Medicine Advice Research Articles

Development of a questionnaire to measure consumers' perceptions of service quality in community pharmacies.

Recent changes within community pharmacy have seen a shift towards some pharmacies providing "value-added" services. However, providing high levels of service is resource intensive yet revenues from dispensing are declining. Of significance therefore, is how consumers perceive service quality (SQ). However, at present there are no validated and reliable instruments to measure consumers' perceptions of SQ in Australian community pharmacies. The aim of this study was to build a theory-grounded model of service quality (SQ) in community pharmacies and to create a valid survey instrument to measure consumers' perceptions of service quality. Stage 1 dealt with item generation using theory, prior research and qualitative interviews with pharmacy consumers. Selected items were then subjected to content validity and face validity. Stages 2 and 3 included psychometric testing among English-speaking adult consumers of Australian pharmacies. Exploratory factor analysis was used for item reduction and to explain the domains of SQ. In stage 1, item generation for SQ initially generated 113 items which were then refined, through content and face validity, down to 61 items. In stage 2, after subjecting the questionnaire to psychometric testing on the data from the first pharmacy (n = 374), the use of the primary dimensions of SQ was abandoned leaving 32 items representing 5 domains of SQ. In stage 3, the questionnaire was subject to further testing and item reduction in 3 other pharmacies (n = 320). SQ was best described using 23 items representing 6 domains: 'health and medicines advice', 'relationship quality', 'technical quality', 'environmental quality', 'non-prescription service', and 'health outcomes'. This research presents a theoretically-grounded and robust measurement scale developed for consumer perceptions of SQ in a community pharmacy.

Gathering tips from carers to support people with dementia: an adaptation of the TOP 5 program for community use.

Behavioral and psychological symptoms of dementia are often managed inappropriately with antipsychotic medicines. The TOP 5 program, which involves recording up to five relevant and meaningful tips that assist in personalizing care for the person with dementia, has been tested in the hospital setting and transitions of care in Australia, and has been found to be useful. Our study aimed to adapt the TOP 5 program as a strategy to support people with dementia in a primary care setting and to test the acceptability of our adapted TOP 5 program materials. The adapted TOP 5 program materials were delivered as part of a larger intervention by the Australian Government Department of Veterans' Affair's Veterans' Medicines Advice & Therapeutic Education Services program to reduce inappropriate antipsychotic use in veterans with dementia. This study focuses on the acceptability of our adapted TOP 5 program materials for ascertaining carer or family members' advice about what actions might help to calm their relative when she or he is agitated. Educational materials relating to the resources for implementing the adapted TOP 5 program together with the one-page survey response to evaluate acceptability of our adapted TOP 5 program materials were mailed to 4827 general practitioners (GPs), 8381 accredited pharmacists, and 2510 Residential Aged Care Facilities. We received survey response forms from 350 (7%) GPs, 366 (4%) pharmacists, and 196 (8%) residential aged care facilities. Although the response rate was low, 90% of respondents in all groups indicated they were very likely or moderately likely to assist family members and carers of patients with dementia to identify their top tips to personalize care. GPs who found the information useful more frequently indicated that they were likely to assist family members and carers in identifying their top tips. Approximately one-third of respondents reported they had received positive feedback from families regarding the helpfulness of sharing their practical tips for care of their loved one. Pharmacists indicated having the tips would assist them when undertaking medicines reviews. Our findings suggest that the TOP 5 program, or an adaptation of the TOP 5 program, such as ours, has potential to improve the health and care of people with dementia and their carers by using patient centerd nonpharmacological approaches and avoiding the unnecessary use of antipsychotics for behavioral and psychological symptoms of dementia. Longer-term follow-up would help to establish whether the apparent benefits persist.

Sustaining practice change in health care: the impact of a national quality improvement program on the uptake of collaborative medicines reviews

AbstractAimWe evaluated the impact of quality improvement interventions at different time points on the uptake of collaborative Home Medicines Reviews (HMRs).MethodsNational interventions to promote HMRs, comprising patient‐specific prescriber feedback and tailored educational materials for patients and clinicians, were conducted in 2004, 2006 and 2011 through the Veterans’ Medicines Advice and Therapeutics Education Services (Veterans’ MATES) program. Primary care patients taking multiple medicines were targeted in each intervention, while primary care patients taking multiple medicines who did not receive the intervention served as comparisons. Monthly HMR rates among targeted patients and a comparison group in the 9 months post‐intervention were determined using health claims data from the Australian Government Department of Veterans’ Affairs and compared using log binomial regression models. Overall trends in the rate of HMRs between November 2001 and December 2016 were also determined.ResultsOver 40 000 patients were targeted in each HMR intervention. Relative increases in HMR uptake were observed among patients targeted in the 2004 intervention (rate ratio (RR) 1.76 (1.39, 2.22), p < 0.0001), the 2006 intervention (RR 1.45 (1.19, 1.76), p = 0.0002) and the 2011 intervention (RR 2.81 (2.34, 3.37), p < 0.0001) compared to the comparison group. Overall, the monthly HMR rate increased from 0.2 per 1000 patients in November 2001 to 2.7 per 1000 patients in December 2012.ConclusionRegular repetition of quality improvement messages has led to sustained increases in HMR uptake among Australian veterans over the last decade.

Preventing diseases in round-the-world travelers: a contemporary challenge for travel medicine advice.

Providing advice for travelers embarking on long-term trips poses a challenge in travel medicine. A long duration of risk exposure is associated with underuse of protective measures and poor adherence to chemoprophylaxis, increasing the chances of acquiring infections. Recently, in our clinic, we observed an increase in the number of travelers undertaking round-the-world trips. These individuals are typically aged around 32 years and quit their jobs to embark on one-to-two-year journeys. Their destinations include countries in two or more continents, invariably Southeast Asia and Indonesia, and mostly involve land travel and visiting rural areas. Such trips involve flexible plans, increasing the challenge, especially with regard to malaria prophylaxis. Advising round-the-world travelers is time-consuming because of the amount of information that must be provided to the traveler. Advisors must develop strategies to commit the traveler to his/her own health, and verify their learnings on disease-prevention measures. Contacting the advisor after the appointment or during the trip can be helpful to clarify unclear instructions or diagnosis made and prescriptions given abroad. Infectious diseases are among the most frequent problems affecting travelers, many of which are preventable by vaccines, medicines, and precautionary measures. The dissemination of counterfeit medicines, particularly antibiotics and antimalarial medicines, emphasizes the need for travelers to carry medicines that they may possibly need on their trip. Additional advice on altitude, scuba diving, and other possible risks may also be given. Considering the difficulties in advising this group, we present a review of the main recommendations on advising these travelers.

Targeted cancer therapies: Oral health care implications

BackgroundTargeted treatments have been incorporated into oncology protocols, often with more traditional therapies, and are not totally free of adverse reactions, some of which affect the orofacial region. MethodsThe authors searched PubMed, the Cochrane Library, and the US Food and Drug Administration Approved Drug Products database to identify reported adverse effects of targeted agents in the orofacial region as well as other implications in oral health care. Their principal focus was the relatively newer category of molecularly targeted drugs which are called small molecules (SMs). ResultsThe authors identified several categories of SMs and biological agents (for example, monoclonal antibodies) with adverse effects in the orofacial region. The oral and perioral regions are also fields for which there are therapeutic applications for targeted therapies, particularly to treat malignant neoplasms such as head and neck cancers. ConclusionsSMs are the most rapidly growing group of targeted cancer treatments. Patients receiving SMs and other targeted antineoplastic agents may require oral medicine advice and special-care dentistry. Practical ImplicationsIn this narrative review, the authors focus mainly on the orofacial adverse effects of targeted cancer therapies and outline many of the agents that are in use so the dentally focused reader can familiarize themselves with these adverse effects and agents.

PROTECTING, BALANCING, AND CONFRONTING: HEALTH-SEEKING AMONG HOMELESS YOUTH IN HO CHI MINH CITY, VIETNAM

The objective of this study was to explore health-seeking behaviors and barriers faced in accessing care among homeless youth living in Ho Chi Minh City, Vietnam. Twelve in-depth interviews were conducted with homeless youth aged 18 to 25. Participants were identified using purposive sampling. Data were analyzed using constructivist grounded theory techniques. Interviews with youth revealed that while living on the streets, they had to balance their need for security with attending to their daily survival needs, which led to a disconnection from thinking about their health. When faced with a major health issue, youth turned to their informal networks of support instead of seeking immediate medical care. To manage their basic health needs, youth obtained medicine and health advice from local pharmacies and sought advice from social workers. Homeless youth interviewed in this study relied on an informal network of peers, social workers, and pharmacies when engaging with the health care system. They also faced several barriers to accessing health services, many of which are tied specifically to policies that make homelessness discriminated against in Vietnam. Within Vietnam’s unique political and social context, there is a need for increased collaboration between service providers such as health clinics, local pharmacies, and social workers to provide appropriate health services to this vulnerable population.

The quantified self during travel: mapping health in a prospective cohort of travellers.

Travel medicine research has remained relatively unchanged in the face of rapid expansion of international travel and is unlikely to meet health challenges beyond infectious diseases. Our aim was to identify the range of health outcomes during travel using real-time monitoring and daily reporting of health behaviours and outcomes and identify traveller subgroups who may benefit from more targeted advice before and during travel. We recruited a prospective cohort of travellers ≥ 18 years and planning travel to Thailand for <5 weeks from the travel clinics in Zurich and Basel (Switzerland). Participants answered demographic, clinical and risk behaviour questionnaires pre-travel and a daily health questionnaire each day during travel using a smartphone application. Environmental and location data were collected passively by GPS. Classification trees were used to identify predictors of health behaviour and outcomes during travel. Non-infectious disease events were relatively common, with 22.7% (17 out of 75 travellers) experiencing an accident, 40.0% ( n = 30) a wound or cut and 14.7% ( n = 11) a bite or lick from an animal. Mental health associated events were widely reported, with 80.0% ( n = 60) reporting lethargy, 34.7% ( n = 26) anxiety and 34.7% ( n = 26) feeling tense or irritable. Classification trees identified age, trip length, previous travel experience and having experienced a sports injury in the past year as the most important discriminatory variables for health threats. Our study offers a revolutionary look at an almost real-time timeline of health events and behaviours during travel using mHealth technology. Non-infectious disease related health issues were common in this cohort, despite being largely unaddressed in traditional travel medicine research and suggest a substantial potential for improving evidence-based travel medicine advice.

Study on effects of community-based management of hypertension patients aged ≥35 years and influencing factors in urban and rural areas of China, 2010

To understand the effects of standardized community-based management of hypertension in urban and rural areas in China and related influencing factors. The study subjects were the hypertension patients aged ≥35 years who were recruited in 2011 from the participants of 2010 national chronic and non-communicable disease surveillance project. The hypertension patients were diagnosed in community health centers or higher level hospitals and included in community based hypertension management project. By face-to-face questionnaire survey and health examination, the information of the subjects' demographic characteristics, risk factors, complications, involvement in community-based management of hypertension, anti-hypertension treatment, blood pressure, body height, waistline and body weight were collected. In this study, Rao-Scott χ(2) test was used to compare the variations among sub-groups. Taylor series linearization method was used to estimate the prevalence rate. The complex sampling and unconditional multivariate logistics regression analysis was conducted to identify the influencing factors for the control of hypertension. A total of 5 120 subjects were recruited in the analysis. The proportion of those receiving management for more than two years was 36.57%, and it was higher in urban area(44.56%)than in rural area(31.79%, P<0.05); In the past 12 months, 6.17% and 14.46% of the patients received no blood pressure measurement and drug therapy advice respectively, but there were no significant differences between urban group and rural group(P>0.05); In the past 12 months, the proportions of the patients receiving diet and physical activity advice were 84.25% and 84.90% respectively, and the proportions were higher in urban group than in rural group(P<0.05); In the past 12 months, the proportions of the subjects receiving tobacco and alcohol use advice were 78.41% and 77.80% respectively, and the proportions were higher in rural group than in urban group(P<0.05). In urban area, the subjects receiving standardized management had lower SBP(142.79±17.39)mmHg, lower DBP(84.26±9.49)mmHg and higher blood pressure control rate(49.77%)than those receiving no standardized management(P<0.05); while in rural area, no difference was found in BP control between the patients receiving and receiving no standardized management(P>0.05). In urban area, the influencing factors for BP control among the subjects receiving community based management were educational level, annual income, body weight, hypertension management mode, times of receiving BP measurement, times of receiving antihypertensive medicine advice and receiving physical activity advice; while in rural area, the influencing factors for BP control among the subjects receiving community based management were annual income, body weight, family history of hypertension, antihypertensive medicine awareness, times of receiving antihypertensive medicine advice and receiving diet advice. The effects of community-based standardized management of hypertension were better in urban area than in rural area, and the quality of the services of community-based hypertension management was lower in rural area than in urban area.

Positive influence of short message service and voice call interventions on adherence and health outcomes in case of chronic disease care: a systematic review.

BackgroundChronic diseases have emerged as a serious threat for health, as well as for global development. They endenger considerably increased health care costs and diminish the productivity of the adult population group and, therefore, create a burden on health, as well as on the global economy. As the management of chronic diseases involves long-term care, often lifelong patient adherence is the key for better health outcomes. We carried out a systematic literature review on the impact of mobile health interventions -mobile phone texts and/or voice messages- in high, middle and low income countries to ascertain the impact on patients’ adherence to medical advice, as well as the impact on health outcomes in cases of chronic diseases.MethodsThe review identified fourteen related studies following the defined inclusion and exclusion criteria, in PubMed, Cochrane Library, the Library of Congress, and Web Sciences. All the interventions were critically analysed according to the study design, sample size, duration, tools used, and the statistical methods used for analysing the primary data. Impacts of the different interventions on outcomes of interest were also analysed.ResultsThe findings showed evidence of improved adherence, as well as health outcomes in disease management, using mobile Short Message Systems and/or Voice Calls. Significant improvement has been found on adherence with taking medicine, following diet and physical activity advice, as well as improvement in clinical parameters like HbA1c, blood glucose, blood cholesterol and control of blood pressure and asthma.Conclusions Though studies showed positive impacts on adherence and health outcomes, three caveats should be considered, (i) there was no clear understanding of the processes through which interventions worked; (ii) none of the studies showed cost data for the m-health interventions and (iii) only short term impacts were captured, it remains unclear whether the effects are sustained. More research is needed in these three areas before drawing concrete conclusions and making suggestions to policy makers for further decision and implementation.

Provision of travel medicine advice through community pharmacies: assessment of knowledge, attitudes and practices of pharmacists in Malaysia.

The risk for travel-related illnesses has increased with significant growth in international travel, but very few travellers seek travel advice. Community pharmacists can play a vital role in the provision of travel medicine advice due to their accessibility. This study aimed to assess travel medicine knowledge, attitudes and practices (KAP) among community pharmacists in Kuala Lumpur, Malaysia. A self-administered KAP questionnaire was distributed to a convenience sample of pharmacists in Kuala Lumpur identified from the list of licensed community pharmacists in Malaysia year 2014. Questionnaires were returned by 111 pharmacists of 143 distributed (response rate, 78%). Most of the respondents (82%) were not trained in travel medicine. Overall, mean knowledge score was 4.4 ( ± 1.7), indicating a moderate level of knowledge on a variety of travel-related health issues. Community pharmacists who graduated from foreign universities possessed significantly higher knowledge scores than did those who graduated locally (P < 0.05). The majority had a positive attitude towards travel medicine. A vast majority provided travel medicine advice mainly to adults who travel as tourists, and the primary travel advice given was on traveller's diarrhoea. There are gaps in the knowledge and practice of travel medicine among Malaysian pharmacists. Positive attitudes of pharmacists towards travel medicine and appropriate interventions, such as incorporation of travel medicine in local pharmacy curricula, continuous pharmacy education or certified training may improve the quality of travel advice given and allow pharmacists to be recognised as a credible source of information on travel medicine.

The Medicines Advice Service Evaluation (MASE): a randomised controlled trial of a pharmacist-led telephone based intervention designed to improve medication adherence.

To test the effectiveness of a tailored, pharmacist-led centralised advice service to improve adherence to patients on established medications. A parallel group randomised controlled trial was conducted. Patients prescribed at least one oral medication for type 2 diabetes and/or lipid regulation were eligible to participate. 677 patients of a mail-order pharmacy were recruited and randomised (340 intervention, 337 control). The intervention comprised two tailored telephone consultations with a pharmacist, 4-6 weeks apart, plus a written summary of the discussion and a medicines reminder chart. The primary outcome was self-reported adherence to medication at 6-month follow-up, collected via a postal questionnaire, analysed using generalised estimating equations. Secondary outcomes included prescription refill adherence, lipid and glycaemic control and patient satisfaction. In intention-to-treat analysis 36/340 (10.6%) of the intervention group were non-adherent (<90% of medication taken in the past 7 days) at 6 months compared with 66/337 (19.6%) in the control group, yielding an unadjusted OR of 1.54 (95% CI 1.11 to 2.15, p=0.01). Analyses of dispensing data also showed that the odds of being classified as adherent (≥90%) were 60% greater for the intervention group compared with the control group (OR 1.60, 95% CI 1.14 to 2.24, p<0.01). In a subsample of patients who provided blood samples, glycaemic and lipid control did not differ significantly between groups (p=0.06 and p=0.24, respectively) but positive trends were observed. Ninety-two per cent of intervention group patients reported that they were satisfied with the service overall. A telephone intervention, led by a pharmacist and tailored to the individuals' needs, can significantly improve medication adherence in patients with long-term conditions, using a mail-order pharmacy. Further work is needed to confirm a trend towards improved clinical outcome. NCT01864239.

Mini-Medical School Programs' Influence on Students' Desire to Pursue Medicine

PurposeMini-Medical school programs have become an increasingly popular means of encouraging high-school students to consider medical professions. However, there is little research evaluating the long-term effect of these programs on influencing career choice. The purpose of our study was to determine the motivational factors for attending the Mini-Medical school programs at our institution, student satisfaction with their experience, and whether it impacts intended secondary education and career choices. MethodsAn online anonymous survey was distributed to Drexel University College of Medicine Mini-Medical school program graduates to determine factors influencing student participation and program satisfaction. ResultsThe most influential factors in attending the program were to confirm an interest in medicine (n = 55, 95%) and parental advice (n = 29, 50%). Most maintained an interest in medicine: 57% (n = 33) pursued a pre-med degree, 55% (n = 32) planned to apply to medical school within 3 years; and 12% (n = 7) were either in medical school or matriculating in the fall of 2015. 91% (n = 53) participants noted the program's influence on choosing a pre-med undergraduate track. ConclusionOur results suggest Mini-Medical school programs significantly impacted students' decision to pursue a medical career through fostering interest and effectively answering students' questions about the field.

Travel Medicine Encounters of Australian General Practice Trainees-A Cross-Sectional Study.

Travel medicine is a common and challenging area of clinical practice and practitioners need up-to-date knowledge and experience in a range of areas. Australian general practitioners (GPs) play a significant role in the delivery of travel medicine advice. We aimed to describe the rate and nature of travel medicine consultations, including both the clinical and educational aspects of the consultations. A cross-sectional analysis from an ongoing cohort study of GP trainees' clinical consultations was performed. Trainees contemporaneously recorded demographic, clinical, and educational details of consecutive patient consultations. Proportions of all problems/diagnoses managed in these consultations that were coded "travel-related" and "travel advice" were both calculated with 95% confidence intervals (CIs). Associations of a problem/diagnosis being "travel-related" or "travel advice" were tested using simple logistic regression within the generalized estimating equations (GEE) framework. A total of 856 trainees contributed data on 169,307 problems from 108,759 consultations (2010-2014). Travel-related and travel advice problems were managed at a rate of 1.1 and 0.5 problems per 100 encounters, respectively. Significant positive associations of travel-related problems were younger trainee and patient age; new patient to the trainee and practice; privately billing, larger, urban, and higher socioeconomic status practices; and involvement of the practice nurse. Trainees sought in-consultation information and generated learning goals in 34.7 and 20.8% of travel advice problems, respectively, significantly more than in non-travel advice problems. Significant positive associations of travel advice problems were seeking in-consultation information, generation of learning goals, longer consultation duration, and more problems managed. Our findings reinforce the importance of focused training in travel medicine for GP trainees and adequate exposure to patients in the practice setting. In addition, our findings have implications more broadly for the delivery of travel medicine in general practice.

On-call hospital pharmacy services in NHS England: service provision and documentation of medicines advice calls

ObjectivesUK hospital pharmacy services have historically been delivered during typical ‘office’ hours, which include the provision of medicines advice via the pharmacy's medicines information department. Outside office hours, an on-call...

Detection of a negative correlation between prescription of Chinese herbal products containing coumestrol, genistein or daidzein and risk of subsequent endometrial cancer among tamoxifen-treated female breast cancer survivors in Taiwan between 1998 and 2008: A population-based study

Ethnopharmacological relevanceTamoxifen users sometimes seek complementary and alternative medicine advice for treatment of a variety of illness and co-administer with phytoestrogen-containing herbs, resulting in an increasing concern of its influence in subsequent endometrial cancer risk. Our study aims to determine the prevalence of Chinese herbal products containing coumestrol, genistein, or daidzein and their association with subsequent endometrial cancer risk among tamoxifen-treated breast cancer survivors in Taiwan. MethodsWe selected all patients who were newly diagnosed with invasive breast cancer and received tamoxifen treatment between January 1, 1998, and December 31, 2008, from the National Health Insurance Research Database. Among the 26,656 tamoxifen-treated breast cancer survivors, we evaluated the usage, frequency of service, and prescription of Chinese herbal products containing coumestrol, genistein, or daidzein. The logistic regression method was employed to calculate the odds ratios for utilization of those herbal products. Cox proportional hazard regression was set to calculate the hazard ratios of endometrial cancer associated with such usage. ResultsOf the patients surveyed, 36.2% (n=9652) of the tamoxifen-treated breast cancer survivors examined in the study had consumed Chinese herbal products containing coumestrol, genistein, or daidzein during the study period. Exposure to Ge Gen(Puerariae Radix) specifically was the most extensive. For it, the population consumed an average cumulative dose of above 180g. Compared to those who had never used Chinese herbal products, breast cancer survivors who had taken Chinese herbal products containing coumestrol, genistein, or daidzein concurrently with tamoxifen treatment did not have a higher hazard ratio for subsequent development of endometrial cancer. ConclusionAmong those tamoxifen-treated female breast cancer survivors in Taiwan, consumption of Chinese herbal products containing coumestrol, genistein, or daidzein is negatively correlated with subsequent endometrial cancer risk.

Access to medicines in remote and rural areas: a survey of residents in the Scottish Highlands & Western Isles

ObjectivesSparsely populated areas are potentially predisposed to health inequalities due to limited access to services. This study aimed to explore and describe issues of access to medicines and related advice experienced by residents of the Scottish Highlands and Western Isles. Study designCross-sectional cohort study. MethodsAnonymized questionnaires were mailed to a random sample of 6000 residents aged ≥18 years identified from the electoral register. The questionnaire contained items on: access to medicines; interactions with health care services; and perceptions of the services. Results were analysed using descriptive, inferential and spatial statistics. ResultsAdjusted response rate was 49.5% (2913/5889). Almost two thirds (63.4%, 1847) were prescribed medicines regularly, 88.5% (1634) of whom considered the source convenient. Pharmacy (73.8%, 1364) or dispensing GP (24.0%, 443) were the most accessed sources. Prescription medicine advice was mainly obtained from the GP (55.7%, 1029). Respondents ≥80 years old were significantly (P < 0.0001) more likely to live alone (45.3%, 92) compared with those <80 (15.8%, 424). Almost a fifth (16.5%, 31) of those >80 years living alone disagreed that they obtained prescribed medicines from a convenient source. The majority of respondents who felt they did not have a convenient medicines source, regardless of urban/rural classification, lived within five miles of a pharmacy or GP practice. ConclusionsRespondents accessed medicines and advice from a variety of sources. While most considered their access to medicines convenient, there were issues for those over 80 years and living alone. Perceived convenience would not appear to be solely based on geographical proximity to supply source. This requires further exploration given that these individuals are likely to have long-term conditions and be prescribed medicines on a chronic basis.

What effect does medicine advice provided by UK Medicines Information pharmacists have on prescriber practice and patient care: a qualitative primary care study.

UK Medicines Information (UKMI) is pharmacist-led service funded by the National Health Service providing evidence-based advice about medicines to health care professionals. Service evaluations have repeatedly shown high user satisfaction but few studies have assessed how this advice influences the care patients receive. Furthermore, no study has assessed how prescribers actually use this information in shaping their decision making. The aim was to explore how UKMI advice influences prescriber decision making and patient care. Doctors and dentists (referred to as prescribers) working in primary care in England and Wales who received reactive medicines advice from a medicines information centre were contacted by telephone to determine how they used the advice provided. Forty semi-structured interviews were analysed and coded using constant comparative content analysis. Five key themes were identified that affected prescriber decision making, these were: prescriber action, patient outcome, medicines information advice, risk management and time factors. Prescribers acted directly on the advice provided enabling them to provide the right care for their patients. Advice had a positive effect on how they viewed a medication problem and empowered them to make decisions that appeared to confer greater confidence in managing patient problems. A favourable patient outcome was described by over half of the prescribers, for example, the advice enabled them to provide patient reassurance, avoid a potential allergic reaction, stabilize the patient's condition or stop treatment. Medicines information advice empowered prescribers in helping them to make decisions about medicines that shaped patient care.

Gaps in Utilizing Traveller Health Services in Dubai, Policies, Practises and Protocols

Background: International travel can pose various risks to health, depending on the characteristics of both the traveller and the travel. Travellers may encounter sudden and significant changes in altitude, humidity, microbes, and temperature, which can result in ill health. In addition, serious health risks may arise in areas where accommodation is of poor quality, hygiene and sanitation are inadequate, medical services are not well developed and clean water is unavailable. Objective: To assess knowledge, attitude and practice towards travel health among Dubai’s travellers traveling abroad. Methods: A cross sectional survey was carried out in Jebel Ali Free zone‘s companies employees where on line self- administrated questionnaire has been distributed to the employees of randomly selected 20 companies. 162 responses were collected. Results: The study showed that only 22.8% of respondents had sought pre-travel health advice from travel clinic, 77.8% of respondents were less than 40 years old, and of (40.7%) of respondents planned their trips only one to 2 weeks before travel. The most frequently reported destinations were, Asia (30.2%), India (24.7%) followed by Africa which constitutes (16%). There was a good knowledge regarding importance of vaccination (96.2%), and malaria drug prophylaxis (83.4%), but there was a low attitude towards vaccinations (55.6%). Conclusions: The result of this short study period provided a valuable insight into the knowledge, attitude and practice of the respondents with significant low awareness of pre-travel health advice as reflected by the low uptake of specialist travel medicine advice with regard to travel vaccinations and malaria Prophylaxis which highlighted an important educational need for Dubai travellers.

Enfermedad y daño. Etiología y tratamiento de la viruela entre las sociedades nativas de Araucanía (fines del siglo XVIII)

In the year of 1791, a smallpox epidemic which affected the Indian populations of the Arauco frontier –south of Bio-Bio river in Chile– worried the colonial authorities of Concepcion, due to the fear that the Spanish inhabitants of that region could also get infected. Acting according to the contagion paradigm, they imposed a cordon sanitaire in order to isolate them from the Natives, and suggested these do the same. Also, conscious that the plague was commonly attributed to Spanish witchcraft, they hurried to offer medicine and medical advice, in order to show there was no will to cause damage. The responses of the different Indian groups demonstrated the co-existence of a wide variety of perspectives regarding the etiology of smallpox and the possible paths of action: from a personalist conception which attributed it to witches’ activities, to the admission of their own inability to find proper treatment, which led to the acceptance of Spanish medicines. The general picture shows a native model of the illness that is both conservative and innovative, complex and dynamic at the same time. The description of those events, found in a folder which was later sent to Spain, and the references contained in other colonial documents, allow the examination of the epidemiologic event using as a comparative context the conceptualizations now current among the Mapuche. They also allow the analysis of dominant conceptions concerning illness among the Spaniards in the late eighteenth century.

Patient reactions to community pharmacies' roles: evidence from the Portuguese market.

There is little knowledge about how patients perceive and react to the extended role of community pharmacies. To develop a model describing the expanded role of Portuguese community pharmacies as comprising three roles - medicines supplier, advice provider and community health promoter - and two important patient reactions: satisfaction and loyalty. In 2010, 1200 face-to-face interviews were conducted with patients of community pharmacies in Portugal. A model comprising the three pharmacy roles and the two patient reactions was developed and tested using structural equation modelling. The results showed that the model was appropriate and that the roles of medicines supplier, advice provider and community health promoter were positively related to patients' satisfaction and loyalty. These results show that patients are aware of the different roles played by community pharmacies in Portugal. The data support the idea that the movement of Portuguese pharmacists' extended role, framed within a global context where society sends expectations regarding the role of organizations in the community in which they operate, is producing positive results for both patients and pharmacists.