Kevin Mc Namara

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.

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.

Challenges in measuring medication adherence: experiences from a controlled trial.

Measurement of adherence is complex and many methods, both direct and indirect are used; there is no universal gold standard. In this article, we share our experiences in a randomised controlled study, the Hypertension Adherence Program in Pharmacy trial, evaluating a community pharmacy-based intervention for improving adherence to antihypertensive medication. Several objective and subjective measures of adherence (Morisky score, TABS score, MedsIndex, Medicines Possession Ratio) were used, but produced varying results, limiting confidence in the conclusions that could be drawn. Despite using a specifically designed data mining software program to identify potentially nonadherent patients from dispensing records, many participants were found to be adherent by the self reported Morisky scale. A lesson to be learned when targeting people for interventions to improve adherence is that information from dispensing records should be supplemented by other methods in order to identify patients most in need of assistance.

Adopting an active learning approach to teaching in a research-intensive higher education context transformed staff teaching attitudes and behaviours

ABSTRACT The conventional lecture has significant limitations in the higher education context, often leading to a passive learning experience for students. This paper reports a process of transforming teaching and learning with active learning strategies in a research-intensive educational context across a faculty of 45 academic staff and more than 1000 students. A phased approach was used, involving nine staff in a pilot phase during which a common vision and principles were developed. In short, our approach was to mandate a move away from didactic lectures to classes that involved students interacting with content, with each other and with instructors in order to attain domain-specific learning outcomes and generic skills. After refinement, an implementation phase commenced within all first-year subjects, involving 12 staff including three from the pilot group. The staff use of active learning methods in classes increased by sixfold and sevenfold in the pilot and implementation phases, respectively. An analysis of implementation phase exam questions indicated that staff increased their use of questions addressing higher order cognitive skills by 51%. Results of a staff survey indicated that this change in practice was caused by the involvement of staff in the active learning approach. Fifty-six percent of staff respondents indicated that they had maintained constructive alignment as they introduced active learning. After the pilot, only three out of nine staff agreed that they understood what makes for an effective active learning exercise. This rose to seven out of nine staff at the completion of the implementation phase. The development of a common approach with explicit vision and principles and the evaluation and refinement of active learning were effective elements of our transformational change management strategy. Future efforts will focus on ensuring that all staff have the time, skills and pedagogical understanding required to embed constructively aligned active learning within the approach.

Potential of pharmacists to help reduce the burden of poorly managed cardiovascular risk

INTRODUCTION Rural areas require better use of existing health professionals to ensure capacity to deliver improved cardiovascular outcomes. Community pharmacists (CPs) are accessible to most communities and can potentially undertake expanded roles in prevention of cardiovascular disease (CVD). OBJECTIVE This study aims to establish frequency of contact with general practitioners (GPs) and CPs by patients at high risk of CVD or with inadequately controlled CVD risk factors. DESIGN, SETTING AND PARTICIPANTS Population survey using randomly selected individuals from the Wimmera region electoral roll and incorporating a physical health check and self-administered health questionnaire. Overall, 1500 were invited to participate. RESULTS The participation rate was 51% when ineligible individuals were excluded. Nine out of 10 participants visited one or both types of practitioner in the previous 12 months. Substantially more participants visited GPs compared with CPs (88.5% versus 66.8%). With the exception of excess alcohol intake, the median number of opportunities to intervene for every inadequately controlled CVD risk factor and among high risk patient groups at least doubled for the professions combined when compared with GP visits alone. CONCLUSION Opportunities exist to intervene more frequently with target groups by engaging CPs more effectively but would require a significant attitude shift towards CPs. Mechanisms for greater pharmacist integration into primary care teams should be investigated.

What makes continuing education effective : perspectives of community pharmacists

Objective To explore how different aspects of the professional environment for Australian community pharmacists are perceived to be influencing the effectiveness of continuing education models in improving practice.

Patient engagement strategies used for hypertension and their influence on self-management attributes

BACKGROUND Several effective methods to facilitate patient self-management of hypertension are available in primary care. These include direct support from community pharmacists and general practice, and the use of home blood pressure (BP) monitoring. The aim of this study is to establish the prevalence of use of key strategies and to determine their independent relationship with patient self-management attributes. METHODS A survey of patients with treated hypertension was undertaken in 27 community pharmacies. This established recent use of BP monitoring and advice from health professionals. Patient awareness of BP and targets, appropriateness of BP targets and adherence to anti-hypertensive medications were assessed as indicative self-management outcomes. Predictors of outcomes were determined using binary logistic regression. RESULTS Overall, 215 surveys were returned. Two-thirds of patients were aged >65 years, and 45% had conditions warranting tighter BP control (<130/80 mmHg). Almost all patients reported monitoring of their BP in the previous year and 63% could report their most recent BP reading. Just 36% reported knowing a target BP, and 78% of reported targets were within guidelines recommendations. One-fifth (22%) monitored their own BP, and 15% reported non-adherence to medication. Doctors provided the large majority of professional advice. Self-monitoring or documentation of BP readings was independently associated with increased likelihood of BP and target BP being known. CONCLUSIONS Regular monitoring of BP does not automatically translate to professional advice. Increased uptake of patient self-monitoring should be promoted as a means of enabling self-management.

Challenges of diabetes prevention in the real world: results and lessons from the Melbourne Diabetes Prevention Study

Objective To assess effectiveness and implementability of the public health programme Life! Taking action on diabetes in Australian people at risk of developing type 2 diabetes. Research design and methods Melbourne Diabetes Prevention Study (MDPS) was a unique study assessing effectiveness of Life! that used a randomized controlled trial design. Intervention participants with AUSDRISK score ≥15 received 1 individual and 5 structured 90 min group sessions. Controls received usual care. Outcome measures were obtained for all participants at baseline and 12 months and, additionally, for intervention participants at 3 months. Per protocol set (PPS) and intention to treat (ITT) analyses were performed. Results PPS analyses were considered more informative from our study. In PPS analyses, intervention participants significantly improved in weight (−1.13 kg, p=0.016), waist circumference (−1.35 cm, p=0.044), systolic (−5.2 mm Hg, p=0.028) and diastolic blood pressure (−3.2 mm Hg, p=0.030) compared with controls. Based on observed weight change, estimated risk of developing diabetes reduced by 9.6% in the intervention and increased by 3.3% in control participants. Absolute 5-year cardiovascular disease (CVD) risk reduced significantly for intervention participants by 0.97 percentage points from 9.35% (10.4% relative risk reduction). In control participants, the risk increased by 0.11 percentage points (1.3% relative risk increase). The net effect for the change in CVD risk was −1.08 percentage points of absolute risk (p=0.013). Conclusions MDPS effectively reduced the risk of diabetes and CVD, but the intervention effect on weight and waist reduction was modest due to the challenges in recruiting high-risk individuals and the abbreviated intervention.

Greater Green Triangle Diabetes Prevention Program: Remaining treatment gaps in hypertension and dyslipidaemia

Greater Green Triangle Diabetes Prevention Program: Remaining treatment gaps in hypertension and dyslipidaemiaajr_1120 43..44 Kevin Mc Namara, Benjamin Philpot, Edward D. Janus and James A. Dunbar Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, Department of Pharmacy Practice, Monash University, Parkville, and Department of Medicine, University of Melbourne, Western Hospital, Footscray, Victoria, Australia

Do statin users adhere to a healthy diet and lifestyle?: the Australian Diabetes, Obesity and Lifestyle Study

Background Lifestyle and dietary advice typically precedes or accompanies the prescription of statin medications. However, evidence for adherence to this advice is sparse. The objective was to compare saturated fat intake, exercise, alcohol consumption and smoking between statin users and non-users in Australia. Methods Data were analysed for 4614 participants aged ≥37 years in the Australian Diabetes, Obesity and Lifestyle study in 2011–2012. Statin use, smoking status and physical activity were self-reported. Saturated fat and alcohol intake were measured via a food frequency questionnaire. Multinomial logistic regression was used to compute adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between statin use and the four lifestyle factors. All models were adjusted for age, sex, education, number of general practitioner visits, body mass index, hypertension, diabetes and prior cardiovascular diseases. Results In total 1108 (24%) participants used a statin. Statin users were 29% less likely to be within the highest quartile versus the lowest quartile of daily saturated fat intake compared to non-users (OR 0.71, 95% CI 0.54–0.94). There were no statistically significant associations between statin use and smoking, physical activity or alcohol consumption. Conclusions Smoking status, alcohol consumption and exercise level did not differ between users and non-users of statins. However, statin users were less likely to consume high levels of saturated fat than non-users. We found no evidence that people took statins to compensate for a poor diet or lifestyle.