Community Pharmacies In Grampian Research Articles

It's not what you do it's the way that it's measured: quality assessment of minor ailment management in community pharmacies.

BackgroundEffective management of minor ailments in community pharmacies could reduce the burden on alternative high‐cost services (general practices, Emergency Departments). Evidence is needed regarding the appropriateness of management of these conditions in community pharmacies.ObjectiveTo explore the appropriateness of minor ailment management in community pharmacies.SettingProspective, observational study of simulated patient (SP) visits to community pharmacies in Grampian (Scotland) and East Anglia (England).MethodEighteen pharmacies (nine per centre) were recruited within a 25‐mile radius of Aberdeen or Norwich. Consultations for four minor ailments were evaluated: back pain; vomiting/diarrhoea; sore throat; and eye discomfort. Each pharmacy received one SP visit per ailment (four visits/pharmacy; 72 visits total). Visits were audio‐recorded and SPs completed a data collection form immediately after each visit.Primary Outcome MeasureEach SP consultation was assessed for appropriateness against product licence, practice guidelines and study‐specific consensus standards developed by a multi‐disciplinary consensus panel.ResultsEvaluable data were available for 68/72 (94.4%) visits. Most (96%) visits resulted in the sale of a product; advice alone was the outcome of three visits. All product sales complied with the product licence, 52 (76%) visits complied with practice guidelines and seven visits achieved a ‘basic’ standard according to the consensus standard.ConclusionAppropriateness of care varied according to the standard used. Pharmacy‐specific quality standards are needed which are realistic and relevant to the pharmacy context and which reflect legal and clinical guidelines to promote the safe and effective management of minor ailments in this setting.

The provision of current and future Healthy Weight Management (HWM) services from community pharmacies: a survey of community pharmacists' attitudes, practice and future possibilities

The extent to which community pharmacists contribute to the management of the global obesity epidemic is unclear. Local, regional and national obesity management schemes need to be informed by existing services which will be influenced by health professionals' attitudes and willingness to engage in service provision. The purpose of this study was to derive an accurate account of community pharmacists' activities and attitudes towards the provision of current and future Healthy Weight Management (HWM) services. A postal survey was developed and disseminated to all 128 community pharmacies in Grampian, north-east Scotland. The response rate was 64.8% (83/128). A range of HWM services was already being provided. The most common services offered were the supply of weight-loss medication (n=69, 84.1%) and advice about its use (n=68, 84.0%). Other services commonly offered were dietary advice (n=59, 72.8%), physical activity advice (n=53, 66.3%) and body mass index (BMI) calculation (n=56, 68.3%). Most pharmacists were confident in measuring weight (n=78, 93.9%), height (n=78, 93.9%) and BMI (n=78, 93.9%). Many pharmacists perceived a need for HWM services in their local area (n=56, 67.5%) as well as a need to extend these services within their pharmacies (n=48, 57.9%). Barriers to the provision of HWM services included workload (n=77, 92.8%) and the need for additional reimbursement (n=63, 75.9%) and additional staff (n=49, 59.7%). The pharmacists' perceived training needs included estimation of body fat (n=67, 81.7%), one-to-one consultation skills (n=60, 73.2%), advice on weight-loss products (n=52, 63.4%), measurement of blood cholesterol (n=51, 63%) and advice on weight-loss drugs (n=49, 60.5%). Community pharmacies could be an ideal setting for the provision of HWM services. The barriers to service provision need to be addressed. Furthermore, the development of appropriate undergraduate and postgraduate training is required to equip pharmacists and their staff with appropriate knowledge and skills to deliver these services effectively.

Over-the-counter ibuprofen: how and why is it used?

Abstract Objectives To pilot an over-the-counter (OTC) medicine pharmacovigilance project, using ibuprofen as a model. Method All users of any tablet or capsule form of ibuprofen (excluding compound products) purchased from 61 participating community pharmacies, aged ≥18 years and able to give informed consent, were eligible to join the study. A postal questionnaire one week after the index purchase monitored the follow-up rate, drug usage, past medical history, concurrent medication, symptoms and health service utilisation. Setting Primary care: community pharmacies in Grampian, Scotland. Key findings A total of 443/544 (81 per cent) questionnaires were completed. The recommended daily dose of OTC ibuprofen (1,200mg) was exceeded by 35 customers (8 per cent) on at least one day and the recommended maximum daily dose that can be prescribed by a physician (2,400mg) was exceeded on five occasions. During the seven days after the index purchase, ibuprofen was used by 15 customers (4 per cent) with an active or past history of peptic ulcer, and 30 (7 per cent) with an active or past history of asthma. Thirty-eight per cent had purchased ibuprofen for a chronic condition and 32 per cent were still taking it at the end of the initial seven-day period. Twenty-eight of 412 customers (7 per cent) sought advice during the seven-day period about at least one symptom: 13 consulted their general practitioner, 12 consulted a pharmacist, two consulted both their GP and a pharmacist, and one consulted a hospital doctor. Some of these consultations (23/28, 82 per cent) might have related to an adverse reaction to ibuprofen: 11 customers (3 per cent) consulted about lower abdominal symptoms, nine about gastric symptoms and three about wheeziness. Conclusions This pilot study identifies instances of contraindicated and excessive use of OTC ibuprofen, indicating a need for pharmacovigilance studies of OTC medicines; it also demonstrates the feasibility of a major study.

The provision of current and future sexual health services from community pharmacies in Grampian, Scotland

Community pharmacies play a vital role in promoting, maintaining and improving the health of the local community. This study explored community pharmacists' activities and attitudes towards the provision of sexual health services (SHS) in North East Scotland, as well as their needs with regard to the delivery of current and future SHS. North East Scotland. A questionnaire was conducted of community pharmacists working in community pharmacies in Grampian (n = 128). Self-reported provision of sexual health services; attitudes towards current and future sexual health services; previous training and perceived training needs; respondent demographics. In total, 73% (94/128) of community pharmacists responded. The average number of SHS/products per pharmacy was six out of a possible 13 (range: 4-10). Respondents expressed positive attitudes towards the provision of current and future SHS. However, they also reported that they had received little or no sexual health training but that they would like to receive training in all areas of sexual health. Barriers to the provision of sexual health included workload, lack of training and the need for payment for additional services. Community pharmacists already provide a limited range of sexual health services. Community pharmacists, their staff and their premises could be used in strategies to reduce unplanned pregnancies, the incidence of sexually transmitted infections and to promote respectful and responsible sexual behaviour.

Using theory to improve communication: designing a communication skills training package for medicine counter assistants

Abstract Objective To design (i) a theory-based communication skills training package for medicine counter assistants (MCAs) and (ii) a method of evaluating its effect on consultation behaviours. Method Thirty MCAs from 20 community pharmacies in Grampian, Scotland were recruited and randomised to the intervention (n = 20) and control (n = 10) groups. The intervention comprised 2 times 4 h of interactive learning sessions. The content of the sessions was based on a model of teaching and learning communication skills, while the teaching and learning techniques used in the sessions were based on active learning and cognitive-behavioural principles. Training focused on information-gathering and information-giving skills. The Theory of Planned Behaviour was used to develop a questionnaire to explore the effect of communication skills training. Key findings The results of the full study are reported elsewhere but, in summary, some improvements in communication were seen in the intervention group in terms of the number of questions asked, although no improvement was shown with the use of open questions. Conclusion The results of this study suggest that using theory to underpin training might well allow the mapping of specific mediators of behaviour change onto intervention components, which in turn provides information on which aspects of training might be successful. Thus, using theory as a basis for interventions may increase the effectiveness of future interventions.

Why educational interventions are not always effective: a theory-based process evaluation of a randomised controlled trial to improve non-prescription medicine supply from community pharmacies†

Abstract Objective The Theory of Planned Behaviour (TPB) has been used to explore health professionals' intentions to behave in a particular way. This study measured community pharmacists' behavioural intention and actual behaviour as part of an evaluation of a randomised controlled trial (RCT) of two educational interventions to promote the appropriate treatment of vaginal candidiasis in community pharmacies. This study aimed to explore reasons for the success or failure of educational interventions by conducting a theory-based process evaluation alongside the RCT. Method The RCT was conducted in 60 community pharmacies in Grampian, Scotland, and compared educational outreach visits and continuing education workshops. A postal questionnaire was conducted, comprising five measures derived from TPB: behaviour; behavioural intention, attitudes, subjective norms, and perceived behavioural control; together with a measure of clinical knowledge of candidiasis and its treatment; and a measure of guideline compliance. Guideline compliance was assessed using four scenarios. Simulated patient visits were made to participating pharmacies to derive objective measures of actual behaviour. Results Completed questionnaires were returned from 50 pharmacists (response rate: 83%). Forty (80%) respondents were fully guideline compliant (correct response with all four scenarios). Pharmacists' knowledge was high and they had positive attitudes towards the supply of antifungals, as well as strong intentions to sell them appropriately. No statistically significant differences were shown in questionnaire responses or actual behaviour across the four trial groups. Conclusion This evaluation demonstrates that the interventions may have failed because of psychological ceiling effects, i.e. existing attitudes and intentions were already strong. Further studies are needed to identify factors that prevent strong intentions from being put into practice, in order to develop effective interventions.

Community pharmacy provision of allergic rhinitis treatments: a longitudinal study of patient reported outcome

Abstract Objective To monitor and compare the symptoms, and reported quality of life, of two groups of people who obtained treatment for allergic rhinitis from community pharmacies (prescribed or purchased). Method Subjects were recruited by 64 community pharmacies in 2001 and followed up by postal questionnaire at four time points: five days, four weeks, eight weeks and 26 weeks. Setting Primary care: community pharmacies in Grampian, Scotland. Results Response rates: five days — 84%; four weeks — 63%; eight weeks — 59%; 26 weeks — 56%. Three hundred and twenty-four subjects completed the five-day questionnaire (138 prescribed, 186 purchased). There were no important differences between groups in socio-economic variables monitored. The commonest treatments provided were antihistamines (non-sedating: 63% prescribed, 59% purchased; sedating: 3% prescribed, 16% purchased). Despite treatment, symptoms and quality-of-life impairments remained high; the prescribed group reported higher levels of many symptoms (including asthma), and lower quality of life at early time points. Most were satisfied with their treatment and few reported unmet need for pharmacy advice (11% prescribed, 3% purchased group). Conclusion Despite high levels of patient satisfaction with allergic rhinitis treatment, symptoms and quality-of-life impairments remained high in both groups. Widespread implementation of ‘allergic rhinitis and its impact on asthma’ (ARIA) guidelines for physicians and for pharmacists might improve management of symptoms and quality of life of patients.

Simulated patient visits with immediate feedback to improve the supply of over-the-counter medicines: a feasibility study

The supply of over-the-counter (OTC) medicines from community pharmacies should be safe and effective, but there is evidence that appropriate practice is not always achieved. The primary objective of this study was to assess the acceptability of simulated patient (SP) visits combined with feedback, delivered by either SPs or pharmacy educators (PEs), as a method for improving the supply of OTC medicines in community pharmacies. This feasibility study used a randomized controlled trial design where participating pharmacies were randomized into two groups (SP or PE, feedback). SP visits were audiotaped and questionnaire data collected from participants post-intervention. Each pharmacy received three covert visits from SPs. Feedback was provided immediately after the first and second visits. Data were collected on information gathering and advice provision. The visits were assessed for minimum standards of practice and appropriateness of outcome. Twenty-two pharmacists and 34 medicine counter assistants (MCAs) from 20 community pharmacies in Grampian, Scotland, participated. Sixty SP visits were completed (three per pharmacy) and were well received, particularly by the pharmacists. Similar results were shown across both study groups in terms of information gathering and information/advice provision during consultations. Few SP consultations achieved the minimum standard of practice although most resulted in an appropriate outcome. SP visits with feedback were acceptable to pharmacists as a method of improving the quality of consultations for OTC medicines, irrespective of the person giving feedback (SP or PE). The process by which pharmacists and their staff derived their recommendations, in terms of information gathering, could be improved. A large-scale study is needed to assess the effectiveness and cost-effectiveness of SP visits with feedback.

Exploring the supply of non-prescription medicines from community pharmacies in Scotland

The objectives of this study were to: (1) explore pharmacy support staff (PSS) opinions of and attitudes towards the supply of non-prescription medicines (NPMs); (2) assess whether NPM supply is compliant with professional and good practice guidelines. This exploratory study was conducted in community pharmacies in Grampian, Scotland, and comprised non-participant observation of NPM consultations, semi-structured interviews with, and a questionnaire of, PSS. Guideline compliance was assessed by a consensus group of practising community pharmacists. The percentage of consultations which achieved compliance with professional guidelines was calculated. A total score was also calculated for each consultation to assess compliance with good practice guidelines. Fifty-seven support staff from 21 pharmacies participated in at least one component of the study. In total, 195 observed consultations were evaluable. Fifty-four participants completed a questionnaire and 95 post-consultation interviews were completed. Most consultations involved product requests and were for self-treatment. Overall, interviewees were satisfied or very satisfied with 78 (83.0%) and 14 (14.9%) of all consultations, respectively. Participants' self-reported scores for the quality of consultation were high indicating that they perceived their consultations to be appropriate. Most PSS were aware of good practice guidelines and thought their use was important/very important, yet few consultations were fully guideline compliant. Non-product consultations were more guideline compliant than product consultations. Just over one third (35.6%) of consultations established whether other medication was being used by the intended recipient of the NPM. Few PSS (21.2%) had read the professional guidelines and as such, compliance with these guidelines was extremely low. The percentage of guideline compliant consultations were 6.6% (n = 5) (sufficient information gathered), 13.2% (n = 10) (adequate advice/information provision), 46.1% (n = 35) (personal involvement of pharmacist), 21.1% (n = 16) (particular care of specific patient groups) and 28.9% (n = 22) (pharmacist involvement with specific NPMs). Few consultations for NPMs in this study were fully guideline compliant. The reasons for non-compliance with good practice and professional guidelines need to be explored. Although failure to comply with professional guidelines could be due to PSS's lack of awareness, this does not explain non-compliance with good practice guidelines.

Theory-based communication skills training for medicine counter assistants to improve consultations for non-prescription medicines

Medicine counter assistants (MCAs) supply the majority of non-prescription medicines (NPMs) to consumers. Suboptimal communication during consultations between consumers and MCAs has been identified as a major cause of inappropriate supply. Evidence from medical consultations suggests that training in specified communication skills can change professional behaviour. A feasibility study was conducted to evaluate the effect of theory-based communication skills training for MCAs. Thirty MCAs were recruited from 21 community pharmacies in Grampian, Scotland. The intervention comprised 2 4-hour training sessions, held 1 month apart. The sessions were informed by results from previous studies and the Calgary-Cambridge evidence-based model of communication skills training. Strategies for guiding individuals through change were adopted from cognitive behavioural therapy techniques. The theory of planned behaviour was used to assess potential pathways to behaviour change. Recorded data were collected during covert visits to the pharmacies by simulated patients at baseline and 1 month after each training session. Communication performance was measured as the number and type of questions asked. Compared with baseline measures, the total number of questions asked increased in the intervention group at both time-points. No change was shown in the control group between baseline and follow-up 1, and a decrease was shown in the total number of questions from follow-up 1 to 2. The intervention appeared to have greater effect on consultations involving advice, compared with those concerning product requests. Communication performance improved following training. Increased information exchange is associated with guideline-compliant supply of NPMs. A substantive randomised, controlled trial is now planned to assess the intervention.

Monitoring adverse drug reactions in children using community pharmacies: a pilot study

To determine the feasibility of a community pharmacy-based parental adverse drug reaction (ADR) reporting system for children. Prospective study of parent-reported ADRs using a questionnaire issued to the parent or guardians of children 0-11 years of age collecting prescribed medicine for amoxicillin, and/or salbutamol, and collecting prescribed medicine for, or purchasing, paracetamol or ibuprofen suspension. Seven community pharmacies in Grampian, Scotland. During a 4-week period 360 prescriptions or purchases for the study medications occurred. Two hundred and sixty-seven parents (85.5%) agreed to participate in the study. One hundred and six participants (40%) returned a total of 122 questionnaires. The demographics of responders and nonresponders including medication, age of child, and social status as assessed by the Depcat score were similar. There was no evidence of under-representation of any socio-economic group. Possible adverse events were detected using a symptom tick list and perceived ADRs using free text entry. Using the symptom tick list approach the most commonly reported symptoms were diarrhoea (28.9%) and tiredness (31.6%) for amoxicillin. The levels of diarrhoea and tiredness reported for ibuprofen, paracetamol and salbutamol were 15% and 20%, 7.4% and 18.5%, and 20% and 0%, respectively. Using the freehand section of the questionnaire 15 specific ADRs were reported by parents (12.3%). Eight children (21.2%) reported ADRs attributed to amoxicilin [diarrhoea (n = 4), fever (n = 1), anorexia (n = 1), hyperactivity (n = 1) and nonspecific (n = 1)], five to paracetamol [diarrhoea (n = 3), anorexia, irritability, crying and very angry (n = 1) and not stated (n = 1)], two to ibuprofen [diarrhoea (n = 1), not stated (n = )]. Only one off-label prescription was identified and this was for salbutamol syrup prescribed to a child under 2 years of age. The prospective monitoring of paediatric ADRs, using a questionnaire issued to parents or guardians in the community pharmacies, is feasible.