W. Neil Cottrell

Ascertaining consumer perspectives of medication information sources using a modified repertory grid technique

ObjectiveTo establish the range of medicine information sources used by consumers and their perception of the reliability of these, using the repertory grid technique.MethodConsumers visiting three community pharmacies in Brisbane, Australia, were interviewed using the repertory grid technique. During the interview, consumers were asked to name up to three medicine information sources that they used for a supermarket medicine, an over-the-counter medicine and a prescription medicine. They were then presented with their named information sources in groups of three and asked to discriminate between these in terms of their perceived reliability of the information source. The descriptors used by the consumer to discriminate between the information sources are known as constructs and these were recorded. The consumer was then asked to rate each of their information sources against each generated construct.Main outcome measureThe range of information sources generated was determined along with the perceived reliability of these from the calculated median score of each information source when rated on each generated construct.ResultsA total of 110 consumers were interviewed and identified 648 information sources that they would use. The most frequent information sources cited by the 110 consumers were their doctor (83%), written information (90%) and the pharmacist (78%). There were a total of 299 constructs generated by 88 of the consumers and these were themed into 16 discrete categories. The most common generated constructs themes were “good knowledge” (15%), “training” (14%) and “trustworthiness” (13%). The consumer perception of their information sources were that the doctor and pharmacist have good knowledge (median score 1) and are trained (median score 1) and were perceived to be trustworthy (median score 3 and 2, respectively).ConclusionThe repertory grid technique was successful in identifying the information sources consumers accessed to find out about their medicines and in identifying the perception of these sources in terms of their reliability. The repertory grid technique offers a novel method for future research into consumer preferences for different treatment options.

The Extended Role of the Clinical Pharmacist in the Management of Heart Failure and Acute Coronary Syndromes

Aim: To discuss the evidence‐based rationale behind the use of clinical pharmacists in the Brisbane Cardiac Consortium Clinical Support Systems Project (CSSP), and detail the pharmacist‐specific interventions that have been implemented.

BODE score is a useful predictor of hospital admission in rural patients with chronic obstructive pulmonary disease.

Background and objective:  COPD is a chronic illness with frequent episodic exacerbations that require admission to hospital. The aim of this study was to identify risk factors (or predictors) for hospital admission in a sample of rural COPD patients.

Chronicles of a primary care practice pharmacist

Background In 2009, a pharmacist commenced working in a nondispensing role at a primary care medical center located in a metropolitan suburb of Brisbane, Australia. Research into the role and function of a practice pharmacist in this setting is still in its infancy. Methods Ethnographic methods were used over a 3-month period to record activities undertaken by the practice pharmacist on a daily basis. Results During the 3-month period, 296 hours of activity were documented. Activities the practice pharmacist performed most frequently included medication review, “pharmaceutical opinion,” student supervision, drug information, and administrative tasks. Conclusion This study demonstrates the broad range of activities which were conducted by a practice pharmacist in the primary care setting as part of a multidisciplinary team.

Optimising care of patients with chronic disease: patient-oriented education may improve disease knowledge and self-management

Many patients with chronic disease do not possess the knowledge and skills required to access and interpret appropriate health information. A pilot study in people with liver cirrhosis (n = 50) identified that only 54% of patients could recall being given written information by a clinician and 64% had self‐sought information, most commonly using the Internet. Many patients reported difficulties understanding the material and the majority wanted more accessible information. A pilot chronic disease educational booklet was well received by the study participants with 85% reporting it was helpful and 78% using it in between clinic appointments.

Medication beliefs predict medication adherence in ambulatory patients with decompensated cirrhosis

AIM To investigate the impact of medication beliefs, illness perceptions and quality of life on medication adherence in people with decompensated cirrhosis. METHODS One hundred adults with decompensated cirrhosis completed a structured questionnaire when they attended for routine outpatient hepatology review. Measures of self-reported medication adherence (Morisky Medication Adherence Scale), beliefs surrounding medications (Beliefs about Medicines Questionnaire), perceptions of illness and medicines (Brief Illness Perception Questionnaire), and quality of life (Chronic Liver Disease Questionnaire) were examined. Clinical data were obtained via patient history and review of medical records. Least absolute shrinkage and selection operator and stepwise backwards regression techniques were used to construct the multivariable logistic regression model. Statistical significance was set at alpha = 0.05. RESULTS Medication adherence was “High” in 42% of participants, “Medium” in 37%, and “Low” in 21%. Compared to patients with “High” adherence, those with “Medium” or “Low” adherence were more likely to report difficulty affording their medications (P < 0.001), lower perception of treatment helpfulness (P = 0.003) and stronger medication concerns relative to medication necessity beliefs (P = 0.003). People with “Low” adherence also experienced greater symptom burden and poorer quality of life, including more frequent abdominal pain (P = 0.023), shortness of breath (P = 0.030), and emotional disturbances (P = 0.050). Multivariable analysis identified having stronger medication concerns relative to necessity beliefs (Necessity-Concerns Differential ≤ 5, OR = 3.66, 95%CI: 1.18-11.40) and more frequent shortness of breath (shortness of breath score ≤ 3, OR = 3.87, 95%CI: 1.22-12.25) as independent predictors of “Low”adherence. CONCLUSION The association between “Low” adherence and patients having strong concerns or doubting the necessity or helpfulness of their medications should be explored further given the clinical relevance.

The use of ACE-inhibitors after myocardial infarction

Background: There is good evidence that angiotensin‐converting enzyme (ACE)‐inhibitors are beneficial after myocardial infarction (MI). However, it is not known how widely this evidence is used in practice and whether all eligible patients receive this therapy.

Use of a patient-centred educational exchange (PCEE) to improve patient’s self-management of medicines after a stroke: a randomised controlled trial study protocol

Introduction National and international guidelines make recommendations for secondary prevention of stroke including the use of medications. A strategy which engages patients in a conversation to personalise evidence-based educational material (patient-centred educational exchange; PCEE) may empower patients to better manage their medications. Methods and analysis This protocol outlines a non-blinded randomised controlled trial. Consenting patients admitted with a diagnosis of stroke or transient ischaemic attack will be randomised 1:1 to receive either a PCEE composed of two sessions, one at the bedside before discharge and one by telephone at least 10 days after discharge from hospital in addition to usual care (intervention) or usual care alone (control). The primary aim of this study is to determine whether a PCEE improves adherence to antithrombotic, antihypertensive and lipid-lowering medications prescribed for secondary prevention of stroke over the 3 months after discharge, measured using prescription-refill data. Secondary aims include investigation of the impact of the PCEE on adherence over 12 months using prescription-refill data, self-reported medication taking behaviour, self-reported clinical outcomes (blood pressure, cholesterol, adverse medication events and readmission), quality of life, the cost utility of the intervention and changes in beliefs towards medicines and illness. Ethics and dissemination Communication of the trial results will provide evidence to aid clinicians in conversations with patients about medication taking behaviour related to stroke prevention. The targeted audiences will be health practitioners and consumers interested in medication taking behaviour in chronic diseases and in particular those interested in secondary prevention of stroke. The trial has ethics approval from Metro South Human Research Ethics Committee (HREC/15/QPAH/531) and The University of Queensland Institutional Human Research Ethics (2015001612). Trial registration number ACTRN12615000888561; Pre-results.

Integration of a consultant pharmacist into a general practice: development of a collaborative care model

To the Editor, We enthusiasticallywelcome the article fromAngley et al. which articulates a model whereby a pharmacist is integrated into a general medical practice. A similar model is described by Farrell et al. by which the practice pharmacist provided services predominately offsite, but also maintained access to the electronic medical record. This model Official Journal of the Society of Hospital Pharmacists of Australia

Adherence and Beliefs

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