Towards concordance in healthcare: perspectives of general practitioners, complementary and alternative medicine practitioners and pharmacists in Australia.

Partnerships and concordance are desirable concepts for optimal healthcare. The concept of concordance is based on negotiation between equals in a therapeutic relationship, forming a therapeutic alliance between all partners. One field of healthcare in which concordant relationships may be particularly desirable is complementary and alternative medicine (CAM). CAM is increasingly used by consumers worldwide, and provider-patient relationships are important across the spectrum of CAM-to-conventional medicine; thus, it was considered useful to research CAM and concordance in parallel. The objective of this problem-detection study (PDS) was to investigate practitioners' (general practitioners', pharmacists' and CAM practitioners') views on their relationships and reaching concordant partnerships with consumers in the areas of both conventional medicine and CAM. Focus groups and semi-structured interviews guided the development of the PDS instrument. The questionnaire consisted of 36 items corresponding to seven thematic units deduced from the preliminary data. The differences in perceptions between the surveyed groups indicated that achieving concordance relies on mutual respect and communication and understanding of roles, responsibilities and limitations, and differences in opinion may be compromising the formation of partnerships. Potentially problematic issues identified by this research could be addressed by educational interventions and enhancement of communication between all parties involved, as information loses value when not shared, and may be prone to contradiction and confusion. Further research is warranted in order to facilitate positive changes in the health system.

Asthma management by New Zealand pharmacists: a pharmaceutical care demonstration project.

BACKGROUND: Pharmaceutical care services became recognized in New Zealand in the mid-1990s, albeit with limited evidence of the acceptability and effectiveness of the model. An asthma-specific pharmaceutical care service was trialled in southern New Zealand, based on a 'problem-action-outcome' method, with pharmacists adopting a patient-centred, outcome-focused approach with multidisciplinary consultation. OBJECTIVE: To report on the implementation and outcomes of a specialist asthma service offered by community pharmacists. DESIGN: Pharmacists in five pharmacies, servicing predominantly rural, established clientele, received training in the asthma service and research documentation. Ten patients per pharmacy were recruited in each year (years 1 and 2) of the study. The patients were entered into the study in cohorts of five per pharmacy twice yearly, with year 2 mirroring year 1. The phase-in design minimized the impact on the pharmacists. The patients acted as their own controls. All patients received individualized care and had approximately monthly consultations with the pharmacist, with clinical and quality of life (QoL) monitoring. RESULTS: A total of 100 patients were recruited. On average, 4.3 medication-related problems were identified per patient; two-thirds of them were compliance-related. The most common interventions were revision of patients' asthma action plans, referral and medication counselling. Clinical outcomes included reduced bronchodilator use and improved symptom control in around two-thirds of patients. Asthma-specific QoL changes were more positive and correlated well with clinical indicators. CONCLUSION: Further research is warranted to integrate this service into daily practice. Clinical outcomes were generally positive and supported by QoL indicators. Characteristics of New Zealand practice and this sample of pharmacies may limit the generalizability of these findings.

Can pharmacists influence the health-related quality of life of patients with asthma?: The New Zealand Pharmaceutical Care experience.

BACKGROUND: The newly emerging practice of Pharmaceutical Care requires that pharmacists take responsibility for the outcomes of drug therapy. Improvement in Quality of Life (QoL) represents the final outcome of the care process and indicates the success of interventions. OBJECTIVES: To assess the impact of a Pharmaceutical Care specialist asthma service provided by community pharmacists to a sample of patients with asthma, the outcome indicators being changes in health status and QoL. METHOD: Sixty-two adult asthma patients (17 years and older) living in two rural regions of New Zealand, were segregated into two groups for phased introduction to the service. The patients acted as their own controls before they received the pharmacists' service. They had been diagnosed with asthma at least six months previously, and their asthma was symptomatic and not considered optimally controlled prior to the study. RESULTS: There was significant improvement in asthma-related QoL (as measured by the Asthma Quality of Life Questionnaire) following introduction of the service, and pharmacists were able to identify, prevent or resolve over 400 drug-related problems. CONCLUSION: The results suggest that with appropriate training and support, New Zealand pharmacists can help asthma patients achieve greater quality of life. This research has implications for the introduction of Pharmaceutical Care services in other countries and for patients with other conditions who require ongoing management.

Nutritional supplement use among 26-year-olds.

AIMS: To estimate the prevalence of use of nutritional supplements among young adults, to examine the source of those supplements and to investigate sex differences in usage. METHODS: Participants in the age-26 years assessments of the Dunedin Multidisciplinary Health and Development Study were asked to bring containers for any medication (including supplements) taken in the previous two weeks. Medication data (including prescription source) were recorded and analysed for 978 of 980 Study members. RESULTS: The prevalence of supplement use was 16.6%; 20.4% among females and 13.3% for males (p<0.01). Multivitamin preparations were the most widely consumed, followed by water-soluble vitamin supplements (such as folate and vitamin C). Folate use was higher among females and was taken by 35.7% of pregnant females. Most supplements were self-prescribed, although a doctor had prescribed over one-third of the mineral supplements. Most supplements had been taken for weeks or months, rather than years. CONCLUSIONS: Nutritional supplement usage among young adults is reasonably common, and involves a wide range of preparations. The extent of use among younger people suggests a need for regulation of their manufacture, sale and usage, and research to examine their efficacy.

Surveillance of a recently switched non-prescription medicine (Diclofenac) using a pharmacy-based approach.

PURPOSE: Postmarketing surveillance of prescription medicines is a routine practice, yet similar evaluation of non-prescription medicines, including those recently switched from prescription status, is uncommon. This study presents the methodologic issues and limitations of the use of pharmacies in the 'post-reclassification' surveillance of oral diclofenac potassium 25 mg which had been recently switched from physician prescription to non-prescription sale. METHODS: Consenting user-purchasers were recruited from 175 New Zealand pharmacies over 4 months. Purchasers were mailed a questionnaire for completion 7 days post-purchase. Those purchasers who met criteria for being potentially 'at risk' of adverse events were re-surveyed 30 days post-purchase. A descriptive analysis was carried out using t-test and chi-square as appropriate. These results were compared to those from other types of studies in this area. RESULTS: The 1240 recruited purchasers returned 990 valid questionnaires (80% response). Of these 557 (56%) met 'at risk' criteria and received the second questionnaire with 480 valid returns (86.2% response). CONCLUSIONS: Useful data was gathered on the 'real-life' usage of a medicine recently reclassified from prescription to non-prescription sale. The use of community pharmacies as recruiting centres was found to be effective. Copyright (c) 2000 John Wiley & Sons, Ltd.