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Introduction and aims: The clinical indication for a prescribed medicine in secondary care is not always clear, accurate or easy to locate within patients' medical notes, making it difficult to assess the appropriateness of the medicine. This study sought to determine the impact of including clinical indications for prescribed medicines in paper and electronic prescribing systems in acute hospitals in England. Methods: This mixed-methods study involved semi-structured telephone interviews with 64 chief pharmacists, 11 focus groups with multidisciplinary healthcare teams (MDTs) from three NHS trusts and a review of medical documentation of 89 patients (who were under the care of MDTs participating in the focus groups). Results: Participants described the inclusion of a clinical indication as "helpful" or "useful". However, from a prescriber's perspective, providing an indication for all medicines would be time consuming and unrealistic, especially with pre-admission medicines where it is more of a transcribing process than a prescribing process and where accuracy may be an issue. Mandatory input of indications in electronic systems was considered impractical unless the systems assisted the prescriber. Only 4 of the 64 trusts (6%) required an indication for all medicines, while 15 trusts (23%) did not require an indication for any medicines because of governance and patient confidentiality issues. Discussion: The inclusion of clinical indications on inpatient prescriptions varies across a range of trusts, which affects clinical workflow, regulation and patient safety. Adding clinical indications to prescriptions impacted negatively on healthcare professionals' clinical workflow, but was viewed favourably in certain circumstances (e.g. for a newly initiated medicine). Conclusion: Current requirements for clinical indications on inpatient prescriptions is variable and the role of electronic systems in enforcing standards is unclear. Management and frontline practitioners recognise both the positives and negatives, but systems that force prescribers through mandatory fields to document clinical indications may be counterproductive. If incorporation of clinical indications on hospital prescriptions is to be successful, health IT systems must embrace user-centred design. [ABSTRACT FROM AUTHOR]

Abstract: Background: Most patients experience changes to prescribed medicines during a hospital stay. Ensuring they understand such changes is important for preventing adverse events post‐discharge and optimising patient understanding. However, little work has explored the information that patients receive about medicines or their perceived needs for information and support after discharge. Objectives: To determine information that hospital inpatients who experience medicine changes receive about their medicines during admission and their needs and preferences for, and use of, post‐discharge support. Methods: Cross‐sectional survey with adult medical inpatients experiencing medicine changes in six English hospitals, with telephone follow‐up 2–3 weeks post‐discharge. Key findings: A total of 444 inpatients completed surveys, and 99 of these were followed up post‐discharge. Of the 444, 44 (10%) were unaware of changes to medicines and 65 (16%) did not recall discussing them with a health professional, but 305 (77%) reported understanding the changes. Type of information provided and patients’ perceived need for post‐discharge support differed between hospitals. Information about changes was most frequently provided by consultant medical staff (157; 39%) with pharmacists providing information least often (71; 17%). One third of patients surveyed considered community pharmacists as potential sources of information about medicines and associated support post‐discharge. Post‐discharge, just 5% had spoken to a pharmacist, although 35% reported medicine‐related problems. Conclusion: In north‐west England, patient inclusion in treatment decisions could be improved, but provision of information prior to discharge is reasonable. There is scope to develop hospital and community pharmacists’ role in medicine optimisation to maximise safety and effectiveness of care. [ABSTRACT FROM AUTHOR]

Background There are few studies of community pharmacy footfall and activity in the existing literature, especially by direct observation. Objective To describe the characteristics of counter interactions between pharmacy staff and customers. Method Structured observation of all interactions between pharmacy staff and customers across the weekly opening hours of five pharmacies diverse in location and ownership. Key findings Three-quarters (76%) of observed interactions were associated with prescriptions, but a significant minority accessed cognitive services. Conclusions Dispensing was the primary activity across the diverse range of pharmacies. Reasons for visits are diversifying into advice and services, particularly among younger users. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and inform emergency supply of prescription-only medicines by community pharmacists (CPs), including how the service could form an integral component of established healthcare provision to maximise adherence. Design: Mixed methods. 4 phases: prospective audit of emergency supply requests for prescribed medicines (October-November 2012 and April 2013); interviews with CPs (February-April 2013); follow-up interviews with patients (April-May 2013); interactive feedback sessions with general practice teams (October-November 2013). Setting: 22 community pharmacies and 6 general practices in Northwest England. Participants: 27 CPs with experience of dealing with requests for emergency supplies; 25 patients who received an emergency supply of a prescribed medicine; 58 staff at 6 general practices. Results: Clinical audit in 22 pharmacies over two 4-week periods reported that 526 medicines were requested by 450 patients. Requests peaked over a bank holiday and around weekends. A significant number of supplies were made during practice opening hours. Most requests were for older patients and for medicines used in long-term conditions. Difficulty in renewing repeat medication (forgetting to order, or prescription delays) was the major reason for requests. The majority of medicines were 'loaned' in advance of a National Health Service (NHS) prescription. Interviews with CPs and patients indicated that continuous supply had a positive impact on medicines adherence, removing the need to access urgent care. General practice staff were surprised and concerned by the extent of emergency supply episodes. Conclusions: CPs regularly provide emergency supplies to patients who run out of their repeat medication, including during practice opening hours. This may aid adherence. There is currently no feedback loop, however, to general practice. Patient care and interprofessional communication may be better served by the introduction of a formally structured and funded NHS emergency supply service from community pharmacies, with ongoing optimisation of repeat prescribing. [ABSTRACT FROM AUTHOR]

Background: Community pharmacies are established service providers for problematic drug users (PDUs). PDUs have many unmet health needs, which pharmacists may be able to help resolve. This paper aims to qualitatively explore the feasibility and desirability of further developing community pharmacy services to meet the wider health needs of problematic drug users. Methods: Semi-structured interviews and focus group discussions were used to explore current and future pharmacy service provision to PDUs. Views were sought from 20 PDUs, 12 staff from community pharmacies, and seven stakeholders and commissioners from relevant agencies. Data were thematically analyzed and potential services including possible barriers identified. Results & Discussion: Data highlighted variability in current services in the study area in terms of availability and quality. Good rapport between users and regular staff was highlighted as an important factor in good quality services. Pharmacies were consistently identified as having key opportunities to make useful health interventions within a range of therapeutic areas including nutrition, dentistry, wound care, and infectious diseases. The most widely supported roles were based around information provision and signposting. However, there was support for direct interventions to be delivered within the pharmacy, by a regular member of staff or a visiting specialist. [ABSTRACT FROM AUTHOR]

Community pharmacies play an important role in providing services to drug users, having provided needle exchange and substitution therapy services for a number of years. Previous studies of these services and the problems faced in implementing them have focused on the attitude and experiences of pharmacists. However, with the increasing use of pharmacy support staff in a range of expanded roles, it is also appropriate to consider this group. This article aims to qualitatively explore the experiences, attitudes, and training needs of pharmacy support staff involved in providing services to drug users. Copies of the questionnaire were issued to a 10% sample of community pharmacies and distributed to up to five support staff working in the pharmacy. The questionnaire asked open questions regarding training needs, personal experiences and attitudes. Data were transcribed and thematically analysed according to Grounded Theory in NVivo v7. 454 respondents made qualitative comments. The data demonstrated a strong desire among some support staff to be further involved in support services. However, many expressed negative attitudes towards drug users and some considered pharmacies as inappropriate venues for providing services to this group. Identified training needs focused on four key areas: advising and working with drug users; the nature of drug use; treatment services and their availability; and clinical and legal detail. Knowledge gaps were evident in some of the responses, most notably a misunderstanding of service aims and intended outcomes. All those involved in designing and delivering pharmacy services to drug users should ensure that they take account of and involve support staff when developing training. [ABSTRACT FROM AUTHOR]

The author reflects on the utilization of brain disease model of addiction (BDMA) to treat drug addiction. Topics discussed include stigma associated addiction, evaluation of brain disease conceptualizations to treat psychiatric disorders, and the importance of reviewing the stigma-reducing effects of BDMA.

An abstract of the article "Developing skills to deliver alcohol screening and brief intervention (SBI) in community pharmacy," by Peter E. Penson and colleagues is presented.

An abstract of the article "Supporting service quality improvement for pharmacy-based alcohol screening and brief advice services," by Adam J. Mackridge, Elizabeth C. Stokes, and Janet Krska is presented.

Objectives: It is recommended that patients are seen within 4 h of arrival in Acute Medical Units in English hospitals. This study explored the frequency and nature of interruptions and delays potentially affecting the duration of the Acute Medical Unit admission process and the quality of care provided., Design: The admission process was directly observed for patients admitted to the Acute Medical Unit over four one-week periods, November 2009 to April 2011., Setting: UK teaching hospital Acute Medical Unit., Participants: Hospital staff n = 36., Main Outcome Measures: Patient waiting times, duration of clerking, number of interruptions and/or delays., Results: Thirty-five doctors and one nurse practitioner were observed admitting 71 medical patients, 48/71 (68%) patients were clerked within 4 h of arrival. A delay and/or interruption affected 49/71 (69%) patients. Sixty-six interruptions were observed in 36/71 (51%) of admissions, of these 19/36 (53%) were interrupted more than once. The grade of doctor had no bearing on the frequency of interruption; however, clerking took significantly longer when interrupted; overall doctors grade ST1 and above were quicker at clerking than foundation doctors. Delays affected 31/71 (44%) of admissions, 14/31 (45%) involved X-rays or ECGs; other causes of delays included problems with equipment and computers., Conclusion: Interruptions and delays regularly occurred during the admission process in the study hospital which impacts adversely on patient experience and compliance with the recommended 4-h timeframe, further work is required to assess the impact on patient safety. Data obtained from this observational study were used to guide operational changes to improve the process.