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Editorial International Journal of
Pharmacy Practice International Journal of Pharmacy Practice 2015, 23, pp. 1–2
A map for the future Christine M. Bond Professor of Primary Care, University of Aberdeen and Editor in Chief, IJPP ([email protected]) doi: 10.1111/ijpp.12175
Welcome to the first issue of 2015, and belated greeting for a productive and successful New Year. This issue has serendipitously included papers that provide a map for the year to come in terms of highlighting key areas of relevance to improving the public’s health through the safe and effective use of medicines, for both short-term and minor self-limiting ailments and long-term conditions. It also touches on the emerging era of telepharmacy, and appropriately in an increasingly globalised world on some international issues. Patient safety is a priority for all involved in health care, and in this issue we have four papers related to this important topic, involving a range of research methods and perspectives. Evidence synthesis from published literature is an increasingly important method to summarise a portfolio of research to either obviate the need for further empirical work or to inform the direction of future research. The Olaniyan review of the literature on the safety of medicines in primary care[1] reminds us that despite increasing emphasis being given to patient safety and knowing that many safety incidents involve medicines, medication error rates remain high. Older and younger sections of the population are more susceptible to errors and the authors suggest that these at-risk groups should be the focus of future interventions. Pharmacists have a central role to play in improving medicine safety but should it always be the safety net to prevent errors made by others reaching the patient? The paper by Green and colleagues[2] illustrates how much pharmacy time is spent correcting errors made by others, an opportunity cost to the detriment of taking forward other clinical services. Another generic issue of importance in influencing patient safety is the culture in the workplace. Are errors used as an opportunity for learning or are they hidden when cultures of blame still exist? The national Australian survey reported by Lalor and colleagues[3] suggests that the blame culture still exists, to the detriment of safety. Finally, safe and appropriate medication use is well exemplified by current worldwide concern about antimicrobial resistance, now widely recognised as being attributable to previous overuse of antibiotics, often when not indicated. Pharmacists have an important and growing role in antibiotic stewardship, and have had considerable success in this area, but there are barriers. This is recognised © 2015 Royal Pharmaceutical Society
internationally as is illustrated by the short report by Pawluk from Qatar[4]. The burden of managing increasing patient demands on the health service is well documented. Indeed, some services, as is the current case in the UK, are reported to be at crisis point. The paper by Porteous and colleagues[5] sheds light on how people manage minor illness using Andersons Behavioural Model applied to the context of analgesic use. This paper is particularly interesting because of its use of a theoretical approach to understanding behaviour. More research is needed to explore how to change patient behaviour to encourage more supported self-care when this is appropriate, rather than a cultural dependence on medical advice. The increasing prevalence of non-communicable disease is another pressure point for health care, a major concern for the next generation and another high-priority area. Cancer, heart disease and diabetes, respiratory disease and mental health are all areas of concern, often dependent for successful outcomes on appropriate use of medicines. Two papers in this issue, by Wright and colleagues, report on community pharmacy-led interventions to identify people with chronic obstructive pulmonary disease (COPD)[6] and to help those with existing COPD use their medicines to better effect[7]. In the screening study, which targeted those at risk of COPD, approximately half of those screened were found to have undiagnosed COPD, allowing early interventions to improve subsequent prognosis. Likewise, Type 2 diabetes is another condition predominantly managed in the community once diagnosed, but also frequently undiagnosed in its early stages. Knowing the diagnosis is especially important so that people can be supported to manage their condition better and avoid later complications of the disease. Twigg and colleagues[8] report how in a community pharmacy screening programme for diabetes, a third of those screened had a high chance of developing Type 2 diabetes in the next 10 years and could be offered advice to change their lifestyle and reduce that risk. Another clinical condition of increasing prevalence, associated in part with ageing populations, is mental health including dementia. In this condition, the responsibility for International Journal of Pharmacy Practice 2015, 23, pp. 1–2
2
A map for the future
ensuring appropriate medication use by the patient increasingly falls to the carer. The study by Smith and colleagues[9] suggests that while carers feel this responsibility and seek advice, current programmes to support better medicines use, such as medication use reviews, do not formally include the carer. More research is called for to explore efficient and effective ways of meeting these needs. One way might be the chatbased telepharmacy scheme introduced in Denmark. Ho and colleagues[10] publish a descriptive report of the calls made to the chat service, showing once again how many people seek advice on medicines, as well as about symptoms and administrative issues. One advantage of a virtual service is the perceived increased confidentiality. Many medical conditions are regarded as sensitive topics, and this is especially the case for mental health. Hattingh and colleagues[11] report from Australia on a study of the perspectives of mental health consumers. They identify the need for new strategies and better staff training to improve the confidential management of these and indeed all patients.
References 1. Olaniyan JO et al. Safety of medication use in primary care. Int J Pharm Pract 2015; 23: 3–20. 2. Green CF et al. A waste walk through clinical pharmacy: how do the ‘seven wastes’ of Lean techniques apply to the practice of clinical pharmacists. Int J Pharm Pract 2015; 23: 21–26. 3. Lalor DJ et al. An exploration of Australian hospital pharmacists’ attitudes to patient safety. Int J Pharm Pract 2015; 23: 67–76. 4. Pawluk S et al. Strategies for improving antibiotic use in Qatar: a survey of pharmacists’ perceptions and experiences. Int J Pharm Pract 2015; 23: 81–83.
© 2015 Royal Pharmaceutical Society
Finally, as an international journal, we welcome the opportunity to publish a Personal View article on the ethical issues for pharmacists involved in global health outreach[12].The fundamental objective for pharmacists in general is to provide the best care for every patient but this is not always possible in medically underserved settings, in which mitigating harm becomes the priority. The article highlights the need for pharmacists working in these settings to develop cultural competency and work within a different framework of local norms. So overall, this is an eclectic but highly relevant issue to start the 2015 volume. As well as topics of widespread importance, the papers reflect the developing methodological expertise and increased research capacity we have in our discipline. We welcome this and particularly invite authors of novel methodological papers to submit their work as well as of course seeking to publish the good developmental studies that lead to the gold standard randomised controlled trial and systematic reviews, which are the evidence base for future policy and practice.
5. Porteous T et al. Self-care behaviour for minor symptoms: can Andersen’s Behavioral Model of Health Services Use help us to understand it? Int J Pharm Pract 2015; 23: 27–35. 6. Wright D et al. Chronic obstructive pulmonary disease case finding by community pharmacists: a potential cost-effective public health intervention. Int J Pharm Pract 2015; 23: 87–89. 7. Wright D et al. An evaluation of a multi-site community pharmacy– based chronic obstructive pulmonary disease support service. Int J Pharm Pract 2015; 23: 36–43. 8. Twigg MJ et al. Community pharmacy type 2 diabetes risk assessment: demographics and risk results. Int J Pharm Pract 2015; 23: 84–86.
9. Smith F et al. Assisting people with dementia with their medicines: experiences of family carers. Int J Pharm Pract 2015; 23: 44–51. 10. Ho I et al. Chat-based telepharmacy in Denmark: design and early results. Int J Pharm Pract 2015; 23: 61–66. 11. Hattingh HL et al. Privacy and confidentiality: perspectives of mental health consumers and carers in pharmacy settings. Int J Pharm Pract 2015; 23: 52–60. 12. Romo ML, DeCamp M. Ethics in global health outreach: three key considerations for pharmacists. Int J Pharm Pract 2015; 23: 77–80.
International Journal of Pharmacy Practice 2015, 23, pp. 1–2
Editorial International Journal of
Pharmacy Practice International Journal of Pharmacy Practice 2015, 23, pp. 1–2
A map for the future Christine M. Bond Professor of Primary Care, University of Aberdeen and Editor in Chief, IJPP ([email protected]) doi: 10.1111/ijpp.12175
Welcome to the first issue of 2015, and belated greeting for a productive and successful New Year. This issue has serendipitously included papers that provide a map for the year to come in terms of highlighting key areas of relevance to improving the public’s health through the safe and effective use of medicines, for both short-term and minor self-limiting ailments and long-term conditions. It also touches on the emerging era of telepharmacy, and appropriately in an increasingly globalised world on some international issues. Patient safety is a priority for all involved in health care, and in this issue we have four papers related to this important topic, involving a range of research methods and perspectives. Evidence synthesis from published literature is an increasingly important method to summarise a portfolio of research to either obviate the need for further empirical work or to inform the direction of future research. The Olaniyan review of the literature on the safety of medicines in primary care[1] reminds us that despite increasing emphasis being given to patient safety and knowing that many safety incidents involve medicines, medication error rates remain high. Older and younger sections of the population are more susceptible to errors and the authors suggest that these at-risk groups should be the focus of future interventions. Pharmacists have a central role to play in improving medicine safety but should it always be the safety net to prevent errors made by others reaching the patient? The paper by Green and colleagues[2] illustrates how much pharmacy time is spent correcting errors made by others, an opportunity cost to the detriment of taking forward other clinical services. Another generic issue of importance in influencing patient safety is the culture in the workplace. Are errors used as an opportunity for learning or are they hidden when cultures of blame still exist? The national Australian survey reported by Lalor and colleagues[3] suggests that the blame culture still exists, to the detriment of safety. Finally, safe and appropriate medication use is well exemplified by current worldwide concern about antimicrobial resistance, now widely recognised as being attributable to previous overuse of antibiotics, often when not indicated. Pharmacists have an important and growing role in antibiotic stewardship, and have had considerable success in this area, but there are barriers. This is recognised © 2015 Royal Pharmaceutical Society
internationally as is illustrated by the short report by Pawluk from Qatar[4]. The burden of managing increasing patient demands on the health service is well documented. Indeed, some services, as is the current case in the UK, are reported to be at crisis point. The paper by Porteous and colleagues[5] sheds light on how people manage minor illness using Andersons Behavioural Model applied to the context of analgesic use. This paper is particularly interesting because of its use of a theoretical approach to understanding behaviour. More research is needed to explore how to change patient behaviour to encourage more supported self-care when this is appropriate, rather than a cultural dependence on medical advice. The increasing prevalence of non-communicable disease is another pressure point for health care, a major concern for the next generation and another high-priority area. Cancer, heart disease and diabetes, respiratory disease and mental health are all areas of concern, often dependent for successful outcomes on appropriate use of medicines. Two papers in this issue, by Wright and colleagues, report on community pharmacy-led interventions to identify people with chronic obstructive pulmonary disease (COPD)[6] and to help those with existing COPD use their medicines to better effect[7]. In the screening study, which targeted those at risk of COPD, approximately half of those screened were found to have undiagnosed COPD, allowing early interventions to improve subsequent prognosis. Likewise, Type 2 diabetes is another condition predominantly managed in the community once diagnosed, but also frequently undiagnosed in its early stages. Knowing the diagnosis is especially important so that people can be supported to manage their condition better and avoid later complications of the disease. Twigg and colleagues[8] report how in a community pharmacy screening programme for diabetes, a third of those screened had a high chance of developing Type 2 diabetes in the next 10 years and could be offered advice to change their lifestyle and reduce that risk. Another clinical condition of increasing prevalence, associated in part with ageing populations, is mental health including dementia. In this condition, the responsibility for International Journal of Pharmacy Practice 2015, 23, pp. 1–2
2
A map for the future
ensuring appropriate medication use by the patient increasingly falls to the carer. The study by Smith and colleagues[9] suggests that while carers feel this responsibility and seek advice, current programmes to support better medicines use, such as medication use reviews, do not formally include the carer. More research is called for to explore efficient and effective ways of meeting these needs. One way might be the chatbased telepharmacy scheme introduced in Denmark. Ho and colleagues[10] publish a descriptive report of the calls made to the chat service, showing once again how many people seek advice on medicines, as well as about symptoms and administrative issues. One advantage of a virtual service is the perceived increased confidentiality. Many medical conditions are regarded as sensitive topics, and this is especially the case for mental health. Hattingh and colleagues[11] report from Australia on a study of the perspectives of mental health consumers. They identify the need for new strategies and better staff training to improve the confidential management of these and indeed all patients.
References 1. Olaniyan JO et al. Safety of medication use in primary care. Int J Pharm Pract 2015; 23: 3–20. 2. Green CF et al. A waste walk through clinical pharmacy: how do the ‘seven wastes’ of Lean techniques apply to the practice of clinical pharmacists. Int J Pharm Pract 2015; 23: 21–26. 3. Lalor DJ et al. An exploration of Australian hospital pharmacists’ attitudes to patient safety. Int J Pharm Pract 2015; 23: 67–76. 4. Pawluk S et al. Strategies for improving antibiotic use in Qatar: a survey of pharmacists’ perceptions and experiences. Int J Pharm Pract 2015; 23: 81–83.
© 2015 Royal Pharmaceutical Society
Finally, as an international journal, we welcome the opportunity to publish a Personal View article on the ethical issues for pharmacists involved in global health outreach[12].The fundamental objective for pharmacists in general is to provide the best care for every patient but this is not always possible in medically underserved settings, in which mitigating harm becomes the priority. The article highlights the need for pharmacists working in these settings to develop cultural competency and work within a different framework of local norms. So overall, this is an eclectic but highly relevant issue to start the 2015 volume. As well as topics of widespread importance, the papers reflect the developing methodological expertise and increased research capacity we have in our discipline. We welcome this and particularly invite authors of novel methodological papers to submit their work as well as of course seeking to publish the good developmental studies that lead to the gold standard randomised controlled trial and systematic reviews, which are the evidence base for future policy and practice.
5. Porteous T et al. Self-care behaviour for minor symptoms: can Andersen’s Behavioral Model of Health Services Use help us to understand it? Int J Pharm Pract 2015; 23: 27–35. 6. Wright D et al. Chronic obstructive pulmonary disease case finding by community pharmacists: a potential cost-effective public health intervention. Int J Pharm Pract 2015; 23: 87–89. 7. Wright D et al. An evaluation of a multi-site community pharmacy– based chronic obstructive pulmonary disease support service. Int J Pharm Pract 2015; 23: 36–43. 8. Twigg MJ et al. Community pharmacy type 2 diabetes risk assessment: demographics and risk results. Int J Pharm Pract 2015; 23: 84–86.
9. Smith F et al. Assisting people with dementia with their medicines: experiences of family carers. Int J Pharm Pract 2015; 23: 44–51. 10. Ho I et al. Chat-based telepharmacy in Denmark: design and early results. Int J Pharm Pract 2015; 23: 61–66. 11. Hattingh HL et al. Privacy and confidentiality: perspectives of mental health consumers and carers in pharmacy settings. Int J Pharm Pract 2015; 23: 52–60. 12. Romo ML, DeCamp M. Ethics in global health outreach: three key considerations for pharmacists. Int J Pharm Pract 2015; 23: 77–80.
International Journal of Pharmacy Practice 2015, 23, pp. 1–2
