Non-pharmacist Staff Research Articles

Pharmacy Staff's Recommendations for Self-Medication Requests on Non-Infectious Productive Cough: A Study in Padang City, Indonesia

Cough is a physiological reflex to liberate the airway from mucus or foreign objects. Many cough medicines in pharmacies require special expertise to select the proper medication according to the patient's condition. This research aims to evaluation recommendations of drugs for non-productive cough for self-medication from pharmacy staff in Kuranji subdistrict, Padang City. A cross-sectional study with total sampling techniques is used for collecting data. This research uses a structured interview technique with the main question, what medicine would pharmacy staff recommend if an adult patient comes with a productive cough without any symptoms of infection? There are 30 pharmacies in Kuranji subdistrict, but data that meets the inclusion criteria is only from 25 pharmacies because five pharmacies are not willing to be research sites. Those who were willing to take part in this research were 16 pharmacists and nine non-pharmacist staff. Only 37.5% (6 of 16) of correct drug recommendations were given by pharmacists, and 33.3% (3 of 9) of proper drug recommendations were provided by non-pharmacist staff. There are still many things that could be improved in drug recommendations for this case, with a total average of correct administration of only 36%. The proper drug choices were Bromhexin and Acetylcysteine, while other drugs that were incorrectly chosen were drugs that should have been given with a doctor's prescription, branded drugs with more than one active ingredient , herbs or not the drug of choice for now.There are still many mistakes in the medicine choice, with an average total of only 36% accurate recommendations.

Non-prescription antibiotics dispensing by community pharmacies: implications for antimicrobial resistance

Introduction: The non-prescription antibiotics dispensing (NPAD) from pharmacies is on the rise in low- and middle-income countries, which contributes to the emergence of antimicrobial resistance (AMR). This study was conducted with the objective to determine the community pharmacy personnel’s perspectives on NPAD and its implications for AMR. Methods: A questionnaire-based cross-sectional survey was conducted in Pakistan among 336 pharmacies. The data were analyzed using SPSS v21 and MedCalc for Windows v12.3.0. Modified Bloom’s cut-off point was utilized to categorize the participants’ overall knowledge, attitude, and practice. For univariable logistic regression analyses, odds ratio (OR) was calculated at 95% confidence interval (CI). For multivariable logistic regression analyses, adjusted OR was calculated at 95% CI. Spearman’s rank correlation coefficient test was used to assess the relationships among knowledge, attitude, and/or practice scores. Results: The majority of the respondents were staff pharmacists (45.5%). About four-fifths (78.9%) and half (50.9%) of the participants demonstrated moderate to good knowledge and practice, respectively. However, about only one-third (33.1%) had a moderate to good attitude. Staff pharmacists had higher odds of moderate to good knowledge (OR: 2.4, 95% CI: 1.2–4.7) and practice (OR: 2.3, 95% CI: 1.4–3.8). Total knowledge and practice (Spearman’s ρ: 0.280; P <0.001) and total attitude and practice (Spearman’s ρ: 0.299; P <0.001) scores were significantly correlated. Conclusion: The qualified pharmacists had satisfactory knowledge, attitude, and practices toward antibiotics. However, non-pharmacist staff lacked knowledge and had probable NPAD practice, which has a negative impact on public health. Regular refresher training, seminars, and strict enforcement of rules and regulations are essential.

Impact of Pharmacist Integration Into Primary Care on Reimbursement for Hospital Follow-Up Visits.

The financial and clinical impact of transitional care management (TCM) outcomes through pharmacist integration within primary care is not well described. The primary objective of this study was to determine the financial impact of pharmacist conducted post-discharge phone calls. The secondary objectives included readmission rates and number of interventions. A computer-generated list identified patients discharged from St. Joseph's/Candler Health System (SJ/C) with a listed primary care provider within the SJ/C Primary Care Medical Group at Eisenhower from November 1, 2019 to April 30, 2020. Eligible patients who received a post-discharge phone call from a pharmacist were compared to those who received a call by another staff member. Data was collected regarding the financial impact of pharmacist conducted post-discharge phone calls. Readmission rates and medication related interventions were also assessed. There were 104 patients discharged meeting criteria. Twenty-four patients were contacted by a pharmacist resulting in 20 subsequent hospital follow up appointments scheduled with the provider. Total amount billed for those appointments was $4220 (average of $211 per visit). Twenty-five calls were made by non-pharmacist staff with 23 appointments scheduled. Total amount billed for those appointments was $2445 (average of $106 per visit). Increased reimbursement was generated by a qualifying 2-way communication by the pharmacist as outlined by Center for Medicaid and Medicare Services enabling providers to bill for a TCM visit versus standard office visit. Pharmacists made 33 clinical interventions including medication reconciliation, medication procurement, referrals, lab orders, and education. One intervention was made by non-pharmacist staff. The 30-day readmission rate for pharmacist contacted patients was 8% versus 12% for non-pharmacist contacted patients. Pharmacist involvement in TCM while integrated into a primary care office is previously not well described. This data highlights an opportunity for pharmacists to demonstrate sustainability and improved outcomes related to TCM.

The impact of pharmacist shortage on the inventory management of medicines at primary healthcare centres in East Java, Indonesia

Background: Pharmacists are the only people authorised to manage the medicines inventory. However, in the case of pharmacist shortage, other personnel may take over this function. This is particularly the case in most primary healthcare centers (puskesmas) in Indonesia. 
 Aim: To compare the outcome of medicine inventory management between pharmacists and non-pharmacists in primary healthcare centres (PHCs). 
 Methods: A survey of 146 puskesmas in East Java was conducted involving 73 pharmacists and 73 non-pharmacist staff. This study was conducted from July to January 2020. Each respondent completed a questionnaire focusing on the inventory aspects of medicine management. 
 Results: Purchasing accuracy is higher for pharmacists (90%) than for non-pharmacists (68%). Pharmacists manage the inventory more efficiently with only 2% of the drugs expired and wasted while non-pharmacist staff wasted 16% of the drugs and 18% of the drugs expired. 
 Conclusion: The role of pharmacists in medicine inventories is vital as they carry out more efficient and accurate medicine management.

A Simulated Client Exploration of Nonprescription Dispensing of Antibiotics at Drugstores for Pediatric Acute Diarrhea and Upper Respiratory Infection in Lahore, Pakistan.

IntroductionThe excessive consumption of antibiotics is a significant contributor to antimicrobial resistance, especially in children. Children are often advised antibiotics for viral infections. In developing countries, drugstores are a prime source of easy access to nonprescription antibiotics. Moreover, in Pakistan, their irrational use is an “everyday routine”. The study, therefore, aimed to evaluate the dispensing of nonprescription antibiotics to children.MethodsUsing pediatric acute diarrhea and acute upper respiratory infection as disease scenarios, a simulated client, cross-sectional study was conducted in Lahore, Pakistan, to explore the antibiotics’ ease of availability at both categories of drugstores (pharmacies and medical stores) from November 1st, 2019 to January 31st, 2020. Chi-square (χ2) test was used to compare the differences in practices of different categorical variables. Multivariable logistic regression was applied to analyze the association of various factors with antibiotics dispensing.ResultsAntibiotics were dispensed without prescription in 456 (59%) of 773 simulated visits out of which 425 (93.2%) were dispensed on the advice of the drugstore staff. A qualified pharmacist was available in only 164 (21.2%) cases. Of the 386 visits for acute diarrhea and 387 for acute upper respiratory infection, nonprescription antibiotic dispensing occurred in 259 (67.1%) and 197 (50.9%) visits, respectively. There were considerable differences (p-value <0.05) in the practices and antibiotics dispensing between each disease scenario presented. Moreover, antibiotics were less commonly dispensed at pharmacist-supervised drugstores compared to unsupervised ones.ConclusionOverall, inappropriate dispensing practices were prevalent to a large extent at the drugstores, and antibiotics were effortlessly obtainable without prescription. The quality of the services provided, especially by the non-pharmacist staff, was also not satisfactory. Therefore, the Drug Regulating Authority of Pakistan must enforce strict implementation of drug laws at the drugstores without delay, especially in major cities to help curb the felonious use of antibiotics.

Establishing consensus for the education, training and assessment requirements of community pharmacy staff to deliver minor ailments services: A modified Delphi study

IntroductionMinor ailments services (MASs) are pharmacy-based and support individuals to manage minor conditions. MASs are delivered by community pharmacists and non-pharmacist staff. Limited information exists regarding education, training, assessment requirements, and suitability of existing processes to support MAS delivery. The purpose of this study was to determine consensus amongst multiple stakeholder participants regarding these processes. MethodsA modified Delphi process was utilized. Phase 1 consisted of stakeholder participants completing two rounds of an online questionnaire responding to Likert-items (Round 1 [R1] [n = 46]; Round 2 [R2] [n = 34]). Phase 2 consisted of three teleconference rounds discussing items that did not achieve consensus in the previous two rounds. Consensus was defined as ≥80% panel agreement. ResultsForty MASs stakeholders participated in the study. MASs stakeholder participants included community pharmacists (n = 7), pharmacy student graduate pharmacist (n = 4), non-pharmacist staff (n = 13), faculty staff/academics (n = 5), general practitioners (n = 5), and individuals affiliated with pharmacy professional organizations (n = 6). Consensus was achieved on 22 of 46 statements in R1, 8 of 34 statements in R2, and 21 of 27 statements in Phase 2. ConclusionsIt may be useful for MAS education and training to consider the clinical and non-clinical elements of service delivery. Training should be available to all community pharmacy staff. The results of this study may be useful to policymakers and professional organizations to enhance existing curricula or inform training guidelines for MAS delivery.

Pharmacies will be able to use non-pharmacist staff to vaccinate during flu season

Pharmacies will be able to use non-pharmacist staff to vaccinate during flu season

Relationship Marketing Practices in Community Pharmacies in Nigeria

The study identified the types of relationship marketing (RM) practices, determined the components of RM that fostered customer loyalty (CL) and evaluated the influence of the RM components on CL in community pharmacies. It was a cross-sectional survey of community pharmacies, pharmacists, non-pharmacist staff and customers. Random sampling was employed to select 40 community pharmacies, while purposive sampling was used to select four staff from each of the community pharmacies (160). Accidental sampling was used to select 510 customers of the pharmacies. Data were obtained with the questionnaire and analysed using appropriate descriptive and inferential statistics. Social RM practices yielded optimal results. The RM components that were determined were trust (TR), commitment (CMT), competence (CP), communication (CM), conflict handling (CH) and accessibility, which accounted for 55.4% of the total variance that occurred in CL. All the components of RM had positive but significant influence on CL with varying magnitudes. The study revealed that the types of RM practices in community pharmacies were the giving of loyalty gifts to customers, personalised telephone CMs, calling customers by name and special greeting codes. Also, special discounts and credits were offered to certain customers in order to build relationships. All the RM components positively influenced CL. Easy A to the pharmacies and pharmacists proved to be most influential in building loyalty followed by CM. The study concluded that RM practices in community pharmacies hold a lot of promise for community pharmacies to sustain their existing customers.

The experiences of the community pharmacy team in supporting people with dementia and family carers with medication management during the COVID-19 pandemic.

BackgroundThe novel coronavirus COVID-19 pandemic has changed the lives of people across the globe in significant and long-lasting ways. People with dementia were significantly and disproportionally affected at the height of the pandemic in England. Community pharmacies in England continued to operate during the pandemic but had to adjust the way they provided key healthcare services. The impact of these changes on the provision of medication services to people with dementia is underexplored.ObjectiveTo explore the experiences of the community pharmacy team in supporting people with dementia and their family carers with the management of medications during the COVID-19 pandemic.MethodsAn interpretivist/constructivist research paradigm was used; semi-structured one-to-one telephone interviews were conducted with any member of the community pharmacy team who had been involved in providing medication services to people with dementia in England before and during the COVID-19 pandemic. Recruitment took place between July and August 2020. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.ResultsFourteen participants were interviewed with equal numbers of qualified pharmacists and non-pharmacist staff. Participants were in their role for an average of 4.5 years. The analysis of interviews generated three themes: 1) key interactions curtailed due to COVID-19 restrictions, 2) utilising resources within and outside of the pharmacy to provide tailored services for people with dementia, and 3) the interplay between professional duty and personal values underpinned decisions to provide medication services.ConclusionsThe study provided a unique and important first insights to our understanding of how the community pharmacy team in England supported people with dementia and their family carers during the COVID-19 pandemic. These insights provide opportunities for reflection by individuals, healthcare teams, healthcare organisations, policy makers and the public, in an international context, to enable long-term planning, investment and implementation of strategies beyond the current pandemic.

Modelling the interactive behaviour of users with a medication safety dashboard in a primary care setting

ObjectiveTo characterise the use of an electronic medication safety dashboard by exploring and contrasting interactions from primary users (i.e. pharmacists) who were leading the intervention and secondary users (i.e. non-pharmacist staff) who used the dashboard to engage in safe prescribing practices. Materials and methodsWe conducted a 10-month observational study in which 35 health professionals used an instrumented medication safety dashboard for audit and feedback purposes in clinical practice as part of a wider intervention study. We modelled user interaction by computing features representing exploration and dwell time through user interface events that were logged on a remote database. We applied supervised learning algorithms to classify primary against secondary users. ResultsWe observed values for accuracy above 0.8, indicating that 80% of the time we were able to distinguish a primary user from a secondary user. In particular, the Multilayer Perceptron (MLP) yielded the highest values of precision (0.88), recall (0.86) and F-measure (0.86). The behaviour of primary users was distinctive in that they spent less time between mouse clicks (lower dwell time) on the screens showing the overview of the practice and trends. Secondary users exhibited a higher dwell time and more visual search activity (higher exploration) on the screens displaying patients at risk and visualisations. Discussion and conclusionWe were able to distinguish the interactive behaviour of primary and secondary users of a medication safety dashboard in primary care using timestamped mouse events. Primary users were more competent on population health monitoring activities, while secondary users struggled on activities involving a detailed breakdown of the safety of patients. Informed by these findings, we propose workflows that group these activities and adaptive nudges to increase user engagement.

PENEGAKAN HUKUM AKIBAT KELALAIAN APOTEKER DALAM MENJALANKAN PEKERJAAN KEFARMASIAN DI PUSKESMAS KABUPATEN BANYUMAS

The existence of the National Health Insurance Program organized by Healthcare and Social Security Agency (Badan Penyelenggara Jaminan Sosial Kesehatan or BPJS Kesehatan) causing increased number of visits to health centers. However, the increase patients were not followed by the increase of health human resources, especially Pharmacists. Being limited number of pharmacists who became one of the factors of negligence of pharmacist task in community healt centre. This research aimed to analyze the implementation of Pharmaceutical care at the health center. This research also aims to analyze law enforcement due to the negligence of pharmacist task at the health center. This research methode is a qualitative by the sociological juridical approach. Collecting data through observation and interviews to 10 Pharmacists who work in health centers and the head of health centers, also the head of Indonesian Pharmacist Association (IAI) in Banyumas region The pharmaceutical care in health centers are still not in accordance with the laws and regulations that apply where the phramacist task in the health centre is still done by a non-pharmacist staff and drug information to patient also incomplete in providing drug services, it is becoming one of the factors the occurrence of negligence. Law enforcement due to the negligence of the pharmacist in performing pharmacist task at the health center willbe solved by take out-of-court action with promote the rights of the patient or the victim, in which patients who experience the error due to the negligence of the pharmacist then directly solved by replacing drug medications error and in case undesirable of side effects from the use of drugs is carried out free medical treatment in accordance with the provisions. In increasing the phramaceutical care at the health center should be no additional health human resources, especially pharmacists or pharmacy technical staff while minimizing an increase in visits of patients will require an active role of other health professionals to optimize preventive health efforts in the awareness level of health awareness in the community. Staff pharmacist in health center should always increase the knowledge, skills and behavior in order to maintain and improve their competence through education and training. Key words : Pharmacist, Negligence, Law Enforcement

Mystery shopping and coaching as a form of audit and feedback to improve community pharmacy management of non-prescription medicine requests: an intervention study

ObjectivesTo determine whether repeated mystery shopping visits with feedback improve pharmacy performance over nine visits and to determine what factors predict an appropriate outcome.DesignProspective, parallel, repeated intervention, repeated measures mystery...

A systematic review in select countries of the role of the pharmacist in consultations and sales of non-prescription medicines in community pharmacy.

Much has been studied in regard to non-prescription medicines (NPMs), but the impact of greater emphasis toward patient self-selection of such agents is still not well understood, and evidence in the literature might be equivocal. The aim was to examine whether or not pharmacist interventions are important in the sale of NPMs and to summarize the evidence of pharmacists' contribution in maintaining patient safety and improving the quality of consultations involving NPMs. Seven online databases were searched to identify the literature on studies conducted within the UK and in countries comparable to the UK reporting on consultations and selling of NPMs published between 1980 and 2013. All study designs except for quantitative surveys were eligible for inclusion into the review. The data extraction and quality assessment were performed according to the National Institute for Health and Care Excellence guidelines. The data extracted from the studies were analyzed and presented qualitatively. Eighty-three studies from an original 12,879 citations were included in this review. Just under half of the studies were published between 2000 and 2009 (n=38; 46%). Thirty-three (44%) of the studies were conducted in the UK. The review showed that in terms of the contribution of community pharmacy staff in consultations for NPMs, non-pharmacist staff dealt with a large proportion of the consultations and pharmacists were usually involved in the consultation through referral from non-pharmacist staff member. Counseling was not consistently offered to everyone. Where counseling was provided it was not always of sufficient quality. Consultations were performed much better when symptoms were presented compared to when people made a direct product request. Pharmacists were reported to conduct better consultations than non-pharmacist staff. There was evidence to suggest that where counseling was appropriately provided this afforded the person a safe environment to utilize their NPMs. Seeking methods to develop better engagement with customers accessing pharmacy services for NPMs is necessary to enhance the interaction between these two parties. Efforts to enhance the community pharmacy environment to bring about a more positive experience for people using pharmacy is needed at present and will be important if the model for the selection of NPMs is modified in the UK. More studies are needed to allow a better understanding of the impact self-selection may have on patient safety in the community pharmacy context.

Qualitative exploration of the views of healthy living champions from pharmacies in England.

In England, the 'Healthy Living Pharmacy (HLP)' initiative has been trialed; positive outcomes led to national roll-out across England to 20 pathfinder sites. A HLP provides health promotion/prevention services through a structured framework to meet local population need. Non-pharmacist staff receive additional training so that they can provide these services, and are known as Healthy Living Champions (HLCs). To explore HLCs views on their role and to identify any barriers or facilitators in performing the role. Fourteen semi-structured face-to-face interviews were conducted during February and March 2013 in NHS Dudley, and analysed using the principles of content analysis. Three themes emerged from the interviews; HLC job role; training; and public awareness. HLC staff showed high levels of motivation, a strong desire to help people and felt a sense of personal reward, resulting in increased levels of job satisfaction. Training had improved their confidence but they still had reservations in offering services such as alcohol intervention and weight management. All believed that public awareness was low despite advertising. HLCs were positive toward their new role and derived job satisfaction from helping people to improve their health, although on-going training and support was perceived as important.

Survey to assess the role of pharmacy technicians and nonpharmacist staff in the operation of research pharmacies.

Results of a survey assessing trends and innovations in the use of pharmacy technicians and other nonpharmacist staff in the research pharmacy setting are reported. A Web-based survey was distributed to Internet communities of members of the American Society of Health-System Pharmacists and the University Health-System Consortium involved in investigational drug research and related practice areas. The survey collected data on the characteristics of institutions with pharmacy department staff dedicated to such research activities and the participation of pharmacists, technicians, and other staff in key areas of research pharmacy operations. Survey responses from 51 institutions were included in the data analysis. Overall, the reported distribution of assigned responsibility for most evaluated research pharmacy tasks reflected traditional divisions of pharmacist and technician duties, with technicians performing tasks subject to a pharmacist check or pharmacists completing tasks alone. However, some institutions reported allowing technicians to perform a number of key tasks without direct pharmacist supervision, primarily in the areas of inventory management and sponsor monitoring and auditing; almost half of the surveyed institutions reported technician involvement in teaching activities. In general, the reported use of "tech-check-tech" arrangements in research pharmacies was very limited. Some responding institutions reported the innovative use of nonpharmacist staff (e.g., paid interns, students and residents on rotation). Although the majority of research pharmacy tasks related to direct patient care are performed by or under the direct supervision of pharmacists, a variety of other essential tasks are typically assigned to pharmacy technicians and other nonpharmacist staff.

Australian pharmacies prevent potential adverse reactions in patients taking warfarin requesting over-the-counter analgesia.

The objective of this article was to assess if Australian pharmacy staff prevent potential adverse reactions in warfarin patients requesting over-the-counter (OTC) analgesia. Mystery shoppers entered 170 pharmacies across Australia to request OTC analgesia for a hypothetical patient with a wrist injury who currently takes warfarin following a heart valve replacement. The request was made to the first pharmacist or non-pharmacist staff member to approach the mystery shopper. The interaction was audio-taped and assessed by a pharmacist. The OTC analgesic recommended was assessed for the potential to cause an adverse bleeding event. The quality of advice given with the OTC analgesic was assessed against determined criteria. Results were compared with scenarios of similar request type where the hypothetical patient was not taking warfarin. Mystery shoppers enquiring about taking OTC analgesics concomitantly with warfarin had access to the pharmacist in 97.0% of cases. All 170 pharmacies recommended OTC analgesics that were less likely to cause adverse events when taken with warfarin. The advice given and the communication between pharmacy staff and mystery shoppers were of high quality. Australian pharmacies support the quality use of medicines by patients taking warfarin by providing expeditious access to the pharmacist, appropriate recommendations of OTC analgesics, high standards of quality of advice and they communicate in a way to ensure ease of understanding by the consumer. The protocols used by pharmacy staff help prevent potentially serious adverse drug events.

A demonstration study comparing "role-emergent" versus "role-established" pharmacy clinical placement experiences in long-term care facilities.

BackgroundIncreasing challenges to recruit hospital sites with full-time on-site pharmacy preceptors for institutional-based Advanced Pharmacy Practice Experiences (APPE) has made it necessary to consider alternate experiential models. Sites with on-site discipline specific preceptors to supervise students have typically been referred to in the literature as “role-established” sites. In British Columbia, long-term care (LTC) facilities offered a unique opportunity to address placement capacity issues. However, since the majority of these facilities are serviced by off-site community pharmacists, this study was undertaken to explore the viability of supervising pharmacy students remotely – a model referred to in the literature as “role-emergent” placements. This paper’s objectives are to discuss pharmacy preceptors’ and LTC non-pharmacist staff experiences with this model.MethodsThe study consisted of three phases: (1) the development phase which included delivery of a training program to create a pool of potential LTC preceptors, (2) an evaluation phase to test the viability of the LTC role-emergent model with seven pharmacists (two role-established and five role-emergent) together with their LTC staff, and (3) expansion of LTC role-emergent sites to build capacity. Both qualitative and quantitative methods were used to obtain feedback from pharmacists and staff and t-tests and Mann–Whitney U tests were used to examine equivalency of survey outcomes from staff representing both models.ResultsThe 76 pharmacists who completed the training program survey rated the modules as “largely” meeting their learning needs. All five role-emergent pharmacists and 29 LTC participating staff reported positive experiences with the pharmacy preceptor-student-staff collaboration. Preceptors reported that having students work side-by-side with facility staff promoted inter-professional collaboration. The staff viewed students’ presence as a mutually beneficial experience, suggesting that the students’ presence had enabled them to deliver better care to the residents. As a direct result of the study findings, the annual role-emergent placement capacity was increased to over 45 by the end of the study.ConclusionsThis study demonstrated that role-emergent LTC facilities were not only viable for quality institutional APPEs but also provided more available sites, greater student placement capacity, and more trained pharmacy preceptors than could be achieved in role-established facilities.

Migraine Management in Community Pharmacies: Practice Patterns and Knowledge of Pharmacy Personnel in Thailand

To describe practice behavior and understanding among pharmacy personnel, both pharmacists and non-pharmacist staff, in the management of mild and moderate migraines. Migraine is recognized as a prevalent and chronic neurological disorder. In developing countries, such as Thailand, community pharmacies are a widely used source of health care for various illnesses including migraine. However, the quality of migraine management and knowledge among pharmacy personnel is unclear. Cross-sectional study. The sample comprised 142 randomly selected community pharmacies in a city in the south of Thailand. Simulated clients visited the pharmacies twice, at least 1 month apart, to ask for the treatment of mild and moderate migraines. After the encounters, question asking, drug dispensing, and advice giving by pharmacy staff were recorded. Subsequently, the providers in 135 pharmacies participated in the interview to evaluate their knowledge in migraine management. The majority of pharmacy personnel were less likely to ask questions in cases of mild migraine when compared with moderate attack (mean score [full score = 12] 1.8 ± 1.6 vs 2.6 ± 1.5, respectively, P < 0.001). Mean difference of question asking between mild and moderate migraines was -0.8 (95% confidence interval -1.1 to -0.5, P < 0.001). Approximately 33% and 54% of the providers appropriately dispensed non-steroidal anti-inflammatory drugs for mild attack and ergotamine for moderate migraine, respectively, P < 0.001. Prophylactic medications (eg, atenolol, propranolol, flunarizine) were inappropriately recommended, particularly in moderate attack (28.2% vs 17.6% in mild migraine, P = 0.018). Less than 30% of providers advised the patients on the maximum limit of dose or discontinuity of medications when recovered. Compared with non-pharmacists, pharmacists tended to ask more questions, give more advice, and dispense less appropriately; however, there were no significant differences. The results from the interview showed that most pharmacy personnel had inadequate knowledge on migraine management. Pharmacists had better knowledge on question asking (mild migraine 5.1 ± 2.1 vs 3.1 ± 1.3, respectively, P < .001; moderate disorder 6.5 ± 3.1 vs 3.9 ± 2.1, respectively, P < .001) and tended to have more knowledge on advice giving but poorer drug dispensing in moderate migraine according to the guidelines, relative to non-pharmacists (20.5% vs 40.3%, P = .014). A large number of community pharmacists and non-pharmacist staff had inappropriate practice behavior and understanding. Continuing education and interventions are important to improve the practice and knowledge of pharmacy personnel, particularly the pharmacists.

From community pharmacy to healthy living pharmacy: Positive early experiences from Portsmouth, England

Research has shown the potential for community pharmacies to promote better health and prevent disease by providing individual services in a limited range of settings. In the UK, the healthy living pharmacy (HLP) framework has been developed to allow pharmacies to provide a portfolio of such services tailored to local need. This paper reports an evaluation of the uptake and success of HLP introduction in Portsmouth, the original pathfinder site for a national program. To assesses the impact on service provision and staff engagement at an early stage in HLP program development. Quantitative data, derived from pharmacy records, on service provision by HLPs (n=17) and non-HLPs (n=19) during April 2011-March 2012 was evaluated for trends and differences. Face-to-face interviews were conducted during November 2011 and February 2012, to gauge staff opinion on HLP development and sustainability, using interpretative phenomenological analysis. Significantly more clients per pharmacy were seen in HLPs than non-HLPs for the following services: targeted respiratory medicine use reviews (medians: 29 vs 11; P=0.0167); smoking cessation at initiation (62 vs 18; P<0.001) and at 4-week (26 vs 10; P<0.001) and 12-week (5 vs 1; P=0.023) follow-ups. Medians for alcohol awareness and weight management were appreciably higher in HLP pharmacies, but the differences did not reach statistical significance. Medians for clients seeking emergency hormonal contraception were comparable. Interviews with 38 staff from 32 pharmacies revealed a positive impact on service development in HLPs, largely engineered through revision of skill mix and additional training of non-pharmacist staff to become healthy living champions. Obstacles to HLP development were managing the increased workload, raising awareness of clients and other healthcare professionals of the services available, and receiving remuneration for service provision. These data point to a largely successful introduction of the HLP program in Portsmouth and the potential for improving client health. Staff interviews suggest that adoption and sustainability of the scheme depend on achieving the right skill mix, including the introduction of healthy living champions, motivation of the entire staff team and the provision of adequate funding for services offered.

Non-prescription medicine supply: protocols and practice

Abstract Focal points