Community pharmacy supply of emergency contraception. Impact of emergency contraception on women's and men's behaviour requires further explanation

Qualitative study to conceptualise a model of interprofessional collaboration between pharmacists and general practitioners to support patients' adherence to medication

OBJECTIVES

Pharmacists and general practitioners (GPs) face an increasing expectation to collaborate interprofessionally on a number of healthcare issues, including medication non-adherence. This study aimed to propose a model of interprofessional collaboration within the context of identifying and improving medication non-adherence in primary care.

SETTING

Primary care; Sydney, Australia.

PARTICIPANTS

3 focus groups were conducted with pharmacists (n=23) and 3 with GPs (n=22) working in primary care.

PRIMARY AND SECONDARY OUTCOME MEASURES

Qualitative investigation of GP and pharmacist interactions with each other, and specifically around supporting their patients' medication adherence. Audio-recordings were transcribed verbatim and transcripts thematically analysed using a combination of manual and computer coding.

RESULTS

3 themes pertaining to interprofessional collaboration were identified (1) frequency, (2) co-collaborators and (3) nature of communication which included 2 subthemes (method of communication and type of communication). While the frequency of interactions was low, the majority were conducted by telephone. Interactions, especially those conducted face-to-face, were positive. Only a few related to patient non-adherence. The findings are positioned within contemporary collaborative theory and provide an accessible introduction to models of interprofessional collaboration.

CONCLUSIONS

This work highlighted that successful collaboration to improve medication adherence was underpinned by shared paradigmatic perspectives and trust, constructed through regular, face-to-face interactions between pharmacists and GPs.

The issue of territoriality between pharmacists and physicians in primary care

This paper discusses the utility of the concept of territoriality in order to understand relationships between pharmacists and physicians in the primary care setting. First, we provide background information on the concept of human territoriality. Secondly, we discuss its potential application to the relationships between pharmacists and physicians. Finally, we suggest ways in which understanding and tackling territorial issues may strengthen the pharmacist-physician link and, in doing so, may improve patient care.

Scanning electron microscopic (SEM) changes of the endometrium in women taking high doses of levonorgestrel as emergency postcoital contraception

Endometrial surface changes by scanning electron microscope were studied in three women who intentionally took high doses of levonorgestrel as an emergency postcoital contraceptive. Based upon findings of a close link between endometrial receptivity and surface integrity, significant alterations of the uterine lining structure may represent a drug effect accomplishing endometrial contraception. High doses of levonorgestrel (4-6 times more than recommended) caused detectable changes on the surface regardless of the menstrual cycle phase when the medication was taken. Cycle classification was based on estradiol and progesterone hormone levels, which corresponded to the menstrual diary. Comparison to control specimens displayed marked restructuralization of the endometrium. As a main feature, the number of ciliated cells were reduced, and cilia disappeared in the proliferative and periovulatory phase. In the secretory phase, pinopodia disappeared and the endometrial integrity broke down. The contraceptive effect of levonorgestrel seems to be accomplished by alteration of the endometrial surface and, therefore, receptivity.