Medicines In Community Pharmacies Research Articles

Spatial analysis of a case of reverse logistics of medicines in community pharmacies in Brazil - a preliminary study

Spatial analysis of a case of reverse logistics of medicines in community pharmacies in Brazil - a preliminary study

A national survey on registered products, availability, prices, and affordability of 100 essential medicines in community pharmacies across Sri Lanka

IntroductionAvailability of essential medicines that meet the expected quality standards, in appropriate dosage forms at affordable prices is a fundamental prerequisite to fulfill healthcare needs of given a population. This study assessed available products, prices and affordability of essential medicines (EM) in community pharmacies in Sri Lanka with comparison of registration status from the National Medicines Regulatory Authority(NMRA).MethodsA cross-sectional island-wide survey of 80 pharmacies was conducted according to World Health Organization and Health Action International Manual (WHO/HAI). Hundred medicines were selected from the global core list(n = 14), regional core list(n = 16) and the Sri Lanka Essential Medicine List (SL-EML) (n = 70) based on healthcare needs. Number of registered products in 2015 and 2021 were compared.FindingsAverage availability was 85.4%(± 12.31) and availability was lowest in the Northern province (69.38 ± 21.18%)(p = 0.008). Availability between the state owned, franchise and privately owned pharmacies was not significantly different (p > 0.05). 89.4% medicines were affordable except for amiodarone, hydroxychloroquine, sitagliptin, soluble insulin, isophane insulin, losartan, levodopa carbidopa combination, clonazepam and ceftriaxone. The median price ratio (MPR) of 33.7% of medicines was less than 1 and MPR of 37.1% originator brands (OB) was over 3. Median number of generic brands in the market was 8(range 2–44), 9% of medicines had 20 or more products in the market and 72.7% medicines had more products available than the number registered in 2015. The average number of registered products were similar in 2015 (8.27) and 2021(7.59) (p = 0.15).ConclusionThe overall availability of EMs in Sri Lanka was high in all categories of community pharmacies. Medicines were largely affordable and reasonably priced in 2015, although OBs were generally more expensive. Majority of medicines had more products in the market than the number of registered products.

Measuring the value of solidarity: The abem financial assistance program for out-of-pocket payments on pharmacy medicines in Portugal.

Out-of-pocket payments for prescribed medicines are still comparatively high in Portugal. The abem program was launched in Portugal in May 2016 to aid vulnerable groups by completely covering out-of-pocket costs of prescribed medicines in community pharmacies. This study assesses the impact of the program on poverty and catastrophic health expenditures. A longitudinal study was carried out with the analysis of several program databases (from the beginning of the program in May 2016 to September 2018) covering the cohorts of beneficiaries, daily data on medicines dispensed, social referencing entities, and solidarity pharmacies. The study provides estimates of standard poverty measures (intensity and severity) as well as the incidence of catastrophic health expenditures. More than 6000 beneficiaries were supported (56.8% female, 34.7% aged 65 or over), encompassing 127,510 medicines (mainly nervous system and cardiovascular system) with an average 26.9% co-payment (payments totalling €1.5 million). The program achieved substantial reductions in poverty (3.4% in intensity, 5.6% in severity), and eliminated cases with catastrophic health expenditures in medicines that would have affected 7.5% of the beneficiaries. Findings confirm a continuous increase in the number of beneficiaries, enabling access to medicines especially for the vulnerable elderly, and a sizable impact on eliminating out-of-pocket payments for medicines in the target population.

Availability of Antimalarial Medicines in Community Pharmacies of Lusaka District, Zambia: Implications on Compliance to Malaria Treatment Guidelines

Background: Malaria remains a major cause of morbidity and mortality in Zambia, affecting all levels of society, with children under the age of five and pregnant women being most at risk of serious illness. The availability of antimalarial medicines is one of the key interventions of malaria management. This study assessed the availability of antimalarial medicines in community pharmacies in Lusaka district, Zambia. Materials and Methods: This was a cross-sectional study that was conducted among 210 community pharmacies from September to November 2022 using a well-structured checklist in selected areas of Lusaka district. The availability was verified by a physical check of the product. The checklist contained the medicines listed both in the guidelines for diagnosis and treatment of malaria in Zambia as well as in the World Health Organization (WHO) malaria treatment guidelines. Results: This study found that all antimalarials listed in the local treatment guidelines for malaria were available in community pharmacies, though with the varying distribution. Of the 210 community pharmacies, 209 (99.5%) had artemether/lumefantrine in stock. The lowest available antimalarial was quinine/clindamycin, which was only available in 3 (1.4%) of the outlets. Conversely, 3 out of 16 (18.8%) antimalarials that were available in community pharmacies were not listed in the local treatment guidelines of malaria in Zambia, despite being listed in the WHO malaria treatment guidelines. This translated into a compliance level of 81.2% based on the local malaria treatment guidelines. Conclusion: This study concluded that antimalarials were available for all categories of malaria management in community pharmacies, though with a varying distribution. The presence of antimalarials not listed in the Zambian treatment guidelines is of public health concern which may have an impact on antimicrobial resistance in the future.

A systematic review of community pharmacist practices in complementary medicine.

The people who use complementary medicines (CMs) believe that these medicines are safe and harmless. They could easily access CMs like herbal or traditional medicines in community pharmacies. Therefore, community pharmacists are important professionals in advising the safe choices of CMs and providing evidence-based information for customers to decrease adverse effects of CMs. To systematically review knowledge, attitude, and practices of community pharmacists about CMs, and the factors associated with CM practices of dispensing, recommending and counseling patients, and answering the patients' queries. An electronic search was performed with four databases: PubMed, Scopus, SpringerLink and ScienceDirect, from 1990 to 19th May 2022. The inclusion criteria were studies 1) about knowledge, attitude, and/or practices of community pharmacists about CMs, 2) written in English, 3) conducted with quantitative methods, and 4) able to retrieve full text. Twenty-three studies were included in this systematic review. Some studies showed that less than half of the pharmacists asked or counselled about CMs to their patients and answered the patients' queries about CMs. Only 20% of the pharmacists did report CM side-effects. Training or education about CMs was a common factor associated with the CM practice of dispensing, recommending, counseling, and answering the patients' queries about CMs. CMs recommended most by community pharmacists were vitamins & minerals, food or dietary supplements, fish oil and probiotics. The most common dispensed CMs were vitamins & minerals, herbs, food or dietary supplements, fish oil and essential oils. Lacks of reliable information sources and scientific evidence were common barriers for the CM practices. Being less expensive than conventional medicines motivated the pharmacists to recommend and discuss about CMs. The community pharmacists that participated in included studies suggested strengthening CM trainings and highlight the pharmacist role in CM therapy. A high percentage of community pharmacists did dispense CMs to their patients, while a low percentage of the pharmacists did report CM side effects. Pharmacists were most comfortable recommending and responding the patients' CM queries. Training or education about CMs associated with CM dispensing, recommending, discussing, and answering the patients' queries about CMs was recommended.

Patient and carer access to medicines at end of life: the ActMed mixed-methods study

Background Patient access to medicines at home during the last 12 months of life is critical for effective symptom control, prevention of distress and unplanned admission to hospital. The limited evidence suggested problems with different components of service delivery and, to the best of our knowledge, the impact of innovations in end-of-life service delivery has remained unevaluated. Objective To provide an evaluation of patient and carer access to medicines at end of life within the context of models of service delivery. Design and data sources The study used a multiphase mixed-methods design, comprising (1) a systematic literature review; (2) an online questionnaire survey of health-care professionals delivering end-of-life care; (3) evaluative mixed-method case studies of service delivery models, including cost and cost-effectiveness analysis; (4) interviews with community pharmacists and pharmaceutical wholesalers and distributors; and (5) an expert consensus-building workshop. Setting Community and primary care end-of-life services in England. Participants Health-care professionals delivering end-of-life care and patients living at home in the last 12 months of life and their carers. Results A systematic review identified a lack of evidence on service delivery models and patient experiences of accessing medicines at end of life. A total of 1327 health-care professionals completed an online survey. The findings showed that general practitioners remain a predominant route for patients to access prescriptions, but nurses and primary care-based pharmacists are also actively contributing. However, only 42% of clinical nurse specialists and 27% of community nurses were trained as prescribers. The majority (58%) of prescribing nurses and pharmacists did not have access to an electronic prescribing system. Health-care professionals’ satisfaction with access to shared patient records to facilitate medicines access was low, with 39% of health-care professionals either not at all or only slightly satisfied. Respondents perceived that there would be a significant improvement in pain control if access to medicines was greater. Case studies (n = 4) highlighted differences in speed and ease of access to medicines between service delivery models. Health-care professionals’ co-ordination facilitated the access process. The work of co-ordination was frequently burdensome, for example because general practitioner services were hard to access or because the stock of community pharmacy medicines was unreliable. Prescription cost differentials between services were substantial when accounting for the eligible population over the medium term. The supply chain generally ensured stocks of palliative medicines, but this was underpinned by onerous work by community pharmacists navigating multiple complex systems and wholesaler interfaces. Limitations Patient records lacked sufficient detail for timelines to be constructed. Commissioners of community pharmacy services and wholesalers and distributors were difficult to recruit. Conclusions Accessing medicines required considerable co-ordination work. Delays in access were linked to service delivery models that were over-reliant on general practitioners prescribing, unreliable stocks of community pharmacy medicines and clinical nurse specialists’ lack of access to electronic prescribing. Key issues were relationships and team integration, diversifying the prescriber workforce, access to shared records and improved community pharmacy stock. Future work Further research should consider policy and practice action for nursing and pharmacy services to fulfil their potential to help patients access medicines, together with attention to improving co-ordination and shared electronic records across professional service interfaces. Study registration This study is registered as CRD42017083563 and the trial is registered as ISRCTN12762104. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 20. See the NIHR Journals Library website for further project information.

Availability of medical schemes’ formulary medicines in community pharmacies in Durban, South Africa

Abstract Objectives This study aimed to calculate the percentage availability of medicine brands for 24 active ingredients across community pharmacies, to establish which brands are listed on medical scheme (MS) formularies and to determine availability trends and patterns among the findings. Methods A quantitative cross-sectional survey was carried out at 30 community pharmacies located in the eThekwini area of Durban, KwaZulu-Natal. The basket of medicines included 24 active ingredients randomly selected from the Abbreviated Primary Health Care Essential Medicines List of South Africa. Medicine formularies from South Africa’s top five MSs, according to the number of dependants, were investigated. Data were collected using an electronic survey and distributed via e-mail to participating pharmacies. All statistical analyses, observations and data collation were performed using tools on Google Forms and Microsoft Excel 2015. Key findings A total of 188 medicine brands were found to be available for sale at 30 community pharmacies. Only 71 medicine brands were on the formulary across all the investigated MSs, indicating that only 37.8% of the available brands were reimbursable. Of the 71 formulary-listed medicine brands, only 17 presented with high percentage availabilities (80% and over). This indicates that only 9.04% of the available medicine brands showed the most desirable results, which is the high availability of formulary medicines that would likely not result in any extra out-of-pocket payments to patients. Conclusions The majority of medicine brands that were identified as available were in fact not reimbursable by the five investigated MSs. Patient confidence in the use of generic medicines should be addressed with the intention of lowering their health expenses and improving treatment adherence. Further studies on formulary medicine availability are encouraged to include a larger basket of medicines, a wider geographical area and more MS plans.

Examining non-medical prescribing trends in New Zealand: 2016\u20132020

BackgroundPopulation growth and general practitioner workforce constraints are creating increasing demand for health services in New Zealand (NZ) and internationally. Non-medical prescribing (NMP) is one strategy that has been introduced to help manage this. Little is known about the NMP practice trends in NZ. The aim of this study was to provide a current overview of the scale, scope, and trends of NMP practice in NZ.MethodsAll claims for community dispensed medicines prescribed by a non-medical prescriber were extracted from the NZ Pharmaceutical Collection for the period 2016–2020. Patient demographics were retrieved from the Primary Health Organisation enrolment collection. These national databases contain prescription information for all subsidised community pharmacy medicines dispensed and healthcare enrolment data for 96% of New Zealanders.ResultsThe proportion of prescriptions written by all NMP providers and patients receiving NMP prescriptions increased each year from 1.8% (2016) to 3.6% (2019) and 8.4% (2016) to 14.4% (2019) respectively. From 2016 to 2019, the proportion of NMP patients who had at least one NMP prescription increased from 26% to 39% for nurse prescribers, from 1% to 9% for pharmacist prescribers, from 2% to 3% for dietitian prescribers, and decreased from 47% to 22% for dentists, and from 20% to 12% for midwives. The most commonly prescribed medicines were antibiotics (amoxicillin, amoxicillin with clavulanic acid, and metronidazole), and analgesics (paracetamol, and codeine phosphate). While some NMP providers were prescribing for patients with greater health needs, all NMP providers could be better utilised to reach more of these patients.ConclusionsThis study highlights that although the NMP service has been implemented in NZ, it has yet to become mainstream healthcare practice. This work provides a baseline to evaluate the NMP service moving forward and enable policy development. Improved implementation and integration of primary care NMP services can ensure continued access to prescribing services and medicines for our communities.

A non-randomised feasibility study of an intervention to optimise medicines at transitions of care for patients with heart failure

BackgroundHeart failure affects 26 million people globally, and the optimal management of medicines is crucial for patients, particularly when their care is transferred between hospital and the community. Optimising clinical outcomes requires well-calibrated cross-organisational processes with staff and patients responding and adapting to medicines changes. The aim of this study was to assess the feasibility of implementing a complex intervention (the Medicines at Transitions Intervention; MaTI) co-designed by patients and healthcare staff. The purpose of the intervention was to optimise medicines management across the gaps between secondary and primary care when hospitals handover care. The study objectives were to (1) assess feasibility through meeting specified progression criteria to proceed to the trial, (2) assess if the intervention was acceptable to staff and patients, and (3) determine whether amendment or refinement would be needed to enhance the MaTI.MethodsThe feasibility of the MaTI was tested in three healthcare areas in the North of England between July and October 2017. Feasibility was measured and assessed through four agreed progression to trial criteria: (1) patient recruitment, (2) patient receipt of a medicines toolkit, (3) transfer of discharge information to community pharmacy, and (4) offer of a community pharmacy medicines review/discussion or medicines reconciliation. From the cardiology wards at each of the three NHS Acute Trusts (sites), 10 patients (aged ≥ 18 years) were recruited and introduced to the ‘My Medicines Toolkit’ (MMT). Patients were asked to identify their usual community pharmacy or nominate a pharmacy. Discharge information was transferred to the community pharmacy; pharmacists were asked to reconcile medicines and invited patients for a medicines use review (MUR) or discussion. At 1 month following discharge, all patients were sent three questionnaire sets: quality-of-life, healthcare utilisation, and a patient experience survey. In a purposive sample, 20 patients were invited to participate in a semi-structured interview about their experiences of the MaTI. Staff from hospital and primary care settings involved in patients’ care were invited to participate in a semi-structured interview. Patient and staff interviews were analysed using Framework Analysis. Questionnaire completion rates were recorded and data were descriptively analysed.ResultsThirty-one patients were recruited across three sites. Eighteen staff and 18 patients took part in interviews, and 19 patients returned questionnaire sets. All four progression to trial criteria were met. We identified barriers to patient engagement with the intervention in hospital, which were compounded by patients’ focus on returning home. Some patients described not engaging in discussions with staff about medicines and lacking motivation to do so because they were preoccupied with returning home. Some patients were unable or unwilling to attend a community pharmacy in person for a medicines review. Roles and responsibilities for delivering the MaTI were different in the three sites, and staff reported variations in time spent on MaTI activities. Staff reported some work pressures and staff absences that limited the time they could spend talking to patients about their medicines. Clinical teams reported that recording a target dose for heart failure medicines in patient-held documentation was difficult as they did not always know the ideal or tolerable dose. The majority of patients reported receiving the patient-held documentation. More than two-thirds reported being offered a MUR by their community pharmacists.ConclusionsDelivery of the Medicines at Transitions Intervention (MaTI) was feasible at all three sites, and progression to trial criteria were met. Refinements were found to be necessary to overcome identified barriers and strengthen delivery of all steps of the intervention. Necessary changes to the MaTI were identified along with amendments to the implementation plan for the subsequent trial. Future implementation needs to take into account the complexity of medicines management and adaptation to local context.

Availability of Medicines in Community Pharmacy to Manage Patients with COVID-19 in Kenya; Pilot Study and Implications

Multiple measures have been instigated across countries to prevent the spread and treat patients COVID-19 with personal protective equipment (PPE), sanitation measures and medicines. However, there has been considerable controversy surrounding initially endorsed treatments such as hydroxychloroquine with misinformation increasing prices and suicides. Prices of PPE and medicines have increased in countries following shortages, potentially catastrophic among lower- and middle-income countries (LMICs) with high co-payment levels. Consequently, there is a need to investigate changes in availability, utilisation, prices and shortages of relevant medicines during the pandemic in Kenya. To address this, a questionnaire was emailed to ten randomly selected community pharmacists from 21 purposely selected pharmacists attached to the University of Nairobi, with the survey covering the period from the start of the pandemic to the end of May 2020. This included suggestions from community pharmacists on potential ways forward with future pandemics. Six pharmacists eventually took in this pilot study. Two thirds noted increased requests for antimalarials and antibiotics; however, these were not dispensed with pharmacists recommending alternatives for symptomatic relief. There was increased use of analgesics as well as vitamins. Price rises were seen for hydroxychloroquine as well as vitamins and zinc (50-100% increase in price); however, no shortages were seen. The pharmacists believed their future role in pandemics include education, improved stock control and patient counselling. Overall, it was encouraging to see increases in the utilisation of vitamins/ immune boosters alongside no antimalarials or antibiotics dispensed without a prescription despite the hype and requests. Community pharmacists have a key role in any pandemic with prevention and guidance, and we will be monitoring this. Countries such as Kenya can also act as exemplar countries where there continues to be high rates of self-purchasing of antibiotics.

COMMUNITY PHARMACY ROLE IN UNIVERSAL HEALTH COVERAGE IN MOMBASA COUNTY

Community pharmacy role in universal health coverage was a qualitative study that entailed close contact to the role played by community pharmacies in healthcare provision. As a "small healthcare" in provision of pharmaceutical services, community pharmacies are required to be included in realization of Universal Health Coverage in Mombasa since it is among the Big 4 Agenda of the national government (MOH, 2013). The objective of the study was to determine community pharmacy role in universal health coverage. A descriptive cross sectional study design was used to collect both qualitative and quantitative data and the design estimate the prevalence of the outcome of interest commonly for the purpose of public health planning. A sample size of 196 was calculated using fishers formula. Data was collected using in-depth interviews and structured questionnaire were administered on a target population of community pharmacies health providers and clients seeking services respectively. The collected data was analysed using SPSS version 20 and interpreted using tables and pie charts. On community pharmacy practitioners respondents; 58% were male, 90.3% diploma holders in pharmacy, 39.8% registered with PPB and 65% had practised for less than two years. 78% of the respondents agree that community pharmacy has a role in UHC and there was 74% affordability of community pharmacy medicines. Bivariate analysis findings show that training and inspection on UHC (P=0.003) Covid 19 (p=0.000) and inspection fee (p=0.000). Accessibility; location of community pharmacies (p=0.000) and doctors attitudes (p=0.000). Essential medicines; acyclovir 200mg tablets (p=0.000), chlorpromazine 100mg tablets (p=0.000) and tetanus toxoid vaccine (p=0.000). Key determinants of community pharmacy role in UHC were diploma (AOR 666.7; CI 129.6-3429.5), Erythromycin 125mg suspension (AOR 120.3; CI 15.4-940.8), Acyclovir 200mg tablets (AOR 46.823; CI 17.7-124.1) and Occupation (AOR 45.271; CI 15.363-133.404. The study recommends reduction of tax on essential medicines, MOH revise the UHC policy to incorporate community pharmacies and empowerment on management of controlled drugs and vaccines in order to realize effective and efficient UHC in Kenya

Towards equity: a qualitative exploration of the implementation and impact of a digital educational intervention for pharmacy professionals in England

BackgroundPatients belonging to marginalised (medically under-served) groups experience problems with medicines (i.e. non-adherence, side effects) and poorer health outcomes largely due to inequitable access to healthcare (arising from poor governance, cultural exclusion etc.). In order to promote service equity and outcomes for patients, the focus of this paper is to explore the implementation and impact of a new co-produced digital educational intervention on one National Health Service (NHS) funded community pharmacy medicines management service.MethodsSemi-structured interviews with a total of 32 participants. This included a purposive sample of 22 community pharmacy professionals, (16 pharmacists and 6 pharmacy support staff) all who offered the medicine management service. In order to obtain a fuller picture of the barriers to learning, five professionals who were unable to complete the learning were also included. Ten patients (from a marginalised group) who had received the service (as a result of the digital educational intervention) were also interviewed. Drawing on an interpretative analysis, Normalisation Process Theory (NPT) was used as a theoretical framework.ResultsThree themes are explored. The first is how the digital learning intervention was implemented and applied. Despite being well received, pharmacists found it challenging completing and cascading the learning due to organisational constraints (e.g. lack of time, workload). Using the four NPT constructs (coherence, cognitive participation, collective action and reflexive monitoring) the second theme exposes the impact of the learning and the organisational process of ‘normalisation’. Professional reflective accounts revealed instances where inequitable access to health services were evident. Those completing the intervention felt more aware, capable and better equipped to engage with the needs of patients who were from a marginalised group. Operationally there was minimal structural change in service delivery constraining translation of learning to practice. The impact on patients, explored in our final theme, revealed that they experience significant disadvantage and problems with their medicines. The medication review was welcomed and the discussion with the pharmacist was helpful in addressing their medicine-related concerns.ConclusionsThe co-produced digital educational intervention increases pharmacy professionals’ awareness and motivation to engage with marginalised groups. However structural barriers often hindered translation into practice. Patients reported significant health and medicine challenges that were going unnoticed. They welcomed the additional support the medication review offered. Policy makers and employers should better enable and facilitate ways for pharmacy professionals to better engage with marginalised groups. The impact of the educational intervention on patients’ health and medicines management could be substantial if supported and promoted effectively.

Opioid use disorder: adherence to prescribed medicines in community pharmacy

Opioid use disorder: adherence to prescribed medicines in community pharmacy

Examining consumer purchase intentions of non-prescription medicines in supermarkets and community pharmacies

As supermarkets continue to expand their healthcare categories, consumers now have more choice and access to non-prescription medicines. The aim of this current research is to empirically examine the drivers and barriers of consumer purchase intentions, namely trust and perceived risk, of non-prescription medicines in both supermarkets and community pharmacy settings. Data were collected using an in-store intercept survey of 402 supermarket shoppers and 310 community pharmacy shoppers. Confirmatory factor analysis including a measurement and structural model tests were employed using AMOS software package to identify variances in the drivers and barriers of purchase intentions between these retail settings. This study found an association between the purchase intention of non-prescription medicines in community pharmacies with their perceived competence, benevolence and provision accurate information. Other than time risk, no other elements of risk were associated with purchase intentions within this setting. In contrast, the perceived risks associated with the purchase of non-prescription medicines within the supermarkets setting - specifically physical and social risk, were present. Results indicate respondents were more likely to intend to purchase medicines from a supermarket if they perceived that the retailer was competent in providing access to safe non-prescription medicines and had the ability to handle transactions. This is the first study to examine the psychological drivers and barriers of purchase intentions of non-prescription medicines in supermarkets and community pharmacies, finding very different results across both retail settings. The study presents a comprehensive model of purchase intentions of non-prescription medicines and recommends directions for pharmacy practitioners and supermarkets.

How do patients with cancer pain view community pharmacy services? An interview study

Pain experienced by many patients with advanced cancer is often not well controlled and community pharmacists are potentially well placed to provide support. The study objective was to explore the views and experiences of patients with advanced cancer about community pharmacies, their services and attitudes towards having a community pharmacist pain medicines consultation. Purposive sampling of GP clinical information systems was used to recruit patients with advanced cancer, living in the community and receiving opioid analgesics in one area of England, UK between January 2015 and July 2016. Thirteen patients had a semi-structured interview which was audio-recorded and transcribed verbatim. Data were analysed deductively and inductively using Framework analysis and incorporating new themes as they emerged. The framework comprised Pain management, Experiences and expectations, Access to care and Communication. All patients reported using one regular community pharmacy citing convenience, service and staff friendliness as influential factors. The idea of a community pharmacy medicines consultation was acceptable to most patients. The idea of telephone consultations was positively received but electronic media such as Skype was not feasible or acceptable for most. Patients perceived a hierarchy of health professionals with specialist palliative care nurses at the top (due to their combined knowledge of their condition and medicines) followed by GPs then pharmacists. Patients receiving specialist palliative care described pain that was better controlled than those who were not. They thought medicines consultations with a pharmacist could be useful for patients before referral for palliative care. There is a need for pain medicines support for patients with advanced cancer, and unmet need appears greater for those not under the care of specialist services. Medicines consultations, in principle, are acceptable to patients both in person and by telephone, and the latter was perceived to be of particular benefit to patients less able to leave the house.

Pharmaceutical interventions on prescribed medicines in community pharmacies: focus on patient-reported problems.

Background While dispensing prescribed medicines, pharmacists frequently encounter technical and clinical problems that require a pharmaceutical intervention. Objective To describe the pharmaceutical interventions performed by community pharmacists while dispensing prescribed medicines and to investigate, in-depth, the patient-reported problems with the prescribed medicines that triggered pharmaceutical interventions. Method Twenty-one pharmacists each collected 30 prescriptions requiring a pharmaceutical intervention on five selected days within a five-week period. All pharmaceutical interventions were classified using the PharmDISC system. Results Of all 430 pharmaceutical interventions, 286 (66.5%) pharmaceutical interventions had a clinical cause and 144 (33.5%) pharmaceutical interventions a technical cause. Pharmacists mainly intervened to substitute a drug (n=132, 30.7%), adjust a dose (n=57, 13.3%), and clarify/complete information (n=48, 11.2%). A total of 243 (56.5%) pharmaceutical interventions resulted in a change of the prescription. The implementation rate of pharmaceutical interventions reached 88.6%. Altogether, patient-reported problems triggered 99 (23.0%) pharmaceutical interventions. In 15 (15.2%) of these PIs, contact with the prescriber was necessary, whereas 61 (84.8%) PIs only involved the pharmacist. Conclusion While dispensing prescribed medicines, pharmacists performed individualised pharmaceutical interventions to solve or prevent drug-related problems. That almost a quarter of all pharmaceutical interventions triggered by patient-reported problems highlights the importance of direct patient-pharmacist interaction when dispensing prescribed medicines.

Ethical responsibilities of pharmacists when selling complementary medicines: a systematic review.

The widespread sale of complementary medicines in community pharmacy raises important questions regarding the responsibilities of pharmacists when selling complementary medicines. This study reviews the academic literature that explores a pharmacist's responsibilities when selling complementary medicines. International Pharmaceutical Abstracts, Embase, PubMed, Cinahl, PsycINFO and Philosopher's index databases were searched for articles written in English and published between 1995 and 2017. Empirical studies discussing pharmacists' practices or perceptions, consumers' expectations and normative studies discussing ethical perspectives or proposing ethical frameworks related to pharmacists' responsibilities in selling complementary medicines were included in the review. Fifty-eight studies met the inclusion criteria. The majority of the studies discussing the responsibilities of pharmacists selling complementary medicines had an empirical focus. Pharmacists and consumers identified counselling and ensuring safe use of complementary medicines as the primary responsibilities of pharmacists. No formal ethical framework is explicitly employed to describe the responsibilities of pharmacists selling complementary medicines. To the degree any ethical framework is employed, a number of papers implicitly rely on principlism. The studies discussing the ethical perspectives of selling complementary medicines mainly describe the ethical conflict between a pharmacist's business and health professional role. No attempt is made to provide guidance on appropriate ways to resolve the conflict. There is a lack of explicit normative advice in the existing literature regarding the responsibilities of pharmacists selling complementary medicines. This review identifies the need to develop a detailed practice-specific ethical framework to guide pharmacists regarding their responsibilities when selling complementary medicines.

Misuse of over the counter medicines in community pharmacies in Scotland

ABSTRACTThe general public are taking more responsibility for their health, using community pharmacy as a source to access medication. There are a reported increase and change in the misuse of OTC medication from community pharmacies in Scotland (Wright et al, 2015). This article was designed to examine the self-reported use of medication from a small sample of community pharmacies in Scotland. The questionnaire gathered patient demographics and details of medicines used. The study concentrated on two treatment areas, opioid analgesics, and sedative antihistamines licensed as a sleep aid. Both previously identified as the most prevalent OTC medications that were perceived to being misused (Matheson et al, 2007). Data were collected over a short time period in 2015 from 15 community pharmacies. The data demonstrate the widespread misuse of OTC. The most prevalent group identified as females, 41–60 years old and employed. It was most commonly reported that the recommended treatment duration is exceeded rather than the maximum recommended daily dose. The recommendations from the article are that there needs to be greater awareness for pharmacists, pharmacy staff, and general public on the potential dangers of misusing OTC medications and the importance of adhering to the recommended dosing and duration guidelines.

Using Failure mode and Effects Analysis to reduce patient safety risks related to the dispensing process in the community pharmacy setting.

• Various failure modes compromising patient safety during the dispensing of medicines in community pharmacies were revealed.

Patients' knowledge of new medicines after discharge from hospital: What are the effects of hospital-based discharge counseling and community-based medicines use reviews (MURs)?

Interventions to reduce medicines discontinuity at transitions during and reinforced after discharge are effective. However, few studies have linked hospital-based counseling with onward referral for community pharmacy-based follow-up to support patients' medicines use. To determine the effects of targeted hospital pharmacist counseling on discharge or targeted community pharmacy medicines reviews post-discharge on patients' knowledge of newly started medication. The study was a controlled trial of targeted medicines discharge counseling provided by hospital pharmacists or follow-up post-discharge medicines review provided by community pharmacists compared with usual care (nurse counseling). Outcomes measured using a structured telephone survey conducted at two and four weeks after patients were discharged from hospital. Patients who received hospital pharmacist counseling were significantly more likely to report being told the purpose of their new medicine and how to take it versus those receiving usual care. Fewer than half of the patients who were allocated to receive a community pharmacy medicines review received one. Patient knowledge of medicines newly prescribed in the hospital was increased by targeted counseling of hospital pharmacists. The findings suggest the need to improve the consistency of the information covered when providing counseling, perhaps by the implementation of a counseling checklist for use by all disciplines of staff involved in patient counseling. The potential of community pharmacy follow-up medicines review is currently undermined by several barriers to uptake.