Dorothy McCaig

Pharmacist prescribing in the UK – a literature review of current practice and research

Objective:  To review the research literature to date on pharmacist prescribing in the United Kingdom (UK) and to explore the main areas of care and practice settings including any benefits and limitations.

Views of pharmacist prescribers, doctors and patients on pharmacist prescribing implementation.

Aim The aim of this study was to explore the perspectives of pharmacist supplementary prescribers, their linked independent prescribers and patients, across a range of settings, in Scotland, towards pharmacist prescribing.

Benefits and challenges of prescribing training and implementation: perceptions and early experiences of RPSGB prescribers

Objective To investigate the challenges experienced by pharmacists in delivering supplementary prescribing (SP) services, to explore their perceptions of benefits of SP and to obtain feedback on both SP training and implementation.

Developing and evaluating training for community pharmacists to deliver interventions on alcohol issues

Objective To evaluate community pharmacists’ readiness to provide brief interventions on alcohol and to use study findings to develop training to enable them to screen for hazardous or harmful drinking and intervene appropriately. Setting Community pharmacies in Scotland. Method Eight community pharmacies in Greater Glasgow, Scotland were purposively selected on the basis of pharmacy (independent, multiple), population deprivation index, location (rural, urban, suburban), and local level of hospital admissions for alcohol misuse. Baseline pharmacist telephone interviews covered: current practice; attitudes towards a proactive role; and perceived training needs. A two-day course was designed focusing on: consequences of problem alcohol use; attitudes; sensible drinking; familiarity with client screening using the Fast Alcohol Screening Tool; brief interventions and motivational interviewing. Main Outcome Measures Knowledge of problem alcohol use and brief interventions; attitudes; competence. Results Participants felt it was feasible for trained pharmacists to provide brief interventions. Core training needs centred on communication and alcohol related knowledge. The training course was positively evaluated and led to increases in knowledge, attitudinal scores and self related competence. Conclusion A training programme for pharmacists to deliver brief interventions to problem drinkers was successfully delivered resulting in enhanced knowledge, attitudinal scores and self related competence.

Effects of two Ca2+ modulators in normal and albumin-sensitized guinea-pig trachea

The voltage-dependent Ca2+ channel blocker, verapamil, and the calmodulin antagonist, trifluoperazine, each reduced resting tone and attenuated constriction induced by acetylcholine or vagal stimulation in normal guinea-pig trachea. Attenuation of vagal responses involved both pre- and post-junctional effects on cholinergic neurotransmission. In albumin-sensitized trachea both drugs caused small increases in resting tone. Vagally mediated constrictor responses were resistant to attenuation by verapamil in sensitized trachea. Trifluoperazine was less effective against acetylcholine-induced tone in sensitized, as compared to untreated, trachea. The results indicate that Ca2+ handling is altered in airway smooth muscle in this animal model of bronchial asthma. Abnormal Ca2+ handling, therefore, may underlie the hyperresponsiveness to vagal input exhibited in sensitized trachea and could contribute to the generalised airway hyperreactivity characteristic of asthma.

Development, implementation and evaluation of a pilot project to deliver interventions on alcohol issues in community pharmacies

Objective The aim was to evaluate the feasibility and acceptability of the provision of brief interventions on alcohol misuse in community pharmacies. The objectives were to: train community pharmacists to initiate discussion of alcohol consumption with targeted pharmacy clients and screen, intervene or refer as appropriate; and to explore with pharmacists and clients the feasibility, acceptability and perceived value of screening and delivering the intervention.

Pharmacist prescribing in primary care: the views of patients across Great Britain who had experienced the service

Objective  To evaluate the views of patients across primary care settings in Great Britain who had experienced pharmacist prescribing.

Cross Sectional Survey of the Scottish General Public's Awareness of, Views on, and Attitudes Toward Nonmedical Prescribing

Background Nonmedical (ie, nonphysician) prescribing is a key development in the UK that has brought about many changes in prescribing policy and practice. Systematic research into the views of the general public toward such developments is limited. Objective To determine the awareness of, views on, and attitudes of members of the Scottish general public toward nonmedical prescribing, with an emphasis on pharmacist prescribing. Methods A questionnaire was mailed in November 2006 to a random sample of 5000 members of the general public in Scotland aged 18 and over, obtained from the UK electoral roll. The questionnaire contained items on awareness of nonmedical prescribing, levels of comfort with specific health professionals, and attitudes toward pharmacist prescribing. Results Response rate was 37.1%. More than half of the individuals who responded were taking prescribed drugs. Nine hundred and seventy-eight (56.6%) were aware that trained health professionals could write prescriptions for medicines previously only prescribed by physicians. Awareness was associated with: increasing age (p < 0.001), having a health professional in their immediate family (p < 0.001), self-rated general health (p < 0.005), and a higher education level (p < 0.01). In logistic regression, all factors were retained as independent predictors of awareness (p < 0.001). Comfort levels for nonmedical prescribing were highest for pharmacists (median 4, IQR 3–5 [1 = low, 5 = high]), closely followed by nurses, and lowest for radiographers (median 2, IQR 1–4) (p <0.001). While more than half of the respondents supported pharmacists having a prescribing role, fewer felt that pharmacists should prescribe the same range of drugs as physicians. There were concerns about lack of privacy in a pharmacy, despite acknowledging its enhanced convenience. Conclusions Our results indicate that more than half of the respondents were aware of nonmedical prescribing. A higher proportion was more comfortable with prescribing by pharmacists and nurses than with other healthcare professionals. Several issues relating to aspects of clinical governance were highlighted, specifically education and data handling.

Antimicrobial optimisation in secondary care : the pharmacist as part of a multidisciplinary antimicrobial programme-a literature review

The aims of this literature review were: (i) to determine what roles have been supported by evidence for the pharmacist in optimising antimicrobial treatment as part of an antimicrobial multidisciplinary team (AMDT) in secondary care; and (ii) to describe the outcomes of interventions of an AMDT in secondary care with pharmacy involvement. Both descriptive and primary research reports were identified and included. The hospital pharmacist emerged as a key member of the AMDT. The dispensary pharmacist was mainly involved in the screening processes and was crucial in implementing restriction policies. The general ward-based clinical pharmacist was involved in guideline development, formulary management, intravenous-to-oral conversions and evaluations of programme outcomes through monitoring of drug usage, and also facilitated identification of patients with specific needs who could be referred to the specialist pharmacist. A role emerged for the specialist pharmacist who was an integral part of the AMDT and was involved in activities including reviewing of more complex patients, attending ward rounds and streamlining of initial empirical antimicrobial treatment. Outcomes of interventions reported in primary research have been classified into: drug outcomes, where most trials measured and reported an increase in adherence to guidelines; microbiological outcomes, only considered in a few trials; clinical outcomes, with different parameters measured and a maintenance or improvement reported; and financial outcomes. The latter were reported in all trials with numerous cost savings, although not all were statistically significant. Moreover, the cost of the intervention was not always considered.

Community pharmacists' views, attitudes and early experiences of over-the-counter simvastatin.

AimTo describe community pharmacists’ views, attitudes and early experiences of OTC simvastatin.MethodA cross-sectional postal questionnaire survey of the main pharmacist in 2000 randomly selected community pharmacy premises in Great Britain (approximately 15%).Main outcome measureThe questionnaire comprised items on: attitudes to OTC simvastatin; continuing education; sales; and general views and experiences. Data were analysed using descriptive statistics and content analysis of responses to open questions.ResultsQuestionnaires were returned by 1,156 community pharmacists (57.8%). Nine hundred and fifty-six respondents (82.7%) reported no sales of simvastatin in the previous fourteen days. Eighty-two (7.1%) sold one pack, 40 (3.5%) sold two packs and 18 (1.6%) sold three packs or more (60 did not answer). Almost all respondents (1,086, 93.9%) stated that they had participated in continuing education. Most (691/1,148, 60.1%) strongly agreed or agreed that they were entirely confident about selling simvastatin and that community pharmacists could make an appropriate risk assessment for the use of simvastatin (898/1,149, 78.2%). Responses to the open question identified a number of themes including: need for access to clinical information; cost as a barrier to supply; those purchasing were least likely to benefit; and the lack of an evidence base for the OTC dose.ConclusionCommunity pharmacists surveyed had undertaken an array of continuing education and felt confident to undertake cardiovascular risk assessment. However, very few sales of OTC simvastatin had been made and a variety of issues were identified, particularly relating to the evidence base, access to clinical information, cost and the product licence.