Jennifer Lillian Marriott

Practitioners’ sources of clinical information on complementary and alternative medicine in oncology

Goals of workThe use of complementary and alternative medicine (CAM) amongst oncology patients is widespread. There is little data regarding the sources of clinical information on CAM that oncology practitioners utilise. The aim of this study was to investigate the sources of clinical information on CAM utilised by Australian oncology practitioners.MethodsA structured self-administered questionnaire was sent to Australian oncology practitioners, defined as oncologists, oncology pharmacists and pharmacists at drug information centres (DICs). Key information was sought on their level of satisfaction with the accessibility, reliability and usefulness of this information and the frequency of, and initiating factors for, seeking this information.Main resultsA substantial proportion of oncologists (57.1%) reported having never sought information on CAM, compared to 27.3% of oncology pharmacists, and 18.8% of DIC pharmacists. Oncologists most commonly reported seeking information on CAM one to three times per year compared to four to ten times per year for oncology pharmacists. Databases were the most common information source used by oncologists (48.1%) and oncology pharmacists (91.7%) and the second most common information source used by DICs (92.3%). There was wide variation in the source of clinical information on CAM used by the three different professional groups.ConclusionOncology practitioners often seek information on CAM; however the frequency, nature and sources of information utilised varied widely. The usefulness and reliability of the sources utilised were inconsistent.

Development and Validation of the Medication-Based Disease Burden Index

Background: Medication lists offer an alternative source of data on comorbidities and disease burden. Objective: To develop and validate the Medication-Based Disease Burden Index (MDBI). Methods: A list of medications corresponding to the leading causes of global death was pilot tested and finalized by an expert panel. The resulting index was tested on drug regimens of patients at risk of medication misadventure. Criterion validity of the index was established against Charlsons index and Chronic Disease Score (CDS). Sensitivity, specificity, predictive validity, convergent and discriminant validity, and interrater and test–retest reliabilities of the index were also assessed. Results: The MDBI consisting of specific medications for 20 chronic medical conditions and corresponding disability weightings was developed. The MDBI was tested on 317 patients with mean ± SD Charlsons index scores of 2.8 ± 2.2 and CDS scores of 7.3 ± 2.8. Mean MDBI scores (0.33 ± 0.28) demonstrated significant correlations with Charlsons index scores (r = 0.31; p < 0.001) and CDS (r = 0.53; p < 0.001). MDBI had satisfactory sensitivity and high specificity. Age of the patients and number of medications had significant correlation with the MDBI scores, but the MDBI scores were not significantly different in males and females. MDBI scores could successfully predict death and planned or unplanned readmissions (OR = 4.7, 95% CI 1.4 to 15.5; p = 0.01). MDBI demonstrated high inter-rater (intraclass correlation coefficient [ICC] = 0.99) and test–retest reliabilities (ICC = 0.98). Conclusions: Initial testing suggests that MDBI could offer an alternative low-cost and convenient method for quantifying disease burden and predicting health outcomes.

A critical analysis of the methods used to develop explicit clinical criteria for use in older people

Older people are the biggest users of medications and with the majority of the population ageing it is important to ensure that their medications are managed properly. Many have developed explicit criteria in order to assist in making appropriate drugs choices in the older population. This paper explores whether the methods used to develop the currently available explicit criteria for appropriate prescribing in older people are applied appropriately, and if not, whether this invalidates the criteria themselves. The wide spread use of the Delphi technique to develop medical criteria indicates that the technique itself should be evaluated for its suitability in the development of criteria in older people before the criteria are themselves evaluated. A number of criteria have been reviewed and none fulfils the requirements for appropriate development. There is a need for new criteria, with transparent referencing of recommendations and rigorous final evaluation.

Community pharmacists' preferences for continuing education delivery in Australia

Introduction: New technologies such as the Internet offer an increasing number of options for the delivery of continuing education (CE) to community pharmacists. Many of these options are being utilized to overcome access‐ and cost‐related problems. This paper identifies learning preferences of Australian community pharmacists for CE and identifies issues with the integration of these into contemporary models of CE delivery. Methods: Four focus group teleconferences were conducted with practicing community pharmacists (n = 15) using a semistructured format and asking generally about their CE and continuing professional development (CPD) experiences. Results: Pharmacists reported preferences for CE that were very closely aligned to the principles of adult learning. There was a strong preference for interactive and multidisciplinary CE. Engaging in CPD was seen as valuable in promoting reflective learning. Discussion: These results suggest that pharmacists have a strong preference for CE that is based on adult learning principles. Professional organizations should take note of this and ensure that new CE formats do not compromise the ability of pharmacists to engage in interactive, multidisciplinary, and problem‐based CE. Equally, the role of attendance‐based CE in maintaining peer networks should not be overlooked.

Implementation of a community liaison pharmacy service: a randomised controlled trial

Objective The aim of this study was to provide a pharmacy service to improve continuity of patient care across the primary‐secondary care interface.

Barriers to pharmacist participation in continuing education in Australia

Background: The pharmacy profession recognises of the need for continuing education (CE), however, the rate of participation in organised CE remains low. Little is known about the reasons for low participation rates in CE, particularly in the Australian context. Aim: This research aimed to identify the barriers to participation of Australian pharmacists in CE. Method: Focus groups were held with Australian community pharmacists, grouped into experienced pharmacists, recently qualified pharmacists, pharmacists with specialist-training needs, and pharmacists practising in rural or remote areas. Focus group transcripts were thematically analysed. Results: Barriers identified by pharmacists included time constraints, accessibility – in terms of travel and cost, relevance, motivation, quality and method of CE delivery. Participants provided ideas to improve uptake of CE. Conclusion: The major barriers identified were time, accessibility and relevance of content. To improve uptake of CE a wider variety of flexibly delivered programs supplemented with in-depth workshops could be utilised.

Gaps in continuity of medication management during the transition from hospital to residential care: An observational study (MedGap Study)

Aim:  To assess continuity of medication management during transition from hospital to residential care facilities (RCFs).

Use and evaluation of “virtual” patients for assessment of clinical pharmacy undergraduates

As an assessment task, third and fourth year undergraduate pharmacy students choose their own individual “virtual” patient using a purpose-designed computer program and respond to a clinical scenario that is randomly allocated to their individual patient according to defined limits. This then forms authentic teacher and peer-assessed, case-based assignments designed to evaluate clinical skills in undergraduate pharmacy students. Large numbers of students can be managed efficiently using the virtual patient program. The assignment has been completed by up to 360 students per year. The development of an authentic assessment tool has proven useful for the assessment of large numbers of undergraduate pharmacy students and is educationally sound. Students also interacted well with the program and felt it contributed to their learning. An evaluation questionnaire was completed by 212 students who reported that the assignment was relevant to the subject and the assessment improved their learning.

Palliative care for patients with cancer: what are the educational needs of community pharmacists?

AimsThe objective of this study was to determine the educational needs of community pharmacists in Australia related to palliative cancer care, to guide the development of an online educational program for pharmacists.MethodsQuestionnaires were posted to a random sample of community pharmacies in Australia. The questionnaire sought information pertaining to pharmacists’: demographics; educational needs by rating the importance of learning more about 18 palliative cancer care topics and self-perceived level of knowledge of them; preference for format(s) for the program; willingness to participate in the program; and perception regarding their practice of palliative cancer care. Results were analysed using Statistical Package for the Social Sciences (SPSS) version 11.5 software.Main resultsA questionnaire return rate of 10.3% was achieved. The characteristics of respondents were reflective of community pharmacy practice in Australia when compared with the latest available labour force figures by the Australian Institute of Health and Welfare. Pharmacists rated all 18 topics as “important/essential”, and their level of knowledge of them as “poor/good”. Pharmacists preferred information provided in these formats: text (89.8%), case studies (80.6%) and multi-choice questions (69.4%). Most pharmacists (85.2%) indicated that they would participate in the program. The majority of pharmacists (71.3%) reported that they deliver palliative cancer care services; usually less-than-monthly (24.1%) or weekly (21.3%).ConclusionsEducational needs of community pharmacists in palliative cancer care were identified. The information gathered will assist in guiding the development of an online educational program for pharmacists to improve their knowledge and skills in palliative cancer care.

Australian Hospital Pharmacists' Experiences of a UK Non‐Medical Prescribing Course

Legislative change and a university course to credential pharmacist prescribers are needed to move the pharmacist prescribing agenda forward in Australia. Non‐medical prescribing courses in the UK aim to produce safe and competent prescribers who understand the prescribing process, know their limitations and practice within their area of competence. As no equivalent course exists in Australia there was interest in exploring whether a UK non‐medical prescribing course could be adopted for the Australian environment.