Use of Prescription Medicines Among Older People

The findings of this study, conducted in 2004, laid the foundation for subsequent research about the use of medicines among older people within the Auckland region of New Zealand. This manuscript includes references relevant at the time of study while recent population statistics, government initiatives and developments are summarized in this forward, providing an updated introduction to the findings from the 2004 pilot study. Tools developed and used in this study were further refined and adapted and subsequently used in a medicines management service piloted by HealthWest Primary Health Organisation in Auckland New Zealand study. These studies informed the business case for funding of a new Medicine Management Service (Medicine Use Review and Adherence Support Service) in the Waitemata District in New Zealand

Funding for change: New Zealand pharmacists’ views on, and experiences of, the community pharmacy services agreement

Objective: To explore pharmacist’s views on the shift in ethos, funding and ser- vice delivery model introduced through the New Zealand’s Community Phar- macy Services Agreement (CPSA). Methods: A purposive sampling approach drew pharmacists from a matrix who were then contacted via telephone and invited to be interviewed. Semistruc- tured interviews were conducted face-to-face with community pharmacists (n = 17) across urban and rural New Zealand. An interview schedule exploring 12 subject areas was used to facilitate discussion and determine pharmacist’s views and understanding of the CPSA. The interviews were recorded and tran- scribed verbatim and a general inductive approach was taken to identifying emergent themes. Key findings: Key themes that emerged were: pharmacists supported the philos- ophy behind the CPSA, pharmacists understanding of the CPSA, implementing CPSA-related services, perceived impact on patient outcomes and future sus- tainability of the CPSA. Overall, pharmacists supported the alignment of fund- ing with patient-centred services, but pharmacy owners reported difficulty understanding the funding model, resulting in uncertainty over income. Several pharmacists believed the quality of care offered had not changed, while others found their attitudes towards care had evolved. All pharmacists communicated an increase in their workload and many perceived the sustainability of the CPSA to be linked to its ability to financially sustain community pharmacies. Conclusions: The majority of pharmacists believed in the philosophy of the CPSA, but expressed concerns over funding, workload and benefits for patients. Future research is required to determine generalisability of these findings, investigate patient perspectives and assess the effect of the CPSA on patient outcomes. Introductio

Provision of health /disease screening and medication monitoring /management in New Zealand community pharmacies

Access to health /disease screening (HDS) and medication monitoring /management (MM) services in New Zealand has traditionally been through general practitioners. While government and professional organisations are supportive of greater community pharmacy involvement, there has been little research on the extent of current provision or of the views of community pharmacists in this area. To describe the characteristics and extent of HDS and MM services provided in New Zealand community pharmacies, and to document pharmacists’ opinions and perceived barriers in regard to the provision of these services. A four-part questionnaire was developed to record: the types of HDS /MM services offered by community pharmacies; the opinions of respondent pharmacists regarding these services; the characteristics of community pharmacies offering the services; and the profiles of the respondent pharmacists. The questionnaire was distributed to 879 community pharmacies in New Zealand. There were 458 valid questionnaires returned, with a response rate of 52%. Over half (59%) of the responding pharmacies reported provision of HDS and /or MM services, although there were relatively few ‘high level’ services such as cardiovascular risk assessment and disease management. Most services were paid for by pharmacy customers, although some District Health Boards paid for services such as Medicines Use Review. Pharmacists cited lack of remuneration, lack of time and limited access to patient information as the main barriers to greater involvement. At the time of this study (2007), community pharmacists in New Zealand were in the ‘early adoption’ phase concerning the provision of HDS and MM services.New Zealand Pharmacy Education and Research FoundationWiley Online librar

Identifying compliance issues with prescription medicines among older people: A pilot study

Background: Older people are at greater risk from polypharmacy and adverse effects due to interactions and altered pharmacokinetics. They may also have greater difficulty managing their medicines and complying with dosage regimens for various reasons. Objective: To identify the types of medicine compliance issues that occur among older people. Method: The study was undertaken in suburbs of the city of Auckland, New Zealand. A sample of 31 older people (≥65 years of age) living in the community consented to participate in the study. Semi-structured interviews and observation were used to determine how older people were managing their medicines. Observation of the interaction between the pharmacist and older person was performed to gather baseline information and semi-structured interviews were undertaken within 1 month to determine how older people were using their medicines and to identify compliance issues surrounding their use of medicines. Observation of the pharmacist-older person interaction was undertaken in the pharmacy where the older people usually collected their medicines, and participants were subsequently interviewed in their homes. The main outcome measure was compliance issues associated with the use of medicines. Results: The main issues identified were alteration of labelled medicine instructions; transferring medicine into other containers and the associated labelling and safety issues; and patients not taking medicines for various reasons, including swallowing difficulties, expense, difficulty in opening packaging, confusion about the regimen and adverse effects experienced and personal reasons. There was an average of five compliance issues per participant. Conclusion: This study identified intentional and non-intentional compliance issues that could hinder the optimal use of medicines by older people who are at greater risk of medicine-related adverse effects. Large quantities of medicines, confusion, and lack of knowledge as to why a medicine had been prescribed contributed to non-compliance. Appropriate communication between the pharmacist and patient, patient education and aids such as medication cards and referral for medication review could improve compliance in this age group

Transient blockage of the CD11d/CD18 integrin reduces contusion volume and macrophage infiltration after traumatic brain injury in rats

The early inflammatory response to traumatic brain injury (TBI) may result in secondary damage. The purpose of this study was to evaluate the effects of a transient treatment employing a blocking monoclonal antibody (mAb) to the CD11d/CD18 integrin on histopathological outcome and macrophage infiltration following TBI. A parasagittal fluid percussion (FP) brain injury (1.8 – 2.1 atmosphere) was induced in male Sprague-Dawley rats. Rats were randomized into two trauma groups, treated (N=7) and nontreated (N=8) animals. In the treated group, a mAb to the CD11d subunit of the CD11d/CD18 integrin was administered 30 minutes, 24 and 48 hours after brain injury. Control animals received an isotype-matched irrelevant mAb using the same dose and treatment regimen. At three days after TBI, animals were perfusion-fixed for histopathological and immunocytochemical analysis. The anti-CD11d mAb treatment reduced contusion areas as well as overall contusion volume compared to vehicle-treated animals. For example, overall contusion volume was reduced from 2.7 ± 0.5 mm(3) (mean ± SEM) to 1.4 ± 0.4 with treatment (p<0.05). Immunocytochemical studies identifying CD68 immunoreactive macrophages showed that treatment caused significant attenuation of leukocyte infiltration into the contused cortical areas. These data emphasize the beneficial effects of blocking inflammatory cell recruitment into the injured brain on histopathological outcome following traumatic brain injury