Abstract: Improved access to effective contraceptive methods is needed in Canada, particularly in rural areas, where unintended pregnancy rates are high and specific sexual health services may be further away. A rural pharmacist may be the most accessible health care professional. Pharmacy practice increasingly incorporates cognitive services. In Canada many provinces allow pharmacists to independently prescribe for some indications, but not for hormonal contraception. To assess the acceptability for the implementation of this innovative practice in Canada, we developed and piloted a survey instrument. We chose questions to address the components for adoption and change described in Rogers’ “diffusion of innovations” theory. The proposed instrument was iteratively reviewed by 12 experts, then focus group tested among eight pharmacists or students to improve the instrument for face validity, readability, consistency and relevancy to community pharmacists in the Canadian context. We then pilot tested the survey among urban and rural pharmacies. 4% of urban and 35% of rural pharmacies returned pilot surveys. Internal consistency on repeated re-phrased questions was high (Cronbach’s Alpha = 0.901). We present our process for the development of a survey instrument to assess the acceptability and feasibility among Canadian community pharmacists for the innovative practice of the independent prescribing of hormonal contraception.
Abstract: To investigate the health literacy of the population and examine the change in knowledge when patients are administered a questionnaire about warfarin at different time points before and after counselling by a pharmacist. Patients were recruited over eight weeks, from May 2011, in a public hospital in Galway, Ireland. Inclusion criteria: (i) newly commenced on warfarin; (ii) 18 years or more; (iii) English as their first language; (iv) absence of visual or hearing difficulties. The Rapid Estimate of Adult Literacy in Medicine (REALM) was used to assess health literacy (HL). Warfarin knowledge was assessed using the Anticoagulation Knowledge Assessment (AKA). Both of these tools were administered following provision of the warfarin booklet and one hour’s reading time before pharmacist counselling. The AKA was re-administered 28–56 days after the counselling. Statistical analysis was performed using PASW® v. 18. Results: Forty-three patients (55.8% male), mean (±SD) age 65.7 years (±14.2) scored an average of 58.5/66 (±9.3) in the REALM. Warfarin knowledge improved from a mean of 19/29 (±4.7), prior to verbal counselling, to 23.8 (±3.7), within 24 hours of verbal counselling. This knowledge score decreased to a mean score of 22.8 (±3.7) 28–56 days following counselling.
Abstract: The purpose of this review is to examine the literature for reports of clinically significant interactions noted amongst HIV antiretroviral medications when coadministered with posaconazole. A literature search was conducted to identify studies addressing drug interactions between posaconazole and HIV antiretroviral medications. Two pharmacokinetic studies and three clinical trials involving the administration of posaconazole to HIV-infected patients were identified. The pharmacokinetic studies involved concomitant administration of either a protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI). Both studies showed alterations in systemic concentrations of either posaconazole or the HIV antiretroviral when administered together. Of the three clinical trials, all patients were on HIV antiretrovirals. However, their potential interaction with posaconazole was not explored. To date, there is no published literature regarding the interaction between maraviroc or elvitegravir and posaconazole. Dose adjustments for each are recommended when coadministered with strong CYP 3A4 inhibitors or inducers. Currently available literature points to the potential for clinically significant drug interactions when posaconazole is coadministered with HIV antiretrovirals, specifically NNRTIs and PIs. More studies are needed involving a wider range of HIV antiretrovirals to determine the significance of the interaction. Clinicians should be aware of this potentially significant interaction and avoid concomitant administration when possible. When available, consideration should be given to therapeutic drug monitoring of antiretroviral serum concentrations in select patients.
Abstract: Substantial complementary medicines (CAM) use is reported worldwide. Australian consumers use CAM for health maintenance, minor self-limiting disease states, and also for chronic conditions. The increasing use of CAM has required pharmacists to become increasingly more knowledgeable about CAM and the ethics of CAM recommendation. When the first Australian non-metropolitan pharmacy program was started at Charles Sturt University, in 1997, it was decided to incorporate two innovative courses to assist rurally educated students to engage with health consumers who expect pharmacists to be able to assist them with CAM. This discussion traces and reflects on the development, implementation and current situation of the Complementary Medicines for Pharmacy course. Over time, this course has evolved from a final year elective with a focus on familiarization to a mandated course with a phytomedicine focus to an integrated topic in final year with a focus on evidence, quality of evidence and professional decision-making demonstrated in a reflective professional portfolio. Of potentially greater importance, however, has been the introduction of complementary medicines as a topic in every year of the course with the goal of facilitating effective professional engagement with health consumers.
Abstract: Community pharmacy is often portrayed as a marriage of professional and business roles in a commercial domain, thereby creating a need for, and value in, pursuing the development of professional competencies for use in the community pharmacy business. In context, professional judgement is the application of knowledge, skills and attitudes (competencies) which, when applied to situations where there is no one or obvious right or wrong way to proceed, gives a patient a better likelihood of a favourable outcome than if a lay-person had made the decision. The challenge for community pharmacists is that professional judgement formation is influenced by professional, commercial and personal criteria with inherent interconnected challenges. In community pharmacy practice in the Republic of Ireland (ROI), this challenge is compounded by the fact that advice is normally provided in an environment where the pharmacist provides professional advice “for free” and then may offer to sell the patient a product or service based on that advice, an activity which amounts to a commercial transaction. While there is currently no evidence to confirm whether or not these professional judgement influences are resolved successfully, their very existence poses a risk that their resolution “in the wrong way”could compromise patient outcomes or professional standing following the delivery of pharmacy services. It is therefore apparent that a community pharmacist requires skills in identifying and analysing professional/commercial/personal influences in order to appreciate the criteria which may affect both parties’ (patient and pharmacist) decision making. By contemplating the interaction between the pharmacist’s professional competencies and the individual influences on that pharmacist, we can consider the enhancement of professional competencies that underpin the “best” advice being offered to the patient, regardless of whether that advice is offered in the course of dispensing prescriptions or delivering vaccination or other services, culminating in a framework of professional judgement formation.