Provision of pharmaceutical care to patients with limited English proficiency.

PURPOSE: A study was conducted to evaluate the current practices of pharmacists in ambulatory care clinics in communicating with and providing pharmaceutical care to patients who have limited English proficiency. METHODS: Semistructured surveys were used to gather data from 16 pharmacists and 8 physicians from 15 ambulatory care clinics in metropolitan Toronto. The survey examined pharmacists' knowledge about the linguistic services, policies, and guidelines in their ambulatory care practice settings; the strategies that pharmacists and physicians use to communicate with patients with limited English proficiency; the challenges pharmacists face when providing pharmaceutical care to those patients; the drug-related problems observed by pharmacists and physicians; and how pharmacists and physicians can collaborate to resolve medication issues for those patients. RESULTS: Many pharmacists (69%) were unaware of existing institutional policies for communicating with patients with limited English proficiency. Language interpretation services in clinics were nonstandardized and did not always reflect practitioners' preferences. All aspects of pharmaceutical care were reported to be difficult to accomplish in patients with limited English proficiency. Pharmacists and physicians identified similar drug-related problems, with nonadherence being the most commonly observed drug-related problem. Strategies suggested by pharmacists and physicians to improve communication with patients involved proactively identifying language needs of patients before appointments, having translated medication information available and using trained language interpreters. CONCLUSION: Pharmacists at 15 ambulatory care clinics reported difficulty communicating with and providing pharmaceutical care to patients with limited English proficiency. Strategies suggested by pharmacists and physicians to enhance communication with those patients may help improve the quality of pharmaceutical care delivered.

Community pharmacists' attitudes toward and professional interactions with users of psychiatric medication.

Consumers of psychiatric medications or services may be stigmatized by health care providers. The authors surveyed community pharmacists (N=283) in the greater Toronto area to determine their attitudes toward and professional interactions with patients who used psychiatric medications and those who used cardiovascular medications. Despite generally positive attitudes, pharmacists reported feeling more uncomfortable discussing symptoms and medications with patients who have mental illness than with patients who have cardiovascular problems. Patients with mental illness appeared to receive fewer pharmacy services than patients with cardiovascular disorders. Barriers to receipt of counseling included a lack of privacy and inadequate training. Adequate training in mental health may be key in improving the professional interactions of community pharmacists toward patients who use psychiatric medication.

Characterization of the optic nerve and retinal ganglion cell layer in the dysmyelinated adult Long Evans Shaker rat: evidence for axonal sprouting.

Myelin in the central nervous system (CNS) is hypothesized to help guide the growth of developing axons by inhibiting sprouting of aberrant neurites. Previous studies using animal models lacking CNS myelin have reported that increasing capacity for sprouting axons is negatively correlated with the degree of myelination. In the present study, we investigated the optic nerves of the recently identified Long Evans Shaker (LES) rat with prolonged dysmyelination of adult axons to determine whether the lack of myelin basic protein (MBP) in adult LES rats could manifest as increases in the population of CNS axons. We observed numerous small, unmyelinated axon profiles (<0.3 microm in diameter) clustered in bundles alongside normal caliber axons in dysmyelinated LES rats but not in normal myelinated Long Evans (LE) rats. These putative axon profiles resembled sprouting axons previously described in the CNS. Moreover, the high number of small putative axon profiles could not be accounted for by any significant increases in the number of ganglion cells and displaced amacrine cells in the ganglion cell layer when compared with normal rats as evaluated by using a variety of techniques. This finding suggests that the observed clusters of putative axon profiles were not due to developmental abnormalities in the retina but to the lack of myelin in the optic nerves of LES rats. The adult LES rat, therefore, may serve as a useful model to study the role of myelin in regulating axon development or axon regeneration after CNS injury in the adult mammalian system.