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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Documentation of pharmaceutical care: development of an intervention oriented classification system.

Background A standardised classification system of pharmaceutical interventions (PI) is in use in several Swiss hospitals, whereas none exists for community pharmacies to date. To promote information exchange between both settings, a compatible structure of the classification system is needed. Objective To develop an intervention oriented classification system for community pharmacies named PharmDISC based on the hospital system; to test it on interrater reliability, appropriateness, interpretability, and face and content validity; to assess pharmacists' opinions. Setting Seventy-seven Swiss community pharmacies. Method Based on previous studies, a modified classification system was developed. Fifth-year pharmacy students (n = 77) received a two-hour training and classified three model PIs with which Fleiss-Kappa coefficients K were calculated to determine interrater reliability. In the community pharmacies, each student consecutively collected ten prescriptions that required a PI. A focus group interview was conducted with pharmacists (n = 9). The anonymised transcript was analysed using thematic analysis. Main outcome measure Number of classified PIs, interrater reliability, pharmacists' opinion/suggestions. Results The classification system includes 5 categories and 52 subcategories. Most of the 725 PIs (94.6%) were completely classified. The PharmDISC system reached an overall substantial user agreement (K = 0.61). Despite some points for optimisation, the pharmacists were satisfied with the PharmDISC system. They recognised the importance of PI documentation and believed that this may allow traceability, facilitate communication within the team and other healthcare professionals, and increase quality of care. Conclusion The PharmDISC system was valid and reached substantial interrater reliability. Refinement based on the pharmacists' suggestions resulted in a final version to be tested in an observational study with community pharmacists.

Quality indicators of pharmacists' services in community pharmacies in Paraná State, Brazil

ABSTRACT Pharmacists and their pharmacies have been evolving in their roles as health promoters in Brazil. Some examples are the recent legislation reaffirming the role of Brazilian pharmacies as health institutions, rather than having only a commercial profile, giving greater clarity to pharmacists about their roles as health care providers. This evolution came with the recognition that is already seen in other developed countries, confirming the need for the pharmacist as a health promoter, and not simply a dispenser of drugs in society. This study has obtained the profile and activities of community pharmacists, as well as the quality indicators of private community pharmacies throughout the State of Paraná through the application of an online survey sent to pharmacists in the state. Out of all pharmacists surveyed, 533 were part of the final analysis, being the pharmacists to complete the survey in full. Participants were mostly female (69.4%) and were, on average, 35.2 ± 9.2 years old. Of these, 60% worked in pharmacy chains and just 37% of all pharmacist respondents were issuing the Declaration of Pharmaceutical Services. The current study showed that many pharmaceutical services are not adopted by pharmacies as these services bring no significant financial reward. Regarding the structure, the Paraná State showed that pharmacies present a good overall structure. The kind of pharmacy (chain or independent) influenced the pharmaceutical services provided and the available structure, where the independent pharmacies provide a wider range of services and have better structure. This study was able to identify the profile and behaviors of pharmacists and also the quality indicators of pharmacies in Paraná State.

Evaluating the impact of pharmacist health education on the perceptions of the pharmacist's role among women living in a homeless shelter / Evaluación del impacto de la educación sanitaria por el farmacéutico sobre las percepciones del papel del farmacéutico entre mujeres que viven en un refugio de personas sin hogar

Objectives: To determine the impact of pharmacist provided educational seminars on the participant’s perception of the pharmacist’s role in providing women’s health education. Secondary objectives include the participant’s level of perceived benefit from the information provided during each presentation, as well as determining characteristics of participants who are interested in attending seminars. Methods: This is a prospective study conducted within a homeless women’s shelter in Phoenix, Arizona. Pharmacists and pharmacy students provided 10 monthly educational seminars on topics related to women’s health. Participants completed a pre- and post-seminar survey regarding their perceptions of the presentations and pharmacists. Results: Fifty-six participants attended at least one of 10 seminars from January to November 2014. The average age was 46 years old, taking approximately 3 medications, and 66% completed a high school degree or lower. Prior to the presentations, 30% of participants agreed or strongly agreed that they would seek advice from a pharmacist on the topic presented, which increased ignificantly to 82% of participants after the presentation (p<0.001). Similarly, 55% of participants rated themselves as agreeing or strongly agreeing with being knowledgeable on the topic presented prior to the presentation, and this increased significantly to 77% after the presentation (p=0.001). After attending the educational session, 70% of participants agreed or strongly agreed that they would make changes to their health, and that they would attend an additional session. The participants noted their increased learning about the topic, the clarity of visual aids and presentation, and knowledge of the presenters as the best parts of the presentation. Conclusion: Pharmacist’s participation in providing educational seminars in the homeless women’s population increases the participant’s knowledge and perception of the pharmacist’s role within the population. Future studies can further investigate an evolving role of pharmacists in optimizing healthcare in the homeless population (AU)

Objetivos: Determinar el impacto de seminarios educativos proporcionados por farmacéuticos sobre la percepción de los participantes del papel del farmacéutico en la provisión de educación sanitaria a mujeres. Los objetivos secundarios incluyeron el nivel del participante del beneficio percibido de la información proporcionada durante cada presentación, así como las características determinantes de los participantes que estaban interesados en asistir a los seminarios. Métodos: Este es un estudio prospectivo realizado en un refugio de mujeres sin hogar en Phoenix, Arizona. Farmacéuticos y estudiantes de farmacia proporcionaron unos seminarios educativos durante 10 meses sobre asuntos relacionados con salud de la mujer. Los participantes completaron un cuestionario pre- y postseminario sobre sus percepciones de las pr4sentaciones y de los farmacéuticos. Resultados: 56 participantes asistieron al menos a uno de los 10 seminarios entre enero y noviembre de 2014. La media de edad fue de 46 años, tomando aproximadamente 3 medicamentos, y el 66% había acabado la educación secundaria o menos. Antes de las presentaciones, el 30% de los participantes concordaba o concordaba fuertemente que buscarían consejo en un farmacéutico sobre el asunto presentado, lo que aumentaba significativamente al 82% después de la presentación (p<0,001). Del mismo modo, el 55% de los participantes se calificó como de acuerdo o fuertemente de acuerdo con saber suficientemente del asunto antes de la presentación, y esto aumentó significativamente al 77% después de la presentación (p=0,001). Después de asistir a la sesión educativa, el 70 % de los participantes concordó o fuertemente concordó que harían cambios en su salud, y que asistirían a otra sesión. Los participantes señalaron su aumento de aprendizaje sobre el asunto, la claridad de las ayudas visuales y la presentación, y el conocimiento de los presentadores como las mejores partes de la presentación. Conclusión: La participación del farmacéutico proporcionando seminarios educativos a una población de mujeres sin hogar aumenta el conocimiento de las participantes y la percepción del papel del farmacéutico en esta población. Próximos estudios pueden investigar en detalle el papel en evolución del farmacéutico optimizando los cuidados de salud de la población sin hogar (AU)

Estudio piloto en una farmacia comunitaria sobre la eficiencia y la efectividad de la prescripción de estatinas / A pilot study in a community pharmacy to determine the efficiency and the effectiveness of statin prescriptions

ANTECEDENTES: La eficacia de las estatinas para reducir los niveles de LDL-colesterol es elevada, aunque sus costes son importantes y su efectividad en ámbitos reales, limitada. OBJETIVO: Analizar la eficiencia y la efectividad de las prescripciones de estatinas y su relación con características del paciente en un estudio piloto en una farmacia comunitaria. DISEÑO: Estudio transversal. Emplazamiento: Farmacia comunitaria. Prescripciones procedentes de 2 Centros de Salud de Lorca (Área III del Sistema Murciano de Salud). PARTICIPANTES: Ciento cuarentaiún pacientes y 32 médicos. MEDICIONES PRINCIPALES: Se recogieron variables sociodemográficas y clínicas de los pacientes, e información sobre el tipo y la dosis de estatina. En cada paciente se determinó: efectividad del tratamiento, en función del RCV y niveles de LDL-colesterol previos al tratamiento, y eficiencia, comparando el coste de la estatina prescrita con el de aquellas de igual potencia famacológica. RESULTADOS: El 57,4% de las prescripciones fueron de atorvastatina. El 63,9% de las prescripciones se consideraron ineficientes y el 17,3% inefectivas. En el análisis bivariado, los pacientes con eventos cardiovasculares previos (8/38; 21% vs.41/103; 39,8%, p = 0,040) y los fumadores (42/114; 36,8% vs.4/23; 17,4%, p = 0,047) tenían más riesgo de recibir una prescripción ineficiente. En el análisis multivariable, los fumadores tenían más probabilidad de recibir prescripciones ineficientes comparados con los no fumadores (OR ajustada 3,76; IC del 95%, 1,03-0,77; p = 0,012). CONCLUSIONES: Los pacientes alcanzaron mayoritariamente los objetivos de LDL-colesterol propuestos, aunque más de la mitad de las prescripciones se consideraron ineficientes

BACKGROUND: The efficacy of statins to reduce LDL-cholesterol serum levels is high, but effectiveness is limited and costs are elevated. OBJECTIVE: The efficiency and effectiveness of prescriptions were analyzed in a pilot study in a community pharmacy. DESIGN: A cross-sectional study. LOCATION: Community pharmacy. Prescriptions from two Murcian Health Service Centers in Lorca, Murcia (Spain). PARTICIPANTS: A total of 141 patients and 32 general practitioners were included. The efficiency was analyzed in 141 and effectiveness in 110 PATIENTS: MAIN MEASUREMENTS: Socio-demographic characteristics and clinical history of patients and information about statin type and dosage were collected. Each patient was analyzed to determine the effectiveness of treatment according to cardiovascular risk and previous LDL-cholesterol level, and efficiency comparing the statin prescribed against other statins with equal pharmacological power. RESULTS: The most prescribed statin was atorvastatin (57.4%). Almost two-thirds (63.9%) of prescriptions were inefficient, and 17.3% were ineffective. In a bivariate analysis, patients with previous cardiovascular events (8/38; 21% vs 41/103; 39.8%. P=.040) and smokers (42/114; 36.8% vs 4/23; 17.4%, P=.047) were more likely to receive an inefficient prescription than patients with no cardiovascular events and non-smokers. In a multivariate analysis, smokers were more likely to receive an inefficient prescription than non-smokers (OR ajusted 3.76; 95% CI;1.03-0.77, P=.012). CONCLUSIONS: Most of the participants reached therapeutic objectives for LDL-Cholesterol levels, but more than half of the prescriptions were considered inefficient

La Evolución a los Servicios Profesionales farmacéuticos Asistenciales / No disponible

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Rational use of medicines: prescribing indicators at different levels of health care

This multicenter study aimed to investigate prescribing patterns of drugs at different levels of health care delivery in university-affiliated outpatient clinics located in eight cities in the South and Midwest of Brazil. All prescriptions collected were analyzed for various items, including WHO prescribing indicators. A total of 2,411 prescriptions were analyzed, and 469 drugs were identified. The number of drugs prescribed per encounter, the frequency of polypharmacy, and the percentage of encounters with at least one injection or antibiotic prescribed were higher in centers providing primary health care services, compared to those where this type of care is not provided. Most drugs (86.1%) were prescribed by generic name. In centers with primary health care services, drug availability was higher, drugs included in the National and Municipal Lists of Essential Medicines were more frequently prescribed, and patients were given more instructions. However, warnings and non-pharmacological measures were less frequently recommended. This study reveals trends in drug prescribing at different levels of health care delivery in university-affiliated outpatient clinics and indicates possible areas for improvement in prescribing practices.

Este estudo multicêntrico teve como objetivo investigar o padrão de prescrição de medicamentos para pacientes ambulatoriais atendidos em serviços de saúde vinculados a universidades com diferentes níveis de atenção, em oito cidades do sul e centro-oeste do Brasil. As prescrições coletadas foram submetidas à análise de diversos itens, incluindo os indicadores de prescrição propostos pela OMS. No total, 2.411 prescrições foram analisadas e 469 medicamentos foram identificados. O número de medicamentos prescritos por consulta, a frequência de polifarmácia e a porcentagem de consultas com pelo menos um medicamento injetável ou um antimicrobiano prescrito foram maiores em centros de saúde que ofereciam cuidados de atenção básica, em comparação com aqueles que não dispunham desse tipo de atendimento. A maioria dos medicamentos foi prescrita pelo nome genérico (86,1%). Em unidades com cuidados de atenção básica, a acessibilidade foi maior, a prescrição de medicamentos presentes nas Listas Nacional e Municipais de Medicamentos Essenciais foi mais frequente e instruções foram fornecidas aos pacientes mais comumente. Entretanto, advertências e medidas não farmacológicas foram indicadas com menor frequência. Este estudo revela tendências de prescrição de medicamentos em serviços de saúde ligados a universidades, com diferentes níveis de atenção, e indica possíveis áreas de melhoria na prática da prescrição.

[Role of community pharmacist in the management of patients in ophthalmology]. / Place du pharmacien de ville dans la prise en charge des patients en ophtalmologie.

OBJECTIVES: To assess the role of community pharmacists in ophthalmology, to evaluate the frequency of giving patients advice, and to report their difficulties in daily practice. MATERIAL AND METHODS: An anonymous questionnaire consisting of 13 questions was sent to 620 community pharmacists of Burgundy (France). Pharmacists were asked about their ophthalmic products, their ophthalmic activity in giving patients advice on ocular symptoms, and patients' expectations. For analysis, community pharmacies were separated into three groups: pharmacies in rural areas (under 2000 inhabitants), pharmacies in an urban zone with fewer than 10,000 inhabitants, and pharmacies in an urban zone with more than 10,000 inhabitants. RESULTS: The response rate was 46.9%. Ophthalmic products were mainly glasses for presbyopia (84.5%), eye care hygiene products (76.0%), and contact lens solutions (55.3%). Ophthalmic vitamin supplements were sold by 36.8% of pharmacists, mainly in urban areas. On average, the pharmacist was consulted for ocular problems seven times a week. Acute benign symptoms were most frequent. Advice on prescriptions came next. Then, information on contact lenses and chronic ocular disease were given (cataract, glaucoma, visual acuity loss, age-related maculopathy). Finally, the pharmacist either sold the patient an ocular treatment or oriented the patient to an ophthalmologist when needed. DISCUSSION: The pharmacist and his staff are active players in providing advice on ocular diseases and taking care of patients. Moreover, pharmacists have to manage ocular therapeutics, urgent symptoms, and chronic diseases. However, in our study, 46.0% of pharmacists felt confident with their knowledge on ophthalmology, 36.4% did not give their opinion, and 7.0% were uncomfortable with some questions. Most community pharmacists mentioned a lack of continuing education from pharmaceutical companies and postgraduate education on ocular diseases and treatment, mainly for age-related maculopathy.

Interacciones entre fármacos en una oficina de farmacia comunitaria / No disponible

Objetivo: cuantificar, valorar y analizar las interacciones farmacológicas en los pacientes que acuden a una oficina de farmacia.Método: Estudio transversal de un año en una oficina de farmacia de Valencia. Las interacciones se detectaron con el programa BotPlus del Consejo General de Colegios Oficiales de Farmacéuticos.Resultados: El 63,64% de las interacciones se produjeron en mujeres. Más del 63% aparecieron en mayores de 56 años. El 57,94% fueron de tipo farmacodinámico. El 69,16% fueron importantes o potencialmente importantes. El 57,01% afectaban a la seguridad. En un 69,16% se recomendaba un control clínico del paciente. La interacción de antiinflamatorios no esteroideos y diuréticos fue la que apareció con una mayor frecuencia.Conclusiones: Es necesario establecer un plan de actuación con protocolos normalizados de trabajo ante posibles interacciones y con intervenciones en la educación de los pacientes para minimizar la aparición de problemas relacionados con medicamentos(AU)

Objective: To quantify, to value and to analyze the pharmacological interactions in the patients who come to a community pharmacy.Method: Cross-sectional study of one year in a community pharmacy of Valencia. The interactions were detected by the program BotPlus of the General Council of Pharmacists’ Official Colleges.Results: 63,64 % of the interactions took place in women. More than 63 % appeared in major of 56 years. 57,94 % were pharmacodinamic type. 69,16 % were important or potentially important. 57,01 % were concerning the safety. In 69,16 % a clinical control of the patient was recommended. The interaction of anti-inflammatories-non-steroidal and diuretics it was the one that appeared with a major frequency.Conclusions: It is necessary to establish an action plan with standard operating protocols to possible interactions and interventions in the education of patients to minimize the occurrence of drug-related problems(AU)

Estudio observacional del gasto farmacéutico en población inmigrante y autóctona de la región sanitaria de Lleida (Cataluña) / Observational study on drug spending in the immigrant and the indigenous population in the Lleida (Catalonia) health region

ObjetivosAnalizar si hay diferencias en el gasto farmacéutico entre inmigrantes y autóctonos en la población general y si el ámbito de residencia (urbano/rural) está asociado al gasto en farmacia.DiseñoEstudio observacional transversal.EmplazamientoRegión Sanitaria Lleida.ParticipantesSe estudiaron 22.847 inmigrantes y 174.768 autóctonos de 15 a 64 años de edad, residentes en la Región Sanitaria Lleida.Mediciones principalesGasto en farmacia durante el año 2007, variables demográficas, zona de procedencia y área de residencia (urbana/rural).ResultadosEn todos los grupos terapéuticos, los individuos autóctonos gastaron más que los inmigrantes. En los hombres, la ratio de riesgo relativo de estar en el cuartil superior de gasto era de 3,2 (ICntervalo de confianza [IC] 95%: 2,96–3,44) en autóctonos respecto a inmigrantes y en las mujeres era de 2,1 (IC 95%: 1,97–2,27). Los inmigrantes de Europa del Este eran los que tenían un riesgo inferior de realizar gasto farmacéutico elevado (último cuartil), con diferencias estadísticamente significativas. Los residentes en el medio rural tenían riesgo superior de realizar gasto farmacéutico elevado respecto a los residentes en el medio urbano.ConclusiónSe observaron desigualdades en el gasto en medicamentos entre inmigrantes y autóctonos. Futuros estudios, cualitativos o mixtos, deberían indagar qué factores se asocian a estas diferencias y proponer acciones dirigidas a reducirlas(AU)

ObjectiveTo evaluate whether there are differences in drug spending between immigrant and Spanish-born populations and to assess whether drug consumption is associated with living environment (urban/rural).DesignObservational cross-sectional study.SettingLleida Health Region (LHR).Participants22,847 immigrants and 174,768 native born subjects, aged 15 to 64 years, residing in the LHR.Main measurementsDrug spending during the year 2007, demographical variables, region of origin and residence area (urban/rural).ResultsNative-born subjects spent more in all therapeutic drug groups than immigrants. In men, the relative risk ratio (RRR) of being in the highest quartile of expenditure was 3.2 (95% CI: 2.96–3.44) for native born versus immigrant and in women it was 2.1 (95% CI: 1.97–2.27). Immigrants from eastern Europe had the lowest risk of being in the highest quartile of expenditure, with statistically significant differences. Residents in the rural environment were more likely to have a higher pharmaceutical consumption than residents in the urban environment.ConclusionInequalities in drug spending were observed between immigrants and native born subjects. Further studies, either qualitative or mixed, should explore which factors are related to these differences and propose strategies addressed to reducing them(AU)

Evaluation of medication reviews conducted by community pharmacists: a quantitative analysis of documented issues and recommendations.

UNLABELLED: What is already known about this subject? There is conflicting evidence concerning the potential benefits of pharmacist-led medication review. Little work has been published on the completeness of medication reviews provided by community pharmacists. What this study adds. The 60 community pharmacists taking part in a large randomized controlled trial showed considerable variation in the completeness of the reviews they recorded for intervention patients. Overall, pharmacists recorded only a minority of the potential issues present in these patients. The frequency with which pharmacists recorded issues was not related to key characteristics or to the number of reviews completed. AIMS: To describe issues noted and recommendations made by community pharmacists during reviews of medicines and lifestyle relating to coronary heart disease (CHD), and to identify and quantify missed opportunities for making further recommendations and assess any relationships with demographic characteristics of the pharmacists providing the reviews. METHODS: All issues and recommendations noted by 60 community pharmacists during patient consultations were classified and quantified. Two independent reviewers studied a subsample of cases from every participating pharmacist and identified and classified potential issues from the available data. The findings of the pharmacists and the reviewers were compared. Relevant pharmacist characteristics were obtained from questionnaire data to determine relationships to the proportion of potential issues noted. RESULTS: A total of 2228 issues and 2337 recommendations were noted by the pharmacists in the 738 patients seen, a median of three per patient (interquartile range 2-4). The majority of the recommendations made (1719; 74%) related to CHD. In the subsample of 169 patients (23% of the total), the reviewers identified 1539 potential issues, of which pharmacists identified an average of 33.8% (95% confidence interval 30.1, 36.4). No relationship was found between the proportion of issues noted and potentially relevant factors such as pharmacists' characteristics and their experience of doing reviews. CONCLUSIONS: The majority of issues and recommendations noted by pharmacists related to CHD, although pharmacists recorded only a minority of the issues identified by reviewers. Variation between pharmacists in the completeness of reviews was not explained by review or other relevant experience.

Factors influencing the pattern of self-medication in an adult Nigerian population.

BACKGROUND: Despite the growing research interest in self-medication, little information has been available about its major determinants especially in developing countries. This informed the conduct of this study to determine the major factors that influence the pattern of self medication in a population of market women in Ifako-Ijaiye area of Lagos, Nigeria. METHODS: Interviewer administered pretested semistructured questionnaire was used to collect data from 205 market women selected by multistage sampling technique. RESULTS: The patent medicine dealers were the commonest source of information on medications (31.4%) and where they were obtained (52.2%). The exceptions were the educated (62.5%) respondents who obtained theirs from hospitals and pharmacies. Trade and generic names (61.1%) were common means of drug recognition especially among the educated respondents (P<.05). Education of the respondents was the major factor influencing the practice of self-medication though the pattern was descriptively associated with the marital status and educational level of the respondents (P<.05). Benefits of the practice includes in the order: curing of ailments (58.0%), saving time and money (32.0%) and independence of care (7.0%). CONCLUSION: Literacy and public health education were the major factors influencing the pattern of self-medication among market women. Recommendations on the role of education of market women, patent medicine dealers and the importance of community pharmacy were suggested.

Adverse pharmaceutical payment incentives and providers' behaviour: the emergence of GP-owned gateway pharmacies in Taiwan.

OBJECTIVES: We investigated whether a 2002 pharmaceutical payment reform policy, which provided adverse incentives, fostered an increase in market share of 'gateway pharmacies' (G-pharmacies--pharmacies owned, operated and located by the same clinics that prescribe medicines); what the financial impact of G-pharmacies to the clinics is; and what factors determine whether a clinic decides to open a G-pharmacy. METHODS: Using the database of the National Health Research Institutes, we collected secondary data on all of Taiwan's National Health Insurance prescription claims from pharmacies and clinics between 1997 and 2003. A G-pharmacy was defined as a pharmacy in which more than 70% of the prescriptions it filled came from the same clinic, which prescribed at least 900 prescriptions monthly, more than 70% of which were released to the pharmacy. Trend plot and frequency were used to analyse the distribution of G-pharmacy data. Logistic regression was used to explore what factors determined whether a clinic decided to open a G-pharmacy. RESULTS: After the 2002 reform, the percentage of total prescriptions filled by G-pharmacies reached 78.71%, the increase in percentage (15.23%) was the highest ever and significant (P < 0.01). The reform's adverse payment incentives resulted in a loss of NT$1.86 billion New Taiwan dollars to all clinics and resulted in a reduction in Taiwan's 2003 fee schedules under the global budget payment system. The decision to establish a G-pharmacy was associated with a clinic's being located in less urbanized areas, being a group practice, having higher patient volumes, being a general practitioner, and being privately owned. CONCLUSION: The 2002 reform's adverse incentive fostered a significant increase in the market share of G-pharmacies, and reduced the earnings of clinics which did not own them. It is necessary to break the link between profits from pharmaceutical sales and physician prescribing behaviour to prevent the conflict of interest in how medicines are prescribed.

[Classification of pharmaceutical services from the viewpoint of patient satisfaction/dissatisfaction].

A survey was conducted to examine what the public expects of pharmacists. We created 26 questions based on 26 different situations that patients encounter at pharmacies in order to assess patient satisfaction/dissatisfaction. Some questions were designed to compare pairs of symmetrical situations. The survey was carried out in February and March 2001. The surveys were conducted with patients and/or patients' relatives who brought their prescriptions to pharmacies and with employees of pharmaceutical companies and their family members. A factor analysis extracted two factors among the 26 variables, the first being patient dissatisfaction and the second being patient satisfaction. However, factor loadings for some paired situations were not necessarily symmetrical and thus the absolute values of the scores were not equal. The results suggest that satisfaction on one side does not entail dissatisfaction on the other side and thus satisfaction and dissatisfaction can be examined as separate and distinct entities. Based on these results, we classified pharmaceutical services into two types. The first type is referred to as instrumental service. In this situation patients do not feel great satisfaction even if such service is provided. However, they feel great dissatisfaction if the service is not provided. The second type is referred to as expressive service. These patients feel some satisfaction if such service is provided, however, they do not feel a fatal dissatisfaction if the service is not provided. Our research documents that when examining data based on the assumption that there is a different dimensionality for patient satisfaction and dissatisfaction, it is possible to gain insights into new aspects of pharmaceutical services that are otherwise impossible to assess.

Ancillary community pharmacy services provided to older people in a largely rural and ethnically diverse region: a survey of consumers in West Texas.

Little is known about the quality of pharmacy services provided to the rural elderly population. This exploratory study examines rural/urban and ethnic differences in perceived access to ancillary pharmacy services among elderly people. Two telephone surveys were conducted using directory listings in West Texas to generate a longitudinal sample. Persons aged 65 years and older who were not cognitively impaired were asked to complete the survey. The number of participants in both rounds of the survey was 3,689. Seven ancillary pharmacy services were examined: delivery of medications, medication counseling, written medication information, blood pressure monitoring, blood glucose monitoring, osteoporosis screening, and immunization. The sample was stratified by county of residence (urban, rural, or frontier) and racial/ethnic background. Chi-square tests were performed to detect rural/urban and racial/ethnic differences in access to the seven ancillary services. The association between proficiency in English and access to the services was also examined. Rural residents were more likely than urban residents to report that their pharmacies provide delivery of medications, medication counseling, and immunization services, but they were less likely than their urban counterparts to report that their pharmacies provide blood pressure monitoring. Access to ancillary pharmacy services was reported as poorer by older Hispanic people compared with non-Hispanics. Deficiency in English was significantly related to inequality in reported access to ancillary pharmacy services. It is essential to consider the special needs of rural and Hispanic elderly people to ensure equitable access to ancillary pharmacy services.