An analysis of hospital pharmacy practice in six countries of sub-Saharan Africa based on the International Pharmaceutical Federation Basel Statements on the future of hospital pharmacy.

OBJECTIVES: The objective of this study was to update the self-assessment tool and to evaluate current hospital pharmacy practices in six sub-Saharan African countries. METHODS: Questions in the validated survey were edited if the revised Basel Statement changed intent. A total of 13 updates were made. The survey was administered via e-mail to pharmacy personnel in any hospital centre in Ghana (258 total hospitals), Nigeria (17 038 total hospitals), Malawi (499 total hospitals), Uganda (155 total hospitals), Zambia (98 total hospitals) and Zimbabwe (1389 total hospitals). Snowball sampling increased reach of the survey across each country. KEY FINDINGS: Responses were received from all six countries, with nine respondents from Ghana, 15 from Nigeria, two from Malawi, five from Uganda, nine from Zambia and four from Zimbabawe. Uganda had the highest achievement rates for tier one and tier three constructs, and Ghana had the highest achievement rate for tier two constructs. Malawi showed the lowest achievement rates in all three tiers. The six countries achieved an average of 82 per cent (SD = 24) of tier one constructs. Three tier one constructs were achieved less than 25 per cent of the time. CONCLUSION: Multiple tier one (minimum standards in hospital pharmacy practice) constructs were achieved greater than 90% of the time, possibly reflecting efforts made towards hospital pharmacy practice advancement in select countries of sub-Saharan Africa. Additionally, all countries achieved a majority of tier one overarching constructs. Despite these achievements, there are still many areas for growth, including select tier one constructs with low achievement rates.

A Simulated Learning Environment for Teaching Medicine Dispensing Skills.

OBJECTIVE: To develop an authentic simulation of the professional practice dispensary context for students to develop their dispensing skills in a risk-free environment. DESIGN: A development team used an Agile software development method to create MyDispense, a web-based simulation. Modeled on virtual learning environments elements, the software employed widely available standards-based technologies to create a virtual community pharmacy environment. Assessment. First-year pharmacy students who used the software in their tutorials, were, at the end of the second semester, surveyed on their prior dispensing experience and their perceptions of MyDispense as a tool to learn dispensing skills. CONCLUSION: The dispensary simulation is an effective tool for helping students develop dispensing competency and knowledge in a safe environment.

Employing the nominal group technique to explore the views of pharmacists, pharmacy assistants and women on community pharmacy weight management services and educational resources.

OBJECTIVES: The objectives of this study were to investigate how pharmacists, pharmacy assistants and women feel about community pharmacy involvement in weight management, and to identify what pharmacists, pharmacy assistants and women want in weight management educational resources. METHODS: Three homogenous and one heterogeneous nominal group (NG) sessions of up to 120-min duration were conducted with nine women, ten pharmacists and eight pharmacy assistants. The NG technique was used to conduct each session to determine the most important issues that should be considered surrounding community pharmacy weight management services and development of any educational resources. The heterogeneous NG session was used to finalise what women, pharmacists and pharmacy assistants want in educational resources. KEY FINDINGS: Overall, pharmacists, pharmacy assistants and women believe that pharmacy staff have an important role in the management of overweight and obesity because of their accessibility, trust and the availability of products in pharmacy. Regarding the most suitable healthcare professional(s) to treat overweight and obesity, the majority of participants believed that no one member of the healthcare team was most suitable and that overweight and obesity needs to be treated by a multidisciplinary team. The importance of having weight management educational resources for pharmacy staff and women that come from trustworthy resources without financial gain or commercialisation was also emphasised. CONCLUSION: Pharmacists, pharmacy assistants and women feel that community pharmacies have a definite role to play in weight management. Pharmacy-specific weight management educational resources that are readily available to pharmacy staff and women are highly desirable.

Improving Australian care home medicine supply services: Evaluation of a quality improvement intervention.

AIM: The study aims to determine the impact of a quality improvement intervention on how accurately and suitably medicines are supplied to residents of residential aged-care facilities (RACFs). METHODS: Between September 2012 and January 2013, pharmacy-supplied dose administration aids (DAAs) were audited at 45 Victorian RACFs (Australia). RACFs had previously received an intervention (education session/toolkit) and were involved in an earlier DAA audit. Recently supplied DAAs containing regular medicines were compared to prescriber-prepared medicine charts to identify, and classify risks of, inaccurate or unsuitable packing incidents. RESULTS: Of 2389 DAAs audited for 983 residents, 770 incidents in 502 DAAs were identified. The overall DAA incident rate increased significantly from 11.5% pre-intervention to 21.0% post-intervention (P < 0.001). The proportion of DAAs affected by incidents classified as 'insignificant' or 'minor' risk increased post-intervention (P < 0.001). CONCLUSIONS: Further wide-scale evaluation of RACF medicine supply services is needed. Interventions that are effective in reducing DAA incidents should be explored.

The relationships between illness and treatment perceptions with adherence to diabetes self-care: A comparison between Arabic-speaking migrants and Caucasian English-speaking patients.

AIMS: To compare illness and treatment perceptions between Arabic-speaking immigrants and Caucasian English-speaking people with type 2 diabetes, and explore the relationships between these beliefs and adherence to self-care activities. METHODS: A cross-sectional study was conducted in healthcare settings with large Arabic populations in metropolitan and rural Victoria, Australia. Adherence to self-care activities, illness and treatment perceptions, and clinical data were recorded. Bivariate associations for continuous normally distributed variables were tested with Pearson's correlation. Non-parametric data were tested using Spearman's rank correlation coefficient. RESULTS: 701 participants were recruited; 392 Arabic-speaking participants (ASPs) and 309 English-speaking participants (ESPs). There were significant relationships between participants' illness and treatment perceptions and adherence to diabetes self-care activities. ASPs' negative beliefs about diabetes were strongly and significantly correlated with poorer adherence to diet recommendations, exercise, blood glucose testing and foot care. ASPs were significantly less adherent to all aspects of diabetes self-care compared with ESPs: dietary behaviours (P=<0.01; 95% confidence interval (CI)=-1.17, -0.84), exercise and physical activity (P=<0.001, 95% CI -1.14, -0.61), blood glucose testing (P=<0.001) and foot-care (P=<0.001). 52.8% of ASPs were sceptical about prescribed diabetes treatment compared with only 11.2% of the ESPs. 88.3% of ASPs were non-adherent to prescribed medication, compared with 45.1% of ESPs. CONCLUSIONS: Arabic-speaking migrants' illness and treatment perceptions were significantly different from the English-speaking group. There is a pressing need to develop new innovative interventions that deliver much-needed improvements in adherence to self-care activities and key health outcomes.

A national mailed survey exploring weight management services across Australian community pharmacies.

This study investigated pharmacists' and pharmacy assistants' current weight management recommendations to consumers across Australian community pharmacies using a mailed questionnaire. Two questionnaires were developed, one for pharmacists and one for pharmacy assistants, each divided into five sections. One pharmacist and pharmacy assistant questionnaire were mailed in November 2011 to a systematic sample of 3000 pharmacies across Australia for one pharmacist and pharmacy assistant each to complete. A total of 537 pharmacist and 403 pharmacy assistant responses, from 880 different pharmacies, were received. Overall 94.5% (n = 832/880) of associated pharmacies stocked weight loss products and 48.2% (n = 424/880) offered a weight management program. Both pharmacists and pharmacy assistants felt that the development of pharmacy-specific educational resources and additional training would help improve their ability to provide weight management services. Australian pharmacists and pharmacy assistants currently appear to be providing weight management services to consumers; however, not all their recommendations are evidence based. The need for additional training for pharmacy staff in areas identified as lacking and the development of pharmacy weight management educational resources needs to be addressed.

Exploring weight management recommendations across Australian community pharmacies using case vignettes.

With the increase in the overweight and obese population, it is critical that pharmacy staff are able to provide weight management advice to women at different stages of their life. This study utilized case vignettes to identify pharmacists' and pharmacy assistants' current weight management recommendations to women of different ages, life stages and co-morbidities. A total of 537 pharmacist and 403 pharmacy assistant responses were received. In the case of the pre-pregnancy vignette, only 57% (46/80) of pharmacy assistants were able to correctly identify a woman's weight category based on her body mass index, which was significantly fewer than 86% (86/108) of pharmacists (P < 0.001). In the pregnancy vignette, both pharmacists and pharmacy assistants were able to identify the risks of using a herbal weight loss medication in pregnancy. The need for a 'multi-disciplinary team approach' was seen in the menopause case vignette with pharmacists, highlighting the need for the involvement of other health care professionals for successful weight loss outcomes. Australian pharmacists and pharmacy assistants are currently providing weight management services to their consumers, however, not all of their recommendations are evidence-based. There is a need for pharmacy weight management educational resources to be developed and implemented across community pharmacies.

Comparing women pharmacy consumers' experiences with weight loss treatment in Victoria and Nottingham: a cross-sectional study.

BACKGROUND: There has been a recent increase in weight management services available in pharmacies across Australia and England. The aim of this study was to determine the following between women in Victoria and Nottingham: similarities and differences of what weight management options are preferred by women pharmacy consumers; how they feel about pharmacists providing advice in this area; and what they desire in a weight management program. METHOD: Women pharmacy consumers were randomly approached by a researcher in community pharmacies in Victoria and Nottingham and asked to complete a questionnaire regarding their own weight management experiences. The questionnaire was self-completed or researcher-administered and was comprised of four main sections that focused on the participant's general health, previous weight loss experiences, their ideal weight management program and their demographics. Data was entered in SPSS 19 and logistic regression was used to identify any differences in weight loss experiences between women. RESULTS: The participant rates were high: 86% (n = 395/460) in Victoria and 98% in Nottingham (n = 215/220). Overall, women in Victoria and Nottingham were similar with comparable demographics. Approximately 50% (250/507) of women were in the overweight or obese body mass index category, with over 70% (n = 436/610) of women having attempted to lose weight in the past. The majority of women (n = 334/436) felt comfortable receiving advice from pharmacists. In the logistic regression analysis women in Nottingham were found to be significantly less likely to have utilised a pharmacy weight management program in the last five years (OR: 0.23 CI: 0.08, 0.63) and were significantly less likely to want an ideal weight management program located in a pharmacy (OR: 0.49 CI: 0.30, 0.82) compared to women in Victoria. No significant associations between location and feeling comfortable with a pharmacist advising on weight loss or wanting a pharmacist in an ideal weight management program were seen. CONCLUSION: Results from this study have provided information on possible ideal pharmacy weight management programs in both Victoria and Nottingham. Although differences were seen between the two populations, similarities between ideal weight management programs and comfort level with pharmacist interaction were noted.

Patient engagement strategies used for hypertension and their influence on self-management attributes.

BACKGROUND: Several effective methods to facilitate patient self-management of hypertension are available in primary care. These include direct support from community pharmacists and general practice, and the use of home blood pressure (BP) monitoring. The aim of this study is to establish the prevalence of use of key strategies and to determine their independent relationship with patient self-management attributes. METHODS: A survey of patients with treated hypertension was undertaken in 27 community pharmacies. This established recent use of BP monitoring and advice from health professionals. Patient awareness of BP and targets, appropriateness of BP targets and adherence to anti-hypertensive medications were assessed as indicative self-management outcomes. Predictors of outcomes were determined using binary logistic regression. RESULTS: Overall, 215 surveys were returned. Two-thirds of patients were aged >65 years, and 45% had conditions warranting tighter BP control (<130/80 mmHg). Almost all patients reported monitoring of their BP in the previous year and 63% could report their most recent BP reading. Just 36% reported knowing a target BP, and 78% of reported targets were within guidelines recommendations. One-fifth (22%) monitored their own BP, and 15% reported non-adherence to medication. Doctors provided the large majority of professional advice. Self-monitoring or documentation of BP readings was independently associated with increased likelihood of BP and target BP being known. CONCLUSIONS: Regular monitoring of BP does not automatically translate to professional advice. Increased uptake of patient self-monitoring should be promoted as a means of enabling self-management.

Exploring factors that contribute to dose administration aid incidents and identifying quality improvement strategies: the views of pharmacy and nursing staff.

BACKGROUND: Dose administration aids (DAAs) organise medicines that have been repacked according to the day of the week and time of the day in which they must be taken. In Australia, DAAs are commonly prepared by pharmacy staff for residential aged care facility (RACF) medicine administration. Although the limited available literature indicates that DAA incidents of inaccurate or unsuitable medicine repacking do occur, there is a paucity of qualitative research identifying quality improvement strategies for this service. OBJECTIVES: This study aims to investigate the perceived contributing factors to DAA incidents and strategies for quality improvement in RACFs and pharmacies. METHODS: Health professional perceptions were drawn from three structured focus groups, including six pharmacists, five nurses, a pharmacy technician and a personal care worker. Participants were involved in the preparation, supply or use of DAAs at pharmacies or RACFs that were involved in a previous DAA audit. Transcripts were analysed using thematic analysis. KEY FINDINGS: Four major themes were identified as contributing to DAA incidents, with quality improvement strategies aligned to those same four themes: communication, knowledge and awareness, medicine handling and attitude. Strategies included improving interprofessional communication and addressing the limitations associated with RACF medicine records; targeting medicine knowledge gaps and increasing awareness of DAA incidents; encouraging greater care when preparing and checking DAAs; and fostering a team mentality among members of the aged care team. CONCLUSIONS: Recommendations include using current findings to develop multidisciplinary quality improvement initiatives to prevent DAA incidents and to improve the quality of this pharmacy medicine supply service.

Can a redesign of emergency pharmacist roles improve medication management? A prospective study in three Australian hospitals.

BACKGROUND: Emergency departments (EDs) face increasing service demands and the imposition of treatment targets which has led to continual process redesign and changes in staff skill mix and functions. OBJECTIVE: To identify extended ED pharmacist roles that could improve medication management and to implement and evaluate one such role change. METHODS: A focus group of clinicians sought to redesign processes around ED medication management. Preparation of medication charts for patients admitted from ED was selected. Baseline data were obtained to define elements of existing medication charting processes. Suitably trained ED pharmacists' trialled the effectiveness of making therapeutic suggestions on a medication chart 'sticker' or by direct 'consultation' with medical staff. At the conclusion of the study focus groups at each site evaluated clinical staff perceptions of the change. RESULTS: Focus group participants thought that ED pharmacists could undertake extended roles in analgesia, nausea control, antibiotic cover, addiction management and preparation of medication charts for admitted patients. In the pre-intervention audit (n = 140), 74% required at least one intervention by the ward pharmacists to address medication discrepancies. Ward pharmacists detected 292 medication discrepancies (median 1, IQR 0-3). In the 'sticker' intervention the ED pharmacist made 84 therapeutic suggestions of which 66 (78.6%) were accepted by medical staff. In the 'consultation' intervention 230 therapeutic suggestions were made of which 219 (95.2%) were accepted. The qualitative evaluation found that pharmacist-prepared medication charts within the processes established were deemed safe, timely, accurate, complete and legible. CONCLUSION: Support exists for ED pharmacists to expand their medication-related roles. ED pharmacists can safely prepare medication charts in a timely fashion and their therapeutic suggestions within a 'consultative' framework are more beneficial than written advice. However, issues relating to resourcing, hours of service, service focus, statutory restrictions and training support for extended roles require resolution.

Women, pharmacy and the World Wide Web: could they be the answer to the obesity epidemic?

OBJECTIVES: The objective of this article is to explore how giving women access to evidence-based information in weight management through pharmacies, and by utilising the World Wide Web, is a much needed step towards dealing with the obesity crisis. KEY FINDINGS: Women's needs should be considered when developing evidence-based information on weight. Excess weight places them at high risk of diabetes and cardiovascular disease, infertility and complications following pregnancy and giving birth. Women are also an important population group because they influence decision-making around meal choices for their families and are the biggest consumers of weight-loss products, many of which can be purchased in pharmacies. Pharmacies are readily accessible primary healthcare locations and given the pharmacist's expertise in being able to recognise underlying causes of obesity (e.g. medications, certain disease states), pharmacies are an ideal location to provide women with evidence-based information on all facets of weight management. Considering the exponential rise in the use of the World Wide Web, this information could be delivered as an online educational resource supported by other flexible formats. CONCLUSIONS: The time has come for the development of an online, evidence-based educational resource on weight management, which is combined with other flexible formats and targeted at women in general and according to different phases of their lives (pregnancy, post-partum, menopause). By empowering women with this knowledge it will allow them and their families to take better control of their health and wellbeing, and it may just be the much needed answer to complement already existing resources to help curb the obesity epidemic.

Management of children's fever by parents and caregivers: Practical measurement of functional health literacy.

Functional health literacy is founded on general and numerical literacy and practical skills and is required for the appropriate and effective management of health symptoms in children. This study aimed to assess the health literacy skills of parents and caregivers of preschool-aged children, using a progressive scenario describing a child with fever and presenting tasks relating to selection of a medicine and hypothetical dosing of their child. Participants (n = 417) from 33 childcare- and health-related sites in Sydney, Brisbane, Melbourne and Auckland completed the study. Participants' responses were largely appropriate regarding actions in response to worsening symptoms, selection of an appropriate product (from a limited range), whereby 84.5% of responses were for a single-ingredient paracetamol product and use of the package directions to state the frequency of dosing (93.1% of frequencies appropriate for paracetamol and 66.7% for ibuprofen). However, in only 50.8% of cases was an appropriate weight-based dose calculated, and doses were not measured to within 10% of the stated dose in 16.7% of cases. Future studies should focus on skill development via educational campaigns for parents and caregivers.

Towards improving dose administration aid supply: a quality improvement intervention aimed at reducing dispensing errors.

BACKGROUND: There is a risk that medicines can be dispensed into dose administration aids (DAAs), inaccurately or unsuitably. Quality improvement interventions (QIIs) may target this pharmacy medicine supply service and reduce the occurrence of these dispensing errors. In turn, medicine administration can improve in nursing homes (NHs) that use these devices. OBJECTIVE: To develop, introduce and evaluate the potential of a QII to improve DAA medicine supply. SETTING: Fourteen Victorian community pharmacies and 45 NHs. METHODS: A QII was developed using findings from three focus groups with 13 participants involved with DAAs at community pharmacies and NHs. The intervention was introduced to community pharmacies and NHs via a pharmacist-facilitated education session; attendees completed an evaluation questionnaire. MAIN OUTCOME MEASURE: Potential usefulness and effectiveness of the QII at improving DAA supply and reducing dispensing errors. RESULTS: The QII was titled: 'Be alert and work together for medicine safety, DAA incident awareness toolkit'. Four-hundred and thirty-five questionnaires were returned (85.0 % response rate). Respondents believed the intervention had the potential to improve pharmacy medicine supply or NH medicine administration involving DAAs 'very' (47.3 % of responses) or 'extremely well' (23.4 %). The intervention had the potential to reduce the occurrence of DAA dispensing errors 'very' (49.6 %) or 'extremely well' (20.5 %). CONCLUSION: A stakeholder informed QII was perceived to have the potential to improve DAA medicine supply from community pharmacies to NHs and reduce the occurrence of dispensing errors found within them. Future quantitative evaluation of the intervention is required.

Women pharmacy consumers' experiences with weight loss treatment across Victoria, Australia.

BACKGROUND: Given the role of pharmacy in weight management is increasing, anecdotally weight loss treatments are consumed by more women than men, and there are some causes of overweight and obesity specific to women, it is important that pharmacists provide evidence-based services that consider women's needs as a basis for a future population based approach. OBJECTIVES: To determine what weight management options are preferred by women pharmacy consumers, how they feel about pharmacists providing advice in this area, and what they desire in a weight management program. METHODS: A random sample of women pharmacy consumers were asked to complete a questionnaire in randomly selected pharmacies across Victoria. Questionnaires were self-completed or with assistance from the researcher. Logistic regression analysis was used to determine any significant associations between demographic characteristics and previous weight loss attempts, pharmacy specific outcomes and what women want in their ideal weight management program. SETTING: Community pharmacies across Victoria, Australia. MAIN OUTCOME MEASURE: The views and opinions of women pharmacy consumers across Victoria regarding pharmacy involvement in weight management and currently available weight management products and/or programs. RESULTS: The response rate was high: 86 % (395/460). Approximately 48 % (153/319) of women were in the overweight, obese or severely obese body mass index category (BMI). 71.1 % (281/395) of women had attempted to lose weight in the past. Women in the overweight BMI category were 2.6 times more likely to have attempted to lose weight (95 % CI 1.4, 4.9), and women in the obese BMI category were 10.6 times more likely to have attempted to lose weight (95 % CI 4.1, 27.7) compared to the women with a BMI <25 kg/m(2). Approximately 80 % (230/281) of women felt comfortable receiving advice from pharmacists with 42 % (117/281) wanting a pharmacist in their ideal weight management program and 42 % (118/281) wanting their program to be delivered in a pharmacy. CONCLUSIONS: Women pharmacy consumers used a range of weight management approaches and had mainly positive views about the involvement of pharmacists in their ideal weight management program.