The Pharmaceutical Journal
Vol 279 No 7469 p304
15 September 2007

This article
Reprint   Photocopy

PDF 30K, Acrobat Reader

British Pharmaceutical Conference 2007

Highlights from the 2007 conference practice research sessions

Changes to community pharmacy practice dominated the topics being presented at this year’s practice research sessions. Medicines use reviews (MURs) and the new community pharmacy contract were particularly popular subjects.

But the research sessions offered something for everyone: other topics included pharmacist prescribing, errors and inter-professional working.

Time to refocus MURs?

Doctors want MURs to focus on helping patients to understand their medicines, rather than clinical recommendations. This is the finding of research conducted by Gianpiero Celino, of Webstar Health, and colleagues from Keele and Aberdeen universities.

They surveyed 20 GPs from different practices in three primary care trusts in England and one local health board in Wales. This revealed GPs were happy with the idea of MURs before they started. GPs believed MURs would focus on patients’ understanding of medicines and that community pharmacists were ideally placed to undertake this kind of review.

However, the reality did not deliver GPs’ expectations. The researchers explain: “In practice, GPs were disappointed with what they saw as a missed opportunity to use the pharmacist’s skills in the way that they had expected. Of particular concern were the type and nature of the pharmacist’s recommendations, the types of patients reviewed by pharmacists, and a lack of integration with the work of the practice.” GPs singled out inappropriate or ill-informed clinical recommendations as a significant issue.

The researchers comment that refocusing MURs around helping patients to understand their medicines would help secure greater support from GPs.

However, another research group report that MURs have had a positive impact on patient care in asthma. The research, led by Louise Baglole, of Lloyds Pharmacy, involved telephone interviews with 154 patients with asthma who had had an MUR. A validated tool was used to assess asthma control.

They found that the proportion of patients whose asthma was rated “under control” increased from 5 to 9 per cent after the MUR, those considered to be “reasonably controlled” increased from 36 to 46 per cent, and those “not controlled” decreased from 59 to 45 per cent.

In a third of cases, the pharmacist referred the patient to a GP or asthma nurse following the MUR. Of those referred, 71 per cent had a treatment or dosage change. Patients also liked MURs with 73 per cent rating it “very good” and 21 per cent “good”.

Pharmacists tackle OTC abuse

Abuse of over-the-counter medicines is always a hot topic with pharmacists, not least because of the media interest it sparks.

Research led by Adam Mackridge, from Liverpool John Moores University, investigated attitudes towards abuse of OTC medicines among 86 pharmacists working in Wirral and West Cheshire. Half of pharmacists suspected OTC abuse occasionally with another fifth suspecting it regularly. Although nearly three-quarters of pharmacists said they felt mostly or completely in control of OTC abuse, this left 30 per cent who did not feel in control.

When they suspected abuse, nearly all pharmacists were confident in refusing sales but fewer pharmacists (75 per cent) felt confident to tackle abuse directly with the customer. Pharmacists cited abusive patients or lack of confidence that abuse was taking place as factors limiting their confidence in raising the issue.

The researchers comment: “Although few formal treatment services exist for this population, a substantial number of pharmacists considered that they would signpost patients to another health professional for help where appropriate.”

Providing patient information leaflets

Arrangements to enable pharmacists to provide a patient information leaflet (PIL) with every single dispensed item remain inadequate, concludes research from the University of Sunderland.

The research investigated the extent of non-original patient pack dispensing and its knock-on effect on provision of PILs. The researchers note that failure to provide a leaflet is a criminal offence and point to Department of Health proposals in 2002 that missing PILs should be photocopied or downloaded from the internet.

Led by Jim Smith, the research assessed 500 items dispensed from four pharmacies. Altogether, 74 per cent of items were entire patient packs, 19 per cent were from split packs and 7 per cent were dispensed from bulk. PILs were missing from 10 per cent of items.

Of the remainder, 86 per cent included a PIL from a patient pack, 2 per cent from a bulk stock of PILs, 2 per cent used a photocopied PIL, and less than 1 per cent included an internet-downloaded PIL.

Reasons for not supplying PILs included: bulk stock only coming with one PIL; PILs being difficult to photocopy (they were attached to the packaging or supplied in booklet form); and internet download of PILs being inconvenient.

Automation: not the complete answer

Automation of dispensing cuts dispensing incidents but it is does not eliminate all types of error, according to research conducted at Llandough Hospital, Cardiff. In fact, the researchers warn pharmacy staff to not be complacent when checking medicines dispensed by an automated system.

The research compared the incidence and type of dispensing errors before and after the installation of an automated dispensing system. Overall, automation reduced the incidence of dispensing errors by 67 per cent.

But more interesting was a proportional change in the type of error reported. After automation there were no errors based on the wrong strength or wrong drug being dispensed when the label was correct.

However, there were more errors where both the label and the item dispensed were wrong. This was because the drugs were issued based on information entered into the computer system.

The researchers conclude that automation has the potential to eliminate drug selection errors associated with look-alike and sound-alike drugs but not other types of errors.

Look-alike and sound-alike drug names are well known as causes of dispensing errors. In another study, a research team from London and Cardiff report the development of two computer programs to identify risky names. They suggest that they could be used in drug labelling warning systems and in the drug naming process.

One program measures orthographic (spelling or look-alike) similarity and the other phonetic (sound-alike) similarity. The programs were tested using 1,932 British approved names and recommended international non-proprietary names, and a mean similarity score obtained. This was then compared with a list of drug combinations involved in dispensing errors in hospitals.

The researchers found that 39 per cent of these drug combinations had higher similarity scores compared with control.

Drug pairs involved in errors with particularly high scores were hydroxyzine and hydralazine, latanoprost and latanoprost/ timolol, amiloride and amlodipine, and procyclidine and prochlorperazine.