摘要:

A two‐stage audit of community pharmacists' service in response to symptoms was carried out using a previously piloted method. Pharmacists from up to 46 pharmacies completed questionnaires indicating the advice they thought should be given in each of 12 scenarios that could present to community pharmacies. The six scenarios with the highest consensus response were later enacted in the same pharmacies by researchers. Three were used in the first stage and three in the second. Meetings were held between the stages to discuss the results and suggest ways of improving them. The consensus advice, determined by the questionnaire responses, was given on only 27 per cent of all visits — 18 per cent in the first stage and 35 per cent in the second. This was mainly due to non‐drug advice being omitted. “Appropriate” products were recommended in 90 per cent of first stage visits but only 74 per cent of second stage visits. “Acceptable” advice was provided in 75 per cent of all visits, with little difference between the two stages. Questioning of the researchers was “good” in 35 per cent of first stage visits and 43 per cent of second stage visits. Inadequate questioning was significantly related to inappropriate advice being given. Inappropriate advice was given on 25 per cent of all visits, with equal frequency by both pharmacists and assistants. Participating pharmacists identified many problems that could contribute to a less than ideal service but most were outside their control, such as television advertising of products and customer expectations. The use of protocols, implementation of staff training and the audit were considered to have had a positive effect on the response to symptoms service. Most participants considered that the method used was acceptable and suggested a similar method should be used on a regular basis to mo

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00855.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The incidence of threatening and violent behaviour in community pharmacy is of concern to pharmacists and their staff, who, if they have not experienced events themselves, will be aware of anecdotal reports and will have their own perceptions about their vulnerability and risks. The frequency of serious and more minor incidents, when and where they occur, is unknown. The concerns of pharmacists may have wide‐ranging implications for pharmacy practice and the services pharmacists are prepared to offer. This study was conducted in two stages: a postal survey of all community pharmacies in six family health services authorities in and around London, followed by semi‐structured interviews with pharmacists who had reported a threat and/or an assault while at work. This first paper reports an investigation of the frequency and nature of events, pharmacists' perceptions of crime and of their own safety, and the association of these findings with demographic and other variables. The second paper addresses the implications for pharmacists and community pharmacy services.Fifty‐one per cent of respondents reported that they or their staff had at some time been threatened with violence and 31 per cent had been assaulted. Incidents involving knives or firearms comprised about one‐fifth of all cases. Approximately one‐third of events related to robbery of drugs, supply of prescriptions or non‐dispensing pharmacy services and would thus be peculiar to community pharmacy. Therefore the possession of drugs on the premises and other aspects of the professional role of pharmacists places them at increased risk over other retail businesses. Significant minorities of pharmacists did not feel safe in the pharmacy on their own, or undertaking certain everyday activities. Events and concerns were more common in areas with a high Jarman score. Only weak associations were found between whether or not pharmacists reported incidents and personal and other business char

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00856.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

This paper reports the second stage of a study into threatening and violent incidents in community pharmacies. The first stage, an investigation of the frequency and nature of incidents, found that a high proportion of practising pharmacists had been threatened and/or assaulted while at work (see p136). The implications of security issues for pharmacists, and how these affect the services they are prepared to offer, are addressed in this paper. Data were collected in semi‐structured interviews with pharmacists who had reported one or more threatening or violent incidents.Many respondents described serious events with lasting psychological effects, including anxiety about their own safety and changed attitudes towards clients. Pharmacists' concerns about personal safety influenced them in their decisions regarding the services they offered. Pharmacists felt vulnerable at opening and closing times and believed that services to intravenous drug users increased the risks of an event; many incidents did actually occur at these times and involve this group of people. Concerns about safety and security affected late‐night and out‐of‐hours dispensing, services to IV drug users and domiciliary visits. More surprisingly, pharmacists also reported effects on their general dispensing and advice‐giving activities.The role of pharmacists in primary health care is becoming more prominent as the Government promotes community based care and encourages individuals to take more responsibility for their own health. Concerns about safety and security could hamper the continuation and development of professional services. The profession must acknowledge the potential impact of these issues in its aspirations and recommendations regarding its future primary

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00857.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

A postal survey was carried out in the Eastern health and social services board in Northern Ireland to evaluate the views of community pharmacists (n= 100) on pharmacy involvement in formulary development. There was one mailing, with a response rate of 66 per cent. Most respondents (78.7 per cent) agreed or strongly agreed that pharmacist involvement in formulary development was important. Almost two thirds of responding pharmacists said they would be prepared to approach a GP in relation to such collaborative work and 27 per cent had had previous contact with GPs on the subject. Respondents considered that their input would be particularly useful in improving prescribing, providing cost advice and developing a closer working relationship with GPs. Evaluation of current levels of interprofessional liaison in relation to prescribing issues showed that 33.3 per cent of the pharmacists were already contacted by a GP regularly and 45.4 per cent contacted a GP regularly. Most (80 per cent) rated their working relationship with the GP as useful or very useful. The results suggest that community pharmacists in the Eastern health and social services board are willing to become involved in formulary development, thereby extending the use of practice formularies in general practice and integrating community pharmacy more fully into the primary health care team.

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00858.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Self‐medication plays an increasingly important role in the health care systems of many countries. In the United Kingdom (UK) this is reflected in the current policy of deregulating increasing numbers of prescription‐only medicines (POM) to pharmacy medicines (P). The purpose of the work described in this paper was to explore factors affecting clients' choice to self‐medicate or to contact their doctor for the treatment of a minor ailment, namely, hay fever. Structured qualitative interviews were conducted with 36 clients recruited through community pharmacies. The main themes investigated were clients' reasons for choosing their particular management option and their attitudes towards the increasing number of OTC medicines and towards self‐medication. For clients who obtained the medicine through their doctor, the most common reason for doing so was cost. For clients who obtained their medicine over the counter, the incentive to self‐medicate was convenience. Payment for or exemption from prescription charges was a major factor. Many clients mentioned potential risks involved in self‐medication and the need for appropriate information. However, clients drew differing conclusions on these issues, reflecting either a negative or a positive attitude towards self

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00859.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The potential intervention rate for cardiovascular drugs dispensed in community pharmacy was investigated by a retrospective study of 300 patient medication records (PMRs) collected from 10 community pharmacies in Sydney, Australia. A medication review protocol and operational definitions were developed for 17 types of clinical intervention and three levels of clinical significance. Spearman's correlation coefficient (rs) was used to examine the relationship between total number of potential interventions and predictor variables. From 5,271 medications dispensed, 1,509 (28.6 per cent) potential interventions were identified. The most frequent types of potential intervention were precautions (27.6 per cent), overutilisation (17 per cent) and dose discrepancy (16.3 per cent). Of the interventions classified as being of major clinical significance, 61.3 per cent were precautions, 19.7 per cent drug interactions and 19 per cent contraindications. The cardiovascular drug classes with the highest potential intervention rate were inotropics (93.2 per cent) and anticoagulants (89.5 per cent). There was a statistically significant correlation between the number of potential interventions per patient and the total number of medications dispensed per patient (rs=0.68,P<0.001), the total number of cardiovascular drugs dispensed per patient (rs=0.67,P<0.001) and the number of different prescribing doctors per patient (rs=0.29,P<0.001). This study demonstrates the potential for community pharmacists to review computerised PMRs and intervene in patients' drug therapy, thereby reducing iatrogenic problems and improving health outcomes for patients.

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00860.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Several authors have questioned the usefulness of serum valproic acid analysis in the routine management of patients with epilepsy. This audit assesses the current practice in a Scottish NHS Trust laboratory for requesting sodium valproate assays and the impact of an intervention on the number and “appropriateness” of the assays. A literature search suggested that assays are only of benefit in patients who are poorly controlled despite optimal dosage, where there is suspected toxicity or where compliance is questioned. A retrospective data collection covering a two‐year period was performed, followed by a 12‐month prospective collection. All sodium valproate assays requested were studied and the reason for requesting them, the assay result and the dose recorded. Throughout both periods the number of other assays was also recorded. Sodium valproate assays were considered “appropriate” if the reason they were requested was poor control, suspected toxicity or doubts about compliance. An arbitrary dose of 2000mg/day was chosen as optimal dosage. Between the two data collection periods an intervention was introduced, namely, the use of two new interpretation comments which reflected the results of the literature search and were used on most of the sodium valproate assays reported. Following the intervention there was a significant fall in the number of valproate assays performed (P= 0.046), an increase in the number of assay results outside the “target range” (P<0.001), a change in the distribution of reasons for the requests (P= 0.030) and an increase in the number of “appropriate

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00861.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Second‐year pharmacy students were divided into two cohorts, one of which participated in structured work‐based learning (WBL) activities in a summer vacation training programme (VTP) in a community pharmacy work placement. Assessment methods were developed to measure quantitatively any change in knowledge and knowledge‐based transferable skills. Results from the assessments showed that participation in structured WBL activities increased the students' knowledge and knowledge‐based transferable

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00862.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

In order to compare the attitudes of general medical practitioners (GPs) and community pharmacists to a broad range of issues concerning prescribing, a questionnaire was mailed in April, 1994, to all GPs and community pharmacists in contract with a local family health services authority (St Helens and Knowsley), an area covering 350,000 people. Replies were received from 60 per cent of the GPs and 84 per cent of the pharmacists. There was general agreement between the doctors and the pharmacists in their attitudes towards prescribing, and agreement that the quality of prescribing was a legitimate subject of concern for local health authorities. The role of community pharmacists was the main area of disagreement, with the GPs generally being more conservative while the pharmacists favoured a wider role. The professions shared a concern to improve the quality of prescribing, and about one third believed that a substantial amount of prescribing was of poor quality. A substantial minority of each profession had little contact with the opposite numbers from the other profession: 43 per cent of doctors had met a pharmacist fewer than four times in 1993.We present evidence of general agreement between the professions on a wide range of issues concerning the quality of prescribing in the community. However, if UK pharmacists are to achieve the wider role they and the government desire, the concerns of GPs need to be addressed.

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00863.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1996.tb00864.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY