Counselling customers at risk of the triple whammy effect at community pharmacies - A feasibility study.

The combination of diuretics, angiotensin-converting enzyme inhibitors (ACE-i)/angiotensin II receptor blockers (ARBs) and non-steroidal anti-inflammatory drugs (NSAID) involves a risk of acute renal failure known as the triple whammy effect (TWE). NSAID can be provided by prescription or over the counter (OTC) and community pharmacies counsel on this medication every day to contribute to medication safety. The objective of this study is to test the feasibility of an intervention where community pharmacies identify and counsel customers at risk of the TWE. Participating pharmacies were recruited across Denmark and the Faroe Islands. In April to May 2021, all staff at 13 community pharmacies chose 10 workdays to collect data in an electronic tool on their risk assessment, the customers' medication, and counselling about the TWE for customers asking for NSAID. Pharmacy staff were instructed in correct data collection and received learning material and a patient information leaflet on the TWE. These data were analysed descriptively. Staff evaluated the learning material and patient information leaflet in a questionnaire. The quantitative answers from the questionnaire were analysed descriptively and the qualitative answers were analysed using content analysis. According to the pharmacies' risk assessment, 12.1% (n = 215) of customers asking for NSAID were at risk of the TWE. The data on customers' medication showed that only 8.0% (n = 142) were actually at risk of TWE. Of those, 43.0% (n = 61) asked for NSAID on prescription and 57.0% (n = 81) for OTC. In the evaluation of materials pharmacy staff reported overall satisfaction with the learning material, which they reported increased their knowledge of TWE and helped them in their counselling. They also reported satisfaction with the patient information leaflet. Despite pharmacy staff reporting satisfaction with the learning material, it still did not educate staff well enough in assessing the risk of TWE for customers asking for NSAID. More research is needed on TWE interventions in community pharmacies because this study shows that there is a potential for community pharmacies to identify and counsel persons at risk of the TWE.

Danish community pharmacies supporting self-care for patients.

In Denmark, self-care has been a part of the health care professional and health political discourse since the middle of the 1970s particularly in relation to prevention. However, the concept has become more visible in connection with the Danish government's public health programme "Healthy throughout life" from 2002 to 2010, where patients' self-care was highlighted as an important element in preventing disease progression and complications. Self-care in Denmark is seen as a partnership between the patient and the health care professional. Some self-care activities in Danish community pharmacies are mentioned in national and municipal guidelines for better prevention and self-care regarding obesity, sexual health, smoking cessation, teaching patients/relatives and vaccination. This paper describes self-care activities and services delivered by Danish community pharmacies gathered from survey results at 33 community pharmacies, oral communication with the Association of Danish Pharmacies and published papers on Danish community pharmacy services. Self-care activities in Danish community pharmacies include counselling (about health, self-care, prescription medication, and OTC medication), health campaigns, collaborations with other health care professionals and patient associations and community pharmacy services, all with the purpose to support correct medication use, medication safety and to contribute to health promotion and prevention. These cover activities on prevention, detection, minor ailments, and chronic disease. Six of ten future community pharmacy contributions to medication safety and prevention in future health care, described by the Association of Danish Pharmacies, are related to community pharmacies' support of patients towards better self-care. In the future, Danish community pharmacies should consider offering self-care activities by expanding existing counselling, community pharmacy services and collaborations. Remuneration also needs to be aligned for the activities to succeed and become an integrated part of prevention packages and national initiatives that support patient self-care.

What do persons with diabetes want from community pharmacies? A qualitative study.

Background: Diabetes is a demanding disease with a complex treatment regimen. Many persons with diabetes have difficulty managing their disease and taking medication as prescribed, possibly because they lack knowledge and sometimes misinterpret medical benefits. Community pharmacies continuously provide professional counselling to persons with diabetes. Objective: This study aimed to explore 1) which services adults with type 1 and type 2 diabetes want from community pharmacies and 2) how pharmacies can meet these wishes. Methods: A qualitative, explorative study design using focus group interviews was chosen. Informants were recruited from Region Zealand in Denmark. Data were digitally recorded, transcribed verbatim and analyzed by means of thematic analysis. Results: Thirteen adults (11 female) with the mean age of 66.2 years (range 49-81 years) participated in one physical (n=6) or one online (n=7) focus group interview. Ten had type 2 diabetes, three had type 1 diabetes. The average duration of participants' diabetes was 13.4 years (range 2.3-33.0 years). The analysis revealed three overall themes of the functions which the informants would like community pharmacies to fulfil: 1) raise awareness of pharmacies' counselling service and competences; 2) act as a dialogue partner; 3) be a source of information and guidance about local activities and support. Conclusion: The informants did not regard community pharmacies as a natural part of the healthcare system or as a place where they would expect counselling. They would like the community pharmacy to make their medical competences and services obvious and the community pharmacy staff to act as a dialogue partner and provide competent counselling. The informants would like to have a contact person with diabetes competences with whom they can book an appointment to complement over-the-counter counselling. They experience a gap in their care between routine visits in the healthcare system and suggest that community pharmacies counselling services become a natural supplement and that healthcare professionals in the primary and secondary sectors inform patients about the services - especially for patients newly diagnosed with diabetes. Finally, they would like a formal collaboration between diabetes associations and community pharmacies to make their competences, services and information visible.

Mapping of Danish Pharmacy Technician Students' Third-Year Projects in a Year with the COVID-19 Pandemic.

To graduate, pharmacy technician students write a project in their third year. They choose between six elective courses, and work with a subject related to their education and everyday practice at community or hospital pharmacies. In this article, we report the mapping of third-year project themes and provide an overview of the challenges that COVID-19 pandemic restrictions have had on completing the projects. On the basis of all project titles, a list of themes was generated and described before all projects were allocated to one of the themes. Challenges experienced due to the COVID-19 pandemic were investigated from an analytical workshop where supervisors discussed their experience with supervising students throughout the completion of the projects. In total, 140 projects were included and thematised into eight themes: advanced pharmacy services, digital patient support, organisation and collaboration, handling of medicine, automated dose dispensing, medication counselling in community pharmacy, hospital pharmacy, and others, covering all six elective courses. The COVID-19 pandemic affected students' possibilities to collect data from either physical interviews or observations. The challenges prompted both constructive and creative discussions between students and supervisors to find ways to complete the projects, and required flexibility from all those involved: students, supervisors, community pharmacies, and hospital pharmacies. In conclusion, all students managed to complete their third-year project at a similar level of achievement statistically compared to average grades for the previous six years (2016-2020).

Using qualitative methods to explore the dynamics of patients' perspective sharing in community pharmacy counseling- conversation analysis and video-stimulated recall interviews.

Background: For patient centered counseling to take place in community pharmacies, patients should feel encouraged to share their perspectives, yet studies show that this rarely happens. The process of patient perspective sharing relies on the interactional details that unfold during an encounter i.e. how patients verbally and nonverbally are encouraged to share their perspective, which in turn is affected by patients' and pharmacy staff members' psychological processes in the situation, i.e. how they perceive and feel when acting. Therefore, employing complimentary methods that study both interactional and psychological processes could deepen the understanding of the dynamics governing patients' perspective sharing in pharmacy encounters. Objective: The objective of this study is twofold: 1) a methodological consideration of the benefits of employing Conversation Analysis (CA) and Video-Stimulated Recall Interviews (VSRI) in parallel, 2) to use the methodological combination to understand patient perspective sharing in community pharmacy interactions. Method: A single case study of one pharmacy encounter to explore the objectives in-depth. This was done through video recording of pharmacy encounters and subsequent CA-analysis; VSRIs were conducted with the involved patient and pharmacy staff member and analyzed using a qualitative thematic approach. Results: By exploring detailed interactional and psychological processes in parallel, specific occurrences which might hinder patients' perspective sharing were revealed. CA demonstrated that staff member's listening activities restricted the patient's perspective sharing. VSRIs with patient and staff member supported this result: the staff member had a narrow conception of what counted as suitable answers and did not consider listening an active process. The patient harbored shame about needing to take the medication which affected her behavior during the encounter. Conclusion: The novelty of the methodological combination is promising in order to grasp the complex process of patient perspective sharing in pharmacy encounters, as it affords aspects such as emotionality to be considered a central part of pharmacy encounters. As a consequence, it is suggested that the psychological concept of mentalizing is added to pharmacy education, as it is a trainable capacity enabling staff to become aware of the mental states that affect both patients and staff themselves during the pharmacy encounter.

Pharmacy practice research priorities during the COVID-19 pandemic: Recommendations of a panel of experts convened by FIP Pharmacy Practice Research Special Interest Group.

Across the globe, pharmacists on the frontline continue to fight COVID-19 and its continuously evolving physical, mental, and economic consequences armed by their knowledge, professionalism, and dedication. Their need for credible scientific evidence to inform their practice has never been more urgent. Despite the exponentially increasing number of publications since the start of the pandemic, questions remain unanswered, and more are created, than have been resolved by the increasing number of publications. A panel of leading journal editors was convened by the International Pharmaceutical Federation (FIP) Pharmacy Practice Research Special Interest Group to discuss the current status of COVID-19 related research, provide their recommendations, and identify focal points for pharmacy practice, social pharmacy, and education research moving forward. Key priorities identified spanned a wide range of topics, reflecting the need for good quality research to inform practice and education. The panel insisted that a foundation in theory and use of rigorous methods should continue forming the basis of inquiry and its resultant papers, regardless of topic area. From assessing the clinical and cost effectiveness of COVID-19 therapies and vaccines to assessing different models of pharmaceutical services and education delivery, these priorities will ensure that our practice is informed by the best quality scientific evidence at this very challenging time.

Pharmacy practice research - A call to action.

Pharmacists have a societal duty of care. How to best provide that type of care requires scientific study. Pharmacy practice is a scientific discipline that studies the different aspects of the practice of pharmacy, and its impact on health care systems, medicine use, and patient care. Its scope has expanded globally to encompass clinical, behavioural, economic, and humanistic implications of the practice of pharmacy, as well as practice change and implementation in routine practice of innovations such as health interventions and patient-care services. The development, impact evaluation, implementation, and sustainability of health interventions and patient-care services represents a key research area for pharmacy practice. An approach for conducting these is provided. There is evidence that collaborative national and international research in this area is growing, showing an increased contribution to global health research. The role of universities and pharmacy professional associations in supporting the advancement of pharmacy through pharmacy practice research is also discussed. Finally, a call to action for pharmacy practice research, education, and practice is made.