Hazel K. Sinclair

Training pharmacists and pharmacy assistants in the stage-of-change model of smoking cessation: a randomised controlled trial in Scotland

OBJECTIVE To evaluate a training workshop for community pharmacy personnel to improve their counselling in smoking cessation based on the stage-of-change model. DESIGN A randomised controlled trial of community pharmacies and pharmacy customers. SETTING All 76 non-city community pharmacies registered in Grampian, Scotland, were invited to participate. Sixty-two pharmacies (82%) were recruited. SUBJECTS All the intervention pharmacy personnel were invited to attend the training; 40 pharmacists and 54 assistants attended. A total of 492 customers who smoked (224 intervention, 268 controls) were recruited during the 12-month recruitment period (overall recruitment rate 63%). MAIN OUTCOME MEASURES The perceptions of customers and pharmacy personnel of the pharmacy support and self-reported smoking cessation rates for the two groups of customers at one, four, and nine months. RESULTS The intervention customer respondents were significantly more likely to have discussed stopping smoking with pharmacy personnel, 85% (113) compared with 62% (99) of the controls (p<0.001). The former also rated their discussion more highly; 34% (45) of the intervention customers compared with 16% (25) of the controls rated it as “very useful” (p = 0.048). Assuming non-responders had lapsed, one-month point prevalence of abstinence was claimed by 30% of intervention customers and 24% of controls (p = 0.12); four months’ continuous abstinence was claimed by 16% of intervention customers and 11% of controls (p = 0.094); and nine months’ continuous abstinence was claimed by 12% of intervention customers and 7% of controls (p = 0.089). These trends in outcome were not affected by potential confounders (sex, age, socioeconomic status, nicotine dependence, and type of nicotine replacement product used) or adjustment for clustering. CONCLUSIONS The intervention was associated with increased and more highly rated counselling, and a trend toward higher smoking cessation rates, indicating that community pharmacy personnel have the potential to make a significant contribution to national smoking cessation targets.

Undergraduate medical students: who seeks formative feedback?

Objective  This study aimed to monitor which undergraduate students collected formative feedback on their degree essays and to quantify any correlations between gender or summative mark achieved and whether formative feedback was sought.

The cost-effectiveness of intensive pharmaceutical intervention in assisting people to stop smoking

Objective — To assess the cost‐effectiveness of intensive pharmaceutical intervention in assisting people to stop smoking.

Long Term Follow-Up Studies of Users of Nonprescription Medicines Purchased from Community Pharmacies Some Methodological Issues

AbstractBackground: Despite the wider availability of medicines to the general public, little is known about their safety when supplied without prescription. Pilot work has already tested 4 methods of recruiting users of ibuprofen purchased from community pharmacies. This paper describes the piloting of a fifth method (a shortened questionnaire), long term follow-up rates of all methods, consistency of reporting of ibuprofen use, and issues relating to possible comparison groups in pharmacovigilance studies. Methods: A shortened version of a previously tested recruitment questionnaire was used. Eligible study participants were all users, aged over 17 years, purchasing ibuprofen from a research network of community pharmacies (n = 61) in Grampian, Scotland. Postal questionnaires were sent at 1 week and 2, 6 and 12 months irrespective of the method of recruitment. The follow-up questionnaires collected information about ibuprofen and other drug usage, symptoms and associated health service utilisation. Results: The shortened form recruited 67% of people issued with a questionnaire. The overall 12-month follow-up rate was 67%, although there were important differences in the rates by method of recruitment. There was reasonable consistency in the reporting of use or non-use of ibuprofen at different follow-up times. In the 12 months after the index purchase, 17% of participants never used any ibuprofen (non-users) and 28% used it for more than 8 weeks in total (long term users). At 12 months, long term users were significantly more likely than short term users (≤8 weeks total use) or non-users to have experienced dizziness, skin rash, itchy skin and wheeziness in the previous week. Conclusions: Our pilot work has confirmed the feasibility of recruiting, and following-up over prolonged periods, users of nonprescription medicines. Evidence of long term use of ibuprofen confirms the need for pharmacovigilance studies of this drug, although further work is required to identify a suitable comparison group in order to inform the interpretation of such investigations.

A future career in general practice? A longitudinal study of medical students and pre-registration house officers

Objective: To monitor the future career preferences of medical students throughout their undergraduate years and into their postgraduate career, and to evaluate which factors may influence career choice intentions, and when this happens, over time. Design: Longitudinal study. Methods: Questionnaire to all Aberdeen, United Kingdom, Medical School entrants in 1996, and five annual follow-ups (four undergraduate, one postgraduate). Results: Response rates: year 1, 100%; year 2, 78%; year 3, 70%; year 4, 64%; year 5, 65%; pre-registration house officer (PRHO), 60%. Throughout the study, females were more positive about a career in general practice. General practice was the first choice for 13% of students in year 1; year 2, 9%; year 3, 22%; year 4, 24%; year 5, 27%; PRHO, 29%. Those choosing general practice were more likely than those choosing other specialties to be female, have their family home in Scotland, rate their academic abilities lower and their non-academic abilities as average, and have decided on their future career earlier. Reasons for general practice included: working in and being part of a community; continuity of patient contact; variety of illnesses and people encountered; undergraduate teaching experiences; dislike of or disillusionment with hospital medicine; and an increasing awareness of part-time opportunities. Conclusion: As medical undergraduates progressed through the curriculum and became PRHOs, general practice became more popular as a career choice, particularly with females. This may be partly explained by the increased exposure to general practitioners and patients in the new community-based teaching programme and the increasing awareness of lifestyle advantages with the particular benefits of more regular hours and working part time.

Over‐the‐counter ibuprofen: how and why is it used?

Objectives — To pilot an over‐the‐counter (OTC) medicine pharmacovigilance project, using ibuprofen as a model.

Cohort study on predicting grades: is performance on early MBChB assessments predictive of later undergraduate grades?

Objective  Timely intervention, based on early identification of poor performance, is likely to help weaker medical students improve their performance. We wished to identify if poor performance in degree assessments early in the medical degree predicts later undergraduate grades. If it does, this information could be used to signpost strategically placed supportive interventions for our students.

A remedial intervention linked to a formative assessment is effective in terms of improving student performance in subsequent degree examinations

Background: Intervention may help weaker medical students improve their performance. However, the effectiveness of remedial intervention is inconclusive due to small sample sizes in previous studies. We asked: is remedial intervention linked to a formative assessment effective in terms of improving student performance in subsequent degree examinations? Methods: This was a retrospective, observational study of anonymous databases of student assessment outcomes. Data were analysed for students due to graduate in the years 2005–2009 (n = 909). Exam performance was compared for students who received remediation versus those who did not. The main outcome measure was summative degree examination marks. Results: After adjusting for cohort, gender, overseas versus home funding, previous degree and previous performance in the corresponding baseline third year summative exam, students receiving a remedial intervention (after poor performance on a formative objective structured clinical examination and written exams mid-fourth year) were significantly more likely to obtain an improved mark on end-of-fourth year summative written (p = 0.005) and OSCE (p = 0.001) exams compared to those students who did not receive remediation. Conclusion: A remedial intervention linked to poor assessment performance predicted improved performance in later examination. There is a need for prospective studies in order to identify the effective components of remedial interventions.

Pharmacovigilance of over-the-counter products based in community pharmacy: a feasible option?

With the increasing range of potent medicines available for sale ‘over‐the‐counter’ (OTC) in community pharmacies, this feasibility study set out to develop and validate a method for the pharmacovigilance of OTC medicine, using ibuprofen as a model.

An evaluation of a training workshop for pharmacists based on the Stages of Change model of smoking cessation

This paper details part of the findings of a randomised controlled trial to evaluate an interactive training workshop, based on the Stages of Change model of smoking cessation, which was commissioned from Grampian Health Promotions. Forty pharmacists and 54 pharmacy assistants from 32 Grampian community pharmacies attended the training intervention in January 1995. Participants were followed up by postal questionnaire at 0, 2 and 12 months to assess their perceptions of the value and utility of the training, and in-depth information was gathered using telephone interviews with a representative sample of participants (n = 20) 18 months after the workshop. The majority of pharmacists and pharmacy assistants thought that: the model was a good way of understanding smoking cessation; the training was a good learning experience and a good use of their time; they had been able to utilise the training; it had made a difference to the way they counselled customers; had helped them to help their customers; and had increased their job satisfaction.