Consumer internet purchasing of medicines using a population sample:A mixed methodology approach

Background: Malta has an average of 3–4 private community pharmacies per locality, providing patients with easy access to medicines yet according to general statistics gathered from European organisations, Internet is used to purchase various online products with medicines being amongst them. Objectives: To identify patterns around internet purchasing of medicines among Maltese residents. Methods: The study followed a mixed methods approach, employing a cross-sectional survey followed by semi-structured interviews. A random sample of 1996 residents were selected from the Maltese electoral register to participate in a postal questionnaire designed to gather data about purchasing prescription-only-medicines (POM) as well as over-the-counter (OTC) medicines. Results were analysed using descriptive statistics and Chi-square to establish associations between responses. Five interviews investigated participants’ concerns related to sourcing of medicines. The participants were purposively chosen from the questionnaire respondents. Data were analysed using thematic analysis. Results: The survey had a 22% response rate (N = 444) (60% female; mean age 52 years ± 17). Two (0.45%) participants reported purchasing POMs online in the past, while 4.3% (n = 19) purchased OTCs including vitamins, supplements and herbal combinations. The main reasons for OTC online purchasing were lack of local availability (n = 6; 1.4%) and lower price (n = 11; 2.5%). A total of 89% (n = 395) of respondents provided a reason for not purchasing online, with safety issues being the primary reason for 41% (n = 181) of these. Interviewees expressed disregard towards internet purchasing of medicines that was evident from the themes that emerged: definition of ‘medicines’, health autonomy and trust in self-care, relationships and trust in health professional, restrictions of medicine supply, influence of cost, need for options. Conclusions: The Maltese appear to be rather cautious and do not purchase POMs online, citing the risks that may be associated with internet purchasing. With regards to OTCs, a small percentage purchase these online and exposing them to risks associated with unauthorised sites.</p

Consumer internet purchasing of medicines using a population sample:A mixed methodology approach

Background: Malta has an average of 3–4 private community pharmacies per locality, providing patients with easy access to medicines yet according to general statistics gathered from European organisations, Internet is used to purchase various online products with medicines being amongst them. Objectives: To identify patterns around internet purchasing of medicines among Maltese residents. Methods: The study followed a mixed methods approach, employing a cross-sectional survey followed by semi-structured interviews. A random sample of 1996 residents were selected from the Maltese electoral register to participate in a postal questionnaire designed to gather data about purchasing prescription-only-medicines (POM) as well as over-the-counter (OTC) medicines. Results were analysed using descriptive statistics and Chi-square to establish associations between responses. Five interviews investigated participants’ concerns related to sourcing of medicines. The participants were purposively chosen from the questionnaire respondents. Data were analysed using thematic analysis. Results: The survey had a 22% response rate (N = 444) (60% female; mean age 52 years ± 17). Two (0.45%) participants reported purchasing POMs online in the past, while 4.3% (n = 19) purchased OTCs including vitamins, supplements and herbal combinations. The main reasons for OTC online purchasing were lack of local availability (n = 6; 1.4%) and lower price (n = 11; 2.5%). A total of 89% (n = 395) of respondents provided a reason for not purchasing online, with safety issues being the primary reason for 41% (n = 181) of these. Interviewees expressed disregard towards internet purchasing of medicines that was evident from the themes that emerged: definition of ‘medicines’, health autonomy and trust in self-care, relationships and trust in health professional, restrictions of medicine supply, influence of cost, need for options. Conclusions: The Maltese appear to be rather cautious and do not purchase POMs online, citing the risks that may be associated with internet purchasing. With regards to OTCs, a small percentage purchase these online and exposing them to risks associated with unauthorised sites.</p

Community pharmacists: members or bystanders of the primary care multidisciplinary team?

ObjectivesThis study investigated who community pharmacists (CPs), general practitioners (GPs) and practice nurses (PNs) included in their multidisciplinary team (MDT), whether they felt part of the MDT, barriers and facilitators to multidisciplinary working and whether the extent of the CPs’ clinical role influenced being part of a MDT.MethodsSurvey to CPs, GPs and PNs in south England. Participants were recruited using social media, journal ads and face-to-face visits/phone calls using NHS and professional networks. Responses were analysed using descriptive statistics, bivariate analyses and content analysis for open text.Key FindingsTwo hundred and fourteen GPs, 147 PNs and 162 CPs responded. Nearly, all PNs (98%) and GPs (99%) considered themselves part of a MDT compared to 78% of CPs. Working in isolation, lack of time and a lack of information sharing were the most common reasons for not feeling part of a MDT. The extent of the CPs’ clinical role was not related to feeling part of a MDT.ConclusionsGreater investment is needed in the structures to support multidisciplinary working in terms of time and resources, as well as a greater awareness of MDT members’ roles and potential contribution

Community pharmacists' views on providing a reproductive health service to women receiving opioid substitution treatment:A qualitative study using the TDF and COM-B

BACKGROUND: The absence of menstruation is common in women who use drugs. This can give a belief that conception is unlikely. When stabilised on Opioid Substitution Treatment (OST), fertility often returns, initially without realisation as ovulation precedes menstruation. This leaves women vulnerable to unplanned pregnancies. Community pharmacists (CPs) are frequently in contact with this patient group through the Supervised Consumption of OST service. This provides a timely opportunity to provide reproductive health (RH) advice. The aim of this study was to investigate pharmacists' views on providing a RH service to women receiving OST. METHODS: Twenty semi-structured interviews based on the Capability-Opportunity-Motivation to Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) were conducted between 2016 and 2017. Data analysis involved deductive coding using the TDF domains. The TDF domains were mapped onto the elements of the COM-B and used in the second step to create the framework and chart the data. The third step involved re-reading and clustering the codes, and inductive themes were generated to explain the data in depth. RESULTS: Nine of the 14 TDF domains, mapped into five elements of the COM-B, were identified. Five inductive themes were generated: 1) The pharmacists' experience and knowledge of reproductive health (RH) needs of women receiving OST, 2) The pharmacists' approach to providing advice, 3) The pharmacists' perception of the relationship with women receiving OST, 4) Social influences, and 5) Environmental factors. Community pharmacists feared causing offense to women receiving OST and described requiring cues as to when the service was needed. Pharmacists' highlighted a power imbalance in the relationship with women receiving OST. This could influence how receptive this patient group would be to pharmacy RH interventions. CONCLUSIONS: CPs' concerns of providing RH service could hinder a proactive service provision. Supporting good rapport and providing a structured consultation would increase the accessibility of such a service

The community pharmacy setting for diabetes prevention: views and perceptions of stakeholders

Background: Diabetes prevention programmes delay or prevent the onset of type 2 diabetes in people with pre-diabetes. To increase accessibility, national guidelines recommend delivering diabetes prevention programmes in primary care settings, including community pharmacy. This study aimed to explore the English community pharmacy setting as an option for delivering diabetes prevention services. Methods: Two focus groups and nine semi-structured interviews were conducted with stakeholders including, community pharmacists, general practitioners and commissioners. The topic guide was framed using the COM-B theoretical model for behaviour change to elicit practitioners’ capability, opportunity and motivation to engage with providing or referring to community pharmacy diabetes prevention services. Data were analysed thematically, and barriers/facilitators mapped to the COM-B framework. Results: Five themes were identified: ‘Pre-diabetes management and associated challenges’, ‘The community pharmacy setting’, ‘Awareness of community pharmacy services’, ‘Relationships and communication’ and ‘Delivery of community pharmacy services’. Community pharmacy was highlighted as an accessible setting for delivering screening and follow-on lifestyle interventions. Key factors for enhancing the capability of community pharmacy teams to deliver the interventions included training and appropriate use of skill mix. Delivering diabetes prevention services in collaboration with general practices was identified as key to the provision of integrated primary care services. Whilst financial incentives were identified as a motivating factor for delivery, service promotion to patients, public and healthcare professionals was perceived as crucial for enhancing engagement. Conclusions: This research highlights a role for community pharmacy in diabetes prevention. New service models should seek to integrate community pharmacy services in primary care to facilitate patient engagement and better communication with general practices

Factors influencing the prescribing behaviour of independent prescriber optometrists:a qualitative study using the Theoretical Domains Framework

Purpose Whilst the number of independent prescriber (IP) optometrists in the United Kingdom is increasing, there is limited evidence describing the experiences of these individuals. The Theoretical Domains Framework (TDF) provides an evidence‐based approach to understand determinants of behaviour. This conceptual framework can enable mapping to the COM‐B behaviour change model and the wider Behaviour Change Wheel to develop interventions to optimise behaviour‐change and healthcare processes more systematically. The study aimed to use the TDF to identify the factors that influence independent prescribing behaviour, and to map these findings to the COM‐B system to elucidate the relevant intervention functions, in order to identify the support required by optometrist prescribers. Methods Using a qualitative design, semi‐structured interviews based on the TDF were undertaken with independent prescriber optometrists. Thematic analysis was used to identify themes inductively, which were then deductively mapped to the TDF and linked to the COM‐B. Results Sixteen participants (9 male, 7 female; median age 45 years, range 28–65 years), based in community (n = 10) and hospital (n = 6) settings, were interviewed. Eleven of the TDF domains were found to influence prescribing behaviour. Findings highlighted the need for good communication with patients (TDF domain: Skills, COM‐B: Capability); confidence (TDF domain: Beliefs about capabilities, COM‐B: Motivation); good networks and relationships with other healthcare professionals, e.g., general practitioners (TDF domain: Social influences, COM‐B: Opportunity; TDF domain: Social/professional role and identity, COM‐B: Motivation); the need for appropriate structure for remuneration (TDF domain: Reinforcement, COM‐B: Motivation; TDF domain: Social/professional role and identity, COM‐B: Motivation) and the provision of professional guidelines (TDF domain: Knowledge, COM‐B: Capability; TDF domain: Environmental context and resources, COM‐B Opportunity). Conclusions Having identified theory‐derived influencers on prescribing decisions by optometrists, the findings can be used to develop a structured intervention, such as a support package to help optimise prescribing by optometrists, with the ultimate goal of eye care quality improvement

Sexual health services in community pharmacy for women on opioid substitution treatment: a qualitative study

BACKGROUND: Women on opioid substitution treatment (WOST) are at heightened risk for the sexual transmission of sexually transmitted infections and blood-borne viruses. This study aimed to explore the opportunities to promote their sexual health in community pharmacies in UK. METHODS: Semi-structured interviews were conducted with 20 WOST and 14 community pharmacists (CPs). A focus group was run with three CPs. Participants were recruited in drug services and a service for sex workers (WOST), and in CP. Data collection took place between October 2016 and September 2017. Data were analyzed using Framework Analysis and directed Content Analysis. RESULTS: CPs could play a role in promoting sexual health among WOST. Sexual health screening, treatment and condom supply were suggested as potential ways of delivering pharmacy-based sexual health services. These services should be actively offered to WOST, delivered in a private space and free of cost. We identified several challenges to overcome in order to design and implement sexual health services for WOST in community pharmacies. CONCLUSIONS: This study highlights the potentially key role CPs can have promoting sexual health and addressing health inequities among WOST. Improvements in pharmacists' training are required in order to address stigma towards WOST, and promote trust and positive rapport. Structural changes are also needed to broaden the services available for this group of women and improve their access to healthcare.</p