Marjorie Weiss

A qualitative study of the views of women aged 18-29 on over-the- counter availability of hormonal emergency contraception

Objective To explore womens views on the deregulation of hormonal emergency contraception (EC) prior to it becoming deregulated on 1 January 2001. Design Qualitative study using face to face, semi-structured interviews. Setting A NHS family planning clinic, a voluntary sector family planning clinic and a general practice in the South West region. Subjects Twenty-seven women aged 18-29 years. Results Most women were in favour of deregulation with over-the-counter provision perceived as quick, convenient and anonymous. Reservations regarding overuse and over-reliance upon EC mirror those of health professionals, although it was not felt that the increased accessibility of EC would lead to changes in sexual activity. Concerns that deregulation would promote an irresponsible attitude towards contraception were largely focused on younger women. Cost was generally regarded as a positive barrier to overuse. However, it was felt that the price should not be prohibitively high. A figure corresponding to the current prescription charge was most often cited. The pharmacy was the preferred choice of provider for most women. Conclusion Although most women in this study would prefer to obtain EC over-the-counter, the current charge of £20 is likely to prove a barrier.

Pharmacists and their customers: a personal or anonymous service?

Aims — To explore the existence and nature of the pharmacist‐customer relationship.

National and local medication error reporting systems: a survey of practices in 16 countries

Objectives To explore the existence and characteristics of national and local medication error reporting (MER) systems and to describe national medication safety experts’ perceptions of a good and effective MER system and barriers to reporting. Methods In a descriptive cross-sectional study, 32 medication safety experts were identified through member organizations of the International Pharmaceutical Federation in 88 countries and other professional organizations in 3 additional countries. These experts were invited to participate in an online survey. Results Sixteen national medication safety experts from different countries participated in the study (response rate, 50%). A national (n = 5) or local (n = 6) MER system existed in 11 of these countries. In 5 countries, no MER system existed. The most common features of the MER systems were confidentiality of the reported information and providing feedback to those involved in reporting. Most experts perceived that a good and effective MER system was characterized by the opportunity to learn from errors by those involved in reporting, having a nonpunitive approach to reporting, and ease of use. They also perceived that a blame culture, lack of time, training, and coordination of reporting were the main barriers to reporting. Conclusions Blame culture, a lack of time, training and coordination of reporting continue to be the major barriers to reporting. Learning from errors and having a nonpunitive approach to reporting were thought to be the most critical features of a MER system. Difficulties in identifying national medication safety experts indicates a need for promoting international networking of medication safety experts and bodies for sharing information and learning from others.

A qualitative thematic review: emotional labour in healthcare settings

AIMS To identify the range of emotional labour employed by healthcare professionals in a healthcare setting and implications of this for staff and organisations. BACKGROUND In a healthcare setting, emotional labour is the act or skill involved in the caring role, in recognizing the emotions of others and in managing our own. DESIGN A thematic synthesis of qualitative studies which included emotion work theory in their design, employed qualitative methods and were situated in a healthcare setting. The reporting of the review was informed by the ENTREQ framework. DATA SOURCES 6 databases were searched between 1979-2014. REVIEW METHODS Studies were included if they were qualitative, employed emotion work theory and were written in English. Papers were appraised and themes identified. Thirteen papers were included. RESULTS The reviewed studies identified four key themes: (1) The professionalization of emotion and gendered aspects of emotional labour; (2) Intrapersonal aspects of emotional labour - how healthcare workers manage their own emotions in the workplace; (3) Collegial and organisational sources of emotional labour; (4) Support and training needs of professionals CONCLUSION This review identified gendered, personal, organisational, collegial and socio-cultural sources of and barriers to emotional labour in healthcare settings. The review highlights the importance of ensuring emotional labour is recognized and valued, ensuring support and supervision is in place to enable staff to cope with the varied emotional demands of their work.

Strategies used by general practitioners to minimise the impact of the prescription charge

Objectives: To determine the strategies used by GPs to make medicines, both prescribed and over-the-counter (OTC), cheaper for patients when deciding whether, and what, to prescribe. Method: Five focus groups were conducted in three Health Authorities in the Northwest of England. Between 10 and 11 GPs participated in each group. Results: GPs used a wide range of strategies to try to make medicines either cheaper for patients or to increase their perceived value for money. These strategies included using the prescription charge system to the patients best advantage, by recommending the purchase of an OTC medicine or increasing the amount of medicine supplied. They could also prescribe more effectively by reducing the number of prescribed items or prescribing a medicine perceived to be more efficacious and more expensive to the healthcare system, to paying patients. Respondents also mentioned questionable practices such as re-using returned medication and prescribing more for a family member that was exempt from prescription charges. Conclusions: The UKs fixed charge prescription system, where patients pay a relatively high rate per prescribed item, may facilitate the development of a wide range of strategies to make medicines cheaper for patients. These strategies, and their diversity across EU member states, is an area that merits further investigation as an influence on patient management decisions at both the GP and patient level.

Trends in emergency hospital admissions in England due to adverse drug reactions: 2008–2015

To determine the scale of adverse drug reaction (ADR)‐related emergency hospital admissions in England from 2008 to 2015 using the Hospital Episode Statistics (HES) database.

Involving patients as advisors in pharmacy practice research: what are the benefits?

Objective To describe the ways in which members of the public with a chronic condition were involved as advisors in a research project exploring pharmacist supplementary prescribing. The primary objective was to be able to reflect upon the benefits and difficulties of this approach so that the patient perspective can be accommodated more fully in future research.

Collaborative commissioning of secondary care services by Primary Care Trusts

This article examines collaborations between primary care trusts in the commissioning of secondary care services in England. It applies principal-agent theory qualitatively to two case studies. The theory suggests that collaboration should take place if organizations share relevant information and agree joint objectives. The study findings show that sharing information is not a major problem for these case studies, but that agreeing joint objectives is.

Medication decision making and patient outcomes in GP, nurse and pharmacist prescriber consultations

UNLABELLED Aim The aims of this study were twofold: (a) to explore whether specific components of shared decision making were present in consultations involving nurse prescribers (NPs), pharmacist prescribers (PPs) and general practitioners (GPs) and (b) to relate these to self-reported patient outcomes including satisfaction, adherence and patient perceptions of practitioner empathy. BACKGROUND There are a range of ways for defining and measuring the process of concordance, or shared decision making as it relates to decisions about medicines. As a result, demonstrating a convincing link between shared decision making and patient benefit is challenging. In the United Kingdom, nurses and pharmacists can now take on a prescribing role, engaging in shared decision making. Given the different professional backgrounds of GPs, NPs and PPs, this study sought to explore the process of shared decision making across these three prescriber groups. METHODS Analysis of audio-recordings of consultations in primary care in South England between patients and GPs, NPs and PPs. Analysis of patient questionnaires completed post consultation. Findings A total of 532 consultations were audio-recorded with 20 GPs, 19 NPs and 12 PPs. Prescribing decisions occurred in 421 (79%). Patients were given treatment options in 21% (102/482) of decisions, the prescriber elicited the patients treatment preference in 18% (88/482) and the patient expressed a treatment preference in 24% (118/482) of decisions. PPs were more likely to ask for the patients preference about their treatment regimen (χ 2=6.6, P=0.036, Cramers V=0.12) than either NPs or GPs. Of the 275 patient questionnaires, 192(70%) could be matched with a prescribing decision. NP patients had higher satisfaction levels than patients of GPs or PPs. More time describing treatment options was associated with increased satisfaction, adherence and greater perceived practitioner empathy. While defining, measuring and enabling the process of shared decision making remains challenging, it may have patient benefit.

Dispensing doctor practices and community pharmacies: exploring the quality of pharmaceutical services

AIMS This research sought (a) to investigate the similarities and differences in how pharmaceutical services are provided by community pharmacies (CPs) and dispensing doctor practices (DPs) and (b) to identify the issues relevant to determining the quality of pharmaceutical services in these settings. BACKGROUND UK pharmaceutical services, including dispensing prescriptions and public health advice, can be provided from both (CP) and, in rural areas, (DP). While there is much similarity between CPs and DPs in the types of services provided, there is also the potential for variation in service quality across settings. METHODS A postal questionnaire of DPs and CPs in South West England was conducted to provide a descriptive overview of pharmaceutical services across the settings. A subsection of questionnaire respondent sites were selected to take part in case studies, which involved documentary analyses, observation and staff interviews. FINDINGS Survey response was 39% for CPs (52/134) and 48% (31/64) for DPs. There were three CP and four DP case study sites, with 17 staff interviews. More pharmacies than practices were open at the weekend and they had more staff trained above NVQ level 2. Both doctors and pharmacists saw themselves as medicines experts, as being accessible and having good relationships with patients. Workplace practices and organisational ethos varied both within and across settings, with good practice observed in both. Overall, CPs and DPs have much in common. Workplace culture and an evidence-based approach to checking prescriptions and error reporting need to be considered in future assessments of service quality.