Optimising the impact of education for community pharmacy in Australia

Aims & rationale/Objectives : This paper examines the extent to which different models of community pharmacist continuing education (CE) are evidence-based. It also describes the impact of varying education models on attendance and attitudes within the profession.

Methods : A literature review was conducted to establish principles that should be applied to health professional education, and pharmacy in particular. Interviews were conducted with representatives from four organisations involved in the education of pharmacists to understand their current models. Four focus groups were held with community pharmacists to understand their educational experiences and attitudes.

Principal findings : The purpose of CE is to improve the clinical performance of health practitioners. Literature examining outcomes from CE underlines the importance of adult learning principles. Focus groups supported the view that consideration of these principles is beneficial. These principles, including problem-based learning, clinical applicability, relevance, and active involvement in the learning process, are currently incorporated into educational models to varying extents. Access problems such as cost, distance, insufficient flexibility in delivery, and poor promotion of educational opportunities prevent many pharmacists from taking responsibility for their own learning. A lack of appropriate assessment by some registering authorities is counterproductive to achieving CE outcomes in clinical practice. Participants already engaged in continuing professional development (CPD) agreed with the principles of its introduction.

Discussion : Optimising outcomes from CE requires considerable input from numerous stakeholders. The recent introduction of mandatory pharmacist CPD across Australia should encourage an individual focus on learning outcomes. Focus group participants are likely to be education enthusiasts and may not represent the views of the entire profession.

Implications : This study identifies the need for a system-wide approach for achieving outcomes from CE. It is therefore advisable that a coordinated strategy be developed by all stakeholders for education delivery so as to optimise the impact of CE.

Evaluation of a community pharmacy-based intervention for improving patient adherence to antihypertensives: a randomised controlled trial

Background
The majority of patients using antihypertensive medications fail to achieve their recommended target blood pressure. Poor daily adherence with medication regimens and a lack of persistence with medication use are two of the major reasons for failure to reach target blood pressure. There is no single intervention to improve adherence with antihypertensives that is consistently effective. Community pharmacists are in an ideal position to promote adherence to chronic medications. This study aims to test a specific intervention package that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications - Hypertension Adherence Program in Pharmacy (HAPPY).

Methods/Design
The HAPPY trial is a multi-centre prospective randomised controlled trial. Fifty-six pharmacies have been recruited from three Australian states. To identify potential patients, a software application (MedeMine CVD) extracted data from a community pharmacy dispensing software system (FRED Dispense®). The pharmacies have been randomised to either 'Pharmacist Care Group' (PCG) or 'Usual Care Group' (UCG). To check for 'Hawthorne effect' in the UCG, a third group of patients 'Hidden Control Group' (HCG) will be identified in the UCG pharmacies, which will be made known to the pharmacists at the end of six months. Each study group requires 182 patients. Data will be collected at baseline, three and six months in the PCG and at baseline and six months in the UCG. Changes in patient adherence and persistence at the end of six months will be measured using the self-reported Morisky score, the Tool for Adherence Behaviour Screening and medication refill data.

Discussion
To our knowledge, this is the first research testing a comprehensive package of evidence-based interventions that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications. The unique features of the HAPPY trial include the use of MedeMine CVD to identify patients who could potentially benefit from the service, control for the 'Hawthorne effect' in the UCG and the offer of the intervention package at the end of six months to patients in the UCG, a strategy that is expected to improve retention.

Trial Registration
Australian New Zealand Clinical Trial Registry ACTRN12609000705280

Intervention fidelity for a complex behaviour change intervention in community pharmacy addressing cardiovascular disease risk

BACKGROUND: Delivery of cardiovascular disease (CVD) prevention programs by community pharmacists appears effective and enhances health service access. However, their capacity to implement complex behavioural change processes during patient counselling remains largely unexplored. This study aims to determine intervention fidelity by pharmacists for behavioural components of a complex educational intervention for CVD prevention. After receiving training to improve lifestyle and medicines adherence, pharmacists recruited 70 patients aged 50-74 years without established CVD, and taking antihypertensive or lipid lowering therapy. Patients received five counselling sessions, each at monthly intervals. Researchers assessed biomedical and behavioural risk factors at baseline and six months. Pharmacists documented key outcomes from counselling after each session. Most patients (86%) reported suboptimal cardiovascular diets, 41% reported suboptimal medicines adherence, and 39% were physically inactive. Of those advised to complete the intervention, 85% attended all five sessions. Pharmacists achieved patient agreement with most recommended goals for behaviour change, and overwhelmingly translated goals into practical behavioural strategies. Barriers to changing behaviours were regularly documented, and pharmacists reported most behavioural strategies as having had some success. Meaningful improvements to health behaviours were observed post-intervention. Findings support further exploration of pharmacists' potential roles for delivering interventions with complex behaviour change requirements.