Conscientious objection - a cross-sectional, vignette-based, mixed methods exploration of Australian pharmacists' perspectives.

Background: Conscientious objection (CO) in healthcare is a controversial topic. Some perceive CO as freedom of conscience, others believe their professional duty-of-care overrides personal-perspectives. There is a paucity of literature pertaining to pharmacists' perspectives on CO. Aim: To explore Australian pharmacists' decision-making in complex scenarios around CO and reasons for their choices. Method: A cross-sectional, qualitative questionnaire of pharmacists' perspectives on CO. Vignette-based questions were about scenarios related to medical termination, emergency contraception, IVF surrogacy for a same-sex couple and Voluntary Assisted Dying (VAD) Results: Approximately half of participants (n = 223) believed pharmacists have the right to CO and most agreed to supply prescriptions across all vignettes. However, those who chose not to supply (n = 20.9%), believed it justifiable, even at the risk of patients failing to access treatment. Strong self-reported religiosity had a statistically significant relationship with decisions not to supply for 3 of 4 vignettes. Three emergent themes included: ethical considerations, the role of the pharmacist and training and guidance. Conclusion: This exploratory study revealed perspectives of Australian pharmacists about a lack of guidance around CO in pharmacy. Findings highlighted the need for future research to investigate and develop further training and professional frameworks articulating steps to guide pharmacists around CO.

Professional stigma towards clients with methamphetamine use disorder - a qualitative study.

Background: Methamphetamine use disorder (MUD) is associated with poor health outcomes. Pharmacists play a role in delivery of substance use treatment, with several studies having examined their attitudes to people with opioid use disorder, but little is known about their attitude towards people with MUD. This study aimed to explore pharmacists' perspectives on the provision of services to clients with MUD. Methods: A convenience sampling strategy was used to recruit community pharmacists across Sydney, Australia. Semi structured interviews examined views and ideas of pharmacists surrounding the treatment and management of MUD, followed by coding of transcribed interview data by all members of the research team. Results: Nineteen pharmacists completed the interviews. The main theme identified was stigma held by healthcare professionals. The almost unanimous perception amongst pharmacists was fear and apprehension towards people with MUD, including underlying assumptions of criminality, misinformation regarding people with MUD, and lack of education and knowledge surrounding MUD. Conclusion: A substantial amount of stigma towards people with MUD was found in this study. Negative attitudes by healthcare professionals can perpetuate healthcare disparities and impede the accessibility of future treatment programs for people with MUD. Appropriate educational interventions on MUD for pharmacists are needed.

A Qualitative Evaluation of the Australian Community Pharmacy Agreement.

The Australian Federal Government's Community Pharmacy Agreement (Agreement), initiated in 1990 and renegotiated every five years with a pharmacy owners' organisation, is the dominant policy directing community pharmacy. We studied the experience with the Agreements of 38 purposively selected individual pharmacists and others of diverse backgrounds, using in-depth, semi-structured interviews. Although perceived to lack transparency in negotiation and operation, as well as paucity of outcome measures, the Agreements have generally supported the viability of community pharmacies and on balance, contributed positively to the public's access to medicines. There were, however, contradictory opinions regarding the impact of the policy's regulation of pharmacy locations, including the suggestion that they provide existing owners with an undue commercial advantage. A reported shortcoming of the Agreements was their impact on pharmacists' abilities to expand their scopes of practice and assist patients to make better use of medicines, in part due to the funding being almost totally focused on supply-related functions. The support for programs such as medication management services was perceived to be limited, and opportunities for diversification in pharmacy practice appeared constrained. Future pharmacy policy developed by the government could be more inclusive of a diverse range of stakeholders, seek to better utilise pharmacists' expertise, and have a greater focus on health outcomes.

Examining pharmacists' anti-doping knowledge and skills in assisting athletes to avoid unintentional use of prohibited substances.

OBJECTIVES: To explore the knowledge and skills of pharmacists practicing in Sydney, Australia, in preventing the use of prohibited medications by athletes. METHODS: Using a simulated-patient study design, the researcher (an athlete and pharmacy student herself) contacted 100 Sydney pharmacies by telephone requesting advice about taking a salbutamol inhaler (a WADA-prohibited substance with conditional requirements), for exercise-induced asthma, following a set interview protocol. Data were assessed for both clinical and anti-doping advice appropriateness. KEY FINDINGS: Appropriate clinical advice was provided by 66% of pharmacists in the study, appropriate anti-doping advice was provided by 68%, and 52% provided appropriate advice across both aspects. Of the respondents, only 11% provided both clinical and anti-doping advice at a comprehensive level. Identification of accurate resources was made by 47% of pharmacists. CONCLUSIONS: Whilst most participating pharmacists had the skills to deliver assistance regarding the use of prohibited substances in sports, many lacked core knowledge and resources to enable them to deliver comprehensive care to prevent harm and protect athlete-patients from anti-doping violations. A gap was identified regarding advising/counselling athletes, indicating the need for additional education in sport-related pharmacy. This education would need to be coupled with the incorporation of sport-related pharmacy into current practice guidelines to enable pharmacists to uphold their duty of care and for athletes to benefit from their medicines-related advice.

Pharmacists supporting athletes: a scoping review exploring the knowledge, role and responsibilities of pharmacists in preventing the unintentional use of prohibited substances by athletes.

BACKGROUND: Following the establishment of the World Anti-Doping Agency in 1999, the International Pharmacy Federation (FIP) published guidelines - The Role of the Pharmacist in the Fight against Doping in Sport (2014) - intended for implementation into national standards of practice, to clarify pharmacists' roles in supporting athletes. Despite 7 years since the publication of these guidelines, the extent of practice and knowledge regarding sport pharmacy remains unclear. OBJECTIVES: To explore the literature to ascertain knowledge held by pharmacists and pharmacy students regarding anti-doping and to determine current/potential roles and responsibilities for pharmacists in the dissemination of information about, and the reduction in unintentional use of, prohibited substances by athletes. METHOD: A literature search of five databases utilising terms such as athlete, performance-enhancing and pharmacist was undertaken. Relevant articles published since 1999 were searched for knowledge, roles and responsibilities of pharmacists. KEY FINDINGS: We identified 16 research studies outlining knowledge, as well as roles and responsibilities of pharmacists in assisting athletes. Pharmacists reportedly had limited knowledge of anti-doping organisations and prohibited substances. Roles identified included counselling, education, advice about prohibited substances and dispensing. Responsibilities included medication review and assisting athletes to avoid unintentional ingestion of prohibited substances. CONCLUSION: Pharmacists, by training, can play a role in providing accurate medication-related information to athletes to avoid prohibited substances. Key barriers identified were pharmacists' lack of knowledge and the absence of guidelines articulating specific roles and responsibilities for pharmacists, highlighting the need for educational programmes and inclusion of specific responsibilities in national guidelines.

Implementing and evaluating a course in professional ethics for an undergraduate pharmacy curriculum: A feasibility study.

BACKGROUND: Pharmacy practice today mandates "patient-centered care", thereby assigning higher levels of professional responsibility for pharmacists leading to ethical challenges. These challenges often involve ethical principles, institutional, personal, or other constraints that can pull practitioners in incompatible opposite directions, creating "ethical dilemmas" in many circumstances. Pharmacists are expected to handle challenges competently and in the best interest of patients. Literature underlines the positive impact of educational interventions focusing on ethical awareness and competence, and that "gaps" existed in pharmacy training/curricula for Jordanian pharmacists. The objective of this study was to develop, implement, and evaluate the utility of a tailored ethics education component in the pharmacy curriculum for students enrolled at a well-ranked Jordanian university. EDUCATIONAL ACTIVITY AND SETTING: Fifth-year pharmacy students attending summer school at a university in Jordan from July to September 2020 were invited to participate in an educational intervention (suite of didactic online lectures and skills-based workshops). This study was delivered in four parts, with a pretest administered immediately before and a posttest survey immediately after the educational intervention, the educational intervention (three phases), and focus-group discussions to elicit students' feedback. FINDINGS: Findings indicated enhanced levels of confidence in students' decision-making. The development of students' moral reasoning and decision-making skills were also observed to be improved. SUMMARY: This study highlighted the importance of the implementation of an ethics course in pharmacy undergraduate curricula. It emphasized the positive impact this course made on the students' learning experiences and provided a strong environment for discussion and group learning.

A mixed-method simulated patient approach to explore implicit bias in health care: A feasibility study in community pharmacy.

BACKGROUND: Implicit bias is prejudice shown towards an individual or group without consciously meaning to do so. This bias may occur due to age, race, and gender among other factors. Implicit bias has been examined and identified in a variety of health care professionals, primarily using Implicit Association Tests. To date, literature has not examined implicit bias using covert simulated patients in a naturalistic setting, or in practicing community pharmacists. OBJECTIVE: To develop and pilot a novel method for exploring and reporting on implicit racial bias by community pharmacists in their practice setting. METHODS: Four female actors of different racial and ethnic backgrounds (Caucasian Australian, East Asian, Middle Eastern, South Asian) completed simulated patient visits at eight community pharmacies in Sydney, Australia between February-March 2019. Actors provided scripted requests for assistance with symptoms or products relating to women's health ailments (cystitis, dysmenorrhea, emergency contraception, vaginal thrush) at a rate of one visit per pharmacy per week. Visits were audio-recorded. Semi-structured interviews were conducted with actors immediately post-visit. Transcriptions of visits and interviews were analyzed through discourse analysis. RESULTS: Thirty-two vists were completed. Discourse analysis identified 3 discursive frames of 'caring', 'neutral, and 'abrupt' and enabled identification of potential differences between pharmacists when responding to actors of different racial and ethnic backgrounds. Consultation length, number of products sold, and number of questions asked did not significantly differ between visits. CONCLUSIONS: This novel method proved feasible and future work could adapt this method to different practitioners and simulated patient demographics to explore different types of implicit bias in a number of naturalistic settings.

Stakeholders' Perceptions of Factors Influencing the Use of Take-Home-Naloxone.

BACKGROUND AND AIMS: Opioid associated death and overdose is a growing burden in societies all over the world. In recent years, legislative changes have increased access to naloxone in the take-home setting for use by patients with a substance use disorder and bystanders, to prevent opioid overdose deaths. However, few studies have explored the factors influencing the uptake by its multiple stakeholders. The aim of this scoping review was to explore the factors influencing the use of take-home naloxone from the perspectives of different stakeholders. METHODS: A scoping review methodology was adopted with a systematic search of databases EMBASE, MEDLINE and PubMed. A variation of the search words "naloxone", "opioid" and "overdose" were used in each database. The articles were screened according to the predetermined inclusion/exclusion criteria and categorized based on their key perspective or target population. RESULTS: The initial database search yielded a total of 1483 articles. After a series of screening processes, 51 articles were included for analysis. Two key stakeholder perspectives emerged: patients and bystanders (n = 36), and healthcare professionals (n = 15). Within the patient and bystander group, a strong consensus arose that there were positive outcomes from increased access to take-home naloxone and relevant training programs. Despite these positive outcomes, some healthcare professionals were concerned that take-home naloxone would encourage high-risk opioid use. CONCLUSION: Take-home naloxone is slowly being introduced into community practice, with a sense of enthusiasm from patients and bystanders. There are still a number of barriers that need to be addressed from healthcare professionals' perspective. Future research should be aimed at emergency care professionals outside of the US, who are most experienced with naloxone and its potential impact on the community.

Exploring Ethical Pharmacy Practice in Jordan.

Patient-centered pharmacy practice involves increased pharmacist engagement in patient care. This increased involvement can sometimes require diverse decision-making when handling various situations, ranging from simple matters to major ethical dilemmas. There is literature about pharmacy ethics in developed Western countries. However, little is known about pharmacists' practices in many developing countries. For example, there is a paucity of research conducted in the area of pharmacy ethics in Jordan. This study aimed to explore the manner in which ethical dilemmas were handled by Jordanian pharmacists, the resources used and their attitudes towards them. Semi-structured, face to face interviews were carried out with 30 Jordanian registered pharmacists. The transcribed interviews were thematically analysed for emerging themes. Four major themes were identified: legal practice; familiarity with the code of ethics; personal judgement, cultural and religious values; and Experience. Findings showed that ethical decision-making in pharmacy practice in Jordan was decisively influenced by pharmacists' personal moral values, legal requirements and managed by exercising common sense and experience. This pointed to gaps in Jordanian pharmacists' understanding and application of basic principles of pharmacy ethics and highlighted the need for professional ethics training, incorporating pharmacy ethics courses in pharmacy undergraduate curricula, as well as professional development courses. This study highlighted that paternalism, personal values and legal obligations were major drivers influencing decision-making processes of Jordanian pharmacists. Findings also highlighted an inclination towards lack of respect for patient autonomy. This illuminated the need for increasing pharmacists' literacy in professional ethics.

Exploring pharmacy ethics in developing countries: a scoping review.

Background Healthcare ethics have been profoundly influenced by principles of bioethics that emerged post-World War II in the Declaration of Geneva 1948. 'Beneficence' (to do good), 'Non-Maleficence' (to do no harm), 'Justice' (fairness and justice in access) and 'Respect for Autonomy' (respect for patient individuality, including decision making, privacy, and right to refuse), have become foundational principles of contemporary medical codes of ethics. These principles are well reflected in most professional pharmacy code of ethics globally. This domain remains relatively unexplored in most developing countries and the majority of what has been published in this area relates to western cultures. There have been no attempts to pool findings from a similar scope of research emanating in developing countries. Aim of the review This study aims to explore the scope of pharmacy ethics in the literature pertaining to developing countries. Methods An extensive search of three relevant (Scopus, CINAHL, IPA) databases was conducted from Jan 2000 to Feb 2020, in order to identify relevant studies conducted in or focussed on ethics in pharmacy in developing countries. A separate Google Scholar search was carried out in an effort to locate supplementary articles, hand-searched articles were also included to achieve an exhaustive investigation of all current relevant studies. Results The full text of 20 relevant articles that met inclusion criteria were critically analysed and qualitatively categorised into three emerging themes; Ethical challenges in pharmacy practice, Approaches used in teaching pharmacy ethics, and Code of ethics analysis and implementation. Conclusions: Findings of this literature review illuminated a gap in pharmacy ethics literacy in developing countries and variances in pharmacists' ethical attitudes in handling ethical dilemmas, as well as a lack of familiarity with ethical principles and codes of ethics. Pharmacists' lack of respect for patients' autonomy and pharmacists being prone to financial pressure were found to have a significant impact on pharmacy practice in most of developing countries. However, attempts are being made to rectify this gap by efforts to incorporate ethical and professional education in undergraduate curricula, and by studies in which new codes of ethics are being implemented.

Pharmacokinetic changes post-bariatric surgery: A scoping review.

Bariatric surgeries induce structural changes that can alter the absorption of drugs in patients already at risk of polypharmacy. This scoping review aimed to explore pharmacokinetic changes of orally administered drugs in patients post-bariatric surgery, and assess the quality and level of bias. Electronic databases were searched for articles relating to bariatric surgery and pharmacokinetics published between 1998 and 2019. Pre-post studies reporting on pharmacokinetic parameters were included, and the Newcastle-Ottawa Scale was used to assess risk-of-bias. A total of 21 studies were included in this review, and changes in absorption were reported in all included studies across 29 drugs. In 11 studies, this change was reported as statistically significant (p<.05), while six reported a nonsignificant change. More drugs exhibited a shorter Tmax and higher Cmax after surgery than otherwise, however changes in AUC were variable. Four studies were assessed as having fair quality while the remainder of the included studies were of good quality and low risk-of-bias. Bariatric surgery alters the absorption of drugs and several mechanisms are implicated to be responsible. Short and long-term monitoring is recommended in patients post-surgery for clinical changes in response to medications. Future research with a higher number of participants and greater control of variables, such as concurrent medications, malabsorptive disorders, and body composition should be considered.

Challenges faced with opioid prescriptions in the community setting - Australian pharmacists' perspectives.

BACKGROUND: Prescription opioids (POs) are well recognised for their role in pain management. However over recent years, use of POs has become an increasingly complex public health issue, with the emergence of increasing quantities of POs being misused and abused. Pharmacists represent the 'gatekeepers' of medicines, which can be a challenging role, relating in particular to POs. OBJECTIVE: This study aimed to gain insight into the challenges Australian community pharmacists experience in the dispensation of POs. SETTING: Sydney Australia. METHOD: Twenty-five pharmacists were recruited from suburbs in and around Sydney, Australia. Pharmacists were interviewed using an in-depth, semi-structured protocol. All interviews were audio-recorded, transcribed and thematically analysed. MAIN OUTCOME MEASURE: Identification of issues/factors that may influence the dispensing of POs. RESULTS: Pharmacists were reportedly confronted with several issues in the dispensing of POs, particularly in relation to the patient and prescriber. Pharmacists reported some individuals becoming increasingly more "creative" in the methods used to obtain POs, rendering detection of potential abuse/misuse increasingly difficult. Poor professional relationships with prescribers-an apparent power dynamic between the two professions, and limited engagement with patients were issues also identified. The majority of participants suggested that an electronic monitoring database would help in the identification of PO abuse/misuse. CONCLUSION: Education is required to emphasise the importance of inter-professional collaboration between pharmacists and prescribers, as is empathy in the pharmacist-patient relationship. Prescription drug monitoring programs and prescribers sending electronic prescriptions directly to the pharmacist were perceived as helpful initiatives to undertake.

The future of weight management in pharmacy education - Perspectives of new generation pharmacists.

INTRODUCTION: Over recent years, the profession of pharmacy has transitioned towards providing more individualised patient care services. In this context, community pharmacy has proven to be an excellent facilitator for weight management programs. However, education on weight management in pharmacy undergraduate curricula is often lacking. The perspectives of early career pharmacists on their perceived role in weight management services and their associated educational needs can inform curricula review. METHODS: In-depth, semi-structured interviews were conducted with 20 final year pharmacy students of The University of Sydney and five early career pharmacists from the greater Sydney, Australia area. Interviews were recorded, transcribed, and analysed for themes emerging. RESULTS: Participants were positive about their perceived role in providing weight management services. They regarded a program not based on commercial products as most suitable for pharmacy-delivered weight management services. However, some barriers were identified, such as lack of training and communication skills related to weight management. Participants requested more educational resources to ensure the delivery of high quality weight management services. DISCUSSION: Methods to enhance (future) pharmacists' knowledge of weight management services could include case-based learning, enhancement of communication skills, and the development of suitable guidelines. CONCLUSIONS: Participants perceived a clear role for themselves in providing weight management services in community pharmacies. However, the current educational system does not meet their requirements to prepare them for this role. A hands-on approach in education on weight management and appropriate communication skills should be introduced in pharmacy curricula to ensure future pharmacists are well prepared to deliver weight management services.

Medicine shortages in Fiji: A qualitative exploration of stakeholders' views.

OBJECTIVES: Medicine access is a human right; yet, concerningly, there are international instances of shortages. Quantitative data has allowed WHO to propose global solutions; however, individualised understanding of specific regions is still required to work towards national solutions. Fiji has an established issue with medication supply and the aim of this study was to use qualitative methods to gain a fuller understanding of this context. METHODS: Semi-structured interviews were used to gain the perspective of key stakeholders involved in the Fijian medicine supply chain in regards to causes, impacts and possible solutions of medicine shortages. Thematic analysis was used to analyse the interview data. RESULTS: In total, 48 stakeholders participated and the information was synthesised into three main themes, causes, impacts and solutions and the sub-themes including; political, system and patient causes, adverse health effects on patients, professional dissatisfaction, monetary loss and loss of faith in the health system, workarounds, operation improvements, government intervention and education and training. CONCLUSIONS: The situation in Fiji is not dissimilar to other instances of shortages around the world and hence international solutions like that proposed by WHO are feasible; however, they must be modified to be uniquely Fijian to work in this context.

Professional Use of Social Media by Pharmacists: A Qualitative Study.

BACKGROUND: Social media is frequently used by consumers and health care professionals; however, our knowledge about its use in a professional capacity by pharmacists is limited. OBJECTIVE: Our aim was to investigate the professional use of social media by pharmacists. METHODS: In-depth semistructured interviews were conducted with practicing pharmacists (N=31) from nine countries. Interviews were recorded, transcribed verbatim, and thematically analyzed. RESULTS: Wikipedia, YouTube, and Facebook were the main social media platforms used. Professional use of social media included networking with peers, discussion of health and professional topics, accessing and sharing health and professional information, job searching, and professional promotion. Wikipedia was the participants' first choice when seeking information about unfamiliar topics, or topics that were difficult to search for. Very few pharmacy-related contributions to Wikipedia were reported. YouTube, a video-sharing platform, was used for self-education. University lectures, "how-to" footage, and professionally made videos were commonly watched. No professional contribution was made to YouTube. Facebook, a general social networking site, was used for professional networking, promotion of achievements, and job advertisements. It also afforded engagement in professional discussions and information sharing among peers. CONCLUSIONS: Participants used social media in a professional capacity, specifically for accessing and sharing health and professional information among peers. Pharmacists, as medicines experts, should take a leading role in contributing to health information dissemination in these user-friendly virtual environments, to reach not only other health care professionals but also health consumers.

Medicine shortages in Australia: causes, impact and management strategies in the community setting.

Background Medicine shortages are an ongoing global problem. The Therapeutic Goods Administration (TGA) dedicated a website for monitoring of medicine shortages in Australia in May 2014, as part of the Medicine Shortage Information Initiative. This study aimed to explore the views of pharmacists regarding medicine shortages in the community setting and the impact of the TGA website in Australia. Setting Community pharmacies in New South Wales, Australia. Method Twenty semi-structured interviews were conducted with community pharmacists. Data collected were analysed thematically utilising the framework analysis method. Main outcome measure Qualitative analysis conducted using the framework approach. Results Findings clearly indicated that medicine shortages were experienced on a regular basis, but most participants were unaware of the TGA website. Medicine shortages reportedly impacted both pharmacists and consumers; and various workarounds were undertaken to manage the issue. The "price disclosure policy" was found to be a prominent contributing factor in emerging shortages. Suggestions were made for ways to improve the growing occurrence of shortages. Conclusion Overall, the study found that there was a lack of familiarity with the TGA website, despite experiencing regular shortages of medicines in practice. Also highlighted, was the importance of pharmacists prioritising patient care over business decisions. To reduce prescribing of out-of-stock medicines notifying doctors about shortages was also considered important, to allow for early action to be taken at higher levels of the supply chain. Findings of this study may help direct future policy-making around the world, as medicine shortages is a problem shared by healthcare providers in most countries around the world.

Incorporating a Weight Management Skills Workshop in Pharmacy Curricula in Australia.

Objective. To develop, implement, and evaluate a competency-based weight management skills workshop for undergraduate pharmacy students in an Australian university. Design. A 3-hour workshop titled "Weight Management in Pharmacy" was implemented with a cohort of fourth-year undergraduate pharmacy students (n=180). Learning activities used included case-based learning, hands-on experience, role-play, and group discussion. Assessment. A 22-item attitudinal survey instrument and the validated Obesity Risk Knowledge (ORK-10) scale were administered at baseline and postworkshop to evaluate the impact of this educational workshop. There was significant improvement in the students' ORK scores and students' perceived level of self-confidence in performing weight management skills. Conclusion. An educational workshop designed to enhance professional competencies in weight management ensured graduates were "service-ready" and had the appropriate knowledge, skills, and attributes to deliver patient-centered pharmacy-based weight management services.

The Role of Medicinal Cannabis in Clinical Therapy: Pharmacists' Perspectives.

BACKGROUND: Medicinal cannabis has recently attracted much media attention in Australia and across the world. With the exception of a few countries, cannabinoids remain illegal-known for their adverse effects rather than their medicinal application and therapeutic benefit. However, there is mounting evidence demonstrating the therapeutic benefits of cannabis in alleviating neuropathic pain, improving multiple sclerosis spasticity, reducing chemotherapy induced nausea and vomiting, and many other chronic conditions. Many are calling for the legalisation of medicinal cannabis including consumers, physicians and politicians. Pharmacists are the gatekeepers of medicines and future administrators/dispensers of cannabis to the public, however very little has been heard about pharmacists' perspectives. Therefore the aim of this study was to explore pharmacists' views about medicinal cannabis; its legalisation and supply in pharmacy. METHODS: Semi-structured interviews with 34 registered pharmacists in Australia were conducted. All interviews were audio-recorded, transcribed ad verbatim and thematically analysed using the NVivo software. RESULTS: Emergent themes included stigma, legislation, safety and collaboration. Overall the majority of pharmacists felt national legalisation of a standardised form of cannabis would be suitable, and indicated various factors and strategies to manage its supply. The majority of participants felt that the most suitable setting would be via a community pharmacy setting due to the importance of accessibility for patients. DISCUSSION: This study explored views of practicing pharmacists, revealing a number of previously undocumented views and barriers about medicinal cannabis from a supply perspective. There were several ethical and professional issues raised for consideration. These findings highlight the important role that pharmacists hold in the supply of medicinal cannabis. Additionally, this study identified important factors, which will help shape future policies for the successful implementation of medicinal cannabis in healthcare. We recommend that these views and strategies be incorporated in the development of policies and legislations.

Developing and testing evidence-based weight management in Australian pharmacies: A Healthier Life Program.

BACKGROUND: Pharmacies represent a valuable opportunity to deliver weight management services, rather than just the routine supply of weight-loss products. In order to provide optimal services and translation of evidence-based weight management in community pharmacy, a best practice model program was designed and pilot tested to facilitate implementation of such services in pharmacies in Australia. OBJECTIVE: To develop and pilot a pharmacist-delivered, evidence-based, non-product-centred weight management service for community pharmacy in Australia. Setting Sydney, New South Wales, Australia. METHOD: A pharmacy-based weight management service called the A Healthier Life Program (AHLP), for overweight and obese individuals, was developed based on current Australian weight management guidelines and recommendations made by key stakeholders. The pharmacist undertook training to acquire specific competencies to deliver the program. The AHLP involved six individual face-to-face sessions with the pharmacist over 3 months. The intervention targeted three areas: diet, physical activity and behavioural change. MAIN OUTCOME MEASURES: Weight, BMI, waist circumference, blood pressure, dietary intake, and physical activity levels at 3 months were compared with values at baseline. Qualitative feedback on participants' satisfaction and willingness to pay were also analysed. RESULTS: Eight pharmacies provided the AHLP between February and December 2013. Thirty-four participants were enrolled in the AHLP; mean age 50.7 years (SD 15.7) and mean BMI 34.3 kg/m(2) (SD 5.3). Of the 22 (65%) participants who completed the program, six had achieved the target weight loss of ≥5%. The mean change in weight was -3.5 kg (95% CI -4.8, -2.2) and waist circumference -2.0 cm (95% CI -2.8, -1.3) for program completers at 3 months. Furthermore, participants reported overall positive experiences of the program, and identified accessibility of the pharmacy and high comfort level with the pharmacist, as the major advantages. CONCLUSION: The AHLP was well received and participants achieved targeted weight loss. This study demonstrated that an evidence-based patient-centred weight management program can be implemented in Australian pharmacies.