Contemporary trends in anaphylaxis burden and healthcare utilisation in Western Australia: A linked data study.

Background: Anaphylaxis is a growing public health problem in Australia. To determine the extent of the problem, we linked multiple health datasets to examine temporal trends in anaphylaxis events across the health system in Western Australia (WA). Methods: We identified an anaphylaxis cohort from 1980 to 2020 using linked datasets from ambulance, emergency departments, hospital inpatients and deaths. Age-standardised anaphylaxis event rates were calculated from 2010 to 2020. Dataset-specific rates for anaphylaxis were also examined, to show differences in health care utilisation. Annual percent change in rates (2010-2019) were estimated using age-adjusted Poisson regression models. Results: A total of 19 140 individuals (mean age 31 years; 51% female) experienced 24 239 anaphylaxis events between 2010 and 2020. From 2010 to 2019, the average annual percent increase (95% CI) in rates was 5.3% (4.8-5.8%), from 70.3 to 113.9, with rates reducing to 76.5/100 000 population in 2020. Adolescents and young adults aged 5-14 years and 15-24 years had the greatest increase of 6.9% (5.6-8.1%) and 6.8% (5.6-8.0) respectively, with those over 25 years increasing by approximately 5% per year and children 1-4 years showing the lowest annual increase of 2.6% (1.1-4.2%). The highest absolute rates were seen in under 1 year (269.7/100 000; 2019). There has been an acceleration of trends from 2015 to 2019, underpinned by large increases in 15-24 and 25-34 years. All databases, show similar increasing trends, with ambulance attendance (33.7 per 100 000), emergency presentation (89.8 per 100 000) and hospital admissions (46.2 per 100 000), for anaphylaxis highest in 2019. However, whilst ambulance and emergency presentations have grown by 8.9% (95%CI 7.9-9.8%) and 6.6% per year (95%CI 6.0-7.2%), respectively, hospitalisations appear to be steadying with only a 0.9% (95%CI 0.2-1.6%) yearly rise. Conclusion: Rates of anaphylaxis continue to increase, with WA having higher rates than previous estimates for Australia. Whilst rates are still high in infants, lower trends in children compared to older ages may indicate better prevention of allergy. Results show more people experiencing anaphylaxis now receive care in emergency and ambulance, rather than hospital. Further exploration of the patient care journey through prehospital and inpatient care is required, to understand the changing health demands of people who experience anaphylaxis.

Overview of registries for anaphylaxis: a scoping review.

OBJECTIVE: This review aimed to describe the scope and operational features of anaphylaxis registries, and to assess their contribution to improving knowledge of anaphylaxis and care of patients who experience anaphylaxis by measuring their research output. INTRODUCTION: Structured data collection and reporting systems, such as registries, are needed to better understand the burden of anaphylaxis and to protect the growing number of patients with severe allergy. There is a need to characterize current anaphylaxis registries to identify their value in anaphylaxis surveillance, management, and research. Information synthesized in this review will provide knowledge on benefits and gaps in current registries, which may inform the implementation and global standardization of future anaphylaxis reporting systems. INCLUSION CRITERIA: This scoping review considered literature describing registries worldwide that enroll patients who have experienced anaphylaxis. Published and gray literature sources were included if they described the scope and operational features of anaphylaxis registries. METHODS: This review followed the JBI methodology for scoping reviews. Embase, MEDLINE, Scopus, and CINAHL were searched for relevant articles. Identified keywords and index terms were adapted for searches of gray literature sources, using Google advanced search functions. Only full-text studies in English were considered for inclusion. Two independent reviewers conducted title and abstract screening and those that did not meet the inclusion criteria were excluded. The full text of potentially relevant articles were retrieved; full-text screening and data extraction were also conducted by two independent reviewers. Any discrepancies were resolved through discussion or with a third reviewer. Tables and a narrative summary were used to describe and compare the scope and features (eg, inclusion criteria, patient demographics, clinical symptoms) of the identified anaphylaxis registries, and to outline their output to assess their contribution to research and clinical practice for anaphylaxis. RESULTS: A total of 77 full-text publications and eight gray literature sources were used to extract data. The literature search identified 19 anaphylaxis registries, with sites in 28 countries including Europe, the United Kingdom, Canada, the United States, Korea, and Australia. The main purposes of the identified registries were to collect clinical data for research; provide clinical support tools to improve patient care; and operate as allergen surveillance systems to protect the wider community with allergies. Differences in inclusion and health care settings exist, with 11 collecting data on anaphylaxis of any cause, two on food reactions alone, three on fatal anaphylaxis, one on perioperative anaphylaxis, and two on allergic reactions (including anaphylaxis). Five registries enroll cases in allergy centers, five in hospital settings, one in schools, and others target a combination of general practitioners, specialists in emergency departments, and other relevant hospital departments and allergy outpatient clinics. Only three registries operate under a mandatory framework. A total of 57 publications were considered research outputs from registries. All registries except two have published studies from collected data, with the greatest number of articles published from 2019 to the present. Publications mostly addressed questions regarding demographic profile, causes and cofactors, severity, fatal reactions, and gaps in management. CONCLUSIONS: This review demonstrated that anaphylaxis registries differ in their scope and operation, having been established for different purposes. Importantly, registries have contributed significantly to research, which has highlighted gaps in anaphylaxis management, provoking allergens, and informed targets for prevention for severe and fatal events. Beyond this, registries relay information about anaphylaxis to clinicians and regulatory bodies to improve patient care and protect the community. The ability to link registry data with other health datasets, standardization of data across registries, and incorporation of clinical care indicators to promote quality health care across the health system represent important targets for future systems.

Exploring stakeholder roles in medication management for people living with dementia.

BACKGROUND: Therapeutic decision making, prescribing, administering and managing medications can be difficult for people with dementia. OBJECTIVES: To explore stakeholder roles in medication management for people with dementia, including barriers and enablers to achieving those roles. METHODS: Focus groups were held with stakeholders (consumers, general practitioners, nurses and pharmacists) from both rural and metropolitan communities in two Australian states. Focus groups were audio-recorded, transcribed and thematically analysed using an inductive approach. RESULTS: Nine focus groups were held with 55 participants. Four major themes were identified: supporting the role of the person with dementia, carer roles and challenges, health professional roles, and process and structure barriers to medication management. Stakeholders discussed the importance of advance care planning, and the potential benefits of early implementation of dose administration aids to support patients in self-managing their medication. Carers were seen to have a vital role as patient advocates, but carer burden and changes in the patient-carer roles acted as barriers to this role. General practitioners were perceived as the main care coordinator for a person with dementia, with effective interprofessional collaboration and communication with allied health professionals and specialists further enabling optimisation of medication use. A lack of evidence, guidelines and practitioner training to guide prescribing and deprescribing decisions in people with dementia were mentioned as barriers to medication management. CONCLUSION: Medication management is increasingly challenging for people with dementia and each stakeholder perceives that they have a different role and faces different barriers and enablers. Future research should focus on improving the evidence base to guide prescribing, facilitating stakeholder communication and ensuring early documentation of patient wishes for the future.

Overview of registries for anaphylaxis: a scoping review protocol.

OBJECTIVE: This review will describe the scope and operational features of global registries for anaphylaxis and assess their contribution to improving knowledge and care of anaphylaxis by measuring their research output. INTRODUCTION: The incidence of anaphylaxis is increasing around the world. Structured reporting systems, such as patient registries, are needed to better understand the burden of anaphylaxis and protect the growing number of allergic patients. INCLUSION CRITERIA: The concept to be mapped is registries across the world that enroll patients who have experienced anaphylaxis. Published and gray literature sources will be considered if they describe the scope and operational features of anaphylaxis registries. Only full-text studies published in English will be included. There will be no date restriction. METHODS: The JBI methodology for scoping reviews will be followed. Embase, MEDLINE, Scopus, and CINAHL will be searched from inception date for relevant articles. Identified keyword and index terms will be adapted for searches of gray literature sources, using Google advanced search functions. The authors and developers of identified registries will be contacted, where possible, to obtain additional information about the development and structure of systems. Data will be extracted by two independent reviewers. Any discrepancies will be resolved by a third reviewer. Tables and a narrative summary will be used to describe and compare the scope and features of anaphylaxis registries and outline their output to assess their contribution to research, clinical practice, and public health policy for anaphylaxis.

Complementary and alternative medicine beliefs in type 2 diabetes: The Fremantle Diabetes Study Phase II.

Complementary medicine (CM) treatment beliefs of people with type 2 diabetes were assessed using a validated three-domain questionnaire. Belief in holistic health, but not natural treatments or participation in treatment, was independently associated with CM use (P = 0.003). Strong holistic health beliefs could identify present/future CM use, with potential management implications.

Complementary medicine use and its cost in Australians with type 2 diabetes: the Fremantle Diabetes Study Phase II.

BACKGROUND: Few studies have examined complementary medicine (CM) use in diabetes. Australian data are inconsistent, limited in scope and have not considered cost. AIMS: To evaluate the prevalence, associates and costs of CM in a contemporary Australian urban, community-based cohort of people with type 2 diabetes. METHODS: Baseline CM use was determined as part of a detailed assessment in 1543 of 1551 Fremantle Diabetes Study Phase II (FDS2) participants with type 2 diabetes (mean age 65.7 years, 51.8% males, median diabetes duration 9.0 years) recruited to the FDS2 between 2008 and 2011 who self-reported medication use including CM defined as non-prescription medicinal products. RESULTS: A total of 672 FDS2 type 2 participants (43.6%) used at least one type of CM, 92% of which were nutritional supplements (omega-3 fatty acids/fish oil in 24% of CM users followed by calcium in 11%, glucosamine in 10% and others in <10%). Independent associates of CM use included older age, female sex, any mobility problem, and, inversely, Southern European or Indigenous Australian background, lack of English fluency, ex/current smoking status, taking oral glucose-lowering medications and higher HbA1c . The total annual estimated cost of CM used by FDS2 participants with type 2 diabetes was A$121 640 or A$79 ± 208 per person (range A$0-2993). Extrapolating these data, the 1 million Australians with type 2 diabetes spend A$79 million/year on CM. CONCLUSIONS: CM use in type 2 diabetes is both common and costly. Healthcare professionals should consider discussing safe and cost-effective use of CM with their patients with type 2 diabetes.

The provision of advice by pharmacy staff in eastern Indonesian community pharmacies.

BACKGROUND: Indonesian community pharmacies hold a strategic position from which to promote the rational use of medicines by providing appropriate advice for patients requesting self-medication. To date, published studies related to the provision of advice in Indonesian community pharmacies are limited and have been conducted only in more developed western Indonesia. No studies have been undertaken in eastern Indonesia, which is less developed than and culturally different from the western region. OBJECTIVES: This paper aims to: (1) describe the types and amount of advice provided by pharmacy staff for three scenarios in a patient simulation study and for two scenarios in pharmacy staff interviews; and (2) ascertain the frequency of appropriate advice given in response to the scenarios. METHODS: A patient simulation study was conducted at community pharmacies in an eastern Indonesian provincial capital. Four weeks after completing a patient simulation study, structured interviews with pharmacy staff were conducted. Two cough scenarios and one diarrhoea scenario were developed for the patient simulation study. Meanwhile, two scenarios (an ACE inhibitor-induced cough and a common cough and cold) were developed for pharmacy staff interviews. The types and amount of advice provided by pharmacy staff were recorded on paper and assessed for its appropriateness. The determination of appropriate advice was based on the literature and by consensus of two Indonesian experts. RESULTS: In patient simulation, the most common type of advice provided in all scenarios was product recommendations. In interviews, medical referrals and recommending cough and cold medicine were the most common types of advice provided for ACE inhibitor-induced cough and common cough and cold scenarios respectively. Appropriate advice was provided in less than 0.5% in the patient simulation study, but two-third of participants in the interviews responded to the scenarios appropriately. CONCLUSIONS: Pharmacy staff did not provide appropriate advice in practice, although they may have adequate knowledge. A contributing factor was insufficient information gathered in patient encounters. Optimising information-gathering practice by pharmacy staff is needed.

A Theory Based Intervention to Enhance Information Exchange during Over-The-Counter Consultations in Community Pharmacy: A Feasibility Study.

Background: Management of minor ailments through self-care and self-medication brings both benefits and risks that can be mitigated if consumers and pharmacy personnel engage in information exchange during over-the-counter (OTC) consultations. Objective: Explore the feasibility of interventions using situational cues to promote information exchange between pharmacy personnel and consumers, during OTC consultations. Methods: Intervention tools were developed prior to conducting the study, in two community pharmacies in Perth, Western Australia. The situational cues included two posters and individual position badges. Data were collected from audio-recording OTC consultations, consumer questionnaires and interviews, and pharmacy personnel interviews. Results: Space required for posters and for researchers conducting interviews was challenging in the retail environment. Pharmacy personnel perceived that the badges positively impacted -consumers' ability to identify the position of personnel they engaged with. Data collection methods were deemed practical and acceptable. Conclusions: The proposed interventions and evaluation methods were feasible. The use of posters and badges as situational cues to address the barriers to information exchange during OTC consultations was found to be practical, in a community pharmacy setting. There is potential to use situational cues to address other barriers identified to information exchange, to add to the effectiveness of the intervention. With growing emphasis on self-care and self-medication, effective interventions are necessary to promote information exchange to enhance appropriate management in community pharmacies.

The provision of advice by pharmacy staff in eastern Indonesian community pharmacies

Background: Indonesian community pharmacies hold a strategic position from which to promote the rational use of medicines by providing appropriate advice for patients requesting self-medication. To date, published studies related to the provision of advice in Indonesian community pharmacies are limited and have been conducted only in more developed western Indonesia. No studies have been undertaken in eastern Indonesia, which is less developed than and culturally different from the western region. Objectives: This paper aims to: (1) describe the types and amount of advice provided by pharmacy staff for three scenarios in a patient simulation study and for two scenarios in pharmacy staff interviews; and (2) ascertain the frequency of appropriate advice given in response to the scenarios. Methods: A patient simulation study was conducted at community pharmacies in an eastern Indonesian provincial capital. Four weeks after completing a patient simulation study, structured interviews with pharmacy staff were conducted. Two cough scenarios and one diarrhoea scenario were developed for the patient simulation study. Meanwhile, two scenarios (an ACE inhibitor-induced cough and a common cough and cold) were developed for pharmacy staff interviews. The types and amount of advice provided by pharmacy staff were recorded on paper and assessed for its appropriateness. The determination of appropriate advice was based on the literature and by consensus of two Indonesian experts. Results: In patient simulation, the most common type of advice provided in all scenarios was product recommendations. In interviews, medical referrals and recommending cough and cold medicine were the most common types of advice provided for ACE inhibitor-induced cough and common cough and cold scenarios respectively. Appropriate advice was provided in less than 0.5% in the patient simulation study, but two-third of participants in the interviews responded to the scenarios appropriately. Conclusions: Pharmacy staff did not provide appropriate advice in practice, although they may have adequate knowledge. A contributing factor was insufficient information gathered in patient encounters. Optimising information-gathering practice by pharmacy staff is needed

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Development of a Theory-Based Intervention to Enhance Information Exchange during Over-The-Counter Consultations in Community Pharmacy.

(1) Background: Community pharmacy personnel help mitigate risks of self-care by consumers who seek over-the-counter (OTC) medicines or treatment of symptoms and/or conditions. Exchange of information facilitates the OTC consultation, but pharmacy personnel often report difficulties in engaging consumers in a dialogue. The aim of this study was to describe the development of a behaviour change intervention to enhance information exchange between pharmacy personnel and consumers during OTC consultations in community pharmacies. (2) Methods: The Behaviour Change Wheel methodological framework was used to link factors that influence consumer engagement with information exchange during OTC consultations with intervention functions to change behaviour. Options generated were rationalized and the final intervention strategy was derived. (3) Results: Education, persuasion, environmental restructuring, and modelling were determined to be potential intervention functions. The intervention incorporated placing situational cues in the form of posters in the community pharmacy modelling information exchange behaviour, persuading through highlighting the benefits of exchanging information and educating about its importance. (4) Conclusions: A systematic, theoretically underpinned approach was applied to develop candidate interventions to promote information exchange in OTC consultations. The feasibility and efficacy of the intervention strategy has since been tested and will be reported elsewhere.

Interventions to enhance effective communication during over-the-counter consultations in the community pharmacy setting: A systematic review.

BACKGROUND: Easy access to effective over-the-counter (OTC) treatments allows self-management of some conditions, however inappropriate or incorrect supply or use of OTC medicines can cause harm. Pharmacy personnel should support consumers in their health-seeking behaviour by utilising effective communication skills underpinned by clinical knowledge. OBJECTIVE: To identify interventions targeted towards improving communication between consumers and pharmacy personnel during OTC consultations in the community pharmacy setting. METHODS: Systematic review and narrative analysis. Databases searched were MEDLINE, EMBASE, Psycinfo, Cochrane Central Register and Cochrane Database of Systematic Reviews for literature published between 2000 and 30 October 2014, as well as reference lists of included articles. The search was re-run on 18 January 2016 and 25 September 2017 to maximise the currency. Two reviewers independently screened retrieved articles for inclusion, assessed study quality and extracted data. Full publications of intervention studies were included. Participants were community pharmacy personnel and/or consumers involved in OTC consultations. Interventions which aimed to improve communication during OTC consultations in the community pharmacy setting were included if they involved a direct measurable communication outcome. Studies reporting attitudes and measures not quantifiable were excluded. The protocol was published on Prospero Database of Systematic Reviews. RESULTS: Of 4978 records identified, 11 studies met inclusion criteria. Interventions evaluated were: face-to-face training sessions (n = 10); role-plays (n = 9); a software decision making program (n = 1); and simulated patient (SP) visits followed by immediate feedback (n = 1). Outcomes were measured using: SP methodology (n = 10) and a survey (n = 1), with most (n = 10) reporting a level of improvement in some communication behaviours. CONCLUSION: Empirical evaluation of interventions using active learning techniques such as face-to-face training with role-play can improve some communication skills. However interventions that are not fully described limit the ability for replication and/or generalisability. This review identified interventions targeting pharmacy personnel. Future interventions to improve communication should consider the consumer's role in OTC consultations.

Barriers and Facilitators for Information Exchange during Over-The-Counter Consultations in Community Pharmacy: A Focus Group Study.

Consumers are confident managing minor ailments through self-care, often self-medicating from a range of over-the-counter (OTC) medicines available from community pharmacies. To minimise risks, pharmacy personnel endeavour to engage in a consultation when consumers present with OTC enquiries however they find consumers resistant. The aim was to determine stakeholder perspectives regarding barriers and facilitators for information exchange during OTC consultations in community pharmacies and to understand the elicited themes in behavioural terms. Focus groups were undertaken with community pharmacist, pharmacy assistant and consumer participants. Independent duplicate analysis of transcription data was conducted using inductive and framework methods. Eight focus groups involving 60 participants were conducted. Themes that emerged indicated consumers did not understand pharmacists' professional role, they were less likely to exchange information if asking for a specific product than if asking about symptom treatment, and they wanted privacy. Consumers were confident to self-diagnose and did not understand OTC medicine risks. Pharmacy personnel felt a duty of care to ensure consumer safety, and that with experience communication skills developed to better engage consumers in consultations. They also identified the need for privacy. Consumers need education about community pharmacists' role and responsibilities to motivate them to engage in OTC consultations. They also require privacy when doing so.

Factors influencing the current practice of self-medication consultations in Eastern Indonesian community pharmacies: a qualitative study.

BACKGROUND: Research has shown that the current practice of pharmacy staff when providing self-medication consultations in Indonesia is suboptimal. To improve the performance of pharmacy staff when providing self-medication consultations in community pharmacies, the factors that influence current practice need to be understood. The aim of this study is to identify the factors that influence current practice of pharmacy staff when handling self-medication consultations in Eastern Indonesian community pharmacies. METHODS: Fifteen in-depth interviews were conducted with pharmacists, pharmacy technicians, pharmacy owners, and counter attendants. Thematic analysis was used to generate findings. RESULTS: The current practice of pharmacy staff when handling self-medication consultations is directly influenced by the professionalism of pharmacy staff and patient responses to the consultations. These factors are in turn affected by the organisational context of the pharmacy and the external pharmacy environment. The organisational context of the pharmacy includes staffing, staff affordability, and the availability of time and facilities in which to provide consultations. The external pharmacy environment includes the number of trained pharmacy staff in the research setting, the relevance of pharmacy education to the needs of pharmacy practice, the support offered by the Indonesian Pharmacists Association, a competitive business environment, and the policy environment. CONCLUSION: Complex and inter-related factors influence the current practice of pharmacy staff when providing self-medication consultations in community pharmacies in this research setting. Multiple strategies will be required to improve consultation practices.

The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis.

AIMS: Deprescribing is a suggested intervention to reverse the potential iatrogenic harms of inappropriate polypharmacy. The review aimed to determine whether or not deprescribing is a safe, effective and feasible intervention to modify mortality and health outcomes in older adults. METHODS: Specified databases were searched from inception to February 2015. Two researchers independently screened all retrieved articles for inclusion, assessed study quality and extracted data. Data were pooled using RevMan v5.3. Eligible studies included those where older adults had at least one medication deprescribed. The primary outcome was mortality. Secondary outcomes were adverse drug withdrawal events, psychological and physical health outcomes, quality of life, and medication usage (e.g. successful deprescribing, number of medications prescribed, potentially inappropriate medication use). RESULTS: A total of 132 papers met the inclusion criteria, which included 34 143 participants aged 73.8 ± 5.4 years. In nonrandomized studies, deprescribing polypharmacy was shown to significantly decrease mortality (OR 0.32, 95% CI: 0.17-0.60). However, this was not statistically significant in the randomized studies (OR 0.82, 95% CI 0.61-1.11). Subgroup analysis revealed patient-specific interventions to deprescribe demonstrated a significant reduction in mortality (OR 0.62, 95% CI 0.43-0.88). However, generalized educational programmes did not change mortality (OR 1.21, 95% CI 0.86-1.69). CONCLUSIONS: Although nonrandomized data suggested that deprescribing reduces mortality, deprescribing was not shown to alter mortality in randomized studies. Mortality was significantly reduced when applying patient-specific interventions to deprescribe in randomized studies.

Deprescribing in frail older people--Do doctors and pharmacists agree?

BACKGROUND: Deprescribing may reduce harmful polypharmacy in older people and is an accepted clinical practice; however, data to guide deprescribing decisions are scarce. OBJECTIVES: This study aimed to determine if physicians and pharmacists agree on medicines to deprescribe. METHODS: Two physicians and two pharmacists independently applied a deprescribing decision-making aid to clinical and medicines data collected during a deprescribing trial of frail older people in four residential aged care facilities. The consensus list of medicines selected for deprescribing by the physicians was compared with the consensus list selected by the pharmacists. Lin's concordance correlation coefficient (CCC) was used to assess agreement in the number of medicines, and agreement on each specific medicine was assessed using the level 2 intra-cluster correlation (ICC) for medicine within patient. RESULTS: Physicians and pharmacists had substantial agreement on the number of medicines to deprescribe (CCC = 0.70; 95% CI: 0.58, 0.82), with a difference of 1.8 ± 2.0 total targeted medicines. For specific medicines, the agreement was moderate (ICC = 0.45, 95% CI: 0.32, 0.58). When considering only orally administered medicines, physicians and pharmacists had substantial agreement (CCC = 0.73; 95% CI: 0.61, 0.84) in the number of medicines, but only moderate agreement for the specific medicines (ICC = 0.44, 95% CI: 0.30, 0.59). CONCLUSIONS: Physicians and pharmacists had substantial agreement in the number of medicines they targeted to deprescribe and to continue, but physicians targeted a greater number of medicines for deprescribing than pharmacists. However, they had only moderate agreement in the specific medicines to deprescribe. This suggests that the deprescribing decision-making aid is a useful tool for health professionals to use when considering medicines to deprescribe.

Development of the My Medicines and Me (M3Q) side effect questionnaire for mental health patients: a qualitative study.

OBJECTIVE: The objective of this study was to assess the acceptability, content validity and usability of the My Medicines and Me (M3Q) self-report side effect questionnaire. METHODS: Eight focus groups consisting of mental health patients, carers, general practitioners, psychiatrists, mental health nurses and pharmacists were conducted, involving 78 participants. Two researchers independently examined the transcriptions and analysed the data thematically using an inductive method. RESULTS: The findings supported changes to the formatting, length and phrasing of questions in the original version of the questionnaire. Although the groups provided differing views on the usability of the M3Q in clinical practice, the patient and carer groups were unconditionally in favour of such a tool to be used systematically to describe patients' subjective experiences with side effects. CONCLUSION: The differing contribution made by all groups involved in the administration and completion of the M3Q assisted with content validity of the questionnaire. The acceptability and usability of this novel side effect questionnaire was also explored, with many participants agreeing it was a necessary tool for a patient centred approach to treatment. Following implementation of the changes to the current format of the questionnaire, investigation into the uptake and use in clinical practice should be carried out.

Construction and validation of the My Medicines and Me Questionnaire for assessment of the self-reported side effects of psychotropic medication.

We aimed to construct and assess the psychometric properties of the My Medicines and Me Questionnaire (M3Q), a self-report side-effect questionnaire for mental health patients. Thirty individuals taking a psychotropic medication completed the M3Q side-effect checklist along with the Liverpool University Neuroleptic Side Effect Rating Scale. Thirty healthy comparison individuals also completed the M3Q checklist. Data were analyzed using factorial analysis. Psychometric evaluations including validity and reliability testing were carried out on the questionnaire's checklist. The original 54-item checklist of the M3Q was shortened to include only those items found to be significant in the factorial analysis. The revised 32-item checklist of the M3Q was found to be valid and reliable. The M3Q is a simple, valid and reliable questionnaire that can be used routinely in clinical practice for detecting bothersome side effects of a range of psychotropic medications. This will provide a platform for improved communication between the clinician and the patient.

Information-gathering for self-medication via Eastern Indonesian community pharmacies: a cross-sectional study.

BACKGROUND: Gathering sufficient information when handling self-medication requests in community pharmacies is an important factor in assisting patients to obtain appropriate health outcomes. Common types of information usually gathered include patient identity, signs and symptoms, action taken, medical history, and current medications being used. The aims of the study were (1) to describe the types and amount of information gathered by Eastern Indonesian community pharmacy staff when handling self-medication requests, and (2) to identify factors associated with the reported amount of information gathered. METHODS: Patient simulation and pharmacy staff interviews were used. First, patient simulation was conducted using 2 cough scenarios and 1 diarrhoea scenario. Second, a structured interview was administered to eligible pharmacy staff in the setting. The types and amount of information gathered during patient simulation encounters and reported during pharmacy staff interviews were noted. A regression analysis was performed to identify factors associated with the amount of information gathered from the interview data. RESULTS: The most frequent types of information gathered in patient simulation encounters were the nature of symptoms (88% in one of the cough scenarios) and patient identity (96% in the diarrhoea scenario). Other types of information were gathered in <40% of encounters in each scenario. From the pharmacy staff interviews, >90% of the 173 interviewees reported that they gathered information on patient identity, nature of symptoms, and associated symptoms. Information on medical history and medication used was gathered by 20% and 26% respectively of the 173 interviewees. The majority of pharmacy staff asked 0 to 2 questions in the patient simulation encounters compared to 5 questions pharmacy staff reported as their usual practice during the interviews. Being qualified as a pharmacist or a pharmacy technician was one of the factors positively associated with the reported amount of information gathered. CONCLUSION: There were deficits in the types of information gathered when pharmacy staff handling self-medication requests. Having a pharmacy educational background and additional work experience in the pharmacy was positively associated with the reported amount of information gathered. There could be other factors contributing to shortcomings in the actual practice which need to be explored.

A review of the provision of appropriate advice by pharmacy staff for self-medication in developing countries.

BACKGROUND: Patients in developing countries often prefer to self-medicate via community pharmacies. Pharmacy staff are therefore in a strategic position to optimize the health of the public by providing appropriate advice to patients who self-medicate. OBJECTIVE: To determine the proportion of pharmacy staff who provide appropriate advice when handling self-medication requests in developing countries. METHOD: A literature search was undertaken via MEDLINE, EMBASE, CINAHL Plus, Web of Science and International Pharmaceutical Abstracts. Studies that reported on the proportion of pharmacy staff providing appropriate advice when handling self-medication requests in developing countries were included. The appropriateness of advice was determined by each author's definition in the original studies. RESULTS: Twenty-eight studies met the inclusion criteria. There were variations in methods, scenarios, how the authors reported and defined appropriate advice, and study populations. The proportion of pharmacy staff providing appropriate advice varied widely from 0% to 96%, with a minority providing appropriate advice in 83% of the scenarios performed. CONCLUSION: There was considerable variation in results, with the majority of studies reporting that inappropriate advice was provided by pharmacy staff when handling self-medication requests in developing countries. Consistent and robust methods are required to provide comparisons across practice settings. There is also a need to identify contributing factors to poor provision of advice for developing intervention strategies for practice improvement.

Demonstration of epinephrine autoinjectors (EpiPen and Anapen) by pharmacists in a randomised, simulated patient assessment: acceptable, but room for improvement.

BACKGROUND: Successful treatment of anaphylaxis in the community relies on early and correct use of epinephrine autoinjectors. Community pharmacists supply these devices and have a crucial role teaching patients how to use them. Supply of epinephrine autoinjectors in Australia increased 70-fold in the past decade. New EpiPen and Anapen autoinjectors were launched in Australia in 2011 and 2012, with the potential to cause confusion. However there is no information about how pharmacists demonstrate epinephrine autoinjectors to patients. Therefore the aim of this study was to assess real-world community pharmacist demonstrations of EpiPen and Anapen. We also sought to identify consultation-based predictors of accurate demonstration. METHODS: Demonstration accuracy was assessed in simulated patient visits to 300 randomly selected pharmacies. Pharmacists were asked by the simulated patient how to use original EpiPen, new-look EpiPen or Anapen, and assessed against the relevant Australasian Society of Clinical Immunology and Allergy (ASCIA) Action Plan for Anaphylaxis. Other anaphylaxis advice provided by the pharmacist was also recorded. Accuracy was analysed descriptively. Binary logistic regression was used to identify predictors of accurate demonstration. RESULTS: All 300 pharmacies were visited. Of 250 pharmacist demonstrations, 46 (18.4%) accurately demonstrated all four steps on ASCIA Action Plan. Failure to state 'do not touch the needle' (74.8%) or 'massage injection site' (68.8%) reduced accuracy. However 163 (65.2%) accurately demonstrated the three steps required to inject epinephrine (no difference by device, p = 0.15). Associations with accurate demonstration were: checking if the patient had an anaphylaxis action plan (odds ratio, OR = 16.1; 95% CI: 3.86-67.3); stating to call an ambulance after use (OR = 4.0; 95% CI: 1.44-11.1); or explaining side effects of epinephrine (OR = 4.5; 95% CI: 1.48-13.4). CONCLUSIONS: It is critical that anaphylaxis patients know how to use their prescribed epinephrine autoinjector correctly. Pharmacists have acceptable rates of EpiPen and Anapen demonstration accuracy, although more is needed to improve this. Those who pay attention to the need for action plans, emergency care after epinephrine use, and informing patients about the side effects of epinephrine may have better knowledge about anaphylaxis, and in turn significantly improve demonstration accuracy.