Does rural and urban community pharmacy practice differ? A narrative systematic review.

OBJECTIVES: Anecdotal comparisons between rural and urban community pharmacy practice have been frequently reported. Therefore, a narrative systematic review was conducted to examine the published international evidence comparing the nature of services provided from community pharmacies in both settings. A comprehensive literature search was undertaken across four databases. The key criterion for inclusion was a comparison of practice, excluding dispensing and associated counselling. Definitions of 'rural' were specific to the country and publication year. KEY FINDINGS: The search yielded 3830 titles, from which 17 publications met the inclusion criteria. The studies investigated current or proposed services and included the provision of pharmaceutical care, public health activities and prescribing. Rural customers were more willing to seek advice and talked longer to the pharmacist, but not always. There was limited evidence that rural pharmacists provided more professional services and they appeared to have better working relationships with prescribers. Many of the authors challenged the validity of their own results, suggesting that other confounding factors accounted for the observed differences. In general, the statistical analyses reported were basic, with multivariate analyses being uncommon. There was some evidence that rural pharmacists were seemingly more willing to take on new professional roles and deliver a higher level of service. However, this conclusion is based on a small number of studies, often with a limited number of respondents and simplistic data analyses. Further high-quality research is required to ascertain and characterise any real differences between rural and urban settings in community pharmacy practice.

A pilot study evaluating multiple risk factor interventions by community pharmacists to prevent cardiovascular disease: the PAART CVD pilot project.

BACKGROUND: There is insufficient evidence for the efficacy of comprehensive multiple risk factor interventions by pharmacists in the primary prevention of cardiovascular disease (CVD). Given the proven benefits of pharmacist interventions for individual risk factors, it is essential that evidence for a comprehensive approach to care be generated so that pharmacists remain key members of the health care team for individuals at risk of initial onset of CVD. OBJECTIVE: To establish the feasibility of an intervention delivered by community pharmacists to reduce the risk of primary onset of CVD. METHODS: A single-cohort intervention study was undertaken in 2008-2009. Twelve community pharmacists from 10 pharmacies who were trained to provide lifestyle and medicine management support to reduce CVD risk recruited 70 at-risk participants aged 50-74 years who were free from diabetes or CVD. Participants received a baseline assessment to establish CVD risk and health behaviors. An assessment report provided to patients and pharmacists was used to collaboratively establish treatment goals and, over 5 sessions, implement treatment strategies. Follow-up assessment at 6 months measured changes in baseline parameters. The primary outcome was the average change to overall 5-year risk of CVD onset. RESULTS: Sixty-seven participants were included in the analysis. The mean participant age was 60 years and 73% were female. We observed a 25% (95% CI 17 to 33) proportional risk reduction in overall CVD risk. Significant reductions also occurred in mean blood pressure (-11/-5 mm Hg) and waist circumference (-1.3 cm), with trends toward improvement for most other observed risk factors. CONCLUSIONS: Findings support previous evidence of positive cardiovascular health outcomes following pharmacist intervention in other patient groups; we recommend generating randomized controlled trial evidence for a primary prevention population.

Engaging community pharmacists in the primary prevention of cardiovascular disease: protocol for the Pharmacist Assessment of Adherence, Risk and Treatment in Cardiovascular Disease (PAART CVD) pilot study.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death globally. Community pharmacist intervention studies have demonstrated clinical effectiveness for improving several leading individual CVD risk factors. Primary prevention strategies increasingly emphasise the need for consideration of overall cardiovascular risk and concurrent management of multiple risk factors. It is therefore important to demonstrate the feasibility of multiple risk factor management by community pharmacists to ensure continued currency of their role. METHODS/DESIGN: This study will be a longitudinal pre- and post-test pilot study with a single cohort of up to 100 patients in ten pharmacies. Patients aged 50-74 years with no history of heart disease or diabetes, and taking antihypertensive or lipid-lowering medicines, will be approached for participation. Assessment of cardiovascular risk, medicines use and health behaviours will be undertaken by a research assistant at baseline and following the intervention (6 months). Validated interview scales will be used where available. Baseline data will be used by accredited medicines management pharmacists to generate a report for the treating community pharmacist. This report will highlight individual patients' overall CVD risk and individual risk factors, as well as identifying modifiable health behaviours for risk improvement and suggesting treatment and behavioural goals. The treating community pharmacist will use this information to finalise and implement a treatment plan in conjunction with the patient and their doctor. Community pharmacists will facilitate patient improvements in lifestyle, medicines adherence, and medicines management over the course of five counselling sessions with monthly intervals. The primary outcome will be the change to average overall cardiovascular risk, assessed using the Framingham risk equation. DISCUSSION: This study will assess the feasibility of implementing holistic primary CVD prevention programs into community pharmacy, one of the most accessible health services in most developed countries. TRIAL REGISTRATION: Australia and New Zealand Clinical Trial Registry Number: ACTRN12609000677202.

Evaluation of the national pharmacy preceptor education program.

OBJECTIVE: The process evaluation findings and key issues from a trial of the effectiveness and national applicability of a national online educational curriculum for pharmacist preceptors are presented. DESIGN: A multi-method triangulated research design was used to elicit qualitative and quantitative data preceptors. The data collection method involved an anonymous questionnaire with both quantitative components and open-ended qualitative responses. SETTING: An online education program for preceptors of Australian pharmacy students in rural areas. PARTICIPANTS: Rural pharmacists in the three states were invited to trial the package and participate in the associated research/evaluation project. MAIN OUTCOME MEASURES: The Australian Pharmacy Preceptor Education (APPE) program is an important and valuable educational tool for the professional development of pharmacists. It contained pertinent information and appropriate activities, and the delivery strategy was well accepted. The evaluation findings support a national implementation. RESULTS: Program strengths include the ease of access, self-directed learning and the interactive nature emphasising the benefit of sharing ideas and feedback. Potential program limitations include technical delays and unclear instructions for undertaking the program. CONCLUSION: The online APPE program is a flexible delivery strategy which has the potential to dramatically improve the skills and knowledge of pharmacists acting as preceptors and, thereby, impact on the learning provided in rural hospitals and community pharmacies for undergraduate students and new graduates alike.

Australian national strategy for pharmacy preceptor education and support.

OBJECTIVES: (i) To develop a national strategy for pharmacy preceptor education and support, with special consideration for rural and remote practitioners. (ii) To deliver an innovative national core pharmacist preceptor education and support model that could be customised for specific undergraduate programs. DESIGN: A steering committee, with representatives from four Pharmacy Schools in three Australian states, was established to develop an educational curriculum and implementation strategy. SETTING: The project was designed to provide an online educational program for preceptors of Australian pharmacy students, particularly those in rural areas. SUBJECTS: The recipients of this program will primarily be rural pharmacy preceptors but could also be urban practitioners. INTERVENTIONS: After consultation with an advisory group, the steering committee considered the educational content, delivery strategy and adaptability of the package to maintain its currency and links to universities, pharmacy boards and professional organisations: an extensive literature search was conducted; writers and an educational designer were employed. The steering committee reviewed and modified the content before transfer of the program to the worldwide web. MAIN OUTCOME MEASURE: The development of a Pharmacy Preceptor Education Program suitable for national application and able to fulfil the needs of rural preceptors. RESULTS: A Preceptor Education Program has been developed suitable for use in all Australian states and capable of meeting the needs of rural pharmacy preceptors. CONCLUSIONS: Collaboration between four schools of pharmacy and pharmacy professional bodies has resulted in development of a flexible program for preceptors of undergraduate pharmacy students. This program can be developed for use by preceptors of pharmacy graduates, and in other disciplines.