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Natalie Lane is production editor for
journals with the Pharmaceutical Press, London
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Alison Blenkinsopp and Alan Hassey review several published studies
in order to identify whether any evidence regarding the effectiveness
or
acceptability of community pharmacy-based intervention in diabetes care
is available. They wanted to assess the existing evidence about the contribution
of community pharmacy-based services to diabetes care, as well as patient
and community pharmacist perspectives on the provision of such care.
This would “enable critical reflection on the design of previous
pharmacy interventions,” and inform recommendations for the future.
The aim was to include quantitative and qualitative evidence and include
intervention studies, and attitudinal and behavioural studies.
Only a small number of community pharmacy-based intervention studies
were found. The reviewers found it difficult to conduct a meta-analysis
of the results of the experimental community pharmacy studies due to
the heterogeneity of the studies and because few studies specified an
intended effect size or power calculation. However, the reviewers believe
that those developing services in this area should be able to access
the evidence that is available, even if it is limited.
From the evidence found in this review, there are indications that community
pharmacy interventions to improve diabetes care show promise but need
further evaluation. For future interventions, designers should “consider
basing advice and information for the patient, family and carers on eliciting
and discussing the patients’ beliefs and attitudes, with agreed
goals”. The reviewers also say that identifying side effects and
simplifying the treatment regimen by formal medication review is valuable,
and that patient education in diabetes is important.
Scotland
Scottish community pharmacists involvement in, and attitudes to, “extended” service
provision is the subject of a further study. A cross-sectional postal
questionnaire survey was carried out among all community pharmacists
working in Scotland.
The authors designed the questionnaire to identify those aspects that
were considered to affect community pharmacy in terms of workload and
relevance and these were grouped into 12 key areas. The questionnaire
explored current workload and working hours; job satisfaction; training
needs; involvement with, and attitudes to, extended services proposed
for community pharmacy.
The response rate to the questionnaire was 56.4 per cent. All pharmacists
were asked if “key services areas” should be provided by
community pharmacies. Agreement was strongly in favour of the provision
of repeat dispensing, followed by emergency hormonal contraception supply.
The area where most doubt was expressed concerned needle exchange but
most respondents still either strongly agreed or agreed to this service
being provided from community pharmacies.
Overall, the study showed community pharmacists to be enthusiastic for
the suggested key service areas in this study but there were some limitations
to the study. First, the response rate was lower than the ideal. This
was surprising but may have reflected current workloads in community
pharmacy, poor morale or uncertainty about the new contract. Also, definitions
used to inform questionnaire respondents were verbatim from the “The
right medicine” policy document, and it was observed that subtle
differences in the definitions could alter responses. The authors also
allowed pharmacists to self-report their involvement and responses were
not validated by the authors (due to budget).
The authors concluded that there appears to a wide variation in current
service provision in the “key service areas” considered but,
that community pharmacists were generally positive about the provision
of the proposed new services “intended to increase the
contribution of pharmacy in delivery of health care”. Social groups
A paper reports a comparison of medication-prescribing patterns in
different social groups by GPs. A study practice was selected by the
authors
with approximately half of the patients registered at a clinic in a
deprived area, and the remaining patients in a less deprived area.
(Areas were ranked in the Indices of Multiple Deprivation 2004.) Five
doctors serving 8,300 patients in two clinics in the two different
areas were included, and patients were included in the study if they
were registered on the computer-based cardiovascular disease register.
The results showed that in the more deprived area, the prescribing
costs and number of items prescribed were higher. There was little
difference
between the clinics for prescribing aspirins and statins but patients
in the more deprived area were less likely to receive prescriptions for
antihypertensive agents and, on average, received only 3.27 different
cardiovascular drugs compared with 3.80 for patients in the area that
was less deprived.
However, the study evaluated general practice statistics and there were
limitations: the doses of each prescribed drug was not taken into account
or of other co-morbidities which may have had an effect on the drugs
prescribed, or the different possible levels of respiratory disease burden.
Also, no patient or GP questionnaires were included in the study, so
there could be no consideration of patient beliefs. Yet, the study is
unique for comparing the prescribing behaviours of the same five GPs
who prescribe to patients in two different communities.
The authors’ conclusions suggest that some prescribing patterns
differed at the two clinics. The burden of CVD appeared to be similar
but the significant difference in the prescribing rates of some individual
antihypertensives and the total number of cardiovascular drugs prescribed
in the more deprived area suggested that GPs followed different prescribing
behaviours in the different areas. The authors suggest that the high
level of deprivation in one area may have influenced the expectations
of the patients, the co-morbidities and the ability of GPs to discuss
possible drug choices. As a result, consultation styles have been developed
to help those patients with educational disadvantages, and alternative
methods of delivering health care, such as pharmacist and nurse management
of long-term disease and older people’s clinics, have been explored.
From a follow-up study of these implemented changes, the authors indicate
there is now little difference between prescribing rates in the two different
areas. IJPP online
The IJPP is available online via Ingenta.com. The full text is available
only to online subscribers or print/online subscribers. Print-only
subscribers and non-subscribers can purchase papers on a “pay-per-view” basis.
Abstracts are available free of charge to all users. Further information
is available here (e-mail ijpp@rpsgb.org). |
The
Pharmaceutical Journal