Influences on prescribing decision-making among non-medical prescribers in the United Kingdom: systematic review.

BACKGROUND: Suitably qualified non-medical healthcare professionals may now prescribe medicines. Prescribing decision-making can be complex and challenging; a number of influences have been identified among medical prescribers but little appears to be known about influences among non-medical prescribers (NMPs). OBJECTIVE: To critically appraise, synthesize and present evidence on the influences on prescribing decision-making among supplementary and independent NMPs in the UK. METHODS: The systematic review included all studies between 2003 and June 2013. Included studies researched the prescribing decision-making of supplementary and independent NMPs practising in the UK; all primary and secondary study designs were considered. Studies were assessed for quality and data extracted independently by two researchers, and findings synthesized using a narrative approach. RESULTS: Following duplicates exclusion, 886 titles, 349 abstracts and 40 full studies were screened. Thirty-seven were excluded leaving three for quality assessment and data extraction. While all studies reported aspects of prescribing decision-making, this was not the primary research aim for any. Studies were carried out in primary care almost exclusively among nurse prescribers (n = 67). Complex influences were evident such as experience in the role, the use of evidence-based guidelines and peer support and encouragement from doctors; these helped participants to feel more knowledgeable and confident about their prescribing decisions. Opposing influences included prioritization of experience and concern about complications over evidence base, and peer conflict. CONCLUSION: While there is a limited evidence base on NMPs' prescribing decision-making, it appears that this is complex with NMPs influenced by many and often opposing factors.

Provision of advice on alcohol use in community pharmacy: a cross-sectional survey of pharmacists' practice, knowledge, views and confidence.

OBJECTIVE: Community pharmacists are well placed to provide advice to clients on public health issues such as alcohol use. The aim of the study was to characterise community pharmacists' current level of activity and views on providing such advice in Scotland. METHOD: A postal questionnaire survey, covering provision of advice, knowledge and views on alcohol issues, was sent to all community pharmacies in Scotland (n=1098). KEY FINDINGS: The response rate was 45% (497/1098). Knowledge of recommended alcohol-intake limits was high (79 and 84% correct for male and female limits, respectively), but few respondents (5%) currently advised clients on alcohol consumption once a week or more and 29% had never done so. Around a quarter were confident in explaining alcohol limits, binge drinking and confidentiality issues, but about 40% lacked confidence in screening and providing a brief intervention on alcohol. Respondents expressed mixed views on the appropriateness of pharmacist involvement in discussing alcohol use with clients. Attitudes to harmful or hazardous drinkers varied: some 20% of respondents felt uncomfortable with this group, whereas another 20% felt they could work with this group as well as with any other. CONCLUSION: Community pharmacists in Scotland provide little advice on alcohol use, have a reasonable knowledge of recommended limits but lack the knowledge and confidence to provide a brief intervention. Implementation of a brief alcohol intervention in community pharmacy, therefore, would need to be underpinned by an appropriate training programme. Such a programme needs to provide factual knowledge but must also address pharmacists' attitudes to clients and promote confidence in service delivery.

General practitioners' views and experiences of over-the-counter simvastatin in Scotland.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Statins are widely used for the primary and secondary prevention of coronary events in high risk populations. In 2004 simvastatin was reclassified in the UK from prescription only to being available over-the-counter (OTC). WHAT THIS STUDY ADDS: The majority of GPs do not support the supply of OTC simvastatin by the community pharmacist. GPs were particularly concerned by the lack of cholesterol and blood pressure data in the CHD risk assessment prior to sale. AIMS: The aims of this study were to determine the views and experiences of Scottish GPs towards CVD risk assessment by community pharmacists and the supply and sale of simvastatin. METHODS: A cross sectional postal questionnaire survey of all primary care general practices in Scotland was carried out. The main outcome measure was GPs' awareness of and opinions regarding OTC simvastatin use, experience of OTC simvastatin and opinions regarding community pharmacist involvement in CHD risk assessment. RESULTS: A response rate of 45.7% was obtained. The majority (92.6%, 428) were aware that community pharmacists could sell simvastatin to reduce the risk of a first coronary event in individuals at moderate risk of CHD. However, over half (55.6%, 257) believed that the OTC sale of simvastatin was inappropriate. Just over half were unaware that the pharmacist's CHD risk assessment for the sale of simvastatin did not include lipid (54.8%, n=253) or blood pressure measurement (53.7%, n=248) and 56.7% (262) and 57.8% (267) of respondents, respectively, thought these omissions inappropriate. Almost half of the respondents (48.1%, 222) supported community pharmacists supplying simvastatin as supplementary prescribers while fewer (26.6%, 132) were in favour of supply via an independent prescribing arrangement. CONCLUSION: This study confirms that the majority of GPs do not support the supply of OTC simvastatin by the community pharmacist, being particularly concerned by the lack of cholesterol and blood pressure data in the CHD risk assessment prior to sale. Other methods of pharmacy based simvastatin supply including supplementary prescribing merit further evaluation.

A pilot study to evaluate a community pharmacy-based monitoring system to identify adverse drug reactions associated with paediatric medicines use.

INTRODUCTION: Current pharmacovigilance systems are limited by spontaneous reporting of adverse drug reactions (ADRs), lack of a denominator, and lower than expected reporting rates. The aim of our study was to undertake a formal pilot evaluation of a community pharmacy-led ADR monitoring system. METHODS: The setting was community pharmacies in five Health Boards areas of Scotland. Subjects were parents, guardians, or children presenting prescriptions for children 16 years and under prescribed serotonin specific reuptake inhibitors (SSRI), anticonvulsants, or medicines for the treatment of attention deficit hyperactivity disorder (ADHD). All pharmacies (n = 827) were invited to participate. Over a 3-month period they were asked to identify prescriptions for targeted medicines and give out an ADR questionnaire. Questionnaire content included child demography, duration of medicine use, indication, perceived ADRs, and their description and severity. The study was approved by the North of Scotland Research Ethics Committee. RESULTS: Seventy-two community pharmacists (8.7%) agreed to take part. Two hundred and twenty-nine questionnaires were distributed and 55 (24%) completed and returned by parents. Forty-one questionnaires related to ADHD medications, 13 to anticonvulsants, and 1 to an SSRI. Thirty questionnaires reported 44 possible ADRs, 19 of which were related to methylphenidate. CONCLUSIONS: The proposed ADR monitoring system identified expected ADRs thus demonstrating face and content validity for our approach. However the process was limited by low community pharmacist participation rates and low questionnaire return rates.

Developing and validating a tool for assessment of pharmacist prescribers' consultations.

OBJECTIVE: To develop and validate an assessment tool, based on the 'Royal College of General Practitioners' (RCGP) Video Assessment Tool', for assessment of pharmacist prescribers' consultation skills. METHODS: Competency areas of the RCGP tool were left unchanged but performance criteria for each were modified to reflect pharmacist prescribing. Each criterion and the overall consultation were rated from 1 (poor) to 5 (excellent). A purposive sample of 10 experienced prescribing pharmacists was selected. Each pharmacist identified, recruited and consented two patients. Video recordings of consultations were assessed independently by two randomly assigned GPs, experienced in the use of the RCGP tool, using the newly developed scale. Inter-rater reliability was assessed. Construct validity was assessed by comparing the assessor score with a patient satisfaction score. Spearman's rho was used to test the correlation between the two scores. RESULTS: The RCGP tool was modified to give the 'Pharmacist Consultation Assessment Tool' (PharmaCAT). The median overall PharmaCAT consultation rating was 3. There was good agreement between the two assessors for total scores (intraclass correlation coefficient=0.694). Fourteen (78%) patient satisfaction questionnaires were returned; most (n=13, 93%) agreed/strongly agreed that they were entirely satisfied with the consultation. Correlations between average total scores on PharmaCAT and the patient satisfaction questionnaire were weak (Spearman's rho=0.142 and 0.242 for both assessors). CONCLUSIONS: The PharmaCAT has been tested in the pharmacist prescriber setting. The tool had discriminatory power across different domains and inter-rater reliability. The PharmaCAT has potential to be used as a formative and/or summative assessment tool.

Exploring pharmacists' perceptions of the feasibility and value of pharmacist prescribing of antimicrobials in secondary care in Scotland.

OBJECTIVES: The introduction of non-medical prescribing in the UK has provided opportunities and challenges for pharmacists to help ensure prudent use of antimicrobials. The objective of this research was to explore pharmacists' perceptions of the feasibility and value of pharmacist prescribing of antimicrobials in secondary care in Scotland. METHODS: Pharmacists' perceptions were explored using focus groups in five Scottish regions representing (a) urban and rural areas and (b) district general hospitals and large teaching centres. Senior hospital pharmacists, both prescribers and non-prescribers, working in specialities where antimicrobials are crucial to patient management, were invited to participate. A topic guide was developed to lead the discussions, which were audio-recorded and transcribed. The framework approach to data analysis was used. KEY FINDINGS: Six focus groups took place and some emerging themes and issues are presented. Pharmacists believed that the feasibility of antimicrobial prescribing is dependent upon the patient's clinical condition and the area of clinical care. They identified potential roles and opportunities for pharmacist prescribing of antimicrobials. Perceived benefits included giving patients quicker access to medicines, reducing risk of resistance and better application of evidence-based medicine. CONCLUSIONS: Pharmacists feel they have a good knowledge base to prescribe and manage antimicrobial treatment, identifying possible opportunities for intervention. Roles within a multidisciplinary antimicrobial team need to be clearly defined.

Cross sectional survey of the Scottish general public's awareness of, views on, and attitudes toward nonmedical prescribing.

BACKGROUND: Nonmedical (ie, nonphysician) prescribing is a key development in the UK that has brought about many changes in prescribing policy and practice. Systematic research into the views of the general public toward such developments is limited. OBJECTIVE: To determine the awareness of, views on, and attitudes of members of the Scottish general public toward nonmedical prescribing, with an emphasis on pharmacist prescribing. METHODS: A questionnaire was mailed in November 2006 to a random sample of 5000 members of the general public in Scotland aged 18 and over, obtained from the UK electoral roll. The questionnaire contained items on awareness of nonmedical prescribing, levels of comfort with specific health professionals, and attitudes toward pharmacist prescribing. RESULTS: Response rate was 37.1%. More than half of the individuals who responded were taking prescribed drugs. Nine hundred and seventy-eight (56.6%) were aware that trained health professionals could write prescriptions for medicines previously only prescribed by physicians. Awareness was associated with: increasing age (p < 0.001), having a health professional in their immediate family (p < 0.001), self-rated general health (p < 0.005), and a higher education level (p < 0.01). In logistic regression, all factors were retained as independent predictors of awareness (p < 0.001). Comfort levels for nonmedical prescribing were highest for pharmacists (median 4, IQR 3-5 [1 = low, 5 = high]), closely followed by nurses, and lowest for radiographers (median 2, IQR 1-4) (p < 0.001). While more than half of the respondents supported pharmacists having a prescribing role, fewer felt that pharmacists should prescribe the same range of drugs as physicians. There were concerns about lack of privacy in a pharmacy, despite acknowledging its enhanced convenience. CONCLUSIONS: Our results indicate that more than half of the respondents were aware of nonmedical prescribing. A higher proportion was more comfortable with prescribing by pharmacists and nurses than with other healthcare professionals. Several issues relating to aspects of clinical governance were highlighted, specifically education and data handling.

Developing and evaluating training for community pharmacists to deliver interventions on alcohol issues.

OBJECTIVE: To evaluate community pharmacists' readiness to provide brief interventions on alcohol and to use study findings to develop training to enable them to screen for hazardous or harmful drinking and intervene appropriately. SETTING: Community pharmacies in Scotland. METHOD: Eight community pharmacies in Greater Glasgow, Scotland were purposively selected on the basis of pharmacy (independent, multiple), population deprivation index, location (rural, urban, suburban), and local level of hospital admissions for alcohol misuse. Baseline pharmacist telephone interviews covered: current practice; attitudes towards a proactive role; and perceived training needs. A two-day course was designed focusing on: consequences of problem alcohol use; attitudes; sensible drinking; familiarity with client screening using the Fast Alcohol Screening Tool; brief interventions and motivational interviewing. MAIN OUTCOME MEASURES: Knowledge of problem alcohol use and brief interventions; attitudes; competence. Results Participants felt it was feasible for trained pharmacists to provide brief interventions. Core training needs centred on communication and alcohol related knowledge. The training course was positively evaluated and led to increases in knowledge, attitudinal scores and self related competence. CONCLUSION: A training programme for pharmacists to deliver brief interventions to problem drinkers was successfully delivered resulting in enhanced knowledge, attitudinal scores and self related competence.

Views of pharmacist prescribers, doctors and patients on pharmacist prescribing implementation.

AIM: The aim of this study was to explore the perspectives of pharmacist supplementary prescribers, their linked independent prescribers and patients, across a range of settings, in Scotland, towards pharmacist prescribing. METHOD: Telephone interviews were conducted with nine pharmacist prescribers, eight linked independent prescribers (doctors) and 18 patients. The setting was primary and secondary care settings in six NHS Health Board areas in Scotland. KEY FINDINGS: In general, all stakeholders were supportive of pharmacists as supplementary prescribers, identifying benefits for patients and the wider health care team. Although patients raised no concerns, they had little idea of what to expect on their first visit, leading initially to feelings of apprehension. Pharmacists and doctors voiced concerns around a potential lack of continued funding, inadequate support networks and continuing professional development. Pharmacists were keen to undertake independent prescribing, although doctors were less supportive, citing issues around inadequate clinical examination skills. CONCLUSIONS: Pharmacists, doctors and patients were all supportive of developments in pharmacist supplementary prescribing, although doctors raised concerns around independent prescribing by pharmacists. The ability of pharmacists to demonstrate competence, to be aware of levels of competence and to identify learning needs requires further exploration.

Antimicrobial optimisation in secondary care: the pharmacist as part of a multidisciplinary antimicrobial programme--a literature review.

The aims of this literature review were: (i) to determine what roles have been supported by evidence for the pharmacist in optimising antimicrobial treatment as part of an antimicrobial multidisciplinary team (AMDT) in secondary care; and (ii) to describe the outcomes of interventions of an AMDT in secondary care with pharmacy involvement. Both descriptive and primary research reports were identified and included. The hospital pharmacist emerged as a key member of the AMDT. The dispensary pharmacist was mainly involved in the screening processes and was crucial in implementing restriction policies. The general ward-based clinical pharmacist was involved in guideline development, formulary management, intravenous-to-oral conversions and evaluations of programme outcomes through monitoring of drug usage, and also facilitated identification of patients with specific needs who could be referred to the specialist pharmacist. A role emerged for the specialist pharmacist who was an integral part of the AMDT and was involved in activities including reviewing of more complex patients, attending ward rounds and streamlining of initial empirical antimicrobial treatment. Outcomes of interventions reported in primary research have been classified into: drug outcomes, where most trials measured and reported an increase in adherence to guidelines; microbiological outcomes, only considered in a few trials; clinical outcomes, with different parameters measured and a maintenance or improvement reported; and financial outcomes. The latter were reported in all trials with numerous cost savings, although not all were statistically significant. Moreover, the cost of the intervention was not always considered.

Experiential learning as part of pharmacist supplementary prescribing training: feedback from trainees and their mentors.

BACKGROUND: A period of learning in practice (PLP) is an integral part of supplementary prescribing training for pharmacists in Great Britain. During the PLP, a designated medical practitioner (DMP) supervises and supports the trainee to develop competence in prescribing. OBJECTIVE: To evaluate the views and experiences of supplementary prescribing pharmacists and DMPs regarding the PLP and identify their perceived support needs during the PLP. METHODS: Prepiloted questionnaires were mailed in September 2006 to all pharmacists who had started their supplementary prescribing training at The Robert Gordon University, Aberdeen, Scotland (n = 242) and their DMPs (n = 232). Nonrespondents were sent up to 2 reminders. Responses were analyzed using descriptive and comparative statistics; responses to open questions were analyzed thematically. RESULTS: Responses were received from 186 (76.9%) pharmacists and 144 (62.1%) DMPs. Just over half of the pharmacists agreed/strongly agreed that they knew what was expected of them and their DMPs during the PLP, but less than half agreed/strongly agreed that it was important to communicate with pharmacist colleagues in the prescribing course. One hundred twelve (60.2%) pharmacists had their consultation skills reviewed by their DMPs during the PLP. Opportunities for professional development and teamwork were regarded as major positive experiences by both pharmacists and DMPs. Organizational, attitudinal, and time barriers were also reported. There was considerable interest among both pharmacists and DMPs for an Internet-based support network during the PLP. CONCLUSIONS: Information on the roles and responsibilities of pharmacists and DMPs during the PLP should be enhanced. The Internet could be a useful medium for communication during the PLP. Input from a multidisciplinary team of healthcare professionals and review of consultation videos could further enhance the PLP experience.

Prescription medications: beliefs, experiences, behavior, and adherence of sheltered housing residents.

BACKGROUND: Data on medication utilization among residents of sheltered housing complexes (SHCs) are limited. OBJECTIVE: To evaluate the extent of nonadherence to prescribed medications among residents of SHCs and identify factors associated with nonadherence. METHODS: A 58 item, pre-piloted questionnaire with validated items for patient self-assessment of medication risk; adherence; disability; health beliefs, experiences, and behavior; and general items on demographics, health, and medication use was mailed to 1137 SHC residents in Aberdeen, Scotland. Predictors of nonadherence (Morisky score >0) were identified using logistic regression. RESULTS: Of the 695 (61.1%) respondents, 645 (mean +/- SD age, 78.2 +/- 7.8 y) reported using prescribed drugs. Nonadherence was reported by 176 of 627 (28.1%) residents. The predictors of nonadherence were: disagreeing with the statement, "I ensure I have enough medicines so that I don't run out" (OR 0.48; 95% CI 0.30 to 0.77), agreeing with the statements, "I make changes in the recommended management to suit my lifestyle" (OR 1.32; 95% CI 1.09 to 1.60) and "I get confused about my medicines" (OR 1.39; 95% CI 1.10 to 1.77), younger age (OR 0.96; 95% CI 0.94 to 0.99), not getting help from someone to use the medications correctly (OR 2.20; 95% CI 1.21 to 3.99), and agreeing with the statement, "I am concerned about the side effects from my medicines" (OR 1.31; 95% CI 1.05 to 1.63). CONCLUSIONS: Over one-quarter of SHC residents were found to be nonadherent to prescribed drugs. Risk factors for nonadherence include younger age, confusion about drugs, lack of support for drug supply and administration, interference of treatment recommendations with lifestyle, and a perceived view of risks outweighing benefits in using recommended drug therapy.

Supplementary prescribing: early experiences of pharmacists in Great Britain.

BACKGROUND: Pharmacists in Great Britain can undertake supplementary prescribing (SP) after training at a higher education institution and completing a "period of learning in practice" in accordance with the Royal Pharmaceutical Society of Great Britain (RPSGB) curriculum. OBJECTIVE: To explore SP pharmacists' early experiences of prescribing and their perceptions of the prescribing course. METHODS: A questionnaire was mailed to all RPSGB prescribers (N = 518, on June 1, 2005; 30 used in pilot questionnaire). Predictors of pharmacists starting to practice SP were identified in univariate analysis, and significant variables were further tested in multivariate analysis. RESULTS: The respondents (n = 401; 82.2%) were mainly female (270; 67.3%), had more than 20 years' experience as a pharmacist (123; 30.7%), worked in hospital settings (160; 39.9%), and focused on cardiovascular conditions (143; 35.7%) during their period of learning in practice. The median course satisfaction score, on a scale of 3 to 15 (lowest to highest), was 10. Practicing SP was self-reported by 195 (48.6%) respondents, 154 (79%) of whom had written a prescription. Ninety (58.4%) of the first prescriptions were written in primary care settings. Better patient management was regarded as the major benefit by 139 (71.3%) of those engaged in SP, while funding issues were identified by 71 (36.4%) as major barriers in implementing the practice. Lack of organizational recognition of SP was the main reason given (37; 18%) for those not commencing the practice. Independent predictors of those practicing SP included a longer time since registering as prescriber (p < 0.001); confidence of pharmacists in their prescribing abilities (p < 0.001); practicing in a setting other than community pharmacy (p = 0.001); and training in cardiovascular conditions or multiple conditions during the period of learning in practice (p = 0.005). CONCLUSIONS: Pharmacists have made progress in implementing SP, which is perceived by pharmacist prescribers as beneficial for both patients and themselves. Pharmacists need more support in terms of infrastructure and integration into the healthcare team to overcome some of the barriers to implementing SP.

Development of consensus guidance to facilitate service redesign around pharmacist prescribing in UK hospital practice.

BACKGROUND: The last decade has seen a drive towards non-medical prescribing in the United Kingdom (UK). However, there is a dearth of any published literature on applying the principles of service redesign to support pharmacist prescribing in any sphere of practice. OBJECTIVE: To develop consensus guidance to facilitate service redesign around pharmacist prescribing. SETTING: UK hospital practice. METHODS: The Delphi technique was used to measure consensus of a panel of expert opinion holders in Scotland. Individuals with key strategic and operational roles in implementing initiatives of pharmacy practice and medicines management were recruited as experts. An electronic questionnaire consisting of 30 statements related to pharmacist prescribing service redesign was developed. These were presented as five-point Likert scales with illustrative quotes. MAIN OUTCOME MEASURES: Consensus, defined as 70 % of panel members agreeing (ranked strongly agree/agree) with each statement. RESULTS: Responses were obtained from 35/40 (87.5 %) experts in round one and 29 (72.5 %) in round two. Consensus in round one was achieved for 27/30 of statements relating to aspects of generic 'service development' (e.g. succession planning, multidisciplinary working, quality evaluation, practice development and outcome measures) and 'pharmacist prescribing role development' (e.g. education and future orientation of service). Issues of disagreement were around targeting of pharmacist prescribing to clinical specialities and financial remuneration for prescribing in the hospital setting. CONCLUSION: Consensus guidance has been developed to facilitate service redesign around hospital pharmacist prescribing.

Pharmacist prescribing in primary care: the views of patients across Great Britain who had experienced the service.

OBJECTIVE To evaluate the views of patients across primary care settings in Great Britain who had experienced pharmacist prescribing. METHODS All Royal Pharmaceutical Society of Great Britain (RPSGB) prescribers (n = 1622) were invited to participate. Those consenting were asked to invite up to five consecutive patients who had experienced their prescribing to participate. Patients were mailed one questionnaire and a reminder. The questionnaire included five sections: demographics; you and your pharmacist prescriber; you and your general practitioner; your views and experiences based on your most recent pharmacist prescriber consultation; and additional views. KEY FINDINGS Of the 482 (29.7%) pharmacists who responded, 92 (19.1%) were eligible to participate, of whom 49 (53.3%) consented. Of those excluded, 193 (49.5%) were prescribing in secondary care and 171 (43.8%) were not prescribing. Between September 2009 and March 2010, 143 patients were recruited. Patient response rate was 73.4% (n = 105/143). Consultation settings were largely general practice (85.7%) or community pharmacy (11.4%). Attitudes were overwhelmingly positive with the vast majority agreeing/strongly agreeing that they were totally satisfied with their consultation and confident that their pharmacist prescribed as safely as their general practitioner (GP). Pharmacists were considered approachable and thorough, and most would recommend consulting a pharmacist prescriber. A slightly smaller majority would prefer to consult their GP if they thought their condition was getting worse and a small minority felt that there had been insufficient privacy and time for all their queries to be answered. CONCLUSIONS Patients were satisfied with, and confident in the skills of, pharmacist prescribers. However, the sample was small, may be biased and the findings lack generalisability.

Exploring patients' perspectives of pharmacist supplementary prescribing in Scotland.

AIM: The aim of this study was to explore patients' perspectives and experiences of pharmacist supplementary prescribing (SP) in Scotland. METHOD: A survey in primary and secondary care in Scotland. Pharmacist supplementary prescribers (n = 10) were purposively selected across Scotland. All pharmacists distributed questionnaires to 20 consecutive patients as they attended appointments during October to December 2006. Reminders were mailed to all 20 patients by each pharmacist 2 weeks after initial distribution. MAIN OUTCOME MEASURES: The questionnaire contained items on: attitudes towards pharmacist SP derived from earlier qualitative research; consultation satisfaction derived from a validated scale developed initially for general practitioners, with the term 'doctor' being replaced by 'pharmacist prescriber'; and demographics. Closed and Likert scales were used as response options. RESULTS: One pharmacist withdrew. The patient response rate was 57.2% (103/180). The median age was 67 years (interquartile range 56.5-73 years), with 53.4% being female. Most (76, 73.8%) consulted with the pharmacist in a general practice setting. Patients reported positive consultation experiences with 89.3% agreeing/strongly agreeing that they were satisfied with the consultation, 78.7% thought the pharmacist told them everything about their treatment and 72.9% felt the pharmacist was interested in them as a person. Most patients were positive in their attitudes, agreeing that they would recommend a pharmacist prescriber to others and that they had trust in the pharmacist. However, 65% would prefer to consult a doctor. CONCLUSION: Most patient respondents were satisfied with, and had a positive attitude towards, pharmacist prescribing consultations. However, most patients would still elect to see a doctor given the choice.

Views, attitudes and self-assessed training needs of Scottish community pharmacists to public health practice and competence.

OBJECTIVE: To assess the education and training needs of community pharmacists to support the delivery of an expanded public health role. Setting Community pharmacy in Scotland. METHOD: Two focus groups of community pharmacists (n = 4 in each) in geographically distinct regions of Scotland explored issues of public health function, competencies and education and training. Findings from thematic analysis were used to develop a draft postal questionnaire. Following piloting, pharmacist managers from a random sample of 500 community pharmacies in Scotland were contacted by telephone to ascertain the number of pharmacists working in each pharmacy in the following 14-day period. A survey pack containing questionnaires for each identified pharmacist working in the study period was sent by post to the pharmacist manager in each pharmacy. The questionnaire contained items on: demographics; views and attitudes towards: public health; competencies for public health practitioners; and education and training needs. One postal reminder was sent 2 weeks later. MAIN OUTCOME MEASURES: Main themes identified from focus group discussions; questionnaire response rate; views and attitudes towards public health competencies and education and training. RESULTS: Four hundred and fifteen managers agreed to participate, providing 904 potential participants. The response rate was 25% (223/904). Most (n = 179, 80%) were aware of the term 'pharmaceutical public health'. While a majority saw the importance of public health to their practice (n = 177, 79%) agreeing/strongly agreeing, they were less comfortable with the term 'specialist'. Respondents viewed competencies relating to health promotion (n = 192, 86%) more relevant than surveillance (n = 70, 31%), risk management (n = 29, 13%) and strategic developments (n = 12, 5%). Responses indicated a desire for education and training with more than half (n = 121, 54%) agreeing/strongly agreeing that they had a need now, with 69% (n = 153) expressing a future need. CONCLUSION: Results should be interpreted with caution due to the response rate. However, this research highlights the self assessed gap in competence related to pharmaceutical public health for community pharmacists in Scotland.

Developing consensus around the pharmaceutical public health competencies for community pharmacists in Scotland.

OBJECTIVE: The new community pharmacy contract in Scotland will formalise the role of pharmacists in delivering public health services. To facilitate assessment of education and training needs it is necessary to define the relevant public health competencies for community pharmacists. The objective of this research was to define and develop consensus around such competencies. METHODS: The "Skills for Health National Occupational Standards for Public Health Practitioners" was used to define an initial set of competencies. A two stage Delphi technique was undertaken to develop consensus. An expert panel, representing public health and pharmacy stakeholders, rated their agreement with the importance of each competency, with the agreement level set at 90%. MAIN OUTCOME MEASURES: Level of agreement (%) with each public health competency; those competencies achieving more than 90% agreement with importance for community pharmacy practice. RESULTS: Ten organisations (83% of those invited) and a total of 30 members (88%) agreed to take part in the process. In round 1 of the Delphi, responses were received from 25 (83%) individuals and 22 (73%) in round 2, with consensus being achieved for 25/68 (37%) competencies in round 1 and a further 8/68 (12%) in round 2. CONCLUSION: Public health competencies for community pharmacists achieving consensus predominantly focused on health improvement activities at individual and local community levels and ethical management of self rather than those relating to surveillance and assessment and strategic development. There is a need to research community pharmacists' views of these competencies and to systematically assess their education and training needs.

Views of pharmacists and mentors on experiential learning for pharmacist supplementary prescribing trainees.

OBJECTIVE: To explore the views and experiences of pharmacists and their mentoring designated medical practitioners (DMPs) about the 'period of learning in practice' (PLP) as part of supplementary prescribing (SP) training. METHOD: Two focus groups (n = 5 and 7) of SP pharmacists were organised in Scotland. The experiences and views of DMPs (n = 13) were explored using one-to-one telephone interviews. The focus groups and interviews were transcribed verbatim and analysed using the framework approach. MAIN OUTCOME MEASURES: Views and experiences of pharmacists and DMPs about the PLP. RESULTS: Planning the PLP in consultation with the DMP was found to be crucial for an optimal learning experience. Pharmacists who did not have a close working relationship with the medical team had difficulties in identifying a DMP and organising their PLP. Participants stressed the importance of focusing on and achieving the core competencies for prescribers during the PLP. Input from doctors involved in the training of others, review of consultation videos, and formal independent assessment including clinical assessment at the end of the PLP might improve the quality of the PLP. Forums for discussing experiences during the PLP and gathering information might be valuable. CONCLUSION: Our findings have implications for prescribing training for pharmacists in the future. The PLP should focus on core competencies with input from doctors involved in the training of others and have a formal assessment of consultation skills. Support for pharmacists in organising the PLP and forums for discussing experiences during the PLP would be valuable.

Risk factors for medication misadventure among residents in sheltered housing complexes.

AIM: To identify risk factors for unplanned hospitalizations among residents of sheltered housing complexes (SHCs). METHODS: Medication-related risk factors for health outcomes among residents of SHCs in Aberdeen (n = 1137) were assessed using a postal questionnaire. Predictors of unplanned hospitalization/emergency department (ED) visit were identified using logistic regression. RESULTS: Of the 695 (61.1%) responses received, 645 were from residents (mean age 78.2 years) using prescribed medications. One or more risk factors for medication-related problems was seen in 467 (72.4%) respondents; 488 (75.7%) were using medications with high potential for adverse drug reactions (ADRs) in the elderly. Unplanned hospitalizations/ED visits (n = 230) were found to be associated with use of drugs of narrow therapeutic index [P < 0.001; odds ratio (OR) 2.98, 95% confidence interval (CI) 1.69, 5.28]; use of five or more different medications (P = 0.001; OR 2.10, 95% CI 1.34, 3.31); and greater disability (Townsend score) (P = 0.005; OR 1.06, 95% CI 1.02, 1.11). CONCLUSION: Residents of SHCs using drugs of narrow therapeutic index, using five or more different medications, and with greater disability warrant periodic monitoring.