General practitioners' views and experiences of over-the-counter simvastatin in Scotland.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Statins are widely used for the primary and secondary prevention of coronary events in high risk populations. In 2004 simvastatin was reclassified in the UK from prescription only to being available over-the-counter (OTC). WHAT THIS STUDY ADDS: The majority of GPs do not support the supply of OTC simvastatin by the community pharmacist. GPs were particularly concerned by the lack of cholesterol and blood pressure data in the CHD risk assessment prior to sale. AIMS: The aims of this study were to determine the views and experiences of Scottish GPs towards CVD risk assessment by community pharmacists and the supply and sale of simvastatin. METHODS: A cross sectional postal questionnaire survey of all primary care general practices in Scotland was carried out. The main outcome measure was GPs' awareness of and opinions regarding OTC simvastatin use, experience of OTC simvastatin and opinions regarding community pharmacist involvement in CHD risk assessment. RESULTS: A response rate of 45.7% was obtained. The majority (92.6%, 428) were aware that community pharmacists could sell simvastatin to reduce the risk of a first coronary event in individuals at moderate risk of CHD. However, over half (55.6%, 257) believed that the OTC sale of simvastatin was inappropriate. Just over half were unaware that the pharmacist's CHD risk assessment for the sale of simvastatin did not include lipid (54.8%, n=253) or blood pressure measurement (53.7%, n=248) and 56.7% (262) and 57.8% (267) of respondents, respectively, thought these omissions inappropriate. Almost half of the respondents (48.1%, 222) supported community pharmacists supplying simvastatin as supplementary prescribers while fewer (26.6%, 132) were in favour of supply via an independent prescribing arrangement. CONCLUSION: This study confirms that the majority of GPs do not support the supply of OTC simvastatin by the community pharmacist, being particularly concerned by the lack of cholesterol and blood pressure data in the CHD risk assessment prior to sale. Other methods of pharmacy based simvastatin supply including supplementary prescribing merit further evaluation.

Experiential learning as part of pharmacist supplementary prescribing training: feedback from trainees and their mentors.

BACKGROUND: A period of learning in practice (PLP) is an integral part of supplementary prescribing training for pharmacists in Great Britain. During the PLP, a designated medical practitioner (DMP) supervises and supports the trainee to develop competence in prescribing. OBJECTIVE: To evaluate the views and experiences of supplementary prescribing pharmacists and DMPs regarding the PLP and identify their perceived support needs during the PLP. METHODS: Prepiloted questionnaires were mailed in September 2006 to all pharmacists who had started their supplementary prescribing training at The Robert Gordon University, Aberdeen, Scotland (n = 242) and their DMPs (n = 232). Nonrespondents were sent up to 2 reminders. Responses were analyzed using descriptive and comparative statistics; responses to open questions were analyzed thematically. RESULTS: Responses were received from 186 (76.9%) pharmacists and 144 (62.1%) DMPs. Just over half of the pharmacists agreed/strongly agreed that they knew what was expected of them and their DMPs during the PLP, but less than half agreed/strongly agreed that it was important to communicate with pharmacist colleagues in the prescribing course. One hundred twelve (60.2%) pharmacists had their consultation skills reviewed by their DMPs during the PLP. Opportunities for professional development and teamwork were regarded as major positive experiences by both pharmacists and DMPs. Organizational, attitudinal, and time barriers were also reported. There was considerable interest among both pharmacists and DMPs for an Internet-based support network during the PLP. CONCLUSIONS: Information on the roles and responsibilities of pharmacists and DMPs during the PLP should be enhanced. The Internet could be a useful medium for communication during the PLP. Input from a multidisciplinary team of healthcare professionals and review of consultation videos could further enhance the PLP experience.

Supplementary prescribing: early experiences of pharmacists in Great Britain.

BACKGROUND: Pharmacists in Great Britain can undertake supplementary prescribing (SP) after training at a higher education institution and completing a "period of learning in practice" in accordance with the Royal Pharmaceutical Society of Great Britain (RPSGB) curriculum. OBJECTIVE: To explore SP pharmacists' early experiences of prescribing and their perceptions of the prescribing course. METHODS: A questionnaire was mailed to all RPSGB prescribers (N = 518, on June 1, 2005; 30 used in pilot questionnaire). Predictors of pharmacists starting to practice SP were identified in univariate analysis, and significant variables were further tested in multivariate analysis. RESULTS: The respondents (n = 401; 82.2%) were mainly female (270; 67.3%), had more than 20 years' experience as a pharmacist (123; 30.7%), worked in hospital settings (160; 39.9%), and focused on cardiovascular conditions (143; 35.7%) during their period of learning in practice. The median course satisfaction score, on a scale of 3 to 15 (lowest to highest), was 10. Practicing SP was self-reported by 195 (48.6%) respondents, 154 (79%) of whom had written a prescription. Ninety (58.4%) of the first prescriptions were written in primary care settings. Better patient management was regarded as the major benefit by 139 (71.3%) of those engaged in SP, while funding issues were identified by 71 (36.4%) as major barriers in implementing the practice. Lack of organizational recognition of SP was the main reason given (37; 18%) for those not commencing the practice. Independent predictors of those practicing SP included a longer time since registering as prescriber (p < 0.001); confidence of pharmacists in their prescribing abilities (p < 0.001); practicing in a setting other than community pharmacy (p = 0.001); and training in cardiovascular conditions or multiple conditions during the period of learning in practice (p = 0.005). CONCLUSIONS: Pharmacists have made progress in implementing SP, which is perceived by pharmacist prescribers as beneficial for both patients and themselves. Pharmacists need more support in terms of infrastructure and integration into the healthcare team to overcome some of the barriers to implementing SP.

Exploring patients' perspectives of pharmacist supplementary prescribing in Scotland.

AIM: The aim of this study was to explore patients' perspectives and experiences of pharmacist supplementary prescribing (SP) in Scotland. METHOD: A survey in primary and secondary care in Scotland. Pharmacist supplementary prescribers (n = 10) were purposively selected across Scotland. All pharmacists distributed questionnaires to 20 consecutive patients as they attended appointments during October to December 2006. Reminders were mailed to all 20 patients by each pharmacist 2 weeks after initial distribution. MAIN OUTCOME MEASURES: The questionnaire contained items on: attitudes towards pharmacist SP derived from earlier qualitative research; consultation satisfaction derived from a validated scale developed initially for general practitioners, with the term 'doctor' being replaced by 'pharmacist prescriber'; and demographics. Closed and Likert scales were used as response options. RESULTS: One pharmacist withdrew. The patient response rate was 57.2% (103/180). The median age was 67 years (interquartile range 56.5-73 years), with 53.4% being female. Most (76, 73.8%) consulted with the pharmacist in a general practice setting. Patients reported positive consultation experiences with 89.3% agreeing/strongly agreeing that they were satisfied with the consultation, 78.7% thought the pharmacist told them everything about their treatment and 72.9% felt the pharmacist was interested in them as a person. Most patients were positive in their attitudes, agreeing that they would recommend a pharmacist prescriber to others and that they had trust in the pharmacist. However, 65% would prefer to consult a doctor. CONCLUSION: Most patient respondents were satisfied with, and had a positive attitude towards, pharmacist prescribing consultations. However, most patients would still elect to see a doctor given the choice.

Views of pharmacists and mentors on experiential learning for pharmacist supplementary prescribing trainees.

OBJECTIVE: To explore the views and experiences of pharmacists and their mentoring designated medical practitioners (DMPs) about the 'period of learning in practice' (PLP) as part of supplementary prescribing (SP) training. METHOD: Two focus groups (n = 5 and 7) of SP pharmacists were organised in Scotland. The experiences and views of DMPs (n = 13) were explored using one-to-one telephone interviews. The focus groups and interviews were transcribed verbatim and analysed using the framework approach. MAIN OUTCOME MEASURES: Views and experiences of pharmacists and DMPs about the PLP. RESULTS: Planning the PLP in consultation with the DMP was found to be crucial for an optimal learning experience. Pharmacists who did not have a close working relationship with the medical team had difficulties in identifying a DMP and organising their PLP. Participants stressed the importance of focusing on and achieving the core competencies for prescribers during the PLP. Input from doctors involved in the training of others, review of consultation videos, and formal independent assessment including clinical assessment at the end of the PLP might improve the quality of the PLP. Forums for discussing experiences during the PLP and gathering information might be valuable. CONCLUSION: Our findings have implications for prescribing training for pharmacists in the future. The PLP should focus on core competencies with input from doctors involved in the training of others and have a formal assessment of consultation skills. Support for pharmacists in organising the PLP and forums for discussing experiences during the PLP would be valuable.