Effect of incentives on recruitment and response rate in a community-based pharmacy practice study

Objectives

To study the feasibility of carrying out a community pharmacy-based drug utilisation study of H2 antagonists and alginate-containing preparations, and to study the effect of two methodological variations — payment of pharmacists and the free issue of medicines — on recruitment rates and response rates.

Method

Pharmacists were asked to recruit customers into the study after deciding that one of these products was appropriate for purchase. Customers were asked to provide their signed consent, their name, address and information about their general practitioner and to complete an initial questionnaire provided by the pharmacist and a second questionnaire which was sent out by the researchers two weeks later. In 20 of the pharmacies the medicines were offered free once customers had agreed to participate; in the remaining pharmacies, customers paid the normal retail price for the product. All pharmacies received incentive payments for each of the three months in the second half of the study period in which they recruited five or more customers.

Setting

Thirty-nine community pharmacies in Scotland and Wales.

Key findings

Similar numbers of customers were recruited to the study irrespective of whether free medicines were offered. Significantly more (P<0.001) customers recruited by pharmacies providing free medicines returned both the first (339/383) and second questionnaires (264) than those recruited by pharmacies not providing free medicines (269 and 208/384, respectively). Of the 608 customers who returned the first questionnaire and were subsequently issued with a second questionnaire, 77.6 per cent returned it; there was no difference in return rates between customers who received free medicines and those who did not. Incentive payments to pharmacies resulted in a small increase (14 per cent) in recruitment rate in the second half of the study and no difference in response rates from the customers recruited.

Conclusion

The study established the feasibility of undertaking drug utilisation studies with high response rates in community pharmacies. The provision of free medicines increased customer response rates, but incentive payments for pharmacists showed no clear effect on recruitment rates.

Community pharmacy provision of allergic rhinitis treatments: a longitudinal study of patient reported outcome

Objective

To monitor and compare the symptoms, and reported quality of life, of two groups of people who obtained treatment for allergic rhinitis from community pharmacies (prescribed or purchased).

Method

Subjects were recruited by 64 community pharmacies in 2001 and followed up by postal questionnaire at four time points: five days, four weeks, eight weeks and 26 weeks. Setting Primary care: community pharmacies in Grampian, Scotland.

Results

Response rates: five days — 84%; four weeks — 63%; eight weeks — 59%; 26 weeks — 56%. Three hundred and twenty-four subjects completed the five-day questionnaire (138 prescribed, 186 purchased). There were no important differences between groups in socio-economic variables monitored. The commonest treatments provided were antihistamines (non-sedating: 63% prescribed, 59% purchased; sedating: 3% prescribed, 16% purchased). Despite treatment, symptoms and quality-of-life impairments remained high; the prescribed group reported higher levels of many symptoms (including asthma), and lower quality of life at early time points. Most were satisfied with their treatment and few reported unmet need for pharmacy advice (11% prescribed, 3% purchased group).

Conclusion

Despite high levels of patient satisfaction with allergic rhinitis treatment, symptoms and quality-of-life impairments remained high in both groups. Widespread implementation of ‘allergic rhinitis and its impact on asthma’ (ARIA) guidelines for physicians and for pharmacists might improve management of symptoms and quality of life of patients.

Pharmacovigilance of over-the-counter products based in community pharmacy: methodological issues from pilot work conducted in Hampshire and Grampian, UK

PURPOSE

The incidence of serious adverse events from non-prescription medicines remains to be established. The aim of this initial pilot work, using an observational cohort design, was to determine the feasibility of conducting a pharmacovigilance study of a non-prescription medicine, based in community pharmacies.

METHOD

Community pharmacists from Grampian, Scotland, and Hampshire, England, recruited user-purchasers of ibuprofen. Exposure data were collected from a series of self-completed questionnaires. Outcome data were any new symptoms, use of concomitant medication and subsequent health-care utilization.

RESULTS

A total of 1021 eligible customers were recruited, 6.4% (466/7320) and 48.2% (555/1152) by the Hampshire and Grampian networks respectively. The cohorts differed with regard to age, smoking and socio-economic status, reason for purchase and recommendation, and duration of use. The two cohorts reported different use of concomitant medication (46.0 and 65.5%), asthma (7.2 and 10.5%), stomach/peptic ulcer (3.5 and 2.1%), a higher prevalence of gastrointestinal symptoms post-compared to pre-purchase (12.9 vs. 7.2%, p = 0.0006 and 8.8 vs. 5.8%, p = 0.034), ingestion of doses in excess of the licensed non-prescription dose by 5.1 and 3.9%, and discontinuation of treatment because the medicine upset them by 4.5 and 3.1%, respectively. Most participants did not seek medical advice for their symptoms.

CONCLUSION

Greater vigilance is required for adverse events that may be attributable to non-prescription product use. Development of pharmacovigilance models using community pharmacies is one means of systematically collecting information regarding drug safety. Further work is needed to identify a method which maximizes patient recruitment whilst maintaining acceptable follow-up rates.

Drug utilization evaluation of nonprescription H2-receptor antagonists and alginate-containing preparations for dyspepsia

AIMS

To evaluate the use, efficacy and adverse effects of nonprescription H2-receptor antagonists and alginate-containing preparations obtained from community pharmacies.

METHODS

Questionnaires were distributed to customers from 39 pharmacies in Scotland and Wales.

RESULTS

Of 767 customers recruited, 608 (79.3%) returned an initial questionnaire and 472 (61.5%) customers a second questionnaire. The vast majority of respondents (424, 69.7%) had suffered their symptoms on three or more occasions and 369 (60.7%) had previously tried medicines to relieve their symptoms. Referrals to a doctor were less frequent than recommended in guidelines and few of those who were referred actually saw a doctor. Over a quarter of those returning the second questionnaire claimed to be taking more than one product simultaneously for symptom control. Eight customers who were taking prescribed ulcer-healing drugs obtained H2-receptor antagonists. The majority of respondents (355/472, 75. 2%) obtained some or complete symptom relief using the product obtained and 369/472 (78.2%) were completely satisfied with their product. H2-receptor antagonists were more likely to produce complete relief of symptoms than alginate-containing preparations (P < 0.05). Only 14 respondents (3.0%) reported side-effects from the product used which were mostly gastro-intestinal.

CONCLUSIONS

The study demonstrated that drug utilization studies are feasible to carry out in a community pharmacy setting. While the results support published evidence of the efficacy and minimal toxicity of these products, they also highlight the possibility of H2-receptor antagonists being used outwith their licenced indications.