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Byrne GA, Wood PJ, Spark MJ. Non-prescription supply of combination analgesics containing codeine in community pharmacy: A simulated patient study. Res Social Adm Pharm 2017; 14:96-105. [PMID: 28283305 DOI: 10.1016/j.sapharm.2017.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/11/2016] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The inappropriate use of non-prescription combination analgesics containing codeine (NP-CACC) has become a significant health issue in Australia. OBJECTIVE To investigate the current management of NP-CACC direct product requests in community pharmacies located in Victoria, Australia. METHODS A covert simulated patient (SP) method was used to observe the responses of pharmacy staff during an NP-CACC request. Four SPs were trained to complete 1 of 2 scenarios. Each scenario involved a direct product request for Nurofen Plus (200 mg ibuprofen, 12.8 mg codeine) with identical reason for use, symptoms, and medical history but varied previous product use. Scenario One (Sc1) involved a first time NP-CACC user and in Scenario Two (Sc2) the SP had used NP-CACC regularly for the past month. Each visit was documented by the SP immediately after they left the pharmacy. A NP-CACC supply score, created from 4 outcomes (pharmacist involvement, establishment of therapeutic need, establishment of safety and provision of counselling), was given to each pharmacy visit (maximum of 8) during data analysis. RESULTS 145 pharmacy visits were completed. Both scenarios were performed in most of the 75 pharmacies visited (73 Sc1 and 72 Sc2). Treatment was provided in the majority of visits but refused in 37(24%) because the SP was unable to provide photo identification. A pharmacist was involved (directly or indirectly) in 77% of visits. Adequate questioning to establish therapeutic need occurred in 50% of pharmacy visits, safety was established in 17% of visits, and adequate counselling provided in 17% of visits. The SP scenario did not significantly affect the NP-CACC supply outcomes. NP-CACC supply scores ranged from 1 to 8, (Md = 5) with only 1 pharmacy visit achieving the maximum score of 8. CONCLUSIONS The majority of pharmacy visits did not achieve a full score relating to NP-CACC supply, illustrating the need for improved awareness of how to assess and manage patients requesting NP-CACC.
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Affiliation(s)
- Georgia A Byrne
- Department of Pharmacy and Applied Science, La Trobe Institute for Molecular Science, LaTrobe University Bendigo, Victoria 3550, Australia
| | - Penelope J Wood
- Department of Pharmacy and Applied Science, La Trobe Institute for Molecular Science, LaTrobe University Bendigo, Victoria 3550, Australia
| | - M Joy Spark
- Department of Pharmacy and Applied Science, La Trobe Institute for Molecular Science, LaTrobe University Bendigo, Victoria 3550, Australia.
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Coulibaly IGS, Morais JCD, Marsiglia RMG, Montanari PM. Doenças sexualmente transmissíveis e a vulnerabilidade da população do Alto Solimões, Amazonas, Brasil. SAUDE E SOCIEDADE 2017. [DOI: 10.1590/s0104-12902017162948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Pessoas que apresentam sintomas de doenças sexualmente transmissíveis na região do Alto Solimões (Amazonas, Brasil), podem procurar farmácias mais próximas de onde residem para tratamento. Este artigo tem por finalidade mostrar como são tratadas e orientadas as pessoas que procuram pelo atendimento em farmácias em vez buscar os serviços de saúde, que são de mais difícil acesso na região. Para tal, realizou-se uma pesquisa de caráter qualitativo e emprego de uma amostra de conveniência. Na pesquisa de campo realizada em três dos nove municípios da região, utilizou-se o “Método do Cliente Misterioso” validado pelo protocolo Situational Analysis of Sexual Health in India (Sashi), desenvolvido pelo London School of Hygiene and Tropical Medicine, já utilizado na Índia, África e no Alto Solimões, seguido de entrevistas semiestruturadas com os mesmos participantes da etapa do cliente misterioso. Observou-se que, quando do uso do Método do Cliente Misterioso, os entrevistados indicaram e venderam antibióticos sem receita médica aos que os procuraram e, quando do uso das entrevistas semiestruturadas, essa prática não foi observada. Em ambas as abordagens, não houve orientação aos clientes sobre os riscos das doenças sexualmente transmissíveis para eles e seus parceiros sexuais. Concluímos com esse estudo que as pessoas que vivem no Alto Solimões estão vulneráveis a essas doenças, sendo necessário que se repense a questão da assistência médica e farmacêutica no âmbito das doenças sexualmente transmissíveis em regiões de difícil acesso do país.
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Chang J, Ye D, Lv B, Jiang M, Zhu S, Yan K, Tian Y, Fang Y. Sale of antibiotics without a prescription at community pharmacies in urban China: a multicentre cross-sectional survey. J Antimicrob Chemother 2017; 72:1235-1242. [DOI: 10.1093/jac/dkw519] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/07/2016] [Indexed: 11/13/2022] Open
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Chauhan BF, Jeyaraman MM, Mann AS, Lys J, Skidmore B, Sibley KM, Abou-Setta AM, Zarychanski R. Behavior change interventions and policies influencing primary healthcare professionals' practice-an overview of reviews. Implement Sci 2017; 12:3. [PMID: 28057024 PMCID: PMC5216570 DOI: 10.1186/s13012-016-0538-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/13/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers. METHODS Study design: overview of reviews. DATA SOURCE MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015). STUDY SELECTION two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language. DATA EXTRACTION AND SYNTHESIS two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors' conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.). RESULTS Of 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found to be as effective as general practitioners in patient satisfaction in settings like asthma, cardiovascular, and diabetes clinics, although this needs further evaluation. Evidence does not support the use of financial incentives to family physicians, especially for long-term behavior change. CONCLUSIONS Behavior change interventions including education, training, and enablement in the context of collaborative team-based approaches are effective to change practice of primary healthcare professionals. Environmental restructuring approaches including nurse-led care and modeling need further evaluation. Financial incentives to family physicians do not influence long-term practice change.
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Affiliation(s)
- Bhupendrasinh F Chauhan
- College of Pharmacy, University of Manitoba, Winnipeg, Canada.
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
| | - Maya M Jeyaraman
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Justin Lys
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Kathryn M Sibley
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ryan Zarychanski
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Haematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
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Satyanarayana S, Kwan A, Daniels B, Subbaraman R, McDowell A, Bergkvist S, Das RK, Das V, Das J, Pai M. Use of standardised patients to assess antibiotic dispensing for tuberculosis by pharmacies in urban India: a cross-sectional study. THE LANCET. INFECTIOUS DISEASES 2016; 16:1261-1268. [PMID: 27568359 PMCID: PMC5067371 DOI: 10.1016/s1473-3099(16)30215-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/20/2016] [Accepted: 06/28/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND India's total antibiotic use is the highest of any country. Patients often receive prescription-only drugs directly from pharmacies. Here we aimed to assess the medical advice and drug dispensing practices of pharmacies for standardised patients with presumed and confirmed tuberculosis in India. METHODS In this cross-sectional study in the three Indian cities Delhi, Mumbai, and Patna, we developed two standardised patient cases: first, a patient presenting with 2-3 weeks of pulmonary tuberculosis symptoms (Case 1); and second, a patient with microbiologically confirmed pulmonary tuberculosis (Case 2). Standardised patients were scheduled to present each case once to sampled pharmacies. We defined ideal management for both cases a priori as referral to a health-care provider without dispensing antibiotics or steroids or both. FINDINGS Between April 1, 2014, and Nov 29, 2015, we sampled 622 pharmacies in Delhi, Mumbai, and Patna. Standardised patients completed 1200 (96%) of 1244 interactions. We recorded ideal management (defined as referrals without the use of antibiotics or steroids) in 80 (13%) of 599 Case 1 interactions (95% CI 11-16) and 372 (62%) of 601 Case 2 interactions (95% CI 58-66). Antibiotic use was significantly lower in Case 2 interactions (98 [16%] of 601, 95% CI 13-19) than in Case 1 (221 [37%] of 599, 95% CI 33-41). First-line anti-tuberculosis drugs were not dispensed in any city. The differences in antibiotic or steroid use and number of medicines dispensed between Case 1 and Case 2 were almost entirely attributable to the difference in referral behaviour. INTERPRETATION Only some urban Indian pharmacies correctly managed patients with presumed tuberculosis, but most correctly managed a case of confirmed tuberculosis. No pharmacy dispensed anti-tuberculosis drugs for either case. Absence of a confirmed diagnosis is a key driver of antibiotic misuse and could inform antimicrobial stewardship interventions. FUNDING Grand Challenges Canada, Bill & Melinda Gates Foundation, Knowledge for Change Program, and World Bank Development Research Group.
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Affiliation(s)
- Srinath Satyanarayana
- McGill International Tuberculosis Centre & Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Ada Kwan
- Development Research Group, The World Bank, Washington, DC, USA
| | | | - Ramnath Subbaraman
- Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew McDowell
- McGill International Tuberculosis Centre & Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | - Ranendra K Das
- Institute for Social and Economic Research on Development and Democracy, Delhi, India
| | - Veena Das
- Department of Anthropology, Johns Hopkins University, Baltimore, MD, USA
| | - Jishnu Das
- Development Research Group, The World Bank, Washington, DC, USA; Center for Policy Research, New Delhi, India
| | - Madhukar Pai
- McGill International Tuberculosis Centre & Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Manipal McGill Center for Infectious Diseases, Manipal University, Manipal, India.
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Obreli-Neto PR, Guidoni CM, Baldoni ADO, Marusic S, Castedalli G, Lahoud YM, Soares CF, Pereira LRL. Evaluation of the effectiveness of an Internet-based continuing education program on pharmacy-based minor ailment management: a randomized controlled clinical trial. BRAZ J PHARM SCI 2016. [DOI: 10.1590/s1984-82502016000100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
ABSTRACT The aim of this work was to evaluate the effectiveness of an internet-based continuing education (CE) program on pharmacy-based minor ailment schemes (PMASs). A controlled randomized clinical trial was conducted in community pharmacies in Brazil. Community pharmacists (CPs) were enrolled in two groups: intervention (n = 61) and control (n = 60). CPs who were enrolled to the intervention group participated in an Internet-based CE program. CPs in the control group received no educational intervention. We evaluated participant perception, learning outcomes, and practice performance. Learner satisfaction with the CE program was high for every point evaluated (mean ± standard deviation = 4.2 ± 0.4). Posttest learner outcome scores and practice performance in the intervention group after the conclusion of the CE program significantly improved compared with pretest scores (p < 0.001) and were significantly better compared with the control group (p < 0.001). The present Internet-based CE program is a viable educational strategy for improving participant perception, learning outcomes, and practice performance in PMASs.
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Die Beratungsqualität von Apotheken bei akutem Durchfall – Eine Analyse unter Verwendung der „Simulated Patient“-Methode. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2016; 112:19-26. [DOI: 10.1016/j.zefq.2016.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/01/2016] [Accepted: 02/04/2016] [Indexed: 11/24/2022]
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Assessment of Community Pharmacists’ Counseling Practices With Simulated Patients Who Have Minor Illness. Simul Healthc 2015. [DOI: 10.1097/sih.0000000000000100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Murphy AL, Martin-Misener R, Kutcher SP, Gardner DM. Pharmacists' performance in a telephone-based simulated patient study after a mental health capacity-building program. Int J Clin Pharm 2015. [PMID: 26210258 DOI: 10.1007/s11096-015-0171-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The More Than Meds program was developed to enhance community pharmacy based services for people with mental illness. OBJECTIVE To evaluate the care of pharmacists who participated in this specific program using a telephone-based simulated patient with insomnia. METHODS A trained actor used a simulated patient case scenario and telephoned pharmacists (i.e., intervention group pharmacists) and a control group of pharmacists approximately 6 months following training. Pharmacists were scored on their assessment of the patient and problem, guidance provided on both pharmacological and nonpharmacological care, communications, and overall quality. RESULTS Sixty-three pharmacists (n = 29 intervention, n = 34 controls) were reached. Call duration was longer with intervention versus control group pharmacists [4.93 min (SD 2.3) vs. 4.00 min (SD 1.8)]. Medication recommendations were made by 76 and 100 % of intervention versus control pharmacists (p = 0.002), respectively. Intervention group pharmacists scored significantly higher on most components within communication and overall quality scores. Scores for assessing the patient, the problem, sleep, and medication supply were lower than expected for both groups. CONCLUSION Intervention group pharmacists performed better than controls on several components of a telephone-based simulated patient scenario for insomnia following More Than Meds training. More research is needed regarding telephone consultations in pharmacy practice.
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Affiliation(s)
- Andrea L Murphy
- Department of Psychiatry & College of Pharmacy, Dalhousie University, 5968 College St., PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, 5869 University Ave., PO Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Stan P Kutcher
- Sun Life Financial Chair in Adolescent Mental Health, Dalhousie University/IWK Health Centre, 5850 University Ave., PO Box 9700, Halifax, NS, B3K 6R8, Canada
| | - David M Gardner
- Department of Psychiatry & College of Pharmacy, Dalhousie University, QEII HSC, AJLB 7517, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada
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Veiga P, Lapão LV, Cavaco AM, Guerreiro MP. Quality supply of nonprescription medicines in Portuguese community pharmacy: An exploratory case study. Res Social Adm Pharm 2015; 11:880-90. [PMID: 25662595 DOI: 10.1016/j.sapharm.2014.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 12/31/2014] [Accepted: 12/31/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Inappropriate use of non-prescription medicines (NPM) can increase morbidity, mortality and health care associated costs. Pharmacists have a well-established role in self-medication; however, the literature shows that pharmacies performance in the supply of NPM is often suboptimal. OBJECTIVE To explore the interaction and dependability of pharmacy staff use of oral language, as well as staff's own assessment of reasons underlying their behavior during consultation regarding NPM. METHODS In a case-study design, a high street urban community pharmacy was purposively selected as the setting. Covert patient simulation, using trained simulated patients (SPs), was used to ascertain staff's performance in dispensing NPM, via 4 symptom-based scenarios (SbS) and 3 product-based scenarios (PbS). Performance data were converted into 2 composite indexes: the Interpersonal Performance Index (IPI) and Technical Performance Index (TPI). Audiotaped interactions were transcribed verbatim and participants' utterances were identified, time stamped and coded employing the eight higher level categories of a framework inspired by the Roter interaction analysis system (RIAS). The transcripts of the in-depth interviews were analyzed using the Framework Approach. The tripartite model of attitudes was employed to develop the thematic framework. RESULTS Ten SP visits were considered for analysis. Overall, the mean TPI score was 50% and the mean IPI score was 78%. TPI was higher for SbS (63%) than PbS (31%), whilst there was little difference IPI between SbS (79%) and PbS (76%). The mean number of questions in the evaluation section of technical performance was 4 for SbS and 1 for PbS. There was a clear predominance of closed questions (32%), when compared with open questions (5.5%). Providing advice was more frequent (23.5%) than giving information (12.5%). In line with the SPs data, comparison of information-gathering in SbS and PbS shows that more questions were asked in the former (44% versus 31%), which resulted in more information given by SPs (56% and 49%, respectively). Staff's reaction to their performance showed all the 3 dimensions of attitude: affective, cognitive and behavioral. Divergence between staff's views on what should be done in NPM consultations and performance data surfaced in the interviewees' accounts on direct product requests. While performance data shows that information gathering was scarce, its importance was overtly acknowledged. CONCLUSIONS The supply of NPM appears to be influenced by both cognitive and emotional issues. This suggests that multimodal improvement interventions are needed, targeting not only technical and interpersonal communication skills but also the organizational context. Managerial tools such as the balanced scorecard, may prove valuable in addressing improvement in the quality supply of NPM.
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Affiliation(s)
- Paulo Veiga
- Instituto de Investigação do Medicamento (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal.
| | - Luís V Lapão
- WHO Collaborating Center for Health Workforce Policy and Planning, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal
| | - Afonso M Cavaco
- Instituto de Investigação do Medicamento (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal; Faculdade Farmácia Universidade de Lisboa (FFUL), Lisbon, Portugal
| | - Mara P Guerreiro
- Centro de investigação interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Monte da Caparica, Portugal; Escola Superior de Enfermagem de Lisboa (ESEL), Lisboa, Portugal
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Steed L, Kassavou A, Madurasinghe VW, Edwards EA, Todd A, Summerbell CD, Nkansah N, Bero L, Durieux P, Taylor SJC, Rivas C, Walton RT. Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011207] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Liz Steed
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Centre for Primary Care and Public Health; Blizard Institute, Yvonne Carter Building 58 Turner Street London UK E1 2AT
| | - Aikaterini Kassavou
- University of Cambridge; Behavioural Science Group; Forvie Site, Robinson Way Cambridge UK CB2 0SR
| | - Vichithranie W Madurasinghe
- Queen Mary University of London; Centre for Primary Care and Public Health, Barts & The London School of Medicine and Dentistry; Yvonne Carter Building, 58 Turner Street London UK
| | - Elizabeth Ann Edwards
- Queen Mary University of London; Centre for Primary Care and Public Health, Barts & The London School of Medicine and Dentistry; Yvonne Carter Building, 58 Turner Street London UK
| | - Adam Todd
- Durham University; School of Medicine, Pharmacy and Health, Wolfson Research Institute; University Boulevard Thornaby Stockton-on-Tees UK TS17 6BH
| | - Carolyn D Summerbell
- Queen's Campus, Durham University; School of Medicine, Pharmacy and Health, Wolfson Research Institute; University Boulevard Thornaby Stockton-on-Tees UK TS17 6BH
| | - Nancy Nkansah
- University of California; Clinical Pharmacy; 155 North Fresno Street, Suite 224 San Francisco California USA 93701
| | - Lisa Bero
- Charles Perkins Centre, University of Sydney; Medicines Use and Health Outcomes; 6th Floor (6W76) University of Sydney Camperdown New South Wales 2006 Australia
| | - Pierre Durieux
- Georges Pompidou European Hospital, Paris Descartes University, INSERM U872 eq 22; Department of Public Health and Medical Informatics; 20 rue Leblanc Paris France 75015
| | - Stephanie JC Taylor
- Centre for Primary Care and Public Health, Barts & The London School of Medicine and Dentistry, Queen Mary University of London; Yvonne Carter Building 58 Turner Street London UK E1 2AB
| | - Carol Rivas
- Queen Mary University of London; Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry; 58 Turner Street London UK E1 2AB
| | - RT Walton
- Queen Mary University of London; Centre for Primary Care and Public Health, Barts & The London School of Medicine and Dentistry; Yvonne Carter Building, 58 Turner Street London UK
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Bennett S, Lagomarsino G, Knezovich J, Lucas H. Accelerating learning for pro-poor health markets. Global Health 2014; 10:54. [PMID: 24961671 PMCID: PMC4105125 DOI: 10.1186/1744-8603-10-54] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 01/30/2014] [Indexed: 11/10/2022] Open
Abstract
Background Given the rapid evolution of health markets, learning is key to promoting the identification and uptake of health market policies and practices that better serve the needs of the poor. However there are significant challenges to learning about health markets. We discuss the different forms that learning takes, from the development of codified scientific knowledge, through to experience-based learning, all in relationship to health markets. Discussion Notable challenges to learning in health markets include the difficulty of acquiring data from private health care providers, designing evaluations that capture the complex dynamics present within health markets and developing communities of practice that encompass the diverse actors present within health markets, and building trust and mutual understanding across these groups. The paper proposes experimentation with country-specific market data platforms that can integrate relevant evidence from different data sources, and simultaneously exploring strategies to secure better information on private providers and health markets. Possible approaches to adapting evaluation designs so that they are better able to take account of different and changing contexts as well as producing real time findings are discussed. Finally capturing informal knowledge about health markets is key. Communities of practice that bridge different health market actors can help to share such experience-based knowledge and in so doing, may help to formalize it. More geographically-focused communities of practice are needed, and such communities may be supported by innovation brokers and/or be built around member-based organizations. Summary Strategic investments in and support to learning about health markets can address some of the challenges experienced to-date, and accelerate learning that supports health markets that serve the poor.
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Affiliation(s)
- Sara Bennett
- Johns Hopkins School of Public Health, Baltimore, MD, USA.
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Provision of smoking cessation services in Australian community pharmacies: a simulated patient study. Int J Clin Pharm 2014; 36:604-14. [PMID: 24718946 DOI: 10.1007/s11096-014-9944-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND With the rising interest in expanding pharmacists' role in smoking cessation, it is pertinent that community pharmacists be equipped with up-to-date knowledge and competence to provide optimal therapeutic services that meet the demands of various presenting subsets of smokers. OBJECTIVE To investigate and evaluate responses to requests of quitting smoking from 'high risk' smokers seeking assistance and treatment within the pharmacy venue. SETTING Community pharmacies located within Sydney greater metropolitan area, New South Wales, Australia. METHOD A simulated patient methodology was utilised. Two scenarios were developed and enacted by two trained simulated patients in 100 randomly selected pharmacies. Scenario 1 involved a 28-year-old pregnant female who presents with a request for help in quitting smoking. Scenario 2 involved a 22-year-old female requesting a quit smoking product for her 55-year-old father who has cardiovascular problems. A standardised scoring key was designed to assess the performance of pharmacists during each encounter. MAIN OUTCOME MEASURE The primary outcome measure was the supply/non-supply of nicotine replacement products and the corresponding provision of counselling and advice to facilitate smoking cessation. RESULTS A product(s) was supplied in 42 % of the 100 encounters, while a product was adequately suggested pending doctor's referral in 45 %. In 13 % of the cases, a product was not supplied based on inappropriate notions of nicotine replacement therapy not being safe in the presented scenario. Pharmacists performed better in dispensing scores (counselling about product use) as compared to pre-dispensing scores (eliciting patient history). ANOVA followed by regression analysis indicated that the estimated age and gender of the pharmacist/staff were significant predictors affecting total scores. CONCLUSION Whilst pharmacists' counselling about smoking cessation aids seems satisfactory, further education is required to improve practice standards in terms of matching a patient's history and smoking status to an appropriate product.
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Coelho RB, Costa FA. Impact of pharmaceutical counseling in minor health problems in rural Portugal. Pharm Pract (Granada) 2014; 12:451. [PMID: 25580167 PMCID: PMC4282762 DOI: 10.4321/s1886-36552014000400002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 10/06/2014] [Indexed: 11/22/2022] Open
Abstract
Objectives: The objectives of this study were to determine the prevalence of self-medication and to evaluate the clinical impact of pharmaceutical counseling. Methods: A cross-sectional study was used with a prospective component, the latter to evaluate the impact of pharmaceutical counseling. The study was conducted in a rural community pharmacy for 14 consecutive days in December 2012, recruiting all individuals who agreed to participate and met the eligibility criteria. During a face-to-face direct interview demographic and clinical characteristics of patients were registered, followed by a pharmaceutical intervention, which consisted of evaluating the symptoms, selecting the most appropriate non-prescription medicine (NPM) available and advising the patient on pharmacologic and non-pharmacologic measures, all according to established protocols for minor health problems. When appropriate, the patient was referred to a medical appointment. One week later, the clinical outcome of such intervention was measured by asking the patients about the resolution of their minor health problems. Results: Data from 298 patients were analyzed, the majority being female (60.1%) with an average age of 44.84 years (SD=22.41). Respiratory problems were the most frequent (n=78; 26.2%) and respiratory tract medication was the most frequently indicated (n= 77; 27.8%). The observed prevalence of self-medication was 40.7%. Of the 271 patients’ beneficiaries of pharmaceutical counseling, 86.8% had their minor health problems solved after one week (ranging from 77.5% to 88.2% according to a sensibility analysis for drop-outs). Conclusions: This work is important as it demonstrates the beneficial impact of pharmaceutical counseling, a very relevant area for the pharmacist and where literature is particularly scarce.
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Affiliation(s)
- Raquel B Coelho
- Master in Pharmaceutical Sciences. Pharmaceutical Care Specialist Pharmacy in Pharmaceutical Alfeirao. Vila Nova de Milfontes ( Portugal ).
| | - Filipa A Costa
- Higher Institute of Health Sciences Egas Moniz . Centre for Interdisciplinary Research Egas Moniz (CiiEM). Almada ( Portugal ).
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