Drug information from pharmacies: desire for more spontaneous information

Effect of verbal encouragement on patient question-asking behaviour during medication counselling

Context

Empowering patients to take a more active role in health-related encounters is a goal of many advocates today. This stems from evidence that patients remain rather passive during interactions with doctors and pharmacists.

Objective

The objective of this study was to examine the effect of verbal encouragement on patient question-asking. It was hypothesised that encouragement to ask questions would elicit a freer flow of questioning.

Method

The study had two arms — intervention and control. The same prescription processing steps occurred for each group except that intervention subjects were presented with a short verbal message (to invite questioning) before the prescription was handed over to a pharmacist for filling. Any questions patients raised during subsequent medication counselling were recorded. Observations took place in one Canadian community pharmacy.

Results

A total of 127 patients were observed for study purposes (60 intervention and 67 control). A total of 141 questions were asked by 59 patients; the other 68 patients had no questions when asked. Subjects in the intervention group (one outlier removed) asked an average of 1.1 questions per encounter, while the control group asked 0.9 questions. This difference was not statistically significant.

Conclusion

The hypothesis of no difference in the rate of patient question-asking between groups was retained. This method of encouraging patients to become more involved in the counselling process proved unsuccessful.

Medication adherence: a review of pharmacy education, research, practice and policy in Finland

AIMS

To describe pharmacy education, research, practice and policy related to medication adherence in Finland since the year 2000.

METHODS

The three universities that provide pharmacy education (Åbo Akademi, University of Eastern Finland, and University of Helsinki) completed a structured pro-forma questionnaire regarding education related to medication adherence. A MEDLINE and EMBASE literature search was performed to identify English language peer-reviewed research that reported medication compliance, adherence or persistence. The Ministry of Social Affairs and Health was invited to nominate policies and documents related to medication adherence. A narrative review of medication counselling practices and professional service delivery through Finnish community pharmacies was undertaken.

RESULTS

Medication adherence was a theme integrated into obligatory and elective courses for bachelors and masters degree students. The literature search identified 33 English language peer-reviewed research articles reporting medication compliance, adherence or persistence published since the year 2000. Policy documents of the Ministry of Social Affairs and Health recognise that poor medication adherence may lead to suboptimal treatment outcomes, and encourage patient participation in treatment decision making. Adherence practice in Finnish pharmacies has been strongly linked to the development of medication counselling services.

CONCLUSIONS

Adherence research and education has focused on understanding and addressing the contextual factors that contribute to medication nonadherence. Adherence practice in community pharmacies has tended to focus on medication counselling and programs specific to particular disease states. Medication adherence is a topic that is integrated into courses for bachelor's and master's level pharmacy students in Finland.

Providing patient care in community pharmacies: practice and research in Finland

OBJECTIVE

To describe the provision of patient care in community pharmacies in Finland.

FINDINGS

The network of 799 community pharmacies across Finland dispensed 42.1 million prescriptions in 2005. Medication counseling has been mandated by law since 1983 and only pharmacists are permitted to provide therapeutic advice in pharmacies. Measurable improvements in the rates of pharmacists' medication counseling have been observed since 2000. Long-term national pharmacy practice initiatives commenced with the World Health Organization EuroPharm Forum's Questions to Ask About Your Medicines campaign from 1993 to 1996. This was followed by the larger Customized Information for the Benefit of Community Pharmacy Patients project. Since the late 1990s, Finnish pharmacies have actively participated in ongoing national public health programs, initially in the areas of asthma and diabetes, and more recently in the treatment and prevention of heart disease. Automated dose dispensing and electronic prescribing are in the process of wider uptake and implementation. A nationwide multidisciplinary project to improve the use of drugs in older people has recently been announced and research in this area is underway.

DISCUSSION

Research has focused on improving the quality of patient care as a strategic priority in community pharmacies. The development of community pharmacy services in Finland has been characterized by strong collaboration among the professional associations, university departments of social pharmacy, continuing education centers, and practicing pharmacists.

CONCLUSIONS

Implementation of new patient care services has required long-term, systematic, and well coordinated actions at the local and national levels. Future services will seek to promote the quality use of medications and to ensure that rising costs do not limit uniform access to drugs by all Finnish residents.

Appraisal of the knowledge of hypertensive patients and assessment of the role of the pharmacists in the management of hypertension: results of a regional survey

The objectives of the study were to appraise the knowledge which the patients have about their hypertension, and to assess the knowledge and involvement of pharmacists in the management of the hypertensive patient. All the pharmacies in the Poitou-Charentes area were invited both to participate in a training session about arterial hypertension and asked to fill in a pharmacist's questionnaire. Furthermore, each participant was required to submit a patient's questionnaire to 20 consecutive hypertensives. A total of 104 pharmacies and 1015 hypertensive patients participated in the survey. In all, 88% of the patients (n = 893) were aware of their blood pressure (BP) figures, but 68% (349/515) considered themselves wrongly, to be normalized; 39% (n = 350) only had BP figures <140/90 mmHg. They said they had been poorly informed about recommended lifestyle changes. In all, 18% (n = 185) were equipped with an automatic device. A total of 77% (n = 779) were able to give the names of their drugs without the help of the pharmacist. Treatment-related unwanted effects were reported by 8% of the patients (n = 79). Only 18% (n = 29) of the pharmacists were able to provide a correct definition of hypertension. Most of them thought hypertension was well controlled in the general population and considered that both tolerance of and compliance with antihypertensive treatment were satisfactory. They could most often (80%, n = 135) supply a SBPM device, but 58 (36%) only were able to provide relevant advice regarding the recommended procedures. In conclusion, The BP goals and the lifestyle modifications are poorly known by the hypertensives. Pharmacists' knowledge is frequently wrong and should be improved by appropriate training programmes.

Drug information for consumers: should it be disease or medication specific? Results of a community survey

OBJECTIVE

To investigate the information-seeking behaviour of medicine users.

METHODS

A telephone survey and follow-up in-depth interviews of a random sample of the adult population in the Hunter Region, NSW, Australia. The survey sought information on medicine use, information seeking, and satisfaction and understanding of the information received. In-depth interviews examined the barriers and facilitators of information seeking.

RESULTS

Seven hundred and eighty-six people completed the telephone survey and 58 completed the follow-up interviews. Over half (51%) of the medicine users sought information, primarily to 'manage' their medicines, such as how to use the medicine. Over 30% of the questions asked by users related to 'therapeutic choices', such as how well the medicine worked for a particular condition. Doctors and pharmacists were the most frequent sources of information. A small proportion (10%) reported a potential unmet need for medicines information by indicating they would have liked to ask a question, but did not, or were dissatisfied with the information they received. Barriers to information seeking included perceptions that health care professionals were 'too busy', and that they were unwilling to provide information.

CONCLUSIONS

Physicians and pharmacists continue to play an important role in providing consumers with medicines information. Although the reported level of unmet need was low, a significant proportion identified needs relating to information on therapeutic choice, rather than 'classical' drug information.

IMPLICATIONS

Medicines-related information for the public should include advice on comparative performance of drugs, and be provided within the wider framework of general health information.

Medicated hypertensive patients' views and experience of information and communication concerning antihypertensive drugs

Semi-structured interviews with mostly open-ended questions were conducted with 21 medicated hypertensive patients regarding their views and experience of information and communication with respect to antihypertensive medicines. The results showed that the physician was the person from whom the patients preferred to receive information about medicines. Pharmacy personnel were not regarded as an information resource and few patients had ever talked to them about drugs. The interviewees expressed a desire to receive information at the beginning of the pharmaceutical treatment, especially concerning possible side-effects. Except for this, information concerning the medicine itself was thought to be relatively unimportant, although patients expressed a desire to know whether the drug after a period of time could accumulate in the body or if the internal organs could be affected.

Establishment of a drug information service on a public-access computer bulletin board

OBJECTIVE

Computerized bulletin board services (BBSs) have existed for several decades; in recent years there has been increased use and acceptance. We have established a drug information service called The Pharmacy on a local public-access BBS, the Cleveland FreeNet. The goal of this service is to provide drug information to the lay public as well as healthcare professionals.

DESCRIPTION

The Pharmacy is divided into 4 areas: (1) About the Pharmacy, which provides instructions for use; (2) Drug Information, which contains postings on selected drug information topics that are prepared by the BBS staff; (3) Pharmacy Questions, the most popular feature, where FreeNet users are invited to post questions, the answers to which are provided by clinical, staff, and consultant pharmacists, as well as baccalaureate and graduate pharmacy students; and (4) Investigational Studies, where patient recruitment for investigational studies is done.

RESULTS

A total of 259 questions have been posted in the first 3 years of operation. An average of 5.2, 7.78, and 8.7 questions/month have been posted in 1992, 1993, and 1994, respectively. Four drug information monographs have been prepared and posted, and approximately 5 investigational studies have been advertised.

CONCLUSIONS

A computerized BBS is a new means of distributing drug information to the public and healthcare professionals. In addition to meeting a need for a public service of drug information in the community, it permits increased visibility for pharmacists and a unique learning experience for students.