Karen Hassell

The challenge of integrating community pharmacists into the primary health care team: A case study of local pharmaceutical services (LPS) pilots and interprofessional collaboration

The aim of this paper is to investigate interprofessional collaboration between general practitioners (GPs) and pharmacists involved in the delivery of enhanced pharmacy services under the local pharmaceutical services (LPS) contract in England. Previous research suggests that a number of interprofessional barriers exist between community pharmacists and GPs which hinders the integration of community pharmacists into the primary health care team (PHCT). One of the aims of the LPS contract, introduced in England in 2002 as an alternative to national contractual arrangements, was to enable pharmacists to work more closely with other health care professionals. A two-stage survey was distributed to all pharmacists involved in the first wave of LPS and in-depth interviews undertaken with pharmacists and GPs at six of the LPS sites. Overall the level to which the LPS pharmacists felt integrated into the PHCT did not substantially increase with the introduction of LPS, although co-location was reported to have facilitated integration. New relationships were formed with GPs and existing ones strengthened. A good existing working relationship with GPs was found to be an important factor in the successful operation of the pilots as many were dependent on GPs for patient referrals. The findings suggest that establishing interprofessional collaboration between GPs and pharmacists is a piecemeal process, with a reliance on goodwill and trust-based relationships.

Advice-giving in community pharmacy: variations between pharmacies in different locations.

The advice and services provided by community pharmacies are viewed by policy makers as having an increasingly important contribution to make as a primary health care resource to local populations. However, little attention has been given to the variations which may exist between pharmacies operating in different localities. Findings from an ethnographic study of pharmacies illuminate differences in the nature and quality of advice and services provided by pharmacies operating in disparate localities. Analysis of qualitative data suggests that differences in the environment within which pharmacies are located and organised influence the type of service provided to local populations. The possibility of an inverse care law operating in relation to the nature of services in poor urban localities compared to those in rural areas is also discussed.

Affordability of Medicines and Patients' Cost-Reducing Behaviour: Empirical Evidence Based on SUR Estimates from Italy and the UK

IntroductionStudies have demonstrated that co-payments on medication reduce the consumption of both non-essential and essential drugs, and that the latter can lead to worse health outcomes. Far less is known about how patients cope with the cost of medication, particularly if affordability is an issue, and how this compares across two countries with different prescription charge policies. Therefore, the aim of this article is to explore empirically how, and to what extent, costs incurred by patients influence their decision-making behaviour in accessing medicines.MethodsBased on the findings from focus groups, a questionnaire was designed that addressed medication cost issues relevant to patients in both the UK and Italy. Using an econometric model, several hypotheses are tested regarding patients’ decision-making behaviour and how it is influenced by health status, sociodemographic characteristics and the novel concept of a self-rated affordability measure.ResultsQuite a large percentage of patients (70.3% in the UK and 66.5% in Italy) stated they have to think about the cost of medicines at least sometimes. Respondents adopted numerous cost-reducing strategies, subdivided into (i) those initiated by patients and (ii) those involving self-medication. Their use was strongly influenced by income and drug affordability problems, but the self-rated affordability measure was a stronger predictor. Commonly used strategies were not to get prescribed drugs dispensed at all, prioritising by not getting all prescribed items dispensed or delaying until the respondent got paid. Furthermore, respondents with affordability issues were also cost-conscious when self-medicating with over-the-counter (OTC) products for minor conditions such as dyspepsia. Despite patients in both countries using cost-reducing strategies, their use was more pronounced in the UK, where the prescription charge was significantly higher than in Italy.Discussion/conclusionThe results from this study provide detail on the kinds of strategies patients use to reduce the cost burden of prescription charges, and support previous research showing they may be foregoing essential medication. Because the same questionnaire was applied in two European countries, where the national health systems aim to provide healthcare services that are accessible to all citizens in need, it offers interesting insights for policy makers in other countries, where patients may have to pay a larger share of their drugs out-of-pocket, such as the US.

Pharmacists and their customers: a personal or anonymous service?

Aims — To explore the existence and nature of the pharmacist‐customer relationship.

Workplace stress in community pharmacies in England: associations with individual, organizational and job characteristics.

Objectives To describe the levels of workplace stress that community pharmacists perceive and to examine associations with individual, organizational and job characteristics. Methods A cross-sectional mailed survey of 2000 randomly selected community pharmacists practising in England incorporating a validated organizational stress screening tool (ASSET). Results Response rate was 48%. Community pharmacists reported significantly higher levels of stress than other health care workers for seven out of eight work-related stressors. Regression analyses demonstrated significant associations between a number of individual, organizational and job characteristics and stress. Long working days, being a pharmacy manager and working for large multiples were associated with higher reported levels of stress across a number of work-related stressors including work overload, control and the job itself. However, self-reported measures of workload (such as dispensing volume) were not associated with higher stress levels. Conclusions The growth in corporate ownership of community pharmacies, which is associated with more stressful working environments, together with current economic pressures could have consequences not only for the future well-being of pharmacists but also for patient safety.

How do pharmacy students learn professionalism

Objective  To understand and clarify how professionalism is learnt, cultivated and facilitated in pharmacy education.

Measuring job satisfaction of UK pharmacists: a pilot study

Objective To review the UK published literature on pharmacy job satisfaction, in order to describe and assess the strengths of their methods and the findings and to validate an existing instrument to measure work satisfaction, with a sample of locum pharmacists.

'You don't really feel you can function normally': women's perceptions and personal management of vaginal thrush

Vaginal symptoms caused by thrush are extremely common. However, there have been few qualitative studies reporting womens perceptions and self - management of this condition. This paper reports the results of 30 telephone interviews that were conducted with women who had previously presented at community pharmacies with a self - diagnosis of vaginal thrush. Some women reported that thrush made them feel miserable, unable to work, embarrassed, or even stigmatized. About half of the women knew that they could take simple measures to prevent the symptoms of thrush, but others wanted more information. Most women reported that over - the - counter medicines had cured their symptoms, but some stressed that alternative remedies such as natural yoghurt were also beneficial. Since it appears that thrush may have a major impact on womens lives, it should be taken seriously by health care professionals. Women need reassurance that thrush is a common condition, and that it is not generally regarded as sexually transmitted. Some researchers have argued that women suffering from chronic thrush may benefit from the development of psychological treatment initiatives. However, it is also important to ensure that women know how to prevent thrush, and to inform women about the range of effective remedies that now exist for this condition.

White and Ethnic Minority Self-Employment in Retail Pharmacy in Britain: An Historical and Comparative Analysis

Despite having opportunities to enter retail or clinical practice, Britains ethnic minority pharmacists display disproportionately high levels of self-employment within the distinctly entrepreneurial business sector of the pharmacy profession. This paper sets out to describe ethnic minority involvement in the profession of pharmacy, and highlights the role that preference plays in their decision to go into independent proprietorship. The study argues that while racism plays a small part, personal choice, available resources, and structural opportunities for business development within the profession largely account for the different work patterns found among white and ethnic minority pharmacists.

Support staff in community pharmacy: who are they and what do they want?

Objective To collect information on different categories of support staff, their deployment in community pharmacy, their levels of experience and qualifications, and their opinions on a number of topical issues, such as training and regulation.