|  Experience in domiciliary medication review (DMR) should be included
in the education of pharmacy students and pre-registration trainees,
say Australian researchers after reporting positive findings from a study
assessing the ability of final (fourth) year pharmacy students to carry
out supervised DMR.
Thirty-six students undertook medication reviews of 189 patients, most
of whom were aged over 60 years. The students were able to identify medication-related
problems, many of which were subsequently endorsed by pharmacists and
GPs. Using the students’ reports, the GPs indicated that 10 per
cent of patients required a change in therapy. In four patients (2 per
cent) the medication problems were considered clinically significant
by the GP. Student-conducted DMR was acceptable to patients — who
commented on the students’ professional approach — and to
the GPs and pharmacists participating in the project. Surprisingly, the
students’ view
of their role, and of the value of DMR as a component of their training,
was weaker than that of the supervising pharmacists and GPs, but anecdotal
comments suggested that confidence would have been improved if they had
had more training.
The researchers conclude: “It is evident that our students fulfilled
a useful role in the DMR process while applying their knowledge in a
challenging practice environment and gaining experience in an important
aspect of contemporary pharmacy practice.”
Sale of non-prescription medicines
In another primary care study, reported from Scotland, pharmacists
and their staff were found to face a range of barriers to the
evidence-based supply of non-prescription medicines. The study involved
observation of medicine sales in nine pharmacies and staff interviews.
Personal experience and feedback from customers were cited as evidence
on which treatment recommendations were made, but no obvious evidence — such
as guidelines, protocols or other information on best practice — was
used in the majority of consultations.
The researchers acknowledge that there has been little rigorous evaluation
of evidence associated with non-prescription medicines but say that pharmacists
and their staff need to be aware of the importance of using evidence,
where possible, to inform the supply of non-prescription medicines. “Interventions
need to be identified and investigated as methods of promoting evidence-based
practice,” they say.
Other barriers to the appropriate supply of non-prescription medicines
included questioning and communication skills (which were highly variable),
limited ongoing training of medicines counter assistants and no formal
criteria on when to refer to the pharmacist. The authors say that as
medicines counter assistants are involved in over 70 per cent of non-prescription
medicine consultations there is an urgent need to address their continuing
education requirements. Questionnaire surveys
Quantitative data on headache and its treatment were collected from
2,662 adults in a cross-sectional survey of a population sample in five
general
practices in North Staffordshire. Seventy per cent of respondents reported
having headache in the past three months and 85 per cent of them had
taken medicines for it. Medicines use was more likely to be reported
by women and by those aged 36 to 50.
The majority had taken medicines bought from a pharmacy, with paracetamol
being by far the most widely used analgesic. Thirty per cent of medicines
users reported taking at least one combination therapy, such as products
containing codeine or caffeine, or both. Few respondents used migraine-specific
treatments, such as triptans, presumably, say the researchers, because
they had not consulted their GP.
The researchers say that their data indicate that most people are using
medicines appropriately, with two-thirds of users treating their headaches
with simple analgesics. However, for the users who reported that treatment
was ineffective (2 per cent) or only partially effective (51 per cent),
advice about other potential therapies or medical referral may be appropriate.
Also, although a minority used combination therapy, the high prevalence
of headache means that this equates to substantial numbers in the population
as a whole and the researchers comment that health professionals should
discourage analgesic overuse.
A UK hospital research paper reports a questionnaire survey to investigate
the involvement of pharmacists in the monitoring of antibiotic prescribing.
It involved investigation of the availability of antibiotic prescribing
control documents and pharmacists’ role in implementation of antibiotic
policy.
Over 90 per cent of the 253 responding hospitals had at least one antibiotic
prescribing control document: 168 hospitals had an antibiotic formulary,
107 had an antibiotic policy and 216 had antibiotic guidelines.
Pharmacists routinely reviewed adherence to prescribing recommendations
in 83 per cent of hospitals. In 77 per cent of these hospitals, review
was undertaken on all wards while in others it was only undertaken on
selected wards (generally the intensive care unit). Antibiotic prescribing
review was proactive and generally covered drug, dosage, regimen length,
drug interactions and patient factors.
Most pharmacists discussed problems directly with the prescriber but
their intervention was often not recorded in the notes or on the prescription.
The researchers say that in around one-third of hospitals, pharmacists
communicated interventions verbally, annotated prescriptions and attended
ward rounds. They describe this combination of antibiotic prescribing
control mechanisms as “best practice” and recommend its implementation
in all hospitals. IJPP online
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here |
The
Pharmaceutical Journal