Provision Of Medicines Information Research Articles

Established and emerging theatre pharmacy services: a scoping review

Abstract Introduction Guidelines recommend that pharmacists contribute to perioperative patient care.[1,2] Expansion of perioperative pharmacy services was considered in Tallaght University Hospital following the appointment of a Critical Care & Anaesthesia Chief II Pharmacist. Preliminary research indicated that activities at surgical pre-assessment clinics, in critical care and on inpatient wards are well-documented, while theatre pharmacy services appear comparatively under-developed. Pharmacists are well-placed to promote the safe and cost-effective use of medicines in this high-risk environment. An understanding of the evidence base could provide a foundation on which pharmacy departments seeking to expand their clinical services can build. Aim To determine the range, extent and nature of theatre pharmacy services internationally, and to describe any reported outcomes of these services. Methods This scoping review was conducted and reported as per the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR checklist. The review protocol was registered on Open Science Framework. A search was conducted across electronic (Ovid® MEDLINE, Embase, CINAHL and PsycInfo) and grey literature databases (Google Scholar, BASE, CADTH, and Google) without limitations on date of publication, study type or language (where English translation available). A manual search of the citation lists of all included publications supplemented the electronic search. One reviewer screened titles and abstracts and carried out data extraction, with a 10% sample screened by a second reviewer. Two reviewers evaluated full texts. Critical appraisal was performed using the Mixed Methods Appraisal Tool where appropriate. A narrative approach to evidence synthesis was employed. Extracted data about the type of pharmacy service(s) and associated outcomes were studied to inform development of key concepts through which results were presented. Results Ninety-two publications were included from 3924 results. Fifty-seven were primary research articles. Most publications were descriptive in nature. Over half of the included publications described services in the United States; the remainder were from Australia, several European countries, Egypt, Morocco, Japan, China and Taiwan. The majority of theatre pharmacy services involved medication management, i.e. procurement, spending, storage, formulary development and distribution of medicines. Clinical services incorporated provision of medicines information, protocol and guideline development, antimicrobial stewardship, education and training of healthcare professionals, engagement with health informatics and medication safety projects, practice-based research and intraoperative emergency support. Reported outcomes included financial savings, improved accountability of controlled substances, improved patient safety and staff satisfaction with the service. Many publications highlighted improved inter-departmental relationships between pharmacy and anaesthesiology. Of the 57 primary research articles, 48 lacked a clear research question and so did not satisfy the MMAT screening criteria. Of the nine assessed, adherence to quality criteria ranged from 40-100%. Conclusion Evidence for theatre pharmacy services is extensive and varied. Empirical research of high methodological quality is required to assess the outcomes of these services. Strengths of this review include the use of reporting guidelines and quality appraisal of the evidence. This review may have been limited by the exclusion of non-English language publications. This review collates practical guidance on the development of theatre pharmacy services and highlights facilitators of successful service establishment.

Formative service evaluation of transfer of care service for care home residents after hospital discharge.

This study provides a service description and analysis of a pilot across two sites involving pharmacists aiming to support care home residents with their medications post-discharge. An interview with the pilot coordinator was undertaken to understand the pilot service. Service data (March 2020-June 2021) were analysed to investigate what was actually delivered to the care home residents. One hundred eighty-eight inpatients were referred and 132 received the post-discharge service. One hundred three residents received medicines reconciliation and 29 received an additional structured medication review. The latter cohort was significantly more likely to receive medicines and illness-related information and have medicines stopped. The service facilitates the provision of medicines information and medicines-related interventions. Further evaluation is required to evidence the value of medicines review alongside the medicines reconciliation.

A national survey of hospice pharmacists and a comparison with international models.

Pharmacists can contribute to improved patient outcomes, improve medicine knowledge, reduce drug costs and minimise errors. However, their role within hospice-based services is not well described. The objective of this paper was to explore the role of pharmacists within UK hospices. Methods include an online survey and follow-up telephone contact of pharmacists working in UK hospices assessing pharmacist provision, duties, communication, medicine sourcing and training. Eighty-nine responses were received from 82 hospices (response rate 50%). Pharmacists had a role in 75% of hospices providing between 6.6 min and 5.5 hrs of pharmacist support per bed per week. The most frequent duty reported was provision of medicines information to the clinical team. Access to patient records varied considerably: 13% had full read and write access to GP records while 29% had no access. Job-specific training had not been received by 36% of the respondents and 47% reported training needs including basic training in palliative care. Three-quarters of UK hospices have pharmacy provision, although this falls below the recommended levels in the majority. Hospice pharmacists lack access to training and records. Medicines sourcing for hospices is variable and could provide opportunities for efficiencies with further research.

Provision and Need for Medicine Information in Asia and Africa: A Scoping Review of the Literature.

Published reviews of written medicine information (WMI) have mainly drawn on studies published in high-income countries, including very few Asian or African studies. We therefore set out to scope the research literature to determine the extent and type of studies concerning WMI for patients/consumers across these two continents. We sought empirical studies published between January 2004 and December 2019, conducted in any Asian or African country, as defined by the United Nations, in English or with an English abstract. The majority of the 923 papers identified were from high-income countries. We retained 26 papers from Africa and 99 from Asia. Most African studies (n = 20) involved patients in the development of PILs, in the assessment of the effectiveness of PILs or in surveys. In contrast, the highest proportion of Asian studies concerned the content of WMI (n = 42). WMI is desired, but needs to be in local languages, and there needs to be more use made of pre-tested pictograms. Existing WMI frequently does not meet local regulatory requirements, particularly locally manufactured products. A number of studies reported potentially positive impacts of providing WMI on knowledge and medicine use behaviours. Provision of medicine information is essential for safe use of medicines in all countries. Internationally agreed guidelines, incorporating good design principles, are needed to ensure the optimal content and design of WMI. The World Health Organization should support African and Asian regulatory bodies to share best practice in relation to WMI for patients/consumers and to develop and implement pan-continental guidelines that take into account consumer needs and preferences.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40264-020-01038-8.

Survey of healthcare professionals' practices, expectations, and attitudes towards provision of patient information leaflets in Thailand.

Background Patient information leaflets are an important source of medicine information for patients. In Thailand, there is a lack of studies exploring activities of healthcare professionals and their attitudes towards provision of patient information leaflets. Objectives This study aimed to survey healthcare professionals' practices on provision of medicine information, expectations of, attitudes towards provision of patient information leaflets and factors influencing these. Setting Two university hospitals in Thailand. Methods A self-completion questionnaire was distributed to chiefs of departments for further distribution to staff. A stratified sample of physicians and nurses was invited, while all pharmacists were invited to ensure sufficient numbers for comparison. Main outcome measure Healthcare professionals' practices on provision of medicine information, expectations of, attitudes towards provision of patient information leaflets. Results Of the total 981 healthcare professionals invited, 493 responded (50.3% response rate). The number of respondents aware of patient information leaflets was 270 (57.6%). Of these, only 44.4% had ever given patient information leaflets to patients. Pharmacists provided patient information leaflets more frequently than other healthcare professionals. The expectation for patient information leaflets to be available was high; mean score 7.9 ± 2.31 of possible 10. Most respondents had positive attitudes towards providing patient information leaflets to patients (58.2%). Respondents who were aware of patient information leaflets availability were more likely to have a positive attitude (OR 0.543, p = 0.002). Level of education, time spent in direct care and being aware of patient information leaflets were factors associated with healthcare professionals' attitudes. Conclusion Limited number of healthcare professionals had provided patient information leaflets to patients but most had positive attitudes regarding the usefulness of patient information leaflets for patients. Increased availability and use of patient information leaflets should be promoted.

Exploring psychiatrists' provision of medicines information to patients

Exploring psychiatrists' provision of medicines information to patients

Patient-focused medicines information: General practitioners’ and pharmacists’ views on websites and leaflets

Objectives: To determine how often general practitioners (GPs) and pharmacists recommend patients obtain information about their medicines via websites and to explore factors that might improve the delivery of written information about medicines to patients. Design: Cross-sectional surveys. Setting: GPs and community pharmacists in New Zealand primary care. Method: Questionnaires were developed and sent to a sample of pharmacists and GPs. Data were collected using SurveyMonkey® and analysed to examine views about websites and leaflets informing patients about medicines. Results: In total, 143 GPs and 126 pharmacists responded. GPs and pharmacists did not routinely direct patients to medicine information websites. Most commonly, GPs did not provide medicine information leaflets due to time constraints and concerns about possibly confusing information. Both professions thought leaflets might cause patients to worry about side-effects. Pharmacists mainly withheld leaflets because the medicine has been taken previously or because leaflet indications differed to prescribed use. A summary leaflet, if available, would be the preferred option for improving leaflet provision. Conclusion: Providing digital medicine information is uncommon in New Zealand. Summarised, relevant information tailored to patient requirements might facilitate the provision of medicines information at the point of care.

Total Quality Management Approach to Drug and Therapeutics Committee Guidelines in a Tertiary Care Government Hospital in Nepal

Background: Drug and Therapeutics Committee (DTC) is the principal policy making and recommending body for Civil Service Hospital (CSH). Condition of no functional DTC and guidelines based on the concept of total quality management (TQM) continuously presented inconsistencies health care delivery system at CSH. The present study was carried out at CSH from March 2012 to October 2015. Objective: The present guidelines were targeted to the prescribers, pharmacists, and nurses for providing rational health care and disseminating uniform and state-of-art medicine information at CSH. Methods: The present study was carried out at CSH from March 2012 to October 2015. The FOCUS-PDCA concept of TQM included following nine aspects: F: Find role of DTC for the improvement in the existing practice; O: Organize trained team knowledgeable of the process; C: Clarify operational definitions of DTC; U: Understand functions of DTC; S: Select rules and regulations for DTC members; P: Plan improvement procedures through the DTC meeting; D: Do improvement in DTC process; C: Check and analyze the results or outcomes obtained from the implementation of DTC guidelines; A: Act to explore the extent and scope of the guidelines. Results: The present guidelines were developed based on the FOCUS-PDCA concept of TQM. DTC also developed quality assurance criteria, medicine information provision, pharmacovigilance center, pharmacoeconomic evaluation criteria and defined roles and responsibilities of the members. Conclusions: DTC guidelines were developed at GoN CSH, based on FOCUS-PDCA model of TQM approach. The guidelines were based on rational pharmacotherapeutics concepts.

Strategic development of medicines information: Expanding key global initiatives.

Medicines information (MI) is a broad concept that includes information targeted to health care professionals as well as to patients. It may be in written, electronic or verbal forms. The internet is becoming more widely used as a source for MI, even though research shows that health care professionals and patient information leaflets are still the most common sources for medicine users. As patients are increasingly looking for the information they need themselves, the role of health care professionals in providing information is evolving, and there exists a need for greater health literacy skills among the patients. Medicines information as a concept is often defined and understood differently. Furthermore, it is such an integral part of pharmacy practice that it is rarely discussed as a separate entity. However, there is a growing recognition of a need to discuss MI in a broader sense and consider national strategies to meet consumer needs for medicines information. It also has been recognized that provision of MI should be a shared responsibility of all stakeholders in health care. This commentary gives an example of national level strategic development of MI, and calls for international collaboration.

A consumer perspective on adverse drug reactions

A consumer perspective on adverse drug reactions

Barriers and facilitators to the provision of clinical pharmacy services in Aboriginal communities

Australia's indigenous population has significantly poorer health outcomes than the rest of the Australian population. Continuity in medication management, an important step in achieving better health outcomes, requires a number of steps to be accomplished.1 Clinical pharmacy services such as the provision of medicines information, clinical interventions and medication reviews have been shown to improve the quality use of medicines; yet little is known about the current provision of clinical services to people served by Aboriginal medical services, or about the barriers and facilitators experienced by pharmacists in providing clinical pharmacy services to indigenous Australians. This project was part of a larger research project exploring issues around the provision of Home Medicines Reviews (HMRs) and other clinical pharmacy services for Aboriginal and Torres Strait Islander Australians. In this aspect of the research, we focused on barriers and facilitators from the pharmacists’ perspective. The aim of this project was to explore how clinical pharmacy services are provided to the people served by Aboriginal medical services, and to identify barriers and facilitators relevant for the improvement in provision of these services from the pharmacists’ perspective. Pharmacists across Australia accredited to undertake HMRs, as well as pharmacists working in Aboriginal and Torres Strait Islander health, were sent an email invitation to participate in the study. The email contained a link to an online survey consisting of both open- and close-ended questions. Data were extracted from the online survey tool and analysed. A total of 187 pharmacists participated in the study; however only 88 respondents were currently working with indigenous clients, reflecting the small number of pharmacists currently engaged in providing indigenous pharmacy services. More than half of all respondents indicated that they worked within 30 km of an Aboriginal Health Service (AHS), however most (72.6%) had not visited an AHS in the last 12 months. For those that had visited an AHS in the last 12 months, the main purpose was supply of medication, rather than clinical services. The greatest barriers identified to working with an AHS were lack of a relationship with the AHS (57.9%) and lack of financial viability for delivery of clinical services (61.6%). The majority of respondents (90.8%) perceived involvement of Aboriginal Health Workers or AHW nursing staff in HMRs as a facilitator in the provision of clinical pharmacy services. Most respondents reported that increased clinical pharmacy services and HMRs could improve both understanding of illness and understanding regarding medicines among indigenous communities. This study showed that while pharmacists support the provision of clinical pharmacy services and HMRs for Aboriginal communities, they currently provide very limited clinical services to this population. Pathways and mechanisms to facilitate relationship building between pharmacists and AHSs and communities, as well as viable funding strategies, are needed to facilitate the provision of clinical services and medication reviews for indigenous Australians. I would like to thank Sanofi and the Society of Hospital Pharmacists Australia for providing financial support for this work through the Sanofi Pamela Nieman Continuum of Care Research Grant. I would also like to acknowledge the research team from the University of Sydney: Ms Lindy Swain, Ms Clare Griffits and Professor Lesley Barclay. This work was published in part in The International Journal of Clinical Pharmacy.2

Providing medicines information and education to hospital in-patients: patients’ experiences and preferences

Background: Providing medicines information and counselling to hospital in-patients is one of the many daily tasks of hospital pharmacists;however,thereisalackofevidencerelatingtotheexpectationsofpatientsaroundmedicinesinformationandeducationinthehospital setting. Aim: To evaluate patients’ experiences and expectations relating to the provision of medicines information and education during their hospital admission. Method: A questionnaire was issued to hospital patients at discharge to elicit responses relating to information and education received about medications during their hospital stay. Results: A total of 1335 questionnaires were issued during the study period, with 292 returned (response rate 22%). Forty-five per cent of respondentsindicatedthat adoctorwasthebestpersontoinformthemabouttheirmedicationswhileinhospital,33%indicatedahospital pharmacist and 22% indicated a nurse. Over one-third of patients (37%) indicated that they would have liked more time to talk about their medications either in hospital or following discharge. Of these, 39% preferred to speak to their general practitioner (GP) after discharge, 21% preferred a hospital doctor, 19% preferred a hospital pharmacist, 14% preferred a community pharmacist and 7% preferred a nurse. Conclusion:Patientsdischargedfromhospitalwouldlikemoretimetodiscussmedication-relatedissues.Doctors,pharmacistsandnurses in hospital and community settings have a role in providing information and education about medications.

Impact of a specialist clinical cancer pharmacist at a multidisciplinary lung cancer clinic.

Medication misadventure contributes to unplanned hospital admissions. General practitioners (GPs) may lack experience in managing problems involving complex cancer-related medication. A previous survey explored the unmet needs of lung cancer outpatients and highlighted their desire for more medication information. Inpatient clinical pharmacy services positively impact on patient care. This study evaluated the effects of extending this service to outpatients. A specialist cancer pharmacist joined the lung cancer clinic team for 6 months. Patients completed assessments of their medication adherence and their satisfaction with the provision of medicine information (at baseline and repeated within 30 days of initial pharmacist review). Following review, a medication list and plan (detailing recommendations/interventions) were provided to patients and their health care providers. Interventions were categorized and graded according to risk avoided. Unplanned admissions and clinic attendance rates were compared with the previous year. GPs' opinion of the service was also evaluated. Forty-eight patients participated in the study. Medication adherence (P = 0.007) and patient satisfaction (P < 0.001) significantly improved. A total of 154 pharmacist interventions were made: 4.5% extreme risk and 43.5% high risk. The mean number of unplanned admissions and clinic attendances per patient decreased from 0.3 to 0.26 (P = 0.265) and from 3.32 to 2.98 (P = 0.004), respectively. Seventy-four percent of surveyed GPs found the service useful. Adding a specialist cancer pharmacist to the outpatient lung cancer team led to significant improvements in patient medication adherence. Both patients and GPs were highly satisfied with the service. Medication misadventure and clinic attendances were reduced.

How pharmacy&amp;#39;s adoption of social media can enhance patient outcomes

How pharmacy&#39;s adoption of social media can enhance patient outcomes Maria Bell, Jan Douglas, Christopher CuttsCentre for Pharmacy Postgraduate Education, Manchester Pharmacy School, University of Manchester, Manchester, UKAbstract: Social media is progressively being used for sharing health information and for networking among health professionals and patients; this is particularly evident among the younger age groups. There is great potential for pharmacy to engage in the utilization of such platforms to improve health outcomes, and this paper explores some of the areas where social media is already in use in pharmacy and potential areas where using social media could make a positive impact on the determinants of health. The literature around this subject is limited; nevertheless, the number of published studies has increased in recent years. This paper concentrates on the use and application of social media by pharmacy to improve health outcomes. The subject was explored in five main areas: provision of medicines information, safer use of medicines, medicines use in chronic disease, implementation of evidence-based medicine and guidelines, and finally clinical research. In each of these areas, there is an increase in uptake and use of social media platforms by pharmacists and other health care professionals to improve patient outcomes. A variety of the more popular social media platforms have been used by health care professionals and the relative merits of these are discussed within each of the subject areas and consideration given to their application in pharmacy practice. It is evident that the majority of social media users fall into the younger age bracket, which is understandable. However, the majority of patients living with long-term conditions typically fall into the older age bracket (over 65 years of age) and this should be taken into account when utilizing social media platforms to improve health outcomes.Keywords: social media, pharmacy, outcomes, impact, health

Evaluation of Consumer Medicine Information Provision from an Outpatient Dispensary

ABSTRACTBackgroundConsumer medicine information (CMI) has been available for prescription medications since 1993. Although provision is not mandated by legislation, CMI use can meet the professional obligations of pharmacy practice.AimTo identify obstacles to provision of CMI from an outpatient dispensary and to gain insight into the decision‐making processes used by pharmacists when supplying CMI.MethodData were collected from patients presenting prescriptions at an outpatient dispensary during a 2‐month capture period. CMI provision was self‐reported by pharmacists using a structured questionnaire and analysed to investigate the influence of therapeutic subgroups and dose intensity on CMI provision.Results165 patient interactions were assessed. In 100 cases (61%), patients were provided with CMI with their medicines. Concerns regarding patients' interpretation of CMI content (43%) and off‐label use of medicines (22%) were the main reasons cited by pharmacists for not supplying CMI. Older patients and those from culturally and linguistically diverse backgrounds were significantly less likely to receive CMI. Therapeutic subgroup analysis and medication dose intensities also influenced provision of CMI.ConclusionObstacles to provision of CMI from an outpatient dispensary included off‐label use of medicines and patients' interpretation of the CMI. Pharmacists' professional judgement was a key factor influencing provision of CMI.

An agenda for UK clinical pharmacology: Provision of medicines information: the example of the British National Formulary

A national war formulary, published during the Second World War, was succeeded by hardback books called British National Formularies (BNFs), which were produced by the British Medical Association and the Royal Pharmaceutical Society about every 3 years until 1976. In 1981 a greatly revised and improved softback version was published and it has been revised and published twice a year since. It has acquired a reputation for being reliable, relevant and up to date. In 2005 the BNF for Children (BNFC) appeared and it has been revised and published every year since. Both BNFs have been used extensively in training prescribers and dispensers, they have supported increasing numbers of 'non-medical' prescribers and overseas use has grown. The current challenge is to provide the BNF data electronically, as three examples show. First, the contents of the BNF and BNFC are available digitally at BNF.org and BNFC.org, and via mobile devices, which require internet access, or as a download, which does not. Secondly, FormularyComplete is a system that enables hospitals, regions, or even countries to create their own formularies, by adding information on costs, local policies and drug availability to an intranet version of the BNF, a data source that cannot be modified. Thirdly, the BNF is working with others to provide the BNF data as computer-readable content, to support electronic prescribing and medicines management. Whatever systems are used, the information on drugs must be reliable and, ideally, all prescribers and dispensers in the UK should be guided by the same data source.

Beyond needs and expectations: identifying the barriers and facilitators to written medicine information provision and use in Australia

AbstractPurpose This study aimed to explore peoples’ needs and expectations of written medicines information (WMI), and to determine the barriers and facilitators experienced or perceived in the context of WMI provision and use.Methods We conducted eight focus groups with 62 participants over 6 weeks in late 2008 in New South Wales, Australia. Using a semi‐structured topic schedule and examples of WMI from Australia and other English‐speaking countries as a guide, we explored themes relevant to WMI, including participant experiences, attitudes, beliefs and expectations.Findings Our findings suggest less than half had previously received WMI, with many unaware of its availability. Many, but not all, wanted WMI to supplement the spoken information they received but not to replace it, and it was predominantly used to facilitate informed choice, ascertain medicine suitability and review instructions. The current leaflets were considered technical and long, and a summary leaflet in addition to comprehensive information was favoured. Accurate side‐effect information was the most important element that participants desired. The most common barriers to effective WMI use were time constraints and patient confidence, with participants citing empowerment, time and health‐care professional (HCP)–patient relationships as important facilitators.Conclusion The findings provide insight and understanding of peoples needs and expectations, and clarify issues associated with use and non‐use of WMI. Challenges include addressing the barriers, especially of time and HCP attitudes to drive changes to workplace practices, and learning from the facilitating factors to encourage awareness and accessibility to WMI as a tool to empower patients.

Medicines information provided by pharmaceutical representatives: a comparative study in Australia and Malaysia

BackgroundPharmaceutical representatives provide medicines information on their promoted products to doctors. However, studies have shown that the quality of this information is often low. No study has assessed the medicines information provided by pharmaceutical representatives to doctors in Malaysia and no recent evidence in Australia is present. We aimed to compare the provision of medicines information by pharmaceutical representatives to doctors in Australia and Malaysia.MethodsFollowing a pharmaceutical representative's visit, general practitioners in Australia and Malaysia who had agreed to participate, were asked to fill out a questionnaire on the main product and claims discussed during the encounter. The questionnaire focused on provision of product information including indications, adverse effects, precautions, contraindications and the provision of information on the Pharmaceutical Benefit Scheme (PBS) listings and restrictions (in Australia only). Descriptive statistics were produced. Chi-square analysis and clustered linear regression were used to assess differences in Australia and Malaysia.ResultsSignificantly more approved product information sheets were provided in Malaysia (78%) than in Australia (53%) (P < 0.001). In both countries, general practitioners reported that indications (Australia, 90%, Malaysia, 93%) and dosages (Australia, 76%, Malaysia, 82%) were frequently provided by pharmaceutical representatives. Contraindications, precautions, drug interactions and adverse effects were often omitted in the presentations (range 25% - 41%). General practitioners in Australia and Malaysia indicated that in more than 90% of presentations, pharmaceutical representatives partly or fully answered their questions on contraindications, precautions, drug interactions and adverse effects. More general practitioners in Malaysia (85%) than in Australia (60%) reported that pharmaceutical representatives should have mentioned contraindications, precautions for use, drug interaction or adverse effects spontaneously (P < 0.001). In 48% of the Australian presentations, general practitioners reported the pharmaceutical representatives failed to mention information on PBS listings to general practitioners.ConclusionsInformation on indications and dosages were usually provided by pharmaceutical representatives in Australia and Malaysia. However, risk and harmful effects of medicines were often missing in their presentations. Effective control of medicines information provided by pharmaceutical representatives is needed.

Provision of medicines information in Australian community pharmacies

To assess the provision of consumer medicines information in Australian community pharmacies. Two methods were employed. One was an exit survey involving consumers just leaving a community pharmacy (n = 554). A total of 42 pharmacies from 6 states were selected randomly. Another was a telephone survey conducted with people aged 15 and over (n = 2,005). The sample was stratified by region at the level of capital city, regional urban and rural with minimum quotas for each category. In the exit survey, 13 (6.4%) of the 208 respondents collecting a script received written instructions such as the Consumer Medicines Information (CMI), including 7 (15%) receiving their prescription for the first time and 6 (4%) who came for a subsequent supply. In the phone survey, 876 (46%)of the 1,576 respondents who ever get prescriptions or OTC medicines declared they never or rarely receive written information on how to use a medicine apart from what is on the bottle or packaging. The strategy of CMI distribution via pharmacies in Australia has failed to reach acceptable levels. Further strategies have to be implemented by the professional and consumer organisations to ensure consumers receive appropriate essential medicine information.

Concordance-based adherence support service delivery: consumer perspectives

To explore consumers' attitudes towards, and expectations of, adherence support services in primary health care, specifically in community pharmacy; and to explore consumers' attitudes towards the concept of concordance. An exploratory qualitative study conducted in Metropolitan Sydney, Australia. Three focus group discussions with consumers on chronic therapy (n = 22) and two focus groups with consumer representatives (n = 15) were conducted in 2002. Consumer representatives were peer educators volunteering in an association which promotes quality use of medicines among elderly patients. All discussions were audio-taped, transcribed verbatim and thematically content analysed. Consumers' experiences with adherence support services delivered by general practitioners and pharmacists, their expectations towards general practitioners' and pharmacists' role in adherence support; and attitudes towards concordance in consultations. Participants expected an increased provision of medicine information and a reduction in the number of medications taken as the main strategies to promote adherence. They believed that once understandable information had been delivered, it was their responsibility to take their medications as prescribed. Yet participants frequently complained about the information received, especially from doctors. Only a subgroup of participants expected pharmacists to be involved in adherence support services. These participants generally relied on pharmacists for medicine information and were satisfied with the communication process when interacting with the pharmacists. All participants were positive about concordance, because they valued two-way communication and increased consideration of their needs and beliefs by healthcare professionals. However, they were hesitant about being involved in a shared treatment decision-making process. Many participants focused on concordance with doctors and identified barriers to the establishment of concordance: time pressures, financial constraints, the gap of competence and power between patients and doctors. Pharmacists should consider consumers' needs for information and establishing concordance, as well as their expectations of the pharmacy profession, in delivering concordance based adherence support services. Given participants' high demand for medicine information, an opportunity might exist for pharmacists to influence consumers' expectations by offering information which is tailored towards their needs.