Community Pharmacy: an untapped patient data resource

As community pharmacy services become more patient centred they will be increasingly reliant on access to good quality patient information. This paper describes how the information which is currently available in community pharmacies can be used to enhance service delivery and patient care. With integration of community pharmacy and medical practice records on the horizon the opportunities this will provide are also considered. The community pharmacy held patient medication record, which is the central information repository, has been used to identify non-adherence, to prompt the pharmacist to clinically review prescriptions, identify patients for additional services and to identify those patients at greater risk of adverse drug events. Whilst active recording of patient consultations for treatment over the counter may improve the quality of consultations and information held, the lost benefits of anonymity afforded by community pharmacies needs to be considered. Recording of pharmacy staff activities enables workload to be monitored, remuneration to be justified and critical incidents to be learned from but is not routine practice. Centralisation of records between community pharmacies enables practices to be compared and consistent problems to be identified. By integrating pharmacy and medical practice records, patient behaviour with respect to medicines can be more closely monitored and should prevent duplication of effort. When using patient information stored in a community pharmacy it is however important to consider the reason why information was recorded in the first instance and whether it is appropriate to use it for a different purpose without additional patient consent. Community pharmacies currently have access to large amounts of information which if stored and used appropriately can significantly enhance the quality of provided services and patient care. Integrating records increases opportunities to enhance patient care yet further. Whilst community pharmacies have significant amounts of information available to them this is frequently untapped

Women's beliefs about medication use during their pregnancy: a UK perspective

Background: Previous research has examined the number and extent of medicines taking in pregnant women but not their beliefs and risk perception surrounding their use. Objective: To describe beliefs and risk perception associated with medicines use for the treatment of common acute conditions among UK women and explore whether this is related to actual medicines use. Settings: Cross-sectional, web-based study in the UK Methods: Pregnant women and mothers within one year of giving birth were invited to participate in an online cross-sectional questionnaire-based study via a pregnancy website in the UK. Anonymous data were collected from women regarding their use of medicines (both over-the-counter and prescribed) and their beliefs regarding medicines use during pregnancy. Main outcome measures: Pregnant women’s beliefs about medicines and their relation to pharmacological treatment of acute conditions in pregnancy. Results: Pharmacological treatment of conditions in pregnancy ranged from 65.4% for urinary tract infections (UTIs) to 1.1% for sleeping problems. Almost three out of ten women avoided using some medications during pregnancy. For heartburn and UTIs, women who did not treat the condition viewed medicines in general as being overused, more harmful and less beneficial, than those who treated the condition. In general, UK pregnant women perceived medicines to be beneficial and slightly overused. Conclusions: Women’s beliefs about medications impact on treatment of specific conditions in pregnancy such as heartburn and UTIs. Healthcare professionals should explore patient’s beliefs regarding medication at the first maternity care visit to promote appropriate medication use in pregnancy

Is there a role for the community pharmacist in the management of long-term conditions?

Abstract The Government agenda is to move pharmacists away from dispensing medicines from a prescription to the provision of clinical services aimed at managing patients with long-term conditions. This thesis uses the approach defined by the MRC framework for developing complex interventions to ascertain whether there is a pharmacist role in this area. An initial study was conducted to determine the feasibility of a community pharmacist eczema management support service (PLEEZ). It demonstrated encouraging results, however failed to recruit the required number of participants. A pharmacist focus group indicated that the study had failed because of an insufficient population, overly complex study design and insufficient intervention preparation and training. Type 2 diabetes was subsequently chosen for the intervention as these patients have an anticipated greater pharmaceutical need and there is a larger available patient population. In line with the MRC framework, appropriate developmental work was then undertaken in the form of a literature review, an audit and a series of focus groups to determine the composition of a novel intervention focused on this condition. These results came together to form the diabetes community pharmacy drop-in clinic comprising the following elements: Targeting poorly controlled patients A system of referral from the medical practice A suitable training programme No appointment system Additional pharmacist to support A focus on adherence and dose optimisation as well as diet and lifestyle advice The clinics, in five pharmacies, recruited 33 participants providing positive results from the outcomes measured, excellent patient feedback and pharmacist comments that can be used to inform future studies. The thesis demonstrates that there is a potential role for the community pharmacist in the care of patients with type 2 diabetes, however further, large scale research is needed to confirm whether this is the case

One lithium level >1.0 mmol/L causes an acute decline in eGFR: findings from a retrospective analysis of a monitoring database

Objectives Lithium is a mainstay of bipolar disorder treatment, however, there are still differences in opinion on the effects of lithium use on renal function. The aim of this analysis was to determine if there is an association between short-term exposure to various elevated lithium levels and estimated-glomerular filtration rate (eGFR) at ≤3 months, 6 months (±3 months) and 1 year (±3 months) follow-up. Setting Norfolk-wide (UK) lithium register and database. Participants 699 patients from the Norfolk database. Primary outcome measures eGFR change from baseline at ≤3 months, 6 months (±3 months) and 1 year (±3 months) after exposure to a lithium level within these ranges: 0.81–1.0 mmol/L (group 2), 1.01–1.2 mmol/L (group 3) and 1.21–2.0 mmol/L (group 4). The reference group was patients whose lithium levels never exceeded 0.8 mmol/L. Results Compared to the reference group, groups 3 and 4 showed a significant decrease in eGFR in the first 3 months after exposure (p=0.047 and p=0.040). At 6 months (±3 months) postexposure group 4 still showed a decline in eGFR, however, this result was not significant (p=0.298). Conclusions These results show for the first time that a single incident of a lithium level >1.0 mmol/L is associated with a significant decrease in eGFR in the following 3 months when compared to patients whose lithium levels never exceeded 0.8 mmol/L. It is still not known whether the kidneys can recover this lost function and the impact that more than a single exposure to a level within these ranges can have on renal function. These results suggest that lithium level monitoring should be undertaken at least every 3 months, in line with current UK guidelines and not be reduced further until the impact of more than one exposure to these lithium levels has been fully established

A systematic review exploring characteristics of lifestyle modification interventions in newly diagnosed type 2 diabetes for delivery in community pharmacy

Objectives: The aim of this systematic review was to examine the characteristics of effective lifestyle modification interventions designed for patients with newly diagnosed type 2 diabetes mellitus (T2DM) in order to determine elements that have the potential to be delivered in the community pharmacy setting. Key findings: Seven studies, comprising three each of the interventions diet and structured education and one of supported exercise, were identified. Interventions were conducted in hospital diabetes clinics and clinics situated in both urban and rural areas. Interventions were delivered face to face by highly skilled personnel including physicians, nurses and dietitians. Duration of interventions ranged from 3 months to 5 years. Summary: Structured education and dietary interventions in newly diagnosed type 2 diabetes effectively controlled blood glucose levels without pharmacological intervention. Important characteristics included face to face, individualised and multicomponent interventions with a duration of at least 6 months. These characteristics demonstrate potential for delivery in a community pharmacy setting, given its current involvement in delivering face to face, individual services with diet and lifestyle components. Further research is required to provide evidence for ideal intervention duration and frequency as well as training requirements for pharmacists

An evaluation of a multi-site community pharmacy based chronic obstructive pulmonary disease support service

Background Chronic obstructive pulmonary disease (COPD) is a progressive chronic condition which can be effectively managed by smoking cessation, optimising prescribed therapy and providing treatment to prevent chest infections from causing hospitalisation. The government agenda in the UK is for community pharmacists to become involved in chronic disease management and COPD is one area where they are ideally located to provide a comprehensive service. Objective To evaluate the effect of a community pharmacy based COPD service on patient outcomes. Method Patients in one UK location were recruited over a 3 month period to receive a community pharmacy based COPD support service consisting of signposting to or provision of smoking cessation service, therapy optimisation, and recommendation to obtain a rescue pack containing steroid and antibiotic to prevent hospitalisation as a result of chest infection. Data was collected over a six month period for all recruited patients. Appropriate clinical outcomes, patient reported medication adherence, quality of life and NHS resource utilisation were measured. Key findings 306 patients accessed the service and full data to enable comparison before and after was available for 137. Significant improvements in patient reported adherence, utilisation of rescue packs, quality of life and a reduction in routine GP visits were identified. The intervention cost was estimated to be off-set by reductions in the use of other NHS services (GP and A&E visits and hospital admissions). Conclusion Results suggest that the service improved patient medicine taking behaviours and that it was cost-effective

Community pharmacy type 2 diabetes risk assessment: demographics and risk results

Objectives: To determine the demographics and risk results of patients accessing a community pharmacy diabetes risk assessment service. Method: Participating patients underwent an assessment using a validated questionnaire to determine their 10-year risk of developing type 2 diabetes. Patients were given appropriate lifestyle advice or referred to their general practitioner if necessary. Key findings: In total, 21 302 risk assessments were performed. Nearly one-third (29%) of 3427 risk assessments analysed yielded a result of moderate or high chance of developing the condition. Conclusions: Community pharmacies can identify a significant number of patients at risk of developing type 2 diabetes in the next 10 years. Further follow-up work needs to be done to determine the cost-effectiveness of such a service and the consequences of receiving a risk assessment

Adult Literacy in Indiana

Mary McLeod Bethune, an African-American educator and adviser to U.S. president Franklin D. Roosevelt, has been quoted as having said, "The whole world opened to me when I learned to read." Unfortunately for many in Indiana, the "whole world" may be closed to them because of illiteracy. According to the Indiana Adult Literacy Coalition in 1989, 12% to 19% of Hoosiers over age 25 could not read or write at a functional level. As early as 1930, illiteracy was recognized as an issue within the state. An article in the Indinapolis Star dated September 25, 1930, headlined that over 50,000 Hoosiers were illiterate ("52,034 in state," 1939). It is natural to assume that at some point Indiana developed a robust statewide initiative to address the problem of illiteracy amongst its citizens. One might imagine a program that over time slowly but surely reduced the number of Indiana citizens who struggled under the mantle of illiteracy; however, myriad reasons and circumstances have conspired to prevent that from happening. Instead of a forceful statewide program, numerous segmented efforts by local or regional entities with modest support from various federal, state, or non-profit organizations are more apt to be found

Medication taking in people with hip and knee osteoarthritis: An analysis of the English Longitudinal Study of Ageing

Objectives: Osteoarthritis (OA) is a highly prevalent condition seen across primary care services. Although evidence‐based guidelines have encouraged the prescription of medications, including analgesics, for this population, there remains uncertainty as to which types of individuals actually take prescribed or over‐the‐counter medications. The purpose of the present study was to determine whether there is a difference in characteristics between people who take medicines for OA compared with those who do not. Methods: A cross‐sectional analysis of the English Longitudinal Study of Ageing (ELSA) cohort was undertaken. Individuals who reported hip and/or knee OA pain were included. Data on medication taking were self‐reported and collected as part of the ELSA data collection programme. Logistic regression analyses were undertaken to determine the relationship between potential predictors (demographic, pathology‐specific, psychological, social and functional) and whether individuals took medications for their OA symptoms. Results: A total of 654 participants reported OA: 543 medicine takers and 111 nontakers. Individuals who had access to a car (odds ratio [OR]: 56.2; 95% confidence interval [CI]: 3.35 to 941.36), those with a greater duration of hip pain (OR: 5.79; 95% CI: 1.40 to 24.0) and those who achieved 10 chair raises at greater speed (OR: 1.08; 95% CI: 1.03 to 1.14) were more likely to take OA medicines. Conclusions: The study identified predictors for medication taking in individuals with hip and/or knee OA. Strategies are now warranted to provide better support to these individuals, to improve health and well‐being for this long‐term, disabling condition

Exploring what patients think when answering the Interpersonal Skills Questionnaire (ISQ): A ‘think aloud’ study

Background: The Interpersonal Skills Questionnaire (ISQ) was developed to collect patient feedback on consultation skills of practitioners. However, it has not yet been evaluated with pharmacists. Objective: To explore the thinking process of patients as they completed the ISQ following a consultation with a pharmacist. Methods: A qualitative think aloud (TA) methodology was used to explore patients' thinking while completing the ISQ following a consultation with a pharmacist. The study was conducted in secondary care with outpatients ≥18 years old. Interviews were carried out in rounds and were informally analysed (i.e., by writing notes while listening to recordings) to identify any associated major problem(s). Discussions were held between researchers to determine whether changes were needed based on patients' comments. Results: Eight patients in total (50% females) participated in this study (mean age: 48 years). Three rounds of TA were conducted. Most items of the ISQ were interpreted similarly by all participants with no major problems necessitating refining the ISQ. Conclusions: Modification of the ISQ was unnecessary as interviews demonstrated no major problems with its use. The ISQ is thus a potentially suitable tool to collect patient feedback on pharmacists' consultations