Prevalence of swallowing difficulties and medication modification in customers of community pharmacists

BACKGROUND: People may alter their solid oral medication dosage forms to make it easier to swallow. However, modification of solid medication dosage forms can lead to undesirable effects, and people may alter the dosage forms without informing the health professionals involved in their care. AIM: To estimate the prevalence of swallowing difficulties and medication modification amongst community pharmacy consumers, and to investigate consumer views, attitudes, and interactions with health professionals regarding such issues. METHODS: Consumers were recruited from five community pharmacies in Brisbane, Queensland and invited to participate in a structured interview. RESULTS: A total of 369 consumers participated in the study. Overall, 16.5% of people reported experiencing swallowing difficulties, and 10.6% of all respondents reported modifying medication dosage forms. Almost half (44.2%) of those surveyed did not think there would be issues with modifying medication dosage forms. Some consumers would not seek advice from health professionals if they experienced swallowing problems and/or would not seek advice from health professionals before modifying their medication dosage forms, regardless of their thoughts about any problems associated with this practice. CONCLUSION: Some consumers appeared to be accustomed to modifying medication dosage forms, even when there was no apparent or obvious need. People were also reluctant to seek advice from health professionals regarding swallowing difficulties, or modifying medication dosage forms. Health professionals must be assertive in educating consumers about swallowing problems, and medication dosage form modification

Prescription-checking skills: There’s an app for that!

Background: Practice makes perfect, and prescription-checking skills is one of these. The mechanics of dispensing a prescription involves developing speed and accuracy in checking the prescription against the dispensing label, against the selected product, and ensuring all three match up. So, how do we fit in hours of practise in an already jam-packed curriculum? Can students be motivated to work through the phases of skill mastery, and begin their journey of life-long learning using the conventions of gaming? Objectives: Investigate if a mobile prescription-checking app engages and motivates students to practice prescription-checking skills, and improve their confidence. Methodology: Data was collected from students and pharmacy educators through surveys and focus groups. They were asked about their perceived usefulness of the app in developing their prescription-checking skills and confidence. Results: The app was well received by both students and educators. The majority of the students indicated they would use the app again and that their confidence in checking scripts had improved. The platform was also more accessible than their standard unit learning management system. Pharmacy educators also saw value in the app particularly since it enabled more time in class to practise other pharmacist skills e.g. communication, as opposed to the mechanics of prescription checking. Discussion: Gamification and mobile apps are useful for self-directed practice of skills. Using such strategies to engage students in a novel, flexible and authentic way helps motivate students to work through phases of skill mastery, and take ownership of their own learning

Strategic planning in public healthcare organisations: Is sustainability a consideration?

Background: In 2008, the World Health Organisation (WHO) urged health sectors to lead by example in undertaking sustainability initiatives to protect people from the effects of climate change.1 Organisational focus and commitment to sustainability encourages employees’ uptake of environmentally responsible behaviours.2 Purpose: To explore organisational commitment to sustainability in two public healthcare organisations – NHS (UK) and Queensland Health (Australia). Methods: The strategic plans for Queensland Health (released 2016) and NHS (released 2017) were uploaded into Leximancer® text analytic software and a Quadrant Overview map produced. Prominent concepts were compared. Results: The Quadrant Overview did not reveal any concepts in either strategic plan document relating to climate change mitigation, the environment, or sustainable development initiatives. Conclusions: Until sustainability is embedded in public health organisations’ DNA and articulated in strategic plans, sustainability initiatives at hospital level will be slow to occur. Both top-down and bottom-up support for sustainability is required for action. References 1. World Health Organisation. Protecting Health from Climate Change - World Health Day 2008 [cited 2011 27 July]; Available from: http://www.who.int/world-health-day/toolkit/report_web.pdf 2. Gladwin TN, Kennelly JJ, Krause T-S. Shifting Paradigms for Sustainable Development: Implications for Management Theory and Research. The Academy of Management Review 1995.20(4):874-907

The impact of drugs on the environment: what do pharmacists and technicians believe?

Background: Climate change is a global public health issue and public health organisations have been urged to deliver healthcare more sustainably to reduce their own impacts on public health.1 Purpose: To compare environmental attitudes, knowledge, and concern of hospital pharmacists and pharmacy technicians between a country with legislated carbon reduction strategies (UK), and one without (Australia). Methods: This study employed mixed methods. Participants were pharmacists and pharmacy technicians working in five Queensland hospitals (public and private hospitals in metropolitan and regional centres) (n = 66) and six NHS England hospitals from four regional cities (n = 40). They completed a New Environmental Paradigm (NEP) scale questionnaire to determine their environmental attitude, and answered questions in a semi-structured format. Results: There was no statistically significant difference in environmental attitudes, environmental knowledge, or environmental concern between the two cohorts regarding the impact of pharmaceuticals on the environment. More Australian participants reported environmental concern. Both cohorts lacked understanding of FIP’s ‘One Health’2, p.1 approach. None of the UK pharmacy staff were aware of the Sustainable Development Unit or its purpose. Conclusions: This study suggests failure of sustainability policy dissemination in the NHS to pharmacy staff, and failure of FIP’s Green Pharmacy Practice to be taken up by national pharmacy bodies and disseminated to pharmacist members in the UK and Australia. Further exploration of ways to improve policy dissemination in large public healthcare organisations is warranted. References 1. Watts N, Adger WN, Agnolucci P, Blackstock J, Byass P, Cai W, et al. Health and climate change: policy responses to protect public health. The Lancet 2015.386 (10006):1861 - 914. 2. International Pharmaceutical Federation (FIP). Green pharmacy practice: taking responsibility for the environmental impact of medicines. The Hague, Netherlands: International Pharmaceutical Federation (FIP); 2015

There’s an app for that – CheckMate: Practise your prescription checking skills on your mobile!

Background Information: Skill mastery takes time and practise, so how can we encourage students to hone their prescription checking skills outside of class time? ‘CheckMate’ may be the answer. A mobile application integrating gamification was designed for students to practise checking prescriptions against a dispended product and label. Purpose: To encourage students to practise prescription-checking skills and improve their confidence in their skills in their own time. Method: Pharmacy students were asked to practise their checking skills on an online (mobile) platform. Students checked prescriptions against dispensed products and labels, and then answered a survey evaluating the app as a learning tool compared to static online or paper-based exercises. Pharmacy educators were also asked to trial the app, and to provide feedback on its potential integration into the teaching of mechanical dispensing and prescription checking skills. Results: Overall students and educators thought the app was beneficial for learning. Students suggested a score-board to display the top ‘checkers’ of the week to promote friendly competition. Many students preferred using the app to static online or paper-based activities. Pharmacy educators had positive feedback about integration of the mobile application into teaching and provided useful ideas for improvements. Conclusion: Integration of gamification in mobile applications may be a clever and time-efficient way to improve student skills and enable extra-curricular practise in a light-hearted, safe and fun way. Topic Area: academic pharmac

Waiter, there is a drug in my soup – using Leximancer® to explore antecedents to pro-environmental behaviours in the hospital pharmacy workplace

<b>Objective/s</b>\ud \ud The aim of this study was to explore Queensland hospital pharmacists’ and pharmacy technicians’ knowledge and understanding of the impact of pharmaceuticals on the environment, and the handling of pharmaceutical waste.\ud \ud <b>Methods</b>\ud \ud This study followed a mixed methods research design. Purposive sampling techniques were used to recruit 64 hospital pharmacists and pharmacy technicians working in five public and private hospitals, in metropolitan and regional Queensland, Australia. Both quantitative and qualitative data were collected. Qualitative data were analysed using both text analytics software and manual coding techniques. Descriptive statistics were used to present the quantitative data.\ud \ud <b>Key Findings</b>\ud \ud Lack of environmental knowledge regarding the impact of pharmaceuticals on the environment, and lack of understanding of systems thinking concepts (that all living things are part of the one environment or system, and therefore any negative impacts on the environment will ultimately have negative impacts on human health) were the key findings of this research. Interviewees expressed concern, but most expressed minimal personal concern, about the impact of pharmaceuticals entering the environment. Most interviewees were unsure as to best practice methods for the disposal of pharmaceutical waste, and by complying with hospital policy assumed appropriate disposal occurred. \ud \ud <b>Conclusion</b>\ud \ud Before the pharmacy profession can take up a leadership role in the more sustainable use of pharmaceuticals, pharmacists and pharmacy technicians require environmental information regarding the negative impacts of pharmaceuticals on the environment, and education on systems thinking to enable them to understand that any negative impacts on the environment will ultimately have negative impacts on human health

Australia’s first Pharmacists Immunisation Pilot – about the service

Background: The first phase of the Queensland Pharmacist Immunisation Pilot (QPIP) ran between April and August 2014, to pilot pharmacists administering influenza vaccinations for the flu season for the first time in Australia. Aim: An aim was to investigate factors facilitating implementation of a pharmacist vaccination service in the community pharmacy setting. Method: The QPIP pharmacies were divided into two arms; the South East Queensland arm consisting of 51 Terry White Chemists (TWCs), and 29 pharmacies in the North Queensland (NQ) arm. The TWCs featured pharmacies which previously provided a vaccination service and that were experienced with using an online booking system, providing an opportunity to capture booking data. Results: The TWCs delivered 9902 (90%) of the influenza vaccinations in QPIP. Of these, 48.5% of the vaccines were delivered via appointments made using the online booking system, while 13.3% were in-store bookings. Over one-third (38.2%) of the vaccinations delivered in were “walk-ins” where the vaccination was delivered ‘on the spot’ as spontaneous or opportunistic vaccinations. The absence of a booking system meant all vaccinations delivered in the NQ arm were “walk-ins”. The online-booking data showed 10:00 am and Tuesday being the most popular time and day for vaccinations. Patients preferred having their vaccinations in private consultation rooms, over areas which used a screen to partition off a private area. Discussion: The presence of an online booking system appeared to increase the efficiency and penetration of the of vaccine service delivery. Also, as the level of privacy afforded to patients increased, the number of patients vaccinated also increased. Conclusions: As pharmacist-delivered vaccination services start to progressively roll out across Australia; these findings pave the way for more efficient and effective implementation of the service

The health professional behind the syringe: Benefits of a pharmacist vaccination program

Background: The Queensland Pharmacist Immunisation Pilot (QPIP) which ran in 2014 was Australia’s first to allow pharmacists to administer vaccinations. An aim of QPIP was to investigate the benefits of trained pharmacists administering vaccinations in a community pharmacy setting. Methods: Participant demographics and previous influenza vaccination experiences were recorded using GuildCare software. Participants also completed a ‘post-vaccination satisfaction survey’ following their influenza vaccination. Results: A total of 10,889 participant records and 8,737 satisfaction surveys were analysed. Overall, 1.9% of the participants reported living with a chronic illness, and 22.5% were taking concomitant medications. As part of the consultation before receiving the vaccine, participants acknowledged the opportunity to discuss other aspects of their health with the pharmacist, including concerns about their general health, allergies, and other medications they were taking. It was worth noting that 17.5% of people would not have received an influenza vaccination if the QPIP service was unavailable. Additionally, approximately 10% of all participants were eligible to receive a free vaccination from the National Immunisation Program, but still opted to receive their vaccine from a pharmacist. Conclusion: The findings from this pilot demonstrate the benefit of a pharmacist vaccination program in increasing vaccination rates, and have helped pave the way for expanding the scope of practice for pharmacists

Amber teething necklaces: Is there any basis to their use in teething infants?

Introduction. Baltic amber-bead necklaces or bracelets are commonly used for managing teething symptoms in infants. The effectiveness of these beads is claimed to be from succinic acid release (a compound said to have analgesic and anti-inflammatory properties), which is then absorbed through the skin. Aims. To investigate whether succinic acid is contained in Baltic amber teething necklaces purchased in Australia, whether it can be released from the beads, and whether it has anti-inflammatory activity. Methods. Infrared spectroscopy was used to confirm that the teething necklaces were made of Baltic amber. The amount of succinic acid contained within the beads was quantified, and succinic acid release from intact beads was measured in phosphate buffered saline (PBS) pH 5.5 or octanol. Anti-inflammatory activity of succinic acid was compared with ibuprofen, paracetamol and hydrocortisone in vitro using THP-1 human macrophages stimulated with LPS. Secretion of the cytokines IL-1a, IL-1b, IL-8 and TNF-α were determined by ELISA. Results. Each necklace (33 beads in length) contained 19.17 ± 4.89 mg of succinic acid (mean ± se). Over a 6-month period, no succinic acid was detected in PBS. While 0.13 ± 0.09 mg of succinic acid per necklace was released in octanol, this was due to only one replicate of amber beads which had fragmented into shards free-floating in the solvent. Succinic acid had no effect on cytokine secretion unless extremely high concentrations were used and changes were likely to be associated with cell apoptosis and death. Discussion. No evidence for anti-inflammatory activity was found in the cytokines studied. It is possible that succinic acid could exert an effect via some other mechanism, but while the teething necklaces do contain small quantities of succinic acid, it is highly unlikely to be released from intact beads

Amber teething necklaces – medical marvel or maternal myth?

BACKGROUND: Baltic amber-bead necklaces or bracelets are commonly used for managing teething symptoms in infants. The effectiveness of these beads is claimed to be from succinic acid release (a compound with analgesic and anti-inflammatory properties), which is then absorbed through the skin. AIM: To investigate whether Baltic amber teething necklaces purchased in Australia contained succinic acid, and to quantify succinic acid release from the beads. METHODS: Infrared spectroscopy was used to confirm that the teething necklaces were made of Baltic amber. The amount of succinic acid contained within the beads was quantified, and succinic acid release from intact beads was measured in phosphate buffered saline (PBS) pH 5.5 or octanol to simulate aqueous or oily skin environments. RESULTS: Each necklace (33 beads in length) contained 19.17±4.89 mg of succinic acid (mean±se). Over a 6-month period, no succinic acid was detected in PBS, while 0.13±0.09 mg of succinic acid per necklace was released in octanol. Only one replicate of amber beads in octanol released succinic acid, and they had fragmented, with shards free-floating in the solvent. DISCUSSION: It is likely succinic acid was only detected because the beads were breaking down in octanol, which does not occur when worn around the neck of a child. Furthermore, the hydrophilic properties of succinic acid would not favour its absorption across hydrophobic layers of the skin and into the bloodstream. CONCLUSION: While the teething necklaces do contain small quantities of succinic acid, it is highly unlikely to be released from intact beads