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Background: Polypharmacy is associated with the prescription of inappropriate medications and avoidable medication-related harm. A novel pharmacist-led intervention aims to identify and resolve inappropriate medication prescriptions in older adults with polypharmacy., Aim: To conduct a preliminary feasibility assessment of the intervention in primary care, testing whether specific components of the intervention procedures and processes can be executed as intended., Method: The mixed-methods study was approved by the New Zealand Health and Disability Ethics Committees and public health agency. Patients from a New Zealand general practice clinic were recruited over 4 weeks to receive the intervention. The preliminary feasibility assessment included measures of intervention delivery, patient-reported outcome measures, and perspectives from ten patients and six clinicians. Data were analysed quantitatively and qualitatively to determine if a full-scale intervention trial is warranted. The study's progression criteria were based on established research and guided the decision-making process., Results: The intervention met the study's progression criteria, including patient recruitment, retention, and adherence to the intervention procedures. However, several modifications were identified, including: (1) enhancing patient recruitment, (2) conducting a preliminary meeting between the patient and pharmacist, (3) supporting pharmacists in maintaining a patient-centred approach, (4) reviewing the choice of patient-reported outcome measure, (5) extending the 8-week follow-up period, (6) allocating more time for pharmacists to conduct the intervention., Conclusion: The study found the intervention feasible; however, additional development is required before progressing to a full-scale trial. This intervention has the potential to effectively reduce medication-related harm and improve outcomes for older adults with polypharmacy., Trial Registration Number: ACTRN12621000268842 Date registered: 11/03/2021., (© 2024. The Author(s).)

Background Community pharmacist-led anticoagulation management service (CPAMS) offers international normalised ratio point-of-care testing of warfarin in a community pharmacy setting. It has now expanded with 7,344 patients enrolled in the service across 164 pharmacies in New Zealand. The clinical benefit of CPAMS has been shown to be superior, but patient satisfaction with the service has not been fully explored. Objective To develop a questionnaire to assess patient satisfaction with CPAMS and evaluate its psychometric properties. Additionally, to determine the level of patient satisfaction with CPAMS and identify determinants of satisfaction with CPAMS. Settings 1071 patients enrolled in CPAMS across New Zealand invited to take part in the study. Main outcome measure Satisfaction with CPAMS service. Methods Adult patients taking warfarin and currently enrolled in CPAMS were recruited through the national international normalised ratio online system and invited to complete a 36-item survey assessing satisfaction with CPAMS. To identify the most important dimensions of patient satisfaction, exploratory factor analysis was used. Multivariate linear regression models were used to examine the effect of independent variables on patient satisfaction. Results A total of 305 patients completed the survey. The mean overall satisfaction score was 94.5% ± 13.1 out of maximum possible points. Five dimensions of patient satisfaction were identified by factor analysis: patient-centred communication, confidence in pharmacist competence, patient-pharmacist relationship, confidence in CPAMS, and pharmacy environment. Being older and more frequent visits to a pharmacy were positively associated with patient satisfaction. Living more than 1 km away from a pharmacy, and 'poor' self-perceived health status were negative predictors of patient satisfaction. Being Māori or of other ethnic minority was also associated with lower satisfaction scores, exploratory analysis suggests patient-pharmacist relationship is an important driver of these differences. Conclusions The high level of patient satisfaction further supports the effectiveness of CPAMS as a delivery model. Patient satisfaction is affected by age, frequency of pharmacy visits, ethnicity, travel distance to pharmacy, and perceived health status. Policy makers and practitioners should consider the characteristics of patients with low levels of satisfaction to improve and enhance CPAMS engagement.

Introduction Pharmacist integration into general practice is gaining momentum internationally, with benefits noted in reducing medication errors, improving chronic disease management and alleviating general practitioner workforce shortages. Little is known about how general practice pharmacists are working in New Zealand. Aim This study characterised the current landscape of pharmacist integration into general practice in New Zealand. Methods An online questionnaire was developed, piloted and distributed to all pharmacists in New Zealand. Results Thirty-six responses were analysed. Respondents were more likely to be female, have been pharmacists for at least 10 years and all but one held formal postgraduate clinical pharmacy qualifications. Seven pharmacists were working as pharmacist prescribers. Primary health organisations (PHOs) were the most common employer, with funding primarily derived from either PHOs or District Health Boards. Pharmacist integration into general practice appears to have progressed further in particular regions of New Zealand, with most respondents located in the North Island. Tasks performed by respondents included medication reviews, managing long-term conditions and medicines reconciliation. Increased job satisfaction compared with previous roles was reported by most respondents. Funding and a general lack of awareness about pharmacists' professional scope were seen as barriers to further expansion of the role. Discussion This study describes the characteristics of pharmacists currently working in general practices in New Zealand and provides insights into key requirements for the role. Understanding the way practice pharmacists are currently employed and funded can inform general practices considering employing pharmacists.

Introduction: Medication adherence can be defined as the extent to which one's medication-taking behaviour follows that mutually agreed upon by the prescribing physician. Optimal medication adherence is often deemed crucial for the success of a patient's treatment, as suboptimal adherence may lead to treatment failure and unnecessary medical expenditure. Increasing evidence has highlighted the positive contribution community pharmacist-led interventions can have on improving patients' adherence and health outcomes., Objectives: To provide an overview of the published literature on community pharmacist-led interventions and their effectiveness in improving patients' adherence and health outcomes., Methods: A search strategy was developed, aiming to retrieve published reports of community pharmacy interventions worldwide. Medline, EMBASE, International Pharmaceutical Abstracts, Google Scholar and ProQuest Dissertations and Theses databases were searched. Articles meeting the inclusion criteria were collated, relevant data extracted, and a risk of bias assessment undertaken., Key Findings: Twenty-two studies were included in the analysis, and their outcomes were reported in 26 peer-reviewed journal articles. Community pharmacist-led interventions have been shown to improve patients' adherence and contribute to better blood pressure control, cholesterol management, chronic obstructive pulmonary disease and asthma control. Studies in this review, however, did not report statistically significant effects of interventions on diabetes or depression control., Conclusion: Community pharmacist-led interventions have been shown to contribute to improved adherence and better disease control. Future research should attempt to better understand which particular intervention components make the greatest contribution towards improving adherence and health outcomes, for patients with different medical conditions., (© 2018 Royal Pharmaceutical Society.)

Objective: To explore pharmacist's views on the shift in ethos, funding and service delivery model introduced through the New Zealand's Community Pharmacy Services Agreement (CPSA)., Methods: A purposive sampling approach drew pharmacists from a matrix who were then contacted via telephone and invited to be interviewed. Semistructured interviews were conducted face-to-face with community pharmacists (n = 17) across urban and rural New Zealand. An interview schedule exploring 12 subject areas was used to facilitate discussion and determine pharmacist's views and understanding of the CPSA. The interviews were recorded and transcribed verbatim and a general inductive approach was taken to identifying emergent themes., Key Findings: Key themes that emerged were: pharmacists supported the philosophy behind the CPSA, pharmacists understanding of the CPSA, implementing CPSA-related services, perceived impact on patient outcomes and future sustainability of the CPSA. Overall, pharmacists supported the alignment of funding with patient-centred services, but pharmacy owners reported difficulty understanding the funding model, resulting in uncertainty over income. Several pharmacists believed the quality of care offered had not changed, while others found their attitudes towards care had evolved. All pharmacists communicated an increase in their workload and many perceived the sustainability of the CPSA to be linked to its ability to financially sustain community pharmacies., Conclusions: The majority of pharmacists believed in the philosophy of the CPSA, but expressed concerns over funding, workload and benefits for patients. Future research is required to determine generalisability of these findings, investigate patient perspectives and assess the effect of the CPSA on patient outcomes., (© 2016 Royal Pharmaceutical Society.)

Objectives: Despite the introduction of new oral anticoagulants, vitamin K antagonists remain the mainstay of the prevention and treatment of thromboembolism. The advent of affordable point-of-care testing presents an opportunity for community pharmacists to provide anticoagulation management services, better utilizing their training, reducing the workload on medical practices and improving accessibility and convenience for patients. This study aimed to determine the effectiveness of anticoagulation management by community pharmacists., Methods: All patients enrolled in a pilot programme for a community pharmacy anticoagulation management service using point-of-care international normalized ratio testing and computer-assisted dose adjustment were included in a follow-up study, including before-after comparison. Outcomes included time in therapeutic range (TTR), time above and below range, number and proportion of results outside efficacy and safety thresholds, and a comparison of care led by pharmacists and care led by a primary-care general practitioner (GP)., Key Findings: A total of 693 patients were enrolled, predominantly males over 65 years of age with atrial fibrillation. The mean TTR was 78.6% (95% CI 49.3% to 100%). A subgroup analysis (n = 221) showed an increase in mean TTR from 61.8% under GP-led care to 78.5% under pharmacist-led care (P < 0.001), reflecting a reduction in the time above and, in particular, below the range. The mean TTR by pharmacy ranged from 71.4% to 84.1%. The median number of tests per month was not statistically different between GP- and pharmacist-led care., Conclusions: Community-pharmacist-led anticoagulation care utilizing point-of-care testing and computerized decision support is safe and effective, resulting in significant improvements in TTR. Our results support wider adoption of this model of collaborative care., (© 2014 Royal Pharmaceutical Society.)

Objective: To determine the alignment between New Zealand pharmacists' views and the New Zealand Ten-Year Vision (TYV) document and explore factors associated with individuals' alignment., Methods: A postal survey of 1892 practicing pharmacists was conducted. The questionnaire included 37 attitude statements informed by analysis of 6 focus groups in which pharmacists discussed 24 statements representing 12 main vision areas. Responses are reported by proportion. Bivariate analysis compared differences in demographic characteristics and alignment with vision statements between 3 professional subgroups: community, hospital, and pharmacists working in District Health Boards or Primary Health Organizations., Results: Nine hundred and eighty (54.6%) analyzable surveys were returned. Respondents broadly agreed with the 12 vision areas. There was a clear patient focus and strong support for extending roles to better serve patient care. Pharmacists believe that current practice and funding models need to change and want greater involvement in setting health policy. There are significant differences in agreement and level of agreement between professional subgroups. Notably, community pharmacists are more likely to put their relationship with the patient above that with the doctor, to believe that other professions would resist role extension, to support minor ailments schemes, and to indicate a shift in funding models was necessary to support innovative pharmacy practice. There are statistically significant and potentially important demographic differences between professional subgroups, including age, sex, formal postgraduate training, and experience working in health care in other countries. Further analysis is required to understand the interplay of these factors and how this may influence alignment with the TYV document., Conclusions: Pharmacists' responses indicated a high level of alignment with vision outlined in the TYV. Pharmacists appear receptive to practice and funding changes in order to facilitate greater contribution to patient care. Respondents demonstrated a clear desire to be involved in setting medicines-related health policy and feel underrepresented at this level., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objectives: The aim was to determine New Zealand pharmacists' views on the range of services outlined in the Ten Year Vision for Pharmacists document and the need for accreditation to provide these services., Methods: A national postal survey of practising pharmacists registered with the Pharmacy Council of New Zealand (n = 1892) was carried out, with two follow-ups., Key Findings: The response rate was 51.8% (n = 980 usable surveys). Findings indicated that the majority of pharmacists believe they should continue to undertake traditional clinical and technical roles (median 98.5%, range 92.7-99.3%). Less than one-third of respondents felt these activities required pharmacists to be accredited. A lower proportion, but still the majority, of respondents thought that pharmacy should undertake selected enhanced or collaborative roles (median 74.85%, range 64-92.5%). However, there was a greater emphasis on accreditation for these roles, with more than two-thirds of respondents suggesting a need for accreditation., Conclusions: There is a high level of support for the retention of current clinical and technical roles. A lack of need for additional accreditation suggests that pharmacists believe their training is adequate. There is a positive, but more tempered view regarding enhanced or collaborative services. There is recognition of a greater need for accreditation for enhanced and collaborative services. This suggests a cautious optimism about new services and a perceived need for pharmacists to learn more about these programmes.

Objectives: This study aimed to determine New Zealand pharmacists' awareness of, recall of consultation about, and potential barriers to the implementation of the Focus on the Future: Ten Year Vision for Pharmacists in New Zealand: 2004-2014 document., Method: A national postal survey was carried out in New Zealand of practising pharmacists registered with the Pharmacy Council of New Zealand (n = 1892). The survey was conducted between September and December 2006., Key Findings: The response rate was 51.8% (n = 980 usable surveys). Approximately three-quarters (73.4%) reported being aware of the 10-year vision document and 40.9% recall being consulted. Fewer than one-third (29.8%) had read the document prior to completing the survey. Thirty-two variables describing potential barriers to implementing the 10-year vision were reduced, through factor analysis, to seven factors with significant eigenvalues (>1.0). The factors describe the underlying themes of barriers identified in the survey, including pharmacist humanistic, integrated systems of care and teamwork, funder stakeholder relationships and remuneration, lack of appreciation of knowledge and skills, lack of research support, current expertise and continuing professional development, and lack of voice. The majority of barrier variables within the seven factors were rated as extremely or quite important., Conclusions: There was a high level of awareness and moderate level of recall of consultation on the document among respondents. Although 40% recall being consulted on the document, fewer than one-third reported having read the document prior to completing our survey. Pharmacists highlighted a significant number of potential barriers to the implementation of the 10-year vision. If the pharmacy profession in New Zealand is to move forward towards the state described in the 10-year vision document then these potential barriers need to be better understood and addressed.

Purpose: The aim of this study was to evaluate the feasibility of a community pharmacy-delivered intervention to shift patients' beliefs about short-acting beta2 agonists (SABA) in asthma management. The study targeted individual beliefs about SABA and assessed actual SABA use, focusing on reducing SABA use as well as adherence to inhaled corticosteroids (ICS) as a preventive measure. Patients and Methods: This non-randomized, before-and-after feasibility study enrolled participants with asthma from four community pharmacies in Auckland, New Zealand. Eligible participants were aged 18 years and above and were prescribed a SABA for their asthma. The intervention included the SABA reliance questionnaire to determine the degree of SABA reliance, verbal discussions with pharmacists personalised according to the degree of SABA reliance identified, and referral to general practitioners as appropriate. Results: Of the 44 patients who consented into the study, 19 were in the control group and 16 in the intervention group. Recruitment and retention were modest, with 10 control and five intervention participants completing the 90-day follow-up. Although not statistically significant, preliminary results indicated reduced SABA reliance and increased ICS adherence in the intervention group, and reduced SABA refill. Feedback showed that 78% of intervention participants found the information easy to understand, and 56% expressed intent to consult their general practitioners. Pharmacy staff found the intervention feasible but noted time constraints as a barrier to intervention delivery. Conclusion: The study demonstrates that a community pharmacy-delivered intervention is feasible and acceptable to both patients and pharmacists. While preliminary results show a positive effect on reducing SABA reliance and improvement of ICS adherence, the results were not statistically significant due to the small numbers recruited. This suggests a larger randomised trial is indicated. This intervention holds promise for addressing the over-reliance on SABA in asthma management and improving adherence to preventive therapies. [ABSTRACT FROM AUTHOR]

Introduction. The link between polypharmacy, risk of potentially inappropriate medication exposure, and avoidable medicines-related harm is well recognised. Not all polypharmacy is harmful, and contemporary multimodal approaches to managing long-term conditions are evidence-based and commonplace. What is needed is a focus on reducing inappropriate medication prescribing in polypharmacy. Aim. This study aims to develop the New Zealand criteria, a set of New Zealand-specific potentially inappropriate medication indicators to correct for older adults with polypharmacy. Methods. A mixed-methods approach was used. An expert panel group comprising four clinical pharmacists, two general practitioners, one geriatrician, and two nurse practitioners generated a collection of ideas via the nominal group technique, which combined with published criteria from literature, provided the list of potential criteria. These potential criteria were reviewed, validated, and ranked for importance via a two-round modified Delphi analysis with the same panel. Results. The nominal group technique generated 35 indicators, of which 23 were rated as important. Fifty-nine of 91 indicators from literature were rated as relevant and important. This generated 82 indicators for the modified Delphi analysis, from which 61 achieved consensus. Overall, 21 unique criteria were judged 'very important', 31 were judged 'important', and nine were judged 'somewhat important'. No indicators were judged 'low importance'. Discussion. The New Zealand criteria provides 61 medication indicators, which New Zealand experts recommend should prompt formal, documented review. The criteria can be used to systematically identify patients at the highest risk of avoidable medication-related harm for proactive review. [ABSTRACT FROM AUTHOR]

Background Optimal anticoagulation management is key for improving outcomes. The Community Pharmacy Anticoagulation Management Service (CPAMS) has beneficial effects on anticoagulant management. However, limited research exists on pharmacists' views of CPAMS provision, particularly the perspectives of pharmacists who do not provide CPAMS. Objectives To explore the experience and attitudes of pharmacists who do and do not provide CPAMS, and to identify factors that may influence further uptake of CPAMS. Setting CPAMS providing and non-providing pharmacies throughout New Zealand. Methods A mixed-methods study design was employed. Separate online surveys were conducted with CPAMS providers (N = 35) and non-providers (N = 73) to explore their views on the service. Twelve interviews were conducted with purposively selected participants, equally distributed between CPAMS providers and non-providers, to gain further insight into the issues surrounding CPAMS provision. Quantitative data were analysed using student's t-test and Mann Whitney U-test, and thematic analysis was used for qualitative data. Main outcome measure Experiences of and attitudes towards CPAMS. Results Our survey findings demonstrated that community pharmacists have high self-efficacy and motivation to providing CPAMS, and CPAMS had increased job satisfaction amongst providers. The overwhelming majority of CPAMS providers' survey participants believed that CPAMS improves the pharmacist–patient relationship, allowing them to assist patients with other aspects of their healthcare. Most non-provider survey participants also believed that their patients would benefit from CPAMS. The two most frequently reported barriers by non-providers survey participants were remuneration and staffing of pharmacists. The interview findings fell within five overarching themes: self-efficacy, CPAMS benefits to patients, barriers to providing CPAMS, the impact of CPAMS on pharmacist–patient and pharmacist–general practitioner relationships. Overall, the current funding model, the capping on the number of enrolled patients, and staffing were the main factors perceived by interview participants preventing the further uptake and implementation of CPAMS. CPAMS non-providers are willing to provide CPAMS; the main factor preventing this is availability of contracts. Conclusions Overall, pharmacists have favourable experiences of and attitudes towards CPAMS and strongly supported its wider implementation. Promoting the benefits and addressing the barriers highlighted in this study may lead to wider implementation of CPAMS. [ABSTRACT FROM AUTHOR]

Background: Recently, New Zealand has taken a system wide approach providing the biggest reform to New Zealand community pharmacy for 70 years with the aim of providing more clinically orientated patient centred services through a new funding model. The aim of this study was to understand the types of services offered in New Zealand community pharmacies since introduction of the new funding model, what the barriers are to providing these services.Method: A survey of all community pharmacies were undertaken between August, 2014 and February, 2015. Basic descriptive statistics were completed and group comparisons were made using the chi squared test with significance set at p < 0.05.Results: 528 responses were received. Education and advice on prescription and non-prescription medicines were the two top listed services provided. There were no significant differences in service provision between rural and metro based pharmacies. Many pharmacies were considering introducing new patient centred services. Four of the top ten frequently provided services have no public funding attached. Costs and staff availability are the most common barriers to undertake services, more predominantly in patient centred services.Conclusion: This study was the first to provide an evaluation of service provision in response to a new funding model for New Zealand Community Pharmacies. A broad range of services are being undertaken in New Zealand community pharmacies including patient-centred services. A number of barriers to service provision were identified. This study provides a baseline for the current levels of service provision upon which future studies can compare to and evaluate any changes in service provision with differing funding models going forward. [ABSTRACT FROM AUTHOR]