Evaluation of a Screening Questionnaire to Identify Patients at Risk of Drug Therapy Problems in Community Pharmacies

Context: Suboptimal drug use is a major contributor to adverse patient outcomes in primary care. Considering their accessibility and frequent interactions with patients, community pharmacists may be well suited to identifying patients who are at high risk of drug therapy problems (DTPs) and who may benefit from a comprehensive medication assessment. Objective: To determine if a short screening tool can identify patients at risk for DTPs in a community pharmacy setting. Design: A five question self-administered screening tool was identified in the literature and adapted to reflect current practice in community pharmacy. Adults requesting a refill prescription from three different community pharmacies over 12 weeks completed the screening tool, and had a comprehensive medication assessment with a pharmacist. Information from the assessment was used to: a) determine the ability of patients to correctly answer the screening tool questions and to classify themselves into the appropriate risk category (High or Low Risk); b) compare the number of DTPs identified in each risk category (High vs Low); and c) determine the number of High Risk and Low Risk patients who would qualify for any of the existing provincial medication review programs in Canada. Results: 49 patients completed the study. Most patients were able to answer the questions on the screening tool correctly. The strength of agreement was very good (Kappa 0.91, p<0.01) between the overall patient determined risk category and pharmacist determined risk category. Patients identified as High Risk (n=18) had a mean of 3.72 (p<0.01) more DTPs than Low Risk patients (n=31). All but one (94.4%) of the High Risk patients had at least one Moderate or Severe DTP, while less than half (48.4%) of Low Risk patients had at least one Moderate or Severe DTP. The majority of High Risk patients were eligible for medication reviews in all programs except for Newfoundland and Labrador, New Brunswick and Saskatchewan. Close to a third of Low Risk patients were eligible for medication reviews in Prince Edward Island, Nova Scotia and Ontario. Conclusions: This screening tool is a trustworthy method for identifying patients in community pharmacies who have a large number of DTPs. Patients identified as High Risk using this screening tool may be good targets for community pharmacy based comprehensive medication assessments

Interprofessional student-run primary health clinics: implications for pharmacy education in Scotland.

Introduction Interprofessional student run primary health care clinics have been a flagship model of health professional education in Canada for many years. The purpose of this study was to determine if there is support for implementing this educational model in the United Kingdom and to highlight the implications for pharmacy education in Scotland. Method A cross-sectional postal survey of 3000 randomly selected citizens of Aberdeen city and shire, Scotland, aged 18 years and over. Results Out of the 824 questionnaires that were returned (response rate 27.5%) over half of respondents (62.4%; n=514) would consider accessing healthcare from a student led, walk in service. The range of services they expect to see include general health checks (60%; n=494); help for sexually transmitted diseases (57.5%; n=474); weight management (56.8%; n=468); smoking cessation (54.4%; n=448) and drug misuse services (47.2%; n=387). Concerns raised pertained to student ability; suitability for children and accessibility. Many comments pertained to the improvement of the current system by offering after-hours care. Discussion The positive response from the general public towards an interprofessional student run primary health care clinic in Aberdeen, suggest that this Canadian model of interdisciplinary health professional education would likely be a successful addition to the pharmacy curriculum in Scotland

Revisiting the political life-cycle model:later maturation and turnout decline among young adults

Published online: 26 January 2015Turnout among young adults has declined steadily in various advanced industrial democracies in recent decades. At the same time, as a consequence of delayed transitions to adulthood, many life-cycle events considered important for the development of electoral participation are experienced later in life. These combined trends call for a revaluation of the political life-cycle model and the way in which it explains voter turnout among young adults. More specifically, in this paper it is argued that variation in the timing of life events has been overlooked as an explanatory factor of generational differences in young adults’ propensity to turn out to vote. With accumulating evidence that the decision to vote is to some extent habitual, a lack of life experiences may cause young adults to form the habit to abstain rather than to vote. If the mechanisms of the life-cycle model are indeed correct, later maturation should at least partially explain why young adults these days are less inclined to vote than their parents or grandparents in their younger years. Based on the British Election Studies from 1964 to 2010, the findings of this study confirm generally observed patterns of a delayed assumption of adult roles by young citizens. This trend toward later maturation negatively affects turnout levels of young citizens. If maturation levels had remained at pre-war levels, the average turnout among Britain’s post-seventies generation would have been no less than 12 percentage points higher.Article is based on parts of the author's EUI PhD thesis, 201

Do People Vote on the Basis of Minimax Regret?

Rational choice theory has yet to provide a satisfactory explanation of voter turnout. One such account, minimax regret, is analyzed using data from a survey involving students at two Canadian universities during the 1993 Canadian federal election campaign. While the minimax regret hypothesis is supported at the bivariate level, it fails to pass a multivariate test in which other components of the calculus of voting are included. Minimax regret appears to be little more than a rationalization on the part of those having a strong sense of duty to vote.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68661/2/10.1177_106591299504800408.pd

Agenda control in EU referendum campaigns : the power of the anti-EU side

European Union (EU) referendums provide unique opportunities to study voters’ attitudes toward a distant level of governance. Scholars have long tried to understand whether EU referendum results reflect domestic (dis-)satisfaction with the incumbent governments or actual attitudes toward the Union. Finding evidence supporting both domestic and European factors, the recent focus has thus turned to referendum campaigns. Recent studies emphasise the importance of the information provided to voters during these campaigns in order to analyse how domestic or European issues become salient in the minds of voters. These studies nonetheless overlook the asymmetrical political advantage in such campaigns. The broader literature on referendums and public opinion suggest that in a referendum, the ‘No’ side typically has the advantage since it can boost the public's fears by linking the proposal to unpopular issues. This article explores whether this dynamic applies to EU treaty ratification referendums. Does the anti-EU treaty campaign have more advantage than the pro-EU treaty campaign in these referendums? Campaign strategies in 11 EU treaty ratification referendums are analysed, providing a clear juxtaposition between pro-treaty (‘Yes’) and anti-treaty (‘No’) campaigns. Based on 140 interviews with campaigners in 11 referendums, a series of indicators on political setting and campaign characteristics, as well as an in-depth case study of the 2012 Irish Fiscal Compact referendum, it is found that the anti-treaty side indeed holds the advantage if it engages the debate. Nonetheless, the findings also show that this advantage is not unconditional. The underlying mechanism rests on the multidimensionality of the issue. The extent to which the referendum debate includes a large variety of ‘No’ campaign arguments correlates strongly with the campaigners’ perceived advantage/disadvantage, and the referendum results. When the ‘No’ side's arguments are limited (either through a single-issue treaty or guarantees from the EU), this provides the ‘Yes’ side with a ‘cleaner’ agenda with which to work. Importantly, the detailed data demonstrate that the availability of arguments is important for the ‘Yes’ side as well. They tend to have the most advantage when they can tap into the economic costs of an anti-EU vote. This analysis has implications for other kinds of EU referendums such as Brexit, non-EU referendums such as independence referendums, and the future of European integration

Shared decision making and experiences of patients with long-term conditions : has anything changed?

Background Medication problems among patients with long-term conditions (LTCs) are well documented. Measures to support LTC management include: medicine optimisation services by community pharmacists such as the Medicine Use Review (MUR) service in England, implementation of shared decision making (SDM), and the availability of rapid access clinics in primary care. This study aimed to investigate the experience of patients with LTCs about SDM including medication counselling and their awareness of community pharmacy medication review services. Methods A mixed research method with a purposive sampling strategy to recruit patients was used. The quantitative phase involved two surveys, each requiring a sample size of 319. The first was related to SDM experience and the second to medication counselling at discharge. Patients were recruited from medical wards at St. George’s and Croydon University Hospitals.The qualitative phase involved semi-structured interviews with 18 respiratory patients attending a community rapid access clinic. Interviews were audio-recorded and transcribed verbatim. Thematic analysis using inductive/deductive approaches was employed. Survey results were analysed using descriptive statistics. Results The response rate for surveys 1 and 2 survey was 79% (n = 357/450) and 68.5% (240/350) respectively. Survey 1 showed that although 70% of patients had changes made to their medications, only 40% were consulted about them and two-thirds (62.2%) wanted to be involved in SDM. In survey 2, 37.5% of patients thought that medication counselling could be improved. Most patients (88.8%) were interested in receiving the MUR service; however 83% were not aware of it. The majority (57.9%) were interested in receiving their discharge medications from community pharmacies. The interviews generated three themes; lack of patient-centered care and SDM, minimal medication counselling provided and lack of awareness about the MUR service. Conclusion Although patients wanted to take part in SDM, yet SDM and medication counselling are not optimally provided. Patients were interested in the MUR service; however there was lack of awareness and referral for this service. The results propose community pharmacy as a new care pathway for medication supply and counselling post discharge. This promotes a change of health policy whereby community-based services are used to enhance the performance of acute hospitals