Perspectives of community pharmacy staff on commonly encountered skin conditions and the key challenges towards enhancing their role in dermatology.

This research letter discusses the perspectives of community pharmacy staff on commonly encountered skin conditions and the key challenges towards enhancing their role in this area. A mixed methods online survey was created, and a total of 174 community pharmacy staff completed the survey. The results highlight the range of conditions currently encountered in community pharmacy and the breadth of challenges facing community pharmacy staff, in particular challenges surrounding providing a differential diagnosis. Community pharmacies are an integral part of the NHS and have a key role in managing skin conditions; however, in order to optimise this role, the perspectives of staff discussed in this letter need to be further explored and addressed.

Blood-derived non-extracellular vesicle proteins as potential biomarkers for the diagnosis of early ER+ breast cancer and detection of lymph node involvement.

Extracellular vesicles (EV's) are membrane surrounded structures released by different cell types and are emerging as potential therapeutic and diagnostic targets in cancer. In the present study, plasma samples derived from 7 patients with metastatic and non-metastatic ER+ (estrogen receptor positive) breast cancer (BC) were collected and their respective (EVs) isolated and the protein content analyzed by mass spectrometry and FunRich analysis. Here we report on the presence of  two putative plasma EV biomarkers (which were absent in healthy controls samples) that could be used to detect early ER+ breast cancer and for those with lymph node (LN) involvement However, given the preliminar nature of the work, further investigation in a larger patient cohort is warranted to corroborate these findings. If confirmed, these biomarkers could be incorporated into simple blood test kit for the early detection of those with ER+ breast cancer and lymph node involvement.

The role of community pharmacists in supporting self-management in patients with psoriasis.

BACKGROUND: The majority of patients with psoriasis have mild to moderate disease which can be managed in primary care with topical therapies. The supportive role of pharmacists for patients with long-term dermatological conditions is largely unknown. OBJECTIVE: To assess the impact of an educational intervention delivered by community pharmacists to improve self-management for people with psoriasis. METHOD: The study involved a pre- and post-intervention design. Seven community pharmacies were selected based on their location (urban, rural etc.) and the pharmacists recruited via local comprehensive research networks. Patients with mild to moderate psoriasis were recruited either opportunistically or via a letter of invite by pharmacists who undertook a face-to-face consultation with one follow-up visit after 6 weeks. The primary outcome was the change in person-centred dermatology self-care index (PEDESI) score and secondary outcomes were the self-assessed psoriasis and severity index (SAPASI), measuring disease severity and the dermatology quality of life index (DLQI). KEY FINDINGS: A total of 47 patients were recruited. At 6 weeks, 42/47 (89.3%) patients completed the follow-up consultation. There was a significant increase in mean PEDESI scores (25.15 versus 17.78, P < 0.001) at 6 weeks compared to baseline. Similarly, SAPASI (11.60 versus 7.74, P < 0.001) and DLQI (7.21 versus 4.14, P < 0.001) scores improved significantly. CONCLUSION: Pharmacist-assisted support for patients with psoriasis improved knowledge, reduced disease severity and the impact on quality of life. These results suggest that community pharmacists might have an important role to play in facilitating self-management for patients with psoriasis.

An exploratory study of the views of community pharmacy staff on the management of patients with undiagnosed skin problems.

OBJECTIVE: The aim of this study was to explore pharmacist and medicine counter assistant (MCA) perceptions of community pharmacy management of patients presenting with symptomatic skin problems. METHODS: The study involved semi-structured telephone interviews with 10 pharmacists and 15 MCAs from seven pharmacies. Interviews focused on perceptions of their role in managing symptomatic skin problems and views on why people sought pharmacy advice and any barriers to management. Advice from the local ethics committee was that approval was not required for the study. We analysed the interviews using the framework approach. KEY FINDING: Pharmacists identified two key themes that defined their role; triage and reassurance. In contrast, MCAs defined their role as information gatherers and independent advisors. Themes identified by both pharmacists and MCAs relating to the use of pharmacy as a source of advice were convenience, the perceived non-serious nature of conditions and inaccessibility of the GP. Additionally, MCAs believed familiarity with the pharmacist was important. Both pharmacists and MCAs identified their lack of dermatological knowledge as a barrier with pharmacists reporting insufficient time to deal effectively with patients. MCAs identified the potential for misdiagnosis by pharmacists as another potential barrier. CONCLUSION: Our findings suggest that the role of pharmacists and MCAs is complementary; MCAs screen and provide the necessary information to pharmacists who then decide upon an appropriate course of action for the patient. Nevertheless, a major barrier to pharmacy-supported self-care of symptomatic skin problems is a perceived lack of knowledge and training in dermatology.

Why people seek advice from community pharmacies about skin problems.

OBJECTIVES: The objective of this study was to explore the reasons why patients with undiagnosed skin problems seek advice at pharmacies. METHODS: Semi-structured telephone interviews were conducted with patients presenting at pharmacies requesting advice for their own (or their child's) undiagnosed skin problem. KEY FINDINGS: Twenty-five patients were interviewed. Key themes around choice of pharmacy were convenience of professional advice, triage to general practitioner (GP) care if warranted, inaccessibility of GP care and perceived non-serious nature of the condition. Interviewees also described high levels of trust in their pharmacists. Few concerns were noted, but those that were centred on lack of privacy and the potential for misdiagnosis. Almost all participants felt positive about their pharmacy care and would re-visit for future skin problems. CONCLUSIONS: Patients with undiagnosed skin problems seek advice from pharmacies for reasons of professional advice, accessibility, familiarity and trust and because they perceive their conditions as non-serious.

An exploratory study demonstrating the diagnostic ability of healthcare professionals in primary care using online case studies for common skin conditions.

OBJECTIVES: To compare the diagnostic ability of pharmacists, nurses and general practitioners (GPs) for a range of skin conditions. METHODS: An online study comprising 10 specifically developed dermatological case studies containing a digital image of the skin condition and a short case history. A total of 60 participants (20 representing each of pharmacists, GPs and primary care nurses) were required to identify the skin condition as well as the features in the case history that supported the diagnosis and the recommended first-line management approach for the condition. KEY FINDINGS: The mean diagnostic scores for each group were GPs = 8.8 (95% confidence interval, CI, 7.9-9.6), pharmacists = 6.2 (95% CI, 5.4-6.9) and nurses = 7.0 (95% CI, 6.1-7.9). Post hoc analysis revealed that the difference in mean diagnostic scores was significant (P < 0.05) between GPs and both pharmacists and nurses. However, pharmacists' diagnostic accuracy was similar to GPs' for some skin conditions such as tinea corporis, scabies and plantar warts and overall at least 40% of pharmacists correctly identified all conditions. CONCLUSION: This small study has demonstrated that for all of the skin conditions considered, pharmacists' overall diagnostic scores were significantly different from those of GPs but similar to those of nurses for the conditions assessed. However, further work with a larger sample is required to determine the accuracy of these preliminary findings and to establish whether advice given by pharmacists in practice results in the appropriate course of action being taken.

The medicines use review in patients with chronic skin diseases: are pharmacists doing them and how confident are they?

OBJECTIVES: The aim of the study was to explore the range of dermatology medicines use reviews (MURs) undertaken by pharmacists and their confidence in dealing with the provision of advice to patients with skin problems. METHOD: A self-completion questionnaire was sent to a random sample of 3500 community pharmacies in England and Wales, UK. KEY FINDINGS: A total of 870 pharmacists responded to the survey giving a response rate of 25% (870/3500). Nearly half of respondents (44%, n = 866) had undertaken a dermatology MUR with eczema/dermatitis and psoriasis being the main conditions encountered. The mean confidence score (on a five-point scale) at conducting dermatology MURs was 3.5 (SD 1.0). CONCLUSION: Many pharmacists currently undertake dermatology MURs and rate themselves as confident in this role. Further work is needed to establish if such reviews lead to improvements in disease specific outcomes.

Community pharmacists' perceptions of the skin conditions they encounter and how they view their role in dermatological care.

OBJECTIVES: To explore pharmacists' perceptions of the skin conditions they encounter, sources of postgraduate dermatological training and views of their role in the management of patients with skin problems. METHOD: A self-completion questionnaire was sent to a random sample of 3500 community pharmacists in England and Wales. KEY FINDINGS: Seventy-eight per cent of pharmacists felt that patients sought their advice on problems about dry skin on a weekly basis. A total of 64.8% had undertaken postgraduate training in dermatology and the majority agreed that they played an important role in managing patients with skin problems. CONCLUSION: Pharmacists routinely encounter a small number of skin conditions and believe they can contribute towards the care of patients with skin diseases.