Impact of Interventions on Medication Adherence in Patients With Coexisting Diabetes and Hypertension.

BACKGROUND: The coexistence of diabetes and hypertension is prevalent due to shared risk factors. Pharmacological treatment has been reported to be effective in managing both conditions. However, treatment effectiveness depends on the extent to which a patient adheres to their treatment. Poor adherence to long-term treatment for chronic diseases is a growing global problem of significant magnitude. Several interventions have been developed to help improve medication adherence in patients with coexisting diabetes and hypertension. This review aimed to determine the characteristics of these interventions and their impact on medication adherence. METHODS: A systematic review of the literature was conducted using the PRISMA guidelines and registered in the PROSPERO International Registry of Systematic Reviews. Studies were searched in the databases CINAHL, Embase and Medline to identify relevant articles published during 2012-2023. The search concepts included 'medication adherence', 'hypertension', 'diabetes' and 'intervention'. Studies were included if they were in English and evaluated the impact of an intervention aimed at promoting adherence to medications for both diabetes and hypertension. RESULTS: Seven studies met the inclusion criteria, with five demonstrating a statistically significant improvement in medication adherence. Of the five studies that improved medication adherence, four were multifaceted and one was a single-component intervention. All successful interventions addressed at least two factors influencing non-adherence. Patient education was the foundation of most of the successful interventions, supported by other strategies, such as follow-ups and reminders. CONCLUSION: Multifaceted interventions that also included patient education had a positive impact on medication adherence in patients with coexisting diabetes and hypertension. Improving adherence in patients with coexisting diabetes and hypertension requires a multipronged approach that considers the range of factors impacting medication-taking. PATIENT OR PUBLIC CONTRIBUTION: This systematic review provides comprehensive insights into the benefits of patient-centred approaches in intervention development and strengthening. Such patient involvement ensures that medication adherence interventions are more relevant, acceptable and effective, ultimately leading to better health outcomes and more meaningful patient engagement in healthcare research.

Asthma patients in Saudi Arabia - preferences, health beliefs and experiences that shape asthma management.

Objectives: The aim of this study was to explore the experience of Saudi participants in managing their asthma and their perspectives about using future pharmacy-based services for asthma management. METHODS: Semi-structured interviews were conducted with adult Saudis with asthma or those who were a carer of a child with asthma. Participants were recruited from medical practices and community centres in Riyadh, Saudi Arabia. Verbatim transcribed interviews were inductively analysed using thematic analysis. RESULTS: Twenty-three Saudi participants with asthma or caring for those with asthma took part in interviews which lasted on average for 25 min. Most participants did not have well-controlled asthma. Thematic analyses of the interview transcripts highlighted four key emergent themes: participants experience of asthma, participants' beliefs and perceptions about health and medicines, perception of health professionals and advocacy and social support. Many participants expressed an emotional burden in their lived experience of asthma. Lack of self-management skills were evident in participants' reluctance to make decisions in emergency situations. Some participants had strong beliefs about using herbal medicines rather than western medicines. Using social media or consulting with their family members with asthma was a common preference, rather than consulting healthcare professionals. Participants' were rather unclear about pharmacy asthma care services and reported not having experienced such services in their pharmacies. CONCLUSION: Inadequate self-management behaviours may affect the level of asthma control in people with asthma in Saudi Arabia. Improved primary care models with extensive focus on asthma education are needed to relieve the over-reliance on tertiary care help-seeking models that are currently the norm. Current evidence-based information also needs to be prepared in patient friendly formats and disseminated widely. Community pharmacists would need to be trained and skilled inpatient engagement and would have to win the public trust for viable asthma services provision.

Exploring Ethical Pharmacy Practice in Jordan.

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

Health consumer engagement in developing novel preventive health community pharmacy roles in cardiovascular disease in Saudi Arabia: A qualitative analysis.

INTRODUCTION: Cardiovascular diseases (CVD) are one of key leading causes of mortality worldwide. Both modifiable and non-modifiable risk factors contribute to the development of CVD. Modifiable risk factors such as smoking, unhealthy diets and lack of exercise are increasing in prevalence in Saudi Arabia but may be mitigated using pharmacological and non-pharmacological approaches. Thus, identifying, assessing and managing these modifiable risks at an early stage is essential. Pharmacists are highly accessible primary health professionals and can play a crucial role in screening and managing these risk factors in collaboration with primary care physicians. There is currently no research in Saudi Arabia exploring the views of health consumers with CVD risk factors regarding their preferences for or willingness to engage with community pharmacy CVD preventive health services. OBJECTIVES: To explore the perceptions of health consumers about current and feasible future services by pharmacists with a specific focus on CVD risk screening and management in Saudi Arabia. METHODS: Semi-structured interviews were conducted with consumers with at least one modifiable CVD risk factor. The interviews were audio-recorded, transcribed verbatim, translated into English and then thematically analysed. RESULTS: A total of 25 individuals, most of whom were Saudi (88%) and women (65%), participated in face to face interviews. Five main themes emerged from the analysis of consumers' responses. 1. Perception of pharmacists' role, the pharmacists' main role was perceived as medication supply. 2. Trust and satisfaction with current service, most participants appeared to have low trust in pharmacists. 3. Preferences for future pharmacy services, most participants were willing to engage in future pharmacy delivered CVD preventive health services, provided there was stringent regulation and oversight of the quality of such services. 4. Viability of new pharmacy services was raised with promotion of such services to the public, collaboration with other health professionals, financial incentivization and motivational rewards thought of as essential ingredient to ensure service feasibility. 5. Health beliefs and help seeking behaviours of consumers were diverse and low health literacy was evident; it was thought that pharmacists can help in these matters by educating and advocating for such consumers. Overall, the data suggested that clinical, communication and professional skills need to be enhanced among Saudi pharmacists to enable them to provide optimal patient cantered services. CONCLUSION: Health consumers participants were willing to participate and utilise CVD risk screening and management pharmacy-based services, when offered, provided their concerns are addressed. Therefore, in light of the burden of CVD disease in the country, development, implementation and evaluation of pharmacist provided CVD risk screening and management should be undertaken.

General Practitioners' experiences of asthma management in culturally and linguistically diverse populations.

OBJECTIVE: The purpose of this study was to explore General Practitioners' experiences and perspectives about asthma management of culturally and linguistically diverse (CALD) people with asthma, particularly with reference to Arabic-speaking patients with low English proficiency (LEP). METHODS: Semi-structured interviews guided by an interview protocol were conducted with general practitioners who deal with CALD patients with asthma. Participants were recruited from medical practices in Melbourne, Australia. Interviews were recorded and transcribed verbatim, followed by an inductive thematic analysis. RESULTS: Data saturation was achieved after 21 interviews. Interviews lasted on average 30 minutes. Thematic analyses of the interview transcripts highlighted five key emergent themes: self-autonomy, language issues, accessibility and engagement, health literacy, and cultural/beliefs issues. Many participants highlighted that CALD patients do not self-manage their asthma. Miscommunication was mentioned by some participants as stemming from language barriers. Patients' difficulty in engagement with the health system, lower accessibility to health care, social isolation, and non-acclimatization were other issues participants highlighted as problems in providing effective asthma care to CALD patients. Participants reported finding it more difficult to treat CALD patients with asthma compared to local patients. CONCLUSION: General practitioners perceived that treating culturally and linguistically diverse patients with asthma is difficult and many key barriers were observed to affect treatment. Cultural competence training for health professionals, as well as improving asthma and health system awareness in CALD patients with asthma and their carers, are key interventions that may address asthma management gaps in CALD patients.

The Legal Underpinnings of Medical Discipline in Common Law Jurisdictions.

Medical regulators have a responsibility to protect, promote, and maintain the health and safety of patients. Here, we compare and contrast the processes for addressing concerns about doctors in four countries with legal systems based on English common law: the UK, Australia, the United States, and Canada. The legal provisions underpinning each jurisdiction's disciplinary processes depict distinctive outlooks from the different authorities as each works toward the same goal. The initial stages of the investigation process are broadly similar in all of the jurisdictions examined. Each process, however, has subtle differences with regard to its comparators. Factors include how matters of discipline are framed, the constitution of disciplinary panels, and how the perceived independence of these panels all philosophically affect the public safety remit of each regulator. This work constitutes the first comparison of international regulatory frameworks for the profession of medicine.

Asthma management experiences of Australians who are native Arabic speakers.

OBJECTIVE: The aim of this study was to explore the asthma management experiences of people with asthma within the Arabic-speaking community in Australia. METHODS: Semi-structured interviews guided by a schedule of questions were conducted with 25 Arabic-speaking women with asthma\carer of a child with asthma, recruited from medical practices and community centers in Melbourne, Australia. RESULTS: Twenty-five Arabic-speaking participants with asthma or caring for those with asthma were interviewed. Interviews lasted on average 25 minutes. Most participants or those they were caring for did not have well-controlled asthma. Thematic analyses of the interview transcripts highlighted five key emergent themes: stigma, health literacy, non-adherence, expectations, and coping styles. Findings indicated that many participants were not conversant about local information avenues or healthcare or facilities such as the Asthma Foundation or availability of Arabic translators during general practitioner (GP) consults. Many recent migrants were generally non-adherent with treatment; preferring to follow traditional folk medicine rather than consulting a GP or pharmacist. Some unrealistic expectations from doctors/treatment goals were expressed by a few participants. Some parents of children with asthma reported disappointment with the fact that their children did not grow out of asthma. CONCLUSION: Low health literacy and in particular knowledge about asthma, cultural beliefs, language, and migration-related issues may all be affecting the level of asthma control in the Arabic-speaking population in Australia. Measures to enhance asthma and health system literacy designed to be culturally concordant with the beliefs, expectations, and experiences of such populations may be key to improving asthma management.

Perspectives and experiences of patients with type 2 diabetes observing the Ramadan fast.

INTRODUCTION: Diabetes is a common chronic disease among Australians. Culturally and linguistically diverse groups are observed to have higher prevalence rates of diabetes. Continuing management needs adherence to medication and diet regimens. Religious practices such as fasting can affect diabetes management and medication use. Pharmacists as medication specialists have a significant role in helping people observing religious practices such as the Ramadan fast, which involves month-long absolute abstinence from food during daylight hours, to maintain good control over their condition. OBJECTIVE: This study investigated the perspective of patients with type 2 diabetes (T2D) who undertake the fast of Ramadan, to understand their experiences, health-related needs and service preferences regarding diabetes management. METHODS: A qualitative, exploratory design was used in this study. Data collection comprised the conduct of semi-structured interviews with a purposive convenient sample of patients in areas of ethnic diversity in Sydney, using a standardised interview guide. Interview data were transcribed verbatim and thematically analysed. RESULTS: Twenty-five semi-structured interviews (68% males) among a heterogeneous sample of fasting T2D patients were conducted. Themes emerging from analysis of transcripts included issues relating to sociocultural pressure for T2D patients to fast; lack of awareness about the role of pharmacists and, most importantly, the need to train pharmacists in cultural sensitivity and clinical implications thereof. CONCLUSIONS: Community awareness about the role of the pharmacists in assisting medication use and adjustment during fasting periods should be enhanced. Furthermore, community pharmacists need to be trained about the unique religious and sociocultural issues of patients with diabetes opting to observe spiritual rituals such as the Ramadan fast. Clinical education in this area should up-skill pharmacists to inculcate self-management behaviours in fasting T2D patients.

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

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

Consumer perspectives about weight management services in a community pharmacy setting in NSW, Australia.

BACKGROUND: Obesity is a public health challenge faced worldwide. Community pharmacists may be well placed to manage Australia's obesity problem owing to their training, accessibility and trustworthiness. However, determining consumers' needs is vital to the development of any new services or the evaluation of existing services. OBJECTIVE: To explore Australian consumers' perspectives regarding weight management services in the community pharmacy setting, including their past experiences and willingness to pay for a specific pharmacy-based service. DESIGN: An online cross-sectional consumer survey was distributed through a marketing research company. The survey instrument comprised open-ended and closed questions exploring consumers' experiences of and preferences for weight management services in pharmacy. It also included an attitudinal measure, the Consumer Attitude to Pharmacy Weight Management Services (CAPWMS) scale. SETTING AND PARTICIPANTS: A total of 403 consumers from New South Wales, Australia, completed the survey. RESULTS: The majority of respondents had previously not sought a pharmacist's advice regarding weight management. Those who had previously consulted a pharmacist were more willing to pay for and support pharmacy-based services in the future. Most consumers considered pharmacists' motivations to provide advice related to gaining profit from selling a product and expressed concerns about the perceived conflicts of interest. Participants also perceived pharmacists as lacking expertise and time. CONCLUSION: Although Australian consumers were willing to seek pharmacists' advice about weight management, they perceived several barriers to the provision of weight management services in community pharmacy. If barriers are addressed, community pharmacies could be a viable and accessible setting to manage obesity.

Factors affecting the implementation of clinical pharmacy services in China.

New policies in China have recently led to the implementation of clinical pharmacy services in hospitals. We explored the views of hospital administrators, pharmacy directors, clinical pharmacists, and dispensing pharmacists about the factors affecting clinical pharmacy services in China, using the framework approach and organizational theory. We conducted 30 interviews with 130 participants at 29 hospitals (both secondary and tertiary) in Beijing, Zhengzhou, Luoyang, and Shanghai. We found that the barriers to and facilitators of implementation of clinical pharmacy services slotted into the environment and participant dimensions of Scott's adapted version of Leavitt's organizational model. External support from government was perceived as crucial to promoting pharmacy services. It is proposed that the internationally recognized Basel Statements of the International Pharmaceutical Federation also provide a strong foundation for guiding China in implementing clinical pharmacy services.

Policies and cost analyses of voluntary assisted dying (VAD) laws - a mapping review & analysis.

OBJECTIVES: To investigate the current literature on healthcare policies and cost analyses around international Voluntary Assisted Dying (VAD) laws. The study design is a mapping literature review following Preferred-Reporting-Items-for-Systematic-Reviews-and-Meta-Analyses (PRISMA) guidelines. METHODS: Original research articles published between January 1990 to March 2023, investigating the financial cost and healthcare budget effect of VAD laws internationally. Citations were screened for relevance and eligibility, and any non-full-text research that did not explore cost analysis was excluded. The following data sources were screened: MEDLINE, PubMed, EMBASE, CINAHL and any relevant international health authority annual reports were also reviewed. RESULTS: Of the 2790 screened articles, eight studies met the inclusion criteria and three were included in the mapping review. The reviewed studies included prospective studies, two Canadian and one US. Only one of the Canadian studies provided a cost analysis using data from current VAD laws. All three studies showed VAD laws would reduce healthcare spending, with the US approximating $627million in 1995. Canada approximating $17.1 to $77.1million in 2017 and $86.9 to $149.0million in 2021, overall, leading to an average percentage reduction in costs of approximately 87% compared to original costs of end-of-life care. CONCLUSION: This review identifies a scarcity in cost-analysis literature and provides a summary of the latest international VAD laws, from which a potential cost reduction is apparent. The absence of retrospectively collated financial VAD data highlights a need for future research to inform policymakers of the economic factors affecting current policies with a need for annual fiscal reports and to optimise future legislative frameworks internationally.

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

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

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

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

Relevance of the community pharmacy policy environment to pharmacists' performance, as reflected in stakeholders' perspectives on professionalism and standards.

Background: A complex array of legislation, regulation, policies and aspirational statements by governments, statutory agencies and pharmacy organisations constitutes the policy environment that influences Australian community pharmacy, including pharmacists' performance. Objective: The objective was to assess the relevance of the policy environment to Australian community pharmacists' performance by examining stakeholders' perspectives on their professionalism and standards. Methods: Inductive thematic analysis was undertaken on 38 semi-structured interviews of purposively selected individuals including pharmacists and other key stakeholders, from 4 socio-ecological strata (societal, community, organisational, and individual) that have influence on the person to person interaction that a consumer may have with a pharmacist in a community pharmacy. Results: As indicators of their performance, pharmacists' professionalism and compliance with standards can no longer be assumed; they must be demonstrated. However, the current dispensing funding model compromises their ability to demonstrate professionalism and policy is lacking in relation to monitoring and rewarding standards. These shortcomings are further compromised by a growth in commercialism in community pharmacy which impacts the delivery of professional services. Conclusion: The findings of this study have implications for pharmacy as an autonomously regulated profession in Australia. Dispensing funding policy could better support and reward quality in pharmacists' performance, and there is strong support for compulsory monitoring of standards. Compliance with a nation-wide quality framework, and provision of a minimum set of professional services should be an obligatory requirement of all community pharmacies.

A grounded theory approach to exploring the experiences of community pharmacists in Lebanon to a triple whammy of crises: The Lebanese financial crisis, COVID-19 pandemic, and the Beirut port explosion.

Background: Community pharmacists like other health care professionals in Lebanon have been grappling with a series of multifaceted, country-wide and ongoing challenges that have formed the impetus for this research. We aimed to explore experiences of community pharmacists in Beirut, Lebanon, during three concurrent crises in 2020: the Lebanese financial crisis, COVID-19 pandemic and the Beirut Port explosion. Methods: A qualitative approach using a constructivist grounded theory methodology was employed. Between October 2020 and February 2021, semi-structured interviews were conducted with purposefully recruited community pharmacists working in Beirut. All interviews were conducted virtually, and data collected were analysed using inductive reasoning, with open coding and concept development. Results: Thirty-five participants (63% female, mean age 30) were interviewed online. Emergent categories and theoretical concepts included 1. painting the picture - pharmacists describing the context/setting; 2. impact of the crises - on community pharmacists, the profession, patients and the system; 3. response to the crises - of community pharmacists, the profession (+ practice), patients and the system; and 4. need for advocacy and leadership. A theory was developed about "unsustainable resilience" in the scheme of ongoing crises. Conclusions: The findings revealed a shared sense of futility and despair among pharmacists collectively as a profession, as well as a sense of unsustainable healthcare systems in Lebanon, and environments impacting on the resilience of pharmacists at an individual level. A call for action is needed for urgent sustainable structural and financial reforms, advocacy and planning for future resilient systems, as well as a resilient pharmacy profession and protection of pharmacists' wellbeing and livelihood.

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

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

A Qualitative Evaluation of the Australian Community Pharmacy Agreement.

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

Comparing comprehensibility of standard and enhanced prescription medicine labels: a randomized simulation.

OBJECTIVES: The objective of this study is to develop and user-test the comparative effectiveness of two enhanced label designs to improve comprehension of patients with low English proficiency versus a standard label representative of the pharmacist-affixed medicine labels currently used in practice. METHODS: Using a randomized two-group study design, 66 participants from Sydney, Australia were allocated to view a set of standard labels followed by a set of enhanced labels named 'linguistically enhanced labels' or 'linguistically and graphically enhanced labels'. Each set of labels depicted medicine directions of three levels of complexity, which participants viewed consecutively. The 'enhanced labels' incorporated several features documented in the literature as improving understanding of low-health-literate/linguistically compromised individuals such as translated directions in a language the person is more proficient in, numeric presentations of numbers/counts, carriage returns and graphic depiction of directions. A user-testing questionnaire relating to comprehensibility was conducted after each label was viewed. Differences in comprehensibility were assessed using a generalized linear model, Cochran-Mantel-Haenszel test for trend and a chi-square test. KEY FINDINGS: Results indicated significant improvements in comprehensibility with both types of enhanced labels compared with standard labels (P < 0.0001). The 'linguistically and graphically enhanced label' improved comprehensibility of the most complex directions to a greater extent than the 'linguistically enhanced label' (P < 0.0001). CONCLUSIONS: This study has highlighted the scope for improvement of existing pharmacist-affixed prescription medicine labels to ensure better understanding by individuals with low English proficiency. The enhanced labels trialled presented a means with which this may be achieved through the incorporation of key design elements, such as simpler, translated and graphically supported directions.

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

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