Pre-hospital ECG E-transmission for patients with suspected myocardial infarction in the highlands of Scotland.

Patients with ST elevation myocardial infarction (STEMI) require prompt treatment, best done by primary percutaneous coronary intervention (PPCI). However, for patients unable to receive PPCI, immediate pre-hospital thrombolysis (PHT) is the best alternative. Evidence indicates that diagnostic and management support for staff increases the use of PHT. This study aimed to describe the patient demographics and management of patients, to determine any potential inter-area differences in referral rates to the ECG e-transmission service and to explore the views and experiences of key staff involved in ECG e-transmission within NHS Highland. Data from 2,025 patient episodes of ECG e-transmission identified a statistically significant geographical variation in ECG e-transmission and PHT delivery. Scottish Ambulance Service (SAS) staff were more likely than GPs to deliver PHT overall, however, GPs were more likely to deliver in remote areas. Interviews with six Cardiac Care Unit (CCU) nurses and six SAS staff highlighted their positive views of ECG e-transmission, citing perceived benefits to patients and interprofessional relationships. Poor access to network signal was noted to be a barrier to engaging in the system. This study has demonstrated that a specialist triage service based on e-transmission of ECGs in patients with suspected STEMI can be implemented in a diverse geographical setting. Work is needed to ensure equity of the service for all patients.

Factors affecting the views and attitudes of Scottish pharmacists to continuing professional development.

OBJECTIVES: To explore factors associated with Scottish pharmacists' views and attitudes to continuing professional development (CPD). METHODS: A retrospective principal component analysis of 552 (22.8%) questionnaires returned from a sample of 2420 Scottish pharmacists randomly selected from the 4300 pharmacists registered with the Royal Pharmaceutical Society of Great Britain and with a Scottish address. KEY FINDINGS: Principal component analysis of questionnaire items (n = 19) revealed four factors associated with Scottish pharmacists' views and attitudes to CPD: having positive support in the workplace, having access to resources and meeting learning needs, having confidence in the CPD process and motivation to participate in the CPD process. Community pharmacists were identified as the subgroup of pharmacists that needed most support for CPD regarding all four factors, while pharmacists working in primary care felt that they had most support in the workplace in comparison to other sectors (P < 0.05) and better access to resources and meeting learning needs when compared to community (P < 0.001) and hospital (P = 0.008) colleagues. Pharmacists working in primary care also felt more motivated to participate in the CPD process than those in the community (P < 0.001), and hospital pharmacists reported having more confidence in the CPD process compared to community pharmacists (P < 0.05). CONCLUSION: Using principal component analysis has identified four factors associated with Scottish pharmacists' views and attitudes to CPD. This may provide an approach to facilitate comparison of CPD views and attitudes with intra and inter professional groupings. Further study may allow identification of good practice and solutions to common CPD issues.

Cross sectional survey of the Scottish general public's awareness of, views on, and attitudes toward nonmedical prescribing.

BACKGROUND: Nonmedical (ie, nonphysician) prescribing is a key development in the UK that has brought about many changes in prescribing policy and practice. Systematic research into the views of the general public toward such developments is limited. OBJECTIVE: To determine the awareness of, views on, and attitudes of members of the Scottish general public toward nonmedical prescribing, with an emphasis on pharmacist prescribing. METHODS: A questionnaire was mailed in November 2006 to a random sample of 5000 members of the general public in Scotland aged 18 and over, obtained from the UK electoral roll. The questionnaire contained items on awareness of nonmedical prescribing, levels of comfort with specific health professionals, and attitudes toward pharmacist prescribing. RESULTS: Response rate was 37.1%. More than half of the individuals who responded were taking prescribed drugs. Nine hundred and seventy-eight (56.6%) were aware that trained health professionals could write prescriptions for medicines previously only prescribed by physicians. Awareness was associated with: increasing age (p < 0.001), having a health professional in their immediate family (p < 0.001), self-rated general health (p < 0.005), and a higher education level (p < 0.01). In logistic regression, all factors were retained as independent predictors of awareness (p < 0.001). Comfort levels for nonmedical prescribing were highest for pharmacists (median 4, IQR 3-5 [1 = low, 5 = high]), closely followed by nurses, and lowest for radiographers (median 2, IQR 1-4) (p < 0.001). While more than half of the respondents supported pharmacists having a prescribing role, fewer felt that pharmacists should prescribe the same range of drugs as physicians. There were concerns about lack of privacy in a pharmacy, despite acknowledging its enhanced convenience. CONCLUSIONS: Our results indicate that more than half of the respondents were aware of nonmedical prescribing. A higher proportion was more comfortable with prescribing by pharmacists and nurses than with other healthcare professionals. Several issues relating to aspects of clinical governance were highlighted, specifically education and data handling.

Views of pharmacist prescribers, doctors and patients on pharmacist prescribing implementation.

AIM: The aim of this study was to explore the perspectives of pharmacist supplementary prescribers, their linked independent prescribers and patients, across a range of settings, in Scotland, towards pharmacist prescribing. METHOD: Telephone interviews were conducted with nine pharmacist prescribers, eight linked independent prescribers (doctors) and 18 patients. The setting was primary and secondary care settings in six NHS Health Board areas in Scotland. KEY FINDINGS: In general, all stakeholders were supportive of pharmacists as supplementary prescribers, identifying benefits for patients and the wider health care team. Although patients raised no concerns, they had little idea of what to expect on their first visit, leading initially to feelings of apprehension. Pharmacists and doctors voiced concerns around a potential lack of continued funding, inadequate support networks and continuing professional development. Pharmacists were keen to undertake independent prescribing, although doctors were less supportive, citing issues around inadequate clinical examination skills. CONCLUSIONS: Pharmacists, doctors and patients were all supportive of developments in pharmacist supplementary prescribing, although doctors raised concerns around independent prescribing by pharmacists. The ability of pharmacists to demonstrate competence, to be aware of levels of competence and to identify learning needs requires further exploration.

Exploring patients' perspectives of pharmacist supplementary prescribing in Scotland.

AIM: The aim of this study was to explore patients' perspectives and experiences of pharmacist supplementary prescribing (SP) in Scotland. METHOD: A survey in primary and secondary care in Scotland. Pharmacist supplementary prescribers (n = 10) were purposively selected across Scotland. All pharmacists distributed questionnaires to 20 consecutive patients as they attended appointments during October to December 2006. Reminders were mailed to all 20 patients by each pharmacist 2 weeks after initial distribution. MAIN OUTCOME MEASURES: The questionnaire contained items on: attitudes towards pharmacist SP derived from earlier qualitative research; consultation satisfaction derived from a validated scale developed initially for general practitioners, with the term 'doctor' being replaced by 'pharmacist prescriber'; and demographics. Closed and Likert scales were used as response options. RESULTS: One pharmacist withdrew. The patient response rate was 57.2% (103/180). The median age was 67 years (interquartile range 56.5-73 years), with 53.4% being female. Most (76, 73.8%) consulted with the pharmacist in a general practice setting. Patients reported positive consultation experiences with 89.3% agreeing/strongly agreeing that they were satisfied with the consultation, 78.7% thought the pharmacist told them everything about their treatment and 72.9% felt the pharmacist was interested in them as a person. Most patients were positive in their attitudes, agreeing that they would recommend a pharmacist prescriber to others and that they had trust in the pharmacist. However, 65% would prefer to consult a doctor. CONCLUSION: Most patient respondents were satisfied with, and had a positive attitude towards, pharmacist prescribing consultations. However, most patients would still elect to see a doctor given the choice.

Views, attitudes and self-assessed training needs of Scottish community pharmacists to public health practice and competence.

OBJECTIVE: To assess the education and training needs of community pharmacists to support the delivery of an expanded public health role. Setting Community pharmacy in Scotland. METHOD: Two focus groups of community pharmacists (n = 4 in each) in geographically distinct regions of Scotland explored issues of public health function, competencies and education and training. Findings from thematic analysis were used to develop a draft postal questionnaire. Following piloting, pharmacist managers from a random sample of 500 community pharmacies in Scotland were contacted by telephone to ascertain the number of pharmacists working in each pharmacy in the following 14-day period. A survey pack containing questionnaires for each identified pharmacist working in the study period was sent by post to the pharmacist manager in each pharmacy. The questionnaire contained items on: demographics; views and attitudes towards: public health; competencies for public health practitioners; and education and training needs. One postal reminder was sent 2 weeks later. MAIN OUTCOME MEASURES: Main themes identified from focus group discussions; questionnaire response rate; views and attitudes towards public health competencies and education and training. RESULTS: Four hundred and fifteen managers agreed to participate, providing 904 potential participants. The response rate was 25% (223/904). Most (n = 179, 80%) were aware of the term 'pharmaceutical public health'. While a majority saw the importance of public health to their practice (n = 177, 79%) agreeing/strongly agreeing, they were less comfortable with the term 'specialist'. Respondents viewed competencies relating to health promotion (n = 192, 86%) more relevant than surveillance (n = 70, 31%), risk management (n = 29, 13%) and strategic developments (n = 12, 5%). Responses indicated a desire for education and training with more than half (n = 121, 54%) agreeing/strongly agreeing that they had a need now, with 69% (n = 153) expressing a future need. CONCLUSION: Results should be interpreted with caution due to the response rate. However, this research highlights the self assessed gap in competence related to pharmaceutical public health for community pharmacists in Scotland.

Views of pharmacists and mentors on experiential learning for pharmacist supplementary prescribing trainees.

OBJECTIVE: To explore the views and experiences of pharmacists and their mentoring designated medical practitioners (DMPs) about the 'period of learning in practice' (PLP) as part of supplementary prescribing (SP) training. METHOD: Two focus groups (n = 5 and 7) of SP pharmacists were organised in Scotland. The experiences and views of DMPs (n = 13) were explored using one-to-one telephone interviews. The focus groups and interviews were transcribed verbatim and analysed using the framework approach. MAIN OUTCOME MEASURES: Views and experiences of pharmacists and DMPs about the PLP. RESULTS: Planning the PLP in consultation with the DMP was found to be crucial for an optimal learning experience. Pharmacists who did not have a close working relationship with the medical team had difficulties in identifying a DMP and organising their PLP. Participants stressed the importance of focusing on and achieving the core competencies for prescribers during the PLP. Input from doctors involved in the training of others, review of consultation videos, and formal independent assessment including clinical assessment at the end of the PLP might improve the quality of the PLP. Forums for discussing experiences during the PLP and gathering information might be valuable. CONCLUSION: Our findings have implications for prescribing training for pharmacists in the future. The PLP should focus on core competencies with input from doctors involved in the training of others and have a formal assessment of consultation skills. Support for pharmacists in organising the PLP and forums for discussing experiences during the PLP would be valuable.

Scottish pharmacists' views and attitudes towards continuing professional development.

OBJECTIVES: To summarise Scottish pharmacists' views and attitudes towards Continuing Professional Development (CPD). SETTING: Random sample of RPSGB registered Scottish pharmacists. METHOD: A postal questionnaire of pharmacists' CPD activity, views and attitudes was developed, piloted and sent to 2420 pharmacists. Questions were collated to produce total scores and to rate pharmacists' motivation and attitudes to CPD separately. The number of CPD hours reported by sector and gender were compared ('t' test) and differences identified between hospital, community and primary care in relation to mean motivational attitudinal scores (Mann-Whitney test). RESULTS: Five hundred and forty three pharmacists completed the questionnaire (22.4% response rate). In this study 9.8% of the pharmacists reported spending no time on CPD. Comparisons of hours showed primary care pharmacists and hospital pharmacists reported similar times spent on CPD and significantly more time than community pharmacists (68 h and 66 h vs 45 h; P<0.05). No statistically significant differences between genders were revealed. Internal reliability on motivation and attitude scores ranged from 0.74-0.83 (Cronbach's alpha). Although scores were similar across sectors of practice in terms of motivation and attitudinal questions, statistical differences were consistent; showing higher scores for separate motivation and attitude among pharmacists in primary care than in hospital or community practice sectors (Mann Whitney test; P<0.001). Community pharmacists had a statistically significantly lower attitude score than pharmacists in hospital or primary care sectors (Mann Whitney test; P<0.001). CONCLUSION: There is a section of pharmacists still not participating in CPD. Primary care pharmacists reported most motivation and scored highest in attitude score. Community pharmacists appear to be the sector requiring most support to increase not only their motivation to CPD but also their confidence and ability in participation.

Developing consensus around the pharmaceutical public health competencies for community pharmacists in Scotland.

OBJECTIVE: The new community pharmacy contract in Scotland will formalise the role of pharmacists in delivering public health services. To facilitate assessment of education and training needs it is necessary to define the relevant public health competencies for community pharmacists. The objective of this research was to define and develop consensus around such competencies. METHODS: The "Skills for Health National Occupational Standards for Public Health Practitioners" was used to define an initial set of competencies. A two stage Delphi technique was undertaken to develop consensus. An expert panel, representing public health and pharmacy stakeholders, rated their agreement with the importance of each competency, with the agreement level set at 90%. MAIN OUTCOME MEASURES: Level of agreement (%) with each public health competency; those competencies achieving more than 90% agreement with importance for community pharmacy practice. RESULTS: Ten organisations (83% of those invited) and a total of 30 members (88%) agreed to take part in the process. In round 1 of the Delphi, responses were received from 25 (83%) individuals and 22 (73%) in round 2, with consensus being achieved for 25/68 (37%) competencies in round 1 and a further 8/68 (12%) in round 2. CONCLUSION: Public health competencies for community pharmacists achieving consensus predominantly focused on health improvement activities at individual and local community levels and ethical management of self rather than those relating to surveillance and assessment and strategic development. There is a need to research community pharmacists' views of these competencies and to systematically assess their education and training needs.

Experiential learning as part of pharmacist supplementary prescribing training: feedback from trainees and their mentors.

BACKGROUND: A period of learning in practice (PLP) is an integral part of supplementary prescribing training for pharmacists in Great Britain. During the PLP, a designated medical practitioner (DMP) supervises and supports the trainee to develop competence in prescribing. OBJECTIVE: To evaluate the views and experiences of supplementary prescribing pharmacists and DMPs regarding the PLP and identify their perceived support needs during the PLP. METHODS: Prepiloted questionnaires were mailed in September 2006 to all pharmacists who had started their supplementary prescribing training at The Robert Gordon University, Aberdeen, Scotland (n = 242) and their DMPs (n = 232). Nonrespondents were sent up to 2 reminders. Responses were analyzed using descriptive and comparative statistics; responses to open questions were analyzed thematically. RESULTS: Responses were received from 186 (76.9%) pharmacists and 144 (62.1%) DMPs. Just over half of the pharmacists agreed/strongly agreed that they knew what was expected of them and their DMPs during the PLP, but less than half agreed/strongly agreed that it was important to communicate with pharmacist colleagues in the prescribing course. One hundred twelve (60.2%) pharmacists had their consultation skills reviewed by their DMPs during the PLP. Opportunities for professional development and teamwork were regarded as major positive experiences by both pharmacists and DMPs. Organizational, attitudinal, and time barriers were also reported. There was considerable interest among both pharmacists and DMPs for an Internet-based support network during the PLP. CONCLUSIONS: Information on the roles and responsibilities of pharmacists and DMPs during the PLP should be enhanced. The Internet could be a useful medium for communication during the PLP. Input from a multidisciplinary team of healthcare professionals and review of consultation videos could further enhance the PLP experience.

Supplementary prescribing: early experiences of pharmacists in Great Britain.

BACKGROUND: Pharmacists in Great Britain can undertake supplementary prescribing (SP) after training at a higher education institution and completing a "period of learning in practice" in accordance with the Royal Pharmaceutical Society of Great Britain (RPSGB) curriculum. OBJECTIVE: To explore SP pharmacists' early experiences of prescribing and their perceptions of the prescribing course. METHODS: A questionnaire was mailed to all RPSGB prescribers (N = 518, on June 1, 2005; 30 used in pilot questionnaire). Predictors of pharmacists starting to practice SP were identified in univariate analysis, and significant variables were further tested in multivariate analysis. RESULTS: The respondents (n = 401; 82.2%) were mainly female (270; 67.3%), had more than 20 years' experience as a pharmacist (123; 30.7%), worked in hospital settings (160; 39.9%), and focused on cardiovascular conditions (143; 35.7%) during their period of learning in practice. The median course satisfaction score, on a scale of 3 to 15 (lowest to highest), was 10. Practicing SP was self-reported by 195 (48.6%) respondents, 154 (79%) of whom had written a prescription. Ninety (58.4%) of the first prescriptions were written in primary care settings. Better patient management was regarded as the major benefit by 139 (71.3%) of those engaged in SP, while funding issues were identified by 71 (36.4%) as major barriers in implementing the practice. Lack of organizational recognition of SP was the main reason given (37; 18%) for those not commencing the practice. Independent predictors of those practicing SP included a longer time since registering as prescriber (p < 0.001); confidence of pharmacists in their prescribing abilities (p < 0.001); practicing in a setting other than community pharmacy (p = 0.001); and training in cardiovascular conditions or multiple conditions during the period of learning in practice (p = 0.005). CONCLUSIONS: Pharmacists have made progress in implementing SP, which is perceived by pharmacist prescribers as beneficial for both patients and themselves. Pharmacists need more support in terms of infrastructure and integration into the healthcare team to overcome some of the barriers to implementing SP.