Tom Fegan

Black and minority ethnic pharmacists' treatment in the UK: A systematic review

BACKGROUND Pharmacists from black and minority ethnic (BME) backgrounds represent a significant proportion of the United Kingdom (UK) pharmacy profession. While there is evidence that BME doctors may be discriminated against in employment and regulatory practices, little is known about the treatment of BME pharmacists. OBJECTIVES To identify published evidence on the disproportionate treatment in employment and regulatory practices of BME pharmacists in the UK. Evidence was sought in four specific domains: recruitment (into the profession); progression; retention (within sector and profession) and regulation. METHODS The following databases were searched: Pubmed, Embase, Scopus, International Pharmaceutical Abstracts, SIGLE and Google Scholar. Inclusion criteria were: English language only, published between 1993 and 2014 and reporting UK-based findings. RESULTS The search strategy identified 11 pertinent items; 6 peer-reviewed articles, 2 published reports, 2 conference papers and one PhD thesis. In employment practices, there was some evidence that BME pharmacists are over-represented among owners and under-represented amongst senior management in the community sector. BME pharmacists reported more difficulties in getting their first job. BME pharmacists were over-represented in disciplinary processes but there was no evidence of disproportionate treatment in the outcomes of inquiries. CONCLUSION Only a small number of studies have been published in this area, and the evidence of disproportionate treatment of BME pharmacists is equivocal. Further research is needed to better understand the role of ethnicity in recruitment, retention, progression and regulation.

How do organisational configuration and context influence the quantity and quality of NHS services provided by English community pharmacies? A qualitative investigation

Community pharmacies are expanding their role into medicines-related healthcare and public health services, previously the domain of physicians and nurses, driven by policies to improve healthcare access for patients and to address problems of increasing demands and rising costs in primary and urgent care services. Understanding the organisational context into which this expansion is taking place is necessary given concerns over the extent to which pharmacies prioritise service volume over the quality of service provision. As part of a larger programme of work, this paper aims to explore stakeholder perceptions of the organisational and extra-organisational factors associated with service quality and quantity in community pharmacy as an established exemplar of private sector organisations providing publicly-funded healthcare. With ethics committee approval, forty semi-structured interviews were conducted with service commissioners, superintendent and front-line pharmacists, purposively selected from across nine geographical areas and a range of community pharmacy organisational types in England. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Findings highlight the perceived importance of appropriate staffing and skill-mix for promoting service quantity and quality in community pharmacy. Organisational cultures which supported team development were viewed as facilitatory whereas those prioritising business targets over service quality seen to be inhibitive. Older local populations and low patient expectations were thought to limit service uptake as was poor integration with wider primary care services. The contractual framework and commissioning processes were also seen as a barrier to increasing service quality, quantity and integration in this sector. These findings suggest that healthcare administrations should take account of organisational and extra-organisational drivers and barriers when commissioning services from private sector providers such as community pharmacies to ensure that the quality of service provision is incentivised in addition to service quantity. Additionally, collaborative working should be encouraged through integrated commissioning mechanisms.

Managing medicines and the role of social networks following hospital discharge: qualitative insights from patients with Chronic Obstructive Pulmonary Disease (COPD)

not available: SESSION 1: GS MIXTE RESPIRATION Bitter taste receptors in the lung: a new pharmacological target? S Grassin-Delyle UPRES EA220, Hôpital Foch, Universit e Versailles Saint Quentin en Yvelines, Saint Quentin en Yvelines Bitter taste receptors (TAS2Rs) are known for long for their role in taste as sensors of the presence of toxic compounds in foods, but their unexpected expression in airways epithelium and smooth muscle cells or in peripheral blood leucocytes has been recently documented. This family of GPCRs includes about 25 members in humans and each subtype has a variable selectivity towards bitter compounds, some of them being restrictedly selective to a unique molecule and others responding to a wider range. More than a hundred molecules such as chloroquine, caffeine, strychnine, colchicine or erythromycin have thus been described as TAS2R agonists while TAS2R19, 41, 42, 45 and 60 are considered as orphans since no agonist has been identified. In the airways, the initial observation by Desphandes et al. (2010) described the relaxation of pre-contracted mouse trachea following exposure to chloroquine, denatonium, quinine or saccharine, which was suggested to be even more pronounced that the relaxation obtained with the reference relaxing agents b2 adrenoreceptor agonists. Interestingly, an original intracellular signaling pathway in the response of airway smooth muscle cells to bitter-taste receptor agonists was proposed, involving the G-protein bc subunit and leading to a localized increase in intracellular calcium, which in turn causes membrane hyperpolarisation through an activation of large conductance potassium channels (BK Ca). In addition to these results in cell cultures or airways preparations, inhaled bitter tastants were shown effective in decreasing airway resistance in ovalbumin-sensitized mice, but very little is known in humans to date. However, transcriptome analysis revealed upregulation of TAS2R signaling in peripheral blood leucocytes from patients with severe asthma, as well as a correlation between clinical markers of asthma severity and TAS2R expression. Overall, these works suggest that bitter taste receptors may constitute a new pharmacological target for obstructive lung diseases such as asthma and COPD. We will address the role of bitter taste receptors in respiratory pharmacology, with a special focus on results obtained in human tissues.