Pharmacy Counseling Research Articles

Making medication communication visible in community pharmacies-pharmacists' experience using a question prompt list in the patient meeting

BackgroundEven though patient engagement in the pharmacy encounter is low, few studies focus on activating patients. A Question Prompt List (QPL) has been used successfully in other parts of healthcare to encourage patients to raise their questions and concerns. For a QPL to be useful in a pharmacy setting, it first must be considered valuable and be accepted by pharmacists. ObjectiveTo investigate the experience of community pharmacists using a QPL in counseling patients about prescribed medications. MethodsAn explorative, qualitative study was conducted in 2020. A QPL, for use in pharmacy counseling, was developed based on previous literature. Semi-structured interviews were held with pharmacists. A thematic analysis approach was conducted, and the analytical framework Technology Acceptance Model (TAM) was used. ResultsData were collected in 7 Swedish community pharmacies in interviews with 29 purposefully selected pharmacists. Three themes were identified: Perceived usefulness: the impact of the QPL on patient activation in the encounter, Perceived ease of use of the QPL in pharmacies, and Increasing the perceived usefulness and ease of use of the QPL. The pharmacists perceived patients as more active in the meeting when using the QPL. The list focused the conversation on medications, which the pharmacists appreciated from a professional point of view. They described the QPL as a useful tool that could easily be integrated into the dispensing process and required little training; however, challenges described were, for example, time constraints and stress. ConclusionsPharmacists reported that using a QPL improved patient participation in the encounter. Encouraging counseling on medications was seen as beneficial from a professional point of view. In the early adoption phase, the QPL was easy to implement and did not increase the pharmacists' workload. A QPL appears to be a promising tool for pharmacists to improve the quality of the consultation experience.

Abstracts 8th PCNE working symposium ‘Navigating research on pharmaceutical care’. 11–12 February 2022, Lisbon, Portugal

Abstracts 8th PCNE working symposium ‘Navigating research on pharmaceutical care’. 11–12 February 2022, Lisbon, Portugal

The content of counselling received about interchangeable medicines and generic substitution—a survey of pharmacy customers

Abstract Objectives This study explored from pharmacy customers’ perspective what information they receive about interchangeable medicines and generic substitution (GS) in pharmacies and from physicians, and whether there were differences in the information received concerning customer characteristics. Methods Questionnaire survey of pharmacy customers. Analytical methods: descriptive methods, Chi-square test and Fischer’s exact test. Key findings The response rate was 40.0% (n = 1043). Of respondents, 64.4% had not received information about the possibility of GS from their physician. Of respondents, 55.6% never discussed medicine prices with their physician, whereas 39.9% sometimes discussed prices. In the pharmacy, respondents reported most commonly that they were told about the possibility of substitution (79.5%), price differences (52.0%) and the option to decline the substitution (38.5%). There were differences in the issues reported in relation to customers’ education, current use of medicine, experience of GS and age. Of respondents, 89.0% considered the information received sufficient. Respondents who found the information insufficient were more frequently aged 18–34 years or had no experience of GS. Conclusions Pharmacy customers are well informed about interchangeable medicines and GS. Counselling in pharmacies focuses on those issues that are most relevant to the substitution. Some customer characteristics may affect the content of counselling. Price counselling should be provided equally to everyone. Neither the possibility of substitution nor prices are commonly discussed in the physician’s office, which emphasizes the importance of pharmacy-based counselling.

LVAD OPTIMIZE Clinic Improves Medication Use and Reduces Hospitalizations Post-Implant

Purpose Guidance on use of GDMT following left ventricular assist device (LVAD) remains scant despite studies showing optimal use may reduce morbidity and mortality. We aimed to evaluate the impact of an LVAD OPTIMIZE clinic on medication utilization and outcomes. Methods A multidisciplinary clinic composed of advanced practice providers, pharmacists, nutritionists, and nurses was developed and enrolled patients after discharge from LVAD implantation. Candidates for enrollment were those who could make the scheduled visits. Our OPTIMIZE clinic consisted of a total of 6 visits each two weeks apart and included medication optimization as well as nutrition and pharmacy counseling. Patients who survived to discharge and were not enrolled in the OPTIMIZE clinic were utilized as controls and their variables were collected approximately 3-4 months post-implant. T-test, Chi square, and negative binomial regression were utilized to compare variables and outcomes between groups. Results From January 2019 and March 2021, 26 patients completed OPTIMIZE clinic. Our control group consisted of 43 LVAD patients. Enrolled patients had an average age of 55.3 (±12.8) years, 11 (42.3%) were female, 24 (92.3%) were HeartMate 3 and 2 (7.8%) were HeartWare, and were enrolled an average of 38 (±16) days post-implant. At the end of OPTIMIZE, there was a 150% increase in beta blocker use (8 vs 20), 140% increase in ARNi use (5 vs 12), 17% increase in aldosterone antagonist use (18 vs 21), 41% reduction in loop diuretic use (17 vs 10), and 7 patients were started on SGLT2i (0 at baseline). Comparison of medication use, lab values, and hospitalizations at the end of LVAD OPTIMIZE clinic compared to controls at similar time points is shown in Table 1. Conclusion A multidisciplinary LVAD OPTIMIZE clinic can help improve medication utilization post-implant and is associated with lower rates of hospitalization and less renal dysfunction. Further studies are needed to help clarify optimal GDMT utilization and timing of initiation in this population. Guidance on use of GDMT following left ventricular assist device (LVAD) remains scant despite studies showing optimal use may reduce morbidity and mortality. We aimed to evaluate the impact of an LVAD OPTIMIZE clinic on medication utilization and outcomes. A multidisciplinary clinic composed of advanced practice providers, pharmacists, nutritionists, and nurses was developed and enrolled patients after discharge from LVAD implantation. Candidates for enrollment were those who could make the scheduled visits. Our OPTIMIZE clinic consisted of a total of 6 visits each two weeks apart and included medication optimization as well as nutrition and pharmacy counseling. Patients who survived to discharge and were not enrolled in the OPTIMIZE clinic were utilized as controls and their variables were collected approximately 3-4 months post-implant. T-test, Chi square, and negative binomial regression were utilized to compare variables and outcomes between groups. From January 2019 and March 2021, 26 patients completed OPTIMIZE clinic. Our control group consisted of 43 LVAD patients. Enrolled patients had an average age of 55.3 (±12.8) years, 11 (42.3%) were female, 24 (92.3%) were HeartMate 3 and 2 (7.8%) were HeartWare, and were enrolled an average of 38 (±16) days post-implant. At the end of OPTIMIZE, there was a 150% increase in beta blocker use (8 vs 20), 140% increase in ARNi use (5 vs 12), 17% increase in aldosterone antagonist use (18 vs 21), 41% reduction in loop diuretic use (17 vs 10), and 7 patients were started on SGLT2i (0 at baseline). Comparison of medication use, lab values, and hospitalizations at the end of LVAD OPTIMIZE clinic compared to controls at similar time points is shown in Table 1. A multidisciplinary LVAD OPTIMIZE clinic can help improve medication utilization post-implant and is associated with lower rates of hospitalization and less renal dysfunction. Further studies are needed to help clarify optimal GDMT utilization and timing of initiation in this population.

Direct patient care practices in community pharmacies in Bayelsa and Rivers State in the Niger Delta Area of Nigeria

Direct patient care practiced in community pharmacy settings remains among the best remedy to the ever-emerging meddling practices of allied health and non-health personnel in the health promotion and disease prevention function of the pharmacy profession. The professional strides for totally owning this hub, though in the progress, were not easy in prehistoric times, nor is it getting any easier now. This study determines the extent of practice carried out in direct patient activities (patient counseling, patient care and technology standards) in community pharmacies in Bayelsa and Rivers states as at the year 2017. Of the three hundred and thirty seven (337) questionnaires distributed, three hundred and twelve (312) were retrieved (92.58% retrieval rate). The questionnaire was constructed in likert form with responses as “never”, “rarely”, “sometimes”, “often” and “always”. The results were analyzed using non parametric analysis using SPSS version 23. Young male pharmacists having B.Pharm (177; 56.7%) with 6 to 10 years’ experience (140; 44.9%) in self-owned premises (190; 60.8%) were observed to contribute significantly to the study domains. Pharmacists were reported to always carry out patient counseling activities (44.2%), always carry out patient care activities (35.9%) and never, apply technological applications in community pharmacies (45.9%) in the study area. Community Pharmacy Practice is below recommended standards in the two states. Improvement is needed in the hub of direct patient care to maintain the needed pharmaceutical care practice and philosophy.

Over-the-counter counseling in community pharmacies and job satisfaction among pharmacy professionals: A reflection of current scenario and possible solutions.

Objectives:This study assessed community pharmacist counseling and dispensing practices to determine their relationship with job satisfaction among pharmacists.Methods:A cross-sectional study was conducted between January 2021 and September 2021on a random sample of community pharmacists. The inclusion criteria were licensed community pharmacists with at least3months of professional experience. The researchers conducted face-to-face interviews using a developed structured questionnaire. The research instrument was comprised of two sections: demographic information and dispensing practices. Data were analyzed using SPSS Version 24.Results:a total of 543pharmacists participated in this study. The average age of respondents was 31 ± 7 SD. The average dispensing practice score was 75% with a 95% confidence interval (CI) of [73.3%, 76.7%]. Better dispensing practices were common among older participants (odds ratio (OR)1.010; 95% CI 1.001–1.020), postgraduates (OR 1.191; 95% CI 1.055–1.344), pharmacists from pharmacy chains (OR 1.452; 95% CI 1.285–1.640), participants with more than 10 years of experience (OR 1.286; 95% CI 1.089–1.520), pharmacists who graduated from regional universities (OR 1.200; 95% CI 1.129–1.497), and pharmacists who graduated from international universities (OR 1.413; 95% CI 1.212–1.648). However, poor dispensing practices were common among participants who were not satisfied with their current community pharmacist job (OR 0.487; 95% CI 0.410–0.577).Conclusion:Patient-centered management strategies oriented toward creating a counseling-friendly environment would open more space to achieve professional self-realization through cognitive services. This could benefit patients via consistent counseling services and increase pharmacists’ satisfaction with their job and profession.

Using qualitative methods to explore the dynamics of patients' perspective sharing in community pharmacy counseling- conversation analysis and video-stimulated recall interviews.

Background:For patient centered counseling to take place in community pharmacies, patients should feel encouraged to share their perspectives, yet studies show that this rarely happens. The process of patient perspective sharing relies on the interactional details that unfold during an encounter i.e. how patients verbally and nonverbally are encouraged to share their perspective, which in turn is affected by patients’ and pharmacy staff members’ psychological processes in the situation, i.e. how they perceive and feel when acting. Therefore, employing complimentary methods that study both interactional and psychological processes could deepen the understanding of the dynamics governing patients’ perspective sharing in pharmacy encounters.Objective:The objective of this study is twofold: 1) a methodological consideration of the benefits of employing Conversation Analysis (CA) and Video-Stimulated Recall Interviews (VSRI) in parallel, 2) to use the methodological combination to understand patient perspective sharing in community pharmacy interactions.Method:A single case study of one pharmacy encounter to explore the objectives in-depth. This was done through video recording of pharmacy encounters and subsequent CA-analysis; VSRIs were conducted with the involved patient and pharmacy staff member and analyzed using a qualitative thematic approach.Results:By exploring detailed interactional and psychological processes in parallel, specific occurrences which might hinder patients’ perspective sharing were revealed. CA demonstrated that staff member’s listening activities restricted the patient’s perspective sharing. VSRIs with patient and staff member supported this result: the staff member had a narrow conception of what counted as suitable answers and did not consider listening an active process. The patient harbored shame about needing to take the medication which affected her behavior during the encounter.Conclusion:The novelty of the methodological combination is promising in order to grasp the complex process of patient perspective sharing in pharmacy encounters, as it affords aspects such as emotionality to be considered a central part of pharmacy encounters. As a consequence, it is suggested that the psychological concept of mentalizing is added to pharmacy education, as it is a trainable capacity enabling staff to become aware of the mental states that affect both patients and staff themselves during the pharmacy encounter.

A mentalising education programme for community pharmacy workforce

This article describes the development and content of the continuing education programme “Counseling first hand – understanding the customer and yourself through mentalising”. The education programme is targeted at the community pharmacy workforce and aims at increasing the pharmacy workforce’ awareness of mental states in pharmacy counselling in order to ultimately centre the interaction around the customer’s perspectives. As such, the education programme combines the traditions of pharmacy practice with a psychologically-based theory of interaction, i.e. mentalising. The education programme is developed between partners from the University of Copenhagen and from Pharmakon-the Danish College of Pharmacy Practice and is funded by the European Institute of Innovation and Technology (EIT) Health. The continuing education programme spans four months and combines physical attendance with online modules.

PHARMACY CONSULTING: NEW DRUG FORMS AND NEW OPPORTUNITIES

Pain syndrome of various origins and varying intensity is the most common and leading reason for seeking medical care in the world. The main drugs for the relief of both acute and chronic pain syndrome from the 20th century to the present are non- steroidal anti-inflammatory drugs (NSAIDs). More than 30 million people worldwide receive them every day. Along with pain, other common indications for NSAIDs are fever and inflammation. All NSAIDs differ in the degree of effectiveness, form of release, speed of onset of clinical effect and dosage. That is why one of the fundamental tasks of the pharmacist, in the framework of pharmacy counseling, is to provide the patient with quality medicines and teach them how to use them rationally. With the rapid development of medical and information technologies in the modern world, the fulfillment of this task becomes more and more important, complex and responsible action. The appearance, on the pharmaceutical market innovative NSAIDs in accelerated-release dosage’s forms (for example, Ketorol® Express), makes it possible to expand the pharmacy list.

Emergency Contraception Access and Counseling in Metropolitan and Nonmetropolitan Pharmacies in Georgia

Background: Emergency contraception (EC) efficacy is dependent on timing of administration. Adequate pharmacy stock information and accurate patient counseling are important to ensure timely access. Objective: This study evaluates pharmacist reported availability and counseling for levonorgestrel (LNG) and ulipristal acetate (UPA), and identifies differences between caller type and pharmacies in metropolitan vs nonmetropolitan areas of Georgia. Methods: This prospective, randomized, telephone-based study included 25% of Georgia community pharmacies, stratified by geographic location. Calls were made by investigators, first posing as a mystery shopper inquiring about EC stock and efficacy, then 3–6 weeks later as a researcher inquiring about EC stock. Analysis utilized descriptive statistics, chi Square, and logistic regression. Results: Of 600 pharmacies, the mystery shopper caller reached 86%: 74% of pharmacists initially discussed LNG, 57.1% had it stocked, more often in metropolitan areas (OR 1.7, 95% CI 1.08–2.6). Ulipristal acetate was discussed by 1.9% and reported in-stock < 1%. Of those who discussed window of efficacy, 79% indicated LNG would either not work 4 days after intercourse or they were unsure. The research caller successfully completed a second call for 64% of pharmacies: 57% stocked LNG, 3% stocked UPA, and UPA was more likely to be stocked in metropolitan pharmacies. Conclusion: In Georgia, UPA availability is poor, and nonmetropolitan pharmacies were less likely to stock LNG and UPA. A minority of pharmacists correctly indicated that LNG may work up to 120 hours after intercourse. Strategies are needed to overcome barriers to EC availability in community pharmacies and support pharmacists’ EC counseling.

Wybrane zagadnienia związane z promocją zdrowia w okresie pandemii

Health promotion during a pandemic is also one of the special tasks not only in the practice of a family doctor, which also results from changes in the lifestyle of patients. Since the start of coronavirus pandemic working from home, called home-office gained popularity not only amongst big corporations. Unfortunately not all the occupations has an option to do their job related responsibilities at their own personal desk. It would sound difficult to keep self-discipline while being able to watch TV without sudden consequences, but the results show that home workers do very well. The most important thing for the employer, which is productivity, increased in COVID-19 times. It can be caused by lack of disturbing noises and uncomfortable surroundings that could lead to stress. Allowing employees to do their jobs from home reduced the time spent every day on getting ready to work. For example for many people morning commute has become the thing of the past. Another positive aspect of home-office is workers time flexibility. While at home some people can plan their day in their own way. Some jobs in this situation have no arranged daily working hours, the only obligation is to do the task until the deadline. Maybe there are more advantages than disadvantages of working from home, but the negative sites can overcome the positives and have negative health effects. After some time one can get bored with their own four walls, or even feel alone and abandoned, which can lead to lowered well-being. In such a new time everybody should keep the balance between social and job-related life, as well as a proper diet and physical activity, for example through gymnastics at home. Communicating this knowledge to patients is important in both medical, in pharmacy counseling and nursing practice.

Pharmacist\u2019s recommendations of over-the-counter treatments for the common cold - analysis of prospective cases in Poland

BackgroundCommon cold is a frequent illness in northern hemisphere between late autumn and early spring. Patients suffering from it frequently turn to pharmacists instead of physicians in order to receive medical advice and treatment. We studied its treatment advised by pharmacists in Poland, as well as evidence for the efficacy of their recommendations by utilizing a self-developed questionnaire and a study of existing literature.MethodsThe data were collected by 27 pharmacists who worked in four large network community pharmacies in Lodz, Poland. The study took place from December 2019 to February 2020. Data were recorded only if the patient asked for pharmacy counselling for over-the counter (OTC) products due to common cold self-diagnosis and a product was sold. Pharmacists’ recommendations were compared with the results of a literature review of best evidence to determine appropriateness of the pharmacists’ decisions.ResultsIn four out of five cases the pharmacists recommended products contained paracetamol. In addition, in one out of three patient encounters they advised nasal decongestant, inosines and/or OTC mucolytics. There was a significant relationship between fever and recommendation frequency of some analgesics, inosines, mucolytics and sore throat products (OR > 1, p < 0.05); rhinorrhea and recommendation frequency of paracetamol, inosines, anti-histamines and alpha-mimetics (OR > 1, p < 0.05); cough and recommendation frequency of paracetamol, inosines, mucolytics and sore throat products (OR > 1, p < 0.05); and fatigue and recommendation frequency of paracetamol, acetylsalicylic acid, inosines and sore throat products (OR > 1, p < 0.05). The pharmacist recommendations were based on patients’ symptoms, product price, pharmaceutical company promotion and the financial incentive. In many cases their recommendations were not in line with current best practice recommendations.ConclusionsOur study suggests that the most common rationale for pharmacist recommendation on anti-common cold treatment was to take a “shotgun” approach. Pharmacists commonly made recommendations for products that lack strong evidence for efficacy (i.e. anti-viral agents) and are potentially unnecessary, based on presentation of the symptom. Reasons for this situation include lack of training, lack of time to evaluate the patient, lack of awareness of evidence as well as drug company marketing and financial incentives (i.e. fulfilling sale plans and target sale bonuses).Trial registrationThe study was a non-interventional, observational research trial. The study registration was not required.

Effect of Pharmacy Counseling on Readmissions in Patients with Acute Exacerbations of COPD: A Randomized Controlled Trial

Objective: To investigate the effects of pharmacy counseling on clinical and economic outcomes in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients.Material and Methods: The outcomes consisted of 28-day hospital readmissions related to AECOPD, direct costs, medication adherence calculated by proportion of days covered (PDC), and health-related quality of life (HRQoL) measured by chronic obstructive pulmonary disease assessment test (CAT). The data derived from the intervention group, for which pharmacy counseling was provided, was compared with that obtained from the control group provided with usual pharmaceutical care. The study also drew comparisons between the PDC and CAT scores of pre- and postintervention periods.Results: Forty-four patients (23 intervention and 21 control) were included in the analysis. There were no significant differences in the readmission rate (13% vs 19%, p-value&gt;0.050), nor the number of readmitted patients (3 vs 3, p-value &gt;0.050). A decrease in direct costs did not reach statistical significance (p-value&gt;0.050). In addition, no difference between the PDC scores was found (96.67 vs 100.00, p-value&gt;0.050). Intervention patients obtained significantly lower CAT scores than the control patients did (9 vs 19, p-value&lt;0.050). Compared with the pre-intervention period, PDC scores were identical; however, CAT scores measured during the post-intervention period were significantly different.Conclusion: Pharmacy counseling for AECOPD patients could enhance HRQoL. Drug therapy and pulmonary rehabilitation may cause such improvement. Further work, which has adequate participants, is required to detect a significant difference in readmissions between the two groups.

Designing, Implementation, and Evaluation of an Online Modular Course on Patient Education and Counseling at the Community Pharmacy

Background: The role of pharmacists has evolved from drug provision to patient care. Considering the Doctor of Pharmacy curriculum in Iran and the small number of programs on pharmaceutical care, Iranian pharmacy graduates may not be able to adjust to their new roles. Methods: A comprehensive online modular course was prepared by a group of well-experienced faculty members of eight universities of medical sciences in Iran. The course included 12 practical and challenging submodules on commonly encountered disorders and commonly used medications in the community pharmacy. Each submodule was followed by an online forum in which the teachers and participants discussed the educational questions. The increase in participants’ knowledge was evaluated using pre-and post-test. The usefulness of submodules and acceptance of the entire course were also evaluated by two specifically designed questionnaires. Results: After the announcement, 154 participants registered in the course. The knowledge of the participants increased significantly in all the 12 submodules. The majority of participants stated that all the submodules were useful. Moreover, the majority of respondents to questionnaires declared that the course has increased their confidence in providing patient counseling in the pharmacy. Conclusion: The comprehensive online course on patient counseling in the community pharmacy increased participants’ knowledge. Besides, the course was useful and well accepted by the participants.

Public Perception Regarding Practice, and Barriers towards Pharmacist Counseling in the Community Pharmacy

Background: The role of the pharmacist includes an effective informative counseling with the patient. Pharmacists should practice delivery of patient-centered services and patients should know their rights for proper counseling. Objectives: To assess patient’s perception and attitude towards counseling in the community pharmacy. Methods: The cross sectional study employed an anonymous questionnaire with closed ended questions, written in English and Arabic and posted online. Results: Only 362 participants responded within the specified period. The majority (314, 86.7%) of participants were females, age range of 17-24 years (238, 66%), Arabs (354, 98%), and single (234, 64.6%). Participant’s visits to the pharmacy were 2-4 times (120, 33.1%) and > 10 times (107, 29.6%) annually. The main reason of these visits was to obtain medications (248, 68.5%). Large number of participants ask about the dose (278, 77%) and frequency of administration and duration of use (238, 65.7%), while only 91 (25.1%) of participants ask about side effects. Surprisingly, 182 (50.3%) of the participants admitted not asking about side effects. Reasons of participants not asking for information include getting these from the prescribing physician (204, 56.4%) and having earlier experience (175, 48.3%) with the medication. Sources of information were mainly the physician (262, 72.4%) followed by the pharmacist (220, 60.8%). Participants who consult a physician when feeling ill comprised 146 (40.3%) and a few consult the pharmacist (64, 17.7%). Conclusion: In UAE, the usual practice in most community pharmacies is product- rather than patient-centered and such a perception negatively influences patient’s satisfaction with community pharmacy services.

Impact of pharmacist-conducted anticoagulation patient education and telephone follow-up on transitions of care: a randomized controlled trial

BackgroundThere is limited published data in Lebanon evaluating the impact of supplemental education for anticoagulants use, especially DOACs, on clinical outcomes such as bleeding. The study aims to assess the impact of pharmacist-conducted anticoagulation education and follow-up on bleeding and readmission rates.MethodsThis study was a randomized, non-blinded interventional study conducted between August 2017 and July 2019 in a tertiary care teaching Lebanese hospital. Participants were inpatients ≥18 years discharged on an oral anticoagulant for treatment. Block randomization was used. The control group received the standard nursing counseling while the intervention group additionally received pharmacy counseling. Phone call follow-ups were done on day 3 and 30 post-discharge. Primary outcomes included readmission rates and any bleeding event at day 3 and 30 post-discharge. Secondary outcomes included documented elements of education in the medical records and reported mortality upon day 30 post-discharge.ResultsTwo hundred patients were recruited in the study (100 patients in each study arm) with a mean age of 73.9 years. In the pharmacist-counseled group, more patients contacted their physician within 3 days (14% versus 4%; p = 0.010), received explicit elements of education (p < 0.001) and documentation in the chart was better (p < 0.05). In the standard of care group, patients were more aware of their next physician appointment date (52% versus 31%, p < 0.001). No difference in bleeding rates at day 3 and 30 post-discharge was observed between the groups.ConclusionsAlthough pharmacist-conducted anticoagulation education did not appear to reduce bleeding or readmission rates at day 30, pharmacist education significantly increased patient communication with their providers in the early days post-discharge.Trial registrationLebanon Clinical Trial Registry LBCTR2020033424. Retrospectively registered. Date of registration: 06/03/2020.

"I've Heard of It, Yes, but I Can't Remember What Exactly It Was"-A Qualitative Study on Awareness, Knowledge, and Use of the UV Index.

Pharmacists and pharmaceutical technicians play an important role in counselling customers regarding sunscreen use and sun protection measures. A potentially helpful tool that can be used during counselling is the ultraviolet index (UVI), which informs individuals when and what sun protection measures are needed at a specific place and time. Our aim in this qualitative study was to explore awareness, knowledge, and use of the UVI during counselling in pharmacies. We used semi-structured interviews with pharmacists and pharmaceutical technicians (n = 20) to answer our research questions. Interviews were audiotaped, transcribed verbatim, and analyzed using qualitative content analysis. During the interviews pharmacists and pharmaceutical technicians revealed a lot of uncertainty and lack of knowledge regarding the UVI. Eight professionals were able to give a correct definition of UVI. Amongst others, the UVI was confused with sun protection factor. Overall, the UVI was hardly used during the counselling of customers. The UVI was developed to provide guidance when which type of sun protection is required to avoid detrimental effects of ultraviolet radiation. For effective implementation, both the general population and health professionals (e.g., pharmacists) have to increase their knowledge about the UVI. This would strengthen its use during professional counselling in pharmacies and may help to reduce the incidence of skin cancer over the long term.

Pharmacist counseling when dispensing naloxone by standing order: A secret shopper study of 4 chain pharmacies

BackgroundTexas has passed legislation to increase access to naloxone, the opioid overdose antidote, allowing pharmacists to dispense by standing order without an outside prescription. Given this added responsibility, there is a need to assess real-world counseling provided by pharmacists when dispensing naloxone. ObjectivesAssess naloxone accessibility and counseling provided by community pharmacists when dispensing naloxone by standing order. MethodsA total of 11 student pharmacists (mean age 25 years; 63.6% female; primarily Hispanic [36.4%], Asian [27.3%], and white [27.3%]) audited community pharmacies by presenting to purchase naloxone. Variables included naloxone availability and price, counseling duration, and whether 13 predetermined counseling points were provided unprompted. Shoppers were prepared with a background story if asked so that each answered questions consistently. All shoppers participated in two 1-hour training sessions, including verification of their ability to accurately assess naloxone counseling. Pharmacies in Bexar County, TX were selected randomly from 4 pharmacy chains, each of which have implemented statewide standing orders within their chain. Descriptive statistics were calculated. A Fisher exact test and linear mixed-effects regression model were used to assess variation across chains in whether naloxone was dispensed and the mean total number of counseling points provided, respectively. ResultsThe shoppers audited 45 pharmacies. Naloxone was dispensed in 31 of 45 (68.9%) encounters (mean cost: $129.59). The mean counseling duration was 89 seconds. The most common counseling points included: administration technique (24 of 31), readministration of second dose (22 of 31), and calling 9-1-1 (20 of 31). All other points were included in less than one-third of pharmacists’ counseling. Across the 4 chains, there was significant variation in naloxone dispensing and the number of counseling points provided. ConclusionSecret shoppers were unable to access naloxone from nearly one-third of pharmacies. Counseling often excluded concepts pertinent to patient safety and effectiveness, suggesting opportunities remain to promote consistent, high-quality naloxone counseling in community pharmacies.

What is the attitude towards and the current practice of information exchange during self-medication counselling in German community pharmacies? An assessment through self-report and non-participant observation.

BackgroundGuidelines encourage relevant information exchange between pharmaceutical staff and patients during self-medication consultation. Thereby, assessing the patient’s situation and providing information is crucial for patient safety. So far, limited studies have investigated this information exchange, particularly in Germany. We aimed to assess the attitude towards and the current practice of guideline-recommended information exchange in German community pharmacies.MethodsIn total, twelve guideline-recommended parameters were predefined for gathering patient-related information and for the provision of information. These information exchange parameters were evaluated in two parts: Firstly, in a self-report of pharmaceutical staff via an online questionnaire to assess the reported importance, difficulty and frequency of the parameters as well as barriers to their implementation; secondly, in a non-participant observation in five pharmacies to evaluate the actual consultation practice.ResultsIn the self-report, all parameters were rated by more than 76% of 1068 participants as important. ‘Concurrent medication’ was determined to be the most difficult parameter to address (54%). All parameters of information gathering were rated to be addressed during routine counselling by at least 70% of the respondents. Parameters of information provision were all rated to be addressed by at least 45%. ‘Lack of patient’s interest’ was identified as the most frequent barrier to appropriate counselling (84%). During the observation, the information gathering parameters were each addressed between 8 to 63% in the consultations, parameters of information provision between 3 to 34%.ConclusionDespite broad acceptance, the guideline parameters of information exchange were comparatively little addressed during the actual routine care. This might be due to a perceived ‘lack of patient’s interest’ in counselling. Our results suggest to scrutinize whether patients are in fact not interested in counselling and to further explore how the positive intention of pharmaceutical staff towards information exchange can be further translated into everyday practice.

Furthering patient-centered counseling: Exploring new aspects around pharmacists' experiences in pharmacy encounters through video-stimulated recall interviewing.

Studies on pharmacy communication have illustrated problems with patient-centeredness. Exploring pharmacists' experiences of pharmacy counseling in depth is essential to understand what hinders patient-centeredness. Existing studies, based primarily on surveys and qualitative interviews, tap into perceptions of pharmacy counseling that are informed by general conceptualizations rather than what participants actually experience during the encounters. Thus, important aspects of the dynamics of pharmacy encounters might be missed. To explore the potential of the method video-stimulated recall interview (VSRI)( Wolters et al., 2017) 1 in a pharmacy setting to gain new insights into pharmacists' experiences of patient encounters. This includes: 1) to investigate the potential of VSRI to reveal accurate and immediate perceptions of pharmacy encounters, and 2) to identify specific perceptions that pharmacists report in VSRIs. Seven VSRIs conducted in 2 different community pharmacies in Denmark were analyzed. Videos of at-the-counter meetings were recorded (interaction1), and then selected for replay in a VSRI between a researcher and the pharmacist featured in the video (interaction2). Descriptive categories that characterized pharmacists' experiences with the encounter were inferred from interview statements. New barriers to patient-centeredness were identified: pharmacists' experiences revealed that they were affected by patients' moods and that they found it inappropriate when patients disclosed personal perspectives. Also, pharmacists seemed to disregard that active listening requires responsiveness and should be seen as a process that pharmacists co-construct together with the patient. The method of VSRI proved useful in revealing new dynamics of pharmacy interaction and pinpointing shortcomings in how pharmacists communicate with patients. Based on the findings, suggestions for how to establish better patient-centered communication are provided.