Comparison of training responses and performance adaptations in endurance-trained men and women performing high-intensity interval training

The efficacy of high-intensity interval training (HIIT) to elicit physiological and performance adaptations in endurance athletes has been established in men and to a lesser extent in women. This study compared lactate threshold (LT₂) and performance adaptations to HIIT between men and women. Nine male and eight female cyclists and triathletes completed trials to determine their LT₂ and 40 km cycling performance before, and after 10 HIIT sessions. Each HIIT session consisted of 10 × 90 s at peak power output, separated by 60 s active recovery. Main effects showed that HIIT improved peak power output (p = 0.05; ES: 0.2); relative peak power output (W.kg^-1; p = 0.04; ES: 0.3 and W.kg^-0.32; p = 0.04; ES: 0.3); incremental time to fatigue (p = 0.01; ES: 0.4), time trial time (p < 0.001; ES: 0.7) and time trial power output (p < 0.001; ES: 0.7) equally in both sexes. Although LT₂ power output explained 77% of the performance improvement in women, no variable explained the performance improvement in men, suggesting another mechanism(s) was involved. Although HIIT improved cycling performance in men and women, it might not be appropriate to evaluate the effectiveness of HIIT using the same variables for both sexes.

The Efficacy of the Lactate Threshold: A Sex-Based Comparison

Hoffmann, SM, Skinner, TL, van Rosendal, SP, Osborne, MA, Emmerton, LM, and Jenkins, DG. The efficacy of the lactate threshold: A sex-based comparison. J Strength Cond Res 34(11): 3190-3198, 2020-The second lactate threshold (LT2) has previously been associated with endurance performance; however, comparisons between sexes are lacking regarding its efficacy. The aim of this study was to compare LT2 between men and women, specifically regarding its (a) relationship with endurance performance and (b) capacity to establish training and competition intensities. Competitive male (mean ± SD: age, 27.7 ± 4.7 years; V[Combining Dot Above]O2max, 59.7 ± 5.2 ml·kg·min; n = 10) and female (mean ± SD: age, 27.3 ± 6.2 years; V[Combining Dot Above]O2max, 54.5 ± 5.3 ml·kg·min; n = 12) cyclists and triathletes completed an incremental cycle trial to volitional fatigue (for determination of V[Combining Dot Above]O2max and LT2 via the modified D-max method), a constant load (±5%) exercise trial of 30 minutes at LT2 power output, and a 40-km cycle time trial. The LT2 significantly correlated with 40-km cycling performance in both men (r = -0.69 to -0.77; p < 0.01-0.05) and women (r = -0.63 to -0.75; p < 0.01-0.05). All men sustained LT2 power output for 30 minutes, compared with 82% of women. Despite LT2 reflecting a similar heart rate, V[Combining Dot Above]O2, and [La] to those elicited during a 40-km time trial in both men and women, power output at LT2 was 6% higher (p < 0.05) than mean time trial power output in women, with no significant difference in men. Based on these findings, sex-specific recommendations have been suggested in regard to the use of LT2 for establishing performance potential, prescribing endurance training intensities and setting 40-km performance intensity.

Oral Contraceptive Use Influences On-Kinetic Adaptations to Sprint Interval Training in Recreationally-Active Women

INTRODUCTION

Oral contraceptive (OC) use influences peak exercise responses to training, however, the influence of OC on central and peripheral adaptations to exercise training are unknown. This study investigated the influence of OC use on changes in time-to-fatigue, pulmonary oxygen uptake, cardiac output, and heart rate on-kinetics, as well as tissue saturation index to 4 weeks of sprint interval training in recreationally active women.

METHODS

Women taking an oral contraceptive (OC; n = 25) or experiencing natural menstrual cycles (MC; n = 22) completed an incremental exercise test to volitional exhaustion followed by a square-wave step-transition protocol to moderate (90% of power output at ventilatory threshold) and high intensity (Δ50% of power output at ventilatory threshold) exercise on two separate occasions. Time-to-fatigue, pulmonary oxygen uptake on-kinetics, cardiac output, and heart rate on-kinetics, and tissue saturation index responses were assessed prior to, and following 12 sessions of sprint interval training (10 min × 1 min efforts at 100-120% PPO in a 1:2 work:rest ratio) completed over 4 weeks.

RESULTS

Time-to-fatigue increased in both groups following training (p < 0.001), with no difference between groups. All cardiovascular on-kinetic parameters improved to the same extent following training in both groups. Greater improvements in pulmonary oxygen up-take kinetics were seen at both intensities in the MC group (p < 0.05 from pre-training) but were blunted in the OC group (p > 0.05 from pre-training). In contrast, changes in tissue saturation index were greater in the OC group at both intensities (p < 0.05); with the MC group showing no changes at either intensity.

DISCUSSION

Oral contraceptive use may reduce central adaptations to sprint interval training in women without influencing improvements in exercise performance - potentially due to greater peripheral adaptation. This may be due to the influence of exogenous oestradiol and progestogen on cardiovascular function and skeletal muscle blood flow. Further investigation into female-specific influences on training adaptation and exercise performance is warranted.

Contribution of mobile health applications to self-management by consumers: review of published evidence

Objective The aim of the present study was to review the contribution of mobile health applications ('apps') to consumers' self-management of chronic health conditions, and the potential for this practice to inform health policy, procedures and guidelines. Methods A search was performed on the MEDLINE, Cochrane Library, ProQuest and Global Health (Ovid) databases using the search terms 'mobile app*', 'self-care', 'self-monitoring', 'trial', 'intervention*' and various medical conditions. The search was supplemented with manual location of emerging literature and government reports. Mapping review methods identified relevant titles and abstracts, followed by review of content to determine extant research, reports addressing the key questions, and gaps suggesting areas for future research. Available studies were organised by disease state, and presented in a narrative analysis. Results Four studies describing the results of clinical trials were identified from Canada, England, Taiwan and Australia; all but the Australian study used custom-made apps. The available studies examined the effect of apps in health monitoring, reporting positive but not robust findings. Australian public policy and government reports acknowledge and support self-management, but do not address the potential contribution of mobile interventions. Conclusions There are limited controlled trials testing the contribution of health apps to consumers' self-management. Further evidence in this field is required to inform health policy and practice relating to self-management. What is known about the topic? Australian health policy encourages self-care by health consumers to reduce expenditure in health services. A fundamental component of self-care in chronic health conditions is self-monitoring, which can be used to assess progress towards treatment goals, as well as signs and symptoms of disease exacerbation. An abundance of mobile health apps is available for self-monitoring. What does this study add? A limited number of randomised control trials have assessed the clinical impact of health apps for self-monitoring. The body of evidence relating to current and long-term clinical impact is developing. Despite endorsing self-care, Australian health policy does not address the use and potential contribution of mobile health apps to health care. What are the implications? Widespread and sustained use of validated mobile health apps for chronic health conditions should have potential to improve consumer independence, confidence and burden on health services in the longer term. However, a significant body of scientific evidence has not yet been established; this is mirrored in the lack of acknowledgement of health apps in Australian health policy referring to consumers' self-management.

Oral Contraceptive Use Dampens Physiological Adaptations to Sprint Interval Training

PURPOSE

Oral contraceptive (OC) use reduces peak aerobic capacity (V˙O2peak); however, whether it also influences adaptations to training has yet to be determined. This study aimed to examine the influence of OC use on peak performance (peak power output [PPO]) and physiological adaptations (V˙O2peak and peak cardiac output [Q˙peak]) after sprint interval training (SIT) in recreationally active women.

METHODS

Women taking an OC (n = 25) or experiencing natural regular menstrual cycles (MC; n = 16) completed an incremental exercise test to assess V˙O2peak, PPO, and Q˙peak before, immediately after, and 4 wk after 12 sessions of SIT. The SIT consisted ten 1-min efforts at 100% to 120% PPO in a 1:2 work-rest ratio.

RESULTS

Though V˙O2peak increased in both groups after SIT (both P < 0.001), the MC group showed greater improvement (OC, +8.5%; MC, +13.0%; P = 0.010). Similarly, Q˙peak increased in both groups, with greater improvement in the MC group (OC, +4.0%; MC, +16.1%; P = 0.013). PPO increased in both groups (OC, +13.1%; MC, +13.8%; NS). All parameters decreased 4 wk after SIT cessation, but remained elevated from pretraining levels; the OC group showed more sustained training effects in V˙O2peak (OC, -4.0%; MC, -7.7%; P = 0.010).

CONCLUSION

SIT improved peak exercise responses in recreationally active women. However, OC use dampened V˙O2peak and Q˙peak adaptation. A follow-up period indicated that OC users had spared V˙O2peak adaptations, suggesting that OC use may influence the time course of physiological training adaptations. Therefore, OC use should be verified, controlled for, and considered when interpreting physiological adaptations to exercise training in women.

Three-step method for menstrual and oral contraceptive cycle verification

OBJECTIVES

Fluctuating endogenous and exogenous ovarian hormones may influence exercise parameters; yet control and verification of ovarian hormone status is rarely reported and limits current exercise science and sports medicine research. The purpose of this study was to determine the effectiveness of an individualised three-step method in identifying the mid-luteal or high hormone phase in endogenous and exogenous hormone cycles in recreationally-active women and determine hormone and demographic characteristics associated with unsuccessful classification.

DESIGN

Cross-sectional study design.

METHODS

Fifty-four recreationally-active women who were either long-term oral contraceptive users (n=28) or experiencing regular natural menstrual cycles (n=26) completed step-wise menstrual mapping, urinary ovulation prediction testing and venous blood sampling for serum/plasma hormone analysis on two days, 6-12days after positive ovulation prediction to verify ovarian hormone concentrations.

RESULTS

Mid-luteal phase was successfully verified in 100% of oral contraceptive users, and 70% of naturally-menstruating women. Thirty percent of participants were classified as luteal phase deficient; when excluded, the success of the method was 89%. Lower age, body fat and longer menstrual cycles were significantly associated with luteal phase deficiency.

CONCLUSIONS

A step-wise method including menstrual cycle mapping, urinary ovulation prediction and serum/plasma hormone measurement was effective at verifying ovarian hormone status. Additional consideration of age, body fat and cycle length enhanced identification of luteal phase deficiency in physically-active women. These findings enable the development of stricter exclusion criteria for female participants in research studies and minimise the influence of ovarian hormone variations within sports and exercise science and medicine research.

A model for assessment and referral of clients with bowel symptoms in community pharmacies

BACKGROUND

To expedite diagnosis of serious bowel disease, efforts are required to signpost patients with high-risk symptoms to appropriate care. Community pharmacies are a recognized source of health advice regarding bowel symptoms. This study aimed to examine the effectiveness of a validated self-administered questionnaire, Jodi Lee Test (JLT), for detection, triage, and referral of bowel symptoms suggestive of carcinoma, in pharmacies.

METHOD

'Usual Practice' was monitored for 12 weeks in 21 pharmacies in Western Australia, documenting outcomes for 84 clients presenting with bowel symptoms. Outcome measures were: acceptance of verbal advice from the pharmacist; general practitioner consultation; and diagnosis. Trial of the JLT involved staff training in the research protocol and monitoring of outcomes for 80 recruited clients over 20 weeks. Utility of the JLT was assessed by post-trial survey of pharmacy staff.

RESULTS

Significantly more referrals were made by staff using the JLT than during Usual Practice: 30 (38%) vs 17 (20%). Clients' acceptance of referrals was also higher for the intervention group (40% vs 6%). Two-thirds of pharmacy staff agreed that the JLT could be incorporated into pharmacy practice, and 70% indicated they would use the JLT in the future.

CONCLUSION

A pre-post design was considered more appropriate than a randomized control trial due to an inability to match pharmacies. Limitations of this study were: lack of control over adherence to the study protocol by pharmacy staff; no direct measure of client feedback on the JLT; and loss to follow-up. The JLT was effective in prompting decision-making by pharmacy staff and inter-professional care between pharmacies and general practice, in triage of clients at risk of bowel cancer.

Consumer Use of "Dr Google": A Survey on Health Information-Seeking Behaviors and Navigational Needs

Background

The Internet provides a platform to access health information and support self-management by consumers with chronic health conditions. Despite recognized barriers to accessing Web-based health information, there is a lack of research quantitatively exploring whether consumers report difficulty finding desired health information on the Internet and whether these consumers would like assistance (ie, navigational needs). Understanding navigational needs can provide a basis for interventions guiding consumers to quality Web-based health resources.

Objective

We aimed to (1) estimate the proportion of consumers with navigational needs among seekers of Web-based health information with chronic health conditions, (2) describe Web-based health information-seeking behaviors, level of patient activation, and level of eHealth literacy among consumers with navigational needs, and (3) explore variables predicting navigational needs.

Methods

A questionnaire was developed based on findings from a qualitative study on Web-based health information-seeking behaviors and navigational needs. This questionnaire also incorporated the eHealth Literacy Scale (eHEALS; a measure of self-perceived eHealth literacy) and PAM-13 (a measure of patient activation). The target population was consumers of Web-based health information with chronic health conditions. We surveyed a sample of 400 Australian adults, with recruitment coordinated by Qualtrics. This sample size was required to estimate the proportion of consumers identified with navigational needs with a precision of 4.9% either side of the true population value, with 95% confidence. A subsample was invited to retake the survey after 2 weeks to assess the test-retest reliability of the eHEALS and PAM-13.

Results

Of 514 individuals who met our eligibility criteria, 400 (77.8%) completed the questionnaire and 43 participants completed the retest. Approximately half (51.3%; 95% CI 46.4-56.2) of the population was identified with navigational needs. Participants with navigational needs appeared to look for more types of health information on the Internet and from a greater variety of information sources compared to participants without navigational needs. However, participants with navigational needs were significantly less likely to have high levels of eHealth literacy (adjusted odds ratio=0.83, 95% CI 0.78-0.89, P<.001). Age was also a significant predictor (P=.02).

Conclusions

Approximately half of the population of consumers of Web-based health information with chronic health conditions would benefit from support in finding health information on the Internet. Despite the popularity of the Internet as a source of health information, further work is recommended to maximize its potential as a tool to assist self-management in consumers with chronic health conditions.

Exploring example models of cross-sector, sessional employment of pharmacists to improve medication management and pharmacy support in rural hospitals

INTRODUCTION

Many rural hospitals in Australia are not large enough to sustain employment of a full-time pharmacist, or are unable to recruit or retain a full-time pharmacist. The absence of a pharmacist may result in hospital nurses undertaking medication-related roles outside their scope of practice. A potential solution to address rural hospitals' medication management needs is contracted part-time ('sessional') employment of a local pharmacist external to the hospital ('cross-sector'). The aim of this study was to explore the roles and experiences of pharmacists in their provision of sessional services to rural hospitals with no on-site pharmacist and explore how these roles could potentially address shortfalls in medication management in rural hospitals.

METHODS

A qualitative study was conducted to explore models with pharmacists who had provided sessional services to a rural hospital. A semi-structured interview guide was informed by a literature review, preliminary research and stakeholder consultation. Participants were recruited via advertisement and personal contacts. Consenting pharmacists were interviewed between August 2012 and January 2013 via telephone or Skype for 40-55 minutes.

RESULTS

Thirteen pharmacists with previous or ongoing hospital sessional contracts in rural communities across Australia and New Zealand participated. Most commonly, the pharmacists provided weekly services to rural hospitals. All believed the sessional model was a practical solution to increase hospital access to pharmacist-mediated support and to address medication management gaps. Roles perceived to promote quality use of medicines were inpatient consultation services, medicines information/education to hospital staff, assistance with accreditation matters and system reviews, and input into pharmaceutical distribution activities.

CONCLUSIONS

This study is the first to explore the concept of sessional rural hospital employment undertaken by pharmacists in Australia and New Zealand. Insights from participants revealed that their sessional employment model increased access to pharmacist-mediated medication management support in rural hospitals. The contracting arrangements and scope of services may be evaluated and adapted in other rural hospitals.

Funding issues and options for pharmacists providing sessional services to rural hospitals in Australia

OBJECTIVE

Many of Australia' s rural hospitals operate without an on-site pharmacist. In some, community pharmacists have sessional contracts to provide medication management services to inpatients. This paper discusses the funding arrangements of identified sessional employment models to raise awareness of options for other rural hospitals.

METHODS

Semistructured one-on-one interviews were conducted with rural pharmacists with experience in a sessional employment role (n =8) or who were seeking sessional arrangements (n = 4). Participants were identified via publicity and referrals. Interviews were conducted via telephone or Skype for ~40-55 min each, recorded and analysed descriptively.

RESULTS

A shortage of state funding and reliance on federal funding was reported. Pharmacists accredited to provide medication reviews claimed remuneration via these federal schemes; however, restrictive criteria limited their scope of services. Funds pooling to subsidise remuneration for the pharmacists was evident and arrangements with local community pharmacies provided business frameworks to support sessional services.

CONCLUSION

Participants were unaware of each other's models of practice, highlighting the need to share information and these findings. Several similarities existed, namely, pooling funds and use of federal medication review remuneration. Findings highlighted the need for a stable remuneration pathway and business model to enable wider implementation of sessional pharmacist models.

Cross-sector, sessional employment of pharmacists in rural hospitals in Australia and New Zealand: a qualitative study exploring pharmacists' perceptions and experiences

BACKGROUND

Many rural hospitals in Australia and New Zealand do not have an on-site pharmacist. Sessional employment of a local pharmacist offers a potential solution to address the clinical service needs of non-pharmacist rural hospitals. This study explored sessional service models involving pharmacists and factors (enablers and challenges) impacting on these models, with a view to informing future sessional employment.

METHODS

A series of semi-structured one-on-one interviews was conducted with rural pharmacists with experience, or intention to practise, in a sessional employment role in Australia and New Zealand. Participants were identified via relevant newsletters, discussion forums and referrals from contacts. Interviews were conducted during August 2012-January 2013 via telephone or Skype™, for approximately 40-55 minutes each, and recorded.

RESULTS

Seventeen pharmacists were interviewed: eight with ongoing sessional roles, five with sessional experience, and four working towards sessional employment. Most participants provided sessional hospital services on a weekly basis, mainly focusing on inpatient medication review and consultation. Recognition of the value of pharmacists' involvement and engagement with other healthcare providers facilitated establishment and continuity of sessional services. Funds pooled from various sources supplemented some pharmacists' remuneration in the absence of designated government funding. Enhanced employment opportunities, district support and flexibility in services facilitated the continuous operation of the sessional service.

CONCLUSIONS

There is potential to address clinical pharmacy service needs in rural hospitals by cross-sector employment of pharmacists. The reported sessional model arrangements, factors impacting on sessional employment of pharmacists and learnings shared by the participants should assist development of similar models in other rural communities.

Widening consumer access to medicines through switching medicines to non-prescription: a six country comparison

Background

Switching or reclassifying medicines with established safety profiles from prescription to non-prescription aims to increase timely consumer access to medicines, reduce under-treatment and enhance self-management. However, risks include suboptimal therapy and adverse effects. With a long-standing government policy supporting switching or reclassifying medicines from prescription to non-prescription, the United Kingdom is believed to lead the world in switch, but evidence for this is inconclusive. Interest in switching medicines for certain long-term conditions has arisen in the United Kingdom, United States, and Europe, but such switches have been contentious. The objective of this study was then to provide a comprehensive comparison of progress in switch for medicines across six developed countries: the United States; the United Kingdom; Australia; Japan; the Netherlands; and New Zealand.

Methods

A list of prescription-to-non-prescription medicine switches was systematically compiled. Three measures were used to compare switch activity across the countries: “progressive” switches from 2003 to 2013 (indicating incremental consumer benefit over current non-prescription medicines); “first-in-world” switches from 2003 to 2013; and switch date comparisons for selected medicines.

Results

New Zealand was the most active in progressive switches from 2003 to 2013, with the United Kingdom and Japan not far behind. The United States, Australia and the Netherlands showed the least activity in this period. Few medicines for long-term conditions were switched, even in the United Kingdom and New Zealand where first-in-world switches were most likely. Switch of certain medicines took considerably longer in some countries than others. For example, a consumer in the United Kingdom could self-medicate with a non-sedating antihistamine 19 years earlier than a consumer in the United States.

Conclusion

Proactivity in medicines switching, most notably in New Zealand and the United Kingdom, questions missed opportunities to enhance consumers' self-management in countries such as the United States.

A pharmacy asthma service achieves a change in patient responses from increased awareness to taking responsibility for their asthma

OBJECTIVES

If novel health services are to be implemented and sustained in practice, the perceptions and views of patients form a critical part of their evaluation. The aims of this study were to explore patient's perceptions and experiences with a pharmacy asthma service and to investigate if there was a change over time.

METHODS

Interviews and focus groups were conducted with patients participating in the asthma service at three time points. Data were transcribed verbatim and thematically analyzed using a framework approach.

KEY FINDINGS

The service led to an enhanced awareness and understanding of asthma, changes in participants' beliefs and attitudes towards asthma management, changes in asthma-related health behaviours and improved self-efficacy. Participants were very positive about the service and the role of the pharmacist in asthma management. There was a shift in participant perceptions and views, from being at an abstract level in those who had completed just one visit of the service to a more experiential level in those who had experienced the entire comprehensive asthma service.

CONCLUSIONS

A sustained experience/multiple visits in a service may lead to more concrete changes in patient perceptions of severity, beliefs, health behaviours and enhanced self-efficacy and control. The study highlights a need for such asthma services in the community.

Interventions to assist health consumers to find reliable online health information: a comprehensive review

Background

Health information on the Internet is ubiquitous, and its use by health consumers prevalent. Finding and understanding relevant online health information, and determining content reliability, pose real challenges for many health consumers.

Purpose

To identify the types of interventions that have been implemented to assist health consumers to find reliable online health information, and where possible, describe and compare the types of outcomes studied.

Data Sources

PubMed, PsycINFO, CINAHL Plus and Cochrane Library databases; WorldCat and Scirus ‘gray literature’ search engines; and manual review of reference lists of selected publications.

Study Selection

Publications were selected by firstly screening title, abstract, and then full text.

Data Extraction

Seven publications met the inclusion criteria, and were summarized in a data extraction form. The form incorporated the PICOS (Population Intervention Comparators Outcomes and Study Design) Model. Two eligible gray literature papers were also reported.

Data Synthesis

Relevant data from included studies were tabulated to enable descriptive comparison. A brief critique of each study was included in the tables. This review was unable to follow systematic review methods due to the paucity of research and humanistic interventions reported.

Limitations

While extensive, the gray literature search may have had limited reach in some countries. The paucity of research on this topic limits conclusions that may be drawn.

Conclusions

The few eligible studies predominantly adopted a didactic approach to assisting health consumers, whereby consumers were either taught how to find credible websites, or how to use the Internet. Common types of outcomes studied include knowledge and skills pertaining to Internet use and searching for reliable health information. These outcomes were predominantly self-assessed by participants. There is potential for further research to explore other avenues for assisting health consumers to find reliable online health information, and to assess outcomes via objective measures.

Health literacy among consumers in community pharmacy: perceptions of pharmacy staff

BACKGROUND

Low health literacy has important consequences for health status, medication adherence and use of health services. There is little insight from the perspective of pharmacy staff into how they identify the information needs of consumers and particularly the signals and risk factors of limited health literacy that they encounter in their day-to-day communication with consumers.

OBJECTIVE

To investigate factors impacting on consumer health literacy, from the perspective of pharmacy staff.

METHODS

The research comprised semi-structured interviews conducted in a convenience sample of pharmacies in the south-east region of Queensland, Australia. Eleven pharmacists and nine pharmacy assistants agreed to participate. Interviews were audio-recorded and transcribed verbatim. Initial coding of the anonymized transcripts was performed using NVivo(®). Codes were analysed into overarching themes and subthemes, which were then re-named and refined through consensus discussion.

RESULTS

Three overarching themes were identified from the coding process: complexity of the health system, clarity of information, and dialogue among consumers and health-care professionals. Two of the themes were system related, namely the health system and pharmacy labels; the health literacy issues included lack of clarity, complexity and misunderstanding. The third theme was related to communication.

CONCLUSIONS

Complexity of the health system, clarity of information and dialogue among consumers and health-care professionals were identified as factors associated with consumers' health literacy. We call for increased engagement between pharmacy staff and consumers with improved focus on areas of potential confusion, such as medicine labels and navigation of the health system, aiming to minimize negative consequences of limited health literacy and optimize patient health outcomes.

Prescribing and medication-initiation roles based on the perspectives of rural healthcare providers in a study community in Queensland

OBJECTIVE

There are recognised health service inequities in rural communities, including the timely provision of medications, often due to shortages of qualified prescribers. The present paper explores the insights of rural healthcare providers into the prescribing and medication-initiation roles of health professionals for their rural community.

METHODS

Forty-nine healthcare providers (medical practitioners, pharmacists, nurses, occupational therapists, a dentist and an optometrist) from four neighbouring towns in a rural health service district in Queensland participated in face-to-face semistructured interviews. The interviews explored medication supply and management issues in the community, including the roles of health professionals to address these issues. The interviews, averaging 45 min in duration, were recorded, transcribed and qualitatively analysed for general trends and unique responses.

RESULTS

Participants recognised the potential for dentists, optometrists and nurse practitioners to reduce the prescribing workload of rural medical practitioners, and there was some support for a 'continued dispensing' model for pharmacists. Medication-initiation orders by endorsed registered nurses were also valued in providing timely medical treatment in rural hospitals.

CONCLUSIONS

Rural communities have unique needs that require consideration of multidisciplinary support to assist medical practitioners in coping with prescription demands for timely medical treatment. WHAT IS KNOWN ABOUT THE TOPIC? Extension of prescribing rights to non-medical prescribers has been a topic of considerable debate in Australia for some decades. Several extended-prescribing or medication-initiation roles were established to supplement and support the medical workforce, particularly in rural areas, where health service inequalities and inefficiencies in prescribing and provision of medications are recognised. To date, workforce dynamics and legislative boundaries have restricted the eventual number of rurally located non-medical prescribers. WHAT DOES THIS PAPER ADD? Little research has been conducted to investigate or evaluate the application of prescribing or medication-initiation roles in rural settings from a multidisciplinary approach. This paper provides the perspectives of rural healthcare providers on the prescribing and medication-initiation roles across health professions. Key findings from this rural-engagement exercise are considered valuable for policymakers and health service planners in optimisation of the prescribing or medication-initiation models. The qualitative methods also added richness and depth to the discussion about these roles. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? According to the literature review and other media, extended prescribing roles are not universally accepted. However, some of the roles are being developed and implemented. Hence, it is important for health practitioners to embrace the roles and optimise their application. Specifically in rural settings, it is also important to recognise the value of multidisciplinary support and collaboration within the limited health workforce.

Experiences of community pharmacists involved in the delivery of a specialist asthma service in Australia

Background

The role of community pharmacists in disease state management has been mooted for some years. Despite a number of trials of disease state management services, there is scant literature into the engagement of, and with, pharmacists in such trials. This paper reports pharmacists’ feedback as providers of a Pharmacy Asthma Management Service (PAMS), a trial coordinated across four academic research centres in Australia in 2009. We also propose recommendations for optimal involvement of pharmacists in academic research.

Methods

Feedback about the pharmacists’ experiences was sought via their participation in either a focus group or telephone interview (for those unable to attend their scheduled focus group) at one of three time points. A semi-structured interview guide focused discussion on the pharmacists’ training to provide the asthma service, their interactions with health professionals and patients as per the service protocol, and the future for this type of service. Focus groups were facilitated by two researchers, and the individual interviews were shared between three researchers, with data transcribed verbatim and analysed manually.

Results

Of 93 pharmacists who provided the PAMS, 25 were involved in a focus group and seven via telephone interview. All pharmacists approached agreed to provide feedback. In general, the pharmacists engaged with both the service and research components, and embraced their roles as innovators in the trial of a new service. Some experienced challenges in the recruitment of patients into the service and the amount of research-related documentation, and collaborative patient-centred relationships with GPs require further attention. Specific service components, such as the spirometry, were well received by the pharmacists and their patients. Professional rewards included satisfaction from their enhanced practice, and pharmacists largely envisaged a future for the service.

Conclusions

The PAMS provided pharmacists an opportunity to become involved in an innovative service delivery model, supported by the researchers, yet trained and empowered to implement the clinical service throughout the trial period and beyond. The balance between support and independence appeared crucial in the pharmacists’ engagement with the trial. Their feedback was overwhelmingly positive, while useful suggestions were identified for future academic trials.

Non-prescription medicines and Australian community pharmacy interventions: rates and clinical significance

OBJECTIVE

To quantify pharmacy intervention rates for non-prescription medications (pharmacist-only and pharmacy medicines), to document the clinical significance of these interventions and to determine the adverse health consequences and subsequent health care avoided as a result of the interventions.

METHODS

Non-prescription medicines interventions undertaken by community pharmacy staff were recorded in two field studies: a study of all Australian pharmacies to determine incidence rates for low-incidence, highly significant interventions, and a study of a sample of pharmacies to collect data on all non-prescription interventions. Recorded interventions were assessed by a clinical panel for clinical significance, potential adverse health consequence avoided, probability and likely duration of the adverse health consequence.

KEY FINDINGS

The rate of professional intervention that occurs in Australia for pharmacist-only and pharmacy medicines is 5.66 per 1000 unit sales (95% confidence interval 4.79-6.64). Rates of intervention varied by clinical significance. When considering health care avoided, the main impact of the interventions was avoidance of urgent general practitioner (GP) visits, followed by avoidance of regular GP visits and accident and emergency treatment. The most common adverse health consequences avoided were exacerbations of an existing condition (e.g. hypertension, asthma) and adverse drug effects.

CONCLUSIONS

This study demonstrates the way in which community pharmacy encourages appropriate non-prescription medicine use and prevents harm through intervening at the point of supply. It was estimated that Australian pharmacies perform 485912 interventions per annum when dealing with non-prescription medicines, with 101324 per annum being interventions that avert emergency medical attention or serious harm, or which are potentially life saving.

Exploring health literacy competencies in community pharmacy

BACKGROUND

Health literacy is the ability to obtain, interpret and use health information. Low rates of health literacy in Australia have been suggested, but no validated measure exists.

OBJECTIVE

To explore health literacy competencies in a sample of community pharmacy consumers.

DESIGN

Structured interviews were undertaken by a team of researchers during August, 2009. The instrument was derived from available literature, measuring aspects of functional, interactive and critical health literacy regarding use of medicines.

SETTING AND PARTICIPANTS

Twelve community pharmacies in the Brisbane region, Australia.

RESULTS

Six hundred and forty-seven consumers participated; 64% were women. A wide distribution of ages was evident. English was the first language of 89% of respondents. More than half of the sample (55%), predominantly aged 26-45 years, was tertiary educated. While 87% of respondents recognized a sample prescription, 20% could not readily match the prescription to a labelled medicine box. Eighty-two percentage of respondents interpreted 'three times a day' appropriately, but interpretation of a standard ancillary label was highly variable. Advanced age, less formal education, non-English-speaking background and male gender were independently related to lower performance in some variables.

DISCUSSION

This health literacy measure applied comprehension and numeracy skills required of adults receiving prescription medications. While the majority of consumers adequately performed these tasks, some behaviours and responses were of sufficient concern to propose additional verbal and written information interventions by pharmacy staff.

CONCLUSIONS

This research provides insight into issues that may affect consumers' appropriate use of medicines and self-efficacy. Initiatives to improve public health literacy are warranted.

Exploration of two risk scenarios in non-prescription medicine purchases

Objective

There is increasing focus on quality supply and use of medicines in the community. This study aimed to quantify and describe people's non-prescription medicine purchasing behaviour for two scenarios in which consumers are considered to be at higher risk of inappropriate medicine use.

Setting

Fifteen community pharmacies in South-East Queensland, Australia.

Method

Each pharmacy hosted a researcher to survey all available eligible customers of non-prescription medicines over a 5-day period in August 2004. Researchers also noted whether medicine-related consultations occurred. In the case of non-response, observational data were recorded, where possible with validation by the salesperson. Two theoretical risk scenarios were proposed and examined in the data.

Key findings

A total of 3017 purchases were recorded, with customers of 77.8% of observed purchases participating in the survey. Overall, 85.4% of the purchases were made with some form of product-related communication. The first risk scenario identified that 10 of 799 sales (1.3%) to customers who had not intended to buy a particular brand resulted in self-selection of a medicine that they had not purchased before, with no consultation in the pharmacy. The second scenario identified that 326 of 1886 sales (17.3%) to customers who intended to buy a particular brand did result in purchase of that brand, but without consultation by a staff member.

Conclusion

The vast majority of purchases were made with some form of communication with a staff member to assist in product selection and/or appropriate use. Although risk was theoretically present in these scenarios, actual harm cannot be ascertained without consumer follow-up. Pharmacy staff are encouraged to be aware of opportunities to become involved in product choice and advice with sales.

Nutritional supplement use among 26-year-olds

AIMS

To estimate the prevalence of use of nutritional supplements among young adults, to examine the source of those supplements and to investigate sex differences in usage.

METHODS

Participants in the age-26 years assessments of the Dunedin Multidisciplinary Health and Development Study were asked to bring containers for any medication (including supplements) taken in the previous two weeks. Medication data (including prescription source) were recorded and analysed for 978 of 980 Study members.

RESULTS

The prevalence of supplement use was 16.6%; 20.4% among females and 13.3% for males (p<0.01). Multivitamin preparations were the most widely consumed, followed by water-soluble vitamin supplements (such as folate and vitamin C). Folate use was higher among females and was taken by 35.7% of pregnant females. Most supplements were self-prescribed, although a doctor had prescribed over one-third of the mineral supplements. Most supplements had been taken for weeks or months, rather than years.

CONCLUSIONS

Nutritional supplement usage among young adults is reasonably common, and involves a wide range of preparations. The extent of use among younger people suggests a need for regulation of their manufacture, sale and usage, and research to examine their efficacy.