The acceptability to the general public of an extended role for community pharmacy was investigated using a social survey methodology. Within one locality, a sample of 133 respondents was drawn from four population groups who were likely to be extensive users of community pharmacy services: active elderly people, mothers of young children, carers of people with disabilities and people in full‐time employment. The evidence from the interview survey was supplemented by discussions with community groups representative of the same sections of the population. The results indicate that there is considerable public support for the development of a range of new services in community pharmacies, with a majority of respondents supporting the provision of more information on prescribed medicines, opportunity to discuss minor symptoms with the pharmacist, medicine delivery services, and the holding of patient medication records. There is less support for discussing health promotion with the pharmacist, while cost was found to be a major obstacle to the acceptability of diagnostic testing. Elderly people found all aspects of the extended role less acceptable than did other respondent groups. It is concluded that there is a need to market unfamiliar services, and, if an extended role is to be developed effectively, the nature of the relationship between the roles of the community pharmacist and the GP needs to be demonstrated more clearly to service users.

An extended information service on prescription medicines was evaluated in four community pharmacies over a period of 11 months, including a three-month pilot phase. Written patient information leaflets (PILs) and structured verbal advice designed according to the preferences of local people were provided by the pharmacist to patients prescribed any of three study drugs -amoxycillin, atenolol or ibuprofen. A total of 1,614 PILs were issued. Data were collected from a sample of 3 11 recipients about their perception and recall of the information service. Altogether, 64 per cent remembered receiving the study leaflet and 56 per cent remembered receiving some verbal information from the pharmacist. More than 80 per cent of service recipients supported the provision of both verbal and written information by the pharmacist. In the main study period (n=203), the types of information respondents could recall receiving most frequently were when to take the medicine (67 per cent), the name of the medicine (53 per cent) and side effects (41 per cent). Sixty seven per cent (40) of those receiving amoxycillin, 61 per cent (43) taking atenolol and 38 per cent (28) taking ibuprofen recognised a side effect of their medicine given in both the leaflet and verbal advice. For all three drugs, side effects were recognised most frequently when included in both the written and verbal information. Support for this aspect of the pharmacist's extended role has been demonstrated in practice and the feasibility of service implementation is discussed.

The therapeutic place of mucolytic drugs remains uncertain; clinical studies have seldom demonstrated significant benefit and the activity of such agents is poorly understood. In this study the effects of the mucolytic agents acetylcysteine (AC) and S-carboxymethylcysteine (SCMC) have been assessed in-vitro, using purified mucus gels and tracheal explant systems and in-vivo, in the mini-pig tracheal pouch model, in order to elucidate their mechanisms of action. A reduction in the elastic modulus (up to 70% over the frequency range 0.2-20 Hz) was apparent after treatment of mucus gels in-vitro with AC (P less than 0.05), but not with SCMC. Gel chromatography indicated that AC reduced the mucus glycoprotein to smaller subunits and a breakdown of gel structure was apparent when visualized using a cryofracture technique. SCMC treated gels were comparable with control samples. Mucus production was assessed in isolated rat trachea by monitoring the uptake and release of [3H] glucosamine. AC (5-15 mM) did not affect secretion whereas SCMC (5 and 10 mM) reduced the production of radiolabelled material (24 and 37%, respectively) over 24 h (P less than 0.05). Single oral doses of SCMC and AC (20 mg kg-1) were administered to mini-pigs and mucus collected from tracheal pouches; no significant changes in the rheological or biochemical properties of the secretion could be determined. The in-vitro mucolytic activity of AC depends upon a direct action on the secretion, SCMC appears able to reduce production of the mucus glycoprotein. Wide inter- and intra-individual variation in the properties of the secretion would suggest that such effects are not readily demonstrated in-vivo.

Tape recordings of verbal interactions between elderly patients (women aged 60 or over; men aged 65 or over) and community pharmacists about prescription medicines were made in four study pharmacies to determine the frequency with which information was provided and to elucidate communication issues relevant to this patient group. Overall, 65 per cent of elderly patients receiving prescribed medications had no verbal interaction at all with the pharmacist, speaking only to other pharmacy staff. The pharmacists provided verbal information to 12.5 per cent of elderly patients about their prescription medicines. It was generally limited to aspects of the dosage regimen and the most common number of items of information given was three. There was no obvious pattern in advice giving related to the estimated workload. However, the frequencies with which advice was provided at all the pharmacies were too low to draw definite conclusions. The mean length of interactions where information was provided was 7 1 seconds (range 8 to During 43 interactions studied, pharmacists asked 38 questions, nearly all of which were closed; patients asked 15 questions of which more than a third were open. As expected, the number of elderly patients visiting the pharmacies and the number of patient interactions showed marked intra-and inter-pharmacy variation. This is relevant to the development of realistic advice-giving protocols.

ObjectivesTo quantify medication-related errors, in particular prescribing errors, identified by pharmacists and assess their potential impact on inpatients in community hospitals.MethodsPharmacists recorded all interventions to optimise medication for community hospital inpatients over 14 days in November 2013. Interventions were subsequently classified by type (prescribing error; omitted or delayed drug administration; or attributable to other issues) and rated for potential clinical impact.Results15 organisations participated in the study reporting on 4077 medication charts. In total, 52 033 medication orders were screened by pharmacists. A medication-related intervention was made on 1 in 3 charts for one or more medications. A total of 2782 interventions were recorded. The majority were categorised as a prescriber error (67%, 1872/2782). The remainder (33%, 910/2782) were not directly attributable to prescriber error; of these omitted and delayed medicine administration accounted for 11% (298/2782). Of the 1872 interventions classed as prescriber error, a third, if left undetected, might have caused moderate or severe patient harm. The prescribing error rate was 3.6 errors per 100 medication orders.ConclusionsPharmacists reported intervening to improve the care provided to over a third of patients in this study. Two-thirds of interventions were in response to prescribing errors, a third of which, if left undetected, could have led to harm. The results suggest that inpatients in community hospitals are subject to prescribing errors at a rate comparable to those seen in acute and mental health hospitals. A clinical pharmacy service is vital to ensure patient safety in community hospitals.