Background Medicines management in care homes requires significant improvement. CHIPPS was a cluster randomised controlled trial to determine the effectiveness of integrating pharmacist independent prescribers into care homes to assume central responsibility for medicines management. This paper reports the parallel mixed-methods process evaluation. Method Intervention arm consisted of 25 triads: Care homes (staff and up to 24 residents), General Practitioner (GP) and Pharmacist Independent Prescriber (PIP). Data sources were pharmaceutical care plans (PCPs), pharmacist activity logs, online questionnaires and semi-structured interviews. Quantitative data were analysed descriptively. Qualitative data were analysed thematically. Results were mapped to the process evaluation objectives following the Medical Research Council framework. Results PCPs and activity logs were available from 22 PIPs. Questionnaires were returned by 16 PIPs, eight GPs, and two care home managers. Interviews were completed with 14 PIPs, eight GPs, nine care home managers, six care home staff, and one resident. All stakeholders reported some benefits from PIPs having responsibility for medicine management and identified no safety concerns. PIPs reported an increase in their knowledge and identified the value of having time to engage with care home staff and residents during reviews. The research paperwork was identified as least useful by many PIPs. PIPs conducted medication reviews on residents, recording 566 clinical interventions, many involving deprescribing; 93.8% of changes were sustained at 6 months. For 284 (50.2%) residents a medicine was stopped, and for a quarter of residents, changes involved a medicine linked to increased falls risk. Qualitative data indicated participants noted increased medication safety and improved resident quality of life. Contextual barriers to implementation were apparent in the few triads where PIP was not known previously to the GP and care home before the trial. In three triads, PIPs did not deliver the intervention. Conclusions The intervention was generally implemented as intended, and well-received by most stakeholders. Whilst there was widespread deprescribing, contextual factors effected opportunity for PIP engagement in care homes. Implementation was most effective when communication pathways between PIP and GP had been previously well-established. Trial registration The definitive RCT was registered with the ISRCTN registry (registration number ISRCTN 17847169 ).

AbstractObjectiveCommunity pharmacies could provide access for clients to commercial weight management organizations. We evaluated recruitment, referral and outcomes of adults provided with free vouchers by community pharmacies to attend Scottish Slimmers classes.DesignProspective cohort design with qualitative interviews with clients and pharmacy personnel. Scottish Slimmers collected weight and attendance data.SettingPharmacies in Aberdeen City, Scotland.SubjectsClients aged ≥18 years with BMI≥30 kg/m2.ResultsTen of twenty-three pharmacies were recruited; eight successfully recruited clients. Of 129 clients recruited, ninety-seven (75 %) attended at least one class and fifty-one (40 %) attended all twelve classes. At baseline, clients’ mean weight was 99·4 (sd 17·5) kg, mean BMI was 37·8 (sd 6·0) kg/m2. After 12 weeks, mean weight change was −3·7 % (last observation carried forward) or −2·8 % (baseline observation carried forward) for all ninety-seven clients. Client interviews indicated that many individuals would have not addressed their weight problems if this referral service had not been available. They had positive attitudes towards the pharmacy signposting service, attributed to the use of consultation rooms for privacy, receiving professional service from personnel and ongoing support and encouragement. The free provision of 12-week access facilitated participation. Service providers had positive attitudes and indicated their willingness to provide this service in future.ConclusionsCommunity pharmacies could be used to increase access to weight management services, with pharmacy personnel providing additional support to clients. Future provision of pharmacy referral schemes should be evaluated on a larger scale with an economic evaluation.

To evaluate a multi-sectoral training programme for pre-

INTRODUCTION:Technology enables medical services to be provided to rural communities. This proof of concept study assessed the feasibility and acceptability of delivering community pharmacy services (CPS; including advice, sale of over-the-counter products and dispensing of prescriptions) by tele-technology (the Telepharmacy Robotic Supply Service (TPRSS)) to a rural population in Scotland.METHODS:Data collection included the following: postal surveys to local residents; focus groups/ interviews with pharmacists, other healthcare professionals (HCPs) and service users, at baseline and follow-up; TPRSS logs. Interviews/focus groups were audio-recorded, transcribed and thematically analysed. Descriptive statistics were reported for survey data.RESULTS:Qualitative results: Pre-installation: residents expressed satisfaction with current pharmacy access. HCPs believed the TPRSS would improve pharmacy access and reduce pressure on GPs. Concerns included costs, confidentiality, patient safety and 'fear' of technology. Post-installation: residents and pharmacy staff were positive, finding the service easy to use. Quantitative results: Pre-installation: almost half the respondents received regular prescription medicines and a third used an over-the-counter (OTC) medicine at least monthly. More than 80% (124/156) reported they would use the TPRSS. There was low awareness of the minor ailment service (MAS; 38%; 59/156). Post-installation: prescription ordering and OTC medicine purchase were used most frequently; the video link was used infrequently. Reasons for non-use were lack of need (36%; 40/112) and linkage to only one pharmacy (31%; 35/112).DISCUSSION:Community pharmacy services delivered remotely using tele-technology are feasible and acceptable. A larger study should be undertaken to confirm the potential of the TPRSS to reduce health inequalities in rural areas.

BACKGROUND:Effective management of minor ailments in community pharmacies could reduce the burden on alternative high-cost services (general practices, Emergency Departments). Evidence is needed regarding the appropriateness of management of these conditions in community pharmacies.OBJECTIVE:To explore the appropriateness of minor ailment management in community pharmacies.SETTING:Prospective, observational study of simulated patient (SP) visits to community pharmacies in Grampian (Scotland) and East Anglia (England).METHOD:Eighteen pharmacies (nine per centre) were recruited within a 25-mile radius of Aberdeen or Norwich. Consultations for four minor ailments were evaluated: back pain; vomiting/diarrhoea; sore throat; and eye discomfort. Each pharmacy received one SP visit per ailment (four visits/pharmacy; 72 visits total). Visits were audio-recorded and SPs completed a data collection form immediately after each visit.PRIMARY OUTCOME MEASURE:Each SP consultation was assessed for appropriateness against product licence, practice guidelines and study-specific consensus standards developed by a multi-disciplinary consensus panel.RESULTS:Evaluable data were available for 68/72 (94.4%) visits. Most (96%) visits resulted in the sale of a product; advice alone was the outcome of three visits. All product sales complied with the product licence, 52 (76%) visits complied with practice guidelines and seven visits achieved a 'basic' standard according to the consensus standard.CONCLUSION:Appropriateness of care varied according to the standard used. Pharmacy-specific quality standards are needed which are realistic and relevant to the pharmacy context and which reflect legal and clinical guidelines to promote the safe and effective management of minor ailments in this setting.

Background: Increasing numbers of national pharmacovigilance schemes are accepting adverse drug reaction (ADR) reports from patients. The extent to which patient ADR reports contribute to pharmacovigilance requires comparisons to be made with reports from healthcare professionals (HCPs).Objective: This systematic review was conducted to identify all comparative studies of patient and HCP ADR reports to national pharmacovigilance schemes.Methods: We conducted a systematic review (which complied with the PRISMA statement) and a narrative synthesis of the results. Electronic databases (1996-2011) were searched, including MEDLINE, EMBASE and PHARM-Line, and supplementary searching of reference lists of included studies, authors' personal reference lists and internet searches was carried out. Studies that compared patient and HCP ADR reports submitted to national reporting schemes were considered for inclusion. Independent, duplicate data extraction, quality assessment and risk of bias were undertaken.Results: Of the 949 hits generated, three comparative studies were identified and included in this review. These studies were conducted on the national pharmacovigilance schemes in the Netherlands, Denmark and the UK.Considerable variation was observed across the national schemes in terms of the proportion of total ADR reports submitted by patients. Some of this variation may be explained by the duration that the schemes have been in operation. The number of serious ADR reports as a percentage of total reports was similar for patients compared with HCPs within each study, but varied across studies. Similarities were shown with the Netherlands and the UK in terms of drugs reported. Both studies featured statins and proton pump inhibitors in the top five drugs.Clear differences were shown between patients and HCPs in the body systems affected by ADRs as well as the therapeutic categories reported in both the UK and Danish studies. There was considerable similarity when considering the nature of ADRs reported. The Dutch study also showed similarities between patients and physicians in terms of the types of drugs for which ADRs were reported.Conclusions: Despite the large and increasing number of national pharmacovigilance schemes that accept ADR reports from patients, few comparative studies have been undertaken of patient and HCP reporting. Comparison across schemes is challenging because of differences in reporting processes, the inclusion criteria of schemes and different reporter types. The true value of patient ADR reports to pharmacovigilance will remain unknown unless more comparative evaluations are undertaken. This systematic review has highlighted both similarities and differences between reporter behaviour, the implications of which, in terms of signal generation, require further exploration.

No randomized controlled trials (RCTs) of screening and brief intervention (SBI) have been conducted in the community pharmacy setting. This pilot study was designed to inform the development and implementation of a large-scale RCT. The study examined the feasibility of providing SBI in community pharmacies, including practical considerations, recruitment of pharmacists and clients, uptake, potential effectiveness, and acceptability. A cluster RCT was conducted involving 20 community pharmacies. Pharmacy customers were screened using the Fast Alcohol Screening Test (FAST) to determine eligibility. The control group received a general lifestyle leaflet, while the intervention group was offered BI from a trained pharmacist. Clients in both groups were asked to complete baseline and three- and six-month postal questionnaires of self-reported alcohol consumption and to re-take the FAST. Qualitative work included follow-up telephone interviews with clients as well as focus groups with the public and participating pharmacists. Over 1000 clients were approached, with 77.6% (n = 846) completing the FAST. Of these, 27.1% (n = 229) were eligible for inclusion (FAST score = 3), 69 of whom (30.1%) consented to participate (27 in the intervention group and 42 in the control group). Nearly twice the number of eligible clients were recruited from control versus intervention pharmacies (41.6% versus 21.2%). A range of barriers and facilitators were identified by participating pharmacists and clients regarding SBI delivery. The main barrier for pharmacists was approaching clients for screening. Delivery of SBI was acceptable to most pharmacists and staff, however, future success of SBI in this setting will depend on identifying strategies for supporting practitioners in engaging pharmacy clients for screening.

Abstract Background Research has shown that implementation of community pharmacy Medicines Use Review and Prescription Intervention (MUR) in the first year of the service in England and Wales was less extensive than anticipated. Several barriers to MUR becoming accepted and embedded in the National Health Service (NHS) were identified. Objective To evaluate progress in the provision of the MUR service in England and Wales in its second year (April 1, 2006-March 31, 2007) compared with the first year; and to analyse trends from available national data from the third year of provision in 2007–2008. Methods The analysis drew on the following data sources: routine data on provision of MURs for community pharmacies in a stratified random sample of 31 primary care organisations in England and Wales, and national datasets on MUR provision from the Pharmaceutical Services Negotiating Committee and NHS Information Centre. Outcome measures The percentage of community pharmacies providing the MUR service, the numbers of MURs provided in 2006–2007 at pharmacy and primary care organisation level, and the extent of, and variation in, provision. Key findings The percentage of community pharmacies providing the MUR service increased from 38 to 67.2%. Overall, 62 559 MURs were provided (a more than four-fold increase on the previous year), representing 13.8% of the possible maximum. The mean number of MURs provided (per provider) increased from 36 to 85. For existing providers the mean number increased from 36 to 111 (median 78, range 0–423). For new providers the mean number was 52 (median 17, range 1–401). More than half (52%) of the pharmacies in the sample claimed for fewer than 50 MURs. Overall, 82% of MURs were provided by multiples and this percentage was lower among new providers (62%) than existing providers (89%). Thirty-three (8.1%) existing MUR providers had no recorded MURs in the second year: almost two-thirds of these (64%) were independents. Eleven pharmacies (1.5%) provided the maximum number of 400 MURs per year: all but one were branches of multiples. Of the pharmacies not yet providing MURs, 78% were independent. Conclusions Both numbers of MURs and numbers of providers of MUR services increased markedly during the service's second year. Those newly providing the service in the second year claimed for more than twice as many MURs as did those who had been ‘new providers' the previous year. Overall just over half of all providing pharmacies claimed for the equivalent of one MUR a week or fewer. Therefore the extent of ‘successful adoption’ of MURs is debatable. Differences in the level of provision continued between independent and multiple pharmacies in terms of both adoption of the service and the number of reviews conducted. As in the previous year, independent pharmacies were less likely to provide the MUR service and when they did the numbers conducted were lower than those provided by multiples.

Abstract Objective To design (i) a theory-based communication skills training package for medicine counter assistants (MCAs) and (ii) a method of evaluating its effect on consultation behaviours. Method Thirty MCAs from 20 community pharmacies in Grampian, Scotland were recruited and randomised to the intervention (n = 20) and control (n = 10) groups. The intervention comprised 2 times 4 h of interactive learning sessions. The content of the sessions was based on a model of teaching and learning communication skills, while the teaching and learning techniques used in the sessions were based on active learning and cognitive-behavioural principles. Training focused on information-gathering and information-giving skills. The Theory of Planned Behaviour was used to develop a questionnaire to explore the effect of communication skills training. Key findings The results of the full study are reported elsewhere but, in summary, some improvements in communication were seen in the intervention group in terms of the number of questions asked, although no improvement was shown with the use of open questions. Conclusion The results of this study suggest that using theory to underpin training might well allow the mapping of specific mediators of behaviour change onto intervention components, which in turn provides information on which aspects of training might be successful. Thus, using theory as a basis for interventions may increase the effectiveness of future interventions.

Context Medicine counter assistants (MCAs) supply the majority of non-prescription medicines (NPMs) to consumers. Suboptimal communication during consultations between consumers and MCAs has been identified as a major cause of inappropriate supply. Evidence from medical consultations suggests that training in specified communication skills can change professional behaviour.Methods A feasibility study was conducted to evaluate the effect of theory-based communication skills training for MCAs. Thirty MCAs were recruited from 21 community pharmacies in Grampian, Scotland. The intervention comprised 2 4-hour training sessions, held 1 month apart. The sessions were informed by results from previous studies and the Calgary-Cambridge evidence-based model of communication skills training. Strategies for guiding individuals through change were adopted from cognitive behavioural therapy techniques. The theory of planned behaviour was used to assess potential pathways to behaviour change. Recorded data were collected during covert visits to the pharmacies by simulated patients at baseline and 1 month after each training session. Communication performance was measured as the number and type of questions asked.Results Compared with baseline measures, the total number of questions asked increased in the intervention group at both timepoints. No change was shown in the control group between baseline and follow-up 1, and a decrease was shown in the total number of questions from follow-up 1 to 2. The intervention appeared to have greater effect on consultations involving advice, compared with those concerning product requests.Discussion Communication performance improved following training. Increased information exchange is associated with guideline-compliant supply of NPMs. A substantive randomised, controlled trial is now planned to assess the intervention.

Overall, 38% (range 13‐60%) of community pharmacies had claimed payment for providing MURs in the first year of the service. There was a seven-fold difference in the mean number of MURs per providing pharmacy, with a mean of 35.7 (8.3‐61.2). Pharmacies from multiples were over-represented in the contractors claiming payment for MURs (71% versus the national percentage of community pharmacies that are multiples, 57%). Multiples undertook 83.6% of all the MURs conducted in our sample PCOs. The number of MURs provided represented 6.8% of the theoretical financially capped maximum. Most SHA and PCO respondents viewed MURs as a part of the new contract with considerable potential but where progress was often slow. PCOs had used a range of methods to support the roll out of MUR implementation locally. Conclusion The uptake and spread of the MUR service in its first year accounted for only a small proportion of allocated funding. There were wide inter-PCO variations in the level of MUR provision. Most of this variation was accounted for by the percentage of providing pharmacies that were from multiple groups. Stakeholders identified a number of barriers to provision. These findings suggest that further action is needed to support and embed the MUR service.

Background: Major changes in the roles and responsibilities of pharmacists across the world are occurring. A new Scottish Community Pharmacy contract was introduced in April 2006, following the introduction of a similar contract in England in 2005. This contract encourages greater involvement in medicines management and other clinical cognitive roles, whilst retaining a supply function.

Abstract Objective To determine Scottish community pharmacists' present involvement with ‘extended’ service provision, as outlined in ‘The right medicine’ policy document, as well as an insight into the attitudes of pharmacists in delivering such services. Setting All community pharmacists working in Scotland. Method A questionnaire was developed, piloted and refined before mailing to all community pharmacists working in Scotland (n = 1621). Two reminders were sent to non-responders. Data on current service provision was analysed using SPSS version 11 for windows. Key findings An overall response rate of 56.4% (914/1621) was achieved for pharmacists. The survey revealed that the majority of respondents either agreed or strongly agreed with the ‘key service areas’ being provided from community pharmacies. Some services were obviously agreed with more than others. In particular repeat dispensing and emergency hormonal contraception (EHC) were rated highly. Least agreement was provided for needle exchange and schemes for supporting carers. Conclusion There appears to be wide variation in current service provision in the ‘key service areas’ considered. The highest involvement included EHC and methadone supervision. The lowest involvement was for needle exchange and schemes for supporting carers. Community pharmacist's attitudinal ratings were generally positive towards the ‘key service areas’ suggested.