M. Joy Spark

A systematic review of psychotropic drug prescribing for prisoners

Objective: To conduct a review of the literature on prescribing psychotropic drugs for prisoners. Methods: Articles were retrieved from nine databases, reference lists, citations, governmental prison websites, and contact with authors. The articles included were written in English, focused on adults’ time as prisoners, included at least one drug of interest, and discussed prescribing. Thirty-two articles met these inclusion criteria. Results: Five main themes were identified from the reviewed studies: polypharmacy, high-dose therapy, duration of treatment, documentation and monitoring, and issues associated with the prisoners’ environment. Conclusions: Consideration of these themes within the included studies identified areas for future research, particularly models of good practice, as numerous descriptions of poor practice exist. Policy-makers and prescribers should review current systems and practices, to ensure the care being offered to prisoners is optimal.

Systematic review of progesterone use by midlife and menopausal women

Progesterone treatment for menopausal symptoms is still controversial. Progesterone levels fall during menopause transition, therefore some menopausal women may benefit from progesterone therapy. A systematic review was conducted of studies published from 2001 reporting on progesterone use to treat symptoms associated with menopause or postmenopausal women. Fourteen data bases were searched using the search terms progesterone, menopause, aged, female and human; exclusions were breast cancer, animal and contraception. Thirteen studies were selected for inclusion (11 clinical trials, 1 cohort study and 1 qualitative study), evaluating progesterone effects on menopausal symptoms, bone, sleep, skin, cognition, plasma lipids and plaque progression. Most studies were of low methodological quality (GRADE low or very low). Progesterone improved vasomotor symptoms and sleep quality, with minimal risk. Large studies designed to identify confounders, such as hormone levels, menopausal status and metabolism are required to understand the place of progesterone in clinical practice.

Application of cognitive interviewing to improve self-administered questionnaires used in small scale social pharmacy research

Validating questionnaires for social pharmacy research with smaller sample sizes can be unnecessarily time-consuming and costly, a solution to this is cognitive interviewing with 2 interviews per iteration. This paper shows how cognitive interviewing with pairs of interviews per iteration of the questionnaire can be used to identify overt and covert issues with comprehension, retrieval, judgment and response experienced by respondents when attempting to answer a question or navigate around the questionnaire. When used during questionnaire development in small scale social pharmacy research studies cognitive interviewing can reduce both respondent burden and response error and should result in more reliable survey results. The process of cognitive interviewing is illustrated by a case study from the development of the Perspectives on Progesterone questionnaire.

Pain severity cut-points and analgesic use by community-dwelling people for chronic pain

To define a descriptive scale for mild, moderate and severe chronic pain experienced by community‐dwelling people; and to use this scale to investigate chronic pain management in community‐dwelling people.

Factors influencing the selection of rural practice locations for early career pharmacists in Victoria

OBJECTIVE   To identify factors influencing the choice of practice location for early career pharmacists working and living in Victoria. DESIGN   Survey. SETTING   Victorian pharmacies. PARTICIPANTS   Pharmacists living in Victoria in April 2009, who had registered with the Pharmacy Board of Victoria after 1 October 2004, stratified into major city and rural areas. MAIN OUTCOME MEASURES   Questionnaire responses analysed via descriptive statistics, chi-square and direct logistic regression. RESULTS   Early career pharmacists were more likely to practice in a rural location if they had undertaken a rural internship, had a spouse or partner with a non-metropolitan background and were not practicing in a hospital pharmacy. Pharmacists who had lived in a rural area during their childhood and had studied pharmacy at a rural university were four times more likely to have undertaken a rural internship than those that studied at a major city university. CONCLUSIONS   The strongest indicator for future practice location was a pharmacists internship location. Childhood location and pharmacy education location were indicators of internship location. Pharmacists with a rural childhood location, especially those who study at rural universities, are more likely to work in rural areas.

Non-prescription supply of combination analgesics containing codeine in community pharmacy: A simulated patient study

Background The inappropriate use of non‐prescription combination analgesics containing codeine (NP‐CACC) has become a significant health issue in Australia. Objective To investigate the current management of NP‐CACC direct product requests in community pharmacies located in Victoria, Australia. Methods A covert simulated patient (SP) method was used to observe the responses of pharmacy staff during an NP‐CACC request. Four SPs were trained to complete 1 of 2 scenarios. Each scenario involved a direct product request for Nurofen Plus (200 mg ibuprofen, 12.8 mg codeine) with identical reason for use, symptoms, and medical history but varied previous product use. Scenario One (Sc1) involved a first time NP‐CACC user and in Scenario Two (Sc2) the SP had used NP‐CACC regularly for the past month. Each visit was documented by the SP immediately after they left the pharmacy. A NP‐CACC supply score, created from 4 outcomes (pharmacist involvement, establishment of therapeutic need, establishment of safety and provision of counselling), was given to each pharmacy visit (maximum of 8) during data analysis. Results 145 pharmacy visits were completed. Both scenarios were performed in most of the 75 pharmacies visited (73 Sc1 and 72 Sc2). Treatment was provided in the majority of visits but refused in 37(24%) because the SP was unable to provide photo identification. A pharmacist was involved (directly or indirectly) in 77% of visits. Adequate questioning to establish therapeutic need occurred in 50% of pharmacy visits, safety was established in 17% of visits, and adequate counselling provided in 17% of visits. The SP scenario did not significantly affect the NP‐CACC supply outcomes. NP‐CACC supply scores ranged from 1 to 8, (Md = 5) with only 1 pharmacy visit achieving the maximum score of 8. Conclusions The majority of pharmacy visits did not achieve a full score relating to NP‐CACC supply, illustrating the need for improved awareness of how to assess and manage patients requesting NP‐CACC.

Compounding of medicines by pharmacies: an update.

84 Compounding or preparing medicines is a traditional role of harmacists/apothecaries. This role has become less common since he advent of the pharmaceutical industry when mechanisation eant that medicines could be produced more cheaply and reproucibly on a large scale. Industry produced medicines have a limited ange of doses and dosage forms for any particular active pharmaeutical ingredient (API) or combination of APIs. These products eet most peoples’ medicine needs but there are some people who equire active ingredients or dosage forms that are not manufacured. When licensed manufactured pharmaceutical products do not eet a person’s medicine requirements then products prepared pecifically for them in a pharmacy (extemporaneous preparaions) can fill the breach [1,2]. A manufactured product may not e able to meet a specific person’s needs because: of unavailabilty as it is unprofitable to either manufacture or distribute the roduct within the country; the person has allergies to compoents such as preservatives or dyes; or there are limitations with ither the available dose or dosage form. For example, if a peron is unable to swallow oral tablets the API could be prepared n an alternative dosage form such as an oral liquid, suppository r cream. Another reason for extemporaneous preparation is to ncrease compliance by combining more than one API into a single osage form [3]. Simple non-sterile extemporaneous preparations an be prepared at any community pharmacy while more comlex products should be prepared at pharmacies that specialise in ompounding. Sterile products are prepared by some compounding harmacies but are more commonly prepared in hospital pharacies [4]. Pharmacopoeias (reference books that set standards or APIs and pharmaceutical products) and legislation around the orld allow for pharmacists to prepare unlicensed products to eet an individual’s specific requirements. Legislation surrounding the manufacture of pharmaceutical roducts allows for pharmacy to fulfil this traditional role proided that the products are prepared in a pharmacy under the upervision of a pharmacist for a specific person. Codes of practice rom professional societies set a framework to ensure that qualty products are prepared. Pharmacies that compound are required o use/apply quality assurance principles, including use of phar-

Compounded progesterone and the Behavioral Model of Health Services Use.

Compounded progesterone (P₄) is a product that, from a clinical experience-based perspective, effectively relieves a range of symptoms. In contrast, from a conventional evidence-based medicine perspective, P₄ is ineffective. As P₄ is not a product prescribed by conventional medicine, it is unlikely to be prescribed by family doctors, which increases the barriers to utilization. Utilization of medicines is influenced by many contextual and individual characteristics. The Behavioral Model of Health Services Use provides a multidimensional framework to conceptualize utilization of health services including medicine use. The 4 main components of this model are: contextual characteristics, individual characteristics, health behaviors and outcomes. This paper reports on the application of The Behavioral Model of Health Services Use to medicines and shows how it can be applied to the use of P₄. The model enables some of the positive reinforcement that contributes to women continuing to use P₄ to be explained. The Behavioral Model of Health Services Use was found to offer the potential to identify and then address issues with access to prescription medicines.

Psychotropic drug prescribing for prisoners

Australian & New Zealand Journal of Psychiatry, 46(11) Griffiths EV, Willis J and Spark MJ (2012) A systematic review of psychotropic drug prescribing for prisoners. Australian and New Zealand Journal of Psychiatry 46: 407–421. Morgan RD, Steffan J, Shaw LB, et al. (2007) Needs for and barriers to correctional mental health services: inmate perceptions. Psychiatric Services 58: 1181–1186. Simpson AI, Brinded PM, Fairley N, et al. (2003) Does ethnicity affect need for mental health service among New Zealand prisoners? Australian and New Zealand Journal of Psychiatry 37: 728–734.

Progesterone or progestogens

There is a lot of confusion in the literature about progesterone. Unlike estrogen, which is the name given to a group of substances with estrogenic activity, progesterone is the name of a single chemical entity. There does not appear to be agreement on the group name for substances with progestational activity. They have been variously called progestins, gestogens, progestogens and progestagens. In a recent paper about estrogen + progestin therapy the authors appear to have used progesterone as a generic term when referring to progestin use in hormone therapy for menopausal symptoms. Statements such as, ‘more research is warranted regarding the effects of progesterone in addition to estrogen’, or ‘including progesterone (EPT) in both younger and older . . .’ after EPT had been defined as estrogen and progestin. In another case, medroxyprogesterone acetate (MPA) is referred to as progesterone. When reporting on previous research comparing estrogen alone to estrogen and progestin the authors state, ‘Progesterone . . . has been described as having adverse effects on cognitive performance.’ Using progesterone as both the hormone name, equivalent to estradiol, and the group name, equivalent to estrogen, makes it very hard to separate the effects of the hormone from the effects of the group. Could you please assist in making this easier by using a name other than progesterone when referring to progestational agents?