Nurse practitioners: An insight into their integration into Australian community pharmacies

Background: Nurse practitioners (NPs) are independent health professionals with prescribing rights, and have recently established primary care roles in pharmacies. Objective: To describe the roles of pharmacy-based NPs in Australia. Methods: Semi-structured interviews were undertaken onsite or by telephone, with 28 staff of all 9 Revive NP Clinics in Western Australia. Participants comprised NPs representing 6 practices and pharmacy staff of all 9 practices. Questions explored the NPs' scope of practice and staff collaboration. Data are descriptively reported. Results: The NPs undertook a range of services, including medication prescribing according to clinical guidelines, provision and ordering of diagnostic services, vaccine administration and provision of medical certificates. Community pharmacists reported to continue ensuring the safe and quality use of medicines and to counsel clients. Both pharmacists and NPs provided consumer medicine information leaflets. NPs are authorized to write prescriptions for Pharmacist-Only (S3) Medicines. Conclusions: NPs' primary healthcare roles appear to complement roles of community pharmacists. Potential exists for further collaboration and interdisciplinary care in health promotion and screening services. Clarification is needed with respect to prescribing and provision of Pharmacist-Only Medicines, and offering consumer medicines leaflets

Medical cannabis: A needs analysis for people with epilepsy

Background and purpose: Medical cannabis may be effective treatment for refractory epilepsy. It is timely to seek users’ and potential users’ opinions in regard to its place in the management of epilepsy. Materials and methods: An online survey was administered to members of an epilepsy support organisation in Western Australia. Experience with cannabis for management of epilepsy was explored, along with desire to trial a particular pharmaceutical formulation(s). Results: People with epilepsy (33/71) and carers (38/71) participated. Fifty-four participants indicated no experience with medical cannabis, although 35, mainly with inadequate response to prescription medicines, were willing to ask for a prescription. Concerns included difficulty accessing cannabis and high cost of this treatment. Tablets/capsules was the most acceptable dosage form for development. Conclusion: These findings suggest wide interest in trialling medical cannabis in individual cases of refractory epilepsy, despite the developing body of literature and some concerns about cost and procurement

Will Australians pay for health care advice from a community pharmacist? A video vignette study

Background: Large proportion of Australians have access to pharmacists' health advice at no cost. The impact of a proposed co-payment levy for general practitioner (GP) consultation by Australian government is unclear. This raises an interesting question about consumers' perceived value of health-related consultations. Objective: This survey of representative sample of Western Australians explores the hypothesis that Australians are willing to pay for advanced model of pharmacy consultation. Methods: Two videos illustrating current-services and quality-enhanced-service (QES) incorporating systematic assessment of symptoms and referral to GP if necessary, were used. Participants viewed videos online and completed a willingness-to-pay (WTP) questionnaire about their perception and WTP for each service. Logistic regression and McNemar tests were used to identify WTP groups. Results: Of the 175 respondents, one in nine (19/175, 11%) were willing to pay and (35/175) 20% might consider paying for advice at pharmacies as per current-practice. Almost one in four (49/175, 28%) were willing to pay and (47/175) 27% would consider paying for QES (McNemar Test P < 0.001). Conclusions: The majority of West Australians may be willing to pay for consultation at pharmacies that offers more private, time-intensive experience with documented GP referral where required. Further research is warranted to test WTP with actual customers to confirm these results

Interventions to Assist Health Consumers to Find Reliable Online Health Information: A Comprehensive Review

BACKGROUND: Health information on the Internet is ubiquitous, and its use by health consumers prevalent. Finding and understanding relevant online health information, and determining content reliability, pose real challenges for many health consumers. PURPOSE: To identify the types of interventions that have been implemented to assist health consumers to find reliable online health information, and where possible, describe and compare the types of outcomes studied. DATA SOURCES: PubMed, PsycINFO, CINAHL Plus and Cochrane Library databases; WorldCat and Scirus ‘gray literature’ search engines; and manual review of reference lists of selected publications. STUDY SELECTION: Publications were selected by firstly screening title, abstract, and then full text.DATA EXTRACTION: Seven publications met the inclusion criteria, and were summarized in a data extraction form. The form incorporated the PICOS (Population Intervention Comparators Outcomes and Study Design) Model. Two eligible gray literature papers were also reported. DATA SYNTHESIS: Relevant data from included studies were tabulated to enable descriptive comparison. A brief critique of each study was included in the tables. This review was unable to follow systematic review methods due to the paucity of research and humanistic interventions reported. LIMITATIONS: While extensive, the gray literature search may have had limited reach in some countries. The paucity of research on this topic limits conclusions that may be drawn.CONCLUSIONS: The few eligible studies predominantly adopted a didactic approach to assisting health consumers, whereby consumers were either taught how to find credible websites, or how to use the Internet. Common types of outcomes studied include knowledge and skills pertaining to Internet use and searching for reliable health information. These outcomes were predominantly self-assessed by participants. There is potential for further research to explore other avenues for assisting health consumers to find reliable online health information, and to assess outcomes via objective measures

Dr Google and the consumer: A qualitative study exploring the navigational needs and online health information-seeking behaviors of consumers with chronic health conditions

Background: The abundance of health information available online provides consumers with greater access to information pertinent to the management of health conditions. This is particularly important given an increasing drive for consumer-focused health care models globally, especially in the management of chronic health conditions, and in recognition of challenges faced by lay consumers with finding, understanding, and acting on health information sourced online. There is a paucity of literature exploring the navigational needs of consumers with regards to accessing online health information. Further, existing interventions appear to be didactic in nature, and it is unclear whether such interventions appeal to consumers’ needs. Objective: Our goal was to explore the navigational needs of consumers with chronic health conditions in finding online health information within the broader context of consumers’ online health information-seeking behaviors. Potential barriers to online navigation were also identified. Methods: Semistructured interviews were conducted with adult consumers who reported using the Internet for health information and had at least one chronic health condition. Participants were recruited from nine metropolitan community pharmacies within Western Australia, as well as through various media channels. Interviews were audio-recorded, transcribed verbatim, and then imported into QSR NVivo 10. Two established approaches to thematic analysis were adopted. First, a data-driven approach was used to minimize potential bias in analysis and improve construct and criterion validity. A theory-driven approach was subsequently used to confirm themes identified by the former approach and to ensure identified themes were relevant to the objectives. Two levels of analysis were conducted for both data-driven and theory-driven approaches: manifest-level analysis, whereby face-value themes were identified, and latent-level analysis, whereby underlying concepts were identified. Results: We conducted 17 interviews, with data saturation achieved by the 14th interview. While we identified a broad range of online health information-seeking behaviors, most related to information discussed during consumer-health professional consultations such as looking for information about medication side effects. The barriers we identified included intrinsic barriers, such as limited eHealth literacy, and extrinsic barriers, such as the inconsistency of information between different online sources. The navigational needs of our participants were extrinsic in nature and included health professionals directing consumers to appropriate online resources and better filtering of online health information. Our participants’ online health information-seeking behaviors, reported barriers, and navigational needs were underpinned by the themes of trust, patient activation, and relevance. Conclusions: This study suggests that existing interventions aimed to assist consumers with navigating online health information may not be what consumers want or perceive they need. eHealth literacy and patient activation appear to be prevalent concepts in the context of consumers’ online health information-seeking behaviors. Furthermore, the role for health professionals in guiding consumers to quality online health information is highlighted

An Exploratory Study of Extended Health Care Practitioner Roles in Medication Supply and Management in a Rural Community

Australia has a recognised shortage of qualified health professionals, particularly in rural and regional areas. Research has shown that rural patients indeed have poorer health status compared to metropolitan communities, with rates of mortality and morbidity constantly higher in rural regions. A number of ‘novel’ and ‘extended’ roles have been developed for existing health care professionals. Some of these roles have application to rural areas, such as additional functions in terms of provision of medicines. In Queensland in particular, the Health (Drugs and Poisons) Regulation 1996 (the Regulation), which provides the regulatory framework for the handling of medicines, has been amended to include a range of endorsements, including Indigenous Health Workers (IHW) and Rural and Isolated Practice-endorsed Nurses (RIPRN). Another development is the amendment of the Regulation to allow for a range of health professionals, namely optometrists, physicians’ assistants and nurse practitioners, to prescribe medicines. Whether such developments have addressed the needs of rural communities remains unknown. Inherently, rural communities will suffer from limited access to health care services, and the services of the existing health care providers may be stretched to, or beyond, the scope of their recognised practice in order to meet the needs of the community. Little is known about the extent and nature of these ‘extended’ practices, the perceived need for (or obligation on) health professionals to adopt these roles, and the ethical, professional and legal considerations if/when they extend their services into non-traditional territories. This research specifically focussed on the involvement of various health care providers in patients’ medication management in a defined community or region. In doing so, it aimed to identify medication-related issues of a community and the potential roles for pharmacists to enhance safe, effective and efficient access to medicines in a rural setting.Griffith Health, School of PharmacyFull Tex

Exploring example models of cross-sector, sessional employment of pharmacists to improve medication management and pharmacy support in rural hospitals

INTRODUCTION: Many rural hospitals in Australia are not large enough to sustain employment of a full-time pharmacist, or are unable to recruit or retain a full-time pharmacist. The absence of a pharmacist may result in hospital nurses undertaking medication-related roles outside their scope of practice. A potential solution to address rural hospitals' medication management needs is contracted part-time ('sessional') employment of a local pharmacist external to the hospital ('cross-sector'). The aim of this study was to explore the roles and experiences of pharmacists in their provision of sessional services to rural hospitals with no on-site pharmacist and explore how these roles could potentially address shortfalls in medication management in rural hospitals. METHODS: A qualitative study was conducted to explore models with pharmacists who had provided sessional services to a rural hospital. A semi-structured interview guide was informed by a literature review, preliminary research and stakeholder consultation. Participants were recruited via advertisement and personal contacts. Consenting pharmacists were interviewed between August 2012 and January 2013 via telephone or Skype for 40-55 minutes.RESULTS: Thirteen pharmacists with previous or ongoing hospital sessional contracts in rural communities across Australia and New Zealand participated. Most commonly, the pharmacists provided weekly services to rural hospitals. All believed the sessional model was a practical solution to increase hospital access to pharmacist-mediated support and to address medication management gaps. Roles perceived to promote quality use of medicines were inpatient consultation services, medicines information/education to hospital staff, assistance with accreditation matters and system reviews, and input into pharmaceutical distribution activities. CONCLUSIONS: This study is the first to explore the concept of sessional rural hospital employment undertaken by pharmacists in Australia and New Zealand. Insights from participants revealed that their sessional employment model increased access to pharmacist-mediated medication management support in rural hospitals. The contracting arrangements and scope of services may be evaluated and adapted in other rural hospitals

Pharmacists and prescribing rights: review of international developments

Purpose. Continuity of care, equitable access, and quality and safety are major foci in health services management. The introduction of limited prescribing rights to pharmacists has the potential to reduce fragmentation within the health system, optimise medication management, improve continuity of patient care and improve patient access to medication. Results. Eight models for pharmacists' prescribing have been implemented internationally, varying in their dependency on protocols, formularies and collaboration with physicians. These have also been described using terms such as Supplementary Prescribing and Patient Group Directions. Conclusion. Issues relating to practical implementation of pharmacists' prescribing include negotiation of national health policy, pharmacists' training and accreditation, liability, reimbursement and documentation

Comparison of prescribing criteria in hospitalised Australian elderly

The Beers criteria (2003) and McLeod criteria (1997) have been applied internationally to quantify inappropriate prescribing in elderly populations. Similarly, guidelines have been published locally by the National Prescribing Service (NPS). Objective: This study aimed to adapt, evaluate and compare the utility of these three established criteria in measuring prescribing appropriateness in a sample of hospitalised elderly patients. Methods: Initial refinement of the criteria produced versions applicable to Australian practice. Inpatient records of 202 patients aged 65 years or older in six wards of the Princess Alexandra Hospital, Brisbane, Australia, were reviewed using the adapted criteria. ‘Potentially inappropriate’ prescribing was descriptively analysed using relevant denominators. Results: The adapted criteria collectively listed 70 ‘potentially inappropriate’ medicines or drug groups and 116 ‘potentially inappropriate’ prescribing practices. Patients (mean age 80.0; SD=8.3 years) were prescribed, a median of eight medicines (SD=4.0). At least one ‘potentially inappropriate’ medicine was identified in 110 (55%) patients. ‘Potentially inappropriate’ prescribing practices averaged 1.1 per patient (range 1-6). The adapted Beers criteria identified more ‘potentially inappropriate’ medicines/practices (44%, 101/232) than the McLeod criteria (41%) and NPS criteria (16%). Aspirin, benzodiazepines, beta-blockers and dipyridamole were most commonly identified. Conclusion: The Beers and McLeod criteria, developed internationally, required considerable modification for local prescribing. The three criteria differed in their focus and approaches, such that development and validation of national criteria, using the key features of these models, is recommended. There is potential to apply validated guidelines in clinical practice and review of prescribing, but only to supplement clinical judgement

An international survey of health literacy education within schools of pharmacy

Background: Health literacy (HL) influences patients’ health status, use of the healthcare system and medication-related behaviours. However, the concept is relatively new to pharmacy and its incorporation in academic curricula has not been examined. Aims: To explore HL training in pharmacy schools internationally, and academics’ opinions in regards to how it should be taught and assessed. Methods: An anonymous, online survey was administered to academics who teach within pharmacy degree courses from countries where English is the main language. Results: Responses were received from 21 pharmacy schools in seven countries; 20 stated that HL was taught within their pharmacy degree, in four as a stand-alone topic. Small-group tutorials were thought to be the most beneficial form of teaching health literacy, best assessed using oral and objective structured clinical examinations. Conclusion: The majority of pharmacy schools taught health literacy and had similar opinions regarding best practice teaching and assessment