A community-pharmacy based influenza vaccination service conducted in the Isle of Wight has increased the uptake of the vaccine and found the patient experience to be positive, according to a new study published in the International Journal of Pharmacy Practice (2013;21:362).
Of the patients who responded to a survey about the service, the researchers found that 98 per cent indicated that they would use the service again and 91 per cent rated the service as "excellent".
The researchers say that accessibility was the major factor in pharmacy use with patients expressing five key reasons: no waiting, no queue, no appointment, convenience and easy access.
In addition, patients spoke of a reduced infection risk in pharmacy and the perception that it would help reduce local medical practices’ workload, the researchers say.
The Isle of Wight Primary Care Trust commissioned the community pharmacy service to boost the uptake of influenza vaccine. The PCT had been in the bottom 15 per cent of all PCTs in England with a vaccination rate of 69.9 per cent for those aged over 65 years and 48.1 per cent for those aged under 65 years and at clinical risk. The UK is trying to meet a European Parliament target of 75 per cent uptake for people aged over 65 years by 2013–14.
The study involved 18 of the island’s 30 pharmacies and the vaccine was administered by specially trained pharmacists. In total, 2,837 patients (making up 9.7 per cent of all patients vaccinated on the island) received the vaccine through pharmacies.
Of those, 1,972 (69.5 per cent) were people aged over 65 years, raising the PCT vaccination rate from 64.1 per cent (which had been doctor-administered) to 70.3 per cent. A further 612 vaccinations (or 21.6 per cent) were administered to those under 65 years and in a clinical risk group; pharmacy contribution raised vaccination rates from 46.4 per cent to 51.2 per cent.
Influenza vaccination services are now being commissioned more frequently in England. The researchers note that in 2004–05 just one PCT had commissioned this service, but by 2011–12 this had risen to 15.
"It therefore appears that influenza vaccination services through pharmacy are becoming more widespread and, in time, may become as commonplace as they are in the US," the researchers say.
They add that accessibility was the key determinant for all patient groups to choose a pharmacy over their medical practice, and probably explains why pharmacies had been able to vaccinate more carers and frontline workers and patients who had not been vaccinated against flu previously.
The important role that medicines information (MI) pharmacists play around the clinical care of patients through answering queries from healthcare professionals has been highlighted in a recent study, published in the International Journal of Pharmacy Practice (2013; 21,393).
The study highlights that in 19.5 per cent of enquiries, MI pharmacists actively provided advice on issues that enquirers had not identified themselves. These pharmacists, based in MI centres in NHS hospitals, are experts in providing evidence-based clinical advice and answer around half a million enquiries annually.
Pharmacy researchers decided to conduct what they describe as the first large multicentre study to assess the impact of MI advice; all previous studies involved single centres, except one study involving three centres.
Thirty-five MI centres in general and teaching hospitals in the south east and east of England participated in the study, which analysed how healthcare staff with patient-related enquiries rated the MI service; this was then independently verified to see any effects on patient outcomes. Enquiries from patients and NHS Direct were excluded from the study.
In total, 179 sets of matching initial and follow-up questionnaires were obtained from 316 initial and 194 follow-up questionnaires completed.
Most enquirers (81 per cent) who used the advice from MI rated the impact on patient care or outcome as "positive": 19.6 per cent said it improved patient outcome and 61.5 per cent replied that their patients’ care was improved. Some 15.1 per cent reported no impact and there were no reports of worsened patient care.
"Avoiding or preventing a disease, symptom, ADR [adverse drug reaction] or drug interaction" was the most common desired outcome for hospital doctor, hospital nurse and community enquiries. Hospital pharmacists were most likely to want to optimise the administration of a drug.
The researchers report that there was a high level of agreement between how the enquirers and an expert panel rated the impact of the service, with disagreement in only a few cases.
"This study found that MI services clearly optimise specific aspects of patient care. These benefits may not previously have been well recognised in UK healthcare because MI often has an indirect clinical role mediated through enquiries. No previously published studies were identified that describe MI pharmacists’ unsolicited clinical input," the researchers say.
Routine measurement of the impact of MI advice on patient care should be added to current UK measures of quality of MI services, they advise.
Sleep disturbances, gastrointestinal problems and dry mouth are likely to be among the side effects that pharmacists list to patients prescribed antidepressants, but what is having to take these medicines really like? If you want to go beyond the text-book descriptions, try visiting healthtalkonline.org, where researchers from Nottingham and Oxford universities have put together the personal stories of 36 patients on film.
In various video clips, the patients talk about the impact of both depression and taking antidepressants on their lives, their experiences of side effects and also their journeys to find a drug that works for them.
“Pharmacists can learn a lot from the site particularly, I think, about what it is like to first be prescribed an antidepressant and the support people need in the first few weeks when the side effects outweigh any positive effects. Health professionals are taught about side effects like dry mouth, lethargy, etc, but patients describe [taking antidepressants] so much more graphically, including the effects on their emotions, work and social life,” Claire Anderson, professor of social pharmacy at the University of Nottingham, told The Journal. For example, in addition to physical side effects or symptoms, some patients reveal initially feeling “detached”, “numb”, “controlled” and “like a zombie” — all of which could make life hard to cope with and make them question whether they want to continue with their treatment, she explained.
Healthtalkonline is a charity-funded website where people can watch and listen to patients sharing their stories about 75 health conditions, including cancer, epilepsy, arthritis, osteoporosis, stroke and diabetes. This latest addition to the site, launched last week, is the first to focus on a medicine rather than a condition. Professor Anderson got involved in managing the research that provides the information in this section after working on analysing the website’s patient transcripts on depression, and successfully secured the funding for it from the National Institute for Health Research School for Primary Care Research.
The videos also allow you to find out how patients feel about dependency, stopping medicines and the stigma associated with antidepressants. But they are not only a useful resource for practitioners and students — patients, too, will find them helpful. “When prescribed antidepressants for the first time people often want to know more about what to expect: how they might feel when they are taking them, how long they take to work, how long they should expect to take them for and about potential side effects. People value being able to hear about other people’s experiences and to make social comparisons,” Professor Anderson said.
She pointed out that although the summaries on the website contain accurate, evidence- based information, the focus is on patient experiences, which are individual and varied. “It is what it is and I think pharmacists can confidently recommend [the site] to people,” she said. The information on the website is approved by The Information Standard, NHS England’s accreditation scheme for health and social care information.
|Stuart explains that he could accept decreased libido as a side effect when he was single but changed to a different, but less effective antidepressant when he remarried||Catherine says that when she changed from mirtazapine to fluoxetine she was given something to help with the changeover and discontinuation symptoms
Perception of pharmacy
Not only does the website reveal what it is really like to be treated for depression, but it also gives an interesting insight into how these patients see pharmacists. “The people we interviewed did not mention pharmacists very much at all and then sometimes in a bad light. I think pharmacists have a lot to learn from this and maybe we don’t support people with mental health issues and support them in their medicines-taking enough,” Professor Anderson said.
She suggested that antidepressants are an ideal candidate for the new medicine service because people need so much support in starting to take them and in continuing with them for the first few weeks. She believes that pharmacists need more support in dealing with mental health patients. Healthtalkonline goes some of the way to providing this and is well worth exploring.
Dr Oliver Harman who has joined Oasis Dental Care...
Dr Oliver Harman who has joined Oasis Dental Care...
Justice Minister David Ford has said he is going to consult on changing Northern Ireland's abortion laws to allow women carrying babies with fatal foetal abnormalities to have a termination.
Is how long you'll live simply down to your postcode?