Jeff Taylor

Use of food labels and beliefs about diet–disease relationships among university students

OBJECTIVE The purpose of this study was to measure the reported use of nutrition information on food labels by a population of university students and to determine if label users differed from non-users in terms of gender and specific beliefs related to label information and diet-disease relationships, specifically fat and heart disease and fibre and cancer. DESIGN A single-stage cluster sampling technique was used. Data was obtained using a self-administered, validated questionnaire. SETTING The present investigation took place at the University of Saskatchewan, Canada in the autumn of 1997. SUBJECTS : A total of 553 students in randomly selected classes in the College of Arts and Science took part in the survey (92% response rate). The sample consisted of roughly equal numbers of males and females, most between the ages of 18 and 24. RESULTS There were approximately equal numbers of label users and non-users among males, while label users outnumbered non-users by almost four to one among females. The importance of nutrition information on food labels was the only belief that differed significantly between label users and non-users for both sexes. For females, no other beliefs distinguished label users from non-users. However, for males, significant differences were found between label users and non-users on the beliefs that nutrition information is truthful and that a relationship between fibre and cancer exists. CONCLUSIONS Females appear to use food labels more often than do males. The only consistently observed difference between label users and non-users (male and female) was that users believed in the importance of nutrition information on food labels while non-users did not.

Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP): A Randomized Trial Design of the Effect of a Community Pharmacist Intervention Program on Serum Cholesterol Risk

OBJECTIVE: To determine the efficacy of a program of intervention by pharmacists on lipid risk management in patients at high risk for cardiovascular events. METHODS: Randomized, multicenter (44 sites in Alberta and Saskatchewan) study of community pharmacist intervention versus usual care in 1000 patients. Patients are those at high risk of vascular events (existing atherosclerotic vascular disease, or diabetes with ≥1 other risk factor). After obtaining consent, the pharmacist calls the Project Office to randomize. Patients allocated to intervention receive a brochure and education about cardiovascular risk factors. Pharmacists also complete a physician contact form, which lists the patients risk factors, medications, and any recommendations. A point-of-care cholesterol test is performed, the result is discussed with the patient, and it is entered on the contact form. If appropriate, the patient is asked to see his or her primary care physician for further assessment and/or treatment, and the form is faxed to the physician. Patients are followed up at two, four, eight, 12, and 16 weeks. During follow-up visits, pharmacists provide educational reinforcement and check for primary end point occurrence. Patients allocated to usual care receive the brochure only, with minimal follow-up. The primary end point is a composite of measurement of a complete lipid panel by the physician, or addition or modification of lipid-lowering drug therapy. Substudies will evaluate economics (third-party payer and pharmacy manager perspective), patient satisfaction, and quality of life. CONCLUSIONS: SCRIP (Study of Cardiovascular Risk Intervention by Pharmacists) is a unique ongoing trial that is evaluating a community pharmacist intervention designed to optimize cholesterol risk management in patients at high risk for cardiovascular events.

Diabetes and Cardiovascular Disease Interventions by Community Pharmacists: A Systematic Review

Objective: To systematically review and assess the quality of studies evaluating community pharmacist interventions for preventing or managing diabetes or cardiovascular disease (CVD) and/or their major risk factors. Data Sources: A comprehensive literature search was performed using MEDLINE (1950-February 2011), EMBASE (1980-February 2011), International Pharmaceutical Abstracts (1970-February 2011), Cumulative Index to Nursing and Allied Health Literature (1982-June 2007), and Cochrane Central Register of Controlled Trials (1898-February 2011). Search terms included: community pharmacy(ies), community pharmacist(s), cardiovascular, diabetes, and intervention. The grey literature was searched using the ProQuest Dissertations and Theses, Theses Canada, and OAlster databases. Study Selection and Data Extraction: Articles published in English or French with all study designs were considered for the review. Studies were included if they contained interventions designed to reduce the incidence, risk, or mortality of CVD or diabetes; affect clinical indicators of CVD or diabetes mellitus (including hypertension, dyslipidemia, or hemoglobin A1c); and/or improve adherence to treatment strategies. Only studies involving interventions carried out primarily by pharmacists in community pharmacy settings were included. Study quality was assessed using a checklist validated for both randomized and nonrandomized studies. Data Synthesis: A total of 4142 studies were initially identified, with 40 meeting our inclusion criteria. Eleven studies were randomized controlled trials, 4 were cluster randomized trials, and 2 studies had randomized before-after designs. The remaining studies were controlled before-after (n = 2), cohort (n = 4), and uncontrolled before-after (n = 17) designs. Interventions focused on diabetes (n = 12), hypertension (n = 9), medication adherence (n = 9), lipids (n = 5), evidence-based medication initiation or optimization (n = 3), risk factor prediction scores (n = 1), and body mass index (n = 1). All studies contained interventions focused at the patient level and the majority of studies (34/40) involved interventions directed at both the physician and patient. No specific intervention emerged as superior, and study quality was generally poor, making it difficult to determine the true effect of the interventions. Conclusions: Poor study quality, time-intensive interventions, and unproven clinical significance warrant the need for further high-quality studies of community pharmacist interventions for preventing or managing diabetes or CVD and/or their major risk factors.

Taking the lead: Community pharmacists' perception of their role potential within the primary care team

BACKGROUND Patient-focused care provided by an interprofessional team has long been presented as the preferred method of primary care delivery. Community pharmacists should and can provide leadership for many clinical and managerial activities within the primary care team. OBJECTIVE To determine the extent to which community pharmacists are prepared to be members of the health care team, and to assess their support for general expansion of clinical responsibilities. METHODS A mail questionnaire (in either English or French) was sent to 1500 community pharmacists between February and April 2004. Respondents were asked to indicate the necessity of pharmacy leadership for a range of clinical and managerial services associated with a primary care team. Respondents were also asked to indicate the extent to which they should be more involved in drug therapy selection and monitoring, as well as assuming greater responsibility for treating both minor and chronic illnesses. RESULTS The response rate was 35.2% (470/1337) with the highest response rate in the Prairie provinces (40.6%) and the lowest in Quebec (24.4%). Most pharmacists in the study did not advocate a strong leadership role for non-discipline-specific clinical and managerial activities. Most of them indicated that community pharmacists should be more involved in selecting (69.9%) and monitoring (81.0%) drug therapy, and be more responsible for treating minor illnesses (72.0%). Support for more responsibility declined to 50% for chronic illnesses. CONCLUSIONS The findings of the study suggest substantial variability among pharmacists in their perception of the need for pharmacy leadership across 16 clinical and managerial activities.

The Collaborative Cardiovascular Risk Reduction in Primary Care (CCARP) Study

Study Objective. To evaluate whether a simple pharmacist protocol, consisting of patient screening and cardiovascular risk stratification, identification and reminders about uncontrolled risk factors, and drug adherence support, can significantly reduce cardiovascular risk.

Impact of pharmacist consultation versus a decision aid on decision making regarding hormone replacement therapy

Objective To compare the effects of pharmacist consultation versus a decision aid on womens decisional conflict regarding use of hormone replacement therapy (HRT) and subsequent satisfaction with the decision‐making process.

Reasons consumers do not ask for advice on non-prescription medicines in pharmacies

Reports in the literature indicate that consumers may hesitate to ask for advice when considering the purchase of non‐prescription products in community pharmacies. Consumers observed purchasing products in 11 pharmacies without asking for advice were surveyed to ascertain why they did not do so. Of the 151 consumers who completed questionnaires, 145 indicated they had not wanted advice, mainly because they had used the product before or had received advice elsewhere on what to purchase. Only six consumers indicated that in fact they had wanted advice, but had hesitated to ask for it. Their main reason for not asking was that the pharmacist appeared too busy.

Evaluating pharmacist prescribing for minor ailments

Saskatchewan is the second Canadian province to allow pharmacists to prescribe medications for minor ailments and the only province that remunerates for this activity. The aim of this project was to determine whether patients prescribed such treatment by a pharmacist symptomatically improve within a set time frame.

Barriers to healthful eating and supplement use in lower-income adults.

PURPOSE We investigated barriers to healthful eating and vitamin/mineral supplement use among groups at risk for low nutrient intakes, particularly those with low income. METHODS Twelve focus groups (73 participants) and 11 key informant interviews were conducted in Saskatoon, Saskatchewan. Focus group participants represented a diverse population. Key informants included health professionals and personnel from community-based organizations who worked in a low-income area. Focus group meetings and key informant interviews were audiotaped and transcribed; thematic coding was used to identify key concepts. RESULTS The focus groups and interviews revealed five themes on barriers to healthful eating and to the use of vitamin/mineral supplements: knowledge, income, accessibility, health, and preferences. Key informants were aware of the barriers, and were able to see not only individual and family reasons but also societal influences. CONCLUSIONS The study results provide valuable information for focusing efforts on reducing barriers to healthful eating and to appropriate vitamin/mineral supplement use.

A pragmatic cluster randomized trial evaluating the impact of a community pharmacy intervention on statin adherence: rationale and design of the Community Pharmacy Assisting in Total Cardiovascular Health (CPATCH) study

BackgroundTraditional randomized controlled trials are considered the gold standard for evaluating the efficacy of a treatment. However, in adherence research, limitations to this study design exist, especially when evaluating real-world applicability of an intervention. Although adherence interventions by community pharmacists have been tested, problems with internal and external validity have limited the usefulness of these studies, and further well-designed and well-conducted research is needed. We aimed to determine the real-world effectiveness of a community pharmacy adherence intervention using a robust study design. This novel design integrates cluster randomization and an outcome evaluation of medication adherence using a population-based administrative data source in the province of Saskatchewan, Canada.Methods/DesignCommunity pharmacies from across the province of Saskatchewan, Canada were randomized to deliver an adherence intervention to their patients or usual care. Intervention pharmacies were trained to employ a practical adherence strategy targeted at new users of statin medications. While randomization and implementation of the intervention occurred at the community pharmacy level, the outcome analysis will occur at the level of the individual subjects. The primary outcome is the mean statin adherence among all eligible new users of statin medications. Secondary outcomes include the proportion of new statin users who exhibit adherence ≥80%, and persistence with statin use.DiscussionThis novel study design was developed to combine the rigor of a randomized trial with a pragmatic approach to implementing and capturing the results in a real-world fashion. We believe this approach can serve as an example for future study designs evaluating practice-based adherence interventions.Trial RegistrationClinicalTrials.gov no. NCT00971412.