Medication errors can occur at the prescribing, transcription, dispensing and administration stage of drug therapy. However, publication of the Organisation with a Memory (OWAM) by the Department of Health in the UK has raised awareness of the need for pharmacies to collect information about dispensing errors and near misses, which occur within an organisation. Such information provides valuable insights into the vulnerabilities of dispensing procedures and identifies areas for improvement in dispensing systems The main aim of this study was to investigate the feasibility of a self-reporting system for dispensing errors and near misses in primary care (community) pharmacies. It was also to identify the types of errors or near misses commonly encountered in community pharmacies. A data collection form was designed and modified for use after a pilot study. Four community pharmacies volunteered to participate in this feasibility study. The data collection was conducted in two phases each of 4 weeks' duration. Any dispensing errors and near misses that occurred during the study periods were recorded by the pharmacy staff in a standard data collection form. A focus group discussion was held with the dispensing staff of participating pharmacies to identify and evaluate the feasibility of the reporting system. Out of a total of 51 357 items dispensed during the two phases of the study, 39 dispensing errors (0.08%) and 247 near misses (0.48%) were detected. The results show that near misses occurred six times more often than dispensing errors, indicating the importance of final checking in pharmacies. The most common types of dispensing errors or near misses appeared to be incorrect strength of medication, followed by incorrect drug, incorrect quantity, incorrect dosage form and incorrect label. Feedback during the focus group discussion indicated that the outcome of the self-reporting scheme was more important than the incidence of errors or near misses. Participating pharmacies also agreed that the self-reporting scheme used was feasible and they would continue using the scheme although some incentives would be helpful. The quantitative results of this study and the qualitative feedback from the participating pharmacies indicate that the self-reporting scheme used is practical and feasible.

On 1 July 2015, the Australian Government established 31 new Primary Health Networks (PHNs), following a review by its former Chief Medical Officer, John Horvath, of 61 Medicare Locals created under the previous Labor administration. The Horvath review recommended, among other things, that new, larger primary health organisations be established to reduce fragmentation of care by integrating and coordinating health services, supporting the role of general practice, and leveraging and administering health program funding.

The pharmaceutical care approach serves as a model for medication review, involving collaboration between GPs, pharmacists, patients, and carers. Its use is advocated with older patients who are typically prescribed several drugs. However, it has yet to be thoroughly evaluated. AimTo estimate the effectiveness of pharmaceutical care for older people, shared between GPs and community pharmacists in the UK, relative to usual care. Design of studyMultiple interrupted time-series design in five primary care trusts which implemented pharmaceutical care at 2-month intervals in random order. Patients acted as their own controls, and were followed over 3 years including their 12 months' participation in pharmaceutical care. SettingIn 2002, 760 patients, aged ≥75 years, were recruited from 24 general practices in East and North Yorkshire. Sixty-two community pharmacies also took part. A total of 551 participants completed the study. MethodPharmaceutical care was undertaken by community pharmacists who interviewed patients, developed and implemented pharmaceutical care plans together with patients' GPs, and thereafter undertook monthly medication reviews. Pharmacists and GPs attended training before the intervention. Outcome measures were the UK Medication Appropriateness Index, the Short Form-36 Health Survey (SF-36), and serious adverse events. ResultsThe intervention did not lead to any statistically significant change in the appropriateness of prescribing or health outcomes. Although the mental component of the SF-36 decreased as study participants become older, this trend was not affected by pharmaceutical care. ConclusionThe RESPECT model of pharmaceutical care (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) shared between community pharmacists and GPs did not significantly change the appropriateness of prescribing or quality of life in older patients. Keywordshealth services for the aged; medication therapy management; pharmaceutical care; polypharmacy; randomised controlled trial.

Objective. To compare different assessments following shoulder surgery for impingement syndrome with or without rotator cuff tear or repair. Methods. A prospective study of 93 patients was conducted. Standard assessments were performed before, at 6 months, and at 4 years following shoulder surgery using the patient-based Oxford Shoulder Score (OSS), the Medical Outcomes Study Short Form-36 (SF-36) questionnaire, and a surgeon-assessed Constant Shoulder Score. Patients were categorized according to the surgery received in relation to the presence of cuff tears: full repair, partial repair, cuff tear/no repair, no tear/no repair. Results. Most patients (57%) received subacromial decompression for impingement with no cuff tear. This group had the fewest pre-and postoperative symptoms. The category of patients who received only partial repair of a cuff tear had worse scores on all outcome assessments compared with other groups. Patient-based measures were more stable over time than the Constant. Conclusion. The shoulder-specific measures had greater sensitivity than the SF-36 in registering significant differences in outcomes between comparison groups at 6 months and 4 years.

Pharmaceutical care serves as a collaborative model for medication review. Its use is advocated for older patients, although its cost-effectiveness is unknown. Although the accompanying article on clinical effectiveness from the RESPECT (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) trial finds no statistically significant impact on prescribing for older patients undergoing pharmaceutical care, economic evaluations are based on an estimation, rather than hypothesis testing. AimTo evaluate the cost-effectiveness of pharmaceutical care for older people compared with usual care, according to National Institute for Health and Clinical Excellence (NICE) reference case standards. MethodsAn economic evaluation was undertaken in which NICE reference case standards were applied to data collected in the RESPECT trial. ResultsOn average, pharmaceutical care is estimated to cost an incremental £10 000 per additional quality-adjusted life year (QALY). If the NHS's cost-effectiveness threshold is between £20 000 and £30 000 per extra QALY, then the results indicate that pharmaceutical care is cost-effective despite a lack of statistical significance to this effect. However, the statistical uncertainty surrounding the estimates implies that the probability that pharmaceutical care is not costeffective lies between 0.22 and 0.19. Although results are not sensitive to assumptions about costs, they differ between subgroups: in patients aged >75 years pharmaceutical care appears more cost-effective for those who are younger or on fewer repeat medications. ConclusionAlthough pharmaceutical care is estimated to be costeffective in the UK, the results are uncertain and further research into its long-term benefits may be worthwhile. Keywordscost-effectiveness; health services for the aged; medication therapy management; pharmaceutical care.