Receiving a pharmaceutical care service compared to receiving standard pharmacy service in Sweden--How do patients differ with regard to perceptions of medicine use and the pharmacy encounter?

Clinical Effectiveness of Renal Transplant Outpatient Pharmaceutical Care Services in Korea

BACKGROUND

The necessity and importance of pharmaceutical care services (PCS) are well recognized, yet the concept and scope of PCS have not yet been clearly defined in Korea, particularly in kidney transplantation outpatient clinics.

AIM

The main purpose of this study is to evaluate whether PCS is effective in the outpatient setting for kidney transplant patients.

METHODS

For three years, a clinical pharmacist provided PCS to kidney transplant patients in an outpatient setting to evaluate the clinical effectiveness of PCS.

RESULTS

A total of 302 patients were matched in a 1:1 ratio, with 151 in the PCS group and 151 in the control group. These patients were followed, and a total of 476 interventions were provided to them, including medication reconciliation (n = 113, 23.7%), medication evaluation and management (n = 186, 39.1%), and pharmaceutical care transition (n = 177, 37.2%) services. The estimated glomerular filtration rate (eGFR) exhibited a notable difference between the control and PCS groups when comparing the pre- and post-study periods measurements. In the control group, there was a decline of 7.0 mL/min/1.73 m2 in eGFR. In contrast, the PCS group showed a smaller decline of 2.5 mL/min/1.73 m2 (p = 0.03). The adjusted odds ratio for end stage renal disease development in the PCS group was 0.51 (95% confidence interval: 0.26-0.96), indicating a significantly lower risk compared to the control group.

CONCLUSION

Our study highlights the promising potential of PCS implementation in kidney transplantation outpatient clinics. Further research is needed to validate and expand upon these findings, especially in diverse clinical settings.

A pilot study to assess the need for new hospital pharmaceutical services in Algerian patients and physicians’ perspective

Objectives

The objective of this study was to assess the needs for pharmaceutical services from the perspectives of physicians and patients in the hospital setting and to contribute to the implementation of new hospital pharmacy activities.

Methods

A cross-sectional descriptive study was carried out among the doctors and patients encountered in hospital departments in Sidi Bel Abbès (Algeria); each service was evaluated using a Likert scale. Associated characteristics with an important need were evaluated by univariate analysis and binary logistic regression.

Key findings

All pharmaceutical services were important to the patients, particularly providing treatment advice and therapeutic education. Women presented an important need for insurance of the availability of pharmaceutical products (P = 0.02) and lifestyle and dietetic information (P = 0.05). High frequency of taking medication was associated with an important need for information about drug interactions (P = 0.005). Patient-oriented pharmaceutical services were not important to the physicians who considered drug information and therapeutic education to be the most important need.

Conclusions

To implement patient-centred services, it is important to improve the contact between pharmacists and physicians and to provide information about pharmaceutical services that can benefit patients. Implementation of new practices in university hospital is more feasible than in public health facilities.

The impact of community pharmacists on older adults in Turkey

OBJECTIVE

This study aimed to evaluate the impact of theory-based, structured, standardized pharmaceutical care services led by community pharmacists (CPs) on patient-related outcomes in older Turkish adults.

PRACTICE DESCRIPTION

This prospective, quasi-experimental pilot study was conducted at the national level at community pharmacies in Turkey. After virtual training of CPs, pharmaceutical care services including medicine bag check-up, medication review, patient medicine card, patient education, and counseling services (including motivational interviewing) were delivered to promote medication adherence in older adults.

PRACTICE INNOVATION

Theory-based, structured, standardized pharmaceutical care services addressing medication adherence problems in older Turkish adults with noncommunicable diseases.

EVALUATION METHODS

Descriptive data (including demographic and clinical data, medication-related problems by using the DOCUMENT classification, potential inappropriate prescribing by using the Ghent Older People's Prescriptions Community Pharmacy Screening- (GheOP³S) tool, and pharmacy service satisfaction) were presented. Pre- and post-evaluation were compared by using the Wilcoxon test (for continuous variables) and McNemar's or McNemar-Bowker chi-square test (for categorical variables).

RESULTS

One hundred and thirty-eight medication-related problems were identified among 52 older adults. The medication adherence rate was significantly increased from 51.9% to 75%, and the mean of total quality of life (QoL) score rose significantly from 51.7 to 53.4 (P < 0.05). There was a statistically significant change in the median of necessity-concern differential (baseline: 7 [2.2-10.0] vs. final: 8.0 [5-11]; P < 0.05). At baseline, all patients had at least 1 potential inappropriate prescribing according to the GheOP³S tool, and the rate was 73.1% at the final assessment.

CONCLUSION

Community pharmacist-led pharmaceutical care services significantly improved patient-related outcomes (such as medication adherence, beliefs about medication, and QoL) in older adults with noncommunicable diseases. No statistically significant change was detected in their lifestyle behaviors (such as physical activity and diet program) or health awareness.

As the twig is bent, so is the tree inclined: a survey of student attitudes toward interprofessional collaboration supported with the curricula analysis

Pharmaceutical care was legally introduced as an interprofessional service in Poland in 2009. However, a collaboration between physicians and pharmacists remains incidental. Proper education at the undergraduate level is necessary to shape the attitudes of students toward establishing interprofessional relations. The aim of the study was to assess the perception of physician-pharmacist collaboration among final-year medical and pharmacy students through questionnaires with both closed-ended and open-ended questions. The study also includes an analysis of medicine and pharmacy curricula in terms of promoting interprofessional collaboration between the two fields. The statistical analysis of data obtained from 502 respondents revealed significant differences between the perceived areas for such collaboration. Moreover, the division of roles and responsibilities during the pharmacotherapy process between both professions seems to be unclear. Importantly, only 10.14% of the respondents evaluated these professional relations as 'good' or 'very good'. Also, 66.87% of the students emphasized the importance of educational interventions to improve interprofessional collaboration between pharmacists and physicians. Although 70% of medical and 87% of pharmacy students wish to establish such collaboration in the future, only 15% and 35%, respectively feel adequately prepared for the task. Understanding similarities and differences in this field appears to be the key to designing effective educational solutions for promoting interprofessional attitudes among healthcare undergraduates.

Competence, competition and collaboration: Perceived challenges among Swedish community pharmacists engaging in pharmaceutical services provision and research

Background

Creating evidence of effectiveness is an important part of service development. In an ongoing research project Swedish community pharmacists participate in services research by recruiting patients initiated on statins to an adherence-promoting cognitive pharmaceutical service, jointly run by nurses and pharmacists.

Aims

To explore the pharmacists’ experiences of providing part of the service and their views regarding future participation in practice research aiming at developing cognitive pharmaceutical services.

Methods

Focus group interviews were conducted with community pharmacists from pharmacies participating in the project. A semi-structured interview guide was developed, based on the aim and earlier research.

Results

The domains identified were the service itself, operative conditions, the pharmacists’ role/profession and stakeholders. The research project was thought to promote the local pharmacy to customers, increase job satisfaction and contribute to service development. However, a perceived lack of competence among pharmacists affected both patient communication and project involvement. Additional resources and strengthened collaboration with other local healthcare were requested. Competition among pharmacy chains was identified as a barrier to patient-centred service provision and research.

Conclusion

The current operative conditions in Swedish community pharmacies were perceived by pharmacists as hampering cognitive pharmaceutical services provision and research. Additional resources, improved communication skills and research competence, and increased collaboration with other healthcare and across pharmacy chains are necessary changes. A stronger patient-centred perspective among all stakeholders is required.

Qualitative study on the implementation of professional pharmacy services in Australian community pharmacies using framework analysis

BACKGROUND

Multiple studies have explored the implementation process and influences, however it appears there is no study investigating these influences across the stages of implementation. Community pharmacy is attempting to implement professional services (pharmaceutical care and other health services). The use of implementation theory may assist the achievement of widespread provision, support and integration. The objective was to investigate professional service implementation in community pharmacy to contextualise and advance the concepts of a generic implementation framework previously published.

METHODS

Purposeful sampling was used to investigate implementation across a range of levels of implementation in community pharmacies in Australia. Twenty-five semi-structured interviews were conducted and analysed using a framework methodology. Data was charted using implementation stages as overarching themes and each stage was thematically analysed, to investigate the implementation process, the influences and their relationships. Secondary analyses were performed of the factors (barriers and facilitators) using an adapted version of the Consolidated Framework for Implementation Research (CFIR), and implementation strategies and interventions, using the Expert Recommendations for Implementing Change (ERIC) discrete implementation strategy compilation.

RESULTS

Six stages emerged, labelled as development or discovery, exploration, preparation, testing, operation and sustainability. Within the stages, a range of implementation activities/steps and five overarching influences (pharmacys' direction and impetus, internal communication, staffing, community fit and support) were identified. The stages and activities were not applied strictly in a linear fashion. There was a trend towards the greater the number of activities considered, the greater the apparent integration into the pharmacy organization. Implementation factors varied over the implementation stages, and additional factors were added to the CFIR list and definitions modified/contextualised for pharmacy. Implementation strategies employed by pharmacies varied widely. Evaluations were lacking.

CONCLUSIONS

The process of implementation and five overarching influences of professional services implementation in community pharmacy have been outlined. Framework analysis revealed, outside of the five overarching influences, factors influencing implementation varied across the implementation stages. It is proposed at each stage, for each domain, the factors, strategies and evaluations should be considered. The Framework for the Implementation of Services in Pharmacy incorporates the contextualisation of implementation science for pharmacy.

The influence of generic substitution on the content of patient–pharmacist communication in Swedish community pharmacies

Objectives

The objective was to study the relationship between the length and content of patient–pharmacist communication in community pharmacies, and generic substitution.

Methods

The study was conducted in six community pharmacies in Sweden. Non-participant observations with audio recordings and short structured interviews were conducted. Out of 32 pharmacists 29 agreed to participate (90.6%), as did 282 out of 407 patients (69.3%). Logistic regression analysis was applied to calculate odds ratio for occurrence of generic substitution. Linear regression (β-coefficients) was applied to test for differences in time spent on different categories.

Key findings

In encounters where generic substitution occurred more time (19.2 s) was spent on non-medical (for instance administrative or economical) issues (P = 0.01, 95% confidence interval 4.8–33.6). However, the total time of the encounter was not significantly longer. The amount of time spent on non-medical issues increased with age of patient (age 60+: β, 33 s, P &gt; 0.001). The results indicate that more time was spent on medical issues with patients who have a higher education (high school: β, 10.8 s, P = 0.07, university: β, 10.2 s, P = 0.11) relative to those with only elementary school education.

Conclusions

Occurrence of generic substitution was correlated with more time spent on communicating on non-medical, but not on medical, issues. No extra time was spent on medical information for the groups normally overrepresented among those with low health literacy. This study suggests that pharmacists need to further embrace their role in promoting rational use of medicines, not least when generic substitution occurs.

Comparison of pharmacist and public views and experiences of community pharmacy medicines-related services in England

BACKGROUND

Services provided by community pharmacists designed to support people using medicines are increasing. In England, two national services exist: Medicine Use Reviews (MUR) and New Medicines Service (NMS). Very few studies have been conducted seeking views of the public, rather than service users, on willingness to use these services or expectations of these services, or determined whether views align with pharmacist perceptions.

OBJECTIVE

To compare the perceptions of pharmacists and the general public on medicines-related services, particularly MUR and NMS services.

METHODS

Two parallel surveys were conducted in one area of England: one involved the general public and was administered using a street survey, and the other was a postal survey of community pharmacists. Similar questionnaires were used, seeking views of services, awareness, reasons for using services, and perceived benefits.

RESULTS

Response rates were 47.2% (1,000/2,012 approached) for the public and 40.8% (341/836) for pharmacists. Few people had experienced a discussion in a private consultation room or were aware of the two formal services, although their willingness to use them was high. Pharmacists estimated time spent on service provision as 10 minutes for MUR and 12 minutes for NMS, which aligned with acceptability to both pharmacists and the public. Pharmacists underestimated the willingness of the public to wait for an informal discussion or to make appointments for formal services. Both pharmacists and the public had high expectations that services would be beneficial in terms of increasing knowledge and understanding, but public expectations and experiences of services helping to sort out problems fell well below pharmacists' perceptions. People who had experienced a pharmacy service had different perceptions of pharmacists.

CONCLUSION

Views differed regarding why people use services and key aspects of service delivery. For services to improve, the pharmacy profession needs a better awareness of what the public, especially those with potential to benefit from services, view as acceptable and desirable.

Patient expectations and willingness to use primary care pharmacy services in the United Arab Emirates

OBJECTIVES

No previous studies have investigated patients' expectations of, or interest in, using primary care pharmacy services in the UAE. The study investigated primary care services that patients would use if they were provided through community pharmacies.

METHODS

A questionnaire was developed in English and translated to Arabic. Participants were asked to rate their likelihood of using future primary care services on a three-point Likert-type scale (very likely-unlikely). Services included screening for disease, monitoring of disease control, health advice and referral, lifestyle and preventive care, supply of printed information, counselling on medication use and side effects, patient record keeping, and pharmacist intervention in chronic disease. The questionnaire was distributed to patrons of public places by hand to eligible participants: ≥21 years, taking at least one scheduled prescription medication and having adequate Arabic or English proficiency.

KEY FINDINGS

Areas of most interest were as follows: the pharmacist explaining how to use medications (Median = 3, interquartile range (IQR) = 1), the pharmacist advising on side effects of medications (Median = 3, IQR = 1), receiving advice on how to use devices (Median = 3, IQR = 1) and receiving printed information about medications (Median = 3, IQR = 1). Participants were least supportive of pharmacists keeping medication records (Median = 2, IQR = 1) and intervening in chronic disease management (Median = 2, IQR = 1). Participants anticipated a caring professional service by pharmacists and a pharmacy layout that allows private communication.

CONCLUSIONS

Participants were interested in accessing enhanced primary care services by community pharmacists. Participants were more supportive of receiving information about medications, help in self-management and monitoring, and advice about disease prevention than management of chronic disease.

Physicians' and patients' valuation of pharmaceutical care implementation in Poznan (Poland) community pharmacies

Implementation of pharmaceutical care (PC) in Poland is of great importance to patients, who, on the one hand, often follow complex pharmacological treatment regimens recommended by several physicians of different specialties, and, on the other, take up the decision on self-treatment due to availability of OTC medications. The aim of the present study was to assess the opinion of both patients and physicians about implementation of PC service in Polish community pharmacies.

A cross sectional study was carried out from September 2009 to September 2010 by a pharmacist (author of the study) on the basis of an anonymous questionnaire, where demand of physicians (n = 104) and patients (n = 202) for implementation of PC in a community pharmacy was assessed. The study was planned to determine the relationship between implementation of PC, cost and time of this service and patients’ and physicians’ socio-economic information.

Responding patients (85.64%) and physicians (76.92%) unanimously confirmed the need for implementation of PC. Most people convinced of the service implementation were 88.89% of physicians under the age of 35 and all the respondents were over 65 years of age (p = 0.027), just as 93.33% with service lesser than 5 years and 73.68% of respondents working a maximum of 20 years (p = 0.023). Mainly according to 90.00% of physicians with specialty in internal medicine and 92.59% of physicians of the group “Others” (p = 0.012), PC should be implemented in pharmacies. Women more frequently than men reckoned that appointments with a pharmacist should last up to 15 min (p = 0.012). According to 77.78% of the youngest physicians and 83.33% of the oldest ones, appointments should last from 5 to 15 min (p = 0.049), and a similar opinion was shared by 80.77% of physicians without specialty and 77.78% of physicians of the group “Others” (p = 0.0009). According to patients, the mean cost of the visit should be USD 7. Physicians most often assessed the mean cost of the appointment at USD 14.

This study provides new data about implementation of PC in Poland. The increased patients’ and physicians’ willingness to benefit from this service provides pharmacists with opportunities to develop PC in community pharmacies.

Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework

BACKGROUND

Patients' beliefs about treatment influence treatment engagement and adherence. The Necessity-Concerns Framework postulates that adherence is influenced by implicit judgements of personal need for the treatment (necessity beliefs) and concerns about the potential adverse consequences of taking it.

OBJECTIVE

To assess the utility of the NCF in explaining nonadherence to prescribed medicines.

DATA SOURCES

We searched EMBASE, Medline, PsycInfo, CDSR/DARE/CCT and CINAHL from January 1999 to April 2013 and handsearched reference sections from relevant articles.

STUDY ELIGIBILITY CRITERIA

Studies using the Beliefs about Medicines Questionnaire (BMQ) to examine perceptions of personal necessity for medication and concerns about potential adverse effects, in relation to a measure of adherence to medication.

PARTICIPANTS

Patients with long-term conditions.

STUDY APPRAISAL AND SYNTHESIS METHODS

Systematic review and meta-analysis of methodological quality was assessed by two independent reviewers. We pooled odds ratios for adherence using random effects models.

RESULTS

We identified 3777 studies, of which 94 (N = 25,072) fulfilled the inclusion criteria. Across studies, higher adherence was associated with stronger perceptions of necessity of treatment, OR = 1.742, 95% CI [1.569, 1.934], p<0.0001, and fewer Concerns about treatment, OR = 0.504, 95% CI: [0.450, 0.564], p<0.0001. These relationships remained significant when data were stratified by study size, the country in which the research was conducted and the type of adherence measure used.

LIMITATIONS

Few prospective longitudinal studies using objective adherence measures were identified.

CONCLUSIONS

The Necessity-Concerns Framework is a useful conceptual model for understanding patients' perspectives on prescribed medicines. Taking account of patients' necessity beliefs and concerns could enhance the quality of prescribing by helping clinicians to engage patients in treatment decisions and support optimal adherence to appropriate prescriptions.

Customer interest in and experience with various types of pharmacy counselling - a qualitative study

BACKGROUND

Despite pharmacists' extensive knowledge in the optimization of patients' medical treatments, community pharmacies are still fighting to earn patients' trust with respect to medicinal counselling at the counter.

OBJECTIVE

The aim was to investigate how patients perceive pharmacy counselling at the present time, in order to develop the patient-pharmacy relationship for the benefit of both patients and pharmacies.

DESIGN

Short semi-structured interviews were carried out with pharmacy customers by pharmacy internship students.

SETTING AND PARTICIPANTS

One hundred and eight customers in 35 independent pharmacies across Denmark were interviewed during the spring of 2011.

MAIN VARIABLES STUDIED

Customers were interviewed about their expectations of pharmacies in general and their experiences with medical counselling in particular.

RESULTS

Customers perceive community pharmacies very differently in terms of both expectations of and positive experiences with counselling. They appear to be in favour of pharmacy counselling with respect to over-the-counter medicine and first-time prescription medicine in contrast to refills. Customers find it difficult to express the health-care role of pharmacies even when experiencing and appreciating it.

DISCUSSION

Lack of appreciation of pharmacy counselling for refill prescription medicine and the difficulty in defining the role of pharmacies might stem from the difficulties that customers have in understanding medicine and thus the role of counselling services with respect to medicine. The pharmacy staff does not seem to realize these barriers.

CONCLUSIONS

For pharmacies to encourage customer interest in pharmacy counselling, the staff should start taking the identified barriers into account when planning communication strategies.

Exploring patients' motivation to participate in Australia's Home Medicines Review program

BACKGROUND

Patients at risk of experiencing medicine-related problems do not always appear willing to participate in collaborative medication management services. Little is known about the psycho-social factors which motivate patients to participate in these services. The theory of motivated information management (TMIM) suggests that patients' willingness to participate may be motivated by their uncertainty and worry about their medicines.

OBJECTIVE

The objective of this study was to investigate factors which may motivate patients to participate in a collaborative medication management program.

SETTING

Fourteen semi-structured focus group interviews held throughout Australia provided the data for the study. Eighty participants were recruited by community pharmacists. Participants were recruited into the study if they had experienced Australia's Home Medicines Review (HMR) program or would be eligible to participate in the program because they were at risk of experiencing medicine-related problems. Methods An interview guide was developed which was informed by TMIM. Focus group data were audio-recorded, transcribed and where necessary, translated into English.

MAIN OUTCOME MEASURE

Qualitative data were thematically analysed to identify participants' expectations about the outcomes of HMR and the factors which may influence these expectations.

RESULTS

Participants' most salient outcome expectancies of HMR were that it was a medication-information source which would assist them to manage their medicines. Recipients of the program held overall positive outcome expectancies, whereas nonrecipients' expectancies varied widely. Consistent with theory, participants who expressed some worry about their medicines, generally held positive outcome expectancies and were willing to participate in HMR. Compared with younger participants, older participants (those aged >74 years) tended to engage less in their thoughts about being at risk, and consequently did not experience worry.

CONCLUSION

Worry about medicines is a key factor in motivating participants to engage in medicines information-seeking. Older persons who rely heavily on heuristics appeared less likely to worry about their medicines and willing to participate in medication management services. Age-related reduction in the motivation to participate may have important implications for medication safety. Further examination of this effect is warranted because older persons are at greatest risk of medicine related problems.

Patients' willingness to use a pharmacist-provided medication management service: the influence of outcome expectancies and communication efficacy

BACKGROUND

Previous research has demonstrated that some patients who are at risk of experiencing medication-related problems express a lack of willingness to use pharmacist-provided medication management services. Little is known about the factors that influence willingness to use these services among patients who have not yet experienced the service.

OBJECTIVES

The aim of this study was to test a model of willingness to use the Australian Home Medicines Review (HMR) service. Specifically, this study aimed to determine the influence of positive and negative outcome expectancies and communication efficacy over willingness among patients who were eligible to receive the service but have not yet experienced it.

METHODS

A cross-sectional survey was conducted with patients who were recruited by 264 community pharmacists throughout Australia. Patients were included in the study if they had not yet experienced HMR but were taking more than 5 medicines daily or more than 12 doses daily. Measurement scales were developed using exploratory and confirmatory factor analyses. Structural equation modeling was used to test the model.

RESULTS

Questionnaires received from 286 patients (15.6%) were analyzed. Multi-item measurement scales were observed to have acceptable construct reliabilities (range, 0.69-0.94). Importantly, respondents held overall neutral expectations about the personal benefits of HMR (positive outcome expectancies) but high communication efficacy. Structural equation modeling revealed that positive outcome expectancies (β=0.56, P<.001) and communication efficacy (β=0.25, P<.05) influenced willingness to use, whereas negative outcome expectancies had no significant effect.

CONCLUSIONS

The extent to which patients believe that HMR would provide them with increased medicines knowledge, improve their medicines management capability, and reduce their medicine concerns had a significant influence over willingness to use the service. Because these expectancies are relatively low, there appears to be significant scope for increasing patient demand for these services. Patient-directed material about medication management services should highlight the provision of medication information.