Lotte Stig Nørgaard

Challenges to counseling customers at the pharmacy counter—Why do they exist?

Challenges to engage pharmacy customers in medicine dialogues at the counter have been identified comprising a new and extended clinical role for pharmacists in the health care system. This article seeks to expand understanding of factors involved in successful interaction at the pharmacy counter between customers and pharmacy staff to develop their relationship further. Practical challenges to customer encounters experienced by community pharmacists are discussed using theory from the field of mainly inter-relational communication and particular studies on pharmacy communication. Preconceived expectation of customers, the type of question asked by pharmacy staff, and differences in perception of illness and medicines between staff and customers are discussed. Both staff and customer influence the outcome of attempts by pharmacy staff to engage customers in dialogue about their medicine use through a complex mechanism of interaction. It is recommended that practitioners and researchers begin to distinguish, both theoretically and practically, between the content of a conversation and the underlying relationship when exploring and further developing the therapeutic relationship between pharmacy personnel and customers.

Patient perspectives on type 2 diabetes and medicine use during Ramadan among Pakistanis in Denmark

Background Type 2 diabetes is highly prevalent among people of Pakistani background. Studies show that adherence to medicines is complicated for people with type 2 diabetes in general. Also, studies indicate that many people with type 2 diabetes and Muslim background fast during the month of Ramadan without adequate counselling on how to adjust their medicines. Objective To explore patient perspectives on medicine use during Ramadan, reasons for fasting and experiences with counselling on medicine use during Ramadan among people of Pakistani background with type 2 diabetes and at least one other chronic condition. Setting Greater Copenhagen, Denmark. Method The analysis is based on a study exploring lived experiences with counselling on medicines using semi-structured interviews and medication reviews. The analysis presented here builds on the subset of patients with Pakistani background (six interviewers). Results All interviewees pointed out that Islam allows ill people to refrain from fasting during Ramadan. However, all had fasted during Ramadan despite being diagnosed with type 2 diabetes. While fasting, they adapted their use of medicines in different ways, e.g. by changing the time of intake or by skipping morning medicines. Fasting during Ramadan meant a feeling of improvement in well-being for all interviewees. Reasons for this improvement included physiological, social and religious aspects. Healthcare professionals were rarely included in the decision-making process on whether or not to fast. Instead, friends and relatives, especially those with type 2 diabetes, were considered important to the decision-making process. Conclusion For people with Muslim background and a chronic condition, fasting during Ramadan may mean changes in medicine use that are not always discussed with healthcare professionals. Healthcare professionals should acknowledge that Muslim patients may find fasting during Ramadan beneficial to their well-being and therefore choose to fast despite the Islamic rule of exemption. This patient-centred approach to counselling on medicines may facilitate better medicine use and thus better clinical health outcomes among patients that choose to fast.

The role of the Danish community pharmacist: perceptions and future scenarios

In recent decades, dramatic changes of the role of the Danish community pharmacist have contributed to widespread uncertainty among professionals about the future content of their job. This case study, which is based on qualitative research interviews and documentary material, describes how key actors belonging to 10 different relevant social groups who have been influential in shaping the role of Danish community pharmacists have different perceptions of the pharmacy profession. These perceptions include: the community pharmacist as a provider of technical, standardised advice, the pharmacist as a drug expert, the pharmacist as a leader, and the pharmacist as a provider of individualised advice. Five future scenarios for the community pharmacist ranging from a role as a pharmacist with no future to a role as the provider of individualised information and future role developer are also described and analysed in the paper. The case study is theoretically based on a specific social constructivist theory, the Social Construction of Technology (SCOT).

How to engage experienced medicine users at the counter for a pharmacy-based asthma inhaler service.

Objectives  Recent studies have identified recruitment of customers at the pharmacy counter as a limiter to successful provision of cognitive services in community pharmacies especially that of experienced customers with refill prescriptions. The aim of the paper is to gain insight into current problems of recruiting.

Social constructivist analysis of a patient medication record experiment — why a good idea and good intentions are not enough

Objective — To explain the limited success of a local patient medication record (PMR) experiment in pharmacy practice in Denmark from a social constructivist perspective and to promote a discussion among pharmacy practice researchers of how on‐going social constructivist analysis can be used to manage experiments in pharmacy practice.

Safe and Effective Use of Medicines for Ethnic Minorities - A Pharmacist- Delivered Counseling Program That Improves Adherence

Background: From studies, we know how ethnic minorities and people with reduced work ability often suffer from health problems, thus being socially disadvantaged. The municipal job centers are confronted with numerous problems related to medicine use and they lack relevant means of referral. Thus, there was a need to adapt a previously developed and validated medicine-based intervention “safe and effective use of medicines” to this vulnerable group of unemployed ethnic minority patients. Methods: The objective of this before-after study was to improve medicines adherence, health status and work ability of the target group through an individualized pharmacist delivered intervention with focus on safe and effective implementation of medical treatments. The target group was ethnic minorities of non-western origin affiliated with a job center. Results: At baseline, 35.7 % of the patients had a potential adherence behavior problem Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation (having an average adherence score of less than 5); at endpoint, this number had decreased to 27.3 %, meaning that 8.4 % no longer had potential adherence problems. Self-reported adherence was significantly improved on three out of four subscales (“Intentional, selfregulation” from 4.5 to 4.7, p=0.016); “Unintentional” from 3.9 to 4.2, p=0.009); “Intentional, effect-related” from 4.0 to 4.4, p=0.025; “General” 4.3 to 4.5, p=0.173.). On average, 47 % of the patients experienced improvements in concordance, due to the intervention. Conclusion: The counseling program “Safe and effective use of medicines” was successfully adapted to unemployed ethnic minority patients, and tested in a new collaboration between job centers and community pharmacies. The counseling program resulted in statistically significant improvements in self-reported adherence as well as improved concordance for approximately half of the patients. Improvements in adherence removes one barrier for returning to the work force that exists in the complex interaction between adherence, health status and work ability.

Going to the doctor with enhancement in mind – An ethnographic study of university students’ use of prescription stimulants and their moral ambivalence

Abstract Aims: With this article, we aim to use students’ moral ambivalence towards prescription stimulants and the doctor’s who prescribe them to problematize the distinction between enhancement and treatment. We do this by investigating a case in which students obtain legitimate prescriptions for (covert) enhancement purposes. Methods: The study is based on ethnographic fieldwork and in-depth interviews with 20 university students from multiple universities in New York City, from which the case is drawn. Findings: Three main themes were identified in the analysis. “The doctor prescribed them” illustrates how these students use doctors as easy access to study drugs, and legitimize their use of stimulants because they were prescribed. The second theme, “A good cause”, shows that the purpose is what counts as a measure for whether stimulant use is considered morally acceptable or not. The third theme, “Being responsible” refers to how they regard themselves as responsible stimulant users, particularly when not following the doctor’s directions. Conclusions: Through an ethnographic approach, we gain a more nuanced understanding of non-medical stimulant use that takes into account the context in which it occurs. We suggest that students’ moral ambivalence reflects the increasingly blurred boundaries between what is considered treatment and enhancement in contemporary society.

Pursuing Pleasures of Productivity: University Students' Use of Prescription Stimulants for Enhancement and the Moral Uncertainty of Making Work Fun

This article presents ethnographic data on the use of prescription stimulants for enhancement purposes by university students in New York City. The study shows that students find stimulants a helpful tool in preventing procrastination, particularly in relation to feeling disinterested, overloaded, or insecure. Using stimulants, students seek pleasure in the study situation, for example, to get rid of unpleasant states of mind or intensify an already existing excitement. The article illustrates the notion that enhancement strategies do not only concern productivity in the quantitative sense of bettering results, performances, and opportunities. Students also measure their own success in terms of the qualitative experience of working hard. The article further argues that taking an ethnographic approach facilitates the study of norms in the making, as students experience moral uncertainty—not because they improve study skills and results—but because they enhance the study experience, making work fun. The article thereby seeks to nuance simplistic neoliberal ideas of personhood.

The ambiguity of ethnicity as risk factor of vitamin D deficiency - A case study of Danish vitamin D policy documents

OBJECTIVES To explore how ethnic minorities at risk of vitamin D deficiency are constructed in Danish policy documents (current as of April 2009), regarding vitamin D supplementation. METHODS Ten policy documents were analysed through content analysis, focusing on definitions and explanations of ethnic minorities being at risk of vitamin D deficiency. This formed the basis for an analysis of constructions of ethnic minorities at risk which was undertaken using the Social Construction of Technology (SCOT) theory as an organising framework. RESULTS The analysis showed a high degree of interpretative flexibility regarding how ethnic minorities are constructed as a risk group for vitamin D deficiency. The ten documents analysed revealed eight different constructions of the ethnic minorities groups at risk. A low degree of interpretative flexibility was found regarding the importance of skin colour and skin covering. Major disagreements were found regarding the importance attributed to the Islamic religion, other traditions, immigration, gender and age, and use of an evolutionary explanation for the increased risk. CONCLUSIONS Ethnic minorities at risk of vitamin D deficiency are constructed very differently in Danish policies current as of April 2009. A more precise definition of ethnic minorities in policies and research may be helpful in seeking to identify which ethnic minorities are and are not at risk of vitamin D deficiency.

Exploring communications around medication review in community pharmacy

Objectives Investigation into aspects that influence outcomes of medication reviews have been called for. The aim of this study was to assess how pharmacy internship students in a Danish medication review and reconciliation model communicated with both diabetes patients and the patients’ General Practitioners (GPs) when conveying the results of the review by writing letters to the different parties. Special attention was drawn to how differences in health care provider and patient perspectives of the disease as well as inclusion of the patient in the decision making process is influenced by the identified practices of communication. Setting 18 Danish community pharmacies with The Department of Pharmacology and Pharmacotherapy at the Faculty of Pharmaceutical Sciences, University of Copenhagen. Method Number of identified drug related problems, life-world problems and solutions to these described in the letters sent to patients and their GPs were registered. Further a qualitative documentary analysis was conducted by analyzing the letters using the theory of transactional analysis, developed by Berne. Main outcome measures Identified and conveyed drug related and life-world related problems when comparing patients’ letters with GPs’ letters. Whether students assumed a superior, inferior or equal role in relation to the recipient of the letter and compared whether students assumed the same role in relation to patients and GPs. Results 18 pairs of patient and GP letters were analyzed. The analysis showed that students conveyed more drug-related problems to GPs than to patients. Furthermore, students assumed an equal relationship to GPs, whereas they frequently took superior positions when writing to patients. Students reported lifestyle problems both to GPs and to patients. Conclusion Pharmacy students in a Danish medication review and reconciliation model managed to detect and address lifestyle problems of patients to their GPs, thereby facilitating the merger of their professionaltechnical perspective with the life-world perspective of patients. However, patients were not encouraged to become more involved in the disease management process.