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Reciprocal arrangements for registration of pharmacists from. Australia and New .... RJ Cooper, L Guillaume, A Avery, C Anderson, P Bissell,. A Hutchinson, V ...
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The International Journal of Pharmacy Practice 2008; Supplement 1

POSTER SESSIONS What do we know about pharmacists who join the register from overseas? EI Schafheutle, K Hassell and EM Seston Centre for Pharmacy Workforce Studies, School of Pharmacy and Pharmaceutical Sciences, The University of Manchester, Oxford Road, Manchester M13 9PT, UK. E-mail: [email protected]

Introduction Reciprocal arrangements for registration of pharmacists from Australia and New Zealand ended in June 2006. Furthermore, a number of new member states joined the European Union between 2004 and 2007, enabling pharmacists from those countries to register in Great Britain (GB) under European agreement. These developments are likely to have an impact on overseas entries onto the register, and thus on the pharmacist workforce. The aim of this paper is to explore the entry routes of non-GB-trained pharmacists and their demographic make-up.1

Method The August 2007 extract of the Register of Pharmacists formed the basis for analysis, register extracts between 2002 and 2005 were also explored, allowing longitudinal comparison. The presentation of results is split into non-GB-trained pharmacists with a registered address in GB, and those who live overseas.

Results In 2007, 11.3% of the 47962 registered pharmacists were non-GB-trained, an annual increase on previous years. The majority (n = 3802) had a GB address, with 1545 having registered from Europe, 1277 via adjudication and 980 through reciprocal arrangements. The numbers of reciprocal pharmacists have generally increased year on year, especially in 2006 before this entry route ended; the number fell in 2007. European pharmacists have a mean age of 31.7 years, reciprocals 40.0 years and adjudication pharmacists 43.0 years. The percentage of women among adjudication (55.3%) and reciprocal pharmacists (58.6%) is similar to all GB-qualified pharmacists (55.8%), but there are proportionately more women among European pharmacists (67.8%). The majority of European and reciprocal pharmacists are white (94.2% and 78.7% respectively); most adjudication pharmacists are black (39.2%), Asian (27.7%), or white (22.0%); 7.1% of GB-registered

pharmacists have a London address – a proportion that is much higher for European (13.9%), adjudication (19.5%) and reciprocal pharmacists (29%). When looking at pharmacists living overseas, 34.3% are non-GB-trained, and most joined the register through reciprocal arrangements (n = 1035). The mean ages of European, reciprocal and adjudication pharmacists are comparable to those in GB (34.4, 40.0, 43.5 years respectively). The ethnic origin of European and reciprocal pharmacists is similar to those in GB (96.3% and 77.2% white respectively), while the ethnic make-up of adjudication pharmacists living overseas differs significantly from that in GB, the predominant group being white (47.4%), only 19.6% being black. The most common addresses overseas are Australia (n = 987), New Zealand (n = 364), USA (n = 495), Canada (n = 289), Hong Kong (n = 375), Malaysia (n = 126), Kenya (n = 112), South Africa (n= 101); 95.2% of European pharmacists live in Europe, 78.3% of reciprocals live in Australia/New Zealand, and 76% of adjudication pharmacists live in a country requiring adjudication.

Conclusions This analysis of the 2007 register provides novel insights into the composition and destinations of non-GB-trained pharmacists. It seems that particularly European and reciprocal entry pharmacists may have a tendency to have a GB address (particularly London) for a limited period of time, possibly before returning to their country of origin. As non-GB-trained pharmacists make up a notable proportion of the register in GB, it is important to gain an understanding of the expectations, plans and experiences of the pharmacists entering via the different routes.

Reference 1 More detail on the different routes of entry onto the Register of Pharmacists from overseas, and their requirements, can be found in the Society’s Register Report 2006 at: http://www.rpsgb.org.uk/pdfs/registersreport06.pdf (accessed December 17, 2007).

Self-care for migraine: community pharmacists’ views and early experiences with over-the-counter sumatriptan D Hansford1, DN John2, S Cunningham1, D McCaig1 and D Stewart1 1

School of Pharmacy, The Robert Gordon University, Aberdeen AB10 1FR, Scotland and 2Welsh School of Pharmacy, Cardiff University, Cardiff, Wales, UK. E-mail: [email protected]

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Introduction Sumatriptan was reclassified from prescription-only (POM) to pharmacy-only (P) in June 2006, representing the first class of over-the-counter (OTC) medicines to target migraine pathology.1,2 Patients require migraine treatment to be rapidly available: community pharmacists (CPs) are well placed to assess suitability for OTC sumatriptan. The aim of this study was to investigate and describe CPs’ early views and experiences regarding OTC sumatriptan.

Method A pre-piloted, postal questionnaire, with covering letter, was sent during winter 2006 to a random sample of 1200 pharmacy premises (11% of those registered), addressed to the pharmacist normally responsible for OTC sales, and an information sheet and prepaid, addressed envelope were included. The questionnaire comprised five-point Likert-type scales for attitudinal data and closed and checklist questions on education, training, sales and experiences. Up to two reminders were sent to non-respondents at monthly intervals. Data were analysed using SPSS (v13). Grampian Research Ethics Committee advised that ethical approval was not required.

OTC sumatriptan to at least one customer, and 114 (22%) reported customers requesting it by name; 142 (27%) reported that the last customer recommended sumatriptan had purchased it.

Conclusions Respondent pharmacists generally welcomed the recent reclassification of sumatriptan and have received educational material to meet their needs. The majority were confident in selling it, although almost one-third were not. Relatively few CPs reported recommending or selling sumatriptan, although patients are requesting it. Long-term studies of pharmacists’ views and experiences are required, together with drug-utilisation and patientoutcome investigations.

Acknowledgements Thanks are due to L Adams, G Grey, A Tierney and R Yousef for data collection, A Dalgarno and W Grieg for data input, and all the community pharmacists for completing questionnaires.

Results

References

A total of 523 questionnaires were returned (44%). Sumatriptan was displayed in 324 (62%) pharmacies. Many respondents (414, 79%) strongly agreed/agreed that sumatriptan was a welcome addition to the OTC market (Table 1). Most (375, 72%) expressed agreement that they were confident about selling it. Education regarding reclassified sumatriptan had been received by 442 (85%), with the most common sources being the drug company (377, 72%), Royal Pharmaceutical Society of Great Britain (RSPGB) guidance3 (185, 35%) and journal articles (174, 33%): the majority (345, 66%) indicated it had met their needs. Sixty-nine per cent of pharmacists (360) stated they had not sold sumatriptan in the previous 14 days. In the same period, 53 (11%) CPs had recommended the purchase of

Table 1

1 Editorial. First pharmacy-only triptan launched by GSK. Pharm J 2006;276:613. 2 Medicines and Healthcare Products Regulatory Authority (MHRA). Press release: First over-the-counter (OTC) migraine pill made available. http://www.mca.gov.uk/home/ idcplg?IdcService=SS_GET_PAGE&useSecondary=true &ssDocName=CON2023768&ssTargetNodeId=389 (accessed December 17, 2007). 3 Royal Pharmaceutical Society of Great Britain. Practice guidance: OTC sumatriptan. London: Royal Pharmaceutical Society of Great Britain; 2006. http://www.rpsgb. org/pdfs/otcsumatriptanguid.pdf (accessed December 17, 2007).

Responses by community pharmacists to attitudinal statements, n % (n = 523)

Statement

Strongly agree

Agree

No opinion

Disagree

Strongly disagree

Sumatriptan is a welcome addition to OTC treatments for migraine. (n = 518) I am confident about selling sumatriptan (n = 520) The education I received regarding sumatriptan failed to meet my needs. (n = 517)

142 (27) 92 (18) 15 (3)

272 (53) 283 (54) 54 (10)

64 (12) 76 (15) 103 (20)

34 (7) 60 (11) 284 (55)

6 (1) 9 (2) 61 (12)

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The safety climate of pharmacist supplementary prescribing in England

pharmacists agreed/strongly agreed that errors were appropriately dealt with where they worked, and 79% agreed/strongly agreed that their suggestions for safety improvements would be acted upon. Work colleagues were perceived to encourage pharmacists’ reporting of safety concerns by 81% of pharmacists, and the disregarding of rules or guidelines by staff was considered infrequent. However, 14% of pharmacists agreed that colleagues had encouraged them to prescribe outside their areas of competence, and 38% agreed that patients had done so, but only 2% of pharmacists agreed that they had concerns about prescribing beyond competencies. In relation to communication, 91% of pharmacists agreed/strongly agreed that independent prescribing doctors were available to discuss patient needs, but only 43% agreed/strongly agreed that they received appropriate feedback about their performance.

RJ Cooper, L Guillaume, A Avery, C Anderson, P Bissell, A Hutchinson, V James, J Lymn, A McIntosh, E Murphy, J Ratcliffe, S Reed and P Ward Division of Social Research in Medicines and Health, University of Nottingham NG7 2RD, UK. E-mail: [email protected]

Introduction The introduction of supplementary prescribing (SP) in the UK for nurses and pharmacists was intended to better utilise their skills and benefit patients. However, such prescribing has been criticised and concerns about patient safety raised.1 Improving patient safety is a key NHS aim, with safety culture and systems rather than individuals’ errors being recognised as being important.2 Several safety culture measures have been developed,3 but research has not addressed the safety culture of pharmacist prescribing. The aims of this study were to assess pharmacists’ perceptions of the safety climate in which they undertake SP in England, in both primary and secondary care.

Method A postal questionnaire survey was sent to all 808 pharmacists registered as supplementary prescribers in England in April 2007, following piloting. One non-respondent reminder was sent. A modified version of the validated Teamwork and Safety Climate instrument (which utilised a five-point Likert attitudinal scale) was included,4 and descriptive (univariate) analyses and analytical (bivariate) tests were undertaken using SPSS (v12). Relevant multicentre research ethics committee approval was obtained.

Results A total of 411 questionnaires were returned (response rate 51%), with 47% (193/411) pharmacists reporting current prescribing. Ninety-three per cent agreed/strongly agreed that they would feel safe if they were a patient receiving the prescribing they offered; 79% of pharmacists agreed/ strongly agreed that management had not knowingly compromised patient safety, and more than half believed their organisation was improving patient safety compared to the previous year. In relation to safety processes, 97% of pharmacists agreed/ strongly agreed they knew the proper channels through which to direct patient safety questions, 74% of

Conclusions Researching healthcare safety culture offers insights into perceptions of safety-related attributes such as communication, leadership and support, and can be useful in revealing failings, encouraging changes to work practices and considering compliance with guidelines. These results do not reveal any obvious safety failures, and indicate that pharmacists perceive there to be no significant safety-related problems with communication, leadership and support. However, study limitations exist in terms of the selfreported nature of the data, which may be biased, and accepting that researching culture using quantitative measures may not adequately explore and reflect the subjective nature of such social phenomena. Also, further research involving measures of prescribing error may be needed to inform some doctors’ concerns about the safety of pharmacist prescribing.

References 1 Avery AJ, Pringle M. Extended prescribing by UK nurses and pharmacists: with more evidence and strict safeguards, it could benefit patients. BMJ 2005;331: 1154–5. 2 Smith J. Building a safer NHS for patients: improving medication safety. London: Department of Health; 2003. 3 Hutchinson A, Cooper KL, Dean JE et al. Use of a safety climate questionnaire in UK health care: factor structure, reliability and usability. Qual Saf Health Care 2006; 15:347–53. 4 The University of Texas Center of Excellence for Patient Safety Research and Practice. http://www.uth. tmc.edu/schools/med/imed/patient_safety/survey&tools.htm (accessed December 17, 2007).

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An investigation of the attitudes of medical and nursing staff to monitoring adverse events associated with antipsychotic medication

three clinicians indicating that they frequently or regularly undertook this monitoring.

Conclusions MJ Davies, AJ Mackridge, R Singh and J Day School of Pharmacy and Chemistry, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, UK. E-mail: [email protected]

Introduction Schizophrenia affects approximately 1% of the UK population,1 and typical and atypical antipsychotics are routinely used to successfully treat this and other psychotic conditions. However, these agents are associated with a range of adverse events (e.g. weight gain and dyslipidaemia), and monitoring is recommended.2 Little published data are available regarding the extent of monitoring that occurs and the attitudes of medical staff towards this. This study aimed to explore the attitudes of medical and nursing staff to the monitoring of adverse events associated with antipsychotic therapy.

The use of a gatekeeper to distribute questionnaires to nursing staff may have led to fewer than 400 nurses being asked to participate, giving rise to a falsely low response rate among this group. However, accurate distribution data were not available owing to the study design. The low response rate of this study limits the conclusions that can be drawn; however, the data demonstrate a clear lack, within this trust, of monitoring according to current guidelines. The data suggest that the importance attached to the monitoring of these adverse events among patients using antipsychotic therapies is substantially less among the clinicians responsible for management of therapy than among the mental health nurses working with these patients. The data also suggest that while monitoring is considered important by both groups of health professionals, the available resources may not be in place to perform this to a satisfactory standard. Further study of this important issue is needed, in order to gauge the level of monitoring that is taking place and further explore the barriers to and consequences of suboptimal monitoring.

Method

References

A 25-item self-completion questionnaire was distributed to 67 medical and up to 400 nursing staff in a mental health trust over a six-week period. Distribution of the questionnaires to medical staff was by mail; distribution to nurses was via the clinical placement leads on an agreed randomised basis. The questionnaire contained Likert scale statements exploring attitudes, and closed questions exploring the frequency of monitoring for a range of metabolic factors, and the perceived importance of monitoring each of these. Data analysis, including chi-square testing, was performed using SPSS (v14). The project was approved by the local NHS research ethics committee and the trust research governance department.

Results A total of 26 clinicians and 45 nurses responded (response rate 15%, 71/467). The majority (68/71) considered monitoring adverse events a justifiable use of time; although half (38/71) indicated that the time available was insufficient. Respondents identified weight gain most often (68/71) as requiring serious consideration when planning treatment, and one-quarter (16/71) suggested that treatment should be changed following significant weight gain even where a clinically significant response occurred. Around half (34/71) indicated that they frequently or always monitored blood pressure; however, these respondents were significantly more likely to be nurses (28/34, P = 0.006) than clinicians. Baseline haemoglobin A1c (HbA1c) was also significantly (P = 0.033) more likely to be monitored by nurses, with 17 nurses and

1 Turner T. ABC of mental health: schizophrenia. BMJ 1997;315:108–11. 2 PRODIGY. Schizophrenia. http://www.prodigy.nhs.uk/ schizophrenia (accessed December 17, 2007).

Community nurse prescribing: curious or conservative J Hall, J Cantrill and P Noyce University of Manchester, School of Pharmacy, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, UK. E-mail: [email protected]

Introduction Researchers have identified the source of information and the means of communication as important influences in the uptake of new products by medical and non-medical prescribers.1,2 However, there has been little attempt to describe how frequently prescribers might change their prescribing. The aim of this study was to investigate, both quantitatively and qualitatively, changes in prescribing of district nurses over a 3-year period.

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Method The prescribing data for nurses in one primary care trust (n =174) prescribing items from selected British National Formulary (BNF) sections on more than 50 occasions (n= 89) were analysed for consistency over three years. Semi-structured interviews were conducted with a purposive sample of 14 district nurse prescribers. It was not possible to link the prescribing of individual nurses to the qualitative findings, due to anonymity of the prescribing data. This project was reviewed by an NHS local research ethics committee and the university ethics committee.

Results Quantitative analyses by prescriber

The number of different items prescribed by a nurse in each of the selected BNF sections ranged from zero to fifteen. There was a continuous spectrum of consistency in the prescribing of the nurses. At one end of the spectrum (the consistent end), there were nurses prescribing a ‘core’ of one or two products continuously, and this ‘core’ accounted for the majority of their prescribing. At the opposite end of the spectrum there were nurses who did not prescribe any products continuously.

nurses’ orientation to prescribing, with the curious being more likely to experiment with the prescribing of different products. The negative views held by the ‘curious’ against the ‘conservative’ and vice versa suggest that there is little overlap between the two groups. Those charged with monitoring the quality of prescribing should acknowledge these differences and recognise that strategies developed to influence prescribers may not be equally effective with all groups.

References 1 Prosser H, Amond S, Walley T. Influences on GPs’ decision to prescribe new drugs – the importance of who says what. Fam Pract 2003;20:61–8. 2 Hall J, Cantrill JA, Noyce P. Fashionable prescribing: product selection by district nurse prescribers. Oral presentation to Health Services Research and Pharmacy Practice Conference, Reading 2005.

Collaboration between community pharmacies and a Thai government primary care unit

Qualitative data

The nurses in this study fell into two distinct groups regarding their approach to the prescribing of new products. The first group admitted to being ‘curious’ and wished to try out new things: “The rep did a presentation and gave us some clinical information. Then we selected a patient to try it on.” (DN4)

The second group was more conservative and less willing to prescribe new products: “If you think one thing [product] has been okay for a few people then you’ll just keep on prescribing that because you know it is a safe type of product.” (DN11)

It is interesting that both groups tended to view the prescribing of the other group in a negative manner. Curious prescribers:

K Saramunee, P Sookaneknun, R Rattarom, S Kongsri, R Senanok and RME Richards Faculty of Pharmacy, Mahasarakham University, Khamreang, Kantharawichai, Maha Sarakham, Thailand 44150. E-mail: [email protected]

Introduction Community pharmacy in Thailand is entirely in the private sector and is not connected to the public healthcare system. This study was designed to investigate a novel model of collaboration between local community pharmacies and a government primary care unit (PCU) in carrying out a chronic disease screening programme and to determine the unit cost of the programme.

“They [conservative prescribers] have got into a bit of a rut with what they like and just stick to those products that they know.” (DN1)

Method

Conservative prescribers: “They [curious prescribers] are perhaps more influenced by reps or see more reps.” (DN13)

Conclusions The large differences in the number of different items prescribed could be related to differences in case mix or to

An action research programme was undertaken, which included collaborative work to set the protocol and to develop three models of screening and referring patients.1–4 The screening programme was provided in Maha Sarakham province from July to September 2007. The eligible population was those at risk of hypertension and diabetes who were aged 40 years and over and who agreed to screening. Blood pressure measurement, finger blood glucose testing and interview were performed using the three models of provision. Model 1

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was in two local pharmacies, each staffed by a pharmacist and two PharmD students. Model 2 was in seven different communities in locations such as footpaths/streets for 4–5 days per month, staffed by one nurse, four to five PharmD students, two to four pharmacists and two to four community health volunteers. Model 3 was a theoretical combination of Model 1 and 2. Activity-based costing was analysed from the provider perspective.

4 WHO expert consultations. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157–63.

Checklists and guidelines for the economic evaluation of medicines: which should pharmacists use?

Results A total of 456 eligible people participated in the study, 51 were screened using Model 1 and 405 using Model 2. Eleven persons attending pharmacies (21.6%) and 26 attending the communities (6.4%) met criteria for referral to the PCU for diagnosis. Only six people attended the PCU as recommended. Two of them (0.4%, 2/456) were diagnosed as having hypertension, one was referred from a pharmacy (2%, 1/51) and the other from a community (0.2%, 1/405). The unit cost of providing screening using the three models was calculated as 351.7 Baht (US$11.2), 136.4 Baht (US$4.3) and 160.5 Baht (US$ 5.1) per person respectively.

Conclusions The results indicate that a working model consisting of community pharmacies in collaboration with a nominated PCU for providing a screening programme can successfully identify patients in the community who are at risk and require treatment. While pharmacy-based screening was more costly, the success rate for referral was higher in comparison to a community-based service. However, more effort is needed to ensure that referred patients actually attend the PCU.

FH Shabaruddin, K Payne and RA Elliott

Health Methodology Research Group, School of Community Based Medicine, First Floor, University Place, The University of Manchester, Oxford Road, Manchester M13 9PL, UK. E-mail: [email protected]

Introduction Economic evaluations can be used to aid decision making at both local and national levels, and to inform the introduction of new medicines. A number of checklists and guidelines exist to inform the design and critique of economic evaluations of medicines. Pharmacists involved in decision making need to be able to critically appraise economic evaluations, but may be confused about the relative strengths and weaknesses of available checklists and guidelines, and which to use in practice. This study aimed to compare economic evaluation checklists and guidelines used in England and Wales, and to suggest which may be of value for pharmacists in their practice.

Acknowledgement The project was supported by a research grant from the Thai FDA (Food and Drug Administration), Health Promotion Project in the Faculty of Pharmacy, Mahasarakham University, and the Collaborative Pharmacy Program for Health Promotion.

References 1 American Diabetes Association. Clinical practice recommendation: standard of medical care in diabetes. Diabetes Care 2005;28(suppl. 1):S4–36. 2 Health Information Division Bureau of Health Policy and Plan. Number of deaths and death rate per 100 000 populations by leading causes of death, 1999–2003. http://203.157.19.191/2.3.4-46.xls (accessed January 4, 2008). 3 National high blood pressure education program.2003. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206.

Method A structured search (in July 2007) of Medline, EMBASE and the internet was used to identify the relevant documents using different combinations of the text words: ‘economic’, ‘evaluation’, ‘checklist’ and ‘guideline’. The search focused on checklists and guidelines relevant to decision making and practice in England and Wales. Key categories of appraisal themes used by these documents were tabulated to enable comparisons in function, content, emphasis and detail, and to identify key differences between the criteria used by each document.

Results Seven economic evaluation checklists or guidelines were identified: British Medical Journal (BMJ) guidelines;1 National Institute for Health and Clinical Excellence (NICE) reference case;2 Drummond et al’s checklist;3 NHS Economic Evaluation Database (NHS EED) Handbook;4 Haycox and

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Walley’s checklist;5 Consensus on Health Economic Criteria (CHEC) checklist;6 and All Wales Medicines Strategy Group (AWMSG) reference case.7 Submission guidelines state the preferred methods in the design and reporting of economic evaluations submitted to a journal or institution and are based on the perspectives of the institutions.1,2,7 The BMJ guidelines aim to ensure that submitted studies meet the standard criteria, thus increasing the quality of published studies.1 NICE and AWMSG use reference case approaches tailored to their decision-making processes,2,7 which suggest the ‘ideal’ study design. Analysts are allowed to deviate from the suggested methods provided they give a valid reason why. Critical appraisal checklists present criteria used to evaluate the quality of a published economic evaluation with the implicit recognition that individual criteria do not carry the same weight.3–6 They provide a checklist to enable a person designing and reporting an economic evaluation to consider the various issues that are crucial when a study is evaluated by a reviewer. The criteria presented by NHS EED are the most comprehensive and detailed, with clear definitions of the standards required for a good-quality economic evaluation.4

consensus on health economic criteria. Int J Technol Assess Health Care 2005;21:240–5. 7 All Wales Medicines Strategy Group. Guidance notes to manufacturers on the completion of the therapeutic development appraisal forms A&B. http://www.wales. nhs.uk/ sites3/Documents/371/AWMSG%20-%20guidance%20 notes%20V3%20updated%20April%2007%20v1.2.pdf (accessed December 17, 2007).

Provision of the Minor Ailment Service by community pharmacy in Scotland SPD MacBride-Stewart1 and A Muir2 1

Edinburgh Community Health Partnership and 2Public Health, NHS Lothian, Edinburgh EH9 2HL, Scotland, UK. E-mail: [email protected]

Introduction

Conclusions The comparison of the documents suggests that all seven can be used to aid pharmacists to evaluate the quality of published economic evaluations of medicines.1–7 These documents apply different key criteria in differing depths. These reflect the target audience and the original purpose of the documents. For the uninitiated, the BMJ guidelines,1 and Drummond et al’s checklist3 present key criteria in a clear and succinct manner. NICE and AWMSG reference cases are specific to decision-making in England and Wales.2,7 NHS EED presents the most comprehensive and detailed criteria to use in the appraisal of an economic evaluation.4

The Minor Ailment Service (MAS) was introduced in all community pharmacies across Scotland in July 2006.1 This first component of the latest Community Pharmacy Contract supports the provision of direct pharmaceutical care in the NHS by community pharmacists to members of the public presenting with a common illness. People who are exempt from prescription charges can register with the community pharmacy of their choice to receive the MAS. Two health board areas piloted the service from April 2003. The frequency of supply during the first year and at the start of the second year of the MAS by health board region was analysed.

Method References 1 Drummond M, Jefferson TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. BMJ 1996;313:275–83. 2 National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal. http://www.nice.org. uk/page.aspx?o=201973 (accessed December 17, 2007). 3 Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes, 3rd ed. New York: Oxford University Press; 2005. 4 Centre for Reviews and Dissemination. 2007 NHS Economic Evaluation Database handbook, 3rd ed. http://www. york.ac.uk/inst/crd/pdf/nhseeed-handb07.pdf (accessed December 17, 2007). 5 Haycox A, Walley T. Pharmacoeconomics: Evaluating the evaluators. Br J Clin Pharmacol 1997;43:451–6. 6 Evers S, de Vet H, Ament A. Criteria list for assessment of methodological quality of economic evaluations:

This is a retrospective analysis of treatments supplied within the 14 Scotland health boards in the first year of the MAS (July 2006 to June 2007) and July 2007. Data on the treatments supplied within the MAS were extracted from the Prescribing Information System for Scotland (PRISMS). Data on the populations and distribution of health-deprived people within the health board regions in 2006 were obtained from the Scottish Government.2,3

Results The first year of the MAS shows a variation in the number of treatments supplied by community pharmacists in each health board region of 26.3 to 282.2 per 1000 population. In July 2007 the variation was seventeen-fold. There is a positive correlation between the frequency of MAS treatments per 1000 population supplied and the proportion of the health board population, with the highest levels of health deprivation

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during the first year of the MAS and in July 2007 (R2 = 0.46; P < 0.01). The most common classes of medicine supplied in the MAS during the first year were analgesics (17.4%), e.g. paracetamol; anti-infective skin preparations (13.0%), e.g. malathion; cough preparations (8.8%), e.g. simple linctus; drugs acting on the oropharynx (5.8%), e.g. benzydamine hydrochloride; non-steroidal anti-inflammatory drugs (5.8%), e.g. ibuprofen; antihistamines (5.6%), e.g. chlorphenamine; emollient and barrier preparations (5.2%), e.g. aqueous cream; and anti-infective eye preparations (4.0%), e.g. chloramphenicol.

Conclusions The MAS is an essential component of the Community Pharmacy Contract in Scotland; there are different arrangements in England and Wales.4 Results from this analysis suggest that populations in Scotland with the greatest proportion of health-deprived people have the highest levels of utilisation of the MAS. Analgesics and anti-infective skin preparations were the most commonly supplied treatments. A comprehensive analysis of the MAS is required to ascertain patient and community pharmacist satisfaction with the service and the impact of the service on the health of the Scottish population.

References 1 The new NHS minor ailment service at your community pharmacy. Edinburgh: The Scottish Government Publications; 2006. http://www.scotland.gov.uk/Publications/2006/06/ 26102829/0 (accessed December 17, 2007). 2 General Register Office for Scotland. Mid-2006 population estimates Scotland. http://www.gro-scotland.gov.uk/ (accessed December 17, 2007). 3 Scottish Executive. Scottish Index of Multiple Deprivation 2006 general report. Edinburgh: Scottish Executive National Statistics Publication; 2006. http://www.scotland. gov.uk/Resource/Doc/151578/0040731.pdf (accessed December 17, 2007). 4 RPS e-PIC references on: pharmacists and minor ailments (minor ailment service/schemes). London: The Royal Pharmaceutical Society of Great Britain; 2007. http://www. rpsgb.org.uk/pdfs/minailschemes.pdf (accessed December 17, 2007).

Herbal medicines and the role of pharmacy

Introduction Consumers spent £147 m on complementary therapies in 2004, of which £87 m was spent solely on herbal medicines.1 Anecdotally, herbal medicines are often considered as ‘natural’ and therefore safe. However, many of these products have potent pharmacological actions and may cause harm directly,2 or through interaction with other medicines.3 The role of pharmacy in the supply of these products and provision of information is currently limited, and there has been little study of this area. This study aims to examine attitudes of the general public towards herbal medicines, with particular regard to the role of community pharmacy.

Method A 35-item questionnaire was distributed to 280 households selected from the postcode address file for a single primary care trust. Questions covered use of herbal medicines, factors influencing location of purchase – including safety and efficacy and advice available. Questions were closed or Likert-style statement type. The study was approved by the university research ethics committee.

Results Valid responses were returned by 73 (26%) recipients. The majority of respondents were female (49, 67%) and aged over 40 years (58, 79%). Respondents primarily purchased herbal products from herbal medicines shops (54, 74%) or pharmacies (32, 44%). Of the 57 respondents who reported recent purchases, 25 (44%) had purchased products for insomnia, 14 (25%) for fatigue or lack of energy and 13 (23%) for arthritis or rheumatism. Factors considered important or very important when purchasing herbal medicines were advice from a pharmacist (52, 71%), convenience (44, 60%), price (42, 58%) and brand (28, 38%). Respondents identified the pharmacist as an important source of information regarding herbal medicines when used with conventional medicines (41, 56%), purchased for a child (36, 49%), for use in pregnancy (35, 48%), recommended by a friend (34, 47%) and purchased for a minor illness (31, 42%). Doctors were also considered a useful source of advice when using herbal medicines in children (39, 53%), in pregnancy (38, 52%) and with conventional medicines (35, 48%). Respondents did not consider herbal medicines to be of higher quality (61, 84%) and efficacy (64, 88%) when purchased from a pharmacy in comparison to other locations. The majority (60, 82%) would trust the advice of a pharmacist in relation to herbal medicines, although many (37, 51%) indicated that qualified herbalists were more knowledgeable than pharmacists.

AJ Mackridge and L Fisher Conclusions School of Pharmacy and Chemistry, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, UK. E-mail: [email protected]

Although limited in scale, this study suggests that herbal medicines are important to self-care for many people, and

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availability of advice is considered important for safe use. Pharmacists were considered to be knowledgeable about herbal medicines and their advice was respected and identified as desirable. However, many pharmacists may not be able to offer comprehensive advice on the use of or potential interactions involving herbal medicines. Although the response rate in this study was small and non-responders were not followed up, the data indicate that some patients associate pharmacists with safe use of herbal medicines. This suggests that as herbal medicine use increases, pharmacists may increasingly be asked to provide advice relating to these products, giving rise to possible training needs.

References 1 Mintel Reports. Complementary medicines – UK – March 2005. London: Mintel Group, 2005. http://academic. mintel.com/sinatra/oxygen_academic//display/&id=1146 26 (accessed December 19, 2007). 2 Dai N, Yu YC, Ren TH et al. Gynura root induces hepatic veno-occlusive disease: a case report and review of the literature. World J Gastroenterol 2007;13:1628–31. 3 Meijerman I, Beijnen JH, Schellens JH. Herb–drug interactions in oncology: focus on mechanisms of induction. Oncologist 2006;11:742–52.

How do people find websites with information about medicines?

were asked to use Internet Explorer to find any site providing information about simvastatin. They were given no further details and could use whatever means they chose. A computer program, Macromedia Captivate, recorded their online activities. Participants were instructed to ‘think aloud’ during all tasks, and their verbal protocols were recorded. They were interviewed immediately afterwards about the task. The outcome measures were (i) the search strategy and search term used; (ii) the URL of the site opened, and how the site was described on the search engine; (iii) the number of search results pages looked at, and the position of the link that was opened on the results page (e.g. 3rd link); (iv) how long the search took; and (v) participants’ verbal protocols (think aloud data). Participants’ search strategies were analysed; and which site they had opened was noted. Coding of participants’ online actions, verbal protocols, and observed behaviours was made by iteratively organising recurring themes into overarching categories.

Results On average, participants spent less than two minutes conducting the search; (range: 31 s to 239 s). No participant looked beyond the fifth link on the first page of search results. The majority typed simvastatin, most often in Google. Only one participant used the NHS Direct portal to search for a site. Participants’ concurrent verbal protocols, and post-study discussions about the task, indicated ‘previous experience’, ‘assessment of quality’, and ‘specific information content’ were factors determining their search strategies. Some participants said they trusted the site because it ‘appeared official’.

P Knapp, DJ Nicolson, P Gardner and DK Raynor Conclusions School of Healthcare, University of Leeds LS2 9UT, UK. E-mail: [email protected]

Introduction There are few available data on how people search the internet for information about health and medicines.1 An observational study found adolescents did not use rigorous search methods and gave little thought to formulating the search strategy.2 Respondents in a focus group reported using a search engine to find the information, although their search strategies varied, and most only looked at the first page of results from the search.3 The aim of this study was to build on this research to systematically observe how medicine users find websites with information about medicines.

Method Research ethics approval was obtained from the University of Leeds, School of Healthcare, Educational Research Ethics Group. Fifteen medicine users, who could use the internet,

These findings provide robust observational evidence of how medicine users search for information about medicines on the internet. The limited search strategy used suggests many sites with information about medicines could be under-utilised if few people access them. The short amount of time participants spent searching indicates the public may give little consideration to using a systematic strategy, shaping the information they find. The ad hoc approaches for assessing quality methods, e.g. trusting sites with an ‘official appearance’, relying on previous experience, and the short period of time spent searching, suggests participants used heuristics based on visual appeal to make short-term decisions about the trust of such sites, reflecting the stage model of trust for web-based health advice.4

References 1 Morahan-Martin JM. How internet users find, evaluate, and use online health information: a cross-cultural review. Cyberpsychol Behav 2004;7:497–510. 2 Hansen DL, Derry HA, Resnick PJ, Richardson CR. Adolescents searching for health information on the internet: an observational study. J Med Internet Res 2003;5:e25.

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3 Peterson G, Aslani P, Williams KA. How do consumers search for and appraise information on medicines on the internet? A qualitative study using focus groups. J Med Internet Res 2003;5:e33. 4 Sillence E, Briggs P, Harris P, Fishwick L. A framework for understanding trust factors in web-based health advice. Int J Hum Comput Stud 2006;64:697–713.

Responding to symptoms in pregnancy and breastfeeding: the experience of Thai women

Results Forty-three women participated in the first interview, and 35 in the second one. It was found that the majority of the pregnant women chose to consult the doctor before taking any medicine if they were ill, while most breastfeeding mothers decided to take advice from family and friends. Both sets of women tried to use non-drug treatments to relieve their symptom. For example, pregnant women increase consumption of fruit to relieve constipation, and breastfeeding women relieve breast engorgement by brushing the tender breast with a hair comb, they also apply breast milk to their nipples after feeding their baby, to prevent nipple damage.

S Boonyaprapa1, C Anderson1 and D Fraser2

Conclusions

1

Pregnant women strongly believe their doctor’s opinion, whereas breastfeeding women tend to follow a traditional practice or advice from family and friends. This study provides a better understanding for healthcare professionals about women’s self-treatment during pregnancy and breastfeeding.

Division of Social Research in Medicines and Health, School of Pharmacy and 2Division of Midwifery, School of Human Development, University of Nottingham, Nottingham NG7 2RD, UK. E-mail: [email protected]

Introduction References During pregnancy and breastfeeding women are concerned about the health and safety of themselves and their baby. They undertake many activities in order to maintain good health, manage minor ailments and improve their lifestyle, including seeking help and advice from pharmacies. 1 Self-treatment or self-medication is popular and important to the health status of Thai people. In addition, health behaviours in Thailand are dependent on Thai culture, family and relatives.2 Therefore, an investigation into the health behaviours of pregnant and breastfeeding women is needed to explore these behaviours in terms of the management of minor ailments. A few previous studies about health behaviours in Thailand have focused on healthy women during pregnancy and breastfeeding. The specific objective of this study is to determine how pregnant and breastfeeding women manage minor symptoms.

Method Two in-depth interviews in the local Thai language were held with 43 women in Chiangmai; the first explored their health experiences and behaviours during pregnancy (after the 34th week of pregnancy) and the second explored them during breastfeeding (more than four weeks after birth). Audiotaped interviews were transcribed, translated and analysed using the principles of the constant comparison method. The semi-structured questions and consent form received ethical approval from the School of Pharmacy, University of Nottingham.

1 Samantha S, Ann R-H, Kimberly AG. Pharmacist counseling of pregnant or lactating women. J Am Pharm Assoc 2001;41:887–90. 2 Charupatanapong N, Rascati KL. Self-medication practices in Thailand. J Pharmacoepidemiol 1992;2:13–34.

Developing a web-based assessment methodology to provide reassurance of competence for pharmacists in relation to safeguarding children M Shaw, P Higginson and C Cutts Centre for Pharmacy Postgraduate Education, Workforce Academy, School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Manchester M13 9PL, UK. E-mail: [email protected]

Introduction Every child matters (2003) required all agencies to develop a shared sense of responsibility for safeguarding children and protecting them from harm.1 The Royal Pharmaceutical Society of Great Britain (RPSGB) has developed a set of competences

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for pharmacists to support them with this. Primary care trusts (PCTs) across England seek reassurance that pharmacists meet these competences. However, assessing potentially all community pharmacists in England in line with these competences would not be feasible using a standard paper-based assessment. Traditionally the Centre for Pharmacy Postgraduate Education (CPPE) had used a binary (true/false) assessment, to validate completion of the learning programme, which did not meet the assessment needs of the PCTs. To overcome these difficulties, a novel, more flexible approach to assessment of pharmacist understanding and ability was needed. The project’s aim was to work with key national agencies in the development of a web-based methodology that would assess pharmacists’ knowledge and application of knowledge in line with the RPSGB competences. The objectives were to determine which competences could be assessed, develop an appropriate approach to assessment, modify the assessment in line with expert feedback, pilot the assessment with potential future users and implement the new assessment system.

Conclusions The web-based approach to assessment for child protection has been successfully developed and provides a reassurance for PCTs of the knowledge and ability to apply that knowledge of the successful participant. The input and reviews from the RPSGB and the NSPCC provide CPPE with a robust assessment that meets national standards.

Reference 1 Every child matters. London: Department of Health; 2003.

Workforce migration: who moves for preregistration training and what kinds of places do they work in? AC Wagner, SC Willis and K Hassell

Method A new web-based assessment system was designed in-house at the CPPE and based on the competences determined by the RPSGB. The researchers developed a series of assessment questions using three different approaches – standard multiple choice questions, extended matching questions, and ‘download and sign’. In the latter approach the respondent downloads a series of exercises and then signs electronically to confirm that these have been completed. These questions were reviewed by experts at the RPSGB and from the National Society for the Prevention of Cruelty to Children (NSPCC), and modifications were subsequently made. The final assessment utilised a random selection of questions targeted against the required competences of the pharmacist. Different sections of the assessment test knowledge of legislation, its application to practice and understanding of referral systems. A pilot assessment was undertaken with practising pharmacists.

Centre for Pharmacy Workforce Studies, School of Pharmacy and Pharmaceutical Sciences, The University of Manchester, Manchester M13 9PT, UK. E-mail: [email protected]

Introduction Pharmacist shortages persist in locations away from large metropolitan cities, in less-affluent areas, and where there is no pharmacy school supplying the local labour market.1 Meeting these shortages requires workforce mobility between urban and rural areas, and away from more affluent settings. Focusing on migration behaviour from university into preregistration training, this paper measures the extent of graduate migration, discusses the roles of sex and ethnicity in migration, and their relationship with sociodemographic features of the locations where graduates train.

Results Since it was launched, the assessment has been undertaken by 489 pharmacists, of whom 214 (43.8%) have completed all sections. The researchers undertake ongoing analysis of question responses to determine whether any questions are subject to high failure rates. Where feedback has been received from participants with concerns relating to questions, we are able to investigate the question item concerned. Questions that are found to be inappropriate are removed from the system. The assessment approach has been accepted by the North West Harmonisation Accreditation Group (HAG), which covers a number of PCTs (n = 24), as evidence of meeting standards.

Method Straight-line distances from pharmacy school postcode to training post were measured for 2006 graduates taking part in a longitudinal study of career development. Geographical information system software allowed us to track the migration behaviour of each graduate, and was used to determine whether an individual had/had not moved from university to take up a training post. Migration was defined as over 15 km from the university attended, since most urban areas have a radius of less than 15 km.2 From these data, patterns of migration flows were mapped. Sociodemographic features were

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attributed to locations using the 2001 census and 2004 Index of Multiple Deprivation.

Why some pharmacists choose non-standard careers soon after qualifying? M Eden, EI Schafheutle, SC Willis, EM Seston and K Hassell

Results Analysis is based on 895 graduates who provided a training post address (52.7% of the total cohort graduating in 2006). Overall, 20.8% remained within 15 km of the pharmacy school where they trained; proportionally more female than male, and more minority ethnic (ME) than white, students migrated. Graduates from Bath, Robert Gordon and Portsmouth were most likely to have migrated (97.5%, 91.1% and 90.6% respectively moved more than 15 km to take up a training post); those graduating from Strathclyde, John Moores, and Kings College were significantly less likely to have moved away (56.4%, 63.4% and 68.3% graduates migrated from these universities respectively). ME males were significantly more likely to be training in a pharmacy in a deprived area (43.4%) than white males (23.3%), white females (23.9%) or ME females (29.5%). Significantly more ME graduates were training in an urban area of England or Wales (93.5%). In fact, three out of five ME graduates (60.6%) were training in locations that had more than the national average ME population of 7.9%, yet 61.5% of white graduates were training in areas characterised as having a lower-than-UK-average ME population.

Centre for Pharmacy Workforce Studies @ The Workforce Academy, School of Pharmacy and Pharmaceutical Sciences, The University of Manchester, Oxford Road, Manchester M13 9PT, UK. E-mail: [email protected]

Introduction Analysis of the GB Register of Pharmacists indicates that 14% of pharmacists leaving the Register in 2006 were younger than 30 years of age.1 The 2005 pharmacy workforce census indicated that 15% of respondents were dissatisfied with their main job and 11% considered leaving the profession.2 In the context of continuing workforce shortages, this reduction in supply has important implications for workforce planning, especially if pharmacists leave soon after registration. The aim of this exploratory study is to advance understanding of why some pharmacists choose to leave pharmacy early in their career or pursue non-standard career paths.

Method

Conclusions Acknowledging that pharmacy graduate migration is affected by the supply of training posts, and is also a function of a range of personal and educational factors such as moving back to a student’s home town after completion of the MPharm, we have nevertheless found differences in patterns of migration. While our findings are limited by not including these factors in our analysis, we have found differences in terms of university effects on who moves, as well as in terms of sex and ethnic differences found on analysing selected sociodemographic features of the locations graduates train in. Since graduate migration is generally correlated to higher overall lifetime earnings,3 future stages of this study will be able to measure the effects of early career migration on graduates’ subsequent career histories and attainments.

References 1 Andalo D. Plentiful work in the community due to increased services and longer hours. Pharm J 2007; 278:769–70. 2 Faggian A, McCann P, Sheppard S. An analysis of ethnic differences in UK graduate migration behaviour. Ann Reg Sci 2006;40:461–71. 3 Sjaastad LA. The costs and returns of human migration. J Polit Econ 1962;70(suppl.):80–93.

Following university ethics approval, recently qualified pharmacists who were either not working in standard pharmacy roles or considering leaving the profession were identified from participants in an ongoing pharmacy workforce study.3 A topic guide was developed based on three pilot interviews with pharmacists in non-standard roles. Semi-structured interviews were tape recorded, transcribed verbatim and subjected to thematic analysis.

Results To date, 10 interviews have been conducted. Interviewees were aged between 24 and 32 years; six were women. Three were undertaking PhDs (one science based, two pharmacy practice), three were studying medicine, two were employed as pharmacy-related scientists, two were practising pharmacists and one worked in pharmacy education. The reasons interviewees gave for deciding to study pharmacy were that the course offered broad-based science skills alongside clinical training. The relative importance of these two course aspects differed for individuals. The medical students reported an early interest in working in health care (one had been unsuccessful in applying to study medicine), and the chance to use their skills to influence care provision was appealing. The range of future opportunities facilitated by the broad-based science aspect of the course was a strong motivational influence on other participants.

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Most interviewees enjoyed their pharmacy degree, which they felt provided them with sound science and clinical training. Views and experiences of their preregistration year (mostly in hospital) were mixed, but nevertheless, it effectively provided their first insight into ‘real’ pharmacy practice. Many felt their clinical skills were under-utilised, something they believed would continue with more experience. The medical students in particular had hoped for more patient involvement, responsibility and opportunities for clinical decision making, which strongly influenced their decision to start a medical degree. For those choosing a more science-focused career, the pharmacy degree had fulfilled their expectations and provided the necessary skills. Those undertaking pharmacy practice PhDs had not ruled out the possibility of returning to work in a standard pharmacy role in future.

Conclusions These findings are based on a relatively small number of interviews. Further interviews will elicit views of those intending to leave the profession. Nevertheless, these preliminary findings indicate that undergraduates’ expectations of, and motivations for, choosing pharmacy influence early career choices. The broad-based nature of pharmacy training seems to provide opportunities for alternative career pathways. However, these interviewees suggest that early career pharmacists feel their clinical skills are under-utilised, which is at odds with the policy drive of recognising and utilising pharmacists’ skills within the healthcare team.

Introduction Pharmacists can extend their role by delivering advanced, enhanced and non-contractual services; however, there have been reports that a lack of time prevents pharmacists from providing these.1 Efficient use of pharmacy staff should free up pharmacist time, enabling more service provision.2 This research aimed to profile the number and type of pharmacy staff and explore links with the range of services provided.

Method Semi-structured telephone interviews were conducted between January and March 2007 in a single primary care trust selected purposively (number of pharmacies, location). Altogether, 33/39 pharmacies agreed to participate. The transcribed interviews were analysed thematically. The project was reviewed by the university ethics committee, and formal approval was not required.

Results The services provided within the sample included medicines use reviews, needle-exchange, emergency hormonal contraception, smoking cessation, cholesterol testing, weight management and blood pressure monitoring. The number of dispensary support staff and services provided can be seen in Table 1. Table 1

Number of dispensary support staff

References 1 Hassell K, Seston EM. Workforce update – joiners, leavers and practising and non-practising pharmacists on the 2006 Register. Pharm J 2006;277:576–8. 2 Hassell K, Seston EM, Eden M. Pharmacy workforce census 2005: main findings. London: Royal Pharmaceutical Society of Great Britain; 2006. 3 Willis S, Shann P, Hassell K. Early choices questionnaire. Piloting the questionnaire. London: Royal Pharmaceutical Society of Great Britain; 2005.

How do staffing levels affect the number of services provided by a community pharmacy?

Support staff and services provided 0–1

2–3

4–5

6+

Mean number of services 0.6 (n = 9) 1.4 (n = 15) 1.8 (n = 6) 2.6 (n = 3)

The mean number of services in pharmacies with one pharmacist was 1.3 and in those with two pharmacists it was 2.3. The mean number of services in pharmacies with an accuracy checking technician (ACT) was 2.0 and in those without an ACT was 1.7. In general, pharmacists were happy to provide more services. Two themes emerged regarding pharmacists not providing more services.

• Staff shortage: “We are being told to do more services. Need more hours and more staff to do this.” • Pharmacists are not good at delegating: “Pharmacists are trying to do far too many things on their own.”

V Crabtree, J Hall, M Zargarani, I Smith and N Turner Conclusions University of Manchester, School of Pharmacy, 1st Floor, Stopford Building, Oxford Road, Manchester M13 9PT, UK. E:mail: Victoria.crabtree@ manchester.ac.uk

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into account the impact that prescription volume and over-the-counter business can have on staffing profiles. Obviously, second pharmacists and ACTs are not financially viable in every pharmacy but the reason for a low number of services identified here was a lack of time due to not enough support staff or poor delegating. Further research is required to ascertain the level of volume of business that these additional services generate (e.g. number of MURs).

References 1 Hall J, Smith I. Barriers to medicine use reviews: comparing the views of pharmacists and PCTs. Int J Pharm Pract 2006;14:B51. 2 Pharmacy workforce in the new NHS: making the best use of staff to deliver the NHS pharmacy programme. London: Department of Health; 2002.

Polypharmacy in dialysis patients: how well do we know our patients’ allergies? P Kendrew, S Chinnappa, J Armitage, M Chintu and S Bhandari

Method We conducted a cross-sectional study in a single satellite dialysis unit involving 25 dialysis patients (16 male and 9 female). Ethics approval was not required as it was an audit. The mean age of the patients was 70.6 ± 12.1 years (median 74 years). These patients had been on dialysis for 2.91 ± 0.36 years (median 2.5 years) and known to the renal services for 6.19 ± 0.98 years (median 5.4 years). During the study the patients were interviewed with the help of a questionnaire, and their allergies were recorded on a form. These records were then compared with the documentation in the allergy column in case notes, case histories and drug cards. Discrepancies were noted.

Results All 25 patients completed the study (response rate 100%). The study showed that 36% of the patients did not have their allergies documented in their case notes or drug cards, in spite of the patients being well known to the renal service for more than 5 years. Of the allergies ascertained, 86% were medication allergies and the rest were due to topical agents like talcum powder, elastoplasts, mouthwash etc. Forty-eight per cent of the medication allergies were antibiotic allergies. Four per cent of the patients were allergic to vancomycin. The commonest drug allergy was to the antibiotic penicillin (20% of patients); however, there was no mention about the nature of the allergy and whether it was significant.

Conclusions

Department of Renal Medicine, Hull and East Yorkshire Hospitals NHS Trust, Kingston upon Hull HU3 2JZ, UK. E-mail: [email protected]

Drug errors remain the commonest potentially avoidable risk in clinical medicine. This study demonstrates that despite being under the long-term care of a renal service, information which is vital for optimal safe practice remains incomplete. Without such information the potential for adverse events is significant in a population that receives polypharmacy and is frequently prescribed antibiotic therapy. Medication histories should be re-evaluated regularly and comprehensively.

Introduction A recent study of hospital admissions in the UK found that 7% of people admitted to hospital had experienced at least one adverse drug reaction. Patients on haemodialysis attend regularly for outpatient dialysis treatment; however, effective documentation regarding allergies in the captive population is unknown. We therefore evaluated how thorough the documents held in the renal unit were regarding potential drug allergies.

Reference 1 Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279:1200–5.

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