Promoting weight management services in community pharmacy: perspectives of the pharmacy team in Scotland

BACKGROUND Obesity has reached pandemic levels with more than 1.4 billion adults affected worldwide. While there is a need to systematically develop and evaluate community pharmacy based models of weight management, it is imperative to describe and understand the perspectives of pharmacy staff. In the UK, trained and accredited community pharmacy medicines counter assistants (MCAs) are commonly the front line staff involved in patient consultations and sale of over-the-counter medicines. OBJECTIVE To explore the beliefs and experiences of pharmacists and MCAs in the North-East of Scotland on community pharmacy weight management. SETTING All 135 community pharmacies in the North-East of Scotland. METHOD A qualitative approach of semi-structured telephone interviews with 31 pharmacists and 20 MCAs in the North-East of Scotland. The semi-structured interview schedule was developed with reference to key domains describing professional practice (i.e. awareness and knowledge, skills, practicalities, motivation, acceptance and beliefs) and contextualised with policy documents and published research on community pharmacy based weight management. Interviews were audio-recorded, transcribed and analysed thematically. MAIN OUTCOME MEASURE Pharmacists' and MCAs' beliefs and experiences with delivering weight management services in community pharmacy. RESULTS There were mixed responses from pharmacists and MCAs around pharmacy based weight management services from positive views of providing the service in community pharmacy to those more reticent who would always favour patients visiting their physician. While all described similar services e.g. measurement of weight, healthy eating advice, supply of products, they acknowledged that support was often opportunistic at the request of customers, with little integration of other providers. Roles described varied from pharmacist only functions to any staff member. While pharmacists generally felt comfortable and confident, MCAs gave more diverse responses. Both Pharmacist and MCAs highlighted the need for a practice model which is systematically developed and suggested a scheme akin to the successful smoking cessation 12-week nicotine replacement therapy service already available in community pharmacies in Scotland. CONCLUSION Pharmacists and MCAs interviewed in this study reported their perceptions of benefits to providing community pharmacy based weight management as part of a wider public health function. They described services as opportunistic and customer driven based on ease of access. There was a notable variation in pharmacist and MCA training, reflected in their levels of comfort and confidence. There is a clear need to systematically develop and provide evidence of effectiveness and cost effectiveness for a pharmacy based practice model with key roles and functions for the full pharmacy team

Additional file 1: Figure S1. of Relaxin deficiency results in increased expression of angiogenesis- and remodelling-related genes in the uterus of early pregnant mice but does not affect endometrial angiogenesis prior to implantation

Expression of (a) Rxfp1, (b) Il1β, (c) VegfA total, (d) Vegfr2, (e) Esr1, (f) Esr2, (g) Mmp14 and (h) Timp3 in the uterus of Rln +/+ and Rln -/- mice on day 6 of pregnancy (Study 3, n = 6–7). Horizontal bars indicate mean values. (PDF 35 kb

Additional file 2: Figure S2. of Relaxin deficiency results in increased expression of angiogenesis- and remodelling-related genes in the uterus of early pregnant mice but does not affect endometrial angiogenesis prior to implantation

Expression of (a) 18 s, (b) PpiA, (c) Sdha and (d) Tbp in the uterus of Rln +/+ mice on days 1 to 4 of pregnancy (n = 6–8). Horizontal bars indicate mean values. Groups that do not share a letter are significantly different from one another (p < 0.05). (PDF 37 kb

Additional file 3: Table S1. of Relaxin deficiency results in increased expression of angiogenesis- and remodelling-related genes in the uterus of early pregnant mice but does not affect endometrial angiogenesis prior to implantation

Primer and probe sequences for the quantitative amplification of murine genes. Table S2. Mean CT values and the range of CT values for each gene analyzed by qPCR in the uterus of wildtype (Rln +/+ ) and relaxin deficient (Rln -/- ) mice (n = 6–8). Table S3. Primer sequences for the RT-PCR amplification of murine genes. (DOC 111 kb

Prescribers' experiences of, and attitudes to, use of morphine for palliative care at a tertiary hospital in Zambia

Objective: To explore medical doctors' experiences of, and attitudes to, use of morphine for palliative care at a tertiary hospital in Zambia. Methods: A qualitative, exploratory case study was undertaken. Semi-structured interviews were used to collect data from 14 medical doctors working in the fields of oncology, pediatrics, and internal medicine at a tertiary hospital in Lusaka, Zambia, regarding their experiences and attitudes to prescribing morphine for palliative care. Thematic analysis of interview transcripts was carried out to establish common themes in the data. The study was approved by BSMS and UNZA research ethics committees. Results: All participants agreed that doctors were becoming more comfortable with the prescribing of morphine, although experiences were notably different for doctors working in oncology, compared to other departments. Themes of difficulty discussing end-of-life, poor recognition of pain, and fear of patient addiction, were more prominent in the responses of non-cancer doctors. Morphine use was generally restricted to cancer and sickle cell disease patients, with most non-cancer doctors stating that they rarely prescribe morphine for outpatient use. Training in pain management and the presence of a palliative care team were perceived to be facilitators to morphine prescribing. Conclusions: Although there is an increased willingness to prescribe morphine, limited knowledge of pain management, especially for nonmalignant disease, underlies many of the findings in this study. Opportunity exists for professional development in pain management to further improve the acceptance and use of opioids in palliative care, especially for out-patients

Training of pharmacists in Zambia: developments, curriculum structure and future perspectives

In Zambia, local training of pharmacists commenced in 2001. Development of pharmaceutical education in Zambia has been largely influenced by the national need for pharmacists in the healthcare sector. Training institutions offer the Bachelor of Pharmacy (B.Pharm.) degree programme which follows a four-year curriculum structure. The B.Pharm. programme aims to produce pharmacists with requisite competences to practise pharmaceutical care and sustain the development of pharmacy in Zambia. Seventeen years down the line, Zambia continues to advance local pharmaceutical education programmes. Over 700 pharmacists have graduated from the national training programmes in Zambia which continue to address the pharmaceutical workforce needs. Pharmaceutical education in Zambia offers a number of career prospects in hospital, community, pharmaceutical manufacturing, medicine regulation, public health administration, and progression to academia. Positive transitions made to advance pharmacists’ training in Zambia give a positive outlook for the future

The treatment of postnatal depression by health visitors: impact of brief training on skills and clinical practice

Background: Postnatal depression can be effectively treated by cognitive behavioural counselling (CBC), a simple intervention designed to be delivered by non-specialists in mental health. Methods: Health visitors were trained in CBC and post-training changes in counselling skills, clinical practice and costs were assessed. Results: Following training health visitors showed improved counselling skills, and they carried out more mental health assessments, recorded mental symptoms more often and treated more women themselves. However, their mean number of contacts with depressed women did not change; and the number of urgent contacts diminished. Referrals to general practitioners did not increase but there was an increase in referrals to mental health services. Costs to health visitor practice did not increase. Limitations: Assessment of clinical practice was based on health visitor records. The study uses a ‘before and after’ design rather than randomisation of subjects. Conclusions: Training health visitors in CBC leads to improved counselling skills and corresponding changes in clinical practice, without increasing the costs of health visitor practice</p

The treatment of postnatal depression by health visitors: impact of brief training on skills and clinical practice

Background: Postnatal depression can be effectively treated by cognitive behavioural counselling (CBC), a simple intervention designed to be delivered by non-specialists in mental health. Methods: Health visitors were trained in CBC and post-training changes in counselling skills, clinical practice and costs were assessed. Results: Following training health visitors showed improved counselling skills, and they carried out more mental health assessments, recorded mental symptoms more often and treated more women themselves. However, their mean number of contacts with depressed women did not change; and the number of urgent contacts diminished. Referrals to general practitioners did not increase but there was an increase in referrals to mental health services. Costs to health visitor practice did not increase. Limitations: Assessment of clinical practice was based on health visitor records. The study uses a ‘before and after’ design rather than randomisation of subjects. Conclusions: Training health visitors in CBC leads to improved counselling skills and corresponding changes in clinical practice, without increasing the costs of health visitor practice</p

Antimicrobial stewardship knowledge and perception among physicians and pharmacists at leading tertiary teaching hospitals in Zambia: implications for future policy and practice

Antimicrobial stewardship (AMS) is a key strategy promoting rational antimicrobial use. In Zambia, information on health professionals’ knowledge, attitude, and practice of AMS is limited. This study was undertaken to address this at Zambia’s leading specialized teaching hospitals. Descriptive, cross-sectional study involved 137 physicians and 61 pharmacists. AMS knowledge was relatively low among physicians (51%) and pharmacists (39%). Few physicians (9%) and pharmacists (20%) demonstrated sufficient knowledge of the basic principles of AMS. Physicians’ and pharmacists’ knowledge levels were significantly associated with years of practice, job position or practice rank, and previous AMS training. The majority (95%) perceived AMR as a current problem in their practise. Most physicians (92%) and pharmacists (86%) had not undertaken AMS training before. All indicated the need for context-specific educational interventions to promote AMS in Zambia. Despite positive perceptions, basic knowledge of AMS was relatively low. Context-specific educational interventions and capacity building are needed to address AMS gaps

Table_1_Mapping intervention components from a randomized controlled trial to scale-up of an early life nutrition and movement intervention: The INFANT program.DOCX

IntroductionEarly life parent-focused interventions can effectively improve infant and child nutrition and movement (physical activity and sedentary behavior) as well as parents' health behaviors. Scale-up of such interventions to real-world settings is essential for population-wide benefits. When progressing to scale-up, intervention components may be modified to reflect contextual factors and promote feasibility of scale-up. The INFANT program, an efficacious early life nutrition and movement behavioral intervention began as a randomized controlled trial (RCT), was modified after a small-scale translation, and is currently being scaled-up in Victoria, Australia. This study mapped and compared discrete intervention components of both the original RCT and the scaled-up version of INFANT to examine modifications for scaling up.MethodsDiscrete intervention components, specifically the target behaviors (child-related and parent-related behaviors), delivery features and behavior change techniques (BCTs) from the RCT and the scaled-up program were coded and mapped using established frameworks and taxonomies. Publications and unpublished materials (e.g., facilitator notes, handouts, videos, app) were coded. Coding was performed independently in duplicate, with final coding validated in a meeting with interventionists. Interventionists reported the rationale for modifications made.ResultsThe INFANT RCT and scaled-up version targeted the same obesity prevention-related nutrition and movement behaviors. Key modified delivery features at scale-up included reduced number of sessions, a broader range of professionals facilitating groups, the addition of a mobile app for parents replacing hard-copy materials and tangible tools (e.g., pedometers), and broadening of content (e.g., early feeding, updated 24-h movement guidelines). BCTs used across the RCT and scale-up sessions were unchanged. However, the BCTs identified in the between-session support materials were almost double for the scale-up compared with the RCT, primarily due to the reduced number of sessions and the app's capacity to include more content.ConclusionsINFANT is one of few early life nutrition and movement behavioral interventions being delivered at scale. With INFANT as an example, this study provides critical understanding about what and why intervention components were altered as the RCT was scaled-up. Unpacking these intervention modifications provides important insights for scale-up feasibility, outcome effects, and how to optimize implementation strategies for population-level benefits.</p