Impact of Standardised Packaging of Tobacco Products Regulations on cigarette consumption and youth smoking in England: interrupted time-series analysis.

BACKGROUND: In the UK in May 2016, standardised packaging of tobacco products was implemented, including minimum pack sizes of 20 sticks or 30 g loose tobacco. The change was intended to reduce uptake by increasing upfront costs to young people, but there was concern it may unintentionally increase consumption among people smoking. This study aimed to assess whether the introduction of the policy was associated with changes in (1) mean daily factory-made (FM)/roll-your-own (RYO) cigarettes consumption among people smoking predominantly (a) FM and (b) RYO cigarettes; and (2) current smoking prevalence among 16-24-year-olds. METHODS: Data (N=257 929) were from a representative monthly cross-sectional survey of adults (≥16 years) in England, collected between November 2007 and January 2020. Outcome measures were mean daily (FM/RYO) cigarette consumption among those smoking FM/RYO cigarettes, and prevalence of current smoking among 16-24-year-olds. Time-series analyses were conducted using Autoregressive Integrated Moving Average with Exogenous variables (ARIMAX) regression models including a gradual level change starting in June 2017 and ending in May 2018 for cigarette consumption and a step change in June 2016 for prevalence of current smoking. RESULTS: The ARIMAX model was not able to detect a change in mean daily cigarette consumption-for FM (Badj=-0.543, 95% CI -1.381 to 0.296) or RYO (Badj=0.002, 95% CI -0.518 to 0.522) following the implementation of standardised packaging. The unadjusted analysis suggested the implementation of standardised packaging was associated with a small (3%) decrease in smoking prevalence among 16-24-year-olds (Bunadj=-0.031, 95% CI -0.062 to 0.000), but this association was attenuated after adjustment for covariates (Badj=-0.010, 95% CI -0.039 to 0.019). CONCLUSIONS: The implementation of standardised packaging of tobacco products was not associated with a meaningful change in the mean number of FM or RYO cigarettes consumed by people smoking in England, suggesting the larger pack size has not had an unintended consequence of substantially increasing cigarette consumption. However, there was also little evidence that the policy substantially reduced smoking among 16-24-year-olds.

Trends in Daily Cigarette Consumption Among Smokers: A Population Study in England, 2008-2023.

INTRODUCTION: This study aimed to estimate time trends in cigarette consumption among smokers in England between 2008 and 2023 and to explore differences by key potential moderators. AIMS AND METHODS: We used data from 57 778 adult cigarette smokers participating in a nationally representative monthly cross-sectional survey between January 2008 and September 2023. We estimated monthly time trends in mean daily consumption of (1) any, (2) manufactured, and (3) hand-rolled cigarettes among all smokers and by main type of cigarettes smoked, smoking frequency, age, gender, occupational social grade, region, nicotine replacement therapy use, and vaping status. RESULTS: Overall cigarette consumption fell from 13.6 [95% CI = 13.3 to 13.9] to 10.6 [10.5 to 10.8] per day between January 2008 and October 2019 (a 22% decrease), then remained stable up to September 2023. Over this period, the proportion mainly or exclusively smoking hand-rolled cigarettes increased (from 30.6% [29.1%-32.1%] in 2008 to 52.1% [49.7%-54.5%] in 2023). As a result, manufactured cigarette consumption fell by 47%, from 9.5 [9.2-9.8] per day in January 2008 to 5.0 [4.7-5.3] in September 2023, while hand-rolled cigarette consumption increased by 35%, from 4.2 [3.9-4.4] to 5.6 [5.3-5.9], respectively. The decline in overall cigarette consumption was observed across all subgroups, but was greater among non-daily smokers, younger smokers, and those who vaped. CONCLUSIONS: Over the last 15 years, the average number of cigarettes consumed each day by smokers in England has fallen by almost a quarter, but has plateaued since October 2019. There has been a sharp decline in the number of manufactured cigarettes consumed and an increase in the number of hand-rolled cigarettes consumed, as smokers have increasingly shifted towards using hand-rolled tobacco. IMPLICATIONS: While average cigarette consumption in England has fallen over the past 15 years, this declining trend has stalled (and reversed in some population groups) since 2019. The availability of cheap, hand-rolled tobacco appears to be undermining policies that aim to reduce smoking by raising the price of tobacco (eg, through taxation) and could be targeted to reignite the decline in cigarette consumption.

'Stopping the start': support for proposed tobacco control policies - a population-based survey in Great Britain 2021-2023.

OBJECTIVES: This study assessed public support for four proposed tobacco control policies in Great Britain: (1) Raising the sales age of tobacco by 1 year every year (Smokefree Generation); (2) Raising the sales age of tobacco from 18 years to 21 years; (3) Providing prescription e-cigarettes as smoking cessation aids to adults who smoke; (4) Restricting e-cigarette advertising to prevent youth uptake. DESIGN: Repeat cross-sectional population-based survey weighted to match the population of Great Britain. SETTING: The survey was conducted in England, Scotland and Wales in September 2021, October 2022 and October 2023. PARTICIPANTS: 6541 adults living in Great Britain. MAIN OUTCOME MEASURES: Support for each policy and year and prevalence ratios (PRs) comparing support between years and subgroups. RESULTS: The most popular policy each year was restricting e-cigarette advertising (74%/79%/85%), followed by raising the sales age to 21 years (50%/58%/64%), providing prescription e-cigarettes (45%/44%/47%) and Smokefree Generation (34%/44%/49%). The largest increases were for policies about the age of sale (Smokefree Generation: 2021/2022 PR=1.28, 95% CI 1.18 to 1.40, 2022/2023 PR=1.12, 95% CI 1.04 to 1.20; raising the age to 21 years: 2021/2022 PR=1.16, 95% CI 1.09 to 1.23, 2022/2023 PR=1.11, 95% CI 1.05 to 1.17). Only 30% opposed Smokefree Generation in 2023 down from 41% in 2021. CONCLUSIONS: Support for each policy increased each year, except for providing prescription e-cigarettes. Restricting e-cigarette advertising was the most popular policy, while support for age of sale policies, in particular for a Smokefree Generation, grew most. TRIAL REGISTRATION: The study protocol was published on the Open Science Framework (https://osf.io/46z2c/) prior to starting the analysis.

Intersection of gambling with smoking and alcohol use in Great Britain: a cross-sectional survey in October 2022.

OBJECTIVES: Gambling is associated with cigarette smoking and alcohol consumption. We explored the intersection of gambling across all risk levels of harm with smoking and alcohol use among adults in Great Britain. DESIGN: A nationally representative cross-sectional survey in October 2022. SETTING: Great Britain. PARTICIPANTS: A weighted total of 2398 adults (18+ years). OUTCOME MEASURES: We examined the prevalence of past-year gambling and, among those reporting gambling, assessed the associations between the outcome of any risk of harm from gambling (scoring >0 on the Problem Gambling Severity Index) and the binary predictor variables of current cigarette smoking and higher risk alcohol consumption (AUDIT-C score≥4). We also explored data on weekly expenditure on gambling with smoking and alcohol use among those categorised at any-risk of harm from gambling. RESULTS: Overall, 43.6% (95% CI 41.2% to 45.9%) of adults gambled in the past year. Among these, 7.3% (95% CI 5.3% to 9.3%) were classified at any-risk of harm from gambling, 16.0% (95% CI 13.2% to 18.8%) were currently smoking and 40.8% (95% CI 37.2% to 44.4%) were drinking at increasing and higher risk levels. There were no associations between any risk of harm from gambling and current smoking (OR adjusted=0.80, 95% CI 0.35 to 1.66) or drinking at increasing and higher risk levels (OR adjusted=0.94, 95% CI 0.52 to 1.69), respectively. Analyses using Bayes factors indicated that these data were insensitive to distinguish no effect from a range of associations (OR=95% CI 0.5 to 1.9). The mean weekly spend on gambling was £7.69 (95% CI £5.17 to £10.21) overall, £4.80 (95% CI £4.18 to £5.43) among those classified as at no risk and £45.68 (95% CI £12.07 to £79.29) among those at any risk of harm from gambling. CONCLUSIONS: Pilot data in a population-level survey on smoking and alcohol use yielded similar estimates to other population-level surveys on gambling participation and at-risk gambling. Further data are needed to elucidate the intersections more reliably between gambling, smoking and alcohol use and inform population-level approaches to reduce harm.

Correction: Mobile App Intervention of a Randomized Controlled Trial for Patients With Obesity and Those Who Are Overweight in General Practice: User Engagement Analysis Quantitative Study.

[This corrects the article DOI: 10.2196/45942.].

Smoking prevalence and purchasing of menthol cigarettes since the menthol flavour ban in Great Britain: a population-based survey between 2020 and 2023.

BACKGROUND: Menthol cigarettes have been banned in Great Britain (GB) since May 2020. Still, menthol accessories and unlabelled cigarettes perceived as mentholated are available, and people can buy menthol cigarettes overseas or illicitly. This study assessed: trends in smoking menthol cigarettes among all adults and 18-24-year-olds in GB between October 2020 and March 2023; trends in and differences between England, Scotland and Wales during the same period and purchase sources among people smoking menthol versus non-flavoured cigarettes. METHODS: Population-weighted data were from a monthly cross-sectional survey of adults in GB. Among people smoking cigarettes, we calculated the proportion smoking menthol cigarettes across all adults and 18-24-year-olds, and prevalence ratios (PR) between the first and last quarter. We also calculated the proportions of people smoking menthol/non-flavoured cigarettes by purchase source (including illicit sources). RESULTS: In the first quarter, 16.2% of adults smoking cigarettes reported menthol cigarette smoking with little to no decline throughout the study (PR 0.85, 95% CI 0.71 to 1.01), while it declined among 18-24-year-olds (PR 0.75, 95% CI 0.63 to 0.89). The prevalence of menthol cigarette smoking fell by two-thirds in Wales (PR 0.36, 95% CI 0.19 to 0.62) but remained relatively stable in England (PR 0.88, 95% CI 0.72 to 1.06) and Scotland (PR 0.94, 95% CI 0.59 to 1.53). The main purchasing sources were licit (93.9%), 14.8% reported illicit sources and 11.5% cross-border purchases, without notable differences from people smoking non-flavoured cigarettes. CONCLUSIONS: Roughly one million adults in GB still smoke menthol cigarettes and, with the exception of Wales and young people, there were no noteworthy changes in the post-ban period. There was no indication that the overall persistence of menthol smoking was driven by illicit purchases.

Mobile App Intervention of a Randomized Controlled Trial for Patients With Obesity and Those Who Are Overweight in General Practice: User Engagement Analysis Quantitative Study.

BACKGROUND: The Health eLiteracy for Prevention in General Practice trial is a primary health care-based behavior change intervention for weight loss in Australians who are overweight and those with obesity from lower socioeconomic areas. Individuals from these areas are known to have low levels of health literacy and are particularly at risk for chronic conditions, including diabetes and cardiovascular disease. The intervention comprised health check visits with a practice nurse, a purpose-built patient-facing mobile app (mysnapp), and a referral to telephone coaching. OBJECTIVE: This study aimed to assess mysnapp app use, its user profiles, the duration and frequency of use within the Health eLiteracy for Prevention in General Practice trial, its association with other intervention components, and its association with study outcomes (health literacy and diet) to determine whether they have significantly improved at 6 months. METHODS: In 2018, a total of 22 general practices from 2 Australian states were recruited and randomized by cluster to the intervention or usual care. Patients who met the main eligibility criteria (ie, BMI>28 in the previous 12 months and aged 40-74 years) were identified through the clinical software. The practice staff then provided the patients with details about this study. The intervention consisted of a health check with a practice nurse and a lifestyle app, a telephone coaching program, or both depending on the participants' choice. Data were collected directly through the app and combined with data from the 6-week health check with the practice nurses, the telephone coaching, and the participants' questionnaires at baseline and 6-month follow-up. The analyses comprised descriptive and inferential statistics. RESULTS: Of the 120 participants who received the intervention, 62 (52%) chose to use the app. The app and nonapp user groups did not differ significantly in demographics or prior recent hospital admissions. The median time between first and last app use was 52 (IQR 4-95) days, with a median of 5 (IQR 2-10) active days. App users were significantly more likely to attend the 6-week health check (2-sided Fisher exact test; P<.001) and participate in the telephone coaching (2-sided Fisher exact test; P=.007) than nonapp users. There was no association between app use and study outcomes shown to have significantly improved (health literacy and diet) at 6 months. CONCLUSIONS: Recruitment and engagement were difficult for this study in disadvantaged populations with low health literacy. However, app users were more likely to attend the 6-week health check and participate in telephone coaching, suggesting that participants who opted for several intervention components felt more committed to this study. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12617001508369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373505. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2018-023239.

Alcohol and smoking brief interventions by socioeconomic position: a population-based, cross-sectional study in Great Britain.

BACKGROUND: Alcohol and smoking brief interventions (BIs) in general practice have been shown to be effective in lowering alcohol and smoking-related harm. AIM: To assess prevalence of self-reported BI receipt among increasing or higher-risk drinkers and past-year smokers in England, Scotland, and Wales, and associations between intervention receipt and socioeconomic position. DESIGN & SETTING: Cross-sectional study using data from a monthly population-based survey in England, Scotland, and Wales. METHOD: The study comprised 47 799 participants (15 573 increasing or higher-risk drinkers [alcohol use disorders identification test consumption score ≥5] and 7791 past-year smokers) surveyed via telephone in 2020-2022 (during the COVID-19 pandemic). All data were self-reported. Prevalence of self-reported BI receipt was assessed descriptively; associations between receipt and socioeconomic position were analysed using logistic regression. RESULTS: Among adults in England, Scotland, and Wales, 32.2% (95% confidence interval [CI] = 31.8 to 32.7) reported increasing or higher-risk drinking and 17.7% (95% CI = 17.3 to 18.1) past-year smoking. Among increasing or higher-risk drinkers, 58.0% (95% CI = 57.1 to 58.9) consulted with a GP in the past year, and of these, 4.1% (95% CI = 3.6 to 4.6) reported receiving BIs. Among past-year smokers, 55.8% (95% CI = 54.5 to 57.1) attended general practice in the past year; of these, 41.0% (95% CI = 39.4 to 42.7) stated receiving BIs. There was a tendency for patients from socioeconomically disadvantaged backgrounds to receive more alcohol (adjusted odds ratio [aOR] 1.38, 95% CI = 1.10 to 1.73) or smoking BIs (aOR 1.11, 95% CI = 0.98 to 1.26), but for the latter the results were statistically non-significant. Results did not differ notably by nation within Great Britain. CONCLUSION: BIs in general practice are more common for smoking than for alcohol. A greater proportion of BIs for alcohol were found to be delivered to people who were from socioeconomically disadvantaged backgrounds and who were increasing or higher-risk drinkers.

Mobile Health Use by Older Individuals at Risk of Cardiovascular Disease and Type 2 Diabetes Mellitus in an Australian Cohort: Cross-sectional Survey Study.

BACKGROUND: The digital transformation has the potential to change health care toward more consumers' involvement, for example, in the form of health-related apps which are already widely available through app stores. These could be useful in helping people understand their risk of chronic conditions and helping them to live more healthily. OBJECTIVE: With this study, we assessed mobile health app use among older Australians in general and among those who were at risk of cardiovascular disease or type 2 diabetes mellitus. METHODS: In this cross-sectional analysis, we used data from the second follow-up wave of the 45 and Up Study. It is a cohort study from New South Wales, Australia, with 267,153 participants aged 45 years and older that is based on a random sample from the Services Australia (formerly the Australian Government Department of Human Services) Medicare enrollment database. The 2019 follow-up questionnaire contained questions about technology and mobile health use. We further used data on prescribed drugs and hospitalizations to identify participants who already had cardiovascular disease or diabetes or who were at risk of these conditions. Our primary outcome measure was mobile health use, defined as having used a mobile health app before. We used descriptive statistics and multivariate logistic regression to answer the research questions. RESULTS: Overall, 31,946 individuals with a median age of 69 (IQR 63-76) years had completed the follow-up questionnaire in 2019. We classified half (16,422/31,946, 51.41%) of these as being at risk of cardiovascular disease or type 2 diabetes mellitus and 38.04% (12,152/31,946) as having cardiovascular disease or type 1 or type 2 diabetes mellitus. The proportion of mobile health app users among the at-risk group was 31.46% (5166/16,422) compared to 29.16% (9314/31,946) in the total sample. Those who used mobile health apps were more likely to be female, younger, without physical disability, and with a higher income. People at risk of cardiovascular disease or type 2 diabetes mellitus were not statistically significantly more likely to use mobile health than were people without risk (odds ratio 1.06, 95% CI 0.97-1.16; P=.18; adjusted for age, sex, income, and physical disability). CONCLUSIONS: People at risk of cardiovascular disease or type 2 diabetes mellitus were not more likely to use mobile health apps than were people without risk. Those who used mobile health apps were less likely to be male, older, with a physical disability, and with a lower income. From the results, we concluded that aspects of equity must be considered when implementing a mobile health intervention to reach all those that can potentially benefit from it.

Remotely Conducted App-Based Intervention for Cardiovascular Disease and Diabetes Risk Awareness and Prevention: Single-Group Feasibility Trial.

BACKGROUND: Cardiovascular disease and type 2 diabetes mellitus are two of the most prevalent chronic conditions worldwide. An unhealthy lifestyle greatly contributes to someone's risk of developing these conditions. Mobile health is an emerging technology that can help deliver health promotion interventions to the population, for example, in the form of health apps. OBJECTIVE: The aim of this study was to test the feasibility of an app-based intervention for cardiovascular and diabetes risk awareness and prevention by measuring nonusage, dropout, adherence to app use, and usability of the app over 3 months. METHODS: Participants were eligible if they were aged 45 years or older, resided in Australia, were free of cardiovascular disease and diabetes, were fluent in English, and owned a smartphone. In the beginning, participants received an email with instructions on how to install the app and a user guide. After 3 months, they received an email with an invitation to an end-of-study survey. The survey included questions about general smartphone use and the user version of the Mobile Application Rating Scale. We analyzed app-generated and survey data by using descriptive and inferential statistics as well as thematic analysis for open-text comments. RESULTS: Recruitment took place between September and October 2021. Of the 46 participants who consented to the study, 20 (44%) never used the app and 15 (33%) dropped out. The median age of the app users at baseline was 62 (IQR 56-67) years. Adherence to app use, that is, using the app at least once a week over 3 months, was 17% (8/46) of the total sample and 31% (8/26) of all app users. The mean app quality rating on the user version of the Mobile Application Rating Scale was 3.5 (SD 0.6) of 5 points. The app scored the highest for the information section and the lowest for the engagement section of the scale. CONCLUSIONS: Nonusage and dropouts were too high, and the adherence was too low to consider the intervention in its current form feasible. Potential barriers that we identified include the research team not actively engaging with participants early in the study to verify that all participants could install the app, the intervention did not involve direct contact with health care professionals, and the app did not have enough interactive features.

A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study.

BACKGROUND: Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. OBJECTIVE: This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. METHODS: The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. RESULTS: The target population was Australians aged ≥45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants' feedback to improve these aspects. CONCLUSIONS: We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing.

Validation of a lifestyle-based risk score for type 2 diabetes mellitus in Australian adults.

The study aimed to assess the performance of a lifestyle-based prognostic risk model (Diabetes Lifestyle Score) for the prediction of 5-year risk of type 2 diabetes mellitus. The model comprises nine self-reported predictors (sex, age, antihypertensive drugs, body mass index, family history of diabetes, physical activity, fruits, vegetables, and wholemeal/brown bread). We conducted an external validation and update of the model in an Australian cohort including 97,615 residents of New South Wales aged 45 years and older who were free of type 1 and 2 diabetes mellitus at baseline. Of all participants, 4,741 developed type 2 diabetes mellitus over 5 years. We conducted the statistical analyses in RStudio using the programming language R. The area under the receiver operating characteristic curve (AUC) of the original model was 0.726 (95% confidence interval: 0.719, 0.733). After adjusting the calibration intercept and slope, the original model performed reasonably well in the external cohort. The best performance was measured by using the numerical predictors as continuous variables and refitting all coefficients (AUC: 0.741, 95% confidence interval: 0.734, 0.748). The results of the original model after calibration were comparable to those received from the AUSDRISK score which is routinely used in Australian clinical practice. Hence, the lifestyle-based model might be a reasonable alternative for laypersons since the required information is most likely known by these. Further, the risk score may communicate the message about the importance of a healthy diet to reduce the risk of diabetes.

Primary Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus Using Mobile Health Technology: Systematic Review of the Literature.

BACKGROUND: Digital technology is an opportunity for public health interventions to reach a large part of the population. OBJECTIVE: This systematic literature review aimed to assess the effectiveness of mobile health-based interventions in reducing the risk of cardiovascular disease and type 2 diabetes mellitus. METHODS: We conducted the systematic search in 7 electronic databases using a predefined search strategy. We included articles published between inception of the databases and March 2019 if they reported on the effectiveness of an intervention for prevention of cardiovascular disease or type 2 diabetes via mobile technology. One researcher performed the search, study selection, data extraction, and methodological quality assessment. The steps were validated by the other members of the research team. RESULTS: The search yielded 941 articles for cardiovascular disease, of which 3 met the inclusion criteria, and 732 for type 2 diabetes, of which 6 met the inclusion criteria. The methodological quality of the studies was low, with the main issue being nonblinding of participants. Of the selected studies, 4 used SMS text messaging, 1 used WhatsApp, and the remaining ones used specific smartphone apps. Weight loss and reduction in BMI were the most reported successful outcomes (reported in 4 studies). CONCLUSIONS: Evidence on the effectiveness of mobile health-based interventions in reducing the risk for cardiovascular disease and type 2 diabetes is low due to the quality of the studies and the small effects that were measured. This highlights the need for further high-quality research to investigate the potential of mobile health interventions. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO) CRD42019135405; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=135405.

Exploring pharmacists' views on an in-pharmacy medication review program in Australia using a mixed-methods design.

Background MedsCheck is an in-pharmacy medication review program funded by the Australian Government. It is intended to improve patient understanding of medicines and resolve adherence issues. Objective To explore MedsCheck from the community pharmacists' perspective, focusing on the perceived effectiveness of the program, barriers to its optimal delivery, and the integration with other services. Setting Individual interviews in one territory and a national online survey of Australian community pharmacists. Method Using a mixed-method triangulation design, the interviews and the survey were conducted concurrently. The interviews were semi-structured, transcribed verbatim and thematically analysed. The survey, comprising closed and open-ended questions, was quantitatively and thematically analysed. The findings were first analysed separately and finally integrated by searching for convergence, complementarity, and discrepancy. Main outcome measure Pharmacists' perceptions of the effectiveness and barriers of MedsCheck. Results Eight interviews were conducted, and 232 survey responses collected. In the interviews, themes related to perceived benefits (appreciation, reduced confusion, and strengthening relationships), barriers (lack of controls, lack of staff, lack of awareness, and lack of understanding of scope of services), and the integration with other services (strong link with dose administration aids) emerged, which mostly correlated with the survey's results. Ten percent of surveyed respondents did not provide the MedsCheck service; their main reason being insufficient staffing. Of the pharmacists offering the service, 76% strongly agreed that patients were benefitting. MedsCheck reviews were usually initiated by pharmacy staff. Fifty-three percent of respondent pharmacists never or only sometimes reported the review outcomes to the patient's general practitioner. Conclusion The pharmacists believed that MedsCheck is useful to improve patients' understanding and management of their medicines. However, there are currently barriers to the effective delivery of the service, including workload issues, lack of patient awareness, and the service's integration with the broader care of the patient. If these were appropriately addressed, the in-pharmacy medication review program could help pharmacists to better engage with patients and general practitioners and enhance understanding of medication and adherence.

Evaluation of Pharmaceutical Compounding Training in the Australian Undergraduate Pharmacy Curricula.

INTRODUCTION: In recent decades the role of the Australian community pharmacist has evolved to focus primarily on pharmaceutical care provision. Despite this, compounding remains an important product service offered by pharmacists. The aim of this study was to qualitatively describe the current integration of training in compounding within Bachelor of Pharmacy courses in Australia. Methods: The Australian Health Practitioner Regulatory Agency website was searched to identify eligible university courses. Subsequently, the educational providers' homepages were consulted, and Bachelor of Pharmacy handbooks and curricula perused. All relevant information regarding training in compounding was extracted. Results: In total, 16 Bachelor of Pharmacy courses were identified. All of these contain compounding training in their curricula, including laboratory classes. Most curricula have units specifically dedicated to compounding and drug formulation. Three universities offer a curriculum which is organ-systems based, and include compounding relevant to the individual organ systems. Discussion and Conclusions: In Australia, the training in compounding is well integrated into pharmacy curriculum and is more emphasised than in many other developed countries. This is congruent with the International Pharmaceutical Federation's needs-based approach to local pharmacy education. In Australia there is a need for pharmacists to routinely dispense simple compounded products. Further research is required to evaluate Australian pharmacy graduates' compounding abilities and how best to promote the achievement of the required knowledge and skills to enable simple compounding.

Analytical quality and effectiveness of point-of-care testing in community pharmacies: A systematic literature review.

BACKGROUND: Point-of-care tests are characterised through the ability of conducting them near the patient's side without the necessity of a laboratory. They can be applied in different healthcare settings to improve patients' access to testing. OBJECTIVE: To evaluate the effectiveness and analytical quality of point-of-care tests performed in the community pharmacy. METHODS: Six electronic databases were systematically searched using a predefined search strategy. Interventional studies that reported on the effectiveness of the point-of-care tests and accuracy studies that investigated their analytical quality were included. The literature search, study selection, and data extraction were performed independently by two researchers. RESULTS: In total, eleven studies were identified focusing on blood glucose, cholesterol, creatinine, uric acid, liver enzymes, international normalized ratio for anticoagulation therapy, bone mineral density for osteoporosis, forced expiratory volume for chronic obstructive pulmonary disease, and infection with human immunodeficiency virus. The included studies showed that point-of-care tests that were conducted and analysed in community pharmacies had satisfactory analytical quality and that the interventions applying these tests were effective overall. CONCLUSIONS: Community pharmacies are well suited to deliver a wide range of point-of-care tests. In the future this will allow easier access to various screening and diagnostic tests for patients.

Identification of Patients At-Risk of QT Interval Prolongation during Medication Reviews: A Missed Opportunity?

The prolongation of the QT interval is a relatively rare but serious adverse drug reaction. It can lead to torsade de pointes, which is potentially life-threatening. The study's objectives were: determine the use of QT interval-prolonging drugs in an elderly community-dwelling population at risk of medication misadventure and identify recommendations regarding the risk of QT interval prolongation made by pharmacists when performing medication reviews. In a retrospective evaluation, 500 medication review reports from Australian pharmacists were analysed. In patients taking at least one QT interval-prolonging drug, the individual risk of drug-induced QT interval prolongation was assessed. Recommendations of pharmacists to avoid the occurrence of this drug-related problem were examined. There was a high prevalence of use of potentially QT interval-prolonging drugs (71% patients), with 11% of patients taking at least one drug with a known risk. Pharmacists provided specific recommendations in only eight out of 35 patients (23%) with a high-risk score and taking drugs with known risk of QT interval prolongation. Pharmacists' recommendations, when present, were focused on drugs with known risk of QT interval prolongation, rather than patients' additional risk factors. There is a need to improve knowledge and awareness of this topic among pharmacists performing medication reviews.

Quality Use of the Pathology Data in Home Medicines Reviews: A Retrospective Evaluation.

BACKGROUND: Laboratory tests can be important tools for the assessment of pharmacotherapy. Nonetheless, there are no previous studies that have explicitly focused on the role of pathology data in Home Medicines Reviews (HMR), an Australian medication review program. OBJECTIVE: Evaluate pharmacists' recommendations regarding laboratory testing in the medication review process. METHODS: This retrospective review of HMRs assessed the prevalence of the pathology data provided by general practitioners. Additionally, the pharmacists' recommendations based on these laboratory data were compared with national and international guidelines. RESULTS: In total, 580 reports were evaluated. Of these, 179 reports did not contain any pathology data. Pharmacists commented on provided laboratory values in 324 reports and recommended further testing in 473 reports. Not all suggestions were related to previous values or were in line with guidelines. Most recommendations were regarding vitamin D and lipids (69% and 62% of medication review reports, respectively). Particularly, regarding renal impairment, pharmacists used their knowledge on dose adjustments and contraindications. In relation to full blood count, vitamin B12, and thyroid function, unjustified screenings were often recommended. In 26% of all reports, the pharmacists requested an array of tests without explaining the necessity for these tests. Conclusion and Relevance: Pharmacists provided useful advice based on the pathology data, which was concordant with national and international guidelines; however, in some cases, there was no rationale for the test recommendations provided. The outcome of the HMR program might be further enhanced if pharmacists had direct access to the patients' pathology data.