Daisy Volmer

Pharmacy Students' Attitudes Toward and Professional Interactions With People With Mental Disorders

Background: Health professionals frequently exhibit negative attitudes toward people with mental disorders. It is not known whether stigmatising attitudes among pharmacy students predict less positive attitudes toward consumer participation in decision-making about medications. Aims: (1) To assess the attitudes of pharmacy students toward people with schizophrenia, and (2) to determine whether stigma predicts less positive attitudes toward concordant medication counselling. Method: All pharmacy students enrolled in a five-year degree program were invited to participate. Students completed the seven-item Social Distance Scale, six items related to stereotypical attributes of people with schizophrenia and the 14-item Leeds Attitudes Toward Concordance Scale. Results: Completed survey instruments were received from 157 students (94% response rate). Previous employment in a pharmacy and personal experience of a mental disorder were associated with low social distance. Later year of study, believing that people with schizophrenia are difficult to talk to, and believing people with schizophrenia have themselves to blame were predictive of high social distance. Low social distance and later year of study were associated with positive attitudes toward providing concordant medication counselling. Conclusion: Mental health stigma was common and predictive of less positive attitudes toward consumer participation in decision-making about medications.

Determinants of Mental Health Stigma Among Pharmacy Students in Australia, Belgium, Estonia, Finland, India and Latvia

Background: Healthcare professionals commonly exhibit negative attitudes toward people with mental disorders. Few international studies have sought to investigate the determinants of stigma. Objective: To conduct an international comparison of pharmacy students’ stigma towards people with schizophrenia, and to determine whether stigma is consistently associated with stereotypical attributes of people with schizophrenia. Method: Students (n = 649) at eight universities in Australia, Belgium, India, Finland, Estonia and Latvia completed a seven-item Social Distance Scale (SDS) and six items related to stereotypical attributes of people with schizophrenia. Results: Mean SDS scores were 19.65 (± 3.97) in Australia, 19.61 (± 2.92) in Belgium, 18.75 (± 3.57) in India, 18.05 (± 3.12) in Finland, and 20.90 (± 4.04) in Estonia and Latvia. Unpredictability was most strongly associated with having a high social distance in Australia (β = —1.285), the perception that people will never recover in India (β = — 0.881), dangerousness in Finland (β = —1.473) and the perception of being difficult to talk to in Estonia and Latvia (β = —2.076). Unpredictability was associated with lower social distance in Belgium (β = 0.839). Conclusion: The extent to which students held stigmatizing attitudes was similar in each country, however, the determinants of stigma were different. Pharmacy education may need to be tailored to address the determinants of stigma in each country.

Pharmaceutical Care in Community Pharmacies: Practice and Research in Estonia

OBJECTIVE To describe the current and possible future development of pharmaceutical care activities and research in healthcare settings in Peru. FINDINGS Pharmaceutical care has developed slowly in Peru because, until recently, clinical practice never was part of community or hospital pharmacy practice. Some activities of the Ministry of Health, schools of pharmacy, pharmacy organizations, and individual pharmacists, including changes in legislation, are now creating the opportunity to develop pharmaceutical care practice. The implementation of pharmaceutical care in different settings will follow, based on the legislation and experiences of the pharmacists involved. DISCUSSION The 2004 legislative changes in Peru in the field of drug regulation and the health system create more opportunities for pharmacists to be active in providing care to patients. To stimulate the provision of care, programs of formal training are offered by universities, but more pharmacists need to participate in these courses. As long as pharmacists are absent from their pharmacies (their presence is required by law), little can be expected. The development of interprofessional collaboration in the Peruvian health system, currently nonexistent, is also important. To improve the performance of the pharmaceutical care system, good relationships between teachers and practitioners must be stimulated. Such links are also essential for developing research into the impact of pharmaceutical care on clinical, economic, and humanistic outcomes of patient care. CONCLUSIONS The pharmaceutical care movement is growing in Peru. The legislation now supports the provision of pharmaceutical care. A number of developments must be stimulated, such as protocol development, appropriate continuing education, different kinds of networking, and remuneration procurement for care provision. When these successfully evolve, pharmaceutical care will become a professional aspect of the work of all pharmacists in Peru.

Complementary Treatment of the Common Cold and Flu with Medicinal Plants – Results from Two Samples of Pharmacy Customers in Estonia

The aim of the current survey was to investigate the complementary self-treatment of the common cold and flu with medicinal plants among pharmacy customers in Estonia. A multiple-choice questionnaire listing 10 plants and posing questions on the perceived characteristics of cold and flu, the effectiveness of plants, help-seeking behaviour, self-treatment and sources of information, was distributed to a sample of participants in two medium size pharmacies. The participants were pharmacy customers: 150 in Tallinn (mostly Russian speaking) and 150 in Kuressaare (mostly Estonian speaking). The mean number of plants used by participants was 4.1. Of the respondents, 69% self-treated the common cold and flu and 28% consulted with a general practitioner. In general, medicinal plants were considered effective in the treatment of the above-mentioned illnesses and 56% of the respondents had used exclusively medicinal plants or their combination with OTC medicines and other means of folk medicine for treatment. The use of medicinal plants increased with age and was more frequent among female than male respondents. Among Estonian-speaking customers lime flowers, blackcurrant and camomile were more frequently used, and among Russian speaking customers raspberry and lemon fruits. Regardless of some statistically significant differences in preferred species among different age, education, sex and nationality groups, the general attitude towards medicinal plants for self-treatment of the common cold and flu in Estonia was very favourable.

Change in public satisfaction with community pharmacy services in Tartu, Estonia, between 1993 and 2005

BACKGROUND The health care systems of Estonia and other Baltic States underwent major reforms between restoration of independence from the USSR and admittance to the European Union. These reforms included changes to the regulations regarding the ownership, location, and number of community pharmacies. OBJECTIVES The objective of this study was to analyze changes in access to, image of, and satisfaction with community pharmacy services in Tartu, Estonia, between 1993 and 2005. METHODS A survey instrument was mailed to a stratified random sample of 713 Estonians aged 20-69 years living in Tartu in 1993 and again to 1000 Estonians aged 20-69 years living in Tartu in 2005. Completed survey instruments were returned by 448 (63%) respondents in 1993 and 386 (39%) respondents in 2005. RESULTS Respondents in 2005 reported more frequent visits to pharmacies than respondents in 1993 (P=.012) and were more likely to indicate that pharmacies have more appropriate locations and opening hours (P<.001). In 2005, 71% of respondents reported always visiting the same pharmacy compared to 35% in 1993. The perceived trustworthiness of pharmacists remained constant. Respondents believed that the role of the pharmacist as a provider of drug information should be expanded; however, demand for extended community pharmacy services was low. CONCLUSION Postindependence reforms to health care and pharmacy systems in Estonia have coincided with greater utilization of community pharmacy services. Higher rates of utilization and continued good standing within the community suggest that pharmacies are potentially well placed to make additional contributions to the evolving primary health care system in Estonia.

How pharmacy students interpret ‘silence’ in pharmacist‐customer communications

Objective To improve communication in the pharmacy we need to be more knowledgeable about the processes that lead to good communication. In a series of studies, video‐vignettes have been used to analyse how pharmacists and pharmacy students assess customers, and how this influences the provision of drug information. The studies are based on a combination of cognitive psychology, attribution theory and discourse analyses. The aim of this study was to analyse how pharmacy students and management science students at Åbo Akademi University interpreted pharmacy‐customer interactions when pharmacists handled requests for prescribed drugs.

Safety concerns in simultaneous use of prescription and 'over-the-counter' medicines- results of patient survey in Estonia.

During the last decades, the share of population using prescription (Rx) medicines has considerably increased. With the wider introduction of self-medication and the use of over-the-counter (OTC) medicines, there is a real threat for drug-drug interactions between Rx and OTC medicines neither identified nor overseen by healthcare specialists.The objectives of this survey were to ascertain how often, and for what conditions OTC and Rx medicines are used simultaneously, and to discuss possible health hazards connected with the concomitant use of these medicines.This survey was designed as a descriptive, cross-sectional questionnaire-based interview which was conducted amongst pharmacy customers and patients in urban and rural areas of Estonia in between 2010–2012.In total, 712 respondents participated in the survey. Of those, 50.4% reported concomitant use of Rx and OTC medicines during the survey. The simultaneous use of Rx and OTC medicines increased with age and the number of chronic diseases (both p < 0.001). Of chronic patients, 37.1% used Rx and OTC medicines on a daily basis over a four-week period before the survey, and considering reported chronic diseases and the most widespread OTC medicines, they could encounter drug-drug interactions between Rx medicines (e.g. antihypertensives, anti-inflammatory medicines) and OTC medicines (e.g. paracetamol, NSAID-s, herbal medicines and adsorbents).The present survey revealed frequent concomitant use of Rx and OTC medicines. Especially vulnerable are chronic and elderly patients. In the future, both patients and healthcare specialists should pay more attention to possible drug-drug interactions of Rx and OTC medicines.

Use of a national database as a tool to identify primary medication non-adherence: The Estonian ePrescription system

Background: Medication adherence can be divided into primary and secondary adherence. Primary medication non‐adherence (PMN) occurs when a patient does not obtain medicine with their initial prescription. Secondary non‐adherence measures prescription refills among patients who previously filled their first prescription. While secondary non‐adherence has been studied thoroughly, PMN has been assessed less extensively, due to lack of available data. Estonian ePrescription system might prove a valuable tool for this. Objectives: The aim of this study was to evaluate PMN and the interval between prescribing and dispensing of medicines using the Estonian ePrescriptions database to establish its potential use for this purpose and for other qualitative drug utilization research measures. Osteoporosis medicines were used as an example. Methods: The Estonian Prescription Centre was used to evaluate if patients purchase medicines after initial prescription of osteoporosis medicine. Prescriptions from 2012 to 2015 of all patients over 18 were included. PMN was defined as the first prescription not being dispensed before it expired (60 days). The rate of PMN was calculated. Results: Estonian ePrescription System enabled fast evaluation of PMN of osteoporosis patients based on data about prescribing, dispensing and time intervals in‐between. Of patients who started osteoporosis treatment 13.1% were primary non‐adherent. Of primary non‐adherent patients 42% still started treatment at some point during the study. Of patients who did purchase their first prescription 80.4% did so within a week and 95% within 25 days. Conclusion: The Estonian ePrescription system is a useful tool for monitoring PMN. The PMN of osteoporosis medicines was identified as lower than previously reported. More similar type of studies about other groups of medicines would be needed to understand the pattern of PMN and give valuable information to healthcare specialists about how to increase initiation of treatment.

Potential drug interactions with statins: Estonian register-based study

Abstract In Estonia, HMG-CoA reductase inhibitors are widely used to modify lipid levels but there are no current data on additional medicines prescribed alongside the statins. The aim of this study was to identify the frequency of potential clinically relevant interactions at a national level among an outpatient population treated with statins between January and June 2008, based on the prescription database of the Estonian Health Insurance Fund. This retrospective prevalence study included 203,646 outpatients aged 50 years or older, of whom 29,367 received statin therapy. The study analysed individuals who had used at least one prescription medicine for a minimum of 7 days concomitantly with statins. Potential drug interactions were analysed using Epocrates online, Stockley’s Drug Interactions, and the drug interaction database developed in Estonia. Statins metabolised by the CYP3A4 isoenzyme were prescribed to 64% of all statin users. Medicines known to have potentially clinically significant interactions with statins were prescribed to 4.6% of patients. The drugs prescribed concomitantly most often with simvastatin were warfarin (5.7%) and amiodarone (3.9%), whereas digoxin (1.2%) and ethinylestradiol (2%) were prescribed with atorvastatin. Potential interactions were not detected in the treatment regimens of rosuvastatin, pravastatin, and fluvastatin users.

The role of community pharmacies in counseling of personal medical devices and drug-delivery products in Estonia.

Objectives: To evaluate the current situation on medical technology at community pharmacies in Estonia, looking into the availability, dispensing and counseling of personal medical devices/drug-delivery products (PMDs/DDPs) and related professional knowledge of community pharmacists. Methods: A descriptive cross-sectional questionnaire-based study using an internet-based eFormular study platform. Results: In total, 137 community pharmacies responded to the study. Of the pharmacies, 51.8% dispensed and 32.1% counseled PMDs/DDPs several times a day. 55.4% of the respondents assessed their professional knowledge on PMDs/DDPs as good to medium and 44.6% as satisfactory to poor. Of the respondents, 79.6% reported a need for systematic education about named devices. Conclusion: Community pharmacies are a frequent source for the dispensing and counseling of PMDs/DDPs in Estonia. However, community pharmacists admitted a strong need for continuing education about general and practical aspects related to the use of PMDs/DDPs for the provision of more professional services in the future.