UK Community Pharmacists Research Articles

Exploring community pharmacists' use of health literacy interventions in their everyday practice.

Limited health literacy often results in people inadequately understanding medicines-related information and subsequently not taking medicines as prescribed. Using health literacy interventions is important for community pharmacists, as they are increasingly managing long-term conditions. However, there appear to be no previous studies of community pharmacists' everyday use of health literacy interventions in the UK. To explore UK community pharmacists' perspectives on the usability of health literacy interventions in their everyday practice. Semi-structured interviews were conducted with participants, following attendance at health literacy training that included practicing the use of four health literacy interventions (Teach-Back, Chunk and Check, Simple Language and visual aids) and two months experience of attempting to use them in their everyday practice. Participants were pharmacists from community pharmacies in Staffordshire, England who were invited to participate by an email sent to the pharmacy. Interviews were audio-recorded, transcribed verbatim and analysed using the Framework Analysis technique. Four themes emerged from 11 interviews undertaken: intervention appeal, limitations, adaptations and continued use. Participants reported using all four health literacy interventions in their everyday practice but Teach-Back appeared to be favoured most. Most participants talked about practicing Teach-Back before using it with patients but described it as useable with patients of all ages, without being prohibitively time consuming. Chunk and Check seemed to be viewed as a type of Teach-Back, whilst visual aids were reported as being used in conjunction with Teach Back rather than as a standalone intervention. Participants reported that Simple Language was an easy concept but easily 'slipped back' into medical jargon and were challenged to use simple enough words. All participants said they would continue to use all four health literacy interventions. The findings suggest that with training, community pharmacists can successfully incorporate these four health literacy interventions into their everyday practice.

A web-based survey of UK pharmacists to assess the effectiveness of Viagra Connect® additional risk minimisation measures

Background To support reclassification in the UK of sildenafil citrate (50 mg) from prescription-only medicine to a pharmacy medicine (P status) under the brand name “Viagra Connect®”, additional risk minimisation measures were implemented that included training materials and an optional checklist to assist community pharmacists in the safe supply of Viagra Connect® to suitable patients. Objective To evaluate the effectiveness of Viagra Connect® additional risk minimisation measures by assessing community pharmacists’ participation in training, their knowledge of key risk messages, and utilisation of the checklist. Setting A post-authorisation safety study implemented as a web-based survey, conducted in a representative population of UK community pharmacists. Method A random sample of community pharmacists who received at least 1 request to supply Viagra Connect® within the past 6 months completed an online questionnaire of 33 closed-ended questions/statements with multiple-choice responses. Data were summarised using descriptive statistics. Main outcome measure Knowledge of key risk messages and dispensing practices communicated in the additional risk minimisation measures. Results The survey was completed by 345 community pharmacists. Respondents displayed a high level of knowledge of key risk messages, with ≥80 % selecting correct answers for 43/51 items. Nearly all respondents (90.1 %) reported that the training materials were useful/very useful, and reported using the checklist at the point of supply (91.9 %). Counselling of patients who requested Viagra Connect® was generally considered a positive exercise. Conclusions The Viagra Connect® additional risk minimisation measures were effective for education of community pharmacists and to ensure safe supply of Viagra Connect® behind-the-counter to patients.

Demographic and psychological predictors of community pharmacists\u2019 cancer-related conversations with patients: a cross-sectional analysis and survey study

BackgroundThere is increasing interest in the role of community pharmacy in the early diagnosis and prevention of cancer. This study set out to examine how often community pharmacists (CPs) encourage patients to spot or respond to potential signs and symptoms of cancer, and how often they help people to make an informed decision about taking part in bowel cancer screening.MethodsData from 400 UK CPs, who completed the 2018 Cancer Research UK Healthcare Professional Tracker survey, were analysed. The primary outcomes were: ‘how often CPs encourage patients to spot or respond to potential signs and symptoms of cancer’ and ‘how often CPs encourage eligible people to make an informed decision to participate in bowel cancer screening’. Associations between behaviours and demographic and psychological variables (Capability, Opportunity and Motivation) were assessed using multivariate logistic regression.ResultsMost (n = 331, 82.8%) CPs reported occasionally, frequently or always encouraging patients to spot or respond to potential signs and symptoms of cancer, while only half (n = 203, 50.8%) reported occasionally, frequently or always helping people make an informed decision to participate in bowel cancer screening. Female sex (aOR: 3.20, 95%CI: 1.51, 6.81; p < 0.01) and increased Opportunity (aOR: 1.72, 95%CIs: 1.12, 2.64; p < 0.05) and Motivation (aOR: 1.76, 95%CIs: 1.37, 2.27; p < 0.001) were associated with encouraging patients to spot or respond to potential signs and symptoms of cancer; all three psychological variables were associated with helping people to make an informed decision to participate in bowel cancer screening (Capability: aOR: 1.39, 95%CIs: 1.26, 1.52, p < 0.001; Opportunity: aOR: 1.44, 95%CIs: 1.11, 1.87; p < 0.01; Motivation: aOR: 1.45, 95%CIs: 1.05, 2.00; p < 0.05).ConclusionsMost CPs encourage patients to spot or respond to potential cancer symptoms, while only half help them make an informed decision to participate in bowel cancer screening. A multifaceted approach, targeting multiple COM-B components, is required to change these behaviours.

Perceptions of UK Community Pharmacists on Current Consultation Skills and Motivational Interviewing as a Consultation Approach: A Qualitative Study.

Objectives: Community pharmacists’ roles in the UK are evolving; pharmacists currently deliver a wider range of clinical services with more patient-focused care. The objectives of this study were (i) to investigate UK community pharmacists’ views on their current communication skills in pharmacist-patient facing consultations, and (ii) to explore the perceptions of UK community pharmacists towards the application of motivational interviewing (MI) in a pharmacy consultation. In-depth qualitative face-to-face, semi-structured interviews with ten practicing community pharmacists were carried out, ranging from 30–60 min in length. The interviews were audio recorded, transcribed verbatim and thematic analysis was employed. Four themes emerged from the data: (1) the fight for time; (2) wrestling with consultation styles; (3) a personal communication evolution; and (4) unfamiliar but engaging motivational interviewing. These themes demonstrated the juxtaposition between the desire for patient-centred care and the pressures of managing broader dispensing work. Participants were critical of academic and continuous professional learning (CPD) training in communication skills and there was a strong recognition of the potential role of MI in promoting patient autonomy and outcomes. Participants recognized a few elements of MI techniques in their current consultations, but welcomed further training on behavioral change for effective consultations, expressing a desire for practical MI-specific training. Face-to-face CPD of consultation skills is needed to avoid the feeling of isolation among UK practicing pharmacists and rigidity in consultation delivery. Support for community pharmacists from other pharmacy staff could relieve current pressures and allow pharmacists time to develop and acquire effective skills for patient facing roles. Behavioural change consultation skills training for pharmacists could be an effective strategy to address these current challenges.

Community pharmacist led medication reviews in the UK: A scoping review of the medicines use review and the new medicine service literatures.

Medicines Use Reviews (MURs) and the New Medicine Service (NMS) are services delivered by UK community pharmacists to improve adherence, improve patient understanding of their medicines and reduce medicines wastage. In this scoping review we aim to identify, map and critically examine the nature of existing empirical evidence in peer reviewed journals relating to MUR and NMS consultations. Systematic searches identified the available MUR and NMS empirical literature. We sought data on barriers and facilitators to conducting MUR or NMS consultations, the perceptions of pharmacists and patients, the conduct of consultations, and outcomes of consultations. Searches from 2005 (when MURs were introduced) to May 2018 were conducted in MEDLINE, PsycINFO, Embase and Scopus databases. Data were extracted into Excel for examination of study characteristics, participant characteristics, type of intervention/services delivered and key study quantitative and/or qualitative findings. Forty-one papers from 37 studies met the inclusion criteria: 28 papers were of MURs, 10 of NMS and 3 for both services. Studies focused on the introduction and implementation of these services, with little attention to outcomes for patients; effectiveness was not evaluated beyond in a single NMS RCT. Observational data indicated that pharmacists and patients view MURs and the NMS positively, despite challenges implementing these services and apparent lack of communication between pharmacists and GPs. Consultations were reported to be short, typically 10-12 min, characterised by limited engagement with patients and their health problems. The extent and nature of advice on health behaviours during consultations or other content was rarely examined. The research literature on MURs and the NMS has developed slowly. There is much scope for further research attention to developing more patient-centred care.

Community pharmacists\u2019 role in preventing opioid substitution therapy-related deaths: a qualitative investigation into current UK practice

Background Opioid substitution therapy involves prescribing of medical substitutes like methadone and buprenorphine to patients who are addicted to opioids. The majority of opioid substitution therapy dispensing in the UK is done by community pharmacists and they often see the patients on daily basis. It is unknown to what extent community pharmacists implement the policy to prevent overdose in patients receiving such treatment. Objective To explore what UK community pharmacists think about their role in preventing opium substitution-related deaths, their understanding of the risks associated with this substitution therapy and their views on what else community pharmacists could do to reduce such deaths. Setting Twenty four community pharmacists from two areas in UK (Worcestershire and Bath and North East Somerset). Method Between January and March 2013, community pharmacists providing opoin substitution therapy were interviewed in their pharmacy, using semi-structured interviews. Interpretative Phenomenology Analysis was used to analyse the data. Main outcome measure Thematically organised description of professional practice as reported by the participants against the clinical/practice guidance for opioid substitution therapy in UK. Results While participants felt their role to be essential in providing the service, they did not feel part of an integrated system. Participants’ ability to act in risk situations was affected by their knowledge, confidence in intervening in such situation, as well as the support they receive in providing the service. Conclusion Participants reported large differences in how ‘opioid substitution therapy’ services are provided in community pharmacy. Lack of knowledge among some pharmacists and lack of support in providing the service resulted in some patients at high risk not having their risks acted upon.

Perceived roles and barriers in caring for the people who are homeless: a survey of UK community pharmacists

Background Community pharmacists can be an accessible source for advice and support for the people who are homeless, given their utilisation of a variety of currently available services such as dispensing of medicines, drugs and alcohol services. Objective To determine community pharmacists’ training, experiences and behavioural determinants in counselling and management of homeless population. Setting UK community pharmacies. Method A questionnaire based on literature and theoretical domains framework was mailed to randomly sampled community pharmacies in England and Scotland (n = 2000). Data were analysed using descriptive and inferential statistics. Main outcome measures Pharmacists’ perspectives, pharmacists’ training, pharmacists’ experiences and behavioural determinants. Results A total of 321 responses (RR 16.1%) were received. Respondents indicated lack of knowledge, skills, intentions as well as contextual factors such as lack of guidelines impacted on their counselling and management of homeless patients. Less than a third (n = 101, 32.2%) indicated that they knew where to refer a homeless patient for social support. Broaching the subject of homelessness was outside their comfort zone (n = 139, 44.3%). Only four (1.2%) respondents could correctly answer all knowledge assessment questions. Conclusions Community pharmacist identified lack of education, training opportunities and guidelines in counselling and management of homeless patients. Targeting community pharmacists’ knowledge, skills and intention to provide care to the homeless patients may enable addressing health inequality through community pharmacy.

Time constraints cause 'overwhelming distress' for one in seven UK community pharmacists

Time constraints cause 'overwhelming distress' for one in seven UK community pharmacists

Launching and evaluating a mobile phone app to provide contemporary, evidence-based advice about self-treatable conditions

Rationale, aims and objectives: As government-funded healthcare provisions are stretched to their limits, it is important that healthcare professionals provide evidence-based advice about minor ailments to facilitate people’s abilities to self-treat these conditions effectively and appropriately, given that self-care is one of the many components of person-centered healthcare. Unfortunately, despite the expanding over-the-counter (OTC) medicines market, there have been doubts cast about advice given by UK community pharmacists. Indeed, research conducted with pharmacists revealed that evidence of effectiveness was a secondary consideration when making decisions about OTC recommendations. We aimed to address these concerns and support decision-making by providing high quality, evidence-based, information about self-treatable conditions and over-the-counter consultations through a mobile phone app.Method: There were 4 main stages, namely: (1) app development (content and design); (2) piloting (use-testing); (3) publication on Apple and Android stores and marketing of the app and, finally, (4) an evaluation (using analytical data obtained through the app content management system, feedback obtained via email, the star-rating and reviews posted on Google Play and Apple stores and comments obtained at events. Additionally, following ethical approval and piloting, we invited 100 people, representing different groups within the pharmacy profession in Northern Ireland, to complete an evaluation questionnaire.Results: Since launching the project in February 2017, there have been over 5000 downloads, 68,453 sessions of use and the app has received a 5-star rating on both Apple and Google Play stores. Positive feedback has centred on the material being relevant and up-to-date, that it facilitates quick access to information in the workplace and is easy to navigate and that it is a good training tool. Future suggestions for improvement include expanding the number of conditions and providing self-assessment questions to help students prepare for professional examinations.Conclusions: The app appears to have had a positive impact on OTC consultations, but it is still evolving to ensure its usefulness in practice is maximised.

The Role of Pharmacists in Caring for Young People With Chronic Illness

PurposeTo explore the perceived and potential roles of pharmacists in the care of young people aged 10–24 years with chronic illness, through the exemplar of juvenile arthritis, from the perspectives of UK community and hospital pharmacists, health service commissioners, rheumatology health professionals, and lay advocates. MethodsA sequential mixed methods study design comprises the following: focus groups with community and hospital pharmacists; telephone interviews with pharmacy and rheumatology stakeholders and commissioners; and multidisciplinary group discussions to prioritize roles generated by the first two qualitative phases. ResultsThe high priority roles for pharmacists, identified by pharmacists and rheumatology staff, were developing generic health care skills among young people; transferring information effectively across care interfaces; building trusting relationships with young people; helping young people to find credible online health information; and the need to develop specialist expertise. Participants identified associated challenges for pharmacists in supporting young people with chronic illness. These challenges included parents collecting prescription refills alone, thus reducing opportunities to engage, and pharmacist isolation from the wider health care team. ConclusionsThis study has led to the identification of specific enhancements to pharmacy services for young people, which have received the endorsement of a wide range of stakeholders. These suggestions could inform the next steps in developing the contribution of community and hospital pharmacy to support young people with chronic illness in the optimal use of their medication.

A survey to identify barriers in the public health role of community pharmacists

Objectives This survey seeks the opinion of UK community pharmacists to identify barriers in the public health role of community pharmacists. Methods This study took the form of a descriptive, cross-sectional survey that generated mostly quantitative data. Questionnaires were mailed to 524 randomly selected community pharmacists from Barnet, London and its surrounding areas, Bedfordshire, Cardiff and Edinburgh. All statistical analyses including tests for significance and correlation of variables were performed using the Statistical Package for the Social Sciences (spss version 19.0). Key findings A majority of the respondents identified time pressure and workload (89.7%, C.I. ±4.94); lack of patients’ records (78.6%, C.I. ±6.66); insufficient funding from the government (75.2%, C.I. ±7.01); lack of understanding by healthcare providers of the training and skill sets of pharmacists (73.7%, C.I. ±7.25); and lack of understanding by the public of the training and skill sets of pharmacists (72.7%, C.I. ±7.29), as the main barriers in enhancing the public health role of community pharmacists in the UK. Male respondents were more likely to agree that ‘insufficient funding’ was a barrier (P = 0.006; Eta, η2 = 0.053). There was a negative correlation between ‘age of respondents’ and respondents agreeing that pharmacists should develop their own expertise in public health (ρ = −0.185; P = 0.029). Free text comments also highlighted a number of barriers, which included, among other things, time pressure and workload, commercial pressure from employers, lack of collaboration between healthcare professionals, and inadequate funding. Conclusions Several barriers associated with the public health role of community pharmacists, mainly time pressure and workload; lack of patients’ records; insufficient funding from the government; lack of understanding by healthcare providers of the training and skill sets of pharmacists; and lack of understanding by the public of the training and skill sets of pharmacists have been identified as hindering the enhancement of this role. To enable the profession to evolve fully from product-oriented services to patient-centred care, many of these barriers will need to be tackled.

The relationships among work stress, strain and self-reported errors in UK community pharmacy

Changes in the UK community pharmacy profession including new contractual frameworks, expansion of services, and increasing levels of workload have prompted concerns about rising levels of workplace stress and overload. This has implications for pharmacist health and well-being and the occurrence of errors that pose a risk to patient safety. Despite these concerns being voiced in the profession, few studies have explored work stress in the community pharmacy context. To investigate work-related stress among UK community pharmacists and to explore its relationships with pharmacists' psychological and physical well-being, and the occurrence of self-reported dispensing errors and detection of prescribing errors. A cross-sectional postal survey of a random sample of practicing community pharmacists (n=903) used ASSET (A Shortened Stress Evaluation Tool) and questions relating to self-reported involvement in errors. Stress data were compared to general working population norms, and regressed on well-being and self-reported errors. Analysis of the data revealed that pharmacists reported significantly higher levels of workplace stressors than the general working population, with concerns about work-life balance, the nature of the job, and work relationships being the most influential on health and well-being. Despite this, pharmacists were not found to report worse health than the general working population. Self-reported error involvement was linked to both high dispensing volume and being troubled by perceived overload (dispensing errors), and resources and communication (detection of prescribing errors). This study contributes to the literature by benchmarking community pharmacists' health and well-being, and investigating sources of stress using a quantitative approach. A further important contribution to the literature is the identification of a quantitative link between high workload and self-reported dispensing errors.

A preliminary investigation of the interactions between UK and US community pharmacists and their prescription clients

Abstract Similar periods of time were spent recording pharmacist-client interactions in each of five pharmacies in North Carolina, United States, and South Wales, United Kingdom. All interactions involving prescription medicines were transcribed and analysed, 63 from the UK pharmacies and 60 from the US. The mean time spent by the US pharmacists counselling their clients (122.7 seconds) was almost twice as long as that spent by UK pharmacists (69.1 seconds). Pharmacists in the US offered significantly more items of information to their clients (11.2 items per interaction) than their UK counterparts (6.5 items per interaction). Although pharmacists from both countries asked their clients similar numbers of questions, UK pharmacists asked significantly more leading questions. Over 95 per cent of questions asked by pharmacists from both the UK and the US were the closed type. Although US pharmacists have been shown to offer more advice to their clients than those in the UK, the study did not assess the quality of advice given nor ascertain the opinion of those who received this advice.

A postal survey to assess the views of community pharmacists on the deregulation of emergency hormonal contraception

Abstract Focal points

`Islands' and `doctor's tool': the ethical significance of isolation and subordination in UK community pharmacy

Empirical ethics research is increasingly valued in offering insights into how ethical problems and decision-making occur in healthcare. In this article, the findings of a qualitative study of the ethical problems and decision-making of UK community pharmacists are presented, and it is argued that the identified themes of pharmacists' relative isolation from others and their subordination to doctors are ethically significant. Semi-structured interviews were conducted with 23 community pharmacists in England, UK. Analysis of interviews revealed that isolation involved separation of pharmacists from their peers, other healthcare professionals, patients and customers. Such isolation is argued to be inimical to ethical practice - impeding ethical discourse as understood by Habermas, resulting in a form of anomie that inhibits the transmission of professional values, leading to a lack of proximity between pharmacist and patient or customer that may impede ethical relationships and resulting, psychologically, in less ethical concern for those who are less close. Pharmacists' subordination to doctors not only precipitated some ethical problems but also allowed some pharmacists to shift ethical responsibility to a prescribing doctor, as in the case of emergency hormonal contraception. The emergence of atrocity stories further supports a culture of subordination that may cause ethical problems. The study has implications for community pharmacy practice in terms of supervision issues, developments such as prescribing responsibilities and how ethical values can be taught and communicated. The potential for isolation and subordination in other healthcare professions, and resultant ethical problems, may also need to be addressed and researched.

Pharmacist‐led medication review: comment on Holland et al. 2008

Holland et al. have produced an excellent technical review of the literature concerning pharmacist-led medication review [1]. They correctly conclude that untargeted review has little impact on clinical outcomes. However, other conclusions that they come to on the basis of their review cannot all be substantiated, and they may make the wrong policy prescription. Despite the lack of evidence concerning clinical effectiveness, clinical medication review has usually been found to be cost neutral or cost saving. If equivalent outcomes can be achieved (and no harm done) at lower total cost, then the savings generated can be recycled into more effective interventions. Effective interventions that utilize pharmacists' expertise are likely to: focus on high risk patients with conditions that affect drug handling by the body, concern treatment with multiple medication (polypharmacy) and, involve a multi-disciplinary approach to case management. Stewart et al. [2] is a good example of a study meeting at least two of these criteria. Paradoxically, Holland et al. set out to see if its positive findings were reproducible and then systematically excluded similar studies. Holland et al. claim that general improvements in knowledge and adherence are of little importance, but these are a priori the most likely consequences of studies meeting their inclusion criteria. They are also major public health concerns since up to 50% of chronic medication is not used as prescribed, and the large number of patients who rely on the knowledge of their carers is evident in many qualitative studies. A major UK Government report has concluded that unless levels of participation in self care can be dramatically increased, which requires better knowledge and more patient responsibility, then future demands for healthcare resources will be unsustainable [3]. Holland et al. seem to conflate so called ‘Medicines Use Review’ (MUR) with clinical medication review and to misunderstand the funding mechanism. MURs are provided as a standard service by UK community pharmacists with the express intention of improving patient knowledge and adherence. Since they are performed in the absence of medical records at the point of dispensing they can hardly achieve anything else. The funding for this service comes from within the sum already allocated for community pharmacists, who are consequently paid less than they would be for their more straightforward supply role. Holland et al. suggest that pharmacist medicine reviews are of no value because they do not reduce hospital admissions or death. Reducing avoidable hospital admissions is a priority for the NHS [4]. However, even focused, designed interventions (support by Government policy) such as case managers have failed to demonstrate reductions in hospital admissions [5].

Ethical decision-making, passivity and pharmacy

Background:Increasing interest in empirical ethics has enhanced understanding of healthcare professionals’ ethical problems and attendant decision-making. A four-stage decision-making model involving ethical attention, reasoning, intention and action offers further insights...

Ethical, religious and factual beliefs about the supply of emergency hormonal contraception by UK community pharmacists

Background and methodologyCommunity pharmacists' role in the sale and supply of emergency hormonal contraception (EHC) represents an opportunity to increase EHC availability and utilise pharmacists' expertise but little is known...

Off‐label and unlicensed prescribing for children: have we made any progress?

Off‐label and unlicensed prescribing for children: have we made any progress?

Dilemmas in dispensing, problems in practice? Ethical issues and law in UK community pharmacy

Do UK community pharmacists encounter the high drama dilemmas of the medical ethics literature or is a 'morality of the mundane' more appropriate? This paper presents the findings of a qualitative study that asked a sample of UK pharmacists to describe their ethical issues and to establish whether these were ethical dilemmas as understood philosophically or ethical problems of a more legal or emotional nature. It emerged that although many pharmacists referred to 'dilemmas', these were often problems involving a conflict between an ethical value and a legal or procedural issue and often arose in the routine minutiae of dispensing prescriptions and selling medicines. Such ethical problems remained of concern for pharmacists and the commercial environment, corporate pharmacy ownership and pharmacists' subordination to doctors, all precipitated ethical problems. Law and ethics appeared to be understood synonymously but this may reflect a modernity that increasingly brackets out ethical experiences by encouraging reliance upon law and procedure.