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The UK Government has highlighted the need to develop appropriate information and support services for informal carers. Previous research that has investigated informal caring has found that managing medication is one aspect of the caring role that presents its own problems; however, these have not been subject to detailed examination. The objective of the present paper was to report the number and type of problems experienced by informal carers when managing medication for older care recipients, and to relate these to measures of coping and health. This was a cross-sectional survey undertaken in one district in each of four randomly selected health authority areas in England. Structured interviews, comprising closed and open questions, with 184 informal carers and 93 associated older care recipients were conducted in participants' own homes. Data were gathered on the number and type of medication-related problems experienced in relation to the informal caring role, and the impact of these from carers' perspectives in terms of coping and health. Sixty-seven per cent of carers reported problems with at least one medication-related activity. Problems were associated with all types of medication-related activities, and experienced by carers providing different levels of care for older people. Four themes were identified from carers' accounts which illustrated a diversity of practical problems and anxieties: maintaining continuous supplies of medication in the home; assisting with administration; making clinical judgements; and communicating with care recipients and health professionals. Carers reporting greater numbers of medication-related problems were more likely to experience higher levels of carer strain (P < 0.001) and poorer mental health status (P < 0.001). The findings of the present study provide insights to inform the development of primary care services to support informal carers in the management of medication for older people.

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ObjectiveTo 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.DesignMixed 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).Setting22 community pharmacies and 6 general practices in Northwest England.Participants27 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.ResultsClinical 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.ConclusionsCPs 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.

These patterns of partnership need to be recognized and taken into account by health professionals when providing information, advice and support. They need to listen for indications of differing perspectives and be aware of their possible implications for adherence to medication regimens. In caring for older people, health professionals need to find a balance that respects their autonomy whilst providing support for carers to enable them to be effective in their roles.

Empirical research with adolescents on this subject is scarce. More research is needed regarding issues such as the impact of software filters on ability to access health information and the medium's potential to help and harm adolescents.

Background Research has shown that implementation of community pharmacy Medicines Use Review and Prescription Intervention (MUR) in the first year of the service in England and Wales was less extensive than anticipated. Several barriers to MUR becoming accepted and embedded in the National Health Service (NHS) were identified. Objective To evaluate progress in the provision of the MUR service in England and Wales in its second year (April 1, 2006-March 31, 2007 compared with the first year; and to analyse trends from available national data from the third year of provision in 2007-2008. Methods The analysis drew on the following data sources: routine data on provision of MURs for community pharmacies in a stratified random sample of 31 primary care organisations in England and Wales, and national datasets on MUR provision from the Pharmaceutical Services Negotiating Committee and NHS Information Centre. Outcome measures The percentage of community pharmacies providing the MUR service, the numbers of MURs provided in 2006-2007 at pharmacy and primary care organisation level, and the extent of, and variation in, provision. Key findings The percentage of community pharmacies providing the MUR service increased from 38 to 67.2%. Overall, 62 559 MURs were provided (a more than four-fold increase on the previous year), representing 13.8% of the possible maximum. The mean number of MURs provided (per provider) increased from 36 to 85. For existing providers the mean number increased from 36 to 111 (median 78, range 0-423). For new providers the mean number was 52 (median 17, range 1-401). More than half (52%) of the pharmacies in the sample claimed for fewer than 50 MURs. Overall, 82% of MURs were provided by multiples and this percentage was lower among new providers (62%) than existing providers (89%). Thirty-three (8.1%) existing MUR providers had no recorded MURs in the second year: almost two-thirds of these (64%) were independents. Eleven pharmacies (1.5%) provided the maximum number of 400 MURs per year: all but one were branches of multiples. Of the pharmacies not yet providing MURs, 78% were independent. Conclusions Both numbers of MURs and numbers of providers of MUR services increased markedly during the service's second year. Those newly providing the service in the second year claimed for more than twice as many MURs as did those who had been 'new providers' the previous year. Overall just over half of all providing pharmacies claimed for the equivalent of one MUR a week or fewer. Therefore the extent of 'successful adoption' of MURs is debatable. Differences in the level of provision continued between independent and multiple pharmacies in terms of both adoption of the service and the number of reviews conducted. As in the previous year, independent pharmacies were less likely to provide the MUR service and when they did the numbers conducted were lower than those provided by multiples.