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Linda Paulus is production editor for
journals at the Pharmaceutical Press, London
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A paper describing the potentially sensitive subject of getting community
pharmacists and GPs to talk about medication errors appears in the September
issue of The International Journal of Pharmacy Practice. Howard et
al describe the use of a multifaceted strategy for getting GPs and pharmacists
to discuss medication errors that have resulted in preventable hospital
admissions.
They investigated four primary care trusts and one teaching hospital
in the UK.
A large number of GPs (85 per cent) and community pharmacists (62 per
cent) responded to the letters that were mailed to them asking them for
provisional consent to be interviewed and permission to contact them
again in case a patient should be admitted to hospital as a result of
a medication error. GPs and pharmacists who were asked to participate
agreed to be interviewed when patients were admitted to hospitals.
The approach was multifaceted and this has proven to be effective. The
researchers concluded that it is possible to recruit healthcare professionals
to talk about harmful medication errors.
Determinants of adherence
A study by Bane et al looks at what determines the extent of medication
adherence in hypertensive patients. It aims to determine the usefulness
of self-efficacy — defined as a person’s perception that
he or she will be able to perform a given behaviour, in this case taking
medicines, successfully — and the theory of planned behaviour
(TPB) in predicting adherence with antihypertensive medication. The
role of medical and sociodemographic factors in determining adherence
was also examined.
A large proportion of patients with hypertension do not adhere to their
prescribed regimens. Previous research has identified a number of obstacles
to adherence.
The authors composed questionnaires incorporating measures of adherence
with medication, medical and sociodemographic factors, together with
measures of self-efficacy and TPB. Medication adherence was measured
through self-report. The authors recognise the shortcomings of such an
assessment, but they
believe that the results of the study are representative of the patient
group.
Contrary to previous research, this study revealed a statistically significant
relationship between adherence and self-efficacy, with adherence patients
perceiving higher levels of self-efficacy.
The study concluded that further research is required on the application
of the TBP in the prediction of health behaviour. This study in itself
provides support for the use of self-efficacy and the TPB in predicting
medication adherence. The findings of this study have implications for
the design of adherence-enhancing interventions. Counselling in back pain
A study assessed the response of community pharmacists to the presentation
of back pain. The researcher posed as a customer to obtain medicines
for back pain for her “grandfather”. The consultations
she received were recorded in a pretested data collection form.
The researcher went to 100 randomly selected community pharmacies located
within the Klang Valley in Malaysia (including Kuala Lumpur and surrounding
suburban areas).
In 85 per cent of the consultations, pharmacists asked at least one question
before recommending a treatment. The most frequently asked question was
about the patient’s medical history (60 per cent). In general,
a median of only five counselling elements were addressed by the pharmacists
out of 13 recommended. The most common element addressed was the route
of administration, followed by the frequency and dose to be taken. Further
information was not volunteered.
The kind of counselling varied among community pharmacists in Malaysia
and was significantly associated with the age of the pharmacist, the
duration of consultation and the types of medicines recommended. The
response of community pharmacists to the presentation of back pain was
regarded as suboptimal by the researchers.
It was found that the pharmacists only focused on recommending a drug
to alleviate symptoms of the back pain, without attempting to determine
the cause of the pain so that appropriate action could be taken to prevent
future occurrence.
The researchers concluded that the Malaysian Pharmaceutical Society should
create awareness among pharmacists regarding their responsibility to
counsel patients or their caregivers. Facilitators of change
In the review article in the September issue, Roberts et al discuss
their investigation of the facilitators of change in community pharmacy
and
their use in the implementation of cognitive pharmaceutical services
(CPS). CPS can be defined as professional services provided by pharmacists,
who use their skills and knowledge to take an active role in patient
health, through effective interaction with both patients and other
health professionals. Community pharmacy has been moving towards
more patient-oriented modes of practice for more than two decades, particularly
in the area of CPS. The changes are occurring slowly and previous
studies
pay attention to what stops the changes.
The focus of this review is on the elements that make adopting a
new behaviour or practice easier as the researchers perceived that
the concept
of facilitating change is not well developed and change is occurring
slowly in the profession.
Roberts et al selected relevant literature to find out about discussions
about facilitators of community pharmacy practice change in relation
to the implementation and delivery of CPS. Few studies identified or
measured facilitators drawn from experience, with many based on the
views of researchers or participants in the studies, in reaction to
identified
barriers to CPS implementation. Few papers met the required criteria
and so a narrative review was thought to be more appropriate.
Roberts et al note that little consideration has been given to how
facilitators can best be used in practice to accelerate CPS implementation.
They conclude
saying that future research should focus not only on their identification
in representative populations, but on how they should be incorporated
into programmes for CPS delivery. Identifying facilitators at both
individual (eg, knowledge) and the organisational (eg, pharmacy layout)
levels is
important. |
The
Pharmaceutical Journal