Preventable drug-related morbidity in community pharmacy: commentary on the implications for practice and policy of a novel intervention.

This commentary relates to a paper on the development and piloting of a risk management intervention in Portuguese community pharmacy, based on validated preventable drug-related morbidity indicators. In the paper we presented the research programme and implications for future evaluation. However, we believe that the intervention may be seen as important for patient safety without further evaluation.

An embedded longitudinal multi-faceted qualitative evaluation of a complex cluster randomized controlled trial aiming to reduce clinically important errors in medicines management in general practice.

Background: There is a need to shed light on the pathways through which complex interventions mediate their effects in order to enable critical reflection on their transferability. We sought to explore and understand key stakeholder accounts of the acceptability, likely impact and strategies for optimizing and rolling-out a successful pharmacist-led information technology-enabled (PINCER) intervention, which substantially reduced the risk of clinically important errors in medicines management in primary care.

Methods: Data were collected at two geographical locations in central England through a combination of one-to-one longitudinal semi-structured telephone interviews (one at the beginning of the trial and another when the trial was well underway), relevant documents, and focus group discussions following delivery of the PINCER intervention.

Preventable drug-related morbidity in community pharmacy: development and piloting of a complex intervention.

Background: Preventable drug-related morbidity (PDRM) arising in the community is a problem of unacceptable magnitude. Effective interventions to reduce this problem will avoid unnecessary patient harm and waste of resources for the health care system.

Objective: To develop and pilot an intervention to manage the risk of PDRM in community pharmacy, underpinned by validated PDRM indicators.

A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis.

Background: Medication errors are common in primary care and are associated with considerable risk of patient harm. We tested whether a pharmacist-led, information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to hazardous prescribing and inadequate blood-test monitoring of medicines 6 months after the intervention.

Methods: In this pragmatic, cluster randomised trial general practices in the UK were stratified by research site and list size, and randomly assigned by a web-based randomisation service in block sizes of two or four to one of two groups.

Validating reasons for medication discontinuation in electronic patient records at hospital discharge.

Rationale, Aims And Objectives: The accuracy of health care professionals in reporting safety events determines their usefulness for both system improvement and research. The study objectives were to: (1) validate (assess the accuracy of) the reasons recorded by doctors and pharmacists for discontinuing medication orders at discharge in a hospital's electronic patient records (EPR); (2) investigate the causes of any detected recording inaccuracy; and (3) collect preliminary data on the frequency and types of medication discontinuation.

Methods: This was a validation study in one English hospital.

Pharmacists' interventions in prescribing errors at hospital discharge: an observational study in the context of an electronic prescribing system in a UK teaching hospital.

Background: Pharmacists have an essential role in improving drug usage and preventing prescribing errors (PEs). PEs at the interface of care are common, sometimes leading to adverse drug events (ADEs). This was the first study to investigate, using a computerized search method, the number, types, severity, pharmacists' impact on PEs and predictors of PEs in the context of electronic prescribing (e-prescribing) at hospital discharge.

Satisfaction predictors and attitudes towards electronic prescribing systems in three UK hospitals.

Objective: Measuring satisfaction of technology users, along with satisfaction determinants, is important to enhance system utilisation and identify potential problems. The aim of this study was to investigate pharmacists' and doctors' attitudes towards e-prescribing systems, and assess the predictors of their satisfaction.

Method: A cross-sectional survey was conducted, with 67 pharmacists and 335 doctors in three English hospitals completing a pre-piloted, postal questionnaire.

Shared care arrangements for specialist drugs in the UK: the challenges facing GP adherence.

Objective: To explore the challenges facing GPs' adherence to shared care arrangements for specialist drugs.

Design: A qualitative study using semistructured interviews; data analysed using the 'framework' approach aided by QSR N-Vivo 2.0.

Acceptability of community pharmaceutical care in Portugal: a qualitative study.

Objectives: In developed countries, community pharmacists are increasingly involved in clinical care. This study aimed to explore the acceptability to users of pharmaceutical care (drug therapy monitoring and management) provided in Portuguese community pharmacies, thereby informing future practice, policy and research.

Methods: Qualitative semi-structured telephone interviews with a maximum variability sample of 21 service users.

Information in general medical practices: the information processing model.

Background: The need for effective communication and handling of secondary care information in general practices is paramount.

Objective: To explore practice processes on receiving secondary care correspondence in a way that integrates the information needs and perceptions of practice staff both clinical and administrative.

Methods: Qualitative study using semi-structured interviews with a wide range of practice staff (n = 36) in nine practices in the Northwest of England.

The prescribing of specialist medicines: what factors influence GPs' decision making?

Background: As Governments worldwide strive to integrate efficient health care delivery across the primary-secondary care divide, particular significance has been placed on the need to understand GPs' prescribing of specialist drugs.

Objective: To explore the factors which influence GPs' decision-making process when requested to prescribe specialist drugs.

Methods: A qualitative approach was used to explore the perspectives of a wide range of practice-, primary care trust-, strategic health authority-level staff and other relevant stakeholders in the North-West of England.

Protocol for the PINCER trial: a cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices.

Background: Medication errors are an important cause of morbidity and mortality in primary care. The aims of this study are to determine the effectiveness, cost effectiveness and acceptability of a pharmacist-led information-technology-based complex intervention compared with simple feedback in reducing proportions of patients at risk from potentially hazardous prescribing and medicines management in general (family) practice.

Methods: RESEARCH SUBJECT GROUP: "At-risk" patients registered with computerised general practices in two geographical regions in England.

How do district nurses choose which products to prescribe?

The aim of this study was to explore the influences on product selection by district nurses when they start to prescribe a product for the first time. Representatives from the pharmaceutical industry had the biggest impact on the prescribing of new products followed by the nurses' colleagues with specialists being viewed more positively than non-specialists. The primary care trust and patients appeared to have little impact on product selection.

Why do district nurse prescribers alter their prescribing patterns?

This paper describes how district nurses decide what products to start prescribing and explores the reasons why prescribing patterns change. It is based on semi-structured interviews with fourteen nurses from one primary care trust. The first products prescribed immediately following qualification depended on the route taken to becoming a prescriber.

Preventable drug-related morbidity: determining valid indicators for primary care in Portugal.

Preventable drug-related morbidity (PDRM) indicators are operational measures of therapeutic risk management. These clinical indicators, which cover a wide range of drugs, combine process and outcome in the same instrument. They were developed in the US and have been validated for primary care settings in the US, UK and Canada.

Pharmacists' changing views of their supplementary prescribing authority.

Objective: To investigate the views and experiences of pharmacists in England before and after they registered as supplementary prescribers.

Method: Eight pharmacists were recruited from training courses; seven from secondary care and one from primary care and interviewed during training and again after registration. In the first interviews, topics included previous experience, views on current roles, responsibilities and accountability for prescribing and how these might change.

Why don't trained community nurse prescribers prescribe?

Aims And Objectives: (i) To identify barriers that could either prevent community nurses from prescribing altogether or reduce the number of times that a nurse might prescribe. (ii) To determine how wide spread the barriers identified above were.

Background: Many community nurses who are trained to prescribe are either not prescribing at all or not routinely doing so.

Development and face validity of explicit indicators of appropriateness of long term prescribing.

Objectives: To develop a set of explicit and operationalisable indicators of appropriate prescribing and assess their face validity using clinical pharmacists practising in secondary and primary care.

Method: Appropriateness indicators were derived from the literature, applied to data in the hospital clinical records of all newly prescribed long-term drugs for 50 randomly selected patients, further refined and then applied to another 25 randomly selected patients. A pre-piloted postal questionnaire was sent to 200 hospitals and primary care pharmacists, asking them to assess the indicators as to their importance for the assessment of appropriateness of long-term prescribing initiated in hospitals.

The validity of explicit indicators of prescribing appropriateness.

Objective: To assess, from the perspective of UK hospital doctors, the content validity and operational validity of a set of 14 previously developed explicit indicators of the appropriateness of long-term prescribing started during a hospital admission.

Method: A combination of data extraction from medical records and qualitative interviews with a maximum variability sample of hospital doctors.

Participants: The indicators were applied to 132 new prescriptions, intended for long-term use, prescribed for 61 patients; 36 doctors, of various grades, were purposively selected for interview.

Inter-rater reliability of explicit indicators of prescribing appropriateness.

Objective: To assess the inter-rater reliability of 14 explicit indicators of appropriate long-term prescribing.

Method: All available data required for the assessment of 59 long-term prescriptions started during a hospital admission for 25 patients were transcribed from the patients' medical records. These transcripts were presented in a standardised format and random order to four raters (two doctors and two pharmacists) who used the indicators to judge the appropriateness of each prescription.

Insights into creation and use of prescribing documentation in the hospital medical record.

Rationale, Aims And Objectives: Extraction of prescribing data from medical records is a common, albeit flawed, research method. Yet little is known about the processes that result in those data. This study explores the creation and use of prescribing documentation in the medical record, from the perspective of the hospital doctors who both create and use it.

The Internet: a window on adolescent health literacy.

Purpose: Adolescents are well served by the Internet through school access, but they will only derive maximum benefit from this information resource if they are able to search for, evaluate, and use its online information effectively. Internet use, however, requires significant literacy skills, and little is known about the health literacy of adolescents. The aim of this paper is to describe functional, critical, and interactive health literacy challenges experienced by adolescent students when using the Internet for online health information.

Health information-seeking behaviour in adolescence: the place of the internet.

The internet is one of a range of health information sources available to adolescents. It is recognised that young people have difficulties accessing traditional health services; in theory, the internet offers them confidential and convenient access to an unprecedented level of information about a diverse range of subjects. This could redress adolescents' state of relative health 'information poverty', compared to adults.

The effectiveness of hospital pharmacy in the UK: methodology for finding the evidence.

Objective: To describe the methodology used to identify United Kingdom (UK) hospital pharmacy practice research work from the last two decades.

Method: A comprehensive search for citations that appeared to contribute to the overall evidence or in some way measure, demonstrate or evaluate the effectiveness of UK hospital pharmacy practice. This involved a search of thirteen electronic databases covering a wide variety of UK, European and international publications, hand searching of selected UK journals and conference proceedings, a written request for details sent to all UK Chief Pharmacists and Directors of Pharmacy and a bibliography search of each reference identified.

The nature of informal pain questioning by nurses--a barrier to post-operative pain management?

Objective: The aim of this study was to explore the nature of nurses' informal pain-related questioning.

Methods: Non-participant observations were performed on one vascular and one urology surgery ward, involving 26 nurses in 402 patient contacts on eight days (total observation time: 39 hours). A questionnaire survey of 180 (of 335 = 53.