Ian Bates

Reducing Adverse Prescribing Discrepancies Following Hospital Discharge

General medical patients from an east London teaching hospital were recruited into intervention and comparison groups. Those recruited into the intervention group were given a copy of a letter listing their drugs prescribed at discharge and asked to give it to their regular community pharmacist when they went to obtain their prescribed drugs following hospital discharge. A comparison group returned home without a letter for their community pharmacist. Recruited patients were visited in their own homes once their community supply of drugs had been obtained. The frequency of all discrepancies between the prescribed drugs were compared for both groups. A consensus panel judged the importance of the discrepancies observed. The numbers deemed as clinically significant were compared for both groups, as the effect of the intervention. The 501 patients followed up (264 in the intervention group and 237 in the comparison group) were prescribed 2,736 drugs. The number of unintentional discrepancies observed was lower for the intervention group (32.2 per cent, 454/1,408) than for the comparison group (52.7 per cent, 700/1,328) (chi‐squared 117.38, P<0.001). The number of discrepancies judged to have a definite adverse effect was lower in the intervention group (1.6 per cent, 23/1,408) than in the comparison group (3.1 per cent, 41/1,328) (chi‐squared 6.32, P<0.01).

Permeability of the blood-brain barrier

Abstract The blood-brain barrier is not the resolutely impermeable barrier once thought. Physiocochemical properties can dictate the free passage of some molecules into and out of the CNS, while facilitated transport mechanisms exist for transport of essential nutrients and substrates. Ian Bates describes the anatomical features of the BBB and the mechanisms of its bypass. While these mechanisms may offer areas for pharmacological exploitation, toxicological considerations also exist.

Patient choice promotes adherence in preventive treatment for latent tuberculosis

The aim of the present study was to compare the effect of patient choice on completion rates and adverse drug reactions for patients treated for latent tuberculosis infection (LTBI) using 3-month rifampicin and isoniazid treatment (3RH) or 6-month isoniazid treatment (6H). Data for all patients treated using 3RH or 6H for LTBI between 1998 and 2004 were analysed. In total, 675 patients attended for chemoprophylaxis. Of these, 314 received 3RH and 277 received 6H. From April 1, 2000, patients were offered a choice of regimen; 53.5% completed the regimen successfully, a further 10.3% potentially completed it successfully and 36.2% failed to complete treatment. Logistic regression analysis suggested that successful completion was more likely in patients who were younger (an association that was lost after removing all patients aged <16 yrs), were offered a choice of regimen and attended all clinic visits before commencing treatment. Treatment was discontinued due to adverse reactions in 16 (5.1%) patients who were prescribed 3RH and 16 (5.8%) who were prescribed 6H. Treatment failure was most likely during the first 4 weeks of treatment for both regimens. At 13 weeks of treatment, more patients taking 6H had stopped compared with those completing the 3RH regimen. Drug costs were greater using 6H compared with 3RH. In conclusion, offering a choice of regimen improves completion. Most patients chose the 3-month rifampicin and isoniazid treatment over the 6-month isoniazid treatment. Adverse drug reaction rates between the two regimens were similar.

Consumers' perceptions of community pharmacy in Portugal: a qualitative exploratory study

AbstractObjective: Pharmacists are health professionals who are ideally positioned to perform a primary health care role. However, the definition of professional value needs to be considered not just as professional education and skills, but also in terms of how consumers perceive it. The main aim of this work was to explore the public’s perceptions and attitudes towards community pharmacy in Portugal. Methods: A pure qualitative approach was undertaken. The data were collected through a semi-structured interview, conducted with a ‘snowball’ like sample. First, individuals (n = 15) were interviewed, allowing for adjustment and validation of the interview schedule, followed latter by group interviews with adults in rural and urban areas. Group participants (n = 25) were asked about their behaviour and beliefs, resulting from their perceptions of community pharmacies, pharmacists and medicines. Future expectations regarding the community pharmacy service were also explored. The interviews were tape recorded and transcribed verbatim. An iterative, reflexive coding process was applied, assisted by the qualitative software package QSR NUD*IST v4. The inductive analysis of the extracted codes assembled those codes into themes. Results and discussion: This article will mainly focuses on community pharmacy service representations and cognitions (theme A) and community pharmacy evaluative perceptions and behaviours (theme B). Participants displayed general and contradictory ideas about the actual functions of the pharmacist, including weak conceptualizations and a positive demand for services in relation to product supply. This superficial understanding is in line with previous results from satisfaction studies, confirming a low expectation level. The public’s poor knowledge and low expectations can justify a reduced desire for an extended role of the pharmacist in the community. This uncertain service conceptualization does not define the professional responsibility from a consumer’s perspective. Conclusions: Although these results allow for the development of a framework to describe the perceptions of community pharmacy users, further research is needed to determine the prevalence of these and other possible results.

The implications of increasing student numbers for pharmacy education

The number of students recruited into UK schools of pharmacy has increased considerably over recent years and is set to increase further still as new schools of pharmacy begin recruiting from 2003. This increase in student numbers mirrors international trends and reflects both the need to address shortages in the pharmacy workforce and the exercise of market forces within UK higher education. Increased enrolments of less academically able students onto MPharm courses potentially threaten academic standards. Pharmacy schools will need to modify their courses and assessment methods to meet this challenge, whilst at the same time striving to ensure that pharmacy programmes meet the rigorous academic demands of a masters level degree. As staff:student ratios worsen, maintaining the quality of the learning experience will become increasingly difficult, and efficiencies in teaching and assessment will inevitably be sought. Computer-based technology might offer innovative, cost-effective solutions to some logistical problems, but such technology distances the learner from the tutor, and reduces opportunities for students to accrue values and attitudes that form part of their professional socialization. As the numbers of students enrolled into existing schools increase and new pharmacy schools are inaugurated, the already small and diminishing pool of full-time pharmacist academics will be stretched to the point that students will have few opportunities to engage with such staff, limiting their opportunities to absorb the “culture of pharmacy” and hindering their development from student to autonomous professional.

The effect of pharmaceutical review of repeat prescriptions in general practice

Objectives — To investigate how a community pharmacist can affect the quality of repeat prescribing, and to develop a model for general practitioner (GP) and pharmacist co‐operation.

Patients' understanding and management of their illnesses and prescribed medicines - a descriptive study

AbstractObjective: The objective of this study was to explore patients’ understanding and management of their illnesses and prescribed medicines. Method: Patients receiving three or more repeat prescription drugs were interviewed in their homes after their repeat prescriptions had drug-related problem (DRP) identified by a community pharmacist in a GP surgery. Results: In total, 58 patients were interviewed. Patients distinguished strongly between ‘forgetting’ and ‘taking less’ of their medicines, and some actively reduced the dose themselves. More than 25% of the patients involved their spouse in the administration of their medicines. Patients had more worries about their illness (48%) than their medicines (31%). Any changes made to their present medication, or introduction of new medicines, were thought to ‘upset the balance’. Conclusion: More information is needed on patients’ perspectives, both on side effects, compliance and how to deal with long-term medication. Health care professionals should seek to understand and respect patients’ choices to assure optimal care.

Medicine information needs of patients: the relationships between information needs, diagnosis and disease

Objective: To identify medicine information needs of patients and explore differences in information needs between different disease groups of patients. Design: Semistructured interviews with general medical patients selected via convenience sampling. Setting: Patients were recruited while inpatients during a hospital stay or as outpatients attending a specific clinic at the hospital. Main outcome measures: Patients’ responses to standardised data-collection tools, including previously validated scale, the Extent of Information Desired scale (EID) to identify their information needs. Results: Data from interviews with 1717 patients were included in the analysis. Each item on the EID scale was scored on a Likert scale (from 1 to 5). The internal consistency of the scale in this sample was good (coefficient α = 0.78). Scores to the EID scale correlated with age and socio-demographic variables. The extent of information desired positively correlated with socio-economic status (Pearson’s r = 0.29, p<0.001). The extent of information desired negatively correlated with the patient’s age (Pearson’s r = −0.32, p<0.001), implying that medicine-information desires decreases with age. Subsequently, significant differences were found in the extent of information desired between disease categories, which remained significant when controlling for age (ANCOVA, F6,1703 = 26.04, p<0.001, partial η2 0.084 (ie, 8.4% “effect size”). Disease categories included: cardiovascular, gastrointestinal, respiratory, endocrine, diabetic, oncology. Patients with endocrine and diabetes diagnoses expressed high desires for information, whereas patients with cardiovascular and respiratory diagnoses expressed low desires for information. From these findings, both the disease and the age of patient are principal influences on desires for medicine information. Conclusions: These findings suggest that the diagnosis and disease have a significant bearing on patients’ medicine-information desires and recommend that healthcare professionals view patients as individuals when providing information that meets their needs. It will be important for healthcare professionals to identify and understand that patients with different diseases have different desires for information about their disease and their drugs which may influence the way they take their medicines and subsequently the ways we manage their long-term disease. We need to determine if the EID scale is an efficient and effective way to identify patients’ desires for drug information and a useful tool for practitioners to effectively target interventions in healthcare provision over time.

The efficacy of heparin in maintaining peripheral infusions in neonates

AbstractThe study set out to determine the survival times of peripheral total parenteral nutrition (TPN) infusion sites in neonates using a prospective, single blind, randomised trial design. The effects of various concentrations of co-administered heparin was measured using survival analysis, and of other continuous variables using multivariate analysis, against a non-heparinized control group. The study was conducted in special care baby unit located within a specialist maternity hospital in London, United Kingdom. Heparin at 0.1, 0.25, 0.5 and 1 IU/ml was added to TPN infusions delivered through peripheral veins and the survival times of the infusions determined. For infusion sites receiving heparinized fluids, the relative risk of failure decreased and the median survival time increased as the heparin concentration increased, with a maximal effect at a heparin concentration of 0.5 IU/ml (P<0.001). Multivariate analysis using the Cox proportional hazard model confirmed the efficacy of heparin and high-lighted a history of infusion therapy and the co-administration of gentamicin (from a range of drugs analysed) as being risk factors associated with infusion site failure.ConclusionIntravenous infusion survival time can be prolonged using heparin additive at an optimal concentration of 0.5 IU/ml. This should also be of additional interest to paediatricians as heparin is an ubiquitous drug on neonatal units and its clinical use needs to be rationalised.

Academic Dishonesty Among Pharmacy Students

In previous studies, academic dishonesty was found to be common among pharmacy students. The aim of this investigation was to find the reasons for dishonest behaviour among pharmacy students. Twelve semi- structured interviews were carried out with first and fourth year pharmacy students, chosen to represent a broad spectrum of views about academic dishonesty. Five principle themes were identified as the motivations for student academic dishonesty: institutional environment, study skills, assessment employed, personal qualities and course specific factors. The results show that the motivational themes for dishonesty varied between the first year students and the fourth year students. The first year students interviewed, when compared to the fourth year students, were generally more uncertain about the definition of academic dishonestly, and consequently the behaviours associated with it. The first year students also appeared to possess poorer study skills and complained that the university failed to provide enough academic support. In contrast, the fourth year students interviewed were more sophisticated in their approach to academic dishonesty. They frequently mentioned pressure and stress as motivational factors leading some students to resort to dishonest behaviours. They were also more aware of the opportunities to engage in dishonest academic behaviour than first year students and generally believed engaging in dishonest behaviour was an institutional culture. All the students interviewed stated that engaging in dishonest behaviour could be motivated by peer pressure, fulfilling their social and esteem needs. Dishonest behaviour could be a way to increase social acceptance and to fit into a group. Students from both years were found to be goal orientated with poor study skills appearing to motivate dishonest behaviour.