Potential Role Of Pharmacists Research Articles

Closing the Tobacco Treatment Gap: A Qualitative Study of Tobacco Cessation Service Implementation in Community Pharmacies.

Tobacco use remains a leading preventable cause of morbidity and mortality, with pharmacotherapy and counseling recognized as effective cessation aids. Yet, the potential role of pharmacists and pharmacy technicians in tobacco cessation services is underutilized. This study explores the integration of such services in community pharmacies, identifying facilitators and barriers to their implementation. A qualitative study was conducted across seven community pharmacies in California that were affiliated with the Community Pharmacy Enhanced Services Network. Participants included 22 pharmacists and 26 pharmacy technicians/clerks who completed tobacco cessation training. Data were collected through semi-structured interviews, focusing on experiences with implementing cessation services. The analysis was guided by Rogers' Diffusion of Innovations Theory. MAXQDA software was used for data management and thematic analysis. Sixteen pharmacy personnel participated in the study, highlighting key themes around the integration of cessation services. Compatibility with existing workflows, the importance of staff buy-in, and the crucial role of pharmacy technicians emerged as significant facilitators. Challenges included the complexity of billing for services, software limitations for documenting tobacco use and cessation interventions, and gaps in training for handling complex patient cases. Despite these barriers, pharmacies successfully initiated cessation services, with variations in service delivery and follow-up practices. Community pharmacies represent viable settings for delivering tobacco cessation services, with pharmacists and technicians playing pivotal roles. However, systemic changes are needed to address challenges related to billing, documentation, and training. Enhancing the integration of cessation services in community pharmacies could significantly impact public health by increasing access to effective cessation support.

GPs’ perceptions of pharmacists working in general practices: A mixed methods survey study

BackgroundPharmacists are increasingly incorporated into general practice teams globally and have been shown to positively impact patient outcomes. However, little research to date has focused on determining general practitioners’ (GPs’) perceptions of practice-based pharmacist roles in countries yet to establish such roles.ObjectivesTo explore GPs’ perceptions towards integrating pharmacists into practices and determine if any significant associations were present between GPs’ perceptions and their demographic characteristics.MethodsIn June 2022, a survey was disseminated to GPs in Ireland via post (n = 500 in Munster region), Twitter, WhatsApp, and an online GP support and education network. Quantitative data were captured through multiple option and Likert-scale questions and analysed using descriptive and inferential statistics. Qualitative data were captured via free-text boxes, with the open comments analysed using reflexive thematic analysis.ResultsA total of 152 valid responses were received (24.6% response to postal survey). Overall, GPs welcomed the role of practice-based pharmacists and perceived that they would increase patient safety. Most agreed with practice pharmacists providing medicine information (98%) vs. 23% agreeing with practice pharmacists prescribing independently. Most agreed they would partake in a practice pharmacist pilot (78.6%). The free-text comments described current pressures in general practice, existing relationships with pharmacists, funding and governance strategies, potential roles for pharmacists in general practice, and anticipated outcomes of such roles.ConclusionThis study provides a deeper understanding of GPs’ perceptions of integrating pharmacists into practices and the demographic characteristics associated with different perceptions, which may help better inform future initiatives to integrate pharmacists into practices.

The potential role of community pharmacy staff in reducing patient delay in consulting with symptoms of rheumatoid arthritis: a qualitative study

BackgroundRheumatoid arthritis (RA) is a chronic inflammatory arthritis which can cause joint damage and reduced quality of life. Early treatment of RA within 3 months of symptom onset is associated with improved clinical outcomes. However, this window of opportunity is often missed. One important contributing factor is patients with symptoms of RA delaying consulting their general practitioner (GP). Previous research indicates that patients with inflammatory arthritis are likely to visit pharmacies for advice before consulting their GP. Therefore, pharmacists are well positioned to identify patients with symptoms of early inflammatory arthritis and signpost them appropriately. This research examines community pharmacy staff’s knowledge, perceptions, and approaches to management of patients presenting with symptoms of RA in order to identify training needs and other opportunities for intervention to enhance the role of pharmacy staff in the pathway to care.MethodsSemi-structured interviews were conducted with 19 community pharmacy staff in the West Midlands (UK), during a 12-month period (2017–2018). The interviews were audio-recorded, transcribed, and analyzed using thematic analysis facilitated by NVivo 12.ResultsThere was considerable variation in knowledge and perceptions of RA and the need for early treatment amongst pharmacists and other pharmacy staff. The potential role of pharmacists and other pharmacy staff in reducing delay in help-seeking was also discussed. Four themes emerged from thematic analysis: (1) Variations in perceptions and knowledge about RA. (2) The role of the pharmacy in increasing public awareness about RA. (3) The role of the pharmacy staff in facilitating access to the GP. (4) Practical considerations for pharmacy-based interventions.ConclusionVariability in knowledge and perceptions of RA amongst pharmacists, and amongst other pharmacy staff will affect effective signposting of suspected RA cases. This study identifies opportunities for enhanced training of community pharmacists and other pharmacy staff in relation to inflammatory arthritis as well as other pharmacy-based interventions, such as public awareness campaigns about RA and other musculoskeletal conditions. Together with existing referral services and other pharmacy-based initiatives this could result in enhanced signposting to GP consultation or other appropriate NHS services for inflammatory symptoms and reduced treatment delay.

Gaps in pharmaceutical care for patients with mental health issues: A cross-sectional study.

BackgroundMental health issues such as depression and anxiety are often underdiagnosed and undertreated. Medications are a primary method of managing mental health problems, and pharmacists therefore have a vital role in supporting patients and providing them with information about the safety and efficacy of mental health medications. However, the potential role of pharmacists in managing mental health issues in Jordan has not been well established.AimThis study aimed to assess Jordanian pharmacists’ attitudes and actual practices related to the provision of mental health services.MethodThis was an exploratory cross-sectional study that used a self-report questionnaire among a convenience sample of 347 pharmacists in Amman, the capital of Jordan.ResultsThe participating pharmacists had positive attitudes towards providing care for patients with mental health problems. However, their actual practices did not resonate with their enthusiasm, particularly in terms of the long-term follow-up of disease symptoms and medication side effects and adherence. The participating pharmacists showed an eagerness to collaborate with their colleagues, but their level of actual cooperation was lower than desired. The most reported barrier to providing care for patients with mental health problems was the lack of education on mental health issues (71.5%), followed by the lack of privacy in pharmacy settings (53.9%).ConclusionTo be effectively involved in the provision of care to mental health patients, pharmacists should receive adequate education/training related to mental health issues, and pharmacies should be redesigned to provide private areas for patient counseling.

Opinions of stakeholders about integrating pharmacists into Community Mental Health Teams

Abstract Introduction Pharmacists are routinely involved in optimising medicines for mental health patients during inpatient admissions through attending ward rounds and providing a clinical pharmacy service. (1) Despite literature demonstrating the benefits, specialist pharmacists are not routinely integrated in Community Mental Health Teams (CMHTs) (2) and there is little research to identify the barriers to pharmacists’ integration. The opinions of stakeholder who influence the design of community mental health services, are key to understanding these issues. Aim To explore the views of relevant stakeholders in one health board (HB) in Wales, regarding integration of pharmacists into CMHTs, and to make recommendations to overcome identified barriers to integration. Methods Semi-structured interviews using open questions with key stakeholders within two CMHTs and the HB’s adult mental health clinical board. Participants were selected purposively to allow recruitment of individuals who would provide insight into the proposed question(s). Written, informed consent was obtained. A deductive approach was used to define interview questions. Interviews were transcribed and analysed thematically using an inductive approach to explore the data without any pre-conceived ideas and identify additional key themes. The study was registered with the HB. Results Interviews (3 pharmacists, 2 consultant psychiatrists, 1 integrated manager, 2 clinical nurse leads and 2 general managers) lasted between 30-45 minutes. Analysis revealed five main themes; relationship with the pharmacist, including previous experiences and individual pharmacist’s personal attributes; CMHT workload relevant to pharmacists’ skills; workforce and financial pressures; the need for ongoing support for and from pharmacists; and pharmacists’ expertise including non-medical prescribing. Previous experience of working with specialist mental health pharmacist influenced participants’ views, those with limited experience were less clear about what a pharmacist’s role would be in CMHTs“…we haven’t had specialist pharmacist linked to us ………“Always can get in touch with pharmacy by e-mail or phone. Can see advantage of a pharmacist in the building, the medics would really like that it wouldn’t need to be every week maybe a morning every two weeks. We know where pharmacy are, not a dire need. Others identified a clear role for pharmacists, “running clinic for us especially when we have referrals from GP purely asking for medication reviews having [pharmacist] here the benefit surpasses most of the options we can offer through medic”. Participants believed pharmacists needed training in risk assessment and consultation skills and they should be prescribers to contribute effectively. Nine participants had worked previously with pharmacists, all advocated their integration into CMHTs. Conclusion This small-scale study suggests there is a desire to integrate pharmacists into CMHTs with a strong emphasis on their role in addressing medicine-related workload pressures. Positive relationships formed from prior experience of working with pharmacists strongly influenced support for integration. There are potential roles for pharmacists that would improve timeliness and quality of care for people supported by CMHTs. Resource constraints such as lack of funding and availability of appropriately trained pharmacists need to be resolved. Further work is necessary to investigate how these barriers can be addressed and to evaluate the cost-effectiveness of any pharmacy service delivered. References (1) Royal Pharmaceutical Society England (2018). No health without mental health: How can pharmacy support people with mental health problems? London. Royal Pharmaceutical Society England (2) Robinson, J. (2017). Challenging the Stigma. The Pharmaceutical Journal, November 2017, Vol 299, No 7907, [online] | DOI: 10.1211/PJ.2017.20203915 [Accessed 1 Mar. 2019]

The potential role of pharmacists in counteracting health misinformation in social media

Background: Health misinformation is often circulated on social media (SM), leading to confusion and jeopardising patients’ health. Aim: This study aimed to identify the pharmacist’s role in responding to health misinformation on SM. Methods: Several focus group discussions were conducted involving pharmacist participants purposively recruited. The discussions were audiotaped and thematically analysed. Results: A total of 41 pharmacists participated in this study. The most frequent misinformation on SM was related to the use of herbal medicines. The misinformation tended to decrease medication compliance, increase delayed treatment, and worsen the illness. Participants reported difficulty in seeking reliable references about traditional and alternative medicines. They were often asked for advice and opinion related to information on SM. Conclusion: Pharmacists need to counteract the health misinformation on SM actively. Lack of reference to a particular topic is a significant obstacle.

A qualitative study to explore the role of pharmacists in healthy weight management in adults in Pakistan: current scenario and future perspectives

BackgroundPharmacists possess significant potential for providing health services to the public when it comes to issues of weight management. However, this practice has not been observed in most parts of the world including low- and middle-income countries (LMICs) such as Pakistan. The aim of this study was to explore the potential role of pharmacists in providing healthy weight management (HWM) services to adults in Pakistan, and the barriers associated with the implementation of this type of role.MethodsThis descriptive qualitative study was set in seven hospitals (public and private) and three chain pharmacies in Lahore, Punjab – a province of Pakistan. Data was collected from in-depth individual interviews with pharmacists (n = 19) and medical doctors (n = 15). Purposive sampling techniques were applied to recruit both types of study participants. Telephone contact was made by the trained data collectors with the pharmacists to set the date and time of the interview after explaining to them the purpose of the study and obtaining their willingness and verbal recorded consent to participate. Registered medical doctors were recruited through snowball sampling techniques. The sample size was determined by applying the point at which thematic saturation occurred. All interviews were audio-recorded and transcribed verbatim. The data were analyzed to draw conclusions using inductive thematic content analysis.ResultsThrough inductive qualitative analysis eight themes emerged; potential role for community pharmacists, collaborative approaches, barriers, ideal pharmacist-based weight management program, professional requirements and need for training, potential for implementation, current scenario in pharmacies and level of trust of pharmacists. The first six themes were common to both pharmacists and medical professionals. The unique theme for doctors was the ‘level of trust of pharmacists’, and for the pharmacists was the ‘current scenario in pharmacies’.ConclusionThe majority of participants in our study had strong convictions that Pakistani pharmacists have the potential for provide effective HWM services to their communities. Of concern, none of the participating pharmacies were offering any sort of weight management program and none of the medical professionals interviewed were aware of HWM programs taking place. Medical doctors were of the opinion that pharmacists alone cannot run these programs. Doctor participants were firm that after being adequately trained, pharmacists should only carry out non-pharmacological interventions. To implement a HWM pharmacy model in Pakistan, it is necessary to overcome barriers outlined in this study.

A qualitative study exploring opportunities for pharmacists to connect with young mental health consumers

ObjectiveTo explore how pharmacists can best support young people using medication for any mental health condition. The experiences of obtaining or supplying psychotropic medication and recommendations for service improvement were explored from the perspectives of young people, community pharmacists, and key stakeholders. DesignA qualitative study using semistructured interviews with young people and pharmacists and the nominal group technique as a consensus method for stakeholders. Setting and participantsFace-to-face interviews were conducted with 18 young people and a nominal group with 6 stakeholders at 1 of 2 mental health support organizations in Brisbane, Queensland, Australia. Phone conversations were held with 11 pharmacists who were located across Australia. The young people were aged between 14 and 25 years, had used a mental health medication for the previous 2 months, and lived in the community. Pharmacists recognized as mental health advocates or providing a mental health service and stakeholders from 1 support organization were purposively recruited. Outcome measuresThemes related to the current and potential roles for pharmacists when interacting with young people using psychotropic medication. ResultsThere was limited awareness of the role of pharmacists, possibly because of the largely transactional nature of the young people’s pharmacy experiences. However, young people perceived value in receiving information from pharmacists about their psychotropic medication, in particular, their adverse effects, and interactions with alcohol and other recreational drugs. Respectful communication and access to a private space to discuss sensitive matters were ways that pharmacists could encourage the development of supportive relationships with young people. ConclusionThis study provides unique insights about the experiences of young people using psychotropic medication within community pharmacies. There is an imperative for pharmacists to move beyond a transactional or reactive approach to create a safe health space and address young people's medication concerns beyond initial supply.

Nitrofurantoin Use in Frail, Community-Dwelling, Older Adults with Renal Impairment

Nitrofurantoin is recommended as a first-line antibiotic for the treatment of urinary tract infections (UTIs). However, it is contraindicated in patients with a creatinine clearance (Clcr) less than 60 mL/min. In 2015, the American Geriatrics Society updated the Beers criteria to recommend nitrofurantoin for short-term use in patients with a Clcr greater than or equal to 30 mL/min. It is unknown if nitrofurantoin can be safely and effectively used in a frail patient population with a high incidence of UTIs and frequent use of antibiotics. It is important to have treatment options other than fluoroquinolones and sulfamethoxazole/trimethoprim for patients with recurrent UTIs and frequent antibiotic use to sustain optimal antimicrobial stewardship practices. This study evaluated the safety and efficacy of nitrofurantoin for UTIs in medically complex patients with renal impairment living in a community setting, and it highlights the potential role for pharmacists to encourage antimicrobial stewardship.

Current and Potential Roles in Sports Pharmacy: A Systematic Review.

(1) Background: The objective of this systematic review was to evaluate current and potential roles for pharmacists in sports medicine and to identify key themes in outcomes reported in studies. (2) Methods: EMBASE, MEDLINE, CINAHL, Scopus and the Cochrane Library were searched in January 2019. Peer-reviewed, original research articles were considered for inclusion. Articles published in a language other than English were excluded. Quality appraisal was performed independently by two authors. (3) Results: Findings of 11 eligible articles (10 observational and 1 experimental study design) were grouped into three themes: (i) doping prevention and control, (ii) injury management and first aid, and (iii) educational and curricular needs. Pharmacists were perceived as a good potential source of information about doping and are enthusiastic about counseling athletes, but lack knowledge and confidence in this area. While pharmacists were frequently consulted for advice on managing sprains and strains, their advice was not always guided by current evidence. Pharmacists and pharmacy students recalled limited opportunity for education in sports pharmacy. (4) Conclusion: Pharmacists showed a willingness and an aptitude to counsel athletes. However, lack of knowledge and confidence, and limited educational opportunities, were key barriers. More research is necessary to support pharmacists in this role.

Instructional design and assessment of an elective course on the use of drugs in sport

Background and purposeThe use and misuse of drugs in sport is becoming increasingly important globally, and the role of pharmacists is evolving in this regard. This paper describes the design and implementation of an elective course “Drugs in Sport” in an undergraduate pharmacy curriculum. Educational activity and settingThe elective course was designed to introduce BSc pharmacy students to an evidence-based approach to safe, effective, and legal use of drugs in sport. The course covered why athletes take drugs, evolution of doping in sport, the international regulations regarding doping and anti-doping in sport including the World Anti-doping Agency Prohibited List, as well as testing and monitoring for drug use in sport. It also included the role of athlete support personnel (ASP) in preventing the use of prohibited substances by athletes. A web-based survey was conducted at the end of the course to assess the students’ perspectives of the course. FindingsStudents provided an evaluation of the course in terms of its content, methods of delivery, and assessment. Overall, the students demonstrated competence. They gained insight into international and national regulations regarding doping and anti-doping in sport and the potential role of pharmacists as ASP in providing support and advice for athletes and the public. SummaryDesigning and implementing an evidence-based course on the use of drugs in sport customized for pharmacy students was achieved successfully. Such courses could provide an opportunity to advance the scope of pharmacy practice and possibly provide a new career path for future pharmacists.

Pharmacist-led screening in sexually transmitted infections: current perspectives.

IntroductionSexually transmitted infection (STI) screening is a crucial initiative that aims to reduce the increasing global prevalence of many common STIs such as chlamydia, gonorrhea, and herpes simplex virus (HSV). Many STIs are either asymptomatic or show mild symptoms that are often attributed to other infections; hence, screening is the only way to identify – and by extension, treat – them. In this way, the spread of STIs can be reduced, and the health implications of an untreated STI are minimized. Community pharmacies could provide an avenue to convenient, confidential STI screening by using noninvasive or minimally invasive sample collection techniques that are used by the consumer or pharmacist. We identified the most common STIs found globally and investigated the current and potential role of pharmacists in provision of STI screening interventions.DiscussionThere is sufficient evidence for pharmacy-based chlamydia screening, with many consumers and pharmacists finding it an acceptable and highly valued service. Some evidence was found for pharmacy-based gonorrhea, hepatitis B virus (HBV), and human immunodeficiency virus (HIV) screening. Appropriate sample collection for gonorrhea screening needs to be further examined in a pharmacy setting. HBV screening presented an increased risk of personal injury to pharmacists through the collection of whole blood specimens, which could be reduced through consumer self-sampling. Pharmacist-collected specimens for HIV is less risky as an oral swab can be used, nullifying the risk of transmission; but pre- and post-screen consultations can be time-intensive; hence, pharmacists would require remuneration to provide an ongoing HIV screening service. Not enough evidence was found for syphilis screening through community pharmacies; more studies are required that consider sampling methods other than pharmacist-collected whole blood specimens. There is no evidence to date for pharmacist-led trichomoniasis or HSV screening.ConclusionPharmacists are well-positioned to provide STI screening services, but further investigations are needed to overcome financial, safety, and confidentiality barriers.

Results of a clinical audit on drug‐related problems identified by a clinical pharmacist in a thoracic outpatient clinic

AbstractAimTo identify the types and severity of drug‐related problems (DRPs) identified by a pharmacist in a thoracic outpatient clinic.MethodsA clinical pharmacist reviewed patients in a thoracic outpatient clinic weekly for 17 weeks where medication history interview and pharmaceutical review were undertaken on available patients. DRPs identified were communicated to the treating respiratory physician or registrar and patient. DRPs were reviewed retrospectively by an independent specialist thoracic pharmacist and a consultant thoracic physician. The DRPs were classified according to the Pharmaceutical Care Network Europe Classification V 6.2 and whether respiratory or non‐respiratory related.ResultsA total of 97 DRPs were identified in 66 patients reviewed; an average of 1.47 DRPs per patient; 50 were non‐respiratory related and 47 respiratory related. The most common DRP was ‘effect of drug treatment not optimal’ (n = 35, 36%) followed by ‘non‐allergic adverse drug event’ (n = 23, 23.7%) and ‘untreated indication’ (n = 23, 23.7%). The most common pharmaceutical intervention performed was ‘patient (medication) counselling’. A total of 37% (n = 36) DRPs were deemed to be high or extremely high risk by an independent pharmacist and 44% (n = 43) high risk by a consultant thoracic physician.ConclusionThere is a potential role for pharmacists in a specialist thoracic outpatient clinic as pharmacist attendance allowed respiratory and non‐respiratory DRPs to be identified and interventions proposed. A large number of DRPs were deemed to be high or extremely high risk. Pharmacist attendance also provides an opportunity for patient education and counselling.

Clinical Pharmacy in Obstetrics: The Role of the Pharmacist

Up to 80% of all women use medication during pregnancy (1). Pregnant women have often questions related to medicine use and they commonly state that the pharmacist is a trusted source of information (2, 3). Consequently, the pharmacist may have an important role in care for pregnant women. It is unclear which areas the pharmacy profession should prioritize when it comes to pregnant and breast feeding women and which role pharmacists have in care for pregnant patients. Aims of the workshop: To discuss the role and opportunities for clinical pharmacy in obstetrics. Learning Objectives: Enhance their own awareness about the role of pharmacists interacting with pregnant women. Learn about the practices in the other countries. Explore, through discussion, future possibilities for clinical pharmacy in obstetrics. The workshop discussion will lead to a joint statement to be published in an international journal about the potential role of pharmacists in clinical pharmacy in obstetrics. Description of Workshop Activities: Introduction: Background and aim (10 min). Group activity: Group discussion for the purpose of sharing experiences and ideas (40 min). Plenary: Report back from each group and discussion (30 min). Summation and evaluation of workshop (10 min). The following topics will be addressed: The role of the pharmacists in several scenarios including promoting folic acid use, adherence to prescribed medication, use of natural remedies, and correcting misconceptions. Additional information: Reading suggestions: Ragland D, Briggs GG, Wasik M, et al. Obstetrical opportunities: will pharmacy ever realize them? Ann Pharmacother. 2012; 46: 297-300. References

An audit of prescribing for type 2 diabetes in primary care: optimising the role of the community pharmacist in the primary healthcare team

The Government has identified that the pharmacist should have greater involvement in the management of long-term conditions. The aim of this audit was to determine the adherence to National Institute for Health and Clinical Excellence guidelines for type 2 diabetes patients and identify whether there is a potential role for pharmacists in their long-term management. All prescribing, in 194 patients, was within guidance for anti-hyperglycaemics. In all, 87.4% of patients prescribed an anti-hypertensive were prescribed an angiotensin-converting enzyme inhibitor or equivalent. A large number of patients remain uncontrolled with respect to blood glucose or blood pressure. There are four potential reasons for this: patients require additional therapy; current therapy has not been optimised; current therapy is not working; or the patient is not fully adherent. Therefore, there may be a role for the pharmacist either in therapy optimisation or improving patient adherence to current therapy in order to support more patients reaching national targets.

Detection and care of familial hypercholesterolaemia in the community: is there a role for the pharmacist?

Familial hypercholesterolaemia (FH) is a dominantly inherited disorder present from birth that causes marked elevation in plasma cholesterol and premature coronary heart disease. It is estimated that there are at 40 million people with FH worldwide, but most remain unrecognised and inadequately treated. To bridge this gap in coronary prevention several guidelines on detecting and managing FH have been published. We briefly review these and comment on the potential role of pharmacists in case detection, point-of-care testing and pharmacotherapy.

Optimising medication use during pregnancy: the potential role of pharmacists

Optimising medication use during pregnancy: the potential role of pharmacists

Defining Reality: The Potential Role of Pharmacists in Assessing the Impact of Progesterone Receptor Modulators and Misoprostol in Reproductive Health

Medical abortion is increasingly heralded as an ideal method for decreasing maternal mortality in health-care resource-deprived areas and as an answer to the shrinking pool of physicians willing to perform abortions. The advent of progesterone receptor modulators (PRMs) and the recent approval by the Food and Drug Administration of ella (ulipristal) as an emergency contraceptive put pharmacists in the center of abortion controversy. Pharmacists, worldwide, need to be aware of the controversy surrounding the introduction of PRMs, particularly with regard to the effect on health policy, their mechanism of action, associated adverse events, and common off-label uses. Once understood, genuine opportunity exists for pharmacists to serve a fundamental role in positively shaping public health policy.

Pharmacists' role in smoking cessation: an examination of current practice and barriers to service provision

Abstract Objective This study addressed the potential role of pharmacists in helping their patients to quit smoking by providing a summary of their self-reported levels of current activities, confidence, and readiness to change around the provision of brief advice and support for patients who smoke. In addition to investigating which barriers are perceived to be most important, this study also examined the relative importance of confidence, barriers and practice factors in relation to pharmacists' smoking cessation practices. Method A 58-item questionnaire was mailed to 720 pharmacists. The questionnaire measured demographic and background variables, level of smoking cessation activity (asking, advising, assessing, assisting and arranging including follow-up), confidence in undertaking smoking-cessation activities, readiness to change, perceived importance of barriers to providing smoking-cessation services, and further education or training in relation to smoking cessation. Setting Community pharmacists in South Australia. Key findings Respondents indicated high rates of activity in relation to assessing and assisting patients to quit smoking, with lower rates of advising and arranging including following up. Recording of smoking status was very low. Confidence emerged as the most important predictor of smoking-cessation activities, with pharmacist barriers including fear of alienating patients approaching significance. Reported levels of smoking-specific education and training were low. Conclusions South Australian pharmacists are contributing to the prevention of tobacco-related harms. With additional support there is a greater scope for involvement. Results indicate a need for a team-based, systematic and multifaceted approach to address barriers and enhance pharmacists' confidence. Further implementation research is required to assess the effectiveness of multifaceted pharmacy support programmes on the uptake and sustainability of smoking-cessation services.

Pharmacogenetics: from discovery to patient care

The basic concepts of pharmacogenetics, pharmacogenetic study approaches, factors to consider when applying pharmacogenetic discoveries to patient care, and potential roles for pharmacists in pharmacogenetics are discussed. The Food and Drug Administration (FDA) has recognized pharmacogenomics as an opportunity to identify new biomarkers that may expedite the drug development process. Currently, there are over 50 drugs with pharmacogenetic discoveries on their labeling. Sequence variations in drug disposition genes can alter the pharmacokinetics of a drug, while sequence variations in drug target genes can change the pharmacodynamics of the drug. The two most common strategies to test a pharmacogenetic question are the candidate-gene approach and genomewide association study. Given the complex interplay among the many factors that influence a drug dose, determination of an appropriate dose of a particular drug for a given patient will eventually require knowledge about both genetic and nongenetic factors that affect drug disposition and pharmacodynamics. Many factors can influence the application of pharmacogenetic discoveries to patient care. Before these discoveries find widespread application in clinical practice, additional work is needed, including randomized clinical trials to evaluate the clinical utility of a pharmacogenetic test, the development of guidelines for the clinical use of various pharmacogenetic tests, and provider education on pharmacogenetics. Pharmacogenetics has made significant progress in the past decade, and many pharmacogenetic discoveries have now been included on FDA-approved drug labeling. Pharmacogenetic discoveries may further promote safe and effective use of medications by more accurately predicting an individual's drug response.