P R Noyce

The dependent consumer: reflections on accounts of the risks of non-prescription medicines

Although academic writing about risk as a conceptual and theoretical category has burgeoned in recent years, debates about the characteristics of the risk society have tended to by-pass more mundane but ubiquitous dimensions of health and health-related behaviour. In this article, we argue that focusing on lay people’s understanding of the risks of a relatively commonplace example of modern medical technology (the use of non-prescription medicines for the self-medication of minor ailments) provides an insight and a challenge to what theorists of the risk society have described as the existential contours of life in late modernity. In the context of an empirical study detailing consumer responses to a naturally occurring risk, we explore some of the arguments proposed by Ulrich Beck and amplified by Anthony Giddens concerning the characteristics of the risk society. We provide evidence both for and against the propositions described by these authors and posit a more nuanced understanding of the risks of scientific medicine which acknowledges both lay expertise over medicines usage coupled with dependence on medicine and medical technology as forms of healing.

The cost of prescription medicines to patients.

The study compares the cost-sharing (co-payment) arrangements for prescribed medicines in a sample of EU countries. Through a set of typical prescription scenarios, the cost burden to individual patients of prescriptions are examined, in the context of drug price, and from the perspective of therapeutic need. The cost to patients of medicines is consistently lower in some, and higher in other, countries, regardless of the type of prescription charge system. Fixed charge systems, as opposed to graduated co-payment systems, are obviously more likely to lead to similar charges for the treatment of comparable clinical conditions, but depending on the level of the charge, can result in the patient paying a higher charge than the price of the drug to the health organisation. Exemption from charges for prescription medicines, commonly relate to clinical condition and level of income. Some systems also have age-related criteria and apply ceilings to the total prescription cost burden borne by the patient. The impact on patient costs of specific policy formulations is discussed and a proposal is made for cost convergence for comparable therapies. The method used in this study may also provide a route for investigating model systems prior to implementation.

Appropriateness measurement: application to advice-giving in community pharmacies

Awareness of variations in the delivery of medical care has resulted in considerable research activity focused on developing measures to assess the appropriateness of health service provision both internationally and within Great Britain. As in other areas of health service provision there is evidence of variation in advice provided alongside sales of non-prescription medicines and variation in response to requests for advice about the treatment of minor ailments within community pharmacies in Great Britain. However, there is little research which has explored the extensive methodological problems associated with developing criteria to assess the appropriateness of these-two activities. Following a critical review of relevant existing research, this paper describes a methodology and empirical findings from a study which aimed to develop criteria to measure the appropriateness of advice provided in community pharmacies. Firstly, details of advice-giving episodes occurring between consumers and pharmacists or medicines counter assistants were captured and documented using a combination of audio tape-recording and non-participant observation. Secondly, the nominal group technique was used to develop a set of explicit criteria for assessing the appropriateness of advice. Thirdly, an assessment instrument was developed in order to operationalise the criteria. The devised criteria include both process and output components. We discuss the utility of these criteria in relation to developments in self-medication practice affecting community pharmacy and the deregulation of medicines within the UK. The criteria have been subject to rigorous statistical testing to establish standards of validity and reliability (Ward, Bissell & Noyce, 2000a [Ward, P. R., Bissell, P. & Noyce, P. R. (2000a). Criteria for assessing non-prescription drug therapy in community pharmacy, Annals of Pharmacotherapy (in press).]). The developed criteria will allow us to identify dimensions of both appropriate and inappropriate advice provided in community pharmacies and provide the basis for education and training initiatives identified as a result of the research. In addition, we suggest that this research is highly relevant to informing the content, structure and operationalisation of protocols and/or guidelines associated with the management of minor ailments and the sale of medicines through community pharmacies.

Criteria for Assessing the Appropriateness of Patient Counseling in Community Pharmacies

OBJECTIVE: To develop valid, reliable criteria for assessing the appropriateness of the management of common ailments and nonprescription drug therapy in community pharmacies in the UK. METHODS: The criteria were developed by an expert panel using the nominal group technique. The validity of the criteria was tested by surveying a random sample of pharmacists who were asked to rate the importance of each criterion on a semantic differential scale from 1 (low) to 7 (high). Subsequently, the reliability of the criteria was assessed: a random sample of pharmacists were each asked to apply the criteria to four vignettes of patient counseling on two separate occasions. RESULTS: All assessment criteria exceeded our predefined level of face, content, and consensual validity. In reliability testing, the overall assessment of appropriateness, along with five component assessment criteria, surpassed our predefined level of reliability. Three criteria, however, did not meet our predefined standard. These criteria were rational content of advice, rational product choice, and referral to another health professional. CONCLUSIONS: This represents the first systematic attempt to develop an instrument of general applicability for assessing the appropriateness of patient counseling and to subject it to rigorous validity and reliability testing. We suggest that further work is required to refine the criteria that did not meet reliability standards and to understand the decision-making processes underlying the assessment of vignettes of patient counseling.

Medicines counter assistants: roles and responsibilities in the sale of deregulated medicines

The work reported here aimed to quantify the involvement of medicines counter assistants (MCAs) in the United Kingdom in the sale of deregulated medicines and to provide insights into their role and experiences in this process. Non‐participant observation for five days in each of 10 community pharmacies was used in conjunction with interviews and focus groups with MCAs working in these pharmacies. It was found that MCAs dealt with 84 per cent of the deregulated medicines requested, without the formal involvement of a pharmacist. MCAs dealt with 96 per cent of requests for aciclovir, and 100 per cent of requests for cetirizine, Canesten Combi, famotidine, hydrocortisone cream and topical ibuprofen without the intervention of a pharmacist. MCAs viewed themselves as front‐line health care workers carrying out an important role in consumer care. However, in instances where difficulties were encountered during an MCA‐consumer interaction, MCAs knew and appreciated that they had the backup of a pharmacist to whom to refer. MCAs identified a number of dilemmas which impinged on their ability to ask questions and provide advice to consumers requesting deregulated medicines. Given these findings, the current role, workload and experiences of MCAs merit more attention than has hitherto been accorded in pharmacy practice and health services research.

Non-dispensing of NHS prescriptions in community pharmacies

Objective — To explore non‐dispensing of National Health Service (NHS) prescriptions in community pharmacies.

Insights into the choice between self‐medication and a doctor's prescription: a study of hay fever sufferers

Self‐medication plays an increasingly important role in the health care systems of many countries. In the United Kingdom (UK) this is reflected in the current policy of deregulating increasing numbers of prescription‐only medicines (POM) to pharmacy medicines (P). The purpose of the work described in this paper was to explore factors affecting clients choice to self‐medicate or to contact their doctor for the treatment of a minor ailment, namely, hay fever. Structured qualitative interviews were conducted with 36 clients recruited through community pharmacies. The main themes investigated were clients reasons for choosing their particular management option and their attitudes towards the increasing number of OTC medicines and towards self‐medication. For clients who obtained the medicine through their doctor, the most common reason for doing so was cost. For clients who obtained their medicine over the counter, the incentive to self‐medicate was convenience. Payment for or exemption from prescription charges was a major factor. Many clients mentioned potential risks involved in self‐medication and the need for appropriate information. However, clients drew differing conclusions on these issues, reflecting either a negative or a positive attitude towards self‐medication.

Developing prevalence-based prescribing units for analysing variations in general practitioner prescribing: a case study using statins

Objective:u2002 To develop regionally specific prevalence‐, age‐ and sex‐standardized prescribing units (PASS‐PUs) and to relate these to statin prescribing.

From compliance to concordance: meeting the needs of patients?

□ Compliance has come under increasing criticism as a means by which to organise health care interactions and interest has been expressed in a new model termed concordance

Community pharmacy management of acute diarrhoea in adults

Objective — To study the community pharmacy management of acute diarrhoea in adults and to explore the attitudes and beliefs of community pharmacists towards the management of this common condition.