To be or not to be: The identity work of pharmacists as clinicians.

This study explores how pharmacists legitimise the expansion of their clinical work and considers its impact on pharmacists' professional identity work. In the context of pharmacy in the English NHS, there has been an ongoing policy shift towards pharmacists moving away from 'medicines supply' to patient-facing, clinical work since the 1950s. Pharmacists are continuously engaging in 'identity work' and 'boundary work' to reflect the expansion of their work, which has led to the argument that pharmacists lack a clear professional identity. Drawing insights from linguistics and specifically Van Leeuwen's 'grammar of legitimation', this study explains how the Pharmacy Integration Fund, a nationally funded learning programme, provides the discursive strategies for pharmacists to legitimise their identity work as clinicians.

Preparing pharmacists for the Community Pharmacist Consultation Service: a questionnaire survey.

OBJECTIVES: The Community Pharmacist Consultation Service launched in England in 2019. Patients requiring urgent care were referred from National Health Service-based telephone/digital triage or general practice to a community pharmacist, who provided a consultation, which could include a physical examination. The aim of the study was to evaluate the effectiveness of a learning programme to prepare community pharmacists for the service. METHODS: Learning programme participants were invited to complete an online survey shortly after the workshop and another survey 3 months later. The survey collected opinions on aspects of the programme, including Likert-type statements and free text questions. The 3-month follow-up survey explored how the programme had helped pharmacists change their practice. Data were analysed in SPSS (v.25; IBM) with inferential statistics used to compare subgroups. Open comments were analysed qualitatively. KEY FINDINGS: The learning programme addressed participants' learning needs including history-taking, clinically observing the patient, performing physical examinations, structuring a consultation, safety-netting, and documenting consultations. Barriers to using skills acquired included low service uptake and a lack of equipment to perform physical examinations. While many participants recognised the importance of skills to provide person-centred care, some participants did not appear to recognise the shift in policy to a more clinical role. CONCLUSIONS: The learning programme resulted in increased confidence and a recognition of a shift in the policy vision for community pharmacist roles. Although some pharmacists appeared to embrace this, others have yet to fully appreciate the need to adapt to be ready for the opportunities that this service can provide.

Community Pharmacist Consultation Service: A Survey Exploring Factors Facilitating or Hindering Community Pharmacists' Ability to Apply Learnt Skills in Practice.

BACKGROUND: The NHS Community Pharmacist Consultation Service (CPCS) offers patients requiring urgent care a consultation with a community pharmacist, following referral from general practice or urgent care. The study explored the impact of undertaking a Centre for Pharmacy Postgraduate Education (CPPE) CPCS learning programme, and barriers and enablers to CPCS delivery. METHODS: CPPE distributed an online survey to those who had undertaken their CPCS learning. The survey explored participants' knowledge, confidence and application of taught skills/tools, including clinical history-taking, clinical assessment, record keeping, transfer of care, and Calgary-Cambridge, L(ICE)F and SBARD communication tools. Details on barriers and enablers to CPCS delivery were also included. RESULTS: One-hundred-and-fifty-nine responses were received (response rate 5.6%). Knowledge of, and confidence in, taught skills were high and respondents reported applying skills in CPCS consultations and wider practice. Barriers to CPCS included a lack of general practice referrals, staffing levels, workload, and GP attitudes. Enablers included a clear understanding of what was expected, minimal concerns over indemnity cover and privacy, and positive patient attitudes towards pharmacy. CONCLUSION: This study demonstrates that community pharmacists can extend their practice and contribute to the enhanced provision of urgent care in England. This study identified barriers, both interpersonal and infrastructural, that may hinder service implementation.

Contribution of supervision to the development of advanced practitioners: a qualitative study of pharmacy learners' and supervisors' views.

OBJECTIVE: To apply educational theory to explore how supervision can contribute to the development of advanced practitioners using the example of several postregistration primary care training pathways for pharmacy professionals (pharmacists and pharmacy technicians). DESIGN: Qualitative semistructured telephone interviews applying Billet's theory of workplace pedagogy for interpretation. SETTING: England. PARTICIPANTS: Fifty-one learners and ten supervisors. PRIMARY OUTCOME: Contribution of clinical and educational supervision to the development of advanced practitioners in primary care. RESULTS: Findings were mapped against the components of Billet's theory to provide insights into the role of supervision in developing advanced practitioners. Key elements for effective supervision included supporting learners to identify their learning needs (educational supervision), guiding learners in everyday work activities (clinical supervision), and combination of regular prearranged face-to-face meetings and ad hoc contact when needed (clinical supervision), along with ongoing support as learners progressed through a learning pathway (educational supervision). Clinical supervisors supported learners in developing proficiency and confidence in translating and applying the knowledge and skills they were gaining into practice. Learners benefited from having clinical supervisors in the workplace with good understanding and experience of working in the setting, as well as receiving clinical supervision from different types of healthcare professionals. Educational supervisors supported learners to identify their learning needs and the requirements of the learning pathway, and then as an ongoing available source of support as they progressed through a pathway. Educational supervisors also filled in some of the gaps where there was a lack of local clinical supervision and in settings like community pharmacy where pharmacist learners did not have access to any clinical supervision. CONCLUSIONS: This study drew out important elements which contributed to effective supervision of pharmacy advanced practitioners. Findings can inform the education and training of advanced practitioners from different professions to support healthcare workforce development in different healthcare settings.

"A little bit more looking listening and feeling" A qualitative interview study exploring advanced clinical practice in primary care and community pharmacy.

Background Growing demands on healthcare globally, combined with workforce shortages, have led to greater skill mix in healthcare settings. Pharmacists are increasingly moving into complex areas of practice, a move supported by policy and education/training changes. Aim To understand the nature of extended roles for pharmacists practising at an advanced level in primary care and community pharmacy settings, to explore how clinical and physical examination was incorporated into practice and to understand the impact of providing such examination on practice and on patient relationships. Method Telephone interviews (N = 15) were conducted with a purposive sample of pharmacists using clinical and physical examination in their practice in Great Britain. The sample included primary care pharmacists (N = 5), community pharmacists (N = 4), pharmacists working across settings (N = 5) and one working in another primary care setting. Participants were recruited through professional networks, social media and snowballing. Results Primary care pharmacists and community pharmacists were utilising clinical and physical examination skills in their practice. Some community pharmacists were operating locally-commissioned services for low acuity conditions. Incorporating such examinations into practice enabled pharmacists to look at the patient holistically and enhanced pharmacist/patient relationships. Barriers to practise included lack of timely sharing of patient data and perceived reluctance on the part of some pharmacists for advanced practice. Conclusion With growing opportunities to provide patient-focussed care, it remains to be seen whether pharmacists, both in Great Britain and elsewhere, are able to overcome some of the organisational, structural and cultural barriers to advanced practice that currently exist in community pharmacy.

Supporting patients with long-term conditions in the community: Evaluation of the Greater Manchester Community Pharmacy Care Plan Service.

The Greater Manchester Community Pharmacy Care Plan (GMCPCP) service provided tailored care plans to help adults with one or more qualifying long-term condition (hypertension, asthma, diabetes and COPD) to achieve health goals and better self-management of their long-term conditions. The service ran between February and December 2017. The aim of this study was to investigate the impact of the service on patient activation, as measured by the PAM measure (primary outcome). Secondary outcomes included quality of life (EQ-5D-5L, EQ-VAS), medication adherence (MARS-5), NHS resource use and costs, systolic and diastolic blood pressure, HDL cholesterol ratio levels and body mass index (BMI). A before and after design was used, with follow-up at 6-months. A questionnaire was distributed at follow-up and telephone interviews with willing participants were used to investigate patient satisfaction with the service. The study was approved by the University of Manchester Research Ethics Committee. Quantitative data were analysed in SPSS v22 (IBM). A total of 382 patients were recruited to the service; 280 (73%) remained at follow-up. Ten patients were interviewed and 43 completed the questionnaire. A total of 613 goals were set; mean of 1.7 goals per patient. Fifty percent of goals were met at follow-up. There were significant improvements in PAM, EQ-5D-5L and EQ-VAS scores and significant reductions in systolic blood pressure, BMI and HDL cholesterol ratio at follow-up. Mean NHS service use costs were significantly lower at follow-up; with a mean decrease per patient of £236.43 (±SD £968.47). The mean cost per patient for providing the service was £203.10, resulting in potential cost-savings of £33.33 per patient (SD ± 874.65). Questionnaire respondents reported high levels of satisfaction with the service. This study suggests that the service is acceptable to patients and may lead to improvements in health outcomes and allows for modest cost savings. Limitations of the study included the low response rate to the patient questionnaire.

Evaluating the implementation and impact of a pharmacy technician-supported medicines administration service designed to reduce omitted doses in hospitals: a qualitative study.

BACKGROUND: Of the various types of medication administration error that occur in hospitals, dose omissions are consistently reported as among the most common. It has been suggested that greater involvement from pharmacy teams could help address this problem. A pilot service, called pharmacy TECHnician supported MEDicines administration (TECHMED), was introduced in an English NHS hospital for a four-week period in order to reduce preventable medication dose omissions. The objective of this study was to evaluate the implementation, delivery and impact of the pilot TECHMED service using qualitative methods. METHODS: Semi-structured interviews with pharmacy technicians, nursing staff and senior management involved with the pilot service were undertaken to evaluate TECHMED. Interviews were transcribed verbatim and analysed using the framework approach, guided by Weiss's Theory Based Evaluation model. RESULTS: Twenty-two stakeholder interviews were conducted with 10 ward-based pharmacy technicians, nine nurses and three members of senior management. Most technicians performed a range of activities in line with the service specification, including locating drugs from a variety of sources, and identified situations where they had prevented missing doses. Nurses reported positive impacts of TECHMED on workload. However, not all technicians fully adhered to the service specification in regard to directly following nursing staff during each medication round, citing reasons related to productivity or perceived intrusiveness towards nursing staff. Some participants also reported a perceived lack of impact of TECHMED on medicine omissions. Seventeen of the 22 interviewees supported an extension of the service. There were however, concerns about the impact on technician workload and some participants advocated support for targeted service extension to wards/rounds with high schedule dose volumes and omitted dose rates. CONCLUSIONS: The findings of this study suggest that the implementation of a pharmacy technician-supported medicines administration scheme to reduce omitted doses may be acceptable to staff in an NHS hospital, and that issues with service fidelity, staff resource/capacity and perceived interventions to avoid dose omissions have important implications for the feasibility of extending the service. The study has identified targets for future development in relation to individual and system factors to improve operationalisation of technician-led initiatives to reduce medicines omissions.

Independent prescribing in primary care: A survey of patients', prescribers' and colleagues' perceptions and experiences.

Besides doctors and dentists, an increasing range of healthcare professionals, such as nurses, pharmacists and podiatrists, can become independent prescribers (IPs). As part of an evaluation for independent prescribing funded training, this study investigated views and experiences of IPs, their colleagues and patients about independent prescribing within primary care. Questionnaires capturing quantitative and qualitative data were developed for IPs, their colleagues and patients, informed by existing literature and validated instruments. IPs were identified following independent prescribing training funded by Health Education England Northwest in 2015-2017. Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically. Twenty-four patients, 20 IPs and 26 colleagues responded to the questionnaires. Most patient respondents had a long-term medical condition (n = 17) and had regular medicines prescribed (n = 21). IPs were nurses (n = 14), pharmacists (n = 4), one podiatrist (n = 1) and one was unknown. Half of the IPs were current prescribers (n = 10), the other half were still training (to become) IPs (n = 10). Colleague respondents were doctors and nurses (n = 15) other healthcare professionals (n = 8) and practice managers (n = 3). Both current IPs (n = 9) and colleague respondents (n = 25) (strongly) agreed that independent prescribing improved the quality of care provided for patients. Nearly all colleagues were supportive of independent prescribing and believed that they worked well with IPs (n = 25). Patients' perceptions and experiences of their consultations with the IP were mostly positive with the vast majority of respondents (strongly) agreeing that they were very satisfied with their visit to the IP (n = 23). Key barriers and enablers to independent prescribing were centred on IPs' knowledge, competence and organisational factors such as workload, effective teamwork and support from their colleagues. Findings from this study were mainly positive but indicate a need for policy strategies to tackle longstanding barriers to independent prescribing. However, a larger sample size is needed to confirm findings.

Extending the scope of community pharmacists' practice to patients requiring urgent care - An evaluation of a training programme using the Theoretical Domains Framework.

Redesigned health systems could meet the rising demand for healthcare, with community pharmacy currently an underused resource for the treatment and management of patients requiring urgent care. This study aimed to investigate whether a training intervention delivered over 2 days to community pharmacists resulted in behaviour and practice change. Validated measures of psychological motivation and capability factors relevant to understanding behaviour and behaviour change were collected 1 week before, 1 week after and 2 months after training in a non-controlled before and after study design. Two targeted behaviours of the intervention were the primary outcome measures: taking a structured history and applying clinical examination techniques to patients requiring urgent care. Secondary outcomes measured participants' reported patient management behaviours to investigate possible bridging of gaps in the health system. Training was provided in 14 locations in the UK to 258 community pharmacists, with data collection occurring from July 2015 to September 2016. In total, 81 participants completed all three rounds of data collection (31.4%). Findings suggest that 1-week post-training significant changes in psychological capability had taken place, and that these were sustained 2 months later: of the eight domains influencing behaviour and stimulating behaviour change, knowledge, skills, professional role, beliefs about capabilities and goals all increased significantly between T1 and T2, and T1 and T3 (all p < 0.0001). At T3, participants were more likely to have taken a structured history than performed a clinical examination, and reported both managing patients themselves and changing referral practices to other healthcare providers. Participants reported workload and the need for liability insurance as structural and contextual barriers to implementation. While findings suggest the potential to transform models of care through training to extend community pharmacists' practice these barriers to successful implementation of the urgent care service would need to be addressed if this service is rolled out nationally.

Evolution of the general practice pharmacist's role in England: a longitudinal study.

BACKGROUND: To address the growing GP workforce crisis, NHS England (NHSE) launched the Clinical Pharmacists in General Practice scheme in 2015. The NHSE scheme promotes a newer, patient-facing role for pharmacists and, currently, there is little insight into the role and activities undertaken. All scheme pharmacists are enrolled on the general practice pharmacist training pathway (GPPTP). AIM: To investigate the role evolution and integration of clinical pharmacists in general practice in England. DESIGN AND SETTING: Longitudinal survey of all phase 1 GPPTP registrants working in general practice at start of (T1) and 6 months into (T2) training. METHOD: An online longitudinal survey was administered to all phase 1 GPPTP registrants (n = 457) at T1 and T2, measuring their perceived knowledge, skill, and confidence, activities performed, and perceptions of practice integration, environment, and support. Descriptive statistics and non-parametric tests were conducted. RESULTS: Response rates were 46% (T1) and 52% (T2); 158 participants completed both questionnaires. Perceived knowledge, skill, and confidence levels increased significantly from T1 to T2 for all areas, except for managing acute or common illness. Scope of practice increased significantly, particularly in patient-facing activities. Sharing office space with administrative staff was common and 13% of participants reported having no designated work area. Perceived integration at T2 was fairly high (median = 5 on a scale of 1-7) but GP clinical support was 'too little' according to one-third of participants. CONCLUSION: Findings show not only patient-facing role expansion, but also practice environment and support issues. Pharmacists may appreciate more GP time invested in their development. Practices need to be realistic about this support and not expect an immediate reduction in workload.

Foundation year one and year two doctors' prescribing errors: a comparison of their causes.

OBJECTIVE: Junior doctors have the highest rates of prescribing errors, yet no study has set out to understand the differences between completely novice prescribers (Foundation year one (FY1) doctors) and those who have gained some experience (Foundation year two (FY2) doctors). The objective of this study was to uncover the causes of prescribing errors made by FY2 doctors and compare them with previously collected data of the causes of errors made by FY1 doctors. DESIGN: Qualitative interviews, using the critical incident technique, conducted with 19 FY2 doctors on the causes of their prescribing errors and compared with interviews previously conducted with 30 FY1 doctors. Data were analysed using a constant comparison approach after categorisation of the data using Reason's model of accident causation and the London protocol. RESULTS: Common contributory factors in both FY1 and FY2 doctors' prescribing errors included working on call, tiredness and complex patients. Yet, important differences were revealed in terms of application of prescribing knowledge, with FY1 doctors lacking knowledge and FY2 misplacing their knowledge. Due to the rotation of foundation doctors, both groups are faced with novel prescribing contexts, yet the previous experience that FY2 doctors gained led to misplaced confidence when caution would have been expedient. CONCLUSIONS: Differences in the contributory factors of prescribing errors should be taken into account when designing interventions to improve the prescribing of foundation doctors. Furthermore, careful consideration should be taken when inferring expertise in FY2 doctors, who are likely to prescribe in contexts in which their experience is little different to an FY1 doctor.

British pharmacists' work-life balance - is it a problem?

OBJECTIVES: Using a validated tool, the study aimed to explore pharmacists' experiences of maintaining work/life balance in a large, nationally representative sample of pharmacists in Great Britain (GB). METHODS: A two-page postal questionnaire was sent in 2008 to all GB-domiciled pharmacists who were registered with the regulatory body for pharmacy in GB (just over 44 000 pharmacists). Demographic information, work patterns and other employment data were collected and analysed using regression techniques to explore the link between these characteristics and a validated measure of work/life balance. KEY FINDINGS: The response rate to the census was 69.6% (n = 30 517). Eighty-three per cent (n = 25 243) of respondents were working as a pharmacist and were therefore eligible to complete the work/life balance statements. The results reported here relate to 12 364 individuals who had full data for the work/life balance scale and the demographic and work variables. Findings indicate that age, ethnicity, having caring responsibilities, sector of practice, hours of work and type of job are significant predictors of work/life balance problems. CONCLUSIONS: Pharmacy employers and government should recognise the changing demographic characteristics of the profession and consider what support might be available to the workforce to help alleviate work/life balance problems being experienced by certain groups of pharmacists.

Identifying and managing performance concerns in community pharmacists in the UK.

OBJECTIVES: To explore current arrangements for identifying and managing performance concerns in community pharmacists in the UK. METHODS: Semi-structured qualitative telephone interviews were conducted with 20 senior managers from community pharmacies and locum agencies. RESULTS: A strong emphasis was placed on business performance alongside other aspects of professional performance in the identification of performance concerns in pharmacists. The majority of concerns were identified reactively, through customer complaints, peer- or self-referral, or following a dispensing error. Community pharmacies sought to manage performance concerns internally where possible, but only the larger organizations had the infrastructure to provide their own training or other remedial support. Several challenges to identifying and managing performance concerns were identified. There were few mechanisms for identifying and supporting locum pharmacists with performance issues. CONCLUSIONS: Being 'for-profit' organizations, community pharmacies may prioritize business performance over ensuring the professional performance of pharmacists, the responsibility for which would be left to the individual pharmacist. This may be detrimental to the quality of care provided. With the growth of independent sector providers more widely, these findings may have implications for the regulation of other health care professionals' performance.

Factors influencing pharmacist performance: a review of the peer-reviewed literature.

OBJECTIVES: To undertake a review of peer-reviewed literature to explore factors affecting pharmacists' performance. METHODS: The following databases were searched: Medline, Embase, Scopus, ISI Web of Knowledge and PsychInfo. Inclusion criteria were: English language only, published between 1990 and 2010 and published in the United Kingdom (UK), United States of America (USA), Canada, Australia, New Zealand or Europe. RESULTS: The search strategy identified 37 items. The review found that there was some evidence to suggest that pharmacists with certain characteristics (e.g. being male, being of ethnic minority origin, working in community pharmacy and having trained overseas) were more likely to experience performance problems. Factors relating to workload and work environment were associated with performance problems, particularly in relation to errors. There was some limited evidence to suggest that experiencing problems with alcohol or drugs could negatively impact on pharmacists' performance. CONCLUSION: The findings suggest that pharmacist performance may be affected by multiple factors, including personal characteristics such as age, gender, ethnicity, place of primary qualification, factors associated with the workplace and mental and physical health problems. The evidence is not unequivocal and gaps in the literature exist, suggesting that pharmacist performance is an under-researched area.

Workload in community pharmacies in the UK and its impact on patient safety and pharmacists' well-being: a review of the evidence.

New contractual frameworks for community pharmacy are believed to have increased workload for pharmacists; too much work has been implicated in high profile cases of dispensing errors leading to patient harm, and concerns about pharmacists' well-being. A review was undertaken to ascertain whether community pharmacists' workload has increased and whether links between workload and patient safety and pharmacists' well-being have been established. We searched Scopus; EMBASE; MEDLINE; PubMed; CINAHL; PsychINFO; ASSIA; E-pic, and International Pharmaceutical Abstracts for research published between 1989 and 2010 containing data on UK community pharmacy workload, and on its consequences when workload was found to be a determinant of either patient or pharmacist outcomes. Researchers assessed retrieved material against inclusion and exclusion criteria and synthesised findings using a data extraction form. Fifteen studies were retrieved that met the inclusion criteria. A number of methodological weaknesses were identified: studies categorised work tasks and workload differently making comparisons over time or between studies difficult; most studies were small scale or conducted in specific localities, or lacked sufficient methodological information to rule out bias; studies that control for possible confounders are rare. The reviewed research suggests that community pharmacists still spend the majority of their time involved in activities associated with the dispensing of prescriptions. There is some evidence that community pharmacists' workload has increased since the introduction of the new contracts in England and Wales, especially around the core activity of dispensing prescriptions and medicines use reviews. There is also some evidence to suggest a link between heavy workload and aspects of pharmacists' well-being but there is no robust evidence indicating threats to patient safety caused by their having too much work to do. More high quality research is required to examine what constitutes too much work, the impact of high workload, and associations with other work place factors.

Exploring the relationship between pharmacists' job satisfaction, intention to quit the profession, and actual quitting.

BACKGROUND: To date there has been no published research on the link between job satisfaction and intentions to quit the profession among pharmacists. OBJECTIVE: To explore job satisfaction, intentions to quit the profession, and actual quitting among pharmacists on the Royal Pharmaceutical Society of Great Britain Register. METHODS: Job satisfaction of pharmacists was measured as part of a workforce census using a validated satisfaction scale. Pharmacists were asked about their intentions to quit pharmacy within the next 2 years and follow-up was done using secondary analysis to see if they had quit within this timescale. Mean values for the satisfaction scale items were recorded and regression techniques were used to explore factors affecting job satisfaction and intentions to quit. The workforce census questionnaire was completed by 32,181 pharmacists (response rate=76.6%). This article considers the job satisfaction and intentions to quit of pharmacists under state pension age who were working in the community, hospital, and primary care sectors (n=21,889). RESULTS: Overall, pharmacists appeared to be satisfied with their work, although female pharmacists were more satisfied than their male counterparts. Pharmacists working in the community sector were less satisfied than those in other sectors. Remuneration was consistently ranked as 1 of the aspects of their work that pharmacists found least satisfying, regardless of age, sex, or sector of practice. Strength of desire to practice pharmacy was a predictor of both job satisfaction and intentions to quit pharmacy. CONCLUSIONS: Several factors were found to affect pharmacists' intentions to quit the profession including sex, age, job satisfaction, and strength of desire to practice pharmacy. However, only a relatively small proportion of pharmacists who expressed an intention to leave the profession appeared to have done so, suggesting that intentions may not be translated into action in this group of pharmacists.

Balancing the benefits and risks of drug treatment: a stated-preference, discrete choice experiment with patients with psoriasis.

OBJECTIVE: To examine the extent to which the attributes of a treatment affect patients' choice of treatment for psoriasis and the magnitude and nature of trade-offs between risks and benefits of treatment. DESIGN: A questionnaire, including a stated-preference, discrete choice experiment, was used to elicit patients' preferences for the treatment of psoriasis. SETTING: Dermatology clinics in England. PATIENTS: A total of 126 patients with psoriasis. MAIN OUTCOME MEASURES: Preferences of patients for, and trade-offs between, the 6 attributes of time to moderate (50%) improvement, relapse, and risks of experiencing skin irritation, high blood pressure, liver damage, and skin cancer. RESULTS: The mean age of respondents was 47.6 years, and the mean duration of psoriasis was 23 years. All 6 attributes were important factors affecting choice of treatment. The results indicated that patients with psoriasis prioritized low risk of skin cancer (beta = -0.054; P < .01) and liver damage (beta = -0.054; P < .01) and preferred treatment that resulted in a shorter time to achieve a moderate improvement (beta = -0.034; P < .01) over a longer time to relapse (beta = 0.028; P < .01). Patients were most willing to wait longer for a treatment to work if the likelihood of skin cancer or liver damage was reduced. CONCLUSIONS: This study shows that treatment attributes influence patients with psoriasis in their choice of treatment. The results of the discrete choice experiment presented herein indicate that most respondents would be willing to trade between different aspects of treatment to achieve improvements in their psoriasis and minimize the risks of adverse events.

Women's preferences for the provision of emergency hormonal contraception services.

OBJECTIVE: To elicit women's preferences for routes of supply for emergency hormonal contraception (EHC). The objectives were to identify which attributes of services women regard as important and to identify how women trade off reductions in one attribute for an improvement in another. METHOD: A stated preference discrete choice experiment. Women attending sexual health services in a Primary Care Trust in the North West of England were invited to complete a self-completion questionnaire. Each respondent completed a questionnaire containing nine pair-wise choices. Demographic data were also collected. Conditional logit models were used to analyse the data. MAIN OUTCOME MEASURE: Women's preferences for, and trade-offs between, the attributes of opening hours, medical staff seen, cost of EHC, length of wait for an appointment, privacy of consultation and attitude of staff. RESULTS: Two hundred and sixty-nine women attending clinics (mean age 23.8 years, SD+/-8.69) completed the questionnaire. Almost two thirds of the sample had previously used EHC. All six attributes of EHC services were statistically significant factors influencing women's preferences for the supply of EHC. A significant proportion of women indicated on at least one occasion that they would risk pregnancy rather than choose one of the services offered to them. CONCLUSION: These results suggest that the way in which a service is configured and presented to women is likely to influence which service is chosen. In this study, women prioritised visiting a service where they would be treated in a sympathetic and non-judgemental manner. They also prioritised privacy. The results also suggest that if women are dissatisfied with aspects of an EHC service, they may choose not to visit it, thereby risking an unwanted pregnancy.