Joe Bush

The corporatization of community pharmacy: Implications for service provision, the public health function, and pharmacy's claims to professional status in the United Kingdom

BACKGROUND Pharmacy has experienced both incomplete professionalization and deprofessionalization. Since the late 1970s, a concerted attempt has been made to re-professionalize pharmacy in the United Kingdom (UK) through role extension-a key feature of which has been a drive for greater pharmacy involvement in public health. However, the continual corporatization of the UK community pharmacy sector may reduce the professional autonomy of pharmacists and may threaten to constrain attempts at reprofessionalization. OBJECTIVES The objectives of the research: to examine the public health activities of community pharmacists in the UK; to explore the attitudes of community pharmacists toward recent relevant UK policy and barriers to the development of their public health function; and, to investigate associations between activity, attitudes, and the type of community pharmacy worked in (eg, supermarket, chain, independent). METHODS A self-completion postal questionnaire was sent to a random sample of practicing community pharmacists, stratified for country and sex, within Great Britain (n=1998), with a follow-up to nonresponders 4 weeks later. Data were analyzed using SPSS (SPSS Inc., Chicago, IL, USA) (v12.0). A final response rate of 51% (n=1023/1998) was achieved. RESULTS The level of provision of emergency hormonal contraception on a patient group direction, supervised administration of medicines, and needle-exchange schemes was lower in supermarket pharmacies than in the other types of pharmacy. Respondents believed that supermarkets and the major multiple pharmacy chains held an advantageous position in terms of attracting financing for service development despite suggesting that the premises of such pharmacies may not be the most suitable for the provision of such services. CONCLUSIONS A mixed market in community pharmacy may be required to maintain a comprehensive range of pharmacy-based public health services and provide maximum benefit to all patients. Longitudinal monitoring is recommended to ensure that service provision is adequate across the pharmacy network.

A comparison of the provision of the My Choice Weight Management Programme via general practitioner practices and community pharmacies in the United Kingdom.

This study aimed to assess the effectiveness of a novel, community‐based weight management programme delivered through general practitioner (GP) practices and community pharmacies in one city in the United Kingdom. This study used a non‐randomized, retrospective, observational comparison of clinical data collected by participating GP practices and community pharmacies. Subjects were 451 overweight or obese men and women resident in areas of high socioeconomic deprivation (82% from black and minority ethnic groups, 86% women, mean age: 41.1 years, mean body mass index [BMI]: 34.5 kg m−2). Weight, waist circumference and BMI at baseline, after 12 weeks and after 9 months were measured. Costs of delivery were also analysed. Sixty‐four per cent of participants lost weight after the first 12 weeks of the My Choice Weight Management Programme. There was considerable dropout. Mean percentage weight loss (last observation carried forward) was 1.9% at 12 weeks and 1.9% at final follow‐up (9 months). There was no significant difference in weight loss between participants attending GP practices and those attending pharmacies at both 12 weeks and at final follow‐up. Costs per participant were higher via community pharmacy which was attributable to better attendance at sessions among community pharmacy participants than among GP participants. The My Choice Weight Management Programme produced modest reductions in weight at 12 weeks and 9 months. Such programmes may not be sufficient to tackle the obesity epidemic.

Clinical pharmacists in general practice: An initial evaluation of activity in one English primary care organisation

This aim of this research was to characterise the breadth and volume of activity conducted by clinical pharmacists in general practice in Dudley Clinical Commissioning Group (CCG), and to provide quantitative estimates of both the savings in general practitioner (GP) time and the financial savings attributable to such activity.

Entry Characteristics and Academic Performance of Students in a Master of Pharmacy Degree Program in the United Kingdom

Objective. To evaluate the characteristics of a cohort of master of pharmacy (MPharm) students upon entry into the program and examine associations between entry qualifications, type of secondary school attended, socioeconomic status, age, and academic performance in the MPharm program. Methods. A retrospective cohort analysis was conducted of student data for graduates of the Aston University MPharm program during the 5-year period 2005-2006 through 2009-2010 (n=644). Results. MPharm entrants were disproportionately drawn from socioeconomically deprived areas and independent (private) schools. Achievement prior to admission was related to the type of school attended but not to socioeconomic status. Performance in the program was not related to type of school or socioeconomic status but was strongly correlated with prior academic achievement. Conclusions. Prior academic achievement was the most important predictor of performance in the MPharm program; however, the superior prior achievement of students who attended independent secondary schools was not seen at the point of graduation. These findings may have implications for admissions policies.

CP-036 evaluation of outpatient clinic letters for medication errors

Background It is well recognised that errors are more likely to occur during transitions of care, especially medicines errors. Clinic letters are used as a communication tool during a transition from hospital (outpatient clinics) to primary care (general practitioners). Little is known about medicines errors in clinic letters, as previous studies in this area have focused on medicines errors in inpatient or outpatient prescriptions. Published studies concerning clinic letters largely focus on perceptions of patients or general practitioners in respect to overall quality. Purpose To investigate medicines errors contained in outpatient clinic letters generated by prescribers within the Neurology Department of a specialist paediatric hospital in the UK. Materials and methods Single site, retrospective, cross-sectional review of 100 clinic letters generated during March–July 2013 in response to an outpatient consultation. Clinic letters were conveniently selected from the most recent visit of each patient. An evaluation tool with a 10-point scale, where 10 was no error and 0 was significant error, was developed and refined throughout the study to facilitate identification and characterisation of medicines errors. The tool was tested for a relationship between scores and number of medicines errors using a regression analysis. Results Of 315 items related to neurology mentioned within the letters, 212 items were associated with 602 errors. Common missing information was allergy (97%, n = 97), formulation (60.3%, n = 190), strength/concentration (59%, n = 186) and weight (53%, n = 53). Ninety-nine letters were associated with at least one error. Scores were in range of 4–10 with 42% of letters scored as 7. Statistically significant relationships were observed between scores and number of medicines errors (R2 = 0.4168, p < 0.05) as well as between number of medicines and number of drug-related errors (R2 = 0.9719, p < 0.05). Conclusions Nearly all clinic letters were associated with medicines errors. The 10-point evaluation tool may be a useful device to categorise clinic letter errors. No conflict of interest.

General public perceptions of pharmacy and pharmacist business practices in English community pharmacy

Background: Business practices are increasingly prevalent within modern society especially in community pharmacy where medicines are often treated as simple products to be bought by members of the public. It has been demonstrated that often, a consumer’s focus is on buying a product rather than using a pharmacist’s expertise during such transactions. The commercial nature of community pharmacy is necessary to support the profession and the re-branding of ‘retail pharmacy’ as ‘community pharmacy’ suggests the profession’s own awareness of a tension between commerce and professionalism. This research aims to identify the public’s perceptions of pharmacy and pharmacist business practices in English community pharmacy. Methods: A self-completion postal questionnaire was sent to a random sample of 9769 members of the public in England. Participants were asked to make a judgement, using a five-point Likert scale, as to whether they considered pharmacy premises as purely business focussed at one extreme to purely healthcare focussed at the other extreme. An additional question was asked asking particpants to make the same judgment (using the same five-point Likert scale) when considering pharmacists. Data were imported into SPSS 22 for analysis. Results: The overall response rate was 15.7% (n=1,537/9,769). Almost two thirds of respondents reported that they considered pharmacists to be ‘purely healthcare focussed’ or ‘more healthcare focussed than business focussed’ (63.6%, n=960/1,510); this was only true for 42.5% of respondents when considering pharmacy premises (n=644/1,516). Very few respondents considered either pharmacy premises or pharmacists as predominantly business focussed (less than 10% for both groups). Conclusions: The majority of the public reported that pharmacy premises were half healthcare focussed, half business focussed. Despite practicing in increaingly commerical enviroments, the public considered pharmacists to be healthcare focussed rather than business focussed. Continued promotion of the pharmacist’s healthcare role may be important to maintain this perception.

Professionalism within Pharmacy – the thoughts of Professional Leaders

To ascertain the thoughts of selected professional leaders on matters relating to pharmacist professionalism. These views will help build a picture of the professional status of pharmacy. Methods - Semi-structured interviews were conducted between July and November 2013 with representatives from eight UK pharmacy leadership bodies. The bodies were selected for their roles in pharmacy policy development, regulation and professional representation. The interviews were recorded and transcribed verbatim. Analysis by constant comparison identified a number of emerging themes. Results - The following emerging themes were identified from the interview data: Influence of the Pharmacy Landscape: Participants highlighted the role that pharmacy plays within the National Health Service and wider society and how future developments may affect the professional status currently afforded to pharmacists. Vocalising Pharmacy: Communication within the profession and also with those external to the profession, including other healthcare professionals and the general public, is important to ensure a high professional standing. The Impact of Commercialism: Professionalism and commercialism were generally seen to be antithetical and a rise in commercialism may adversely impact on external perceptions of the professionalism of pharmacy. Responsibility for Professionalism: The professional image of pharmacy is maintained by the individuals operating within it regardless of their scope of practice. It is the responsibility of all those individuals to ensure that they actively demonstrate ‘professional’ behaviours. The Journey to Professionalism: Acquiring a professional ethos is a continual process but there are stages in a pharmacist’s development that are considered particularly important. These include upbringing, undergraduate education and pre-registration training. Conclusions - Pharmacy’s professional status in the UK remains open to challenge and vital to retaining that status is the public perception of pharmacists. Future research examining pharmacy’s claims to professional status should focus on exploring the attitudes of the general public in addition to the views of pharmacists.

An exploration of pharmacy-specific reasons for non-adherence to prescribed medicines in a socioeconomically deprived, ethnically diverse UK cohort

Methods - Ethical approval for the study was granted by both the local National Health Service (NHS) Research Ethics Committee (REC) and Aston University’s REC. Seven focus groups were conducted between October and December 2011 in medical or community settings within inner-city Birmingham (UK). Discussions were guided by a theme plan which was developed from key themes identified by a literature review and piloted via a Patient Consultation Group. Each focus group had between 3 and 7 participants. The groups were digitally recorded and subsequently transcribed verbatim. The transcriptions were then subjected to thematic analysis via constant comparison in order to identify emerging themes. Results - Participants recognised the pharmacist as an expert source of advice about prescribed medicines, a source they frequently felt a need to consult as a result of the inadequate supply of medicines information from the prescriber. However, an emerging theme was a perception that pharmacists had an oblique profit motive relating to the supply of generic medicines with frequent changes to the ‘brand’ of generic supplied being attributed to profit-seeking by pharmacists. Such changes had a negative impact on the patient’s perceived efficacy of the therapy which may make non-adherence more likely. Conclusions - Whilst pharmacists were recognised as medicines experts, trust in the pharmacist was undermined by frequent changes to generic medicines. Such changes have the potential to adversely impact adherence levels. Further, quantitative research is recommended to examine if such views are generalisable to the wider population of Birmingham and to establish if such views impact on adherence levels.