Ingunn Björnsdóttir

Provision of pharmaceutical care by community pharmacists: a comparison across Europe

Objective To investigate the provision of pharmaceutical care by community pharmacists across Europe and to examine the various factors that could affect its implementation. Methods A questionnaire-based survey of community pharmacies was conducted within 13 European countries. The questionnaire consisted of two sections. The first section focussed on demographic data and services provided in the pharmacy. The second section was a slightly adapted version of the Behavioral Pharmaceutical Care Scale (BPCS) which consists of three main dimensions (direct patient care activities, referral and consultation activities and instrumental activities). Results Response rates ranged from 10–71% between countries. The mean total score achieved by community pharmacists, expressed as a percentage of the total score achievable, ranged from 31.6 (Denmark) to 52.2% (Ireland). Even though different aspects of pharmaceutical care were implemented to different extents across Europe, it was noted that the lowest scores were consistently achieved in the direct patient care dimension (particularly those related to documentation, patient assessment and implementation of therapeutic objectives and monitoring plans) followed by performance evaluation and evaluation of patient satisfaction. Pharmacists who dispensed higher daily numbers of prescriptions in Ireland, Germany and Switzerland had significantly higher total BPCS scores. In addition, pharmacists in England and Ireland who were supported in their place of work by other pharmacists scored significantly higher on referral and consultation and had a higher overall provision of pharmaceutical care. Conclusion The present findings suggest that the provision of pharmaceutical care in community pharmacy is still limited within Europe. Pharmacists were routinely engaged in general activities such as patient record screening but were infrequently involved in patient centred professional activities such as the implementation of therapeutic objectives and monitoring plans, or in self-evaluation of performance.

Diagnosing infections: a qualitative view on prescription decisions in general practice over time

Objective Antibiotics may frequently be prescribed on the basis of vague diagnoses, possibly resulting in unnecessary antimicrobial resistance. Our aim is to map general practitioners’ (GPs’) decision-making for common infections, exploring their diagnostic basis for antibiotic prescriptions. Setting General practice in Iceland. Method Ten in-depth qualitative interviews with, and three observations of, GPs in 1995. Diagnostic issues extracted and analysed. In 2006, eight GPs commented on analysis and updated (email/telephone). Main outcome measure Diagnostic variability and reasons for prescribing antibiotics, consistency or changes over time. Results Wide variations were uncovered in diagnostic procedures, although each GP remained consistent through time. Some GPs had developed “rules-of-thumb”. They often balanced risks against issues like money, time, need for the workforce (perceived importance of the patient’s job), client’s need for job/earnings (perceived ability to afford a sick day) and doctor-patient relationship (risk of refusal adversely affecting the relationship). Perceptions of risk varied from focusing on resistance development to focusing on possible harm from untreated infections, also ranging between considering both to worrying about neither. Changes over time were not prominent but included increased point-of-care testing and the perception by GPs that patients were increasingly willing to “wait and see”. Conclusions Large variability and individuality characterized the GPs’ diagnostic procedures, contrasted by consistency through time. If modification of diagnostic routines is needed, provision of “scientific facts” and technological aids is insufficient. A prerequisite for changing practice is GPs’ acceptance of accuracy of information and of reliability, applicability, and relevance of technology, for physician and/or patient.

Interviewing the Moderator: An Ancillary Method to Focus Groups

There has been an upsurge of academic interest in using focus groups (FGs) as a main or stand-alone qualitative method. In this article, the authors introduce a recently developed ancillary method to FGs called interviewing the moderator. The method is employed immediately after an FG and consists of a one-on-one interview with the FG moderator by another member of the research team. The authors argue, with reference to a specific study, that interviewing the moderator adds a new and valuable dimension to group interviews used in research. They describe how this method came about and provide a concrete example of its use in a recently completed research project. They discuss several advantages of the interview, among them that it provides information about group interaction and participant behavior, and furnishes additional data on what is discussed when the tape recorder is turned off.

The lay user perspective on the quality of pharmaceuticals, drug therapy and pharmacy services - results of focus group discussions

Background: This article presents the results of a study on quality of pharmacy services and perceived risk of pharmaceuticals. The results presented here are part of a multi-study evaluation of major changes in drug distribution in Iceland. Objectives: This sub-study addressed the question: what is the lay user perspective on pharmaceuticals and pharmacy services, including their perception of risk? Methods: To answer this question, seven focus group discussions were conducted with pharmacy customers in different locations in Iceland following new drug distribution legislation in 1996.Results: The lay perspective emphasizes a definite split between lay and expert views on the value and quality of pharmaceuticals, drug therapy and pharmacy services, as well as in their assessment of risk. Participants voiced spontaneous criticism of the roles of both physicians and pharmacists in drug therapy; and expressed concern about the quality and safety of pharmaceuticals. Some scope for shared values was noted between the legislative goals and the lay user perspective, despite the fact that the public was in no way involved in the drafting of the new legislation. Conclusion: The results of this study raise questions about the nature and extent of the perceived gap between the medical and pharmacy professions on the one side and the lay public and health policy decision-makers on the other side in their views on the quality and safety of pharmaceuticals and pharmacy services.

'I'm Happy if I Can Help'. Public views on future medicines and gene-based therapy in Iceland

Objective: To explore lay perceptions about medicine and drug therapy (including gene-based therapy) in the present and in the future. Background: Following almost a year of national debate, the Icelandic parliament passed the Health Sector Database (HSD) Act in 1998. No single issue has been as much debated in Iceland as this database. Despite the explosion of popular and scientific literature in the field of bioethics, there is still a paucity of research concerning ‘lay’ contributions to the debates. Methods: The study was designed as a qualitative study. Focus groups (FGs) were conducted followed by one-on-one interviews with the FG moderator. Participants were asked to comment on a future scenario consisting of predictions concerning the consequence of the Human Genome Project over the next 40 years. Participants: Forty-two persons participated in eight FGs in Iceland. The Icelandic moderator was interviewed in English after each group. Conclusions: The lay public was relatively optimistic with regard to the future of drugs and gene-based therapy. Reasons for this optimism can be found in a basic trust and belief in the welfare state and the health system. These results are not consistent with studies carried out in other countries where the public appears to be focused on the negative effects of genetic research and the threats to privacy. Most participants expressed concern about potential problems with regard to social and equity issues, whereas the HSD controversy, a discourse based on the rhetoric of bioethics, was at variance with the issues focused on by the lay public.

Pharmacists in a liberalised system — results from a profession-wide survey in Iceland

Background — The study reported here was part of a multi‐study evaluation of new drug distribution legislation in Iceland.

'I'm Happy if I Can Help'. Public views on future medicines and gene-based therapy in Iceland.

Objective: To explore lay perceptions about medicine and drug therapy (including gene-based therapy) in the present and in the future. Background: Following almost a year of national debate, the Icelandic parliament passed the Health Sector Database (HSD) Act in 1998. No single issue has been as much debated in Iceland as this database. Despite the explosion of popular and scientific literature in the field of bioethics, there is still a paucity of research concerning ‘lay’ contributions to the debates. Methods: The study was designed as a qualitative study. Focus groups (FGs) were conducted followed by one-on-one interviews with the FG moderator. Participants were asked to comment on a future scenario consisting of predictions concerning the consequence of the Human Genome Project over the next 40 years. Participants: Forty-two persons participated in eight FGs in Iceland. The Icelandic moderator was interviewed in English after each group. Conclusions: The lay public was relatively optimistic with regard to the future of drugs and gene-based therapy. Reasons for this optimism can be found in a basic trust and belief in the welfare state and the health system. These results are not consistent with studies carried out in other countries where the public appears to be focused on the negative effects of genetic research and the threats to privacy. Most participants expressed concern about potential problems with regard to social and equity issues, whereas the HSD controversy, a discourse based on the rhetoric of bioethics, was at variance with the issues focused on by the lay public.

Quality assessment of drug sales data: the case of antibacterials in Iceland

Background: Two sets of drug sales data, published by the Icelandic Ministry of Health, did not match for antibacterials in 1989. The search for causes turned out to be a project in itself. Objective: To analyze quality problems in the sales data on antibacterials and describe a method for systematic quality assessment of drug sales data. Methods: Documentary analysis based on the following sources: 1) Nordic Statistics on Medicines, 1975-95; 2) Drug Use (Notkun lyfja), 1975‐93; 3) Icelandic Drug Market, 1975‐94; 4) Unpublished data from the Icelandic Ministry of Health. The following framework was developed to evaluate the quality of drug sales data: 1. Completeness of registration; 2. Accuracy and degree of completeness of data; 3. Size and coverage of the data source; 4. Data format; 5. Data accessibility, availability and cost. Results: Four discrepancies were found, two due to changes in DDD, and two larger ones stemming from errors in calculating DDD, resulting in an overestimation of the contribution of the respective products to the total DDD/1000 inhabitants/day. Errors were detected in available sales data at least back to 1980, resulting in sales being overestimated by up to 13%. The reasons for the discrepancies were found mostly under point 2 in the framework. Conclusion: The errors uncovered by this study indicate a possible low quality of drug statistics which might lead to wrong conclusions about the level and development of sales of drugs. As a tool, the framework might be used for quality assessment of drug sales data.

‘I’m Happy if I Can Help’

Objective: To explore lay perceptions about medicine and drug therapy (including gene-based therapy) in the present and in the future. Background: Following almost a year of national debate, the Icelandic parliament passed the Health Sector Database (HSD) Act in 1998. No single issue has been as much debated in Iceland as this database. Despite the explosion of popular and scientific literature in the field of bioethics, there is still a paucity of research concerning ‘lay’ contributions to the debates. Methods: The study was designed as a qualitative study. Focus groups (FGs) were conducted followed by one-on-one interviews with the FG moderator. Participants were asked to comment on a future scenario consisting of predictions concerning the consequence of the Human Genome Project over the next 40 years. Participants: Forty-two persons participated in eight FGs in Iceland. The Icelandic moderator was interviewed in English after each group. Conclusions: The lay public was relatively optimistic with regard to the future of drugs and gene-based therapy. Reasons for this optimism can be found in a basic trust and belief in the welfare state and the health system. These results are not consistent with studies carried out in other countries where the public appears to be focused on the negative effects of genetic research and the threats to privacy. Most participants expressed concern about potential problems with regard to social and equity issues, whereas the HSD controversy, a discourse based on the rhetoric of bioethics, was at variance with the issues focused on by the lay public.