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Natalie Lane is production editor for
journals at the Pharmaceutical Press, London
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A review by Watson et al discusses the use of simulated patients (ie, “mystery
shoppers”) who are trained to test pharmacists or pharmacy staff
in specific scenarios as a methodological tool for pharmacy practice
research. The authors aimed to provide a definitive review and identify
the important characteristics that should be considered for inclusion
in any study that uses this method.
Of the 46 studies included in the review, nine were randomised controlled
trials, three were controlled clinical trials and 30 were cross-sectional
studies. The review details the randomisation, blinding and follow-up
used in the studies and how validity in the studies was achieved. Several
studies used formal scenarios for the simulated patients in order to
achieve some standardisation in the visits and it was noted that simulated
patients may require “face validity” so that pharmacy staff
did not become suspicious and alter their behaviour. The purpose of the
studies was also detailed as was the characteristics and training of
the simulated patients.
Watson et al note that their results demonstrate a growth in the use
of simulated patient methodology during the past 30 years, stating that “this
can be a rigorous and robust method of measuring practice”. However,
the review was limited by variable reporting, by including studies from
developing countries, making it difficult to classify the setting, and
others did not state if staff were pharmacists or not. Future studies
using simulated patients should present sufficient data and information
to allow assessment. The review also discusses quality, validity and
ethics. The authors noted that simulated patient methodology is an internationally
applicable tool with which to derive outcome measures in pharmacy practice
research.
Cognitive services
Roberts et al carried out a literature search that contained discussion
of models or frameworks for the implementation of cognitive pharmaceutical
services (CPS) in pharmacy practice. It is noted that community pharmacy
practice has been documented along a “continuum” from manufacturing,
compounding and distribution to pharmaceutical care and CPS. There
have been few studies that have evaluated the implementation process
for pharmaceutical care or CPS and the authors’ objective was
to review the literature on practice change models so that approaches
for implementing CPS could be investigated.
Only a small number of papers met the criteria for inclusion. However,
many of the papers were either conceptual, descriptive or non-empirical
and so did not have methods sections. Thus, the authors divided the papers
into two categories: conceptual and empirical. Within both categories
the papers could be separated into two broad areas: models relating to
specific services and general models focusing on implementation or change
management process. The papers in these categories were discussed in
further detail.
Roberts et al conclude that emphasis is still placed on the skills, knowledge
and attitudes of individual pharmacists, assuming that improving those
areas will “automatically result in successful change”. Many
models identified overlooked the importance of the organisational process
and, although some included elements such as business plans and external
support, the authors believe that “it is of concern that the majority
of models in which business and financial aspects were included remain
conceptual” and in practice were not used. Furthermore, organisational
models for implementing CPS that existed had not been tested thoroughly.
Many studies used small groups of pharmacists and most studies contained
participants who had actively chosen to be involved. It is accepted that “the
characteristics of innovators are different from those of later adopters” and
can affect the ability to generalise findings. Roberts et al find it
clear that improving the ability to generalise and applicability of the
models requires larger samples to be used in future research. Individual
factors are important but the authors highlight the fact that the implementation
process is complex and involves both internal and external factors. Literature
from other health care settings have been faster to adopt key concepts
in organisational change management and cognitive services “should
no longer be presented in the absence of a clear framework” for
implementation.
Oncology documentation system
Fisher et al discuss ensuring that appropriate pharmaceutical care
continues with increasing numbers of day-case cancer patients. The increase
in
patients being treated with oral chemotherapy at day-case chemotherapy
clinics has increased and clinical monitoring is needed in primary
care in order to minimise the risks associated with the medicines used.
Detailed information about monitoring requirements needs to be conveyed
from the day-case clinic to the patient’s GP and community pharmacist,
and both need to be aware of the “therapeutic plan for the patient,
the management of potential toxicities and possible drug interactions”.
Methods involved a postal survey sent to pharmacists in cancer centres
and units in the UK. Pharmaceutical care issues (PCIs) from 90 day-case
patients at the Edinburgh Cancer Centre were recorded in order to obtain
a profile of pharmaceutical needs, and PCIs were categorised. Six community
pharmacists from NHS Lothian who provide pharmaceutical care to palliative
care and elderly patients participated in interviews to agree the PCIs
to be transferred and followed up in the community and a patient medication
profile (PMP) document was designed and tested in a “purposive
sample” of 20 consecutive patients (10 had received intravenous
and 10 oral chemotherapy).
This study confirmed a need for continuity of pharmaceutical care between
hospital and community pharmacists and confirmed that no established
systems currently exist. The authors discuss one limitation that no community
pharmacists were involved when identifying PCIs. The PMP should be assessed,
ideally, at a national level so as to identify the PCIs that would be
raised in a
larger group of oncology patients and “determine the opinions of
more community pharmacists”.
It was concluded that further development work is needed in order to
identify patients’ needs and to establish a system addressing community
pharmacists’ needs and expectations, thus helping to strengthen
dialogue between oncology specialists and primary care users. |
The
Pharmaceutical Journal