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Background:  Pharmacy professionals working in community pharmacies frequently provide pharmacist-initiated therapy, including codeine-containing medicines. Codeine is an opioid with great potential for misuse, adding to the global opioid epidemic burden. Professional pharmacy personnel are the first intervention point in relation to management of codeine use. This study highlights the importance of pharmacy professionals' perceptions and behaviours in combatting the opioid epidemic., Methods:  A descriptive cross-sectional study was conducted. Simple random sampling included pharmacy professionals in the metropolitan city of Johannesburg. An electronic questionnaire was distributed via e-mail and data analysed descriptively., Results:  Findings indicate that pharmacy personnel routinely ask patients about codeine use (n = 48; 53.9%), avoid dispensing over-the-counter (OTC) codeine as an initial treatment (n = 61; 69%) and express confidence to identify and manage codeine misuse (n = 69; 77.5%). Despite this, increased patient demands for OTC codeine (n = 69; 77.5%) were concerning, highlighting the ease of availability from internet sources (n = 76; 85.4%) and multiple pharmacies (n = 84; 94.4%). Apprehension about the lack of patient awareness on adverse health consequences (n = 66; 74.2%) and the risk of codeine dependence (n = 79; 88.8%) was expressed., Conclusion:  Growing concern regarding availability and accessibility of codeine-containing medicines within the community pharmacy sector is highlighted. Adverse health consequences of codeine misuse and dependence are not understood by customers and the ineffective information provided by pharmacy personnel was highlighted as a concern.Contribution: The results of this study give insight to the influence of dispensing personnel's attitude towards the growing challenges with respect to codeine containing medication abuse.

Background: The use of generative artificial intelligence (AI) applications such as ChatGPT is becoming increasingly popular. In Japan, consumers can purchase most over-the-counter (OTC) drugs without having to consult a pharmacist, so they may ask generative AI applications which OTC drugs they should purchase. This study aimed to systematically evaluate responses from ChatGPT to consumer inquiries about various OTC drugs. Methods: We selected 22 popular OTC drugs and 12 typical consumer characteristics, including physical and disease conditions and concomitant medications. We input a total of 264 questions ( i. e. , all combinations of drugs and characteristics) to ChatGPT in Japanese, asking whether it is safe for consumers with each characteristic to take these OTC drugs. We used the generic name for 10 of the 22 drugs and the brand name for the remaining 12. Responses were evaluated based on the following three criteria: 1) coherence between the question and response, 2) scientific correctness, and 3) appropriateness of the instructed actions. When we received a response that satisfied all three criteria, we input the exact same question on a different day to assess reproducibility. Results: The proportions of ChatGPT's answers that satisfied criteria 1, 2, and 3 were 79.5%, 54.5%, and 49.6%, respectively. However, the proportion of responses that satisfied all three criteria was only 20.8% (55/264); 61.8% (34/55) of these responses were reproduced when the same question was input again on a different day. Compared with questions using generic names, those using brand names resulted in lower coherence and scientific correctness. Among the 12 characteristics, the appropriateness of the instructed actions tended to be lower in responses to questions about driving and concomitant medications. Conclusions: Our study revealed that ChatGPT was less accurate in its responses and less consistent in its instructed actions compared with the package inserts. Our findings suggest that Japanese consumers should not consult ChatGPT regarding OTC medications, especially when using brand names.

Background: Over-the-counter (OTC) medicines intended for short-term use for self-care may be abused or misused., Aim: To explore the experiences and perceptions of community pharmacists (dispensers, pharmacists, and pharmacy owners) of the use, abuse, and misuse of OTC medicines by pharmacy customers, and to identify their perceptions of the most appropriate methods to prevent inappropriate use of OTC medicines., Method: A cross-sectional national online survey to community pharmacists in Finland. A previously validated structured questionnaire was modified. Three national pharmaceutical associations were contacted to help in recruitment of their members ( n  = 5594, calculated target sample size n  = 360). Descriptive statistical analyses were conducted., Results: In total, 442 responses were received. Most respondents strongly agreed (Md all = 5) that OTC medicines could be abused or misused; pharmacy owners were more likely to strongly agree than pharmacists ( p  = 0.012). Pharmacy owners were more likely to think that laxatives were liable for abuse than dispensers ( p  = 0.008), and that travel sickness medicines were liable for misuse than dispensers ( p  < 0.001) and pharmacists ( p  = 0.013). Patient counseling was the most commonly employed method to prevent the problem. Respondents perceived that providing training to staff about OTC medicines that can be abused (Md all = 5) was the most appropriate strategy to prevent OTC medicine abuse; pharmacy owners were more likely to strongly agree or agree of this ( p  = 0.005) than dispensers. Conclusion: Community pharmacists are aware of the liability of OTC medicines for the potential abuse and misuse. They employ various methods as advising and counseling the customer to support the rational use of OTC medicines.

Objectives: Guidelines support best practice for healthcare practice. In Australia, some non-prescription medicines are only accessible after consultation with a pharmacist and are known as Pharmacist Only medicines. Guidelines for providing some Pharmacist Only medicines are available, however, it is currently unknown if and how these guidelines are used in practice.The objective was to characterise pharmacists', intern pharmacists and pharmacy students' use of guidelines for Pharmacist Only medicines., Methods: A cross-sectional electronic survey of Australian registered pharmacists, intern pharmacists and pharmacy students was administered in July 2020. Questions explored the participants' use of Pharmacist Only medicine guidelines (available both in print and online; available online only) in the preceding 12 months. Data were analysed descriptively (i.e. frequencies, percentages)., Key Findings: In total, 574 eligible respondents completed the survey. Overall, 396 (69%) reported accessing the online and in-print guidelines in the previous 12 months with 185 (33%) accessing online-only guidelines. The guideline on emergency contraception was used the most out of all guidelines in the past 12 months (278, 48%). Overall, respondents reported accessing guidelines to update knowledge, check their practice reflected best practice and content familiarisation. Respondents' reasons for not accessing guidelines were due to respondents stating they did not need the information or that they had previously accessed the guidelines more than 12 months ago. These reasons varied between respondent groups., Conclusions: Access and use of the Pharmacist Only medicines guidelines varied between pharmacists, interns and students. Further understanding of the influences of the use of these guidelines will help inform professional bodies on how best to develop guidelines to increase consistent use in practice and implement interventions to increase use., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society.)

Medication non-adherence is currently estimated to have caused at least 100 000 preventable deaths and over $100 billion in preventable medical costs. Adherence is particularly poor in dermatological conditions, with more than 50% of patients discontinuing topical treatments within the first year. Pharmacists are among the most accessible health-care professionals with the potential to greatly impact medication non-adherence through patient education, medication therapy management, and improved access to care. This review aimed to determine how pharmacists have improved medication adherence in dermatology and discuss strategies for further involvement. An extensive medical literature search using the PubMed database was conducted to evaluate clinical studies, published in the last 20 years, that have evaluated the pharmacist's role and impact on adherence of to dermatological products. PubMed search terms include: "pharmacists' role in dermatologic medication adherence", "pharmacist-led interventions in dermatology", "pharmacist medication adherence dermatology" and "pharmacist intervention dermatology". A total of 18 relevant studies were identified. Pharmacists improved dermatological medication adherence by increasing access to medications, providing medication counseling programs, and performing treatment monitoring services. However, corticophobia may contribute to pharmacists' hesitancy in making corticosteroid over-the-counter recommendations. Pharmacists are accessible health-care providers with the potential to improve dermatological medication adherence. Future advanced training in dermatology medications may refine pharmacists' knowledge of dermatological products., (© 2023 The Authors. The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.)

Within digital health, digital therapeutics (DTx) are increasingly used to provide clinical treatment. DTx are evidence-based, U.S. Food and Drug Administration-authorized software to treat or manage medical conditions and are available either via prescription or as nonprescription products. DTx that require clinician initiation and oversight are called prescription DTx (PDTs). DTx and PDTs have unique mechanisms of action and are expanding treatment options beyond traditional pharmacotherapy. They may be implemented on their own or used in combination with a drug and in some cases may be the only treatment option for a particular disease state. This article explains how DTx and PDTs function and how these technologies can be incorporated by pharmacists as they attend to their patients' care., (Copyright © 2023 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Purpose: To explore the perceived need and enthusiasm for over the counter (OTC) progestogen-only pills (POP)., Materials and Methods: A web-based survey of 1000 sexually active women (16-45) and 100 pharmacists in Germany, Italy and Spain., Results: Despite not wanting to conceive, 5-6% of women in each country were not using contraception and 8-20% were using methods less effective than condoms. At least 74% of respondents felt knowledgeable about the different contraceptives available but at least 1/3 had experienced difficulty accessing oral contraceptive (OCs) in the past two years. The cost of contraceptives, the need to see a doctor and long waits for appointments were cited as barriers for not using OCs. The majority agreed they would discuss with their doctor the decision to buy the POP, consult about side effects and other reproductive health issues. Over 2/3 of pharmacists in each country would be very, or fairly, likely to recommend the POP, agreeing that the benefits included improved access for women, and offered them more independence., Conclusions: Asked directly, women in Germany, Spain and Italy currently using contraception are positive about a POP OTC. Pharmacists are also positive, with the overwhelming majority in favour of providing POPs.

Background: Guidelines encourage engagement in self-care activities for osteoarthritis (OA), but there are gaps in consumers' knowledge about suitable choices for self-care. Community pharmacists are in an ideal position to contribute to OA management through screening and supporting evidence-based pain management choices. Prior research established an association between health literacy and advice-seeking and appropriateness of analgesics choices (both lower in participants with limited health literacy) amongst people living with OA. This article explores the implications of these data for pharmacists in OA management., Methods: A national online survey was conducted amongst 628 adults aged 45-74 years, currently residing in Australia, with self-reported symptoms of OA. All data were collected using a customized online questionnaire, which was completed only once. 'Self-reported symptoms of OA' was based on six validated screening questions to identify people with OA without a formal clinical diagnosis., Results: Respondents matched the typical profile of people diagnosed with OA; more than half were female (56%), knees (59%) and hips (31%) were the primary affected joints and 74% were either overweight or obese. Self-identification of OA was limited (41%). Overall, 38% self-managed their pain, and limited health literacy was associated with less advice-seeking. Efficacy and ease of use were the main reasons cited for prompting use across all classes of nonprescription analgesic, with less than 20% reporting recommendation from a pharmacist. Participants were managing their pain with an average of 1.74 (95% confidence interval: 1.60-1.88) analgesics, but 73% reported inadequate pain relief and 54% had disrupted sleep., Conclusion: Our findings highlight three key themes: lack of self-identification of OA, suboptimal pain relief and limited use of the community pharmacist as a source of management advice. Equipping community pharmacists with tools to identify OA could bridge this gap. More research is needed to determine if it will improve consumers' ability to appropriately manage OA pain., Patient or Public Contribution: Consumers living with OA contributed to the study outcomes, reviewed the survey questionnaire for face validity and advised on plain language terminology., (© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background: Pharmacists are positioned to play important roles in implementing evidence-based prevention and harm reduction approaches for opioid misuse and related health care outcomes such as human immunodeficiency virus (HIV) and hepatitis C. More research is needed to understand how best to facilitate harm reduction practices among pharmacists., Objectives: This hypothesis-generating study investigated (1) whether subgroups (latent classes) were observable among pharmacists based on self-reported comfort with specific harm reduction behaviors, (2) whether having reported expertise in key content areas was associated with any latent classes that might be identified, and (3) whether comfort and training were associated with actually having dispensed syringes for likely nonprescription drug use., Methods: This was a statewide census of community managing pharmacists in Arizona conducted from December 2018 to May 2019. Participants reported their degree of comfort with 10 harm reduction behaviors, their expertise (e.g., recent continuing pharmacy education or specialization) in selected content areas, and their syringe dispensing behavior. Additional sociodemographic information was also collected. Subgroups related to harm reduction were computed using latent class analysis, and associations between study variables were assessed using the Fisher's exact tests., Results: Data suggested the existence of 4 latent, comfort-based harm reduction classes: high comfort, moderate comfort, and clinical comfort, and opioid prevention only. Reported expertise in pre-exposure prophylaxis for HIV was likely associated with harm reduction class. However, class membership was not associated with reporting having dispensed nonprescription syringes, although the single comfort item for syringe dispensing, by itself, was associated therewith., Conclusion: Comfort with harm reduction likely clusters, so pharmacists may be broadly comfortable with topics or methods of harm reduction; however, comfort with a specific harm reduction pharmacy practice may be a better predictor of engaging in that behavior than harm reduction comfort class. In contrast, strategies to improve comfort, such as intervention development, might successfully be informed by pharmacists' latent class., (Copyright © 2022 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objectives: To explore the current perceived relationship between older adults with varying levels of frailty and healthcare needs and community pharmacists., Methods: This qualitative study conducted a thematic analysis of focus groups with older adults and older adult caregivers and community pharmacist participants. Participants were recruited following a maximum variation sampling technique. Verbatim transcripts were inductively coded using NVivo to develop key findings., Key Findings: Four major themes emerged: (i) Pharmacy Landscape, (ii) Prescription and Non-Prescription Drug Safety, (iii) Patient-Pharmacist Relationship and (iv) Recommendations for Pharmacy Practice. Themes demonstrate three key findings: (1) older adults approach drug information with a key focus on safety and cost of both prescription and non-prescription drugs, (2) there is a demonstrated opportunity, recognized by older adults and practitioners, for community pharmacists to expand their role in the care of older adults, (3) community pharmacists are able, interested and/or have already incorporated frailty assessments into their practice to better support their care of the older adult population with varying levels of frailty., Conclusions: The results demonstrate a reason for the community pharmacist role to shift. The unique knowledge and skills of community pharmacists, coupled with their accessibility and strong patient-clinician relationship, have the potential to better support older adults with varying levels of frailty., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Emergency contraceptive (EC) pills are used to prevent pregnancy after unprotected sexual intercourse. Levonorgestrel is an EC pill, which has been only approved in Japan; it is more effective the sooner it is used after intercourse and safe without serious side effects. EC pills are already available at accessible community pharmacies in more than 90 countries around the world. In Japan, citizens have signed a petition calling for the sale of emergency contraceptives at community pharmacies. However, little is known about the thoughts of pharmacists who engage with patients and sell medicines at pharmacies. Therefore, we conducted a web-based cross-sectional survey to determine the level of preparation in community pharmacies and the awareness of pharmacists regarding the sale of EC pills. A total of 1338 pharmacists responded to the survey from November 7, 2020, to December 16, 2020. In terms of the level of preparation for selling EC pills at pharmacies, 1067 (83.9%) respondents cited "lack of preparation of medical questionnaires and explanatory materials", and 975 (76.7%) respondents cited "lack of knowledge of pharmacists" as the most common reasons that were "barriers to EC pill sales at pharmacies". In terms of confidence level, only 289 (22.7%) respondents were confident about conducting the necessary checks while administering medicine. On the other hand, 944 (74.3%) respondents agreed to be able to sell EC pills at their pharmacies. The survey revealed that most of the pharmacists who participated in the survey believe that it is possible to sell EC pills in pharmacies.

Background: Unintended pregnancy occurs due to incorrect or inconsistent use of a contraception method. Such pregnancies can create an economic burden on the family, society and nation as a whole. Unintended pregnancy is the underlying cause of abortion which can also result in infertility and maternal death. Adequate knowledge of emergency contraceptive pills (ECPs) and positive attitudes among the community pharmacy practitioners (CPPs) is a prerequisite for timely access of ECP, thus ultimately lessening the incidence of unintended pregnancies. This study intended to explore the knowledge, attitude and practice of CPPs toward ECPs in Kathmandu valley., Methods: Cross-sectional study conducted in community pharmacies located in three districts of Kathmandu valley. A convenience sampling method was employed to interview CPPs in 227 community pharmacies using a validated questionnaire. Questionnaire assessed the demographic characteristics; knowledge, attitude and dispensing practice of the CPPs. Data were subjected to descriptive and inferential analysis using SPSS 18 (SPSS Inc., Chicago, IL, USA)., Results: Approximately 75% of respondents had a good practice on dispensing ECPs, and 70% of them counselled all the users. A significant association (p-value< 0.05) was obtained between the dispensing practice of respondents and their knowledge level. ECP related knowledge was higher among the age group 40-49 years, BPharm degree holders with experience above 10 years and community pharmacies located inside the city and in the Kathmandu district. After adjusting the possible confounder variables, age, degree and district of pharmacy were significantly associated with knowledge. Similarly, respondents' practice towards ECP was higher among the age group 40-49 years with experience above 10 years and community pharmacies located inside the city and in the Kathmandu district. Adjusted for other variables, only community pharmacies located at Kathmandu district was significantly associated with the practice., Conclusion: CPPs lacked specific important information on ECP and opined against its' availability as an over-the-counter drug, despite good overall knowledge and positive attitude. Many thought that ECP without prescription would increase promiscuity towards sexual behaviour and result in unsafe sex along with its' repeated use. Hence, training and proper counselling strategies should be afoot to refine the delivery of service by CPPs.

Patients often approach a pharmacist instead of visiting a doctor for minor ailments such as cough, cold, allergies, pain, fever, acidity, diarrhea, and skin-related conditions. Purchase of specific medicines over the counter is legally recognized in most countries. 'Over-the-Counter (OTC) Medicines' means drugs which are legally allowed to be sold by pharmacists without need for a prescription. The term does not have a legal definition in India. Technically, drugs are OTC unless they are specifically stated as prescription only drugs. OTC drugs allow faster and cheaper access to healthcare; however, their misuse and adverse health effects cause concerns. This article describes concept of OTC medicines and practices in India against the background of globally prevalent regulations and practices. A recognized category of OTC medicines by law, patient awareness programs, and support of pharmacists and pharmaceutical companies are required to optimize the use of OTC medicines in India., Competing Interests: None

Background: Opioid overdose is a significant public health issue among people who use pharmaceutical opioids and/or heroin. One response to reducing overdose deaths is to expand public access to naloxone. The Australian Therapeutic Goods Administration down-scheduled naloxone from prescription only (S4) to pharmacist only over-the-counter (OTC, schedule 3) in February 2016. There is little research examining pharmacists' perspectives or experiences of this change., Methods: Thirty-seven semi-structured interviews with Australian community pharmacists were conducted in 2016-2017 to investigate pharmacists' attitudes to and experiences of OTC naloxone. Transcripts were thematically analysed, guided by a broad interest in facilitators and barriers to OTC supply., Results: Around half of the pharmacists were aware of the down-scheduling and only two had provided OTC naloxone. Core barriers to pharmacist provision of OTC naloxone included limited understanding of opioid overdose, confusion about the role and responsibilities of pharmacists in providing OTC naloxone, concerns about business, stigma related to people who inject drugs (PWID) and system-level challenges., Conclusion: Pharmacy provision of OTC naloxone offers an important opportunity to reduce overdose mortality. Our study suggests this opportunity is yet to be realised and highlights several individual- and structural-level impediments hindering the expansion of public access to naloxone via community pharmacies. There is a need to develop strategies to improve pharmacists' knowledge of OTC naloxone and opioid overdose as well as to address other logistical and cultural barriers that limit naloxone provision in pharmacy settings. These need to be addressed at the individual level (training) as well as the system level (information, regulation and supply)., (Copyright © 2019. Published by Elsevier B.V.)

Background: Visual impairment poses various challenges to individuals in taking their medications, but there is a lack of studies on visually impaired population and their use of medications and pharmacy services., Objectives: In this study, we aimed to examine (1) the usage pattern of medications and pharmacy services in visually impaired persons and (2) the status of medication counseling conducted to the visually impaired persons by the community pharmacists., Methods: This was a cross-sectional study conducted both to visually impaired and community pharmacists. After pilot testing, survey questionnaires were prepared for each group. Visually impaired participants were recruited from two institutions for visually impaired in South Korea. Pharmacists working at 47 community pharmacies that were selected for braille sticker distribution by the Seoul Metropolitan Government were recruited. SPSS Statistics 23 was used for statistical analysis., Results: One hundred and fourteen visually impaired and 36 pharmacies participated in this study. Majority of the visually impaired participants reported experiencing challenges in identifying medications at home but were using their own methods, such as the use of different storage containers or locations to distinguish medications. While the visually impaired preferred more detailed counseling and use of various tools for medication counseling, the majority of the pharmacists performed counseling to the patients' family members or caretakers., Conclusions: For challenges in managing medications by the visually impaired persons, community pharmacists can play a role by putting efforts to understand their impairment and utilize tools available to guide them., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The advertisement has a great influence on the public and, in over the counter medicines (OTC), it can generate health risks on the population if it is misregulated. The aim of this work is to analyze and disclose strategic viable actions emerged from a forum debate during an online course for fostering the pharmacist’s compromise related to OTC advertisement. Methods: A content analysis was carried on, grouping by themes and categories the opinions of community pharmacists participating in a forum debate about OTC advertisement. Two audiovisual advertisement pieces were analyzed as triggers of discussion. Results: Sixty-five professionals participated in 3 groups of debate, and 103 opinions were collected. Among individual strategies, to guarantee the attention by a pharmacist was highlighted when health conditions or the use of medicines are consulted about. Other strategies include denouncing to the ANMAT the advertisements that do not comply with the norms, procuring a better regulation and assuming a critical posture. Within the collective strategies, including pharmacists in the evaluation committee of advertisement of ANMAT and furthering norms to reassess the role of the pharmacist and the community pharmacy in minor illnesses were stressed. Conclusion: The contribution of the community pharmacists allows disposing a set of professional strategies, both individuals and collectives, to promote a rational use of OTC for the patients and the community., (Revista de la Facultad de Ciencias Médicas de Córdoba)

Background: Recommending effective minor ailment treatments and using non-prescription or over-the-counter (OTC) medicines is a pharmacist's duty. Although common in most European countries, self-medication counseling practices may differ from country to country., Objectives: This study explored Turkish community pharmacists' attitudes concerning the present self-medication market, professional responsibilities toward patients' self-care, and the usefulness of e-learning for patients' counseling education., Methods: The study was comprised of three phases: initially, a document content analysis searched for relevant OTC regulatory and/or practice frameworks; secondly, qualitative individual interviews on self-medication with purposively selected Turkish community pharmacists were performed; finally, a focus group with practitioners and continuing education experts was conducted to deepen previous results. A thematic data analysis, based on the attitudinal theory, was conducted, supported by MAXQDA v12 software., Results: Sixteen documental sources allowed the extraction of three initial main themes: self-medication, classification of medicines and pharmacists' role. Individual interviews outlined four themes that informed the focus group discussion, which produced four new themes. Themes and their codes reflected dissimilar practitioners' cognitions towards OTCs, OTC usage and self-medication, particularly if compared to other European conceptualizations. Contradictory feelings towards the value of OTCs for professional development, e.g., patient counseling influenced by profit-based expectations, were identified., Conclusion: Turkish community pharmacists and their minor ailments treatment competences have yet to thrive as a relevant professional intervention. There are risks of missing the best pharmacy practice standards, thus losing their contribution to rational self-care. Besides weakening the societal recognition of the profession to help individuals' everyday health decisions and well-being, there might be a reduced active role in public health., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Aim: Given the potential to expand naloxone supply through community pharmacy, the aim of this study was to estimate Australian pharmacists': (1) level of support for overdose prevention, (2) barriers and facilitators for naloxone supply and (3) knowledge about naloxone administration., Design: Online survey from nationally representative sample of community pharmacies., Setting: Australia, September-November 2015., Participants: A total of 1317 community pharmacists were invited to participate with 595 responses (45.1%)., Measurements: We assessed attitudes towards harm reduction, support for overdose prevention, attitudes and knowledge about naloxone. We tested the association between attitudes towards harm reduction and different aspects of naloxone supply., Findings: Pharmacists were willing to receive training about naloxone (n = 479, 80.5%) and provide naloxone with a prescription (n = 537, 90.3%). Fewer (n = 234, 40.8%) were willing to supply naloxone over-the-counter. Positive attitudes towards harm reduction were associated with greater willingness to supply naloxone with a prescription [odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.11-1.19] and over-the-counter (OR = 1.13, 95% CI = 1.09-1.17). Few pharmacists were confident they could identify appropriate patients (n = 203, 34.1%) and educate them on overdose and naloxone use (n = 190, 31.9%). Mean naloxone knowledge scores were 1.8 (standard deviation 1.7) out of 5. More than half the sample identified lack of time, training, knowledge and reimbursement as potential barriers for naloxone provision., Conclusion: Community pharmacists in Australia appear to be willing to supply naloxone. Low levels of knowledge about naloxone pharmacology and administration highlight the importance of training pharmacists about overdose prevention., (© 2016 Society for the Study of Addiction.)

Background In 2012, in a first for the developed world, New Zealand reclassified trimethoprim to allow specially trained pharmacists to supply the medicine without a prescription to women with cystitis fitting specific criteria. Objective This study explored pharmacists' views of the training and screening tool, impact on practice, and the pharmacists' perceptions of views of patients and doctors. Methods Structured interviews were conducted with 28 New Zealand pharmacists trained to supply trimethoprim. These pharmacists were selected to represent geographical spread as well as urban, suburban and rural. The key areas for investigation were: satisfaction about training, appropriateness of training, opinions on the screening tool, impact on clinical practice and perception of others. Audio recorded interviews were thematically analyzed. Results Of 40 pharmacies invited, 28 pharmacists agreed to participate. Most pharmacists were positive about being able to supply trimethoprim, the training and increased clinical focus of their practice. The content of the training was considered appropriate, as was the screening tool, which was well utilised during consultations. Minor suggestions on the training and consultation materials were provided. Some pharmacists reported that referral to the doctor without supply in a minority of trimethoprim consultations, frustrated some women. Frequency of supplies varied considerably by pharmacists from none supplied to weekly supplies. Some pharmacists questioned the exclusion to supply for women who had taken antibiotics in the last six months. Many women had reportedly appreciated the easier access in the pharmacy compared with doctor access, especially at weekends, but sometimes misunderstood the role of the pharmacist in the supply. While pharmacists reported that some doctors had been negative about pharmacist-supply, others were informing women about the service from the pharmacist. Conclusion Pharmacist supply of trimethoprim using mandated training and a screening tool or algorithm for supply is workable and well-accepted by pharmacists. Minor changes have been recommended. Further research is needed to understand perspectives of other stakeholders (women, doctors and practice nurses) and outcomes for patients.

Objectives: To examine the effect of one standardized patient question on the length, number and type of new topics pharmacists addressed. To explore how community pharmacists counsel secret shoppers on two types of over-the-counter (OTC) medications-ibuprofen (IB) and emergency contraceptives (EC)., Methods: 25 pharmacists from 7 independent, midwestern community pharmacies consented to have secret shoppers purchase an OTC medication and to have their consultations audio-recorded. Following standardized scenarios, 5 secret shoppers audio-recorded 73 encounters. At the end of 36 encounters secret shoppers asked one standard question, "What else should I know before taking this product?" Role Theory informed the study design with apriori hypotheses that topics assessed, topics discussed, and consultation length would vary by the OTC medication (IB or EC) and whether secret shoppers asked a question. Audio-recording coding had high inter-rater reliability (kappa=0.94)., Results: Length of encounter was significantly associated with patients asking the question (p<0.05), but not type of OTC medication. On average 1.22 new topics were discussed with a patient question. New topics included information about safe and efficacious use of the OTC's., Conclusion: Results highlight the importance of encouraging patients to ask pharmacists their questions about OTC products for safe use and thorough consultations., (Copyright © 2016. Published by Elsevier Ireland Ltd.)

Kampo medicines must be used according to an individual's physical characteristics and symptoms to avoid lack of efficacy, adverse reactions or interactions with other drugs. As category-2 over-the-counter drugs (OTCs), Kampo OTCs are not targets of active explanations by pharmacists, and consumers usually decide to use OTCs by themselves on the basis of drug label information. However, information on the label is occasionally brief. To promote the proper use of Kampo OTCs, we herein propose an informative tool based on the Australian Shelf-Talker (information on the proper use of OTCs with a self-check questionnaire for consumers), the Self-Check Card (SCC). We also prepared the informative material, Information to the Pharmacist (IP), directed at pharmacists regarding these Kampo OTCs. We created SCCs and IPs for 16 prescriptions in the 5 most demanded categories (cold, cough/sore throat, urination problems, women's diseases, and shoulder stiffness or joint/nerve pain). The SCC with questions in a simplified language specifies individuals who should avoid the drug, or those who should consult a pharmacist before purchase, according to the safety information on the respective drug labels. The IP provides information to pharmacists on safety issues and those concerning recognition of the consumer's symptoms and physical characteristics needed for the selection of appropriate Kampo OTCs. Such SCCs and IPs are now in use in 2 pharmacies to know pharmacists' suggestions about improvements and consumer's opinions and degree of satisfaction. We believe these risk-benefit communication tools, SCC and IP, will contribute to improve the proper use of Kampo OTCs.

At the time of consultation with a patient regarding OTC drugs, a pharmacist goes through the following five steps. In Step 1 information is collected, including the patient's gender, age, health condition, living situation, etc. In Step 2, upon analyzing and evaluating this collected information, the pharmacist decides whether to recommend that the patient see a medical doctor or whether an OTC drug is sufficient. In Step 3, when an OTC drug is required, the pharmacist suggests the most suitable OTC drug. In Step 4, the pharmacist provides the patient recommendations and information about the selected OTC. In Step 5, sales record entry and aftercare are performed. In these five steps, the pharmacist is making a decision on whether the consultation recommendation is required or optional; the step of making an optimal selection of an OTC drug is distinct from prescription dispensing. In many cases, at the time of OTC drug consultation, since the patient is not consulting a medical doctor, a pharmacist becomes a "first access" health professional. In this instance, the advice of a pharmacist may have a great influence on a patient's prognosis regarding the particular health challenge. Therefore, pharmacists who perform patient consultations regarding OTC drugs are required to have broad medical knowledge and communication skills. The features of consultation and information dissemination about OTC drugs by a pharmacist, and the practice and study of this subject in present-day pharmaceutical education, are described herein.

In the amendment of the Pharmaceutical Affairs Law in 2013, a new category, Pharmacist Intervention Required Medicines (PIRM), was introduced, and other OTC medicines, which were classified after the 2006 amendment, were allowed to be sold via the Internet. Regarding PIRM, Japan's Ministry for Health, Labour and Welfare designates medicines which require special intervention by a pharmacist who explains their proper use to a patient through a face-to-face consultation, wherein the pharmacist provides guidance based on pharmaceutical knowledge and experience. This encourages consumers to approach their longer term personal healthcare with a rational knowledge of medicines, and dovetails with the direction described in "Japan is Back". Along with the 2006 amendment, an upgraded 6-year curriculum for the study of pharmacy in preparation for becoming a pharmacist was introduced. This allows student pharmacists to have more experience working in community pharmacies, thus supporting and providing pharmacists with the knowledge they need to better help the consumer to rationally use OTC medicines and self-select proper OTC medications. And this is not only restricted to OTC medicines, as there are many items sold in local pharmacies available to be utilized by the consumer with reasonable support by pharmacists. There is an expectation that the pharmacist be prepared to assist the consumer not only with prescriptions, but also with OTC medications, supplements, medical accessories, etc. using their knowledge and experience.

Background: In China, increasingly OTC-western medicine is obtained at the community pharmacy. It is unknown which care the community pharmacists in China provides with such medicines., Objective: This study investigated community pharmacists' attitude, practice and perceived barriers about pharmaceutical care of over-the-counter western medicine. Moreover, community pharmacists' suggestions of improvement measures were also collected., Methods: Questionnaire survey targeting community pharmacist., Results: Respondents generally showed positive attitude towards pharmaceutical care. About 30 % of the respondents reported that they provided pharmaceutical care "whenever necessary", while about 40 % did it "as frequent as possible" or "to all consumers". Respondents considered "ambiguity of the professional role of pharmacists" (50.7 %), "Lack of scientific evidence of over-the-counter western medicine" (42.9), and "Lack of time" (40.0 %) as the main barriers. The 3 most important improvement measures suggested were "Formulating or refining legislation to clarify the legal professional role of pharmacists with respect to western medicine" (63.2 %), "Promoting public education of pharmacist role" (50.7 %), and "Formulating or refining the standards of pharmacists' practice with respect to western medicine" (50.7 %)., Conclusion: Community pharmacists in Harbin of China have a relatively positive attitude and intention to provide pharmaceutical care of OTC western medicine. However, lack of professional role definition, limited pharmaceutical knowledge and lack of human and financial resources limited the provision of pharmaceutical care by community pharmacists.

The requirement that mifepristone be dispensed only by physicians in offices, clinics or hospitals - and not by prescription in pharmacies - has likely limited uptake by providers in the United States. However, in several other countries, provision by prescription in pharmacies is allowed, including in Australia. Mifepristone was first registered in Australia in 2012, and in 2015, a composite package including 200 mg mifepristone and four tablets of misoprostol 200 mcg was registered. Both were approved as Schedule 4 medications, which require prescribing by a physician and may be dispensed at pharmacies. As part of the registration for both products, a risk management plan was instituted that has several components. First, physicians must be certified to prescribe mifepristone. General practitioners wishing to become certified must complete online training that includes prescribing requirements and managing the medical abortion process; obstetrician-gynecologists are exempt from the online learning module. Pharmacists must also be certified in order to dispense the medication, although this does not require additional training. When a pharmacist receives a prescription for mifepristone, she or he must confirm through a secure website that the prescriber is certified. In every region of the country, there are more certified prescribers and dispensers of mifepristone than the number of facilities providing abortion care. The experience in Australia demonstrates the feasibility of mifepristone by prescription and should be a model for expanding access to early medical abortion in the United States., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To evaluate the current management of over-the-counter (OTC) insomnia complaints in Australian community pharmacies using standardized patient methodology., Methods: Trained standardized patients visited a sample of 100 randomly selected South East Queensland community pharmacies in June 2011. The standardized patients enacted two OTC insomnia scenarios: a direct product request (DPR) (n = 50) and a symptom-based request (SBR) (n = 50). Results of the interactions were documented immediately after each visit and evaluated using the Pharmaceutical Society of Australia's WHAT STOP GO protocol as a standard comparison., Key Findings: Of all DPRs, 30% were handled entirely by the pharmacist, 70% of staff enquired about specific symptoms and 28% investigated the cause of insomnia. No staff investigated the frequency of product use. The DPR scenario resulted in a 92% supply of the requested doxylamine product (Restavit). In the SBR scenario, 18% of requests were handled entirely by the pharmacist, 58% of staff enquired about specific symptoms and 44% investigated the cause of insomnia. Staff recommended medicated products (38%), or herbal (78%) or non-drug techniques (18%). Investigation into smoking and alcohol intake was not undertaken in DPR or SBR interactions, while questioning on caffeine intake was undertaken in 2 and 14% of cases respectively. There were no significant differences found in the handling of sleep requests by pharmacists compared to pharmacy assistants., Conclusion: The standardized patient methodology was a successful way to assess the community pharmacy counselling provided with OTC sleep requests and suboptimal staff responses were found when compared with recommended practice standards., (© 2013 Royal Pharmaceutical Society.)

The role of pharmacists in self-medication is to provide informed and objective advice on medicines and their use, and to promote the concept of pharmaceutical care. In 2012, the teaching of medicines and their use was started in junior high schools, and pharmacists should be providing samples and the example package inserts, and/or giving lessons in cooperation with teachers. In this article, a number of examples of how to do this will be shared. In 2009, the Pharmaceutical Affairs Law was revised and the role of pharmacists being key figures in supplying medicines was significantly increased. Pharmacists should have a professional obligation to provide advice about self-medication and medicines for self-medication. We introduced some approaches for student pharmacists to enhance the self-medication leading ability. 1) Problem-based learning, and combination learning of basic problems and clinical topics for 1st-year students, 2) An e-learning system to provide objective information about medicines, and 3) A case study system to cultivate pharmacists and student pharmacists who can contribute to providing advice about the safe use of over the counter (OTC) medicines.

Background: Many studies have reported the use of over-the counter (OTC) or nonprescription medications (medications that are available to consumers without a prescription) to be inappropriate and associated with risks to consumers. Among healthcare professionals, pharmacists have a key role in providing information and helping customers make a safe choice of nonprescription medicines., Objective: This study aimed to measure the attitudes and beliefs of community pharmacists toward the use of nonprescription medications by Egyptian customers., Subjects and Methods: A cross-sectional descriptive study was carried out among community pharmacies in Alexandria. A self-administered questionnaire was used to collect data from 335 pharmacists working in community pharmacies., Results: The use of nonprescription medicine among patients/consumers was reported by 66.9% of pharmacists to have increased in the past 4 years and 94.1% of them considered such a use to be very serious or somewhat serious. Long-term or chronic use was cited by 76.7% of pharmacists as the most common reason for the widespread inappropriate use of nonprescription medications, and 82.4% of the pharmacists considered the most common contributing factor to be lack of knowledge of patients/customers about the active ingredients in a branded product. The most common medications enquired about by patients/consumers were those for cough, cold, or sore throat, as reported by 73.5% of pharmacists, whereas 79.4% of pharmacists reported that patients asked about how to use nonprescription drugs. Sixty percent of pharmacists reported that the main reason that patients/customers did not seek consultation for nonprescription medicines was that they believed that nonprescription medicines were safe, and 52.5% reported that patients believed that taking advice on how to use it was unnecessary. To learn about nonprescription medicine, 93.7% of pharmacists turned to drug product labeling., Conclusion and Recommendations: Use of nonprescription drugs is a serious problem that has increased over the past few years. Long-term or chronic use of nonprescription medicine was the most common form of inappropriate use of nonprescription medications and lack of knowledge on the part of patients/customers about the active ingredient in a branded product was the most common factor contributing to its inappropriate use. Pharmacists should receive continuous professional education to increase their knowledge on and improve their practice of prescribing nonprescription medication; further, drug companies should be precise when disclosing information on OTC drug labels as the majority of pharmacists consult the drug label as a source of information about OTC.

Objective: To evaluate the financial and clinical outcomes of an over-the-counter (OTC) medication consultation performed by doctorate of pharmacy student pharmacists in a community pharmacy., Design: Cross-sectional survey., Setting: Independent and chain community pharmacy locations in Pittsburgh, Pennsylvania., Participants: Fourth professional year (PY4) advanced experiential student pharmacists on community rotations at the designated settings who performed OTC consultations and the participants of these encounters., Main Outcome Measured: Financial and clinical impact of an OTC consultation performed by student pharmacists on rotation., Results: A total of 559 OTC consultations were offered in 5 participating community pharmacy settings over a period of 1 year. Student pharmacists initiated 62.4% of all documented interactions and 60.5% of all participants accepted the consultation offer. The student pharmacists' OTC recommendations resulted in significant cost savings to the participant. Those participants accepting consultation reported being more likely to consult with a pharmacist in the future. PY4 students were also able to demonstrate capability in impacting clinical outcomes on several occasions by implementing OTC medication changes due to patient safety concerns., Conclusion: Student pharmacist OTC consultations have the potential to positively impact both financial and clinical outcomes associated with the use of OTC medications.

Background: More than 90 medicines in the United Kingdom alone have been reclassified from "prescription only" to "pharmacy" availability, and many of these have further been deregulated to "general sales" status. Pharmacist perspectives of reclassified medicines adoption into practice are important to inform future reclassifications., Objectives: The aim of this research was to explore the factors associated with adoption into practice of newly reclassified medicines by community pharmacists based on the theoretical framework of diffusion of innovations., Methods: Focus groups and qualitative interviews with 20 community pharmacists selected randomly from 4 Health Boards in Scotland were conducted. Results were analyzed using a framework method for thematic analysis., Results: Factors associated with pharmacists' decision making regarding adoption into practice of newly reclassified medicines related to pharmacists' perceived attributes of newly reclassified medicines such as evidence of benefits and risks to patients (ie, efficacy and safety); organizational contextual factors such as sources of information and training; external factors, such as support from wider stakeholders; and adopter characteristics such as pharmacists' perception toward adopting new behaviors. Many newly reclassified medicines were highlighted by participants to have been highly adopted into practice or were less/not adopted based on these diverse factors. Decisions at organizational level to stock new medicines did not necessarily translate into adoption at practitioner level., Conclusions: Pharmacists' decision making regarding adoption of newly reclassified medicines is a complex and multidimensional process. This is the first study of this sort, and results of this qualitative study will aid development of a research instrument aimed at quantifying the importance of the factors identified., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The sale of over-the-counter (OTC) medicines from community pharmacies offers important opportunities for members of the public to access medicines and self-treat conditions. They are increasingly recognised, however, as having the potential for abuse and harm despite their perceived relative safety. This study reports on a qualitative study that explored the experiences and views of community pharmacy staff in relation to current practices and concerns, management and support relating to OTC medicine abuse. Semi-structured interviews were undertaken with a purposive sample of ten pharmacists and seven medicines counter assistants in the United Kingdom. Analysis of interviews indicated that a range of medicines was implicated, including opiates, sedative antihistamines, laxatives and decongestants. A surveillance role was apparent for assistants, who placed emphasis on regulations, procedure and monitoring frequency of purchases to manage abuse, with referral on to pharmacists. Frequency of purchase was central to assistants' definition of those suspected of OTC medicine abuse, which pharmacists also utilised as well as a distinction between intentional abuse and unintentional medicine misuse. A lack of information about customers, easy access to, and poor communication between community pharmacies were emergent barriers to pharmacists providing more support. Many appeared uncertain of referral options or how pharmacists could effectively stop the problem of abuse. The commercial environment was a particular concern, in relation to customer expectations, medicine advertising and easy access to different community pharmacies. A key tension emerged between providing medicine supplies that permitted consumer freedom, with the needs of healthcare professionals to understand more about those consumers qua patients. Policy implications include the need for improved knowledge for community pharmacy staff about signposting to relevant services, increased awareness of who might be affected, and a review of how pharmacists can have more information about patients to inform OTC medicine sales., (© 2013 Blackwell Publishing Ltd.)

Due to the removal of many pharmaceuticals from the prescription requirement, self-medication implies an increasing responsibility for pharmacists towards their patients. The application of evidence-based guidelines could be a responsible basis for consulting in pharmacies. Evidence-based guidelines represent the systematically accumulated and evaluated facts (the evidence) of desired and undesired effects of pharmaceuticals in the population. We wanted to find out which interest pharmaceutical professionals have in evidence-based guidelines and which are the exact requirements on their content, deducted from public pharmacies everyday demands. With this purpose, three surveys were conducted between March and August 2012, in which 365, 350, and 486 pharmaceutical professionals participated respectively. The results show that pharmacy staff is very interested in evidence based guidelines. Furthermore, they suggest that the pharmacy staff feel safe with the self-diagnosis of the customer, with the consideration of limits of self-medication, as well as with the selection of the--according to own assessment--appropriate active substance. For the selection of the correct active substance, the following criteria are named: self-security in the counselling, first-hand experiences as well as the wish of the customer. At the same time, it is striking that the most frequent critique the pharmacy staff gets from pharmacy customers is the lack of effectiveness of the selected medication. With that in mind, it is possible that not the appropriate medication was selected, and the chosen criteria as selection method should be replaced by an evidence-based decision. Secondly, the results show that in up to 52% of the cases, depending on the indications, the participating consultants felt less certain to uncertain with regards to possible interactions or contraindications. Also in this context, it is desirable to prepare the existing data in such a practical way, that the pharmacies are able to apply them directly.

Pharmacists who refuse to provide certain services or treatment for reasons of conscience have been criticized for failing to fulfil their professional obligations. Currently, individual pharmacists in Great Britain can withhold services or treatment for moral or religious reasons, provided they refer the patient to an alternative source. The most high-profile cases have concerned the refusal to supply emergency hormonal contraception, which will serve as an example in this article. I propose that the pharmacy profession's policy on conscientious objections should be altered slightly. Building on the work of Brock and Wicclair, I argue that conscientious refusals should be acceptable provided that the patient is informed of the service, the patient is redirected to an alternative source, the refusal does not cause an unreasonable burden to the patient, and the reasons for the refusal are based on the core values of the profession. Finally, I argue that a principled categorical refusal by an individual pharmacist is not morally permissible. I claim that, contrary to current practice, a pharmacist cannot legitimately claim universal exemption from providing a standard service, even if that service is available elsewhere., (© 2011 Blackwell Publishing Ltd.)

Background: Worldwide Ministries of Health (MoH) are encouraged to publish an updated Over-the-Counter (OTC)-Directory that pharmacists should adhere to in dispensing non-prescription medications. The Saudi Ministry of Health has published the OTC-Directory in the year 2000, and since then, it was readily available to all practicing pharmacists at no cost. This study was aimed to investigate the knowledge of practicing pharmacists in Riyadh, Saudi Arabia, regarding permitted self-prescription medications (i.e., OTC-Directory), as well as pharmacists professional competence and adherence at dispensing OTC drugs without prescription., Methods: The study was cross-sectional by design. A computer generated list of simple random sampling was used to select the pharmacies out of 1,500 working in Riyadh. The data was collected from 384 randomly selected community pharmacies by questionnaire using direct investigation method and the total respondents were 405. Associations between qualitative variables were observed using Pearson Chi-square and Fisher Exact test., Results: Four hundred and five (405) pharmacists participated in the survey of which 100% were males and 362 (89.4%) were below the age of 40 years. Majority of them (361, 88.9%) were holding bachelors degree. Almost one-third of the respondents (123, 30.4%) were not aware of the existence of the Saudi OTC-Directory. The pharmacists' geographical location, nationality and attendance of CME activity had significant association with knowledge about the OTC-directory (p < 0.05). Two hundred and eighty-two (69.6%) of the pharmacists who had knowledge about Saudi OTC-directory did not comply with its guidelines. Pharmacists with higher degrees were more observant of the OTC-Directory as compared to those with diploma and Bachelor Degree (p = 0.014)., Conclusions: There is significant non-compliance of OTC-directory by the community pharmacists while providing non-prescription drugs in Riyadh, Saudi Arabia.

Objectives: To define constipation, assess the pharmacist's role in identifying and treating constipation, and review clinical evidence for the efficacy, safety, and tolerability of polyethylene glycol (PEG) 3350 (MiraLAX-Merck Consumer Care), an osmotic laxative now available over the counter (OTC), across a variety of patient populations routinely encountered in pharmacy settings., Data Sources: Systematic PubMed search of the primary literature for constipation treatment guidelines and clinical trial results for PEG 3350., Data Synthesis: Pharmacists have a unique role in assisting patients with identifying and managing constipation. Multiple controlled clinical trials have established the efficacy, safety, and tolerability of PEG 3350 at its recommended dose of 17 g once daily. On the basis of this evidence, various professional groups have recommended PEG 3350 for use in improving stool frequency and consistency in patients with constipation. PEG 3350 is approved for short-term use, including treatment of constipation caused by medications., Conclusion: Pharmacists can play an important role in managing constipation with OTC agents. Compared with other available OTC agents, PEG 3350 can be recommended to patients suffering from constipation on the basis of a large body of clinical evidence supporting its efficacy and safety, as well as the high patient acceptance shown for its palatability and once-daily dosing.

Background: As 5 years have elapsed since the emergency contraceptive pill (ECP) was made available without prescription in Australia, information was sought about the current attitudes and practices of pharmacists in relation to their increased role in ECP provision., Study Design: A mail survey was implemented; questionnaires were distributed to 750 pharmacies across Australia during 2008-2009. Descriptive statistics were calculated and multiple logistic regression was used to examine factors associated with declining to dispense ECP., Results: Response rate was 29%. Most pharmacists used a protocol to guide ECP dispensing (77.3%) and the majority had declined ECP provision (75.1%) in certain circumstances. Many usually counselled where confidentiality could be assured (62.8%), and agreed that it is a pharmacist's role to counsel on regular contraception (81.9%). Factors significantly associated (p ≤.05) with dispensing practices included pharmacists' attitudes towards acceptability of advance prescription, their age, gender and pharmacy accessibility., Conclusions: New information about Australian pharmacists' current attitudes and practices towards ECP dispensing was identified. Pharmacists had stronger, more conservative attitudes than overseas pharmacists; however, the issues that emerged were similar to those reported overseas. To address these, revised training for local pharmacists is recommended., (Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.)

In recent years, it is necessary to acquire knowledge not only about medicine but also over-the-counter (OTC) drugs and health food for children, because lowering trend in the age of the health hazard by improper use of health food is reported. Therefore, in order to estimate the extent of use of OTC drugs and health food, the school pharmacists administered a questionnaire to students in grade-school (n=123), junior high school (n=303), and high school (n=115) in Fukuyama city. As a result of the questionnaire survey, surprisingly, the usage ratio of OTC drugs and health food showed the most increase in grade-schooler. The trigger of use of health food is "parents' recommendations" in the lower grades, otherwise the ratio of "use by themselves" was increased in the higher grades. Moreover, a remarkable difference was observed by the kinds of use in students with or without exercise. Interestingly, exercise group expected "physical strength" effects than no exercise group. In addition, the ratio of consultation to the pharmacist at the time of purchase of OTC drugs and health food was low in all grade students. In particular, the ratio of consultation to the pharmacist at the time of purchase of health food was very low in high school students. Therefore, to provide accurate information of medicine and health food for students, the school pharmacist should engage not only in routine work but also in positive guidance about OTC drugs and health food in the future.

After the Ministry of Edcation, Culture, Sports, Science and Technology of Japan has ratified the UNESCO "International Convention Fight against Doping in Sport" in December 2006, the government increased its support to Anti-Doping activities. About 5 years ago, the total number of doping control samples a year in Japan was around 2000, and this number was not enough to demonstrate Japanese athletes' cleanness to the rest of the world. However, after the government's ratification of the UNESCO international convention, the government increased its support both financially and politically. By receiving the increased support from the government, testing number has increased and reached 5000 samples a year. 5 years ago, our target athletes range was only international level athletes who compete in the Olympics or international events. As we expanded our testing numbers, the target range of the athletes was also expanded and national level athletes also became our targets. As a result, athletes without having adequate knowledge about anti-doping regulations became our target. This situation caused inadvertent anti-doping rule violation cases. Most of those anti-doping rule violations were the result of taking over-the-counter medicines, etc. In order to cope with those inadvertent anti-doping rule violation problems, we, Japan Anti-Doping Agency launched "Sport Pharmacist Project" in cooperation with Japan Pharmaceutical Association. In this project, we provide anti-doping information/regulation to the pharmacists and make those pharmacists knowledgeable about the current anti-doping rules and regulations.

Peoples have been much concerned on their healthy life. Recently, many kinds of dietary supplements and food for specified health uses are distributed and consumed in large quantities. Concurrently, medical case insurance in Japan has been accommodating a lot of patients increasingly year by year, when the importance and enlightenment of self-care and primary care of people with nonprescription medications is proposed. The Pharmacists Law defines the responsibility of the pharmacists for the public health and welfare with medication and hygienic affairs. The recent pharmacy education for 6 years in Japan is likely to orient pharmaceutical care practice for contribution to the treatment of patients by appropriate management of medication. The multidisciplinary knowledge on medicines and diseases, and the patient consultation technique are required in the pharmacy practice. The contribution and accountability of the community pharmacists to self-care and primary care with nonprescription medications, as social needs, is expected. In this review, social responsibility on the treatment with nonprescription medications and their information provided by the community pharmacists in future is discussed.

Objectives: In Hungary, the one-dose levonorgestrel-only emergency contraception pill (ECP) is available only with prescription. There is a perceived need among both doctors and women to introduce ECP over-the-counter (OTC). The aim of this study was to gain information--which, as in most geographical areas, was lacking so far--on the knowledge and attitude of pharmacists relating to OTC use of ECP in South-Eastern Hungary., Methods: A questionnaire survey with 22 questions was conducted among the members of the Chamber of Pharmacists in the three-county area., Results: Completed questionnaires were returned by 108 pharmacists. The vast majority (97%) of the respondents were aware of the dosing schedule of the available ECP. Nearly three quarters (73.4%) of the pharmacists estimated the effectiveness of ECP to be 80%. However, the knowledge around side effects, mode of action and effect on the menstrual cycle varied. Fifty-five per cent of the pharmacists would prefer OTC distribution of ECP., Conclusions: This is the first study in Hungary about knowledge and awareness of pharmacists regarding ECP. Most respondents were reasonably informed but further training courses for pharmacists are recommended before introducing OTC access to ECP in Hungary.

Objective: To determine the experiences, practices, and challenges associated with nonprescription syringe sales (NPSS) among pharmacists whose pharmacies were enrolled in the Disease Prevention Demonstration Project in San Francisco, CA., Methods: Self-administered survey mailed to 69 pharmacies and interviews with pharmacists and technicians., Results: A total of 55 of 69 pharmacies (80%) returned the survey, and eight pharmacy managers and three pharmacy technicians were interviewed in person. Of pharmacists, 72% reported none or very few problems with NPSS in the previous year, although surveys and interviews illustrated challenges associated with NPSS in terms of time management, educating patients about syringe disposal, and understanding patient preferences for syringes. Of pharmacists, 62% reported NPSS to no more than 10 to 20 patients per week and 67% collected more than 400 syringes in the previous year. One-third of pharmacists perceived that their pharmacies were located in areas where drug activity was high and that the majority of NPSS patients injected illegal drugs., Conclusion: Access to sterile syringes is a prominent public health issue, and pharmacists can play an important role in injection drug user (IDU) education and disease prevention. This evaluation suggests that pharmacies are selling nonprescription syringes to individuals perceived to be IDUs with no major problems. Additional evaluations from health department programs are needed to demonstrate the efficacy of NPSS in California.

Objective: To determine the individual- and neighborhood-level predictors of frequent nonprescription in-pharmacy counseling., Design: Descriptive, nonexperimental, cross-sectional study., Setting: New York City (NYC) during January 2008 to March 2009., Intervention: 130 pharmacies registered in the Expanded Syringe Access Program (ESAP) completed a survey., Participants: 477 pharmacists, nonpharmacist owners/managers, and technicians/clerks., Main Outcome Measures: Frequent counseling on medical conditions, health insurance, and other products., Results: Technicians were less likely than pharmacists to provide frequent counseling on medical conditions or health insurance. Regarding neighborhood-level characteristics, pharmacies in areas of high employment disability were less likely to provide frequent health insurance counseling and pharmacies in areas with higher deprivation were more likely to provide counseling on other products., Conclusion: ESAP pharmacy staff members are a frequent source of nonprescription counseling for their patients in disadvantaged neighborhoods of NYC. These findings suggest that ESAP pharmacy staff may be amenable to providing relevant counseling services to injection drug users and warrant further investigation.

Background: Earlier work established an evidence practice gap during provision of nonprescription salbutamol (albuterol). Pharmacist interns are hypothesized to be in a position to improve professional practice in the community pharmacy setting., Objective: To explore the potential of intern pharmacists to improve the professional practice of community pharmacy staff in the provision of nonprescription salbutamol., Methods: Intern pharmacists (n = 157) delivered an asthma intervention in 136 pharmacies consisting of an educational activity to pharmacy staff and a health promotion campaign to consumers. Post-intervention, simulated patients presented to 100 intervention and 100 control community pharmacies with a request for salbutamol. The appropriate outcome was medical referral for poor asthma control and correction of poor inhaler technique. Incidence and quantity of patient assessment and counseling provided during the visit were also assessed. Logistic regression was used to determine the predictors of medical referral., Results: A doubling in the rate of medical referral was seen in the intervention group (19% vs 40%; p = 0.001). Assessment of reliever use frequency was the main predictor of medical referral (OR = 22.7; 95% CI 9.06 to 56.9). Correction of poor inhaler technique did not improve; however, a reduction in salbutamol supplied without patient assessment (23% vs 8%; p = 0.009) or counseling (75% vs 48%; p < 0.001) was noted., Conclusions: A doubling in the rate of medical referral showed a clear improvement in professional practice during the provision of nonprescription salbutamol. The improved patient outcome in the intervention group was due to increased assessment of reliever use frequency. Identification of poor inhaler technique remained near zero in both groups, which suggests that intern pharmacists were able to improve the current practice of community pharmacies yet were unable to establish a new practice behavior. This study provides evidence that intern pharmacists can act as change agents to improve pharmacy practice.

Ideas of participation and partnership in health care consultations have attracted increasing attention in recent years; however the consequences in terms of the necessary shifts in existing relationships are often overlooked. We examine how pharmacists work to maintain their professional expertise against the rise of health-care consumerism. We draw on the following data from a UK study of consultations for over-the-counter (OTC) medicines in two pharmacies: (i) an outline of the pharmacy owners' views of their practice model, (ii) data from observations and tape recorded consultations (iii) interviews with customers and pharmacists and (iv) views expressed in two feedback sessions discussing vignettes developed from observational and interview-based fieldwork. There was no suggestion that attempts to engage customers in discussions about their treatment necessitated a diminution of the importance of pharmaceutical expertise. Indeed, both pharmacists and customers acknowledged the importance of the asymmetry of knowledge between pharmacists and customers. Pharmaceutical expertise was however not always perceived to be necessary and transactions in pharmacies may be treated like those in any other retail environment. Further research using a larger dataset to investigate problems in interactions resulting from tensions between pharmaceutical expertise and consumerism is indicated.

Aim: To describe community pharmacists' views, attitudes and early experiences of OTC simvastatin., Method: A cross-sectional postal questionnaire survey of the main pharmacist in 2000 randomly selected community pharmacy premises in Great Britain (approximately 15%)., Main Outcome Measure: The questionnaire comprised items on: attitudes to OTC simvastatin; continuing education; sales; and general views and experiences. Data were analysed using descriptive statistics and content analysis of responses to open questions., Results: Questionnaires were returned by 1,156 community pharmacists (57.8%). Nine hundred and fifty-six respondents (82.7%) reported no sales of simvastatin in the previous fourteen days. Eighty-two (7.1%) sold one pack, 40 (3.5%) sold two packs and 18 (1.6%) sold three packs or more (60 did not answer). Almost all respondents (1,086, 93.9%) stated that they had participated in continuing education. Most (691/1,148, 60.1%) strongly agreed or agreed that they were entirely confident about selling simvastatin and that community pharmacists could make an appropriate risk assessment for the use of simvastatin (898/1,149, 78.2%). Responses to the open question identified a number of themes including: need for access to clinical information; cost as a barrier to supply; those purchasing were least likely to benefit; and the lack of an evidence base for the OTC dose., Conclusion: Community pharmacists surveyed had undertaken an array of continuing education and felt confident to undertake cardiovascular risk assessment. However, very few sales of OTC simvastatin had been made and a variety of issues were identified, particularly relating to the evidence base, access to clinical information, cost and the product licence.

Background: In Turkey, some drugs can be purchased from pharmacists without a prescription and there is no legal classification corresponding to the international term "over-the-counter drugs". The purpose of this study was to identify these non-prescribed drugs and to define the role of pharmacists in their sale and their use in primary healthcare., Material/methods: This cross-sectional study was carried out in Istanbul between December 1, 2003, and August 31, 2004. Seventy-three of the 901 pharmacies in two districts of Istanbul were chosen with systematic sampling, and information concerning drug sales and pharmacists' behavior regarding primary healthcare services was collected by observations as well as by interviews with the pharmacists., Results: The study demonstrated that 41% of the drugs sold were non-prescribed. In pharmacies remote from healthcare institutions, remote from district centers, and in the summer seasons, the rates of non-prescribed drug sales were higher than those of prescribed drugs (Chi(2)=10.5, d.f.=1, p=0.001; Chi(2)=62.8, d.f.=1, p=0.0001; Chi(2)=23.4, d.f.=1, p=0.0001). The pharmacists stated that aside from drug sales, consumers visited them to consult about drugs, to get information on their health status, and to learn about family planning (78.1%, 72.1%, and 72.6% of the pharmacists, respectively)., Conclusions: Extensive sale of non-prescribed drugs as a response to public demand, including those used for serious illnesses, has been observed in private pharmacies in Istanbul. The role of pharmacies and pharmacists in primary healthcare should be discussed more thoroughly and redefined on a legal basis.

Background: Consultation of patients in community pharmacies (CPs) must meet standards, especially in selling over-the-counter drugs; however, there has been no information as to whether northeastern German CPs meet these standards., Objective: To estimate aspects of consultation quality in CPs in Mecklenburg-Vorpommern, located in northeastern Germany, study factors related to consultation quality, and check compliance with Pharmacy Practice Law, because not all pharmaceutical professions may legally sell drugs., Methods: In 2005, 6 mystery shoppers (pharmacy students) presented with a headache to 146 of 398 CPs; they requested a sleeping pill plus an antihistaminic drug and completed data collection forms. Consultation scores were calculated and effects of pharmacy/staff characteristics on consultation were modeled with linear (consultation score) and logistic regression (failure to detect a drug-drug interaction). Variables used in models were staff profession, pharmacy size (number of staff), city/town size (number of pharmacies), and day of the week in which shoppers visited the pharmacy., Results: Despite a high willingness of pharmacy staff to provide consultation (83% spontaneously offered advice), northeastern German CPs did not achieve their professional mission. Extreme variation was evident in their questioning of the mystery shoppers regarding use of important single items (from 1% for pregnancy/breast-feeding considerations to 56% for dosing instructions). In all cases, drugs were sold to the shoppers; most (91%) were single agents. Drug-drug interaction detection was low: 43 (30%) counselors informed mystery shoppers about the interaction. The profession of the consulting staff and the size of the pharmacy were associated with consultation quality (highest for pharmacists; lowest for small pharmacies [2-4 staff]). For interaction detection, consulting staff profession was relevant: pharmacists had OR of 3.2 for the detection compared with pharmacy engineers/assistants. In 7 pharmacies, staff illegally sold drugs to customers., Conclusions: Northeastern German CPs have much need and potential for improvement in consultation quality and drug-drug interaction detection. In-depth elicitation of symptoms and details of patients' situations must be improved. Relevant training should be provided, including use of software to identify drug interactions. Mystery shopper studies give valuable information for tailoring training schemes.

Objective: To determine how knowledgeable pharmacy customers are regarding their own health and information about minor illnesses and over-the-counter medicines., Methods: A written questionnaire was sent in the period of January to April 2003 to a sample of pharmacies in different regions of Estonia. Questionnaires were then distributed to randomly selected pharmacy customers. Of 886 questionnaires given out, 727 were answered and returned; a response rate was 82%., Results: Half of the respondents assessed their health as good or excellent. When minor illnesses occurred, most used home remedies or over-the-counter medicines. Their knowledge of such illnesses was better than that of over-the-counter medicines. In both cases, the pharmacist was the most frequently used information source. Drug administration, which preparation should be chosen for which illness, and the drug price were the three most often asked questions in the pharmacy. The information about over-the-counter medicines given in the pharmacies was regarded as sufficient by 51% of the respondents., Conclusion: Although lay people do know about over-the-counter medicines and especially about minor illnesses, pharmacists play a very important part in providing information about medicines. However, drug communication by healthcare professionals regarding over-the-counter medicines should be given more attention in the future.