Description and process evaluation of pharmacists’ interventions in a pharmacist-led information technology-enabled multicentre cluster randomised controlled trial for reducing medication errors in general practice (PINCER trial)

Objective To undertake a process evaluation of pharmacists' recommendations arising in the context of a complex IT-enabled pharmacist-delivered randomised controlled trial (PINCER trial) to reduce the risk of hazardous medicines management in general practices. Methods PINCER pharmacists manually recorded patients’ demographics, details of interventions recommended, actions undertaken by practice staff and time taken to manage individual cases of hazardous medicines management. Data were coded and double entered into SPSS v15, and then summarised using percentages for categorical data (with 95% CI) and, as appropriate, means (SD) or medians (IQR) for continuous data. Key findings Pharmacists spent a median of 20 minutes (IQR 10, 30) reviewing medical records, recommending interventions and completing actions in each case of hazardous medicines management. Pharmacists judged 72% (95%CI 70, 74) (1463/2026) of cases of hazardous medicines management to be clinically relevant. Pharmacists recommended 2105 interventions in 74% (95%CI 73, 76) (1516/2038) of cases and 1685 actions were taken in 61% (95%CI 59, 63) (1246/2038) of cases; 66% (95%CI 64, 68) (1383/2105) of interventions recommended by pharmacists were completed and 5% (95%CI 4, 6) (104/2105) of recommendations were accepted by general practitioners (GPs), but not completed at the end of the pharmacists’ placement; the remaining recommendations were rejected or considered not relevant by GPs. Conclusions The outcome measures were used to target pharmacist activity in general practice towards patients at risk from hazardous medicines management. Recommendations from trained PINCER pharmacists were found to be broadly acceptable to GPs and led to ameliorative action in the majority of cases. It seems likely that the approach used by the PINCER pharmacists could be employed by other practice pharmacists following appropriate training.

Dispensing activity in a community pharmacy-based repeat dispensing pilot project

Objective: To measure changes in dispensing activity in a UK repeat dispensing pilot study and to estimate any associated cost savings. Method: Patients were provided with two successive three-monthly repeat prescriptions containing all of the items on their "repeat medicines list" and valid at a study pharmacy. Pharmacists consulted with patients at the time of supply and completed a patient-monitoring form. Prescriptions with pricing data were returned by the UK Prescription Pricing Authority. These data were used to calculate dispensing activity, the cost of dispensed items and an estimate of cost savings on non-dispensed items. A retrospective identification of items prescribed during the six months prior to the project was used to provide a comparison with those dispensed during the project and thus a more realistic estimate of changes. Setting: 350 patients from two medical practices in a large English City, with inner city and suburban locations, and served by seven pharmacies. Key findings: There were methodological challenges in establishing a robust framework for calculating changes. Based on all of the items that patients could have obtained from their repeat list, 23.8% were not dispensed during the intervention period. A correction was then made to allow for a comparison with usage in the six months prior to the study. Based on the corrected data, there was an estimated 11.3% savings in drug costs compared with the pre-intervention period. There was a marked difference in changes between the two practices, the pharmacies and individual patients. The capitation-based remuneration method was acceptable to all but one of the community pharmacists. Conclusion: The repeat dispensing system reduced dispensing volume in comparison with the control period. A repeat dispensing system with a focus on patients' needs and their use of medicines might be cost neutral.

The new UK research governance: its impact on pharmacy undergraduate research projects

Implementation of the Department of Health Research Governance Framework (RGF) in the United Kingdom has major implications for the conduct of pharmacy practice undergraduate research projects. This paper draws upon a survey of local ethics research committees (LRECs) in the greater Birmingham area to identify the issues that arise from the RGF in relation to non-clinical practice research in community pharmacy. Although there is some evidence of minor differences between LRECs, the overwhelming finding is that projects will be subject to the full force of the RGF. The implications are discussed in relation to specific issues relating to non-clinical research, the professional aspirations for a research capable workforce, and the expertise within pharmacy to meet the current accreditation requirements for undergraduate projects.

An evaluation of motivations for studying pharmacy, career commitment and future career plans

It has been predicted that there will be a full time pharmacist workforce shortage of over 15,000 by 2013. It is therefore necessary to recruit more students of a suitable calibre to undergraduate pharmacy degree courses. This study was designed to investigate the motivations of pre-university and MPharm students for studying pharmacy. A series of focus groups was conducted with Year 12 students and a national survey of Year 13, 1st year MPharm and 4th year MPharm students was undertaken. The study found that amongst Year 12 students, pharmacy is perceived as a background profession and was also perceived as being of a lower status than medicine and dentistry. It was concluded that there was a need for greater promotion of pharmacy as a career amongst pre-university students, including the provision of structured work experience placements. Analysis of UCAS applicant data for pharmacy shows that the applicant pool is buoyant and that the majority of applicants are female. Female respondents to the surveys were significantly more likely than males to wish to work part time if they had a family. This could lead to further shortages in the full time workforce. The largest ethnic group of applicants to pharmacy degree courses were Asian. Business ownership and self-employment were motivations for entering the procession of pharmacy and career aims for significantly more Asian than White respondents. Ownership of independent pharmacies is declining and this could be a barrier to future recruitment to pharmacy degree courses. A high degree of interest in locum working may present a problem for continuity in commissioned services within community pharmacy practice. Further work is needed to examine the motivations for working as a locum pharmacist.

FASTtrack applied pharmaceutical practice

This revision guide takes the student pharmacist or pharmacy technician through the main stages involved in pharmaceutical dispensing. It gives bullet points of basic information on applied pharmacy practice followed by questions and answers. This reference text accompanies the compulsory dispensing courses found in all undergraduate MPharm programmes and equivalent technical training courses. Changes for the new edition include: * Information on revisions to the community pharmacy contract. * Additional content on new advanced community pharmacy services. * Revised worked examples and student questions. * Updated prescription labelling information, including the use of new cautionary and warning labels. * Updated references and bibliography.

Intern pharmacists as change agents to improve the practice of nonprescription medication supply: provision of salbutamol to patients with asthma

BACKGROUND: Earlier work established an evidence practice gap during provision of nonprescription salbutamol (albuterol). Pharmacist interns are hypothesized to be in a position to improve professional practice in the community pharmacy setting. OBJECTIVE: To explore the potential of intern pharmacists to improve the professional practice of community pharmacy staff in the provision of nonprescription salbutamol. METHODS: Intern pharmacists (n = 157) delivered an asthma intervention in 136 pharmacies consisting of an educational activity to pharmacy staff and a health promotion campaign to consumers. Post-intervention, simulated patients presented to 100 intervention and 100 control community pharmacies with a request for salbutamol. The appropriate outcome was medical referral for poor asthma control and correction of poor inhaler technique. Incidence and quantity of patient assessment and counseling provided during the visit were also assessed. Logistic regression was used to determine the predictors of medical referral. RESULTS: A doubling in the rate of medical referral was seen in the intervention group (19% vs 40%; p = 0.001). Assessment of reliever use frequency was the main predictor of medical referral (OR = 22.7; 95% CI 9.06 to 56.9). Correction of poor inhaler technique did not improve; however, a reduction in salbutamol supplied without patient assessment (23% vs 8%; p = 0.009) or counseling (75% vs 48%; p < 0.001) was noted. CONCLUSIONS: A doubling in the rate of medical referral showed a clear improvement in professional practice during the provision of nonprescription salbutamol. The improved patient outcome in the intervention group was due to increased assessment of reliever use frequency. Identification of poor inhaler technique remained near zero in both groups, which suggests that intern pharmacists were able to improve the current practice of community pharmacies yet were unable to establish a new practice behavior. This study provides evidence that intern pharmacists can act as change agents to improve pharmacy practice.

FASTtrack applied pharmaceutical practice

This revision guide takes the student pharmacist or pharmacy technician through the main stages involved in pharmaceutical dispensing. It gives bullet points of basic information on applied pharmacy practice followed by questions and answers. This reference text accompanies the compulsory dispensing courses found in all undergraduate MPharm programmes and equivalent technical training courses. Changes for the new edition include: * Information on revisions to the community pharmacy contract. * Additional content on new advanced community pharmacy services. * Revised worked examples and student questions. * Updated prescription labelling information, including the use of new cautionary and warning labels. * Updated references and bibliography.

Pharmacy undergraduate students:career choices and expectations across a career choices and expectations across a four-year degree programme

Report commissioned by the Pharmacy Practice Research Trust

Postgraduate training offered to primary care pharmacists by schools of pharmacy - changes over the last five years

Poster session - A review of the postgraduate training courses offered by the 15 schools of pharmacy within Britain was undertaken - The training currently on offer was compared with that offered by the same schools of pharmacy five years ago - It was found that although the numbers of training courses offered by the 15 schools had significantly increased, the orientation of the courses remained more or less as it was five years ago - The increases in the number of courses had not reflected the increased roles that pharmacists currently have and are hoping to undertake in the future - Any new training offered will need to reflect a wider “modernising and managing NHS organisations” agenda

Paediatric prescribing practice and opinions of paediatric prescribers on ePrescribing

Objective The aim of this study was to provide an initial insight into current UK paediatric prescribing practice. Methods In 2012 focus groups were conducted at Birmingham Children's Hospital (UK specialist hospital) with both medical and non-medical prescribers and analysed using thematic analysis. Key findings Both sets of prescribers used a wide range of resources to support their prescribing decisions. Dosing information was most commonly checked, and a lack of specialist paediatric information was reported in existing resources. All groups had high expectations of the support functions that should be included in an electronic prescribing system and could see many potential benefits. Participants agreed that all staff should see the same drug alerts. The overwhelming concern was whether the current information technology infrastructure would support electronic prescribing. Conclusions Prescribers had high expectations of electronic prescribing, but lacked confidence in its delivery. Prescribers use a wide range of resources to support their decision making when prescribing in paediatrics.