*Menopause clinical and research unit, Northwick Park and St Marks NHS trust, Harrow; †pharmacy practice group, King's College London; ‡ now pharmacy school, University of Nottingham
Introduction A structured training programme has been in place for two years at a menopause clinic, sited within a district general hospital (DGH) in London. Designed by the specialist menopause pharmacist, the training is available to both secondary and primary health care professionals. Community pharmacists (CPs) counsel patients on hormone replacement therapy (HRT), providing information and advice.1 This study reports on the impact of this training on CPs working within the health authority serving this DGH.
Method With funding, 20 randomly selected CPs underwent training (April-November, 1997). The aims were to demonstrate the multidisciplinary team approach for patient health care provision and to facilitate professional development for CPs. With two trainees per session, the bookings resulted in a mix from various medical disciplines. A week before, each trainee was mailed an educational supplement. The morning started with an introduction to management of menopausal patients followed by an HRT products workshop. A half-hour discussion session led by the nurse counsellor and specialist pharmacist, where patients were encouraged to actively participate, then took place in the clinic waiting room. The rest of the morning was spent observing various patient consultations, with the clinician, clinical nurse specialist or specialist pharmacist. Patient consent was obtained prior to the trainee joining any consultation. The CPs then undertook an eight-week HRT prescriptions intervention study. Twenty CPs who had not undergone training formed the control group. A pre-piloted HRT prescription report form (acknowledgement) was completed each time an HRT prescription was dispensed. Both groups were given uniform instructions on completing the forms. Demographic and "hours worked" data for participating pharmacists were collected by telephone. Data analysis was undertaken using the Statistical Package for Social Sciences (SPSS); the test applied was the c2 test.
Results Of the 40 CPs (19 male, 21 female), 35 were of Asian origin and five Caucasian. Eighteen CPs in the trained group and 12 from the non-trained, control group returned intervention forms for analysis (n=552). The trained group reported dispensing more "new HRT" prescriptions but there was a uniform distribution for "handwritten or computer generated" prescriptions and those dispensed for Asian and Caucasian patients. A significantly higher response came from trained proprietor (79%) and manager pharmacists (65%) (p<0.05). The effect of training was more marked on newly qualified pharmacists (p<0.05). The response from trained pharmacists who had not undertaken any other HRT study courses and non-trained CPs who had undertaken other HRT training was significantly higher (p<0.05). In the trained group, the pharmacists reported initiating more enquiries; in the non-trained cohort, the pharmacists were more likely to respond to a query initiated by the customer or GP (65% v 35%). Trained CPs were less likely to report "no outcome" (67% v 33%), but were more likely to have coded a problem as trivial or minor nuisance, reporting spending slightly more time with patients (over 4 minutes). Trained CPs clarified the HRT prescription more often, and with a prescription change it was more likely to be as per the pharmacist's advice. Non-trained CPs were more likely to get the prescription confirmed as written. Trained pharmacists enquired about administration frequency and quantity prescribed; in the non-trained group dosage was more often questioned.
Discussion HRT is prescribed to manage menopausal symptoms and as preventative therapy for postmenopausal osteoporosis and cardiovascular disease.2 The ideal management plan incorporates a holistic approach with lifestyle interventions as important as medical intervention. These issues were addressed within the training session. Discussion considered audits that can be undertaken within GP practices to assess good patient care. Therefore it is not surprising that the trained CPs, including proprietors, were reporting more interaction with patients and GPs. All 20 trained CPs evaluated the training session at the end of the morning as having achieved the objective of demonstrating multidisciplinary working. Further qualitative analysis of interventions made is under way to assess if they support the preliminary findings from this pilot study that trained community pharmacists counselling menopausal patients, focus on important aspects of the HRT prescription, liaising with GPs and addressing patient concerns more effectively.
Acknowledgment: Pharmacy Practice Research Resource Centre — the Pharmacist Rx Intervention Report Form
*Menopause clinical and research unit, Northwick Park and St Marks NHS trust, Harrow; †pharmacy practice group, King's College London; ‡ now pharmacy school, University of Nottingham