Australian's are avid travelers. In the recent past, Australians have been heading overseas i... more Australian's are avid travelers. In the recent past, Australians have been heading overseas in record numbers. Most often, people are travelling for business purposes or short-term holidays.
ABSTRACT Background Integrating pharmacists into general practice is not a novel concept. However... more ABSTRACT Background Integrating pharmacists into general practice is not a novel concept. However, it is new to Australia and evidence supporting this role is limited.AimTo seek the views of pharmacists, general practitioners and consumers on integrating pharmacists into general practice.Method Questionnaires were used to elicit the opinions of pharmacists, general practitioners and consumers on integrating pharmacists into general practice.Results1038 participants (829 pharmacists, 167 consumers, 42 general practitioners) completed the survey. Commonly agreed roles for pharmacists in general practice included drug information and medication review. Perceived barriers to service provision included the pharmacist's clinical ability and turf protection. Remuneration was viewed as a facilitator and a barrier. Perceived facilitators included additional training for pharmacists and an existing rapport with the general practitioners.Conclusion There was support for integrating pharmacists' professional activities into general practice. These findings will guide the development of a new model of integrated primary care with practice pharmacists.
Sample medications represented 4% (3.8 million Australian dollars) of the Australian general prac... more Sample medications represented 4% (3.8 million Australian dollars) of the Australian general practice promotional budget of pharmaceutical companies in the second quarter of 2005. In the United States, general practitioners have been shown to use sample medication in up to 20% of encounters both for commencing and for full treatment. Given the USA does not have a universal subsidy for medications like Australia, sample use may be higher than Australian GPs operating with the Pharmaceutical Benefits Scheme. Australian GPs perceive benefits for samples as a trial run: to test patient tolerability, enhance patient satisfaction, and for those who cannot afford multiple trials of drugs. Acceptance of samples by GPs is associated with preference for and rapid prescription of new drugs and positive attitudes toward pharmaceutical representatives. Concerns with sample medications include prescribing medication that is not the GP's preferred choice owing to the limited range of samples a...
To evaluate the current management of over-the-counter (OTC) insomnia complaints in Australian co... more To evaluate the current management of over-the-counter (OTC) insomnia complaints in Australian community pharmacies using standardized patient methodology. Trained standardized patients visited a sample of 100 randomly selected South East Queensland community pharmacies in June 2011. The standardized patients enacted two OTC insomnia scenarios: a direct product request (DPR) (n = 50) and a symptom-based request (SBR) (n = 50). Results of the interactions were documented immediately after each visit and evaluated using the Pharmaceutical Society of Australia's WHAT STOP GO protocol as a standard comparison. Of all DPRs, 30% were handled entirely by the pharmacist, 70% of staff enquired about specific symptoms and 28% investigated the cause of insomnia. No staff investigated the frequency of product use. The DPR scenario resulted in a 92% supply of the requested doxylamine product (Restavit). In the SBR scenario, 18% of requests were handled entirely by the pharmacist, 58% of staff enquired about specific symptoms and 44% investigated the cause of insomnia. Staff recommended medicated products (38%), or herbal (78%) or non-drug techniques (18%). Investigation into smoking and alcohol intake was not undertaken in DPR or SBR interactions, while questioning on caffeine intake was undertaken in 2 and 14% of cases respectively. There were no significant differences found in the handling of sleep requests by pharmacists compared to pharmacy assistants. The standardized patient methodology was a successful way to assess the community pharmacy counselling provided with OTC sleep requests and suboptimal staff responses were found when compared with recommended practice standards.
There is controversy surrounding the risk of metformin and the development of lactic acidosis. Th... more There is controversy surrounding the risk of metformin and the development of lactic acidosis. There have been no reports of a pharmacist preventing a patient developing metformin-associated lactic acidosis. Our objective was to report on a pharmacist potentially preventing an evolving case of metformin-associated lactic acidosis (MALA). A patient who had been having episodes of nausea and vomiting for a year was referred for a home medicines review (HMR) by his general practitioner. The pharmacist who conducted the HMR suspected that the patient's symptoms could have been due to metformin. It was recommended to measure the serum lactate level and suspend metformin. Our patient was found to have a high lactate level and was referred to the emergency department by his general practitioner. Recovery was prompt with symptomatic support and cessation of metformin. This appears to be the first case reported in the literature of a pharmacist recognizing an evolving case of MALA. Although the incidence of MALA is rare, health professionals should be aware of the initial symptoms of lactic acidosis, especially in elderly patients with risk factors, to prevent a fatal lactic acidosis event.
To describe the effect of integrating a pharmacist into the general practice team on the timeline... more To describe the effect of integrating a pharmacist into the general practice team on the timeliness and completion of pharmacist-conducted medication reviews. A pharmacist was integrated into an Australian inner-city suburb general practice medical centre to provide medication reviews for practice patients. A retrospective analysis of medication reviews with two time periods was conducted: pre-integration of the practice pharmacist and post-integration of the practice pharmacist. In an effort to obtain a measure of external validity the data were compared to data from the Division of General Practice in which the medical centre is located. There were 70 patients referred for medication review in the pre-integration phase and 314 patients referred in the post-integration phase. The time to complete the medication review process was significantly reduced from a median of 56 days to 20 days with a practice pharmacist. Prior to having a practice pharmacist 52% of patients did not have the service billed by the general practitioner, which was reduced to 6% during the post-integration phase. The results from this trial show that the integration of a pharmacist into the general practice team was associated with an increase in the timeliness and completion rate of medication reviews.
There is a growing body of evidence which supports that a pharmacist conducted medication review ... more There is a growing body of evidence which supports that a pharmacist conducted medication review increases the health outcomes for patients. A pharmacist integrated into a primary care medical centre may offer many potential advantages in conducting medication reviews in this setting however research describing this is presently limited. To compare medication review reports conducted by pharmacists practicing externally to a medical centre to those medication review reports conducted by an integrated practice pharmacist. The secondary objective was to compare medication review reports conducted by pharmacists in the patient's home to those conducted in the medical centre. A primary care medical centre, Brisbane, Australia. A retrospective analysis of pharmacist conducted medication reviews prior to and after the integration of a pharmacist into a medical centre. Types of drug related problems identified by the Pharma cists, recommended intervention for drug related problems made by the pharmacist, and the extent of implementation of pharmacist recommendations by the general practitioner. The primary drug related problem reported in the practice pharmacist phase was Additional therapy required as compared to Precautions in the external pharmacist phase. The practice pharmacist most frequently recommended to add drug with Additional monitoring recommended most often in the external pharmacists. During the practice pharmacist phase 71 % of recommendations were implemented and was significantly higher than the external pharmacist phase with 53 % of recommendations implemented (p < 0.0001). Two of the 23 drug related problem domains differed significantly when comparing medication reviews conducted in the patient's home to those conducted in the medical centre.
Australian's are avid travelers. In the recent past, Australians have been heading overseas i... more Australian's are avid travelers. In the recent past, Australians have been heading overseas in record numbers. Most often, people are travelling for business purposes or short-term holidays.
ABSTRACT Background Integrating pharmacists into general practice is not a novel concept. However... more ABSTRACT Background Integrating pharmacists into general practice is not a novel concept. However, it is new to Australia and evidence supporting this role is limited.AimTo seek the views of pharmacists, general practitioners and consumers on integrating pharmacists into general practice.Method Questionnaires were used to elicit the opinions of pharmacists, general practitioners and consumers on integrating pharmacists into general practice.Results1038 participants (829 pharmacists, 167 consumers, 42 general practitioners) completed the survey. Commonly agreed roles for pharmacists in general practice included drug information and medication review. Perceived barriers to service provision included the pharmacist's clinical ability and turf protection. Remuneration was viewed as a facilitator and a barrier. Perceived facilitators included additional training for pharmacists and an existing rapport with the general practitioners.Conclusion There was support for integrating pharmacists' professional activities into general practice. These findings will guide the development of a new model of integrated primary care with practice pharmacists.
Sample medications represented 4% (3.8 million Australian dollars) of the Australian general prac... more Sample medications represented 4% (3.8 million Australian dollars) of the Australian general practice promotional budget of pharmaceutical companies in the second quarter of 2005. In the United States, general practitioners have been shown to use sample medication in up to 20% of encounters both for commencing and for full treatment. Given the USA does not have a universal subsidy for medications like Australia, sample use may be higher than Australian GPs operating with the Pharmaceutical Benefits Scheme. Australian GPs perceive benefits for samples as a trial run: to test patient tolerability, enhance patient satisfaction, and for those who cannot afford multiple trials of drugs. Acceptance of samples by GPs is associated with preference for and rapid prescription of new drugs and positive attitudes toward pharmaceutical representatives. Concerns with sample medications include prescribing medication that is not the GP's preferred choice owing to the limited range of samples a...
To evaluate the current management of over-the-counter (OTC) insomnia complaints in Australian co... more To evaluate the current management of over-the-counter (OTC) insomnia complaints in Australian community pharmacies using standardized patient methodology. Trained standardized patients visited a sample of 100 randomly selected South East Queensland community pharmacies in June 2011. The standardized patients enacted two OTC insomnia scenarios: a direct product request (DPR) (n = 50) and a symptom-based request (SBR) (n = 50). Results of the interactions were documented immediately after each visit and evaluated using the Pharmaceutical Society of Australia's WHAT STOP GO protocol as a standard comparison. Of all DPRs, 30% were handled entirely by the pharmacist, 70% of staff enquired about specific symptoms and 28% investigated the cause of insomnia. No staff investigated the frequency of product use. The DPR scenario resulted in a 92% supply of the requested doxylamine product (Restavit). In the SBR scenario, 18% of requests were handled entirely by the pharmacist, 58% of staff enquired about specific symptoms and 44% investigated the cause of insomnia. Staff recommended medicated products (38%), or herbal (78%) or non-drug techniques (18%). Investigation into smoking and alcohol intake was not undertaken in DPR or SBR interactions, while questioning on caffeine intake was undertaken in 2 and 14% of cases respectively. There were no significant differences found in the handling of sleep requests by pharmacists compared to pharmacy assistants. The standardized patient methodology was a successful way to assess the community pharmacy counselling provided with OTC sleep requests and suboptimal staff responses were found when compared with recommended practice standards.
There is controversy surrounding the risk of metformin and the development of lactic acidosis. Th... more There is controversy surrounding the risk of metformin and the development of lactic acidosis. There have been no reports of a pharmacist preventing a patient developing metformin-associated lactic acidosis. Our objective was to report on a pharmacist potentially preventing an evolving case of metformin-associated lactic acidosis (MALA). A patient who had been having episodes of nausea and vomiting for a year was referred for a home medicines review (HMR) by his general practitioner. The pharmacist who conducted the HMR suspected that the patient's symptoms could have been due to metformin. It was recommended to measure the serum lactate level and suspend metformin. Our patient was found to have a high lactate level and was referred to the emergency department by his general practitioner. Recovery was prompt with symptomatic support and cessation of metformin. This appears to be the first case reported in the literature of a pharmacist recognizing an evolving case of MALA. Although the incidence of MALA is rare, health professionals should be aware of the initial symptoms of lactic acidosis, especially in elderly patients with risk factors, to prevent a fatal lactic acidosis event.
To describe the effect of integrating a pharmacist into the general practice team on the timeline... more To describe the effect of integrating a pharmacist into the general practice team on the timeliness and completion of pharmacist-conducted medication reviews. A pharmacist was integrated into an Australian inner-city suburb general practice medical centre to provide medication reviews for practice patients. A retrospective analysis of medication reviews with two time periods was conducted: pre-integration of the practice pharmacist and post-integration of the practice pharmacist. In an effort to obtain a measure of external validity the data were compared to data from the Division of General Practice in which the medical centre is located. There were 70 patients referred for medication review in the pre-integration phase and 314 patients referred in the post-integration phase. The time to complete the medication review process was significantly reduced from a median of 56 days to 20 days with a practice pharmacist. Prior to having a practice pharmacist 52% of patients did not have the service billed by the general practitioner, which was reduced to 6% during the post-integration phase. The results from this trial show that the integration of a pharmacist into the general practice team was associated with an increase in the timeliness and completion rate of medication reviews.
There is a growing body of evidence which supports that a pharmacist conducted medication review ... more There is a growing body of evidence which supports that a pharmacist conducted medication review increases the health outcomes for patients. A pharmacist integrated into a primary care medical centre may offer many potential advantages in conducting medication reviews in this setting however research describing this is presently limited. To compare medication review reports conducted by pharmacists practicing externally to a medical centre to those medication review reports conducted by an integrated practice pharmacist. The secondary objective was to compare medication review reports conducted by pharmacists in the patient's home to those conducted in the medical centre. A primary care medical centre, Brisbane, Australia. A retrospective analysis of pharmacist conducted medication reviews prior to and after the integration of a pharmacist into a medical centre. Types of drug related problems identified by the Pharma cists, recommended intervention for drug related problems made by the pharmacist, and the extent of implementation of pharmacist recommendations by the general practitioner. The primary drug related problem reported in the practice pharmacist phase was Additional therapy required as compared to Precautions in the external pharmacist phase. The practice pharmacist most frequently recommended to add drug with Additional monitoring recommended most often in the external pharmacists. During the practice pharmacist phase 71 % of recommendations were implemented and was significantly higher than the external pharmacist phase with 53 % of recommendations implemented (p < 0.0001). Two of the 23 drug related problem domains differed significantly when comparing medication reviews conducted in the patient's home to those conducted in the medical centre.
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