Community Pharmacy Staff Research Articles

Training Community Pharmacy Staff How to Help Manage Urgent Mental Health Crises.

Nearly 44 million Americans are affected by mental illness every year. Many individuals, however, are not diagnosed and/or do not receive treatment. The present manuscript reviews the incidence of mental illness, the continuum from mental wellness to mental illness, and the role of the pharmacy staff in helping individuals manage different mental health needs. In particular, there is discussion of stigma of mental illness that those with mental health needs experience by those around them including health professionals such as pharmacy staff. One way to resolve such stigma is through training such as Mental Health First Aid (MHFA). The paper reviews key aspects of MHFA, the evidence supporting MHFA, and how MHFA relates specifically to pharmacy practice and services. A conceptual framework for MHFA and its relationship to individual factors, attitudes, behaviors, and outcomes. Lastly, a discussion is presented that briefly compares MHFA to other similar approaches to helping those in mental health crises, the limits of what is known about MHFA, and what future research might explore to better understand the outcomes of pharmacy staff providing mental health education, support, and referral to care.

Current and potential contributions of community pharmacy teams to self-harm and suicide prevention: A qualitative interview study.

BackgroundSuicide prevention is a global priority. Despite the focus on primary care in suicide prevention, little is known about the contributory role of community pharmacists and nothing about the role of the wider community pharmacy team in this area. We aimed to explore the current and potential role of community pharmacy teams in self-harm and suicide prevention.MethodsWe conducted one-to-one semi-structured qualitative interviews with community pharmacy staff (pharmacists, pre-registration pharmacists, pharmacy technicians, dispensing/pharmacy assistants, delivery drivers) in the North West of England, UK. We identified themes from the interview transcripts through an iterative process of inductive thematic analysis.ResultsWe conducted twenty-five interviews with community pharmacy staff. Many described examples of helping those who were contemplating suicide or self-harm. No participants had received suicide prevention training. We identified six themes. The first two themes (i) Relationship with Patient and (ii) Pharmacy environment were seen as facilitators, which, if supported by (iii) Training, could underpin the final three themes: (iv) Opportunities for contact, (v) Facilitated referral pathway and (v) Restricting access to means. The distinct lack of training should be overcome with evidence-informed training. Referral pathways should be clear and enable direct and accessible referral by community pharmacy teams. There are opportunities for existing pharmacy services and schemes to be adapted to maximise suicide and self-harm prevention activities. Pharmacy teams did not identify themselves to have a clear role in restricting access to medication.ConclusionsPharmacy teams already support patients in relation to self-harm and suicide, often relying on their personal experience in the absence of formal training. With the implementation of evidence-informed training and clear referral pathways, this could be done in a more effectively.

Perceived Roles of Independent Community Pharmacists and Pharmacy Technicians in Patient Referrals to Community Resources: A Study from the Medication Safety Research Network of Indiana (Rx-SafeNet).

Referrals to community resources represent one element of the Chronic Care Model, however, little is known about the perceived role of community pharmacy staff in referring patients to community resources. The objective of this study was to describe community pharmacists', community pharmacy technicians', and patients' perceptions of pharmacist referrals to community resources. Semi-structured interviews were conducted with community pharmacists, pharmacy technicians, and patients from community pharmacies that are members of the Medication Safety Research Network of Indiana (Rx-SafeNet). Qualitative analysis was conducted to identify emergent themes. A total of 37 participants, including six community pharmacists, one pharmacy student completing an advanced pharmacy practice experience, 15 community pharmacy technicians, and 15 patients across four independently-owned community pharmacies were interviewed. Themes included: 1) Need to build on a foundation of strong patient-community pharmacist relationships to clearly define the pharmacist's role in referrals, 2) Need to improve familiarity with community resources, 3) Need to clearly delineate and support the role for pharmacy technicians in making referrals, and 4) Need to follow-up on referrals. To enhance community pharmacy staff provision of referrals to community resources, interventions are needed to improve patient and pharmacist familiarity with available resources, patients' perception of the pharmacist's role outside of prescription fulfillment, and follow-up on referrals. Moreover, pharmacy technician education and training could be expanded to optimize their role in supporting community pharmacists in making referrals.

Experiences of the Pharmacy-Led Weight Management Service: Views of Service Providers in England.

Obesity constitutes one of the main modifiable risks of developing cardiovascular disease. In the UK, in 2016, 30% of the adult population were obese (30% of females and 29% of males). Community pharmacies are ideally situated to offer weight management (WM) services, enabling individuals to control and lose their excess weight. This study aimed at exploring the views of the pharmacy-led WM service providers in England. Semi-structured interviews were conducted with 15 trained community pharmacists and pharmacy staff—11 (73.3%) from Kent, three (20%) from Kingston and Richmond and one (6.7%) from Hackney and City—offering the WM service, either owning or working in independent pharmacies or for pharmacy chains. All interviews were audio-recorded, transcribed and anonymised. The analysis was conducted using thematic analysis. Three themes emerged: training and support, barriers and approach. Interestingly, service providers (SP) stated that obesity is a tough topic to talk about: they found it difficult to start a conversation about it, even if they had received training to facilitate this role. Additionally, several barriers for running such a service were identified, such as lack of time, too much work pressure and too little advertising, which could potentially lead to poor sustainability of the service. SPs can effectively intervene in an individual’s weight through the WM service that they offer. It is clear that further training should be provided in order for SPs to feel more comfortable in approaching and communicating with people and to increase the public’s awareness of the pharmacy-led WM service, so as to ensure the service’s sustainability.

The provision of advice by pharmacy staff in eastern Indonesian community pharmacies.

Background:Indonesian community pharmacies hold a strategic position from which to promote the rational use of medicines by providing appropriate advice for patients requesting self-medication. To date, published studies related to the provision of advice in Indonesian community pharmacies are limited and have been conducted only in more developed western Indonesia. No studies have been undertaken in eastern Indonesia, which is less developed than and culturally different from the western region.Objectives:This paper aims to: (1) describe the types and amount of advice provided by pharmacy staff for three scenarios in a patient simulation study and for two scenarios in pharmacy staff interviews; and (2) ascertain the frequency of appropriate advice given in response to the scenarios.Methods:A patient simulation study was conducted at community pharmacies in an eastern Indonesian provincial capital. Four weeks after completing a patient simulation study, structured interviews with pharmacy staff were conducted. Two cough scenarios and one diarrhoea scenario were developed for the patient simulation study. Meanwhile, two scenarios (an ACE inhibitor-induced cough and a common cough and cold) were developed for pharmacy staff interviews. The types and amount of advice provided by pharmacy staff were recorded on paper and assessed for its appropriateness. The determination of appropriate advice was based on the literature and by consensus of two Indonesian experts.Results:In patient simulation, the most common type of advice provided in all scenarios was product recommendations. In interviews, medical referrals and recommending cough and cold medicine were the most common types of advice provided for ACE inhibitor-induced cough and common cough and cold scenarios respectively. Appropriate advice was provided in less than 0.5% in the patient simulation study, but two-third of participants in the interviews responded to the scenarios appropriately.Conclusions:Pharmacy staff did not provide appropriate advice in practice, although they may have adequate knowledge. A contributing factor was insufficient information gathered in patient encounters. Optimising information-gathering practice by pharmacy staff is needed.

Community pharmacy staff interactions with patients who have risk factors or warning signs of suicide.

Little is known about community pharmacy staff members' interactions with patients at risk of suicide. To: 1) develop a measure to assess the frequency with which pharmacy staff encounter patients with suicide risk factors and warning signs; 2) to assess the measure's validity and reliability; and 3) describe pharmacy staff members' interactions with at-risk patients and their suicide prevention training preferences. A convenience sample of 501 community pharmacy staff members who worked in North Carolina completed an anonymous online survey. A 10-item measure (the Pharmacy Suicide Interaction Scale (PSIS)) assessed how often respondents encountered patients with suicide risk factors or warning signs, and one open-ended question elicited barriers to interacting with these patients. Psychometric analyses, including an exploratory factor analysis, were performed to examine the validity and reliability of the PSIS. Descriptive statistics were calculated, and responses to open-ended questions were analyzed thematically. The PSIS possessed two factors (or subscales): a non-verbal suicide warning signs and risk factors subscale (Cronbach's alpha = 0.79) and a verbal warning signs subscale (Cronbach's alpha = 0.67). Respondents who knew a patient who had died by suicide had higher mean scores on the non-verbal and verbal subscales, indicating that the PSIS had construct validity. Many respondents (22.4%) knew a patient who died by suicide, and 21.6% of respondents had patients request a lethal dose of medication. Interactions occurred both face-to-face and over the phone, and respondents most commonly reacted to patients by contacting others or offering emotional support. Few respondents (8.8%) had suicide prevention training or resources, but most (89.6%) desired additional training. Many community pharmacy staff members have interacted with patients who exhibited suicide warning signs or died by suicide. Suicide prevention training may help prepare pharmacy staff to recognize, communicate with, and refer at-risk patients.

A RCT evaluating a pragmatic in-hospital service to increase the quality of discharge prescriptions.

To improve discharge prescription quality and information transfer to improve post-hospital care with a pragmatic in-hospital service. A single-centre, randomized controlled trial. Internal medicine wards in a Swiss teaching hospital. Adult patients discharged to their homes, 76 each in the intervention and control group. Medication reconciliation at discharge by a clinical pharmacist, a prescription check for formal flaws, interactions and missing therapy durations. Important information was annotated on the prescription. At the time of medication dispensing, community pharmacy documented their pharmaceutical interventions when filling the prescription. A Poisson regression model was used to compare the number of interventions (primary outcome). The significance of the pharmaceutical interventions was categorized by the study team. Comparative analysis was used for the significance of interventions (secondary outcome). The community pharmacy staff performed 183 interventions in the control group, and 169 in the intervention group. The regression model revealed a relative risk for an intervention of 0.78 (95% CI 0.62-0.99, p = 0.04) in the intervention group. The rate of clinically significant interventions was lower in the intervention group than in the control group (72 of 169 (42%) vs. 108 of 183 (59%), p < 0.01), but more economically significant interventions were performed (98, 58% vs. 80, 44%, p < 0.01). The pragmatic in-hospital service increased the quality of prescriptions. The intervention group had a lower risk for the need for pharmaceutical interventions, and clinically significant interventions were less frequent. Overall, our pragmatic approach showed promising results to optimize post-discharge care.

Audit on the incidence &amp; management of drug-related hospital admissions for drug-induced gastro-intestinal bleeding.

The complex healthcare system that provides patients with medicines places them at risk when care is transferred between healthcare organisations, for example discharge from hospital. Consequently, understanding and improving medicines management, particularly at care transfers, is a priority.This study aimed to explore the medicines management system as patients experience it and determine differences in the patient-perceived importance of people in the system.We used a Social Network Analysis framework, collecting ego-net data about the importance of people patients had contact with concerning their medicines after hospital discharge. Single- and multi-level logistic regression models of patients' networks were constructed, and model residuals were explored at the patient level. This enabled us to identify patients' networks with support tie patterns different from the general patterns suggested by the model results. Qualitative data for those patients were then analysed to understand their differing experiences.Networks comprised clinical and administrative healthcare staff and friends and family members. Networks were highly individual and the perceived importance of alters varied both within and between patients. Ties to spouses were significantly more likely to be rated as highly important and ties to community pharmacy staff (other than pharmacists) and to GP receptionists were less likely to be highly rated. Patients with low-value medicines management networks described having limited information about their medicines and a lack of understanding or help. Patients with high-value networks described appreciating support and having confidence in staff.Patients experienced medicines management as individual systems within which they interacted with healthcare staff and informal support to manage their treatment. Multilevel models indicated that there are unexplained variables impacting on patients' assessments of their medicines management networks. Qualitative exploration of the model residuals can offer an understanding of networks that do not have the typical range of support ties.

Patient and Prescriber Characteristics Associated with the Use of Antidepressant Monotherapy in Pediatric Patients with Bipolar Disorder

The complex healthcare system that provides patients with medicines places them at risk when care is transferred between healthcare organisations, for example discharge from hospital. Consequently, understanding and improving medicines management, particularly at care transfers, is a priority.This study aimed to explore the medicines management system as patients experience it and determine differences in the patient-perceived importance of people in the system.We used a Social Network Analysis framework, collecting ego-net data about the importance of people patients had contact with concerning their medicines after hospital discharge. Single- and multi-level logistic regression models of patients' networks were constructed, and model residuals were explored at the patient level. This enabled us to identify patients' networks with support tie patterns different from the general patterns suggested by the model results. Qualitative data for those patients were then analysed to understand their differing experiences.Networks comprised clinical and administrative healthcare staff and friends and family members. Networks were highly individual and the perceived importance of alters varied both within and between patients. Ties to spouses were significantly more likely to be rated as highly important and ties to community pharmacy staff (other than pharmacists) and to GP receptionists were less likely to be highly rated. Patients with low-value medicines management networks described having limited information about their medicines and a lack of understanding or help. Patients with high-value networks described appreciating support and having confidence in staff.Patients experienced medicines management as individual systems within which they interacted with healthcare staff and informal support to manage their treatment. Multilevel models indicated that there are unexplained variables impacting on patients' assessments of their medicines management networks. Qualitative exploration of the model residuals can offer an understanding of networks that do not have the typical range of support ties.

Is ward round participation by clinical pharmacists a valuable use of time and money? A time and motion study

Dispensing antibiotics without a prescription, although forbidden by Sri Lankan law since 1986, is a common practice throughout the country. This study attempted to quantify this practice for the first time.To evaluate the response of community pharmacy staff to an antibiotic product request without a prescription and to explore possible factors influencing such practice.A cross-sectional simulated client study was conducted from Jan to Sept 2017. A total of 242 community pharmacies were visited by trained simulated clients (SCs) and they requested for one of four antibiotics (erythromycin tablets, amoxicillin syrup, metronidazole tablets, or ciprofloxacin tablets) without a prescription. Data on the interaction between the pharmacy staff and SC was recorded using a data collection sheet immediately after each visit.Nearly 50% of pharmacies had a pharmacist on duty during the visit. Attending pharmacy staff asked for a prescription for the requested antibiotic in 47% of the instances. Only 16 (7%) pharmacy staff recommended the SC to see a doctor. Overall, 61% of pharmacies dispensed antibiotics without a prescription. The highest dispensed antibiotic was ciprofloxacin (44/63 requests; 70%) and the least was amoxicillin (32/62; 52%). Patient history was obtained in only a few instances and none of the pharmacies dispensed alternative over the counter medicines. The availability of a pharmacist reduced the risk of dispensing an antibiotic without a prescription (Adj. OR = 0.54, 95% CI: 0.30–0.95; P = 0.033), however, it did not have any impact on patient history taking.Dispensing antibiotics without a prescription is a common practice in Sri Lankan community pharmacies. In most instances, pharmacy staff neither inquired about patient history nor requested the patient to obtain the advice of a doctor. Presence of a pharmacist may reduce dispensing antibiotics without prescription, but may not have an effect on interactions with clients requesting antibiotics.

A cross-sectional national survey of community pharmacy staff: Knowledge and antibiotic provision.

BackgroundPharmacists’ knowledge about the clinical and legal aspects of antibiotic supply has an impact on appropriate dispensing practice. There are limited studies evaluating community pharmacists’ knowledge of antibiotic dispensing in low and middle-income countries, including Sri Lanka. We aimed (i) to evaluate community pharmacy staff’s self-reported knowledge about antibiotics and dispensing behaviour of antibiotics without a prescription, and (ii) to identify possible factors impacting their antibiotic dispensing behaviour.MethodsA cross-sectional survey was conducted among a random sample (n = 369) of community pharmacies across all nine provinces in Sri Lanka using a self-administered questionnaire on their antibiotic knowledge and dispensing practice. Data were analysed using descriptive and inferential statistics including; t-test, one-way ANOVA or chi-square test, and binary and multiple logistic regression.ResultsA total of 265 pharmacy staff (210 (79%) pharmacists and 55 (21%) assistants) responded. Overall mean antibiotic knowledge score was 26.1 (SD 3.9; range 1–33, max possible score 34). The overall mean knowledge score t(263) = 2.41, p = 0.017, specific knowledge about antibiotic resistance (ABR) t(262) = 4.98, p = 0.021 and legal aspects of antibiotic dispensing χ2(1, N = 265) = 8.55, p = 0.003) were significantly higher among pharmacists than assistants. One in every three pharmacy staff reported that they dispensed antibiotics without a prescription on patient request; however the proportion was close to half when the patient was known to them. About 30% of the staff reported to have supplied antibiotics for minor infections in the week prior to the survey. However, there was no significant difference in the supply between pharmacists and assistants except for acute sore throat (12% vs 23%, respectively; p = 0.040). Those pharmacists with higher ABR knowledge were less likely to give out antibiotics without a prescription for viral infections in adults (Adj. OR = 0.73, 95% CI: 0.55–0.96; p = 0.027) and children (Adj. OR = 0.55, 95% CI: 0.38–0.80; p = 0.002). Awareness of legal aspects of antibiotic supply reduced overall dispensing (Adj. OR = 0.47, 95% CI: 0.30–0.75; p = 0.001), and specifically for bacterial infections in adults (Adj. OR = 0.45, 95% CI: 0.20–0.99; p = 0.047). Knowledge about antibiotic use and misuse reduced the likelihood of illegal dispensing for common cold (Adj. OR = 0.75, 95% CI: 0.60–0.94; p = 0.011) and acute diarrhoea (Adj. OR = 0.76, 95% CI: 0.58–0.99; p = 0.048).ConclusionDespite the law prohibiting provision, antibiotic dispensing without a prescription continues in community pharmacies in Sri Lanka. Appropriate antibiotic dispensing was associated with high levels of pharmacists’ legal and clinical knowledge about antibiotics. Strategies to change the current practice are urgently needed.

Unavailable prescriptions at Danish community pharmacies: A descriptive study.

Background Handling of unavailable prescriptions, i.e. prescriptions missing on the online server, is considered troublesome and time-consuming by community pharmacy staff and may result in both patient dissatisfaction and non-compliance. Objective To describe the occurrence and reasons for unavailable prescriptions at Danish community pharmacies as well as the types of drugs involved. Method An online 11-item questionnaire was developed and distributed to 24 community pharmacies across Denmark which each collected data on unavailable prescriptions handled within a 3-week period. Results Out of 194,358 prescriptions dispensed during the study period, a total of 2765 (1.4%) unavailable prescriptions were registered. Of these, 51.1% (n = 1412) occurred when a patient expected a new prescription after having consulted a physician, most often the patient's general practitioner (75.6%; n = 1067). Of all unavailable prescriptions, 68.1% (n = 1882) concerned prescriptions on regular drugs for treatment of a chronic condition, with the patient not having any medication left in 27.9% (n = 526) of these cases. Unavailable prescriptions most frequently concerned cardiovascular drugs (15.8%; n = 437) followed by nervous system drugs (14.4%; n = 399). Conclusion Unavailable prescriptions occur in approximately 1% of all dispensing at Danish community pharmacies. Miscommunication between the patient and general practitioner seems to be the primary source of unavailable prescriptions.

Community pharmacy staff\u2019s response to symptoms of common infections: a pseudo-patient study

BackgroundInappropriate over-the-counter supply of antibiotics in pharmacies for common infections is recognised as a source of antibiotic misuse that can worsen the global burden of antibiotic resistance.ObjectivesTo assess responses of community pharmacy staff to pseudo-patients presenting with symptoms of common infections and factors associated with such behaviour.MethodsA cross-sectional pseudo-patient study was conducted from Jan-Sept 2017 among 242 community pharmacies in Sri Lanka. Each pharmacy was visited by one trained pseudo-patient who pretended to have a relative with clinical symptoms of one of four randomly selected clinical scenarios of common infections (three viral infections: acute sore throat, common cold, acute diarrhoea) and a bacterial uncomplicated urinary tract infection. Pseudo-patients requested an unspecified medicine for their condition. Interactions between the attending pharmacy staff and the pseudo-patients were audio recorded (with prior permission). Interaction data were also entered into a data collection form immediately after each visit.ResultsIn 41% (99/242) of the interactions, an antibiotic was supplied illegally without a prescription. Of these, 66% (n = 65) were inappropriately given for the viral infections. Antibiotics were provided for 55% of the urinary tract infections, 50% of the acute diarrhoea, 42% of the sore throat and 15% of the common cold cases. Patient history was obtained in less than a quarter of the interactions. In 18% (44/242) of the interactions staff recommended the pseudo-patient to visit a physician, however, in 25% (11/44) of these interactions an antibiotic was still dispensed. Pharmacy staff advised the pseudo-patient on how to take (in 60% of the interactions where an antibiotic was supplied), when to take (47%) and when to stop (22%) the antibiotics supplied. Availability of a pharmacist reduced the likelihood of unlawful antibiotic supply (OR = 0.53, 95% CI: 0.31–0.89; P = 0.016) but not appropriate practice.ConclusionsIllegal and inappropriate dispensing of antibiotics was evident in the participating community pharmacies. This may be a public health threat to Sri Lanka and beyond. Strategies to improve the appropriate dispensing practice of antibiotics among community pharmacies should be considered seriously.

Exploring oral healthcare management across Australian community pharmacies using case vignettes.

In Australia, more than 80% of pharmacists and pharmacy assistants are consulted for oral healthcare advice up to five times or more each week. This study assesses Australian community pharmacy staff's (pharmacists and pharmacy assistants) ability to recognize and manage common oral health presentations using case vignettes, and determine whether appropriate identification and management are associated with self-reported confidence. Five oral healthcare case vignettes were developed based on previous literature by a multidisciplinary team of dental and pharmacy practitioner academics. Topics included pulpitis, gingivitis, oral hygiene advice for a toddler, a mouth ulcer and a dry mouth scenario. Pharmacies were randomly selected from each Australian State and Territory and community pharmacy staff invited to complete the case vignettes. A total of 312 and 932 case vignettes were completed by pharmacy assistants and pharmacists, respectively. Approximately one-third of staff appropriately identified a non-healing mouth ulcer and up to 16% recognized a pulpitis (inflamed dental pulp) presentation. Provision of best practice or evidence-based recommendations were reported in up to 28%, 19%, 57% and 31% of pharmacy staff offering appropriate advice and guidance for pulpitis, gingivitis, a non-healing mouth ulcer and oral health promotion messages, respectively. No participants provided all best practice recommendations for drug-induced xerostomia. In all five vignettes, confidence was not associated with best practice recommendations and was only modestly associated with improved rates for recognizing gingivitis symptoms. To allow community pharmacists and assistants to fulfil their role as important members of the oral healthcare team, additional training and support are required to facilitate improved recognition of common oral health presentations and to offer recommendations which are in line with current best practice guidelines.

Can Pharmacists Fill the Primary Care Provider Gap in Recommending Breast Screening?

Background and context: BreastScreen Victoria (BSV) provides free breast screening to women aged 40+, targeting women aged 50-74. The program reduces breast cancer deaths by up to 28%. Primary care is important in improving uptake of breast screening. In particular, a recommendation from a health professional is a strong influencer. Many general practitioners (GPs) recommend screening, however, it is important to expand recruitment to other health professionals given many women do not visit a GP regularly. Community pharmacists and pharmacy staff may be a trusted source of health information, and are potentially an underutilized opportunity to promote breast screening to women. Based on this gap, BSV developed a three month pharmacy-based screening awareness campaign that was trialed in community pharmacies throughout 2017/18. The campaign is based on a UK community pharmacy model that was shown to successfully increase public awareness about cancer screening. Aim: BSV aims to diversify the types of health professionals that recommend screening to reach women who do not visit a GP regularly. The aim of the pharmacy-based breast screening awareness campaign is to: • build capacity of pharmacy staff to deliver breast screening messages to their communities • increase awareness of breast screening in women aged 50-74 • increase awareness of breast screening among family and friends of women Strategy/Tactics: BSV's pharmacy-based breast screening awareness campaign was trialed in 4 community pharmacies in 2017. Each pharmacy received a grant of up to $1550 which enabled them to: • allow pharmacy staff to attend training to increase their knowledge of breast screening and the campaign • display BreastScreen collateral throughout the store to provide information and prompt queries • initiate conversations and answer questions about breast screening • monitor campaign activity via a number of methods Outcomes: • Posttraining, 100% of staff were confident in promoting breast screening to customers • Staff across 4 pharmacies had 638 conversations about breast screening with customers (average 160/pharmacy). The majority were with women in the target age group • Most pharmacies suggested shortening the campaign to 2 months • All pharmacies said the funding was a critical motivator to participation • All pharmacies stated that the campaign was worthwhile, and allowed them to participate in health promotion Two additional trials are scheduled to test a reduced campaign duration and funding model. Results will be available later in 2018 What was learned: • Many women do not visit their GP regularly • Community pharmacists and pharmacy staff are an underutilized opportunity to promote breast screening • Delivering cancer screening messages through community pharmacies is an effective way to reach women aged 50-74 • Pharmacy funding and training are critical in enabling pharmacies to deliver a breast screening awareness campaign

Investigating the management of potentially cancerous nonhealing mouth ulcers in Australian community pharmacies

We sought to examine the management and referral of nonhealing mouth ulcer presentations in Australian community pharmacies in the Greater Brisbane region. Trained simulated patients visited 220 randomly selected community pharmacies within the Greater Brisbane region in 2016. Simulated patients enacted two nonhealing (>1month) mouth ulcer scenarios: A direct product request (DPR) (n=110) and a symptom-based request (SBR) (n=110). Results were documented and evaluated against Australian national pharmacy practice standards. Referral rates for pharmacy staff (pharmacist, pharmacy assistant or mixed-pharmacist and assistant) were also assessed. Australian pharmacy practice standards recommend staff ask six key questions during SBR and DPR consultations to enable informed decision-making. Two questions relating to identifying the patient and their symptoms were asked in the majority of interactions (76% and 69% respectively); the remaining four questions relating to symptom duration, treatments tried, other medications, and medical conditions were enquired in only 32%, 53%, 31%, and 27% of interactions, respectively. Simulated patients were referred to the doctor/dentist in only 11.8% of all interactions (both scenarios requiring referral). Overall, staff handling of nonhealing mouth ulcer consultations was suboptimal compared to national professional standards. In particular, duration of the nonhealing mouth ulcer was enquired in less than one-third of consultations potentially resulting in low referral rates by staff. This study identifies the need for increased oral cancer awareness and education for community pharmacy staff and reinforcing the importance of practising according to professional standards to effectively screen for potentially cancerous nonhealing mouth lesions.

Developing recommendations for the safe handling of oral anti-cancer drugs in community pharmacies: A pan-Canadian consensus approach.

To create a set of consensus-based and evidence-informed recommendations to provide guidance around the safe dispensing and handling of oral anti-cancer drugs in low-volume settings unique to the community pharmacy setting. A review of published and grey literature (published in non-commercial domains such as national organizations and associations) documents and nine key informant interviews were conducted and a modified Delphi approach was taken to achieve consensus. The final list of 47 candidate recommendations was reviewed by a task force and validated by multi-disciplinary stakeholders. A draft of the statements was circulated broadly within the community pharmacy community in an effort to assess relevance and implementation feasibility. The final report included 44 recommendations that addressed 11 key areas germane to the safe handling of oral anti-cancer drugs in community pharmacies. Mean agreement increased from 70% to 95%. Early feedback from community pharmacy leaders during the external review suggests that many of the proposed recommendations can be feasibly implemented within a reasonable timeframe when released with appropriate education and resource materials. A modified-Delphi approach supplemented by key informant interviews and a comprehensive external review resulted in a set of evidence-informed, community-driven recommendations for community pharmacies. The recommendations address a gap in existing literature to improve understanding of the risks associated with handling and dispensing oral anti-cancer drugs for both community pharmacy staff and management and offer mitigating strategies to reduce those risks. Incorporating feasibility assessment actions early (through the key informant interviews) and late (through the external review) ensures recommendations are grounded in practicality and support broad and early knowledge translation strategies.

Reducing pharmacy patient waiting time

PurposePharmacy services start right from prescribing medicines and continue as the medication’s effect is monitored. Hospital and community pharmacy staff promote rational prescribing and medicine use. Consequentially, pharmacy is a complex and busy field. Often there are peak workload hours when patients must wait, which is associated with patient dissatisfaction that may negatively affect patient experience and the organisation’s reputation. The purpose of this paper is to enlist techniques, methods and technological advancements that have been successfully employed to reduce patient waiting time.Design/methodology/approachA database search was conducted in 2017 to locate articles addressing methods and technologies that reduce pharmacy waiting time. The literature revealed various techniques and technologies like queuing theory, tele-pharmacy, evidence-based pharmacy design, automated pharmacy systems (robotics), system modelling and simulation and the Six Sigma method for identifying potential problems associated with increased wait time.FindingsThe authors conclude that various techniques and methods, including automated queuing technology, tele-pharmacy, automated pharmacy devices/machines for quick and accurate filling and dispensing, computer simulation modelling, evidence-based pharmacy infrastructure for smooth workflow and Six Sigma can maintain customer satisfaction, reduce waiting time, attract new customers, decrease workload and improve the organisation’s reputation.Practical implicationsThe authors conclude that various techniques and methods, including automated queuing technology, tele-pharmacy, automated pharmacy devices/machines for quick and accurate filling and dispensing, computer simulation modelling, evidence-based pharmacy infrastructure for smooth workflow and Six Sigma methodology can maintain customer satisfaction, reduce waiting time, attract new customers, decrease workload and improve the organisation’s reputation.Originality/valueThe authors carried out a literature search and identified the techniques that have been successfully implemented to reduce pharmacy patient waiting time and methods that can identify potential process behind medication dispensation delays.

How community pharmacy customers and staff perceive prescription encounters at the pharmacy counter

How community pharmacy customers and staff perceive prescription encounters at the pharmacy counter

Antibiotic dispensing practice in community pharmacies: A simulated client study.

Dispensing antibiotics without a prescription, although forbidden by Sri Lankan law since 1986, is a common practice throughout the country. This study attempted to quantify this practice for the first time. To evaluate the response of community pharmacy staff to an antibiotic product request without a prescription and to explore possible factors influencing such practice. A cross-sectional simulated client study was conducted from Jan to Sept 2017. A total of 242 community pharmacies were visited by trained simulated clients (SCs) and they requested for one of four antibiotics (erythromycin tablets, amoxicillin syrup, metronidazole tablets, or ciprofloxacin tablets) without a prescription. Data on the interaction between the pharmacy staff and SC was recorded using a data collection sheet immediately after each visit. Nearly 50% of pharmacies had a pharmacist on duty during the visit. Attending pharmacy staff asked for a prescription for the requested antibiotic in 47% of the instances. Only 16 (7%) pharmacy staff recommended the SC to see a doctor. Overall, 61% of pharmacies dispensed antibiotics without a prescription. The highest dispensed antibiotic was ciprofloxacin (44/63 requests; 70%) and the least was amoxicillin (32/62; 52%). Patient history was obtained in only a few instances and none of the pharmacies dispensed alternative over the counter medicines. The availability of a pharmacist reduced the risk of dispensing an antibiotic without a prescription (Adj. OR = 0.54, 95% CI: 0.30-0.95; P = 0.033), however, it did not have any impact on patient history taking. Dispensing antibiotics without a prescription is a common practice in Sri Lankan community pharmacies. In most instances, pharmacy staff neither inquired about patient history nor requested the patient to obtain the advice of a doctor. Presence of a pharmacist may reduce dispensing antibiotics without prescription, but may not have an effect on interactions with clients requesting antibiotics.