Em Seston

Impact of Pharmacists Providing a Prescription Review and Monitoring Service in Ambulatory Care or Community Practice

OBJECTIVE: To systematically review the impact, on patient outcomes and costs to the healthcare system, of pharmacists reviewing and monitoring prescribing in ambulatory care or community practice. DATA SOURCES: We conducted a systematic search of published literature, up to and including 1998, on outcomes of prescription monitoring and review by pharmacists. Thirteen electronic databases were reviewed, along with a hand search of 11 journals known to publish pharmacy practice research. Fifty-five articles describing 50 comparative studies were identified. DATA EXTRACTION: Data were extracted including study design, clinical site, and results. A qualitative synthesis of the findings was conducted and methodological quality was appraised. DATA SYNTHESIS: Pharmacist-run services may be accompanied by improvements in clinical outcomes. Inconsistent definitions used in the research evaluated meant that an overall interpretation of a change in the incidence of compliance and adverse drug reactions was impossible. Other outcomes such as knowledge and satisfaction showed equivocal results overall. There was little or no change in quality of life where this was assessed. Savings in drug acquisition costs may have accrued, but it was impossible to calculate the magnitude. Pharmacist involvement produced a positive impact on cost—benefit and cost-effectiveness. CONCLUSIONS: The heterogeneity of the studies found and the variety in quality of much of the research design prevent the rigorous assessment of the direction and magnitude of any changes reviewed. Further studies are required, which must be rigorously designed, with blind and independent assessment of clearly defined outcomes. In particular, there is a need to investigate the effect of such services on the incidence of adverse drug reactions and quality of life and to conduct robust cost—benefit analyses.

Trade-offs between the benefits and risks of drug treatment for psoriasis: a discrete choice experiment with U.K. dermatologists.

Background  The choice of drug treatment for an individual patient is a complex matter. In the case of psoriasis there is a range of treatments available, with varying degrees of efficacy and risk of adverse events.

Measuring job satisfaction of UK pharmacists: a pilot study

Objective To review the UK published literature on pharmacy job satisfaction, in order to describe and assess the strengths of their methods and the findings and to validate an existing instrument to measure work satisfaction, with a sample of locum pharmacists.

Motivators and barriers to the implementation of pharmacist-run prescription monitoring and review services in two settings

Objectives — To assess the strong motivators and barriers to the implementation of prescription monitoring and review services by community pharmacists either in pharmacies or in general practitioner (GP) surgeries.

Non-dispensing of NHS prescriptions in community pharmacies

Objective — To explore non‐dispensing of National Health Service (NHS) prescriptions in community pharmacies.

The UK pharmacy degree: Attrition rates and demographics of non-completers

Introduction: While it is known that a significant proportion of students within the higher education system do not graduate as expected, knowledge about student attrition in pharmacy is limited. A greater understanding of attrition rates will allow workforce planners and policy makers to estimate the number of new pharmacists that can be expected to join the register each year. Aim: This paper aims to provide information on attrition among pharmacy students in the UK. Method: Data are collated from a range of sources to explore trends or patterns in attrition according to factors such as gender, institution and student type. Results: Between the years 1994 and 2000 overall attrition reached a peak (19%) in 1997, although time series analysis found no significant trend ( p = 0.612). Attrition rates vary by institution, overseas compared with home students and male students compared with females are at greater risk of dropping out. Conclusion: Changes to the way in which student data are collected are recommended, as it is currently difficult to track a cohort with absolute certainty. Nevertheless, the paper draws attention to the extent to which attrition from the pharmacy degree occurs, enabling workforce planners to estimate future intake onto the professional register.

Identifying and managing performance concerns in community pharmacists in the UK.

Objectives To explore current arrangements for identifying and managing performance concerns in community pharmacists in the UK. Methods Semi-structured qualitative telephone interviews were conducted with 20 senior managers from community pharmacies and locum agencies. Results A strong emphasis was placed on business performance alongside other aspects of professional performance in the identification of performance concerns in pharmacists. The majority of concerns were identified reactively, through customer complaints, peer- or self-referral, or following a dispensing error. Community pharmacies sought to manage performance concerns internally where possible, but only the larger organizations had the infrastructure to provide their own training or other remedial support. Several challenges to identifying and managing performance concerns were identified. There were few mechanisms for identifying and supporting locum pharmacists with performance issues. Conclusions Being ‘for-profit’ organizations, community pharmacies may prioritize business performance over ensuring the professional performance of pharmacists, the responsibility for which would be left to the individual pharmacist. This may be detrimental to the quality of care provided. With the growth of independent sector providers more widely, these findings may have implications for the regulation of other health care professionals’ performance.

Black and minority ethnic pharmacists' treatment in the UK: A systematic review

BACKGROUND Pharmacists from black and minority ethnic (BME) backgrounds represent a significant proportion of the United Kingdom (UK) pharmacy profession. While there is evidence that BME doctors may be discriminated against in employment and regulatory practices, little is known about the treatment of BME pharmacists. OBJECTIVES To identify published evidence on the disproportionate treatment in employment and regulatory practices of BME pharmacists in the UK. Evidence was sought in four specific domains: recruitment (into the profession); progression; retention (within sector and profession) and regulation. METHODS The following databases were searched: Pubmed, Embase, Scopus, International Pharmaceutical Abstracts, SIGLE and Google Scholar. Inclusion criteria were: English language only, published between 1993 and 2014 and reporting UK-based findings. RESULTS The search strategy identified 11 pertinent items; 6 peer-reviewed articles, 2 published reports, 2 conference papers and one PhD thesis. In employment practices, there was some evidence that BME pharmacists are over-represented among owners and under-represented amongst senior management in the community sector. BME pharmacists reported more difficulties in getting their first job. BME pharmacists were over-represented in disciplinary processes but there was no evidence of disproportionate treatment in the outcomes of inquiries. CONCLUSION Only a small number of studies have been published in this area, and the evidence of disproportionate treatment of BME pharmacists is equivocal. Further research is needed to better understand the role of ethnicity in recruitment, retention, progression and regulation.

A comparison of the causes of FY1 and FY2 Trainees' prescribing errors: A Preliminary Analysis

PRESCRIBING AND RESEARCH IN MEDICINES MANAGEMENT (UK & IRELAND)

Evolution of the general practice pharmacist’s role in England: a longitudinal study

Background To address the growing GP workforce crisis, NHS England (NHSE) launched the Clinical Pharmacists in General Practice scheme in 2015. The NHSE scheme promotes a newer, patient-facing role for pharmacists and, currently, there is little insight into the role and activities undertaken. All scheme pharmacists are enrolled on the general practice pharmacist training pathway (GPPTP). Aim To investigate the role evolution and integration of clinical pharmacists in general practice in England. Design and setting Longitudinal survey of all phase 1 GPPTP registrants working in general practice at start of (T1) and 6 months into (T2) training. Method An online longitudinal survey was administered to all phase 1 GPPTP registrants (n = 457) at T1 and T2, measuring their perceived knowledge, skill, and confidence, activities performed, and perceptions of practice integration, environment, and support. Descriptive statistics and non-parametric tests were conducted. Results Response rates were 46% (T1) and 52% (T2); 158 participants completed both questionnaires. Perceived knowledge, skill, and confidence levels increased significantly from T1 to T2 for all areas, except for managing acute or common illness. Scope of practice increased significantly, particularly in patient-facing activities. Sharing office space with administrative staff was common and 13% of participants reported having no designated work area. Perceived integration at T2 was fairly high (median = 5 on a scale of 1–7) but GP clinical support was ‘too little’ according to one-third of participants. Conclusion Findings show not only patient-facing role expansion, but also practice environment and support issues. Pharmacists may appreciate more GP time invested in their development. Practices need to be realistic about this support and not expect an immediate reduction in workload.