dimensions.ConclusionOur data highlighted the influence of the severity of excess weight, gender, age and socioeconomic status on QOL. These factors should be taken into account when interpreting QOL in pre-obese and obese persons.

Neighborhood geographical factors and the presence of advanced community pharmacy practice sites in Greater Chicago.

To determine the availability of experiential learning opportunities in culturally diverse areas and to identify opportunities and barriers to attract and sustain sites for the University of Illinois at Chicago College of Pharmacy. Utilizing variables of census tract income, racial/ethnicity composition and crime index, data analyses included descriptive statistics and multivariate logistic regression. Faculty members involved in experiential education were interviewed to identify other factors influencing site placement and selection for community-based advanced pharmacy practice experiences (APPEs). Median family income and Asian population were significantly higher and black population was significantly lower in census tracts with community APPE sites than in census tracts without APPE sites (p < 0.05). No significant differences were found in the population variables of white and Latino populations and crime index. The Asian population variable was the only significant predictor of an APPE site (p = 0.0148) when controlling for other variables. Distance from the College, pharmacy staffing issues, goodwill, influence of district and corporate managers, and strategic initiatives were critical considerations in site establishment and overall sustainability. Advanced community pharmacy practice sites were fairly well distributed across metropolitan Chicago, indicating that exposure to diverse populations during the advanced community practice experiences parallels with strategic College objectives of expanding and diversifying experiential sites to enhance pharmacy students' abilities to meet emerging patient care challenges and opportunities.

Pharmaceutical care for patients with ischemic stroke: improving the patients quality of life

To improve patients health-related quality of life (HQL) after transient ischemic attack (TIA) or ischemic stroke; to guarantee an effective secondary prevention; to increase the patient's satisfaction with recommendations regarding their medication by pharmacists. Stroke Unit, neurological ward at the Klinikum Fulda, rehabilitation hospitals and community-based pharmacies in the region of Fulda, Germany. Patients with TIA or ischemic stroke were included. The patients were assigned to an intervention group (IG) or a control group (CG). The individual assignment of patients to IG or CG was based on the type of the local pharmacy to which patients belong. Community-based pharmacies either delivered standard care (CG) or provided additional intensified pharmaceutical care (PC; IG). Pharmacies delivering PC belong to a pre-existing "Quality Assurance Working Group" (QAWG). To evaluate the patient's HQL, the Short Form-36 (SF-36) was used at study entry in hospital and at 12 months. The secondary prevention was documented at study entry in hospital and at 12 months. The patients' satisfaction was measured by a questionnaire at the end of the study. Patients' HQL; secondary prevention; patients' satisfaction with recommendations of the pharmacists with regards to their medication. Out of 1316 patients screened for participation in this study, 255 were recruited with 90/255 patients assigned to the IG and 165/255 patients assigned to the CG. During the study, the HQL of the patients in the IG did not change significantly. A significant decrease in the HQL was observed for the CG in 7/8 subscales and in both summary measures of the SF-36. After 12 months, 85.3% of the patients in the IG and 86.3% of the patients in the CG were treated with antiplatelet drugs or oral anticoagulants in accordance to treatment guidelines. Patients in the IG were significantly more satisfied with the individualized recommendations of the pharmacists than patients in the CG. Our findings indicate that an intensified PC of patients after ischemic stroke by dedicated pharmacists may have a positive impact on HQL and patients' satisfaction. PC in this study had no impact on adherence to secondary prevention medication.

Counter design influences the privacy of patients in health care

A re-furnishing of counter areas in primary health care was used to assess patient privacy and its influences on the nature of conversations in a controlled experiment. Patients in two community-based pharmacies in the Netherlands were assigned to enclosed counters and a queue at distance, or to counters that exposed patients mutually and a closer queue. Patients assigned to counters with reduced sight were more satisfied with the privacy than patients at visually exposed counters. However, in comparison with visually exposed pharmacy counters, conversations of patients at enclosed counters could still be overheard and did not have different conversations to other patients. Architectural design of health-care institutions has potential to positively influence perceived patient privacy in areas in where multiple patient-staff communications routinely occur and where patient privacy is an important issue, but enclosed counters with a queue at distance do not prevent incidental disclosure of individually identifiable health information.

Secondary exchange of sterile injecting equipment in a high distribution environment: A mixed method analysis in south east Sydney, Australia

Background In Australia, sterile needles are distributed to people who inject drugs through formal services for the purposes of limiting the transmission of blood borne viruses (BBV). Secondary exchange (SE) involves people acquiring needles from formal services and redistributing them to others. This paper describes the extent, patterns and contexts of SE in south east Sydney, Australia and examines whether SE is independently associated with BBV risk practices. Methods Quantitative and qualitative data were collected through a cross-sectional study using surveys and in-depth interviews. Respondents were people using community-based pharmacies to obtain sterile needles and syringes. Results Data were collected from 229 survey respondents, over half of whom (54%) reported SE in the previous month. Of these, 40% engaged in distribution only, 25% in receipt only and 36% in both. Respondents reported passing on 21.7% of their needles to others in the last month, most commonly to friends (51.6%) and partners (27.4%). Recipients of SE were four times more likely than non-secondary exchangers to report borrowing used syringes in the last month. Respondents reported supplying sterile equipment to others to prevent reuse and to reduce risks associated with unplanned drug use. Conclusion SE is a common activity in south east Sydney but does not appear to be highly organised, usually taking place in small networks of friends and/or partners for altruistic reasons. Harm reduction programs could capitalise on the prevalence of SE to reach injecting drug users who do not use formal distribution services.

Ensuring contributions to the revision of the classifications from the world scientific community: Example of German speaking countries

Classification of patients with pharmaceutical opioid use disorder and dependence varies depending on which definition is used. We compared how WHO's ICD-10 and proposed ICD-11 and the American Psychiatric Association's DSM-IV and DSM-5 classified individuals in a community-based sample of Australians with chronic non-cancer pain for which opioids have been prescribed.We studied participants in the Pain and Opioid IN Treatment (POINT) cohort, a 2 year prospective cohort study of 1514 people prescribed pharmaceutical opioids for their chronic pain who were recruited in 2012–13 from community-based pharmacies across Australia. After giving patients the Composite International Diagnostic Interview about their opioid use, we assessed which patients would be categorised as having disorders of pharmaceutical opioid use by ICD-10, the draft ICD-11, DSM-IV, and DSM-5. We examined agreement between classification systems, and tested the unidimensionality of the syndrome with confirmatory factor analysis.We included 1422 participants (median time of pain disorder 10 years [IQR 5–20]; median length of strong opioid prescription 4 years [IQR 1·5–10·0]; mean age 58 years). Similar proportions of individuals met lifetime criteria for dependence with DSM-IV (127; 8·9%), ICD-10 (121; 8·5%), and ICD-11 (141; 9·9%). Criteria in DSM-5 classified 127 (8·9%) participants with moderate or severe use disorder. There was excellent agreement between ICD-10, ICD-11 and DSM-IV dependence (κ>0·90). However, there was only fair to moderate agreement between ICD-10 and DSM-IV dependence diagnoses, and DSM-5 use disorder (mild, moderate, or severe). There was only good agreement between moderate to severe use disorder in DSM-5 and the other definitions. Criteria for all definitions loaded well on a single factor; the best model fit was for the definition for dependence in the draft ICD-11, the worst was in DSM-5.Classification of problematic pharmaceutical opioid use varies across editions of ICD and DSM. The much lower levels of agreement between DSM-5 and other definitions than between other definitions might be attributed to DSM-5 containing an increased number of criteria and treating dependence and problematic use as a continuum. The more parsimonious ICD-11 dependence definition showed excellent model fit and excellent agreement with previous classificatory systems.Australian National Health and Medical Research Council.

Baseline albuminuria predicts the efficacy of blood pressure‐lowering drugs in preventing cardiovascular events

Albuminuria has been proven to be associated with cardiovascular morbidity and mortality. Such an association has been found not only in subjects with diabetes and hypertension, but also in the general population. It could therefore be expected that especially subjects with higher albuminuria levels may benefit from blood pressure-lowering agents to improve their cardiovascular outcome. This study indicates that the efficacy of blood pressure-lowering agents to prevent cardiovascular events is dependent of the level of albuminuria before start of such treatment. The higher baseline albuminuria, the better the relative and absolute risk reduction for cardiovascular events with blood pressure-lowering drugs. The data also suggest a possible better cardiovascular protective effect of renin-angiotensin intervening agents compared with other blood pressure-lowering agents. Albuminuria has been proven to be associated with cardiovascular (CV) events in specific patient populations, but also in the general population. This study aimed to investigate whether the efficacy of blood pressure-lowering agents in preventing CV events depends on baseline urinary albumin excretion (UAE) and, if so, whether this holds true for blood pressure-lowering agents in general, or is limited to agents that interfere in the renin-angiotensin system. Data were used from a community-based cohort study and pharmacy dispensing records. Included were subjects with hypertension (systolic blood pressure >or=140 and/or diastolic blood pressure >or=90 mmHg), no cardiovascular disease history, and no previous use of blood pressure-lowering agents. During study follow-up (7.1 +/- 1.6 years), 122 CV events were observed in 1185 subjects included. Start of blood pressure-lowering agents vs. non-use was associated with a difference in absolute CV event risk of 0.7%, 6% and 12.6% for all subjects, those with UAE >or= 15 mg day(-1) and >or=30 mg day(-1), respectively. Cox regression analysis showed that the relative risk for CV events after start of blood pressure-lowering agents was significantly dependent (P < 0.05) on baseline UAE; with hazard ratios of 0.87 [95% confidence interval (CI) 0.48, 1.60, P = NS], 0.58 (95% CI 0.36, 0.94, P < 0.05) and 0.37 (95% CI 0.20, 0.68, P < 0.05), for subjects with UAE < 15, >or=15 and >or=30 mg day(-1), respectively. Results adjusted for covariates were essentially similar. The use of angiotensin converting enzyme inhibitor/angiotensin-II receptor blocker (ACEi/ARB) treatment tended to be associated with a more favourable CV prognosis when compared with non-ACEi/ARB treatment (difference P = 0.06). Our results suggest that the efficacy of blood pressure-lowering agents to prevent CV events is dependent on baseline albuminuria. The higher baseline albuminuria, the more absolute as well as relative risk reduction can be achieved. Our data suggest that this may especially be true for ACEi/ARBs. We caution that this is an observational study, and that these conclusions should therefore be regarded as hypothesis generating, rather than hypothesis testing.

Changing availability and cost of Internet physician consultations and prescription medications

Internet use by the public to obtain medical information and services continues to grow. In 1999, we found cost of general physician visits was 15% higher, and cost of medications was 10% greater via the Internet than from community providers. The goal of this study was to re-examine changes in product availability and costs to consumers four years later. We searched multiple websites 1 June 2003 - 31 August 2004, offering physician consultations and prescription medications. We compared mean cost of Internet physician visits and price per pill to costs of community-based general physicians and pharmacies in the Philadelphia region. We found 144 sites worldwide providing physician services and prescription medications. Mean charge for an Internet physician consultation was 55 dollars, 8.3% lower than for a comparable visit to a community practitioner. Mean cost per pill across 204 available medications was 36.7% higher at Internet sites than at local pharmacies. Shipping and handling (S&H) added a mean of 15.40 dollars. Total cost to Internet consumers was similar whether or not Internet sites charged for a physician consultation and/or S&H. Obtaining physician visits and medications over the Internet was about 40% more costly than in the local community. The Internet continues to hold great promise for provision of health and medical care services by expanding access. However, increased access to physician care and medications entails higher cost, and quality of physician services and pharmaceuticals provided remain controversial.

The Transformation of Pharmacy Concepts into Building and Organization

To explore the transformation of soft systems pharmacy concepts, with a special attention for pharmaceutical care, into hard systems properties of building and organization in community-based pharmacy practice in The Netherlands. The applied methods for data-collection were interviews. The interviews were conducted at eight community pharmacies and four architectural firms. The central topics in the questionnaire were the building and the design process. The role of the architect was included in the questions for the pharmacist and the role of the pharmacist was included for the architect. The data were completed with simple observations, relevant documents, designs, photographic material and bills of quantities of best, ordinary and worst case practices. The data were used to address the coherence between pharmacy, building, and organization. The main outcome measure was the relevance for the objective of the study. Data-selection was based upon its supposed connection with the transformation of soft into hard systems. The main focus was on documentation, classification, and derivation that would improve the current understanding of the transformation of a pharmacy concept, especially pharmaceutical care, into building and organization. No further data-selection was made. The results show that architectural and organizational designs are actually used in the support of pharmaceutical care. A large variety of soft and hard systems were observed. However, pharmacists seem to agree on the use of the soft systems key words 'professional', 'accessible', and 'transparent', and also on the activities with respect to the provision of information and the cooperation with other disciplines. Although most observed transformations appear sensible, hard evidence provided by the pharmacist is very poor. The full impact of the implemented changes on pharmaceutical care or other concepts remains a mystery. There is a large variety of different hard properties in building and organization, reflecting different (but still related) soft pharmacy concepts. The connections in building and organization are regarded as the resources that make the provision of care possible. Observed were resources to support the provision of written and oral information, the conversation setting, and the cooperation with other professionals. Potentially important developments for pharmaceutical care are the separate consultation room, the multi-disciplinary health centre, and robotization. This study has revealed some of the interdisciplinary relations between pharmaceutical, architectural, and organizational designs in Dutch community pharmacy practices. From this study we can conclude that interventions in building and organization are actually used in the support of pharmacy concepts, specifically of pharmaceutical care. However, the hard evidence of supposed improvements remains poor and mostly absent.

A Community-based Program for Cardiovascular Health Awareness

The objective of the Cardiovascular Health Awareness Program (CHAP) is to improve the processes of care related to the cardiovascular health of older adults. Two Ontario communities including family physicians (FP), pharmacists, public health units and nurses, volunteer peer health educators, older adult patients and community organizations. Community pharmacies and family physician offices. CHAP is designed to close a process of care loop around cardiovascular health awareness that originates from, and returns to, the FP. Older patients are invited by their FP to attend pharmacy CHAP sessions. At these sessions, trained volunteer peer health educators (PHEs) assist patients both in recording their blood pressure using a calibrated automated device and in completing a cardiovascular risk profile. This information is relayed to their respective FP via an automated computerized database. Pharmacists and patients receive copies of the results. Based on these cumulative risk profiles, patients are advised to follow-up with their FP. Of the FPs and pharmacists asked, 47% and 79%, respectively, agreed to participate in the project. 39% of older adult patients invited by their FPs attended the CHAP community pharmacy sessions. Of these, 100% agreed to having their risk profile, including their blood pressure readings, forwarded to their FP. Positive feedback about CHAP was expressed by the volunteer PHEs, the FPs and the pharmacists. The community-based pharmacy CHAP sessions are a feasible way of improving patient, physician, and pharmacist access to reliable blood pressure measurements and to cardiovascular health information. A randomized trial is in progress that will assess the impact of CHAP on monitoring of blood pressure.

Randomised controlled trials (RCTs) to evaluate complex healthcare interventions - a case study

In 2001 the UK National Health Service (NHS) issued its National Service Framework for the Elderly (NSF-E). This identified the elderly as a vulnerable group needing a high level of pharmaceutical intervention. As such, the NSF-E outlined plans to implement 'medicines management' and 'pharmaceutical care' within community-based clinical pharmacy on behalf of older people. In response a group of researchers from Pharmacy, General Practice and Health Services Research set about designing a project to evaluate community-based pharmaceutical care for the elderly whi would be funded under the Medical Research Council's (MRC) 'primary care' initiative. This article describes the application of the MRC's framework for complex interventions to a large randomised trial of pharmaceutical care and discusses the stages through which the research passed, from ideas, through planning, to implementation and modification after piloting. The authors also highlight difficulties encountered, e.g., issues of patient confidentiality, and how these problems were resolved. This description is intended to be of value to other pharmacy practice researchers.

Safety and usage pattern of low-dose diclofenac when used as an over-the-counter medication: results of an observational cohort study in a community-based pharmacy setting.

The widespread and unsupervised nature of nonprescription drug usage makes it important that evidence of effectiveness and safety should be gathered in a real-world, over-the-counter (OTC) setting. This study was designed to evaluate the "real life" behavior of consumers with nonprescription access to low-dose diclofenac-K, with special focus on tolerability and the pattern of product usage. Participants were recruited from consumers presenting at 62 community-based pharmacies in Norway after they had purchased low-dose diclofenac-K. Baseline data were collected from the participants in the pharmacy and information on diclofenac usage, the condition for which it was used, comprehensibility of the package insert, efficacy and safety were collected 5 days after commencing the medication. Follow-up safety data were collected 19 days after commencing study medication. 446 individuals participated in the study with 383 taking medication and completing questionnaires at each time point. The directions for use were followed well with regard to recommended indications, contraindications and maximum dosages, but less well with respect to the recommended duration of use and concurrent medications. Most participants reported complete relief, a lot of relief, fair relief or some relief from the symptoms from which they were suffering and 70% were willing to purchase diclofenac-K again. Only 6.5% of participants reported adverse events and 6 participants (1.6%) were considered to have experienced a drug-related adverse event, none of which was considered to be severe. Overall, this study showed that low-dose diclofenac-K is efficacious, safe and commonly used in accordance with the directions for use when used as an OTC medication. It also demonstrated that the use of an OTC analgesic medication can be successfully monitored in a pharmacy-based cohort study.

Medication Dispensing Errors in Community Pharmacies: A Nationwide Study

The available literature concerning medication dispensing errors provides relatively few studies that focus on community-based pharmacies. This paper presents the results of a nationwide, observation-based study of dispensing errors. Although community-based pharmacies were the primary focus, a small number of health-system pharmacies were also included. Investigators collected information concerning the frequency and type of errors and near errors as well as data regarding a number of task and environmental factors previously correlated with dispensing errors. A total of 5,784 prescriptions were inspected, revealing 91 errors (1.57%) and 74 near errors (1.28%). Errors were categorized as either content (41.76%) or labeling (58.24%) errors. Results are consistent with findings in the available literature. In particular, lighting levels, type of inspection system used (e.g., bar code product verification), number of available employees, and the arrangement of drug stock were significantly associated with both types of errors.

A Comparative Analysis of Prescriptions—Writing Errors Observed in Two Community-based Pharmacies

s and Brief Reports: Selected Abstracts from the Annual Poster Session of the American Academy of Physician Assistants Boston, Massachusetts, May 2002: PDF Only

An Assessment of Herbal Therapy Use, Adherence and Utilization of Pharmacy Services in HIV Clinics

To assess herbal therapy use, adherence to antiretroviral therapy (ART) and pharmacy service utilization in two HIV clinics using a prospective questionnaire-based assessment. Seventy-six patients completed the questionnaire. Twenty-six patients (34%) reported using at least one herbal therapy; 14 (54%) reported this to their provider. Providers correctly predicted herbal therapy use in 10 (38%) patients reporting herbal therapy use. Seventy-three patients (96%) reported a high level of adherence (> 90%), while only 37% had a viral load < 80 copies/ml. Clinic and community-based pharmacy services were underutilized. Herbal therapy use was common, under-reported and difficult for providers to predict. Unreported herbal therapy use could lead to virologic failure as a result of unknown drug-herb interactions. Consultative pharmacy services in the clinic and retail pharmacies are underutilized.

An Assessment of Herbal Therapy Use, Adherence and Utilization of Pharmacy Services in HIV Clinics

Objective: To assess herbal therapy use, adherence to antiretroviral therapy (ART) and pharmacy service utilization in two HIV clinics using a prospective questionnaire-based assessment.Results: Seventy-six patients completed the questionnaire. Twenty-six patients (34%) reported using at least one herbal therapy; 14 (54%) reported this to their provider. Providers correctly predicted herbal therapy use in 10 (38%) patients reporting herbal therapy use. Seventy-three patients (96%) reported a high level of adherence (> 90%), while only 37% had a viral load < 80 copies/ml. Clinic and community-based pharmacy services were underutilized.Conclusions: Herbal therapy use was common, under-reported and difficult for providers to predict. Unreported herbal therapy use could lead to virologie failure as a result of unknown drug-herb interactions. Consultative pharmacy services in the clinic and retail pharmacies are underutilized.

Pharmaceutical Care Services and Results in Project ImPACT: Hyperlipidemia

ObjectiveTo demonstrate that pharmacists, working collaboratively with patients and physicians and having immediate access to objective point-of-care patient data, promote patient persistence and compliance with prescribed dyslipidemic therapy that enables patients to achieve their National Cholesterol Education Program (NCEP) goals. DesignObservational study. Participants26 community-based ambulatory care pharmacies: independent, chain-professional, chain-grocery store, home health/home infusion, clinic, health maintenance organization/managed care. Main Outcome MeasuresRates of patient persistence and compliance with medication therapy and achievement of target therapeutic goals. ResultsIn a population of 397 patients over an average period of 24.6 months, observed rates for persistence and compliance with medication therapy were 93.6% and 90.1%, respectively, and 62.5% of patients had reached and were maintained at their NCEP lipid goal at the end of the project. ConclusionWorking collaboratively with patients, physicians, and other health care providers, pharmacists who have ready access to objective clinical data, and who have the necessary knowledge, skills, and resources, can provide an advanced level of care that results in successful management of dyslipidemia.