Lyda Blom

The Utrecht Pharmacy Practice network for Education and Research: a network of community and hospital pharmacies in the Netherlands

Practice-based networks can serve as effective mechanisms for the development of the profession of pharmacists, on the one hand by supporting student internships and on the other hand by collection of research data and implementation of research outcomes among public health practice settings. This paper presents the characteristics and benefits of the Utrecht Pharmacy Practice network for Education and Research, a practice based research network affiliated with the Department of Pharmaceutical Sciences of Utrecht University. Yearly, this network is used to realize approximately 600 student internships (in hospital and community pharmacies) and 20 research projects. To date, most research has been performed in community pharmacy and research questions frequently concerned prescribing behavior or adherence and subjects related to uptake of regulations in the pharmacy setting. Researchers gain access to different types of data from daily practice, pharmacists receive feedback on the functioning of their own pharmacy and students get in depth insight into pharmacy practice.

Patient-provider communication about medication use at the community pharmacy counter.

The objectives of this study were to, first, describe the information exchanged between pharmacy staff and patients about prescribed medication at the community pharmacy counter, and second, to investigate to what extent this met professional medication counselling guidelines.

“These patients look lost” – Community pharmacy staff's identification and support of patients with limited health literacy

To date, routine use of health literacy assessment in clinical settings is limited. The objective of this study was to explore if community pharmacy staff can identify patients with limited health literacy, how they identify patients and how they support patients to improve medication use. In addition, perceived barriers in providing care for patients with limited health literacy were assessed.

Effects of a management technician on structured working in Dutch community pharmacies

Methods: The intervention program provided the management technician with knowledge, tools and skills needed for the organisation of patient education activities in her community pharmacy. Twenty-eight pharmacies were selected for the study. After matching, each pharmacy was randomly assigned to either the experimental or control group. In the pharmacies of the experimental group, a technician was selected to become the management technician.Main outcome measures: Pharmacy technicians were assessed by means of written questionnaires at baseline and immediately after the intervention (12 months). The outcomes were the variables that were directly targeted by the intervention, and included technicians’ perception of the availability of policy plans, support for patient education activities towards their implementation, evaluation, and provisions for continuity.Results: After 12 months, the following indicators for structured working were noted to have increased in the experimental group compared to the control group: the technicians in the experimental group more often reported an awareness of policy plans, less lack of continuity of activities, support and evaluation for implementing patient education activities. We also observed that the control group had a higher baseline level and the effects on support and evaluation showed differences between pharmacies. The observed increases were more pronounced in pharmacies that had a higher exposure to the intervention, and in the case of support and evaluation relevant in this more exposed group.Conclusion: We found indications for effects of the intervention program, especially in the pharmacies with increased exposure. However, results could be influenced by regression to the mean, as the control group started with a higher mean than the experimental group. We conclude that technicians’ participation in the management of patient education activities appears to be effective when she has a minimum of hours to spend on this task in her pharmacy.

Informational needs and recall of in-hospital medication changes of recently discharged patients

Purpose The need for information for patients and caregivers at the point of hospital discharge is paramount and potentially extensive. Objective The objective of this study was to assess patients’ informational needs at hospital discharge, patients’ recall of medication changes implemented in the hospital and patients’ medication related problems experienced one week after hospital discharge. Methods The study was conducted in a teaching hospital where patients received structured discharge counseling. Patients were interviewed at hospital discharge regarding their informational needs. One week post‐discharge, patients were interviewed by phone to assess any changes in informational needs, their recall regarding in‐hospital medication changes and the medication related problems. Descriptive analysis and logistic regression were used to address study objectives. Results The 124 patients in the study regarded the following topics as most relevant for counseling: what the medicine is for (57%), side effects (52%), drug‐drug interactions (45%), action of the drug (37%) and reimbursement (31%). In 9% of patients the informational needs changed post‐discharge, e.g. the topic side effects increased in importance. Forty‐nine percent could recall whether and which medication was changed during hospitalization. Medication‐related problems and side effects were reported by respectively 27% and 15% of patients, whereas only 7% contacted their doctor or pharmacist. Conclusions Patients’ informational needs are very individual and can change post‐discharge. Despite structured counseling, only half of the patients were able to recall the medication changes implemented in the hospital. Furthermore, patients reported several problems for which they did not consult a healthcare provider. This insight could help in smoothing the transition from hospital to the primary care setting.

To dispense or not to dispense? Ethical case decision-making in pharmacy practice

In daily practice, pharmacists are regularly confronted with moral problems in which deciding what to do is not always a straightforward decision. In this contribution we show how the use of a specific method for moral deliberation can (in retrospect or prospective) aid moral judgements. We use the case of dispensing isotretinoin to demonstrate one ethical reflection method, namely the Utrecht Method.

Quality of pharmaceutical care at the pharmacy counter: patients’ experiences versus video observation

Introduction Consumer Quality Index questionnaires are used to assess quality of care from patients’ experiences. Objective To provide insight into the agreement about quality of pharmaceutical care, measured both by a patient questionnaire and video observations. Methods Pharmaceutical encounters in four pharmacies were video-recorded. Patients completed a questionnaire based upon the Consumer Quality Index Pharmaceutical Care after the encounter containing questions about patients’ experiences regarding information provision, medication counseling, and pharmacy staff’s communication style. An observation protocol was used to code the recorded encounters. Agreement between video observation and patients’ experiences was calculated. Results In total, 109 encounters were included for analysis. For the domains “medication counseling” and “communication style”, agreement between patients’ experiences and observations was very high (>90%). Less agreement (45%) was found for “information provision”, which was rated more positive by patients compared to the observations, especially for the topic, encouragement of patients’ questioning behavior. Conclusion A questionnaire is useful to assess the quality of medication counseling and pharmacy staff’s communication style, but might be less suitable to evaluate information provision and pharmacy staff’s encouragement of patients’ questioning behavior. Although patients may believe that they have received all necessary information to use their new medicine, some information on specific instructions was not addressed during the encounter. When using questionnaires to get insight into information provision, observations of encounters are very informative to validate the patient questionnaires and make necessary adjustments.

Exploring the concept of patient centred communication for the pharmacy practice

Background Patient centred communication can improve pharmaceutical care, but is not well described for pharmacists. Aim of the review To provide a comprehensive and accessible overview of the concept of patient centred communication for the pharmacy practice. Method A scoping review and thematic analysis was undertaken to synthesize the extracted data and present it in a model. Results Literature search and selection resulted in eighteen articles. Thematic analysis of the extracted data led to five categories regarding patient centred communication. Two categories refer to phases of a pharmaceutical consultation: (1) shared problem defining and (2) shared decision making; three refer to underlying concepts and assumptions about patient centredness regarding (3) the patient, (4) the pharmacist and (5) the therapeutic relation. The categories were modelled in the so called Utrecht’s Model for Patient centred communication in the Pharmacy. Conclusion Although there might be barriers to implement patient centred communication in the pharmacy, the concept of patient centred communication as described in the literature is relevant for the pharmacy practice.

Patient's understanding of drug label instructions: A study among different populations living in the Netherlands

Aim of study Health literacy concerns the knowledge and competences of an individual person that are necessary for adequate response to information about health(care). Health literacy is strongly associated with educational level and overall literacy. Previous research has shown low (health) literacy to be associated with poor adherence, increased health consumption and poor health outcomes. The assumption of health care providers that their patients can read, understand and respond adequately to the instructions found on prescription drug labels may (sometimes) be unfounded. The aim of this study was to assess understanding of drug label instructions in different (non-native) populations living in the Netherlands. Method Four different populations living in the Netherlands were studied: people born in Iran, Turkey, the (former) Antilles and Surinam (Hindustani). Participants were recruited at meeting places for a particular ethnic group (mosques, cultural centres). Only people with sufficient comprehension of the Dutch language were included (tested by a short screening questionnaire on literacy skills). First year pharmacy students, who were born in the Netherlands, were included as reference group. All participants completed a survey with questions about the correct interpretation of 4 drug label instructions, with instructions like “Complete the prescribed course (antibiotics prescribed for 7 days)” and “Take 1 tablet as needed, maximal 6 tablets a day (acetaminophen)”. For correct interpretations of the instructions presented in the survey experts of the university (staff members, practicing pharmacists) and the Royal Dutch Pharmacist Association were consulted. Results In total, 180 Iranian, 188 Turkish, 168 Antillean, 155 Hindustani born in Suriname and 153 Dutch (reference) participants were included in the study. Some drug label instructions were misunderstood; misunderstanding of instructions occurred both in non-natives and Dutch natives (3 out of 4 labels were misunderstood by the majority of participants), but non-natives had more often problems with the instructions. For example, the instruction “Complete the prescribed course (antibiotics prescribed for 7 days)” was more often correctly answered (use the drugs for 1 week) by the Dutch reference group (95.4 %) compared to the other groups: Iranian (80.6 %), Turkish (88.3 %), Hindustani (91.6 %) and Antillean (81.0 %) participants (p

Clinical education for hospital pharmacists in the Netherlands and the United States of America: Some observations

Three parameters for the quality of clinical education for hospital pharmacists are postulated: the number of pharmacists who can serve as preceptors, the depth and scope of clinical pharmacy services, and the structure of the training. Dutch hospital pharmacies exhibit consistently lower pharmacist staffing ratios than their American counterparts. For the scope of services provided in Dutch (as compared to American) hospitals, the emphasis is on pharmacokinetic consultation and handling of radiopharmaceuticals, services which require less patient involvement and are consequently less labour intensive than services, such as patient profile and drug interaction monitoring services, which are more prevalent in American hospital pharmacies. 17% Of Dutch respondents were not exposed to patient profile monitoring during their training, 16% were not exposed to drug interactions monitoring, 9.8% were not exposed to pharmacokinetic services and 8.9% were not exposed to drug information services, although these services are provided at the current worksite. Dutch hospital pharmacists are often solo practitioners maintaining a high standard of practice by focusing on core tasks and activities.