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

The extent that health professionals suspect and address addiction to medicines in primary care: Findings from a survey in Northwest England.

Addiction to medicines available over the counter or via prescription is of growing international concern. The authors of the current article ran an online survey of health professionals in general medical practice and community pharmacy settings in Northwest England to explore the frequency of suspecting and responding to addiction to medicines. Health professionals reported frequently identifying addiction to medicines among patients including those with long-term pain, mental health problems, sleep disorders, and other substance use disorders, but that these addictions often go unchallenged. This adds to the evidence indicating the under-diagnosis of addiction to medicines in the United Kingdom. Strategies to improve diagnosis and treatment should recognize the diversity of individuals with addiction to medicines

Needle exchange services in Knowsley: An investigation into the needs and experiences of staff and service users

This work was commissioned by Knowsley Council to inform the development of needle exchange (NEX) services in Knowsley and to ensure that they meet the needs of people who inject drugs (PWID) locally. The views and experiences of both service users and staff from drug services and pharmacies offering needle exchange services in Knowsley were sought regarding the extent to which NEX are meeting the needs of PWID including their perceptions regarding the support available, NEX accessibility and service delivery. Findings are considered in the context of NICE guidelines on the optimal provision of needle and syringe programmes in England

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

Inpatient prescribing systems used in NHS Acute 65 66 Trusts across England: a managerial perspective

Objective The individualised patient prescription chart, either paper or electronic, is an integral part of communication between healthcare professionals. The aim of this study is to ascertain the extent to which different prescribing systems are used for inpatient care in acute hospitals in England and explore chief pharmacists’ opinions and experiences with respect to electronic prescribing and medicines administration (EPMA) systems. Method Audio-recorded semistructured telephone interviews with chief pharmacists or their nominated representatives of general acute hospital trusts across England. Results Forty-five per cent (65/146) of the chief pharmacists agreed to participate. Eighteen per cent (12/65) of the participants interviewed stated that their trust had EPMA systems fully or partially implemented on inpatient wards. The most common EPMA system in place was JAC (n=5) followed by MEDITECH (n=3), iSOFT (n=2), PICS (n=1) and one in-house created system. Of the 12 trusts that had EPMA in place, 4 used EPMA on all of their inpatient wards and the remaining 8 had a mixture of paper and EPMA systems in use. Fifty six (86% 56/65) of all participants had consulted the standards for the design of inpatient prescription charts. From the 12 EPMA interviews qualitatively analysed, the regulation required to provide quality patient care is perceived by some to be enforceable with an EPMA system, but that this may affect accuracy and clinical workflow, leading to undocumented, unofficial workarounds that may be harmful. Conclusions The majority of inpatient prescribing in hospital continues to use paper-based systems; there was significant diversity in prescribing systems in use. EPMA systems have been implemented but many trusts have retained supplementary paper drug charts, for a variety of medications. Mandatory fields may be appropriate for core prescribing information, but the expansion of their use needs careful consideration

Predicting the potential value of the new discharge medicines service in England

Objectives In 2021, community pharmacies in England were commissioned to support patients post-discharge through the discharge medicines service (DMS). Past studies described the benefit of DMS in avoiding readmissions. This study aimed to estimate the impact of DMS in this respect, projecting the maximal benefit if all areas mirrored the most active region. Methods A retrospective observational study, including modelling, using DMS claims data from March 2021 to February 2022, obtained from the NHS Business Services Authority (data from all community pharmacies in England for patients discharged where hospital clinicians referred them to community pharmacy). The impact of DMS on reducing readmission during this period was estimated using previous study data and estimated maximal benefit from full implementation of the service across England. Key findings In the study period 65 634 completed DMS claims were made. Claims at Integrated Care System (ICS) area level varied from 509/10 000 admissions to 29 000 readmissions at 90 days each year. Conclusions DMS has significant potential to reduce readmissions. DMS implementation is currently variable and full implementation across all-ICS areas could increase the benefits five-fold

The use of community pharmacies in Northwest England: an observational study

Background: There are few studies of community pharmacy footfall and activity in the existing literature, especially by direct observation. Pharmacies in England have the ability to provide a range of services and products since the change to their contractual framework in 2005. Objective: To describe the frequency and characteristics of interactions at the counter between pharmacy staff and customers to inform future policy development around pharmacy services. Method: A market researcher used a checklist to directly observe all interactions between pharmacy staff and customers taking place at the counter at specified days and times across the weekly opening hours of five pharmacies across the Northwest of England. Pharmacies were diverse in terms of ownership and location, across an area of significant deprivation. Key findings: Around three-quarters (76%) of all counter interactions observed were associated with prescriptions. Among adults aged <45 years, female: male customer visits were 2:1, changing to almost 1:1 for those aged 45 plus. Pain relief medication (74/307; 24%) and cold and flu remedies (53/307; 17%) were the most commonly purchased types of over-the-counter (OTC) medicines. Approximately two-thirds (62.6%; n=2,078) of the interactions observed at the counter were between a customer and a Medicines Counter Assistant (MCA). Conclusions: Dispensing was the primary activity across the diverse range of pharmacies, but access to other pharmacy services and self-care activities were significant - especially at the weekend. Skill mix observation suggested that different pharmacies were deploying their pharmacists and other staff in different ways across similar patterns of activity

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

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