BackgroundWhile the home is the most common setting for the provision of palliative care in Australia, a common problem encountered here is the inability of patient/carers to manage medications, which can lead to misadventure and hospitalisation. This can be averted through detection and resolution of drug related problems (DRPs) by a pharmacist; however, they are rarely included as members of the palliative care team. The aim of this study was to pilot a model of care that supports the role of a pharmacist in a community palliative care team. A component of the study was to develop a cost-effective model for continuing the inclusion of a pharmacist within a community palliative care service.MethodsThe study was undertaken (February March 2009-June 2010) in three phases. Development (Phase 1) involved a literature review; scoping the pharmacist's role; creating tools for recording DRPs and interventions, a communication and education strategy, a care pathway and evidence based patient information. These were then implemented in Phase 2. Evaluation (Phase 3) of the impact of the pharmacist's role from the perspectives of team members was undertaken using an online survey and focus group. Impact on clinical outcomes was determined by the number of patients screened to assess their risk of medication misadventure, as well as the number of medication reviews and interventions performed to resolve DRPs.ResultsThe pharmacist screened most patients (88.4%, 373/422) referred to the palliative care service to assess their risk of medication misadventure, and undertook 52 home visits. Medication reviews were commonly conducted at the majority of home visits (88%, 46/52), and a variety of DRPs (113) were detected at this point, the most common being "patient requests drug information" (25%, 28/113) and "condition not adequately treated" (22%, 25/113). The pharmacist made 120 recommendations in relation to her interventions.Fifty percent of online survey respondents (10/20) had interacted 10 or more times with the pharmacist for advice. All felt that the pharmacist's role was helpful, improving their knowledge of the different medications used in palliative care. The six team members who participated in the focus group indicated that there were several benefits of the pharmacist's contributions towards medication screening and review.ConclusionsThe inclusion of a pharmacist in a community palliative care team lead to an increase in the medication-related knowledge and skills of its members, improved patients' medication management, and minimised related errors. The model of care created can potentially be duplicated by other palliative care services, although its cost-effectiveness was unable to be accurately tested within the study.

Objective: To determine current contraceptive management by general practitioners in Australia. Design, setting and participants: Analysis of data from a random sample of 3910 Australian GPs who participated in the Bettering the Evaluation and Care of Health (BEACH) survey, a continuous cross‐sectional survey of GP activity, between April 2007 and March 2011. Consultations with female patients aged 12–54 years that involved all forms of contraception were analysed. Main outcome measures: GP and patient characteristics associated with the management of contraception; types of contraception used; rates of encounters involving emergency contraception. Results: Increased age, ethnicity, Indigenous status and holding a Commonwealth Health Care Card were significantly associated with low rates of encounters involving management of contraception. The combined oral contraceptive pill was the most frequently prescribed method of contraception, with moderate prescription of long‐acting reversible contraception (LARC), especially among women aged 34–54 years. Rates of consultations concerned with emergency contraception were low, but involved high rates of counselling, advice or education (48%) compared with encounters for general contraception (> 20%). Conclusion: A shift towards prescribing LARC, as recommended in clinical guidelines, has yet to occur in Australian general practice. Better understanding of patient and GP perspectives on contraceptive choices could lead to more effective contraceptive use.

Objective. To develop communication skills in second-year pharmacy students using a virtual practice environment (VPE) and to assess students' and tutors' (instructors') experiences. Design. A VPE capable of displaying life-sized photographic and video images and representing a pharmacy setting was constructed. Students viewed prescriptions and practiced role-playing with each other and explored the use of nonverbal communication in patient-pharmacist interactions. The VPE experiences were complemented with lectures, reflective journaling, language and learning support, and objective structured clinical examinations (OSCEs). Assessment. Most students believed the VPE was a useful teaching resource (87%) and agreed that the video component enabled them to contextualize patient problems (73%). While 45% of students questioned the usefulness of watching the role plays between students after they were video recorded, most (90%) identified improvement in their own communication as a result of participating in the tutorials. Most tutors felt comfortable using the technology. Focus group participants found the modified tutorials more engaging and aesthetically positive than in their previous experience. Conclusion. The VPE provided an effective context for communication skills development classes.

Abortion costs are substantial, increase at later gestations, and are a financial strain for many women. Poor knowledge, geographical and financial barriers restrict method choice. Implications for public health: Policy reform should focus on reducing costs and enhancing early access.

P lanned parenthood has important benefits for maternal and infant health. Monitoring and preventing unintended pregnancy is therefore an important public health goal. 1 In the only Australian national household survey about mistimed or unintended pregnancy (undertaken 2005), 18% of women of reproductive age (18e44 years) reported that their most recent pregnancy was mistimed, and a further 17% reported that the pregnancy was unwanted. 2 We undertook a contemporary national population survey to assess the prevalence and outcomes of unintended pregnancy during the preceding ten years. Trained female interviewers (Hunter Valley Research Foundation) undertook a national random computerassisted telephone (mobile and landline) survey (weekdays, 9 ame8 pm) during December 2014 e May 2015. Women aged 18e45 years with adequate English were asked whether they had had an unintended pregnancy during the past ten years, and whether any unintended pregnancy was unwanted. We also asked about the outcomes of all pregnancies. A population sample size of 2000 was required to detect a prevalence of unwanted pregnancy of 10e50% with 90% power. La Trobe University Human Research Ethics Committee approved the study (reference, 14-075).Of 2571 eligible women, 2013 (78.3%) completed interviews. A total of 1390 women (69.1%) had been pregnant during the past ten years, including 362 unintended pregnancies (26%). Most unintended pregnancies (246, 68%) were reported as wanted; 94 (26%) were described as unwanted (Box 1).Half the women with an unintended pregnancy gave birth (194, 53.6%); 110 (30.4%) had abortions, 55 (15.2%) miscarriages, and three (0.8%) were still pregnant at the time of the survey. Of the women who had been pregnant but did not report an unintended pregnancy, 14.7% (151 of 1024) reported having had an abortion (Box 2).Twenty-one of the 246 women (8.5%) with unintended but wanted pregnancies reported abortions. Of the 94 women with unwanted pregnancies, 78 (83%) had abortions, nine (10%) had miscarriages, and seven (8%) carried the pregnancy to term. A total of 261 of 1390 women who had been pregnant (18.8%) reported abortions (Box 1).Most women who had unintended pregnancies (205 of 362, 56.6%) reported not having used contraception at the time. Of the 150 women (41.4%) who had an unintended pregnancy while using contraception, 96 (64%) had used oral contraceptives and 40 (26.9%) had used condoms as their primary methods; nine (6%) were using long-acting reversible contraception (Box 2).

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Many breastfeeding women require and regularly take medicines, especially those available over-the-counter, and the safe use of these is dependent on the advice provided by health professionals such as general practitioners and pharmacists. The primary aim of this review therefore, was to investigate the literature relating to health professionals' and women's knowledge, attitudes and practices towards medication use and safety in breastfeeding. The limited literature that was uncovered identified that general practitioners and pharmacists have poor knowledge, but positive attitudes, and variable practices that are mostly guided by personal experience. They tend to make decisions about the use of a medicine whilst breastfeeding based on the potential 'risk' that it poses to the infant in terms of possible adverse reactions, rather than its 'compatibility' with breast milk. The decision-making process between health professionals and women is usually not a negotiated process, and women are often asked to stop breastfeeding whilst taking a medicine. Women, in turn, are left dissatisfied with the advice received, many choosing not to initiate therapy or not to continue breastfeeding. Some directions for future research have been suggested to address the issues identified in this critical area. This review is important from a societal perspective because many breastfeeding women require and regularly take medications, especially those available without prescription, and the safe use of these is dependent on the advice provided by health professionals, which is ultimately influenced by their knowledge, attitudes and practices. However, there is an absence of high quality evidence from randomised controlled trials on the safety of medications taken during breastfeeding, which naturally would hinder health professionals from appropriately advising women. It is equally important to know about women's experiences of advice received from health professionals, and whether there is consistency between recommendations made across resources on medication safety in breastfeeding, in order to gain a full understanding of the issues prevalent in this area of practice.