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Introduction The link between polypharmacy, risk of potentially inappropriate medication exposure, and avoidable medicines-related harm is well recognised. Not all polypharmacy is harmful, and contemporary multimodal approaches to managing long-term conditions are evidence-based and commonplace. What is needed is a focus on reducing inappropriate medication prescribing in polypharmacy. Aim This study aims to develop the New Zealand criteria, a set of New Zealand-specific potentially inappropriate medication indicators to correct for older adults with polypharmacy. Methods A mixed-methods approach was used. An expert panel group comprising four clinical pharmacists, two general practitioners, one geriatrician, and two nurse practitioners generated a collection of ideas via the nominal group technique, which combined with published criteria from literature, provided the list of potential criteria. These potential criteria were reviewed, validated, and ranked for importance via a two-round modified Delphi analysis with the same panel. Results The nominal group technique generated 35 indicators, of which 23 were rated as important. Fifty-nine of 91 indicators from literature were rated as relevant and important. This generated 82 indicators for the modified Delphi analysis, from which 61 achieved consensus. Overall, 21 unique criteria were judged ‘very important’, 31 were judged ‘important’, and nine were judged ‘somewhat important’. No indicators were judged ‘low importance’. Discussion The New Zealand criteria provides 61 medication indicators, which New Zealand experts recommend should prompt formal, documented review. The criteria can be used to systematically identify patients at the highest risk of avoidable medication-related harm for proactive review.

Background Hospital-acquired thrombosis (HAT) is a leading cause of preventable death and disability worldwide. HAT includes any venous thromboembolic (VTE) event occurring in-hospital or within 90-days of hospitalisation. Despite availability of evidence-based guidelines for HAT risk assessment and prophylaxis, guidelines are still underutilised. Aim To determine the proportion of patients who developed HAT that could have been potentially prevented with appropriate VTE risk assessment and prophylaxis at a large public hospital in New Zealand. Additionally, the predictors of VTE risk assessment and thromboprophylaxis were examined. Method VTE patients admitted under general medicine, reablement, general surgery, or orthopaedic surgery service were identified using ICD-10-AM codes. Data were collected on patient characteristics, VTE risk factors, and the thromboprophylaxis regimen prescribed. The hospital VTE guidelines were used to determine rates of VTE risk assessment and the appropriateness of thromboprophylaxis. Results Of 1302 VTE patients, 213 HATs were identified. Of these, 116 (54%) received VTE risk assessment, and 98 (46%) received thromboprophylaxis. Patients who received VTE risk assessment were 15 times more likely to receive thromboprophylaxis (odds ratio [OR] = 15.4; 95% CI 7.65–30.98) and 2.8 times more likely to receive appropriate thromboprophylaxis (OR = 2.79; 95% CI 1.59–4.89). Conclusion A large proportion of high-risk patients who were admitted to medical, general surgery and reablement services and who developed HAT did not receive VTE risk assessment and thromboprophylaxis during their index admission, demonstrating a significant gap between guideline recommendations and clinical practice. Implementing mandatory VTE risk assessment and adherence to guidelines to improve thromboprophylaxis prescription in hospitalised patients may help reduce the burden of HAT.

Background Community pharmacist-led anticoagulation management service (CPAMS) offers international normalised ratio point-of-care testing of warfarin in a community pharmacy setting. It has now expanded with 7,344 patients enrolled in the service across 164 pharmacies in New Zealand. The clinical benefit of CPAMS has been shown to be superior, but patient satisfaction with the service has not been fully explored. Objective To develop a questionnaire to assess patient satisfaction with CPAMS and evaluate its psychometric properties. Additionally, to determine the level of patient satisfaction with CPAMS and identify determinants of satisfaction with CPAMS. Settings 1071 patients enrolled in CPAMS across New Zealand invited to take part in the study. Main outcome measure Satisfaction with CPAMS service. Methods Adult patients taking warfarin and currently enrolled in CPAMS were recruited through the national international normalised ratio online system and invited to complete a 36-item survey assessing satisfaction with CPAMS. To identify the most important dimensions of patient satisfaction, exploratory factor analysis was used. Multivariate linear regression models were used to examine the effect of independent variables on patient satisfaction. Results A total of 305 patients completed the survey. The mean overall satisfaction score was 94.5% ± 13.1 out of maximum possible points. Five dimensions of patient satisfaction were identified by factor analysis: patient-centred communication, confidence in pharmacist competence, patient-pharmacist relationship, confidence in CPAMS, and pharmacy environment. Being older and more frequent visits to a pharmacy were positively associated with patient satisfaction. Living more than 1 km away from a pharmacy, and 'poor' self-perceived health status were negative predictors of patient satisfaction. Being Māori or of other ethnic minority was also associated with lower satisfaction scores, exploratory analysis suggests patient-pharmacist relationship is an important driver of these differences. Conclusions The high level of patient satisfaction further supports the effectiveness of CPAMS as a delivery model. Patient satisfaction is affected by age, frequency of pharmacy visits, ethnicity, travel distance to pharmacy, and perceived health status. Policy makers and practitioners should consider the characteristics of patients with low levels of satisfaction to improve and enhance CPAMS engagement.

Background In July 2012 a nationwide community pharmacy-based service was launched in New Zealand. The Long Term Conditions (LTC) service was introduced to help patients with chronic medical conditions, who have difficulties adhering to their medication regimens, improve their adherence. As part of the service pharmacists provide a variety of interventions including: patient education, medication reconciliation, medication synchronization, as well as preparing adherence support aids such as blister packs, sending reminders, and providing tailored dispensing frequencies. Seven years after its introduction scant data are available measuring the impact of the service on patients’ health outcomes. Objective To examine the impact of LTC on patients’ medication adherence and ambulatory sensitive hospitalizations. Methods This was a retrospective matched-cohort study using routinely collected health data. The population studied were individuals enrolled in LTC between July 2013 and December 2014 and a control group of propensity score matched individuals who never received the service. Outcomes were assessed during and after completion of the intervention. Sensitivity analysis was also undertaken whereby only those who completed the intervention and their controls were used in the analysis. Results The matched cohort consisted of 51,138 individuals in the intervention and 51,138 in the control. Enrolment in LTC was associated with greater medication adherence, with individuals in the intervention group having 2.99 (95% CI: 2.79–3.20) greater odds of being adherent 12 months after the start of the study period, compared to the control group. These patients also had 1.86 (95% CI: 1.78–1.96) greater odds of having an ambulatory sensitive hospitalization 12 months after the start of the study period, compared to the control group. Conclusion This study found that enrolment in LTC achieved one of the service's primary aims of improved medication adherence. However, enrolment in the service also appears to be associated with greater ambulatory sensitive hospitalizations, which is an unexpected finding. Further research is needed to better understand this.

BackgroundIn patients with asthma, over-reliance and overuse of short-acting beta2 agonist (SABA) is common and associated with increased morbidity and mortality. Patient beliefs are a key driver of inappropriate reliever use. A recently developed, brief, online intervention has been shown to identify and shift patient beliefs that drive inappropriate reliever use. Whether this intervention works to shift beliefs in individuals with asthma when delivered by community pharmacists is unknown. ObjectiveTo investigate the feasibility and acceptability of a brief community pharmacist-delivered behavior change intervention, and its effect on beliefs about SABA and SABA use in patients with asthma. MethodsThis is a non-randomised, before- and after- study of 120 individuals aged 18 years and older, prescribed a SABA for their asthma symptoms, presenting to one of two enrolled community pharmacies in Auckland, New Zealand. At enrolment, all participants will complete the SABA Reliance Questionnaire (SRQ), Asthma Control Test and 5-item Medication Adherence Report Scale via an online survey platform. Control participants will receive usual asthma care from their community pharmacy. Intervention participants will receive the intervention to shift any misplaced beliefs about SABA, comprising the SRQ to identify individual beliefs about SABA, then personalized information and discussion between pharmacist and patient based on the specific responses to the questionnaires. Those on SABA monotherapy and/or are at risk of SABA overuse will be referred to the general practitioner. Effect on beliefs about SABA and actual SABA use will be assessed by the SRQ and dispensing records, respectively. Feasibility will be evaluated through participant recruitment and retention rates, intervention fidelity, appropriateness and procedures of outcome measures pre- and post-intervention, and acceptability by obtaining feedback from participants (both patients and pharmacists) on the intervention.

Introduction Electronic adherence monitoring (EAM) is increasingly used to improve adherence. However, there is limited evidence on the effect of EAM in across chronic conditions and on patient acceptability. We aimed to assess the effect of EAM on adherence and clinical outcomes, across all ages and all chronic conditions, and examine acceptability in this systematic review and meta-analysis. Methods A systematic search of Ovid MEDLINE, EMBASE, Social Work Abstracts, PsycINFO, International Pharmaceutical Abstracts and CINAHL databases was performed from database inception to December 31, 2020. Randomised controlled trials (RCTs) that evaluated the effect of EAM on medication adherence as part of an adherence intervention in chronic conditions were included. Study characteristics, differences in adherence and clinical outcomes between intervention and control were extracted from each study. Estimates were pooled using random-effects meta-analysis, and presented as mean differences, standardised mean differences (SMD) or risk ratios depending on the data. Differences by study-level characteristics were estimated using subgroup meta-analysis to identify intervention characteristics associated with improved adherence. Effects on adherence and clinical outcomes which could not be meta-analysed, and patient acceptability, were synthesised narratively. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed, and Risk of bias (RoB) assessed using the Cochrane Collaboration’s RoB tool for RCTs. The review is registered with PROSPERO CRD42017084231. Findings Our search identified 365 studies, of which 47 studies involving 6194 patients were included. Data from 27 studies (n = 2584) were extracted for the adherence outcome. The intervention group (n = 1267) had significantly better adherence compared to control (n = 1317), (SMD = 0.93, CI:0.69 to 1.17, p2 = 86%). There was a significant difference in effect according to intervention complexity (p = 0.01); EAM only improved adherence when used with a reminder and/or health provider support. Clinical outcomes were measured in 38/47 (81%) of studies; of these data from 14 studies were included in a meta-analysis of clinical outcomes for HIV, hypertension and asthma. In total, 13/47 (28%) studies assessed acceptability; patient perceptions were mixed. Interpretation Patients receiving an EAM intervention had significantly better adherence than those who did not, but improved adherence did not consistently translate into clinical benefits. Acceptability data were mixed. Further research measuring effects on clinical outcomes and patient acceptability are needed.

BackgroundClinical guidelines recommend specific targets for low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) for primary prevention of cardiovascular disease (CVD). Furthermore, individual variability in lipid response to statin therapy requires assessment of the association in diverse populations.AimTo assess whether lower concentrations of LDL-C and non-HDL-C are associated with a reduced risk of major adverse cardiovascular events (MACE) in primary prevention of CVD.Design & settingAn international, new-user, cohort study will be undertaken. It will use data from three electronic health record databases from three global regions: Clinical Practice Research Datalink, UK; PREDICT-CVD, New Zealand (NZ); and the Clinical Data and Analysis Reporting System, Hong Kong (HK).MethodNew statin users without a history of atherosclerotic CVD, heart failure, or chronic kidney disease, with baseline and follow-up lipid levels will be eligible for inclusion. Patients will be classified according to LDL-C (ConclusionResults will inform clinicians about the benefits of achieving guideline recommended concentrations of LDL-C for primary prevention of CVD.

Guidelines recommend using antipsychotic monotherapy at the lowest effective dose, however high-dose and antipsychotic polypharmacy prescribing (APP) remain commonplace. The aim of this study was to determine the prevalence and patterns of high-dose antipsychotic prescribing and APP among mental health service users in New Zealand (NZ).A retrospective audit of service users discharged from inpatient (n=657), or registered with community (n=1560), mental health services at Auckland District Health Board was undertaken. Case notes were reviewed and data on demographics, antipsychotic routes and doses were collected. Outcomes measures included: frequency of total high-dose prescribing, high-dose monotherapy, APP, high-dose APP, and factors associated with these prescribing practices. Logistic regression models were used to examine the relationships between explanatory and outcome variables.Of the service users prescribed an antipsychotic (n = 2217), 14% were prescribed a high-dose antipsychotic. The frequency of high-dose monotherapy, APP, and high-dose APP was 3%, 26% and 11%, respectively. Being male, Māori, on compulsory treatment, having a schizophrenia diagnosis, or being prescribed polypharmacy were associated with high-dose antipsychotics. Olanzapine was most frequently prescribed in both high dosing (55%) and APP (40%).There is a high prevalence of high-dose prescribing and APP in this NZ setting.

Pharmacy practice research is often concerned with opinions, perspectives, values, or a variety of other subjective domains, whether that be in regard to the experiences of patients, views of stakeholders about innovative pharmacy services, or culture in pharmacy practice. This article offers a brief introduction to Q methodology, which is a philosophical, conceptual, and technical framework well-suited to shed light on such subjective views. Q methodology combines qualitative and quantitative processes to uncover distinct viewpoints present about any given topic. While other textual analyses focus on identifying the constituent themes about a topic, Q methodology instead detects and interprets holistic and shared perspectives. The introduction covers key theoretical principles, as well as the logistics and procedures involved in completing a Q-methodological study. Example data from a study investigating views on pharmacist integration into general practice in New Zealand are presented to highlight the potential of Q methodology for pharmacy practice research.

Background Optimal anticoagulation management is key for improving outcomes. The Community Pharmacy Anticoagulation Management Service (CPAMS) has beneficial effects on anticoagulant management. However, limited research exists on pharmacists’ views of CPAMS provision, particularly the perspectives of pharmacists who do not provide CPAMS. Objectives To explore the experience and attitudes of pharmacists who do and do not provide CPAMS, and to identify factors that may influence further uptake of CPAMS. Setting CPAMS providing and non-providing pharmacies throughout New Zealand. Methods A mixed-methods study design was employed. Separate online surveys were conducted with CPAMS providers (N = 35) and non-providers (N = 73) to explore their views on the service. Twelve interviews were conducted with purposively selected participants, equally distributed between CPAMS providers and non-providers, to gain further insight into the issues surrounding CPAMS provision. Quantitative data were analysed using student’s t-test and Mann Whitney U-test, and thematic analysis was used for qualitative data. Main outcome measure Experiences of and attitudes towards CPAMS. Results Our survey findings demonstrated that community pharmacists have high self-efficacy and motivation to providing CPAMS, and CPAMS had increased job satisfaction amongst providers. The overwhelming majority of CPAMS providers’ survey participants believed that CPAMS improves the pharmacist–patient relationship, allowing them to assist patients with other aspects of their healthcare. Most non-provider survey participants also believed that their patients would benefit from CPAMS. The two most frequently reported barriers by non-providers survey participants were remuneration and staffing of pharmacists. The interview findings fell within five overarching themes: self-efficacy, CPAMS benefits to patients, barriers to providing CPAMS, the impact of CPAMS on pharmacist–patient and pharmacist–general practitioner relationships. Overall, the current funding model, the capping on the number of enrolled patients, and staffing were the main factors perceived by interview participants preventing the further uptake and implementation of CPAMS. CPAMS non-providers are willing to provide CPAMS; the main factor preventing this is availability of contracts. Conclusions Overall, pharmacists have favourable experiences of and attitudes towards CPAMS and strongly supported its wider implementation. Promoting the benefits and addressing the barriers highlighted in this study may lead to wider implementation of CPAMS.

Suneela Mehta,1 Rod Jackson,1 Sue Wells,1 Jeff Harrison,2 Daniel J Exeter,1 Andrew J Kerr1,3 1Section of Epidemiology and Biostatistics, 2School of Pharmacy, University of Auckland, 3Cardiology Services, Middlemore Hospital, Auckland, New Zealand Background: Despite widespread use of cardiovascular disease (CVD) preventive medications in cohorts used to develop CVD risk prediction models, only some incorporate baseline CVD pharmacotherapy and none account for treatment changes during study follow-up. Therefore, current risk prediction scores may underestimate the true CVD event risk. We examined changes in CVD pharmacotherapy over 5 years in preparation for developing new 5-year risk prediction models.Methods: Anonymized individual-level linkage of eight national administrative health datasets enabled identification of all New Zealanders aged 30–74 years, without prior hospitalization for CVD or heart failure, who utilized publicly funded health services during 2006. We determined proportions of participants dispensed blood pressure lowering, lipid lowering, and antiplatelet/anticoagulant pharmacotherapy at baseline in 2006, and the proportion of person years of follow-up (2007–2011) where dispensing occurred.Results: The study population comprised of 1,766,584 individuals, representing ~85% of all New Zealanders aged 30–74 years without prior CVD or heart failure in 2006, with mean follow-up of 4.9 years (standard deviation 0.6 years; 8,589,931 total person years). CVD medications were dispensed to 21% of people at baseline, with most single or combination pharmacotherapies continuing for ≥80% of follow-up. Complete discontinuation of baseline treatment accounted for 2% of follow-up time while CVD pharmacotherapy that commenced after baseline accounted for 7% of total follow-up time. Conclusion: In a national primary prevention cohort of 30–74 year olds, one in five received baseline CVD primary preventive pharmacotherapy and medication changes over the subsequent 5 years were modest. Baseline medication use is an important consideration when estimating CVD risk from modern cohorts. It is currently unclear how to incorporate available methods to account for treatment changes during follow-up into risk prediction scores, but this study demonstrates that baseline therapy captures most of the effect of treatment in 5-year risk models. However, the impact of treatment changes on the more common 10-year risk models requires further investigation. Keywords: cardiovascular diseases, primary prevention, drug therapy, routine data, record linkage&nbsp

Objective Guidelines recommend using antipsychotic monotherapy at the lowest effective dose, however high-dose and antipsychotic polypharmacy prescribing (APP) remain commonplace. The aim of this study was to determine the prevalence and patterns of high-dose antipsychotic prescribing and APP among mental health service users in New Zealand (NZ). Methods A retrospective audit of service users discharged from inpatient (n=657), or registered with community (n=1560), mental health services at Auckland District Health Board was undertaken. Case notes were reviewed and data on demographics, antipsychotic routes and doses were collected. Outcomes measures included: frequency of total high-dose prescribing, high-dose monotherapy, APP, high-dose APP, and factors associated with these prescribing practices. Logistic regression models were used to examine the relationships between explanatory and outcome variables. Results Of the service users prescribed an antipsychotic (n = 2217), 14% were prescribed a high-dose antipsychotic. The frequency of high-dose monotherapy, APP, and high-dose APP was 3%, 26% and 11%, respectively. Being male, Māori, on compulsory treatment, having a schizophrenia diagnosis, or being prescribed polypharmacy were associated with high-dose antipsychotics. Olanzapine was most frequently prescribed in both high dosing (55%) and APP (40%). Conclusions There is a high prevalence of high-dose prescribing and APP in this NZ setting.

An efficient and cost-effective quantification procedure for lidocaine by HPLC has been developed to estimate lidocaine from an EVA matrix, plasma, peritoneal fluid and intra-articular fluid (IAF). This method guarantees the resolution of lidocaine from the degradation products obtained from alkaline and oxidative stress. Chromatographic separation of lidocaine was achieved with a retention time of 7 min using a C18 column with a mobile phase comprising acetonitrile and potassium dihydrogen phosphate buffer (pH 5.5; 0.02 M) in the ratio of 26:74 at a flow rate of 1 mL min-1 with detection at 230 nm. Instability of lidocaine was observed to an oxidizing (0.02% H2O2) and alkaline environments (0.1 M NaOH). The calibration curve was found to be linear within the concentration range of 0.40-50.0 μg/mL. Intra-day and inter-day accuracy ranged between 95.9% and 99.1%, with precision (% RSD) below 6.70%. The limit of quantification and limit of detection were 0.40 μg/mL and 0.025 μg/mL, respectively. The simple extraction method described enabled the quantification of lidocaine from an EVA matrix using dichloromethane as a solvent. The assay and content uniformity of lidocaine within an EVA matrix were 103 ± 3.60% and 100 ± 2.60%, respectively. The ability of this method to quantify lidocaine release from EVA films was also demonstrated. Extraction of lidocaine from plasma, peritoneal fluid and IAF followed by HPLC analysis confirmed the utility of this method for ex vivo and in vivo studies where the calibration plot was found to be linear from 1.60 to 50.0 μg/mL.

ABSTRACT IntroductionPharmacist integration into general practice is gaining momentum internationally, with benefits noted in reducing medication errors, improving chronic disease management and alleviating general practitioner workforce shortages. Little is known about how general practice pharmacists are working in New Zealand. AimThis study characterised the current landscape of pharmacist integration into general practice in New Zealand. MethodsAn online questionnaire was developed, piloted and distributed to all pharmacists in New Zealand. ResultsThirty-six responses were analysed. Respondents were more likely to be female, have been pharmacists for at least 10 years and all but one held formal postgraduate clinical pharmacy qualifications. Seven pharmacists were working as pharmacist prescribers. Primary health organisations (PHOs) were the most common employer, with funding primarily derived from either PHOs or District Health Boards. Pharmacist integration into general practice appears to have progressed further in particular regions of New Zealand, with most respondents located in the North Island. Tasks performed by respondents included medication reviews, managing long-term conditions and medicines reconciliation. Increased job satisfaction compared with previous roles was reported by most respondents. Funding and a general lack of awareness about pharmacists’ professional scope were seen as barriers to further expansion of the role. DiscussionThis study describes the characteristics of pharmacists currently working in general practices in New Zealand and provides insights into key requirements for the role. Understanding the way practice pharmacists are currently employed and funded can inform general practices considering employing pharmacists.

Analysis of dispensings of prescription medicines in New Zealand in 2006/07 reported large inequities between Māori and non-Māori. This present study has now updated the earlier work by describing variations in disease burden-adjusted medicines access by ethnicity in 2012/13, and changes over time.The update has linked prescription medicine data with burden of disease estimates by ethnicity for 2012/13 and comparing with 2006/07. This has re-examined the shortfall in prescriptions for Māori vs non-Māori adjusting for age, population and burden of disease (ie, health loss, in disability-adjusted life years (DALYs)).After adjusting for age, population and burden of disease, large inequalities still existed for Māori compared with non-Māori, with generally no improvement over the six years. In 2012/13, Māori had 41% lower dispensings overall than non-Māori; this was nominally worse compared with the 37% relative gap in 2006/07, but the trend was not statistically significant. Many complexities and limitations hamper valid interpretation, but large inequities in access and persistence, across many therapeutic groups, remain. The full University of Auckland report details these inequities.Large inequities in medicines access for Māori continue. Inequities in access are unacceptable, their causes likely complex and entrenched; we believe they need deeper understanding of systems and barriers, pragmatic ways to monitor outcomes, and an all-of-sector approach and beyond. PHARMAC has committed to strategic action to eliminate inequities in access to medicines by 2025, recognising it needs partners to drive the necessary change. Kei a tātou tonu katoa te wero kia mahikaha, kia mahi tino mōhio, me te mahitahi (The challenge continues for us to work harder, work smarter, and work together); everyone in the health sector has a role.

Aims To evaluate the effect of participation in a simulation exercise, on Bachelor of Pharmacy (B.Pharm.) undergraduates׳ attitudes and beliefs toward those living in poverty. To explore the acceptability of the simulation to students and their perception of how it related to their future practice. Method Second-year B.Pharm. undergraduates participated in the Community Action Poverty Simulation (CAPS), designed to allow participants to experience aspects of what it is like to live in poverty. Students completed the Short Form of the Attitude Toward Poverty Scale (ATP-SF) anonymously one week prior- and post-participation to examine the effect of the simulation. A paired comparison of the ATP-SF score and its subscales was undertaken. Free-text questions examined students׳ opinions of the simulation, what they learned from participating and how it could be improved. Results In total, 76 pairs of complete questionnaires were analyzed. A trend toward improvement in attitudes toward those living in poverty was seen (change in ATP-SF total score, P = 0.07). This appeared to be associated with changes in the structural perspective subscale (implying more attribution of poverty to societal structures) post-simulation ( P Conclusion Participation in the simulation had some positive effects on student attitudes, empathy, and beliefs related to those of low socioeconomic status.

Objective To explore pharmacist’s views on the shift in ethos, funding and service delivery model introduced through the New Zealand’s Community Pharmacy Services Agreement (CPSA). Methods A purposive sampling approach drew pharmacists from a matrix who were then contacted via telephone and invited to be interviewed. Semistructured interviews were conducted face-to-face with community pharmacists (n = 17) across urban and rural New Zealand. An interview schedule exploring 12 subject areas was used to facilitate discussion and determine pharmacist’s views and understanding of the CPSA. The interviews were recorded and transcribed verbatim and a general inductive approach was taken to identifying emergent themes. Key findings Key themes that emerged were: pharmacists supported the philosophy behind the CPSA, pharmacists understanding of the CPSA, implementing CPSA-related services, perceived impact on patient outcomes and future sustainability of the CPSA. Overall, pharmacists supported the alignment of funding with patient-centred services, but pharmacy owners reported difficulty understanding the funding model, resulting in uncertainty over income. Several pharmacists believed the quality of care offered had not changed, while others found their attitudes towards care had evolved. All pharmacists communicated an increase in their workload and many perceived the sustainability of the CPSA to be linked to its ability to financially sustain community pharmacies. Conclusions The majority of pharmacists believed in the philosophy of the CPSA, but expressed concerns over funding, workload and benefits for patients. Future research is required to determine generalisability of these findings, investigate patient perspectives and assess the effect of the CPSA on patient outcomes.

A new methodology is introduced that leverages data harvested from social media for tasking the collection of remote-sensing imagery during disasters or emergencies. The images are then fused with multiple sources of contributed data for the damage assessment of transportation infrastructure. The capability is valuable in situations where environmental hazards such as hurricanes or severe weather affect very large areas. During these types of disasters it is paramount to ‘cue’ the collection of remote-sensing images to assess the impact of fast-moving and potentially life-threatening events. The methodology consists of two steps. First, real-time data from Twitter are monitored to prioritize the collection of remote-sensing images for evolving disasters. Commercial satellites are then tasked to collect high-resolution images of these areas. Second, a damage assessment of transportation infrastructure is carried out by fusing the tasked images with contributed data harvested from social media such as Flickr and Twitter, and any additional available data. To demonstrate its feasibility, the proposed methodology is applied and tested on the 2013 Colorado floods with a special emphasis in Boulder County and the cities of Boulder and Longmont.

Background Recently, New Zealand has taken a system wide approach providing the biggest reform to New Zealand community pharmacy for 70 years with the aim of providing more clinically orientated patient centred services through a new funding model. The aim of this study was to understand the types of services offered in New Zealand community pharmacies since introduction of the new funding model, what the barriers are to providing these services. Method A survey of all community pharmacies were undertaken between August, 2014 and February, 2015. Basic descriptive statistics were completed and group comparisons were made using the chi squared test with significance set at p