Evaluation of Antibiotic Supply Decisions by Community Pharmacists in Thailand: A Vignette Study.

In Thailand, antibiotics are available lawfully from community pharmacies without a prescription. Inappropriate supply of antibiotics from Thai community pharmacies to the public for common, self-limiting diseases has been reported. The study aimed to evaluate the appropriateness of antibiotics selected by community pharmacists in Thailand in response to vignettes. A cross-sectional survey of community pharmacists across Thailand was conducted using a self-administered questionnaire including nine case vignettes with three conditions, namely upper respiratory infections (URIs), acute diarrhoea and simple wounds. A total of 208 questionnaires were completed and analysed (20.8% response rate). In response to vignettes relating to URIs, 50.8% of pharmacist recommendations were not in accordance with antibiotic guidelines. Inappropriate recommendations for diarrhoea and wound cases were 20.8% and 16.7%, respectively. A higher proportion of younger pharmacists, those with less experience, Pharm. D. graduate pharmacists, employee pharmacists and those pharmacists who worked in a chain pharmacy were more likely to recommend appropriate antibiotic treatment in response to the vignettes (p < 0.05). These findings will be useful to promote educational interventions for community pharmacists regarding common infectious disease management in order to improve appropriate antibiotic use.

Evaluating an undergraduate interprofessional education session for medical and pharmacy undergraduates on therapeutics and prescribing: the medical student perspective.

BACKGROUND: The current literature on undergraduate interprofessional education (IPE) for pharmacy and medical students highlights a range of positive outcomes, although to date IPE has focused predominantly on student views and experiences of IPE sessions with these opinions being sought at the end of the sessions. This study aimed to evaluate medical students' experiences of therapeutics and prescribing IPE, with pharmacy students, 1 year following the session. METHODS: Following ethics committee approval, 3rd year medical students at Cardiff University were invited to participate using non-probability sampling. Topic guide development was informed by the literature and research team discussions, including a review of the materials used in the IPE session. Semi-structured one-to-one interviews explored experiences, prior to, during, and after the IPE session. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. RESULTS: Eighteen medical students were interviewed; 11 were females. Seven themes were identified, namely 1) refinement of pre-session preparation, 2) session value, 3) learning with a pharmacy student, 4) learning about a pharmacist, 5) learning from a pharmacy student, 6) importance and application of what was learnt into practice, and 7) suggestions for change. CONCLUSION: This study provides a valuable insight into medical students' experiences of a therapeutics and prescribing IPE session and emphasizes the value they placed on interaction with pharmacy students. Medical students were able to recall clear learning experiences from the IPE session that had taken place 12 months earlier, which itself is an indicator of the impact of the session on the students. Furthermore, they were able to describe how knowledge and skills learnt had been applied to subsequent learning activities. Those developing IPE sessions should consider the following: clarify professional roles in the session content, incorporate IPE as a series of activities, and use small groups of students to optimize student-student interaction and active learning.

An exploratory study of the patient experience of pharmacist supplementary prescribing in a secondary care mental health setting.

BACKGROUND: Management of chronic disease has become an increasing challenge to the National Health Service in the United Kingdom. The introduction of supplementary prescribing was seen as a possible mechanism to address the needs of this patient group. Individuals with mental illness were considered particularly suitable for management in this way. OBJECTIVE: To explore the views and experiences of patients with mental illness on being managed by a pharmacist supplementary prescriber in a secondary care outpatient setting. METHODS: A study of patient experiences utilising semi-structured interviews and self-completion diaries was adopted. Eleven patients participated in the study. Data were analysed utilising code and retrieve, and content analysis respectively. RESULTS: Patients valued the increased accessibility to, and continuity of, their prescriber compared with their experience of other healthcare professionals. Patients reported they were able to trust the pharmacist's knowledge of medication, were provided with sufficient information regarding reasons for treatment and side effects, and felt that they had an active role in decisions concerning their healthcare. CONCLUSIONS: This exploratory study showed that patients had positive views of being managed by a supplementary prescriber. However, it should be noted that the number of participants was small. It is therefore important that further, more wide ranging research is conducted to evaluate pharmacist prescribing within mental health settings.

An exploratory study of the patient experience of pharmacist supplementary prescribing in a secondary care mental health setting / Estudio exploratorio de la experiencia de los pacientes sobre la prescripción farmacéutica suplementaria en una clínica secundaria de salud mental

Background: Management of chronic disease has become an increasing challenge to the National Health Service in the United Kingdom. The introduction of supplementary prescribing was seen as a possible mechanism to address the needs of this patient group. Individuals with mental illness were considered particularly suitable for management in this way. Objective: To explore the views and experiences of patients with mental illness on being managed by a pharmacist supplementary prescriber in a secondary care outpatient setting. Methods: A study of patient experiences utilising semi-structured interviews and self-completion diaries was adopted. Eleven patients participated in the study. Data were analysed utilising code and retrieve, and content analysis respectively. Results: Patients valued the increased accessibility to, and continuity of, their prescriber compared with their experience of other healthcare professionals. Patients reported they were able to trust the pharmacist’s knowledge of medication, were provided with sufficient information regarding reasons for treatment and side effects, and felt that they had an active role in decisions concerning their healthcare. Conclusions: This exploratory study showed that patients had positive views of being managed by a supplementary prescriber. However, it should be noted that the number of participants was small. It is therefore important that further, more wide ranging research is conducted to evaluate pharmacist prescribing within mental health settings (AU)

Antecedentes: El manejo de las enfermedades crónicas se ha convertido en un reto para el Sistema Nacional de Salud del Reino Unido. La introducción dela prescripción suplementaria fue vista como un mecanismo para afrontar las necesidades de este grupo de pacientes. Los individuos con problemas de salud mental fueron considerados particularmente apropiados para teste tipo de manejo. Objetivo: Explorar las visiones y experiencias de los pacientes con salud mental al ser manejados por un farmacéutico prescriptor suplementario en una clínica ambulatoria de cuidaos secundarios. Métodos: Se adoptó un estudio de las experiencias de los pacientes utilizando entrevistas semiestructuradas y diarios auto-cumplimentados. Once pacientes participaron en el estudio. Los datos se analizaron usando codificación y recuperación, y un análisis de contenido respectivamente. Resultados: Los pacientes valorizaron el aumento de accesibilidad y la continuidad de su prescriptor comparado con otros profesionales de la salud. Los pacientes comunicaron que eran capaces de confiar en los conocimientos sobre medicación del farmacéutico, que les proporcionaba con suficiente información sobre los motivos de su tratamiento y efectos adversos, y sentían que tenían un papel activo en las decisiones sobre su salud. Concusiones: Este estudio exploratorio mostró que los pacientes tenían visiones positivas al ser manejados por un prescriptor suplementario. Sin embargo, debe reconocerse que el número de participantes fue pequeño. Por ello es importante que se realice más investigación y más amplia para evaluar la prescripción farmacéutica en las clínicas de salud mental (AU)

An international comparison study of pharmacy students' achievement goals and their relationship to assessment type and scores.

OBJECTIVE: To identify pharmacy students' preferred achievement goals in a multi-national undergraduate population, to investigate achievement goal preferences across comparable degree programs, and to identify relationships between achievement goals, academic performance, and assessment type. METHODS: The Achievement Goal Questionnaire was administered to second year students in 4 universities in Australia, New Zealand, England, and Wales. Academic performance was measured using total scores, multiple-choice questions, and written answers (short essay). RESULTS: Four hundred eighty-six second year students participated. Students showed an overall preference for the mastery-approach goal orientation across all sites. The predicted relationships between goal orientation and multiple-choice questions, and written answers scores, were significant. CONCLUSION: This study is the first of its kind to examine pharmacy students' achievement goals at a multi-national level and to differentiate between assessment type and measures of achievement motivation. Students adopting a mastery-approach goal are more likely to gain high scores in assessments that measure understanding and depth of knowledge.

An international validation study of two achievement goal measures in a pharmacy education context.

BACKGROUND: Achievement goal theory helps us understand what motivates students to participate in educational activities. However, measuring achievement goals in a precise manner is problematic. Elliot and McGregor's Achievement Goal Questionnaire (AGQ) and Elliot and Murayama's revised Achievement Goal Questionnaire (AGQ-R) are widely used to assess students' achievement goals. Both instruments were developed and validated using undergraduate psychology students in the USA. METHODS: In this study, our aims were to first of all, assess the construct validity of both questionnaires using a cohort of Australian pharmacy students and, subsequently, to test the generalizability and replicability of these tools more widely in schools of pharmacy in other English-speaking countries. The AGQ and the AGQ-R were administered during tutorial class time. Confirmatory factor analysis procedures, using AMOS 19 software, were performed to determine model fit. RESULTS: In contrast to the scale developers' findings, confirmatory factor analysis supported a superior model fit for the AGQ compared with the AGQ-R, in all countries under study. CONCLUSION: Validating measures of achievement goal motivation for use in pharmacy education is necessary and has implications for future research. Based on these results, the AGQ will be used to conduct future cross-sectional and longitudinal analyses of the achievement goals of undergraduate pharmacy students from these countries.

An investigation of prescription and over-the-counter supply of ophthalmic chloramphenicol in Wales in the 5 years following reclassification.

OBJECTIVES: The aims of the study were to (i) quantify the sales of over-the-counter (OTC) ophthalmic chloramphenicol from all community pharmacies in Wales and investigate the impact on primary care prescriptions up to 5 years after reclassification and (ii) investigate the temporal relationship between items supplied OTC and on NHS primary care prescriptions. METHODS: Primary care prescription data (2004-2010) and OTC sales data (2005-2010) for ophthalmic chloramphenicol were obtained. The quantity sold OTC was calculated from pharmacy wholesale records and sales data from a large pharmacy multiple. Spearman's rank correlation for prescription and OTC supplies of ophthalmic chloramphenicol was calculated for data from January 2008 to December 2010. KEY FINDINGS: OTC supply of chloramphenicol eye drops and ointment were both highest in 2007-2008 and represented 68% (57,708/84,304) and 48% (22,875/47,192) of the corresponding prescription volume, respectively. There was a steady year-on-year increase in the combined supply of OTC ophthalmic chloramphenicol and that dispensed on prescription from 144,367 items in 2004-2005 to 210,589 in 2007-2008 before stabilising in 2008-2009 and 2009-2010. A significant positive correlation was observed between prescription items and OTC sales of chloramphenicol eye drops and ointment combined (r=0.7, P<0.001). CONCLUSION: OTC availability increased the total quantity of ophthalmic chloramphenicol supplied in primary care compared to that seen prior to reclassification. Although growth in the sales of ophthalmic chloramphenicol OTC has stabilised and the supply pattern mirrors primary care prescribers, further work is required to investigate whether use is appropriate and whether the publication of updated practice guidance has changed this.

Microneedles in clinical practice--an exploratory study into the opinions of healthcare professionals and the public.

PURPOSE: Microneedles are being developed to administer vaccines and therapeutics to and through skin. To date there has been no qualitative or quantitative research into public and health professionals' views on this new delivery technique. METHODS: Focus groups (n=7) comprising public and healthcare professionals were convened to capture the perceived advantages for, and concerns with, microneedles. Discussions were audio-recorded and transcribed. Transcript analysis identified themes that were explored using a questionnaire identifying consensus or otherwise. RESULTS: Participants identified many potential benefits of the microneedle delivery system, including reduced pain, tissue damage and risk of transmitting infections compared with conventional injections, as well as potential for self-administration (subject to safeguards such as an indicator to confirm dose delivery). Delayed onset, cost, accurate and reliable dosing and the potential for misuse were raised as concerns. A range of potential clinical applications was suggested. The public (100%) and professional (74%) participants were positive overall about microneedle technology. CONCLUSIONS: This exploratory research study captured the views of the eventual end-users of microneedle technology. Microneedle researchers should now reflect on their research and development activities in the context of stakeholder engagement in order to facilitate the transfer of this new technology 'from bench to bedside.'

Eleven themes of patient-centred professionalism in community pharmacy: innovative approaches to consulting.

OBJECTIVES: The study aimed to clarify patient-centred professionalism within and across community pharmacy settings; position that knowledge in a modern-day environment, accessing the opinions and experiences of patients and professionals; inform the literature on the value of consultation workshops within this context; and develop a template of positive and challenging exemplars of patient-centred professionalism within these contexts. METHODS: Thirty-nine study participants contributed to extended consultation workshops. Sessions were supported by bio-photographic data of healthcare practices across a range of different settings, and a final forum event. KEY FINDINGS: Thematic analysis of qualitative data, supported by the Nominal Group Work technique, led to a template containing 11 themes of positive and challenging aspects of patient-centred professionalism: safety, professional characteristics, relationships with patients, confidentiality and privacy, accessibility, training, professional pressures, services, environment, changing professional roles and patient characteristics. Themes, while descriptive and rich, highlight difficulties in defining this notion, which is both nuanced and ambiguous. While study participants were interested in the everyday examples of practice and interaction, they were strongly influenced by their different agendas and experiences. Patients, for example, wanted a quick and efficient dispensing service, where their needs and expectations came first. Pharmacists, on the other hand, found that pressing patient demands and overarching company policies led to professional anxiety that distracted them from what they perceived to be the defining aspect of their professionalism, dispensary work. CONCLUSIONS: The study outcomes indicate, in line with international literature, that while proud of supporting patients, many pharmacists feel demoralised, torn between pressing public and professional demands and the expectations of advice-giving in unfamiliar, formal situations within nondescript, corporate workspaces.

Language issues in the community pharmacy: a perspective from Wales.

OBJECTIVES: This study aimed to obtain the views of Welsh speakers to explore the role of the Welsh language in community pharmacies in bilingual communities in Wales. METHODS: Two communities with a high proportion of Welsh speakers were purposively identified for the research: one in North Wales and one in West Wales. Stage 1: semi-structured interviews with a purposive sample of Welsh speakers to identify key themes. Data collection continued until no new themes emerged. Interviews were tape-recorded, transcribed verbatim, coded manually and analysed thematically. Stage 2: self-complete questionnaire developed based on the interview results. The anonymous, bilingual questionnaire and covering letter, with a postage-paid envelope, were delivered to 500 homes (250 in each community) for completion by the person in the household who visited a pharmacy most often. There was no follow-up mailing due to anonymity. Data were analysed using SPSS version 12. KEY FINDINGS: Results from both interviews (n = 36) and questionnaires (response rate was 52%, 82% of whom were Welsh speakers) found that the majority of Welsh speakers in the study were able to understand English but preferred to use Welsh in the pharmacy. They would find it easier to explain symptoms and would ask more about their medication if they could speak Welsh with the pharmacist. In addition, the study participants would generally feel more at ease with a Welsh-speaking pharmacist and would feel they were getting a better service if they could use their first language. CONCLUSIONS: This study of Welsh speakers indicates that language choice is important for bilingual people who may prefer to use their native, minority language for consultation with health professionals. Further, it is clear that a concordant partnership between patient and pharmacist is less likely where one party is using a language with which they are not confident or comfortable. Pharmacists need to be aware of the linguistic needs and preferences of bilingual clients.

Roles of Medicines Counter Assistants in advice giving in community pharmacies: a Discourse Analysis.

OBJECTIVE: Research in interaction and communication in community pharmacies has been reported in a number of countries but to date, talk at the micro-level in the community pharmacy context in the UK has received virtually no study. The objective of this exploratory study was to identify what light a Discourse Analytic approach could shed to describe the role(s) of Medicines Counter Assistants (MCAs) when dealing with clients relating to health, illness or medicines. METHODS: Discourse Analysis is a growing field of study which has its roots in linguistics, but also in critical theory, philosophy, sociology, psychology and more. It is used in various ways by social scientists studying spoken and written language in use. Following research ethics approval and informed consent from participants, audio-recordings of staff-client interactions in three community pharmacies in Wales, UK were transcribed and analysed from a Discourse Analytic perspective, focussing on the emerging role of the MCA in the negotiation of advice. Main outcome measure Transcripts of interactions in community pharmacies analysed using Discourse Analysis. RESULTS: Ten hours of recordings were made. Of the 41 recorded interactions obtained, 29 involved an MCA regarding health and/or medicines. Example extracts represent different ways in which MCAs are involved in the interactions, ranging from dealing solely with the client, to the MCA dealing with the client but checking advice with the pharmacist, the MCA acting as a gatekeeper, the pharmacist intervening in the MCA-client interaction, the MCA keeping the client 'on hold' until the pharmacist is ready to interact with them and the MCA acting as an active intermediary. With the differing involvement, slightly different institutional and participant roles emerge for the MCAs through talk and interaction. CONCLUSION: This exploratory study succeeded in producing transcripts of interactions between MCAs, and clients and indicated that Discourse Analysis is helpful in assisting our understanding of the involvement of MCAs in UK community pharmacy encounters. With regards the negotiation of advice, we have shown how the physical and legal contexts, in addition to the discursive/interactional context, play a part in information delivery, as does the different staff's access to knowledge.