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AimsThis research sought (a) to investigate the similarities and differences in how pharmaceutical services are provided by community pharmacies (CPs) and dispensing doctor practices (DPs) and (b) to identify the issues relevant to determining the quality of pharmaceutical services in these settings.BackgroundUK pharmaceutical services, including dispensing prescriptions and public health advice, can be provided from both (CP) and, in rural areas, (DP). While there is much similarity between CPs and DPs in the types of services provided, there is also the potential for variation in service quality across settings.MethodsA postal questionnaire of DPs and CPs in South West England was conducted to provide a descriptive overview of pharmaceutical services across the settings. A subsection of questionnaire respondent sites were selected to take part in case studies, which involved documentary analyses, observation and staff interviews.FindingsSurvey response was 39% for CPs (52/134) and 48% (31/64) for DPs. There were three CP and four DP case study sites, with 17 staff interviews. More pharmacies than practices were open at the weekend and they had more staff trained above NVQ level 2. Both doctors and pharmacists saw themselves as medicines experts, as being accessible and having good relationships with patients. Workplace practices and organisational ethos varied both within and across settings, with good practice observed in both. Overall, CPs and DPs have much in common. Workplace culture and an evidence-based approach to checking prescriptions and error reporting need to be considered in future assessments of service quality. [ABSTRACT FROM PUBLISHER]

Aims. To identify the range of emotional labour employed by healthcare professionals in a healthcare setting and implications of this for staff and organisations. Background. In a healthcare setting, emotional labour is the act or skill involved in the caring role, in recognizing the emotions of others and in managing our own. Design. A thematic synthesis of qualitative studies which included emotion work theory in their design, employed qualitative methods and were situated in a healthcare setting. The reporting of the review was informed by the ENTREQ framework. Data sources. 6 databases were searched between 1979-2014. Review methods. Studies were included if they were qualitative, employed emotion work theory and were written in English. Papers were appraised and themes identified. Thirteen papers were included. Results. The reviewed studies identified four key themes: (1) The professionalization of emotion and gendered aspects of emotional labour; (2) Intrapersonal aspects of emotional labour - how healthcare workers manage their own emotions in the workplace; (3) Collegial and organisational sources of emotional labour; (4) Support and training needs of professionals Conclusion. This review identified gendered, personal, organisational, collegial and socio-cultural sources of and barriers to emotional labour in healthcare settings. The review highlights the importance of ensuring emotional labour is recognized and valued, ensuring support and supervision is in place to enable staff to cope with the varied emotional demands of their work. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: This study investigated who community pharmacists (CPs), general practitioners (GPs) and practice nurses (PNs) included in their multidisciplinary team (MDT), whether they felt part of the MDT, barriers and facilitators to multidisciplinary working and whether the extent of the CPs’ clinical role influenced being part of a MDT. Methods: Survey to CPs, GPs and PNs in south England. Participants were recruited using social media, journal ads and face‐to‐face visits/phone calls using NHS and professional networks. Responses were analysed using descriptive statistics, bivariate analyses and content analysis for open text. Key Findings: Two hundred and fourteen GPs, 147 PNs and 162 CPs responded. Nearly, all PNs (98%) and GPs (99%) considered themselves part of a MDT compared to 78% of CPs. Working in isolation, lack of time and a lack of information sharing were the most common reasons for not feeling part of a MDT. The extent of the CPs’ clinical role was not related to feeling part of a MDT. Conclusions: Greater investment is needed in the structures to support multidisciplinary working in terms of time and resources, as well as a greater awareness of MDT members’ roles and potential contribution. [ABSTRACT FROM AUTHOR]

AimThe aims of this study were twofold: (a) to explore whether specific components of shared decision making were present in consultations involving nurse prescribers (NPs), pharmacist prescribers (PPs) and general practitioners (GPs) and (b) to relate these to self-reported patient outcomes including satisfaction, adherence and patient perceptions of practitioner empathy.BackgroundThere are a range of ways for defining and measuring the process of concordance, or shared decision making as it relates to decisions about medicines. As a result, demonstrating a convincing link between shared decision making and patient benefit is challenging. In the United Kingdom, nurses and pharmacists can now take on a prescribing role, engaging in shared decision making. Given the different professional backgrounds of GPs, NPs and PPs, this study sought to explore the process of shared decision making across these three prescriber groups.MethodsAnalysis of audio-recordings of consultations in primary care in South England between patients and GPs, NPs and PPs. Analysis of patient questionnaires completed post consultation.FindingsA total of 532 consultations were audio-recorded with 20 GPs, 19 NPs and 12 PPs. Prescribing decisions occurred in 421 (79%). Patients were given treatment options in 21% (102/482) of decisions, the prescriber elicited the patient’s treatment preference in 18% (88/482) and the patient expressed a treatment preference in 24% (118/482) of decisions. PPs were more likely to ask for the patient’s preference about their treatment regimen (χ2=6.6, P=0.036, Cramer’s V=0.12) than either NPs or GPs. Of the 275 patient questionnaires, 192(70%) could be matched with a prescribing decision. NP patients had higher satisfaction levels than patients of GPs or PPs. More time describing treatment options was associated with increased satisfaction, adherence and greater perceived practitioner empathy. While defining, measuring and enabling the process of shared decision making remains challenging, it may have patient benefit. [ABSTRACT FROM AUTHOR]

Background. The opening solicitation is a key element of the primary care consultation as it enables patients to express their ideas, concerns and expectations that can lead to improved patient outcomes. However, in practice, this may not always occur. With nurses and pharmacists now able to prescribe, this research explored the opening solicitation in a multi-professional context. Objective. To compare the nature, frequency and response to opening solicitations used in consultations with nurse prescribers (NPs), pharmacist prescribers (PPs) and GPs. Methods. An observational study using audio-recordings of NP, PP and GP patient consultations in 36 primary care practices in southern England. Between 7–13 prescriber–patient consultations were recorded per prescriber. A standardized pro forma based upon previous research was used to assess recordings. Results. Five hundred and thirty-three patient consultations (213 GPs, 209 NPs, 111 PPs) were audio-recorded with 51 prescribers. Across the prescribing groups, pharmacists asked fewer opening solicitations, while GPs used more open questions than NPs and PPs. The mean number of patient agenda items was 1.3 with more items in GP consultations. Patients completed their opening agenda in 20% of consultations, which was unaffected by professional seen. Redirection of the patient’s agenda occurred at 24 seconds (mean). Conclusion. All prescribers should be encouraged to use more open questions and ask multiple solicitations throughout the consultation. This is likely to result in greater expression of patients’ concerns and improved patient outcomes. [ABSTRACT FROM PUBLISHER]

OBJECTIVE: Recognising patients' cues and concerns is an important part of patient centred care. With nurses and pharmacists now able to prescribe in the UK, this study compared the frequency, nature, and professionals' responses to patient cues and concerns in consultations with GPs, nurse prescribers and pharmacist prescribers. METHODS: Audio-recording and analysis of primary care consultations in England between patients and nurse prescribers, pharmacist prescribers and GPs. Recordings were coded for the number of cues and concerns raised, cue or concern type and whether responded to positively or missed. RESULTS: A total of 528 consultations were audio-recorded with 51 professionals: 20 GPs, 19 nurse prescribers and 12 pharmacist prescribers. Overall there were 3.5 cues or concerns per consultation, with no difference between prescriber groups. Pharmacist prescribers responded positively to 81% of patient's cues and concerns with nurse prescribers responding positively to 72% and GPs 53% (PhP v NP: U=7453, z=-2.1, p=0.04; PhP v GP: U=5463, z=-5.9, p<0.0001; NP v GP: U=12,070, z=-4.9, p<0.0001). CONCLUSION: This evidence suggests that pharmacists and nurses are responding supportively to patients' cues and concerns. PRACTICE IMPLICATIONS: The findings support the importance of patient-centredness in training new prescribers and their potential in providing public health roles. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Recognising patients’ cues and concerns is an important part of patient centred care. With nurses and pharmacists now able to prescribe in the UK, this study compared the frequency, nature, and professionals’ responses to patient cues and concerns in consultations with GPs, nurse prescribers and pharmacist prescribers. Methods: Audio-recording and analysis of primary care consultations in England between patients and nurse prescribers, pharmacist prescribers and GPs. Recordings were coded for the number of cues and concerns raised, cue or concern type and whether responded to positively or missed. Results: A total of 528 consultations were audio-recorded with 51 professionals: 20 GPs, 19 nurse prescribers and 12 pharmacist prescribers. Overall there were 3.5 cues or concerns per consultation, with no difference between prescriber groups. Pharmacist prescribers responded positively to 81% of patient''s cues and concerns with nurse prescribers responding positively to 72% and GPs 53% (PhP v NP: U =7453, z =−2.1, p =0.04; PhP v GP: U =5463, z =−5.9, p <0.0001; NP v GP: U =12,070, z =−4.9, p <0.0001). Conclusion: This evidence suggests that pharmacists and nurses are responding supportively to patients’ cues and concerns. Practice implications: The findings support the importance of patient-centredness in training new prescribers and their potential in providing public health roles. [Copyright &y& Elsevier]

Abstract: Objective: To investigate the applied and conceptual relationship between two measures of shared decision making using the OPTION instrument developed in Wales and the Informed Decision Making instrument developed in Seattle, USA using audio-taped consultation data from a UK general practice population. Methods: Twelve general practitioners were recruited from 6 general practices in the southwest of England. One hundred twenty-three GP-patient consultations were audio-recorded. Audiotapes were sent off to, and rated by, respective experts in the use of the OPTION and the Informed Decision Making instruments. Results: Compared to earlier work using the Informed Decision Making tool, consultations in this sample were shorter, had fewer decisions and tended to have a greater number of elements present. Similar to previous research using the OPTION, values using the OPTION instrument were low with two items, giving the patient opportunities to ask questions and checking patient understanding, exhibiting the most variability. Using a ‘key’ decision in each consultation as the basis for comparison, the Informed Decision Making score was not related to the overall OPTION score (Spearman''s rho=0.14, p =0.13). Both instruments also predicted different ‘best’ and ‘worst’ doctors. Using a Bland–Altman plot for assessing agreement, the mean difference between the two measures was 1.11 (CI 0.66–1.56) and the limits of agreement were −3.94 to 6.16. There were several elements between the two instruments that appeared conceptually similar and correlations for these were generally higher. These were: discussing alternatives or options (Spearman''s rho=0.35, p =0.0001), discussion of the patient''s role in decision making (Spearman''s rho=0.23, p =0.012), discussion of the pros/cons of the alternatives (Spearman''s rho=0.20, p =0.024) and assessment of the patient''s understanding (Spearman''s rho=0.19, p =0.03). Conclusion: Measures of shared decision making are helpful in identifying those shared decision making skills which may be problematic or difficult to integrate into practice and provide a tool by which the development of skills can be assessed over time. Research may implicitly place undue value on those aspects of shared decision making which are most easily measured. Practice implications: Shared decision making tools are a useful way of capturing the presence or absence of specific shared decision making skills and changes in skills acquisition over time. However there may be limits in the extent to which the concept of shared decision making can be measured and that more easily measured skills will be emphasised to the detriment of other important shared decision making skills. [Copyright &y& Elsevier]

This study adopted a qualitative approach to explore patients’ views on the usefulness of a decision analytic decision aid (DA). Semi-structured interviews were conducted with 15 newly diagnosed hypertensive patients who had been recruited for a factorial randomised controlled trial of two decision aids. Issues investigated included respondents’ attitudes to information, their views on the nature of their relationship with their general practitioner (GP) (paternalistic, shared or consumerist), the ease of use and potential wider application of the computerised decision aid and its influence upon their decision-making about whether or not to begin anti-hypertensive treatment. Views on the decision aid were favourable. For the majority, the decision aid appeared to confirm and/or clarify their stated preferences towards medicine-taking. Occasionally it could provoke a major shift in a respondent’s attitude to medicine-taking, while in a few it had no discernible effect. While views on the decision aid were favourable, it was difficult to determine whether this was due to the individualised cardiovascular risk information it provided or the decision analytic process itself. [Copyright &y& Elsevier]

Objectives--To explore British community pharmacists' views on PAS, including professional responsibility, personal beliefs, changes in law and ethical guidance. Design--Postal questionnaire Setting--Great Britain Subjects--A random sample of 320 registered full-time community pharmacists Results--The survey yielded a response rate of 56%. The results showed that 70% of pharmacists agreed that it was a patient's right to choose to die, with 57% and 45% agreeing that it was the patient's right to involve his/her doctor in the process and to use prescription medicines, respectively. Forty-nine per cent said that they would knowingly dispense a prescription for use in PAS were it to be legalised and 54% believed it correct to refuse to dispense such a prescription. Although 53% believed it to be their right to know when they were being involved in PAS, 28% did not. Most pharmacists (90%) said that they would wish to see the inclusion of a practice protocol for PAS in the code of ethics of the Royal Pharmaceutical Society of Great Britain (CE-RPSGB) in the event of a change in the law on PAS. In addition, 89% would wish to see PAS included in the Conscience Clause of the CE-RPSGB. Males were found to be significantly less likely to favour PAS than females (p<0.05), as were those declaring an ethnic/religious background of consideration when dealing with ethical issues in practice compared with their counterparts (p<0.00005). Conclusion--Pharmacists view their professional responsibility in PAS to be more obligatory than a physician's, in having to provide the means for PAS. It is worrying that a proportion of the respondents prefer to remain in ignorance of the true purpose of a prescription for PAS; a finding at odds with current developments within the pharmaceutical profession. A practice protocol for PAS and an extension of the conscience clause should be considered in the event of PAS becoming legal. Such measures would allow the efficient provision of ... [ABSTRACT FROM AUTHOR]

The present paper examines the developing role of the medicines counter assistant (MCA) based in community pharmacies in the UK. In recent years, community pharmacies have been promoted as sources of primary care advice, and this has been accompanied by an increase in the number of pharmacy-only medicines made available for purchase without prescription. At the forefront of these changes is the MCA, who responds to requests for medicines and also advises customers seeking guidance on treating minor illness. This paper uses qualitative data drawn from non-participant observation of interactions between MCAs and customers in six community pharmacies in the south-west region of the UK. The data show communication in the pharmacy to be a complex process, characterised by multiple discourses including medical, retail and pharmaceutical information. At times, the different discourses worked in equilibrium, but there were also regular occurrences of clashes between the different discourses, where interaction became problematic. The authors argue that the current focus on pharmacy protocols to structure communication is, in some cases, too rigid for meaningful interaction and does not acknowledge the complexity of the encounter. A specific way forward for developing the interaction is discussed. [ABSTRACT FROM AUTHOR]

Describes the ways in which charge system influences the prescribing decisions of Italian and British physicians. Discussion on patient cost-sharing in Great Britain and Italy; Cost reduction strategies used by physicians in the countries; Types of charges for health care and pharmaceuticals.