Evaluation of NHS Health Checks in Community Pharmacies

Background Community pharmacy is a potentially useful, easily accessed provider of NHS Health Checks. Little published work has reported outcomes or sought views of pharmacy Health Check attenders. This evaluation assessed findings of pharmacy Health Checks plus subsequent attendance after referral to general practices and obtained client views. Methods Mixed methods including: data abstraction from Health Check and practice records, questionnaire to all attenders and interviews with sample of questionnaire respondents. Results Data from 190 pharmacy Health Checks, performed in four pharmacies, showed that the majority of attenders (58%) were female, 53% white, with 80% aged under 55. Seventy five per cent had at least one modifiable cardiovascular risk factor, 8% had a cardiovascular disease risk score of ?20%, 30% were referred to their practice for further tests/consultation, but only half of these attended. Lifestyle advice was offered to 74% and referral for support with changing lifestyle accepted by 20%. Survey respondents (66) were unrepresentative and fewer had modifiable risk factors. Many indicated that making lifestyle changes and their views on pharmacy Health Checks were positive, particularly reflecting accessibility. Conclusions Pharmacy NHS Health Checks reach people with modifiable risk factors, identify those requiring further investigation and refer appropriately. Greater emphasis and encouragement are required to act on referrals if Health Checks are to maximize benefits

Patients’ use of information about medicine side effects in relation to experiences of suspected adverse drug reactions

Background Adverse drug reactions (ADRs) are common, and information about medicines is increasingly widely available to the public. However, relatively little work has explored how people use medicines information to help them assess symptoms that may be suspected ADRs. Objective Our objective was to determine how patients use patient information leaflets (PILs) or other medicines information sources and whether information use differs depending on experiences of suspected ADRs. Method This was a cross-sectional survey conducted in six National Health Service (NHS) hospitals in North West England involving medical in-patients taking at least two regular medicines prior to admission. The survey was administered via a questionnaire and covered use of the PIL and other medicines information sources, perceived knowledge about medicines risks/ADRs, experiences of suspected ADRs, plus demographic information. Results Of the 1,218 respondents to the survey, 18.8 % never read the PIL, whilst 6.5 % only do so if something unexpected happens. Educational level was related to perceived knowledge about medicines risks, but not to reading the PIL or seeking further information about medicines risks. Over half the respondents (56.0 %) never sought more information about possible side effects of medicines. A total of 57.2 % claimed they had experienced a suspected ADR. Of these 85.9 % were either very sure or fairly sure this was a reaction to a medicine. Over half of those experiencing a suspected ADR (53.8 %) had read the PIL, of whom 36.2 % did so before the suspected ADR occurred, the remainder afterwards. Reading the PIL helped 84.8 % of these respondents to decide they had experienced an ADR. Educational level, general knowledge of medicines risks and number of regular medicines used all increased the likelihood of experiencing an ADR. Conclusion More patients should be encouraged to read the PIL supplied with medicines. The results support the view that most patients feel knowledgeable about medicines risks and suspected ADRs and value information about side effects, but that reading about side effects in PILs or other medicines information sources does not lead to experiences of suspected ADRs

Pharmacists’ and patients’ views and feedback on Italian Medicines Use Review (I-MUR)

Rationale, aims and objectives: Although medicine review services are offered by community pharmacists in many countries, they are non-existent in Italy. A novel intervention I-MUR, was developed for patients with asthma aiming to improve medicines use. The aim of this study was to obtain pharmacists’ and patients’ views on the acceptability of the I-MUR service provided by community pharmacists to asthma patients in four regions of Italy. Methods: Pharmacists’ expectations, experiences and attitudes to delivering the I-MUR were obtained through questionnaires distributed before and after delivering the I-MUR, plus focus groups. Patients’ views were obtained via questionnaires, distributed by the pharmacists and returned anonymously. Results: Seventy-four pharmacists provided the I-MUR service to 895 asthma patients; 49 pharmacists completed both questionnaires, 53 participated in focus groups and 246 patients returned questionnaires. Barriers anticipated most frequently by pharmacists before the I-MUR were lack of time (53%) and lack of co-ordination with other health professionals (61%), while lack of financial compensation was identified by 37%. Lack of co-ordination proved the most common actual barrier (88%), with lack of financial compensation being cited less frequently after providing the intervention (8%). Ninety-six percent of pharmacists anticipated providing both education on inhaler technique and medication counselling, but in practice slightly fewer had provided these (90% and 86% respectively). Focus groups highlighted a lack of relevant undergraduate education to support medication review and structural barriers within some pharmacies, but described positive patient feedback and desire to extend the I-MUR. Patients’ respondents were positive; 62% indicated the reason for having an I-MUR as making sure that they were using medication correctly, 75% considered they benefited from it and 86% would recommend it to others. Conclusions: The I-MUR service was perceived positively by both pharmacists and patients, supporting the extension of medicine review services to community pharmacists in Italy

Feeding Ecology of Fishes in a South Dakota Power Plant Cooling Reservoir

The food habits of bluegills (Lepomis macrochirus), black bullheads Ictalurus melas), and muskellunge (Esox masquinongv) in the Big Stone Power Plant cooling reservoir were studied from January through December 1979. The diet of 794 bluegills \u3e50 mm TL was dominated by vegetation, planktonic crustaceans, dipteran larvae and pupae, and fishes: 214 bluegills \u3c 50 mm TL fed primarily upon chironomid larvae and pupae and cladocerans. There was a significant difference (P50 mm. This was determined by Spearman rank correlation coefficients based upon percent number and percent volume of food items, and mean number of taxa per stomach. Both bluegill length-groups positively selected Chydorinae, ostracods, Caenis spp. larvae, chironomid pupae, and Physa spp., while they negatively selected cyclopoid copepods, Ceriodaphnia spp., and Tanypodinae larvae. Chironomid larvae were positively selected by bluegills mm, but were negatively selected by those \u3e50 mm. Fishes and chironomid larvae were the major food items of 105 black bullheads \u3e120 mm TL; fishes and filamentous algae were the dominant food items of 146 bullheads 5120 mm. Ostracods and dipteran pupae were positively selected, while Tanvpodinae and Chironominae larvae were negatively selected. Chydorinae, cyclopoid copepods, and Physa spp. were negatively selected by bullheads \u3e120 mm. Chydorinae and Physa spp. were positively selected and cyclopoid copepods were ingested in proportions equal to those in the environment by bullheads X120 mm. The diet of 107 yearling and young-of-the-year muskellunge was dominated by Johnny darters (Etheostoma nigrum), fathead minnows (Pimephales promelas), and centrarchids (Lepomis spp.). There were positive correlations between jaw width (closed) of muskellunge and prey size (total length and body depth); and body depth of muskellunge and prey size

Issues potentially affecting quality of life arising from long-term medicines use: a qualitative study

Background Polypharmacy is increasing and managing large number of medicines may create a burden for patients. Many patients have negative views of medicines and their use can adversely affect quality of life. No studies have specifically explored the impact of general long-term medicines use on quality of life. Objective To determine the issues which patients taking long-term medicines consider affect their day-to-day lives, including quality of life. Setting Four primary care general practices in North West England Methods Face-to-face interviews with adults living at home, prescribed four or more regular medicines for at least 1 year. Interviewees were identified from primary care medical records and purposively selected to ensure different types of medicines use. Interviews were recorded, transcribed and analysed thematically. Results Twenty-one interviews were conducted and analysed. Patients used an average of 7.8 medicines, 51 % were preventive, 40 % for symptom relief and 9 % treatment. Eight themes emerged: relationships with health professionals, practicalities, information, efficacy, side effects, attitudes, impact and control. Ability to discuss medicines with health professionals varied and many views were coloured by negative experiences, mainly with doctors. All interviewees had developed routines for using multiple medicines, some requiring considerable effort. Few felt able to exert control over medicines routines specified by health professionals. Over half sought additional information about medicines whereas others avoided this, trusting in doctors to guide their medicines use. Patients recognised their inability to assess efficacy for many medicines, notably those used for prophylaxis. All were concerned about possible side effects and some had poor experiences of discussing concerns with doctors. Medicines led to restrictions on social activities and personal life to the extent that, for some, life can revolve around medicines. Conclusion There is a multiplicity and complexity of issues surrounding medicines use, which impact on day-to-day lives for patients with long-term conditions. While most patients adapt to long-term medicines use, others did so at some cost to their quality of life

A cross-sectional study using freedom of information requests to evaluate variation in local authority commissioning of community pharmacy public health services in England.

OBJECTIVES: This study aims to provide a national picture of the extent and nature of public health services commissioned by local authorities (LAs) from community pharmacies across England in financial year 2014/15. DESIGN: Cross-sectional survey of public health services commissioned in community pharmacies by LAs, gathered via freedom of information requests and documentary analysis. SETTING AND PARTICIPANTS: All 152 LAs in England. RESULTS: A total of 833 commissioned services were reported across England (range 3-10 per LA). Four services were commissioned by over 90% of LAs: emergency hormonal contraception (EHC), smoking cessation support, supervised consumption of methadone or other opiates and needle and syringe programmes (NSPs). The proportion of pharmacies commissioned to deliver these services varied considerably between LAs from <10% to 100%. This variation was not related to differences in relevant proxy measures of need. NHS Health Checks and alcohol screening and brief advice were commissioned by fewer LAs (32% and 15%, respectively), again with no relationship to relevant measures of need. A range of other services were commissioned less frequently, by fewer than 10% of LAs.Supervised consumption and NSPs were the most frequently used services, with over 4.4 million individual supervisions and over 1.4 million needle packs supplied. Pharmacies provided over 200 000 consultations for supply of EHC, over 30 000 supplies of free condoms and almost 16 000 chlamydia screening kits. More than 55 000 people registered to stop smoking in a community pharmacy, almost 30 000 were screened for alcohol use and over 26 000 NHS Health Checks were delivered. CONCLUSIONS: There is significant variation in commissioning and delivery of public health services in community pharmacies across England, which correlate poorly with potential benefit to local populations. Research to ascertain reasons for this variation is needed to ensure that future commissioning and delivery of these services matches local need

Understanding and optimising an identification/brief advice (IBA) service about alcohol in the community pharmacy setting

This is the final report of an evaluation into the identification/brief advice (IBA) service about alcohol in community pharmacy settings in the North West of England. Since 2007, almost 100 pharmacies in the North West have - at some point - been commissioned to provide an identification and brief advice (IBA) service for alcohol. This evaluation sought to understand how the service had been adapted for and implemented in the community pharmacy setting, and how its potential might be maximised. Its aims were: 1. To characterise, consolidate and optimise both the constant and variable elements of the pharmacy alcohol identification/brief advice (IBA) service in NHS Northwest, and 2. To inform planning for current and future pharmacy based services promoting safe consumption of alcohol. The evaluation was split into three main workstreams, supported by a preliminary scoping phase, and combined quantitative and qualitative methods: • Descriptive and comparative statistical analysis of pharmacy alcohol IBA data; • In-pharmacy work, including observation of staff engagement with customers, recording consultations between staff and customers, follow-up telephone interviews with customers, and group feedback interviews with pharmacy staff; • Stakeholder engagement through self-completion surveys, semi-structured interviews and a workshop. This report gives the background to the project, and details the methods, results and implications

Public attitudes towards community pharmacy attributes and preferences for methods for promotion of public health services

Objective: To identify attitudes towards pharmacy characteristics and promotional methods for selected pharmacy public health services (lifestyle advice and screening for cardiovascular risk factors) among different sectors of the general public. Study design: Cross-sectional survey, using a previously validated questionnaire. Methods: Three survey methods were used, across 15 areas of England, to maximise diversity: face-to-face, telephone and self-completion of paper questionnaires. Responses to closed questions regarding characteristics and promotion were quantified and differences among sub-groups explored by univariate and multivariate analysis. Results: In total, 2,661 responses were available for analysis: 2,047 face-to-face, 301 telephone and 313 paper. There were strong preferences for a pharmacy near to home or doctor’s surgery and for long opening hours, particularly among employed people and non- whites. Fifty percent preferred not to use a pharmacy in a supermarket, particularly older people, the retired, those of lower education and frequent pharmacy users. Personal recommendation by health professionals or family/friends was reported as most likely to encourage uptake of pharmacy public health services, with older people and males being less likely and frequent pharmacy users more likely to perceive any promotional method as influential. Posters/leaflets were preferred over mass media methods, with fewer than 30% perceiving the latter as potentially influential. Conclusion: Pharmacists, pharmacy companies and service commissioners should use promotional methods favoured by potential users of pharmacy public health services and be aware of differences in attitudes when trying to reach specific population sub-groups. For personal recommendation to be successful good inter-professional working and a pro-active approach to existing customers are neede

Safe food and feed through an integrated toolbox for mycotoxin management: the MyToolBox approach

There is a pressing need to mobilise the wealth of knowledge from the international mycotoxin research conductedover the past 25-30 years, and to perform cutting-edge research where knowledge gaps still exist. This knowledgeneeds to be integrated into affordable and practical tools for farmers and food processors along the chain inorder to reduce the risk of mycotoxin contamination of crops, feed and food. This is the mission of MyToolBox – a four-year project which has received funding from the European Commission. It mobilises a multi-actorpartnership (academia, farmers, technology small and medium sized enterprises, food industry and policystakeholders) to develop novel interventions aimed at achieving a significant reduction in crop losses due tomycotoxin contamination. Besides a field-to-fork approach, MyToolBox also considers safe use options ofcontaminated batches, such as the efficient production of biofuels. Compared to previous efforts of mycotoxin reduction strategies, the distinguishing feature of MyToolBox is to provide the recommended measures to theend users along the food and feed chain in a web-based MyToolBox platform (e-toolbox). The project focuseson small grain cereals, maize, peanuts and dried figs, applicable to agricultural conditions in the EU and China. Crop losses using existing practices are being compared with crop losses after novel pre-harvest interventionsincluding investigation of genetic resistance to fungal infection, cultural control (e.g. minimum tillage or cropdebris treatment), the use of novel biopesticides suitable for organic farming, competitive biocontrol treatment and development of novel modelling approaches to predict mycotoxin contamination. Research into post-harvestmeasures includes real-time monitoring during storage, innovative sorting of crops using vision-technology, novelmilling technology and studying the effects of baking on mycotoxins at an industrial scale

Methodological and economic evaluations of seven survey modes applied to health service research

Objective: To evaluate methodological outcomes and cost-effectiveness of seven survey modes, using a study of general public views towards pharmacy public health services. Methods: A cross-sectional survey was conducted in North West England among people aged =?18 years, using two approaches. Three interviewer-assisted modes were street, door-to-door and telephone. Four self-completion modes were single-and double-mailing to residential addresses, surveys sent to public/private business by post (postal-business), and questionnaires dropped-off at venues (drop-off). The study compared response rates, demographics and two domains ((a) actual use of and (b) willingness to use pharmacy public health services) between modes. Incremental cost-effectiveness ratios of different modes were assessed against the single-mailing. Key findings: Response rate varied between 5.1% (postal-business) and 34.5% (street). Respondent age, education, employment, socioeconomic and deprivation status varied between different modes. Results for domain (a) were similar for all modes. Interviewer-assisted modes resulted in more positive views on willingness to use advisory services (P < 0.05). The drop-off mode saved ?45.92 (US$72.55) per 1% increase in response rate compared to single mailing, while interviewer-assisted and double-mailing were more costly. At higher response rates, cost-savings by the drop-off mode diminished, but for other survey modes, additional costs decreased. Conclusion: Drop-off mode is cost-effective compared to the standard single mailing, but selection bias is possible. Street surveys are also an efficient method, but may carry a higher risk of social desirability bias. Mixed-modes surveys may reach wider sectors of the population. The similarity in use of services suggests all survey modes reach members of the public relevant to pharmacy researchers