Emergency supply of prescription-only medicines to patients by community pharmacists: a mixed methods evaluation incorporating patient, pharmacist and GP perspectives

Objective To evaluate and inform emergency supply of prescription-only medicines by community pharmacists (CPs), including how the service could form an integral component of established healthcare provision to maximise adherence. Design Mixed methods. 4 phases: prospective audit of emergency supply requests for prescribed medicines (October–November 2012 and April 2013); interviews with CPs (February–April 2013); follow-up interviews with patients (April–May 2013); interactive feedback sessions with general practice teams (October–November 2013). Setting 22 community pharmacies and 6 general practices in Northwest England. Participants 27 CPs with experience of dealing with requests for emergency supplies; 25 patients who received an emergency supply of a prescribed medicine; 58 staff at 6 general practices. Results Clinical audit in 22 pharmacies over two 4-week periods reported that 526 medicines were requested by 450 patients. Requests peaked over a bank holiday and around weekends. A significant number of supplies were made during practice opening hours. Most requests were for older patients and for medicines used in long-term conditions. Difficulty in renewing repeat medication (forgetting to order, or prescription delays) was the major reason for requests. The majority of medicines were ‘loaned’ in advance of a National Health Service (NHS) prescription. Interviews with CPs and patients indicated that continuous supply had a positive impact on medicines adherence, removing the need to access urgent care. General practice staff were surprised and concerned by the extent of emergency supply episodes. Conclusions CPs regularly provide emergency supplies to patients who run out of their repeat medication, including during practice opening hours. This may aid adherence. There is currently no feedback loop, however, to general practice. Patient care and interprofessional communication may be better served by the introduction of a formally structured and funded NHS emergency supply service from community pharmacies, with ongoing optimisation of repeat prescribing

Cross?sectional survey of patients’ need for information and support with medicines after discharge from hospital

Background: Most patients experience changes to prescribed medicines during a hospital stay. Ensuring they understand such changes is important for preventing adverse events post-discharge and optimising patient understanding. However, little work has explored the information that patients receive about medicines or their perceived needs for information and support after discharge. Aim: To determine information that hospital in-patients who experience medicines changes receive about their medicines during admission and their needs and preferences for, and use of, post-discharge support. Methods: Cross-sectional survey with adult medical in-patients experiencing medicines changes in six English hospitals, with telephone follow-up 2-3 weeks post-discharge. Results: A total of 444 in-patients completed surveys and 99 of these were followed-up post-discharge. Of the 444, 44 (10%) were unaware of changes to medicines and 65 (16%) did not recall discussing them with a health professional, but 305 (77%) reported understanding the changes. Type of information provided and patients’ perceived need for post-discharge support differed between hospitals. Information about changes was most frequently provided by consultant medical staff (157; 39%) with pharmacists providing information least often (71; 17%). One-third of patients surveyed considered community pharmacists as potential sources of information about medicines and associated support post-discharge. Post-discharge, just 5% had spoken to a pharmacist, although 35% reported medicines-related problems. Conclusion: In North-West England, patient inclusion in treatment decisions could be improved, but provision of information prior to discharge is reasonable. There is scope to develop hospital and community pharmacists’ role in medicines optimisation to maximise safety and effectiveness of care

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

Multi-taxa spatial conservation planning reveals similar priorities between taxa and improved protected area representation with climate change

Protected area (PA) networks have in the past been constructed to include all major habitats, but have often been developed through consideration of only a few indicator taxa or across restricted areas, and rarely account for global climate change. Systematic conservation planning (SCP) aims to improve the efficiency of biodiversity conservation, particularly when addressing internationally agreed protection targets. We apply SCP in Great Britain (GB) using the widest taxonomic coverage to date (4,447 species), compare spatial prioritisation results across 18 taxa and use projected future (2080) distributions to assess the potential impact of climate change on PA network effectiveness. Priority conservation areas were similar among multiple taxa, despite considerable differences in spatial species richness patterns; thus systematic prioritisations based on indicator taxa for which data are widely available are still useful for conservation planning. We found that increasing the number of protected hectads by 2% (to reach the 2020 17% Aichi target) could have a disproportionate positive effect on species protected, with an increase of up to 17% for some taxa. The PA network in GB currently under-represents priority species but, if the potential future distributions under climate change are realised, the proportion of species distributions protected by the current PA network may increase, because many PAs are in northern and higher altitude areas. Optimal locations for new PAs are particularly concentrated in southern and upland areas of GB. This application of SCP shows how a small addition to an existing PA network could have disproportionate benefits for species conservation

Views of the general public on the role of pharmacy in public health

Objectives: To determine the views of healthy adults on the importance of activities aimed at improving public health, on the role of community pharmacies in contributing to these and on a range of potential pharmacy-based public health services. Method: Three hundred healthy adults completed a questionnaire developed from the literature, using a street survey technique in an English city centre. Key findings: More than half of the respondents (57%) were infrequent pharmacy users, but 65% (195) had asked for advice about health and/or medicines from community pharmacy staff and 41.3% (124) had received unsolicited advice on health. Only 23% considered that pharmacies were the best place from which to seek general health advice, irrespective of frequency of pharmacy use. There was a general lack of awareness of pharmacy capacity and role in public health. With the exception of smoking-cessation support, the role of pharmacy in providing activities related to improving public health did not relate to respondents views on the importance of the activity. However, most supported the provision of specific services by pharmacies, especially among frequent pharmacy users. A significant proportion of respondents said they would not use pharmacy as a source of public health advice, due to issues around confidentiality, privacy, space and busyness. Conclusions: There is little awareness of pharmacy's involvement in providing services designed to improve public health among the general public and a need exists to market these effectively. More research is required to further explore the public's views on how to facilitate pharmacy's contribution to public health

Demographic composition, not demographic diversity, predicts biomass and turnover across temperate and tropical forests

The growth and survival of individual trees determine the physical structure of a forest with important consequences for forest function. However, given the diversity of tree species and forest biomes, quantifying the multitude of demographic strategies within and across forests and the way that they translate into forest structure and function remains a significant challenge. Here, we quantify the demographic rates of 1961 tree species from temperate and tropical forests and evaluate how demographic diversity (DD) and demographic composition (DC) differ across forests, and how these differences in demography relate to species richness, aboveground biomass (AGB), and carbon residence time. We find wide variation in DD and DC across forest plots, patterns that are not explained by species richness or climate variables alone. There is no evidence that DD has an effect on either AGB or carbon residence time. Rather, the DC of forests, specifically the relative abundance of large statured species, predicted both biomass and carbon residence time. Our results demonstrate the distinct DCs of globally distributed forests, reflecting biogeography, recent history, and current plot conditions. Linking the DC of forests to resilience or vulnerability to climate change, will improve the precision and accuracy of predictions of future forest composition, structure, and function