Kritsanee Saramunee

Economic analysis of the diabetes and hypertension screening collaboration between community pharmacies and a Thai government primary care unit.

AIMS To evaluate models for collaboration between community pharmacies and a government primary care unit (PCU) in carrying out a screening program for diabetes and hypertension. METHODS An action research was undertaken and a screening and referring protocol developed. Study sites were two community pharmacies (Model 1) and footpaths/streets and seven communities (Model 2) under supervision of PCU in the city of Maha Sarakham Province, Thailand. The Combined Model consisted of Models 1 and 2. Those eligible were aged 40 years and over, not known to have diabetes or hypertension. Activity based costing of three models was analyzed from the provider perspective. RESULTS The study involved 456 people during July-September 2007; 11 out of 51 attending pharmacies (21.6%) and 27 out of 405 attending the communities (6.6%) met criteria for referral to PCU for confirmatory diagnosis. Only six attended the PCU. Two of 456 (0.4%) were confirmed the diagnosis having hypertension, one was referred from a pharmacy (2%, 1/51) the other from a community (0.2%, 1/405). Model unit costs were US

General public's views on pharmacy public health services: current situation and opportunities in the future

11.2, 4.3 and 5.1 per screened person, respectively. CONCLUSIONS The results indicate a working model can identify people in the community requiring treatment of hypertension or diabetes. Pharmacy-based screening was more costly, but the success rate for referral was higher compared with a community-based service. More effort is needed to ensure referred patients attend the PCU.

Public attitudes towards community pharmacy attributes and preferences for methods for promotion of public health services

OBJECTIVES To explore the experience of and willingness to use seven pharmacy public health services related to cardiovascular risk among the general public in England. STUDY DESIGN Mixed-methods study. METHODS A mixed-methods study, involving a cross-sectional survey using multiple distribution methods followed by a focus group discussion (FGD) with a sample of survey respondents. RESULTS From 3596 approachable individuals, 908 questionnaires were completed (response rate 25.3%). Few respondents (2.1-12.7%) had experienced any of the seven pharmacy public health services. About 40% stated they would be willing to use health check services, fewer (9.3-26.3%) were willing to use advisory services. More females, frequent pharmacy users and those in good health were willing to use services in general (P < 0.05). Smokers, overweight individuals and those with alcohol-related problems were most willing to use specific advisory services supporting their problems (P < 0.05). FGD identified barriers to service use; for example, frequent staff changes, seeing pharmacist as medicines suppliers and concerns about competence for these services. CONCLUSION The general public are receptive to pharmacy public health services. Pharmacists must consider barriers if uptake of services is to increase.

Methodological and economic evaluations of seven survey modes applied to health service research

OBJECTIVE To identify attitudes towards pharmacy characteristics and promotional methods for selected pharmacy public health services (lifestyle advice and screening for cardiovascular risk factors) among different sectors of the general public. STUDY DESIGN Cross-sectional survey, using a previously validated questionnaire. METHODS Three survey methods were used, across 15 areas of England, to maximize diversity: face-to-face; telephone; and self-completion of paper questionnaires. Responses to closed questions regarding characteristics and promotion were quantified and differences among sub-groups explored by univariate and multivariate analysis. RESULTS In total, 2661 responses were available for analysis: 2047 face-to-face; 301 telephone; and 313 paper. There were strong preferences for a pharmacy near to home or doctors surgery and for long opening hours, particularly among employed people and non-whites. Fifty percent preferred not to use a pharmacy in a supermarket, particularly older people, the retired, those of lower education and frequent pharmacy users. Personal recommendation by health professionals or family/friends was reported as most likely to encourage uptake of pharmacy public health services, with older people and males being less likely and frequent pharmacy users more likely to perceive any promotional method as influential. Posters/leaflets were preferred over mass-media methods, with fewer than 30% perceiving the latter as potentially influential. CONCLUSION Pharmacists, pharmacy companies and service commissioners should use promotional methods favoured by potential users of pharmacy public health services and be aware of differences in attitudes when trying to reach specific population sub-groups. For personal recommendation to be successful, good inter-professional working and a pro-active approach to existing customers are needed.

Unit cost of common illness management: a comparison between a primary care unit and a community pharmacy in Thailand

To evaluate methodological outcomes and cost‐effectiveness of seven survey modes, using a study of general public views towards pharmacy public health services.

How to enhance public health service utilization in community pharmacy?: General public and health providers' perspectives

Aim This study was to perform unit cost analysis of managing common illnesses comparing between a primary care unit (PCU) and a community pharmacy. BACKGROUND PCU is a key point of access for primary care in Thailand. Although a community pharmacy is an ideal setting, it has not been successfully incorporated in Thailands health service. Common illnesses are encountered everyday by community pharmacists, an appropriate compensation for this service has not been established. METHODS A primary care service of one educational institution was a study site. Eight common illnesses were emphasised. Patient visits were observed, prospectively at community pharmacy and retrospectively at PCU, during August to October 2013. Labour and material costs related to management of common illnesses were recorded. Total cost divided by total patient visits determined the unit cost. For the community pharmacy, patients were followed up after 3-14 days of visit to evaluate the effectiveness. Sensitivity analysis was performed by varying direct medical cost at ±10-30%. Findings At the community pharmacy, community pharmacists performed multiple tasks including interviewing and assessing patients, choosing an appropriate treatment and dispensing. Of 9141 visits, 775 (8.5%) with common illnesses were included. Upper respiratory disorder was found the highest 41.9% (325/755). Unit cost of treatment ranged from 54.16 baht (£1.18) for pain to 82.71 baht (£1.80) for skin disorder. Two-thirds of pharmacy visits (77.9%, 539/692) reported complete recovery. Managing common illnesses at the PCU was performed by nurse assistants, nurses, doctors and pharmacists. Of 6701 patient visits to the PCU, 1545 (23.1%) visits were at least one of the eight illnesses. Upper respiratory disorder was the majority, 53.0% (771/1454). Unit cost of treatment ranged from 85.39 baht (£1.86) for eye/ear to 245.93 baht (£5.36) for sexual health. Managing common illness at a community pharmacy shows satisfactory effectiveness with lower unit cost.