Poster Session - Wiley Online Library

40

International Journal of Pharmacy Practice 2011; Supplement 1

allowed patients easier access to medicines (n = 44, 88%), helped promote self-care (n = 42, 84%) and allow patients to receive treatment more quickly than through GP services (n = 42, 84%). For sections 2 to 4, Table 1 summarises the findings. IJPP 2011, Supplement 1: 40–51 © 2011 The Authors IJPP © 2011 Royal Pharmaceutical Society of Great Britain

Conclusions

Poster Session Abstract 1 Nurse independent prescribers (NIPs) views on recent and proposed medicine switches from prescription only medicines (POM) to pharmacy (P) medicines P. Rutter and G. Tsang Pharmacy Department, University of Wolverhampton, United Kingdom

Background As the deregulation of medicines has increased the views of medical practitioners, and to lesser extent pharmacists, has been sought.[1–4] However, there are no studies that investigate the attitudes of nurses. It is especially important to investigate those nurses with prescribing rights as their understanding and perceptions toward medicines will affect their decision making. The principal research objective of this study was to ascertain how receptive NIPs were to POM to P medicine deregulation. Ethics approval was granted by The University of Wolverhampton Ethics Committee, and 12 PCTs sanctioned the work.

Method A self-administered questionnaire, primarily consisting of 5-point Likert scales (strongly agree to strongly disagree) was distributed to all known NIPs currently working in a prescribing role (n = 128) within 12 PCTs across East and West Midlands Strategic Health Authorities. The questionnaire consisted of 4 sections; the first asked for general opinion on deregulation and sections two to four considered their attitude toward recent deregulations, those currently under consideration, and possible future candidates. Data was analysed on a pre-coded template using Statistical Package for the Social Sciences (SPSS) software.

Results Fifty replies were received, yielding a response rate of 39%. Respondents agreed that deregulation of medicines

NIPs were positive towards the majority of current and future deregulated medicines. Only for those medicines used to treat chronic conditions, namely simvastatin, tamsulson and atenolol were strong negative opinion expressed. Interestingly, they broadly supported antibiotic deregulation and contradicts that expressed by doctors.

References 1. Bayliss E, Rutter P. General Practitioners’ views on recent and proposed medicine switches from POM to P. Pharm J 2004; 273: 819–821. 2. Bond C. POM to P – Implications for practice pharmacists. Prim Care Pharm 2001; 2: 5–7. 3. Aneblom G, Lundborg CS, Carlsten KE, Tydén T. Emergency contraceptive pills over the counter: practices and attitudes of pharmacy and nurse-midwife providers. Patient Educ and Couns 2003; 55: 129–135. 4. Blenkinsopp J, Gathoga L, O’Connell K, Mukhtar M, Rehman I, Shan N, Tariq M. OTC simvastatin supply – what changes in practice and education do pharmacists want? Pharm J 2004; 271: 191–193.

Table 1 Respondents preference to current, considered and potential POM to P deregulations Post 2000 deregulations

Strongly Agree Strongly Disagree & Agree (%, n) & Disagree (%, n)

Chloramphenicol (n = 50) Omeprazole (n = 50) Sumatriptan (n = 50) Naproxen (n = 50) Diclofenac (n = 50) Azithromycin (n = 50) Orlistat (n = 48) Simvastatin (n = 49)

88% 70% 70% 68% 66% 64% 56% 29%

Under consideration Trimethoprim (n = 49) Nitrofurantoin (n = 49) *Tranexamic acid (n = 49) *Tamsulosin (n = 49)

73% (36) 67% (33) 63% (31) 20% (10)

24% (12) 26% (13) 20% (10) 45% (22)

Potential Clindamycin (n = 50) Salbutamol for asthma (n = 50) Amoxicillin (n = 50) Atenolol (n = 50)

82% (41) 50% (25) 40% (20) 22% (11)

6% (3) 40% (20) 46% (23) 62% (31)

(44) (35) (35) (34) (33) (32) (27) (14)

8% 12% 16% 12% 22% 18% 33% 45%

(4) (6) (8) (6) (11) (9) (16) (22)

*Now deregulated but at the time of research were still under consideration.

© 2011 The Authors. IJPP © 2011 Royal Pharmaceutical Society 2011 International Journal of Pharmacy Practice, 19 (Suppl. 1), pp. 40–51

Poster Session

Abstract 12 Perception towards disease state management among Pakistani hypertensive patients: findings from a focus group discussion F. Saleema, M.A. Hassalia, A.A. Shafiea and S. Bashirb a

Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, Malaysia and bFaculty of Pharmacy, University of Sargodha, Punjab, Pakistan

Background Management of chronic diseases is a challenge for both patients and healthcare providers. The World Health Organization advocates the addition of self-management programs for chronic conditions, to enhance patient care[1]. Self-management relates to the tasks that an individual must undertake to live well with one or more chronic conditions. These tasks include gaining confidence to deal with medical management, role management, and emotional management[2]. Within this context, self management practices for chronic diseases is an under researched area in many developing countries including Pakistan. Understanding of self management practices by patients in chronic diseases management such as hypertension will help healthcare providers to be more aware about their patients’ needs for better treatment outcomes. There fore, we aimed to explore the perceptions toward disease state management among Pakistani hypertensive patients. Permission for conducting the interviews was obtained from the medical superintendent of the hospital. Written consent was also obtained from each of the respondents.

Conclusion Patients suffering from chronic diseases such as hypertension do tend to make personal decisions about managing their illnesses. This may include use of medications, prophylactic measures and self management. In our study, patients seemed to have more influence from peers, family members and people with past exposure, thus try to manage their condition on advises from their sides. In addition, their ideology towards medication use and hypertension being an uncontrollable disease urges them to focus more on self management practices. There is no doubt in the success of self management practices, but for proper implementation of self management in therapeutic plans, amalgamation of behavioral strategies to improve self-management requires a multidisciplinary team effort (physicians, pharmacists, nurses). The approach to patients should be individualized, taking into consideration their culture, economic situation, knowledge and beliefs regarding the disease and treatment, response to medication and changes in status over time.

References 1. Epping-Jordan JE et al. Improving the quality of health care for chronic conditions. Qual Saf Health Care 2004; 13: 299–305. 2. Adams K et al. Report of a summit. The 1st annual crossing the quality chasm summit – A focus on communities. Washington, DC: National Academies Press, 2004.

Abstract 14 Competency based assessments from the students’ perspective – are students confident at engaging with this new assessment method?

Method

A. Conway and S. Glaspole

A focus group discussion was conducted with 19 hypertensive patients in order to get the insight of hypertension patients’ self management practices. The study was conducted in Sandeman Provincial Hospital at the city of Quetta, Pakistan.

The Clinical Pharmacy Unit, School of Pharmacy & Biomolecular Sciences, University of Brighton, Brighton, United Kingdom

Results Analysis of the focus group discussion yielded four major themes. 1) Effect of hypertension on participants’ physical, mental and social states, 2) involvement in self management, 3) factors contributing to self management and 4) perception of participants towards antihypertensive agents. Majority of the patients admitted that they were involved in self management of hypertension but these management strategies came from social, peer or family and very little information come from the health care professionals. Exercise of self management was strongly connected to the philosophy of the patients towards drug nature and comparative advantages and disadvantages. Patients also expressed uncertainties against continuous drug usage for the management of chronic illnesses.

41

Background The University of Brighton MPharm degree contains elective modules in the final year. Previous work has sought to map over registration level performance standards[1] (competencies) from the UK Pre-registration Pharmacist Trainee training program[2] to two of these modules, with the aim of smoothing the transition between study at the academic institution and workplace study in the pre-registration pharmacist training year. The two clinical elective modules concerned are assessed using elements of this pre-registration competency based training program, with students collecting evidence via assignment subsequently presented in a portfolio to show their competence This works aims to assess the confidence of students in engaging with this comparatively new assessment modality. BERA ethical guidelines were adhered to during this study.


42


Method A competence confidence questionnaire (CCQ) was developed which contained 10 items answered on a four point Likert scale. The items were developed in an iterative fashion after a period of pilot testing. Items in the CCQ pertained to the student’s perception of their ability to document their reflective practice and highlight further learning needs. Students in both clinical elective modules were asked to complete the CCQ when the module had ended.

Results 28 students completed the CCQ, accounting for 100% of students studying the two clinical elective modules. 12 (43%) students strongly agreed and 16 (57%) agreed that after studying the competency based training program they were able to demonstrate their knowledge, skills and behaviors. Similarly 16 (57%) strongly agreed and 12 (43%) agreed that they were able to document their activities. 22 (79%) of students strongly agreed and 6 (21%) agreed that the program enabled them to identify their ongoing learning needs. 24 (86%) strongly agreed and 4 (14%) agreed that they applied their learning to practice.

Discussion or conclusion Competency based training programs are commonly used in pre registration and registration level education, but are rare at the undergraduate academic level. Our work shows that early introduction of this style of assessment, in the latter part of undergraduate instruction can help support their confidence in engaging with a competency based training program. Further work to establish whether this approach eases this transition to the workplace, together with further validation of the CCQ in a larger sample would be useful.

References 1. Royal Pharmaceutical Society of Great Britain. Preregistration Trainee Workbook 2010/11. London: RPSGB, 2010. 2. Glaspole S, Conway, A. Bridging the Divide Between Undergraduate and Pre-registration Education. Proceedings of the 5th Pharmacy Education Symposium, Prato, Italy 2009.

Abstract 22 Do the public still trust the community pharmacist? J.G. Cowley and W. Gidman SIPBS, University of Strathclyde, Glasgow, United Kingdom

Introduction International surveys suggest that pharmacists are one of the most highly trusted professions[1]. Community pharmacy (CP) has evolved to increase patient access in response to GP

shortages. New pharmacy contracts frameworks (NPCF) formalised these changes[2,3]. Pharmacists have extended their role by becoming involved in providing medicine optimisation, health promotion and screening services. Some additional services are offered at a charge. Additionally, the Government has sought to decrease prescription medicine costs by incentivising generic prescribing[4]. This paper considers the views of the general public on the changing role of the community pharmacist and whether pharmacy is still a trusted profession. Ethical approval was granted by the University of Strathclyde.

Methods Twenty-six members of the public took part in five focus groups in April 2010. Respondents were purposively sampled with respect to age, gender and area locality. Focus groups were comprised of two senior aged groups, age range 58–94, two groups of mothers with young children age range 18–40 and a male only group age range 21–63. A semi-structured topic guide was developed and piloted. The aim of the guide was to establish the general publics’ perceptions of the role of the CP. Each focus group was digitally recorded and transcribed verbatim. Transcripts were independently coded by three researchers using a thematic analysis. Emerging themes were identified with the research team meeting to discuss themes.

Results One of the main themes emerging from the data was the importance of trusting the healthcare provider. Respondents, predominately those from the older adult categories, commented that it is important to have ‘lot of trust in the pharmacist’ when seeking advice on medication and minor ailments. However, older adults particularly, perceive that there are hierarchies in healthcare. The GP was considered to be better qualified than the CP and the point of reference for more serious health concerns. Some felt that GP’s could provide a more complete service because they had access to medical records. Participants questioned whether pharmacist’s link with commercial enterprise made them untrustworthy. Furthermore, respondents expressed concern about generic medication, which they perceive to be the ‘cheaper’ option. In some cases they viewed this as an example of the pharmacist maximising profits. In contrast the younger participants, particularly mothers with young children were more likely to perceive the pharmacist as trustworthy. Furthermore, they prefer to seek advice on minor health concerns from their pharmacist commenting that pharmacists were more familiar with over the counter treatments.

Discussion Our data highlights the importance of trust and rapport within a healthcare context. There appears to be generational differences in public perceptions of the trustworthiness of the community pharmacist. Older adults defer to the GP and might be resistant to services offered by the pharmacist, unless they


Poster Session

43

are endorsed by the GP. To ensure efficient service provision it would be beneficial for policymakers, GPs and pharmacists to develop and publicise integrated cohesive service packages which minimise service duplication and avoid incomplete service delivery.

was employed to allow the first author to immerse herself in a foreign culture, hence gaining a deeper understanding of opinions expressed and/or attitudes displayed by the local informants[2]. This study was approved by the ethics authority in Malawi.

References

Results

1. Reader’s Digest Europe Health. (2008) Page 3/5. http://www.rdeuropehealth.com/health/information.shtml (accessed 21 September 2010). 2. Blenkinsopp A, Bond C, Celino G, Inch J, Gray N. National evaluation of the new community pharmacy contract: executive summary. London: Pharmacy practice research trust, 2007. http://www.pprt.org.uk/Documents/Publications/National_ evaluation_of_the_new_pharmacy_contract.pdf (accessed 28 March 2010). 3. Scottish Executive. Delivering for Health. [online] Edinburgh: Scottish Executive, 2005. http://www.scotland.gov.uk/ Publications/2005/11/02102635/26356 (accessed 28 March 2010). 4. Williamson T, Howarth M, Greene L, Arvin A. 2010. Older people’s experiences of changed appearances of medications due to generic prescribing: a qualitative study. Final report, University of Salford.

Although quantitative evidence could not be established to prove drug pilferage, most informants acknowledged the presence of this problem. Drugs were believed to have been stolen by health workers at different points of drug distribution and then sold to street vendors or private clinics. This resulted in severe shortage of essential medicines. Patients were instructed to buy from private pharmacies the out-ofstock items, which were not always affordable. Prescribers were forced to prescribe from a very limited range of available drugs. In some cases, patients might be left untreated. This was believed to result in treatment failure or death in extreme cases. Among perceived causes contributing to drug pilferage were low pay of health workers who handled drugs, incomplete stock records, inadequate supervision, uninformed general public, penalty insufficient to deter offenders and policy to allow civil servants to open private clinics. Most informants thought employing more pharmacists at public health institutions should stop drug pilferage. Most informants felt it was pharmacists’ responsibility to create a theft-proof system. It was also generally assumed that pharmacists were supposed to have a ‘higher level of ethics’ and hence would not commit such unethical crime. There were only two pharmacists serving at public health facilities in the country, whilst most work in the private sector. It was hoped that drug pilferage would be solved in the future when the school of pharmacy produces sufficient pharmacists.

Abstract 23 Drug pilferage: is this just about ethics? Exploring a sensitive issue using an ethnographic approach Z. Lima, C. Anderson

a

and S. McGrathb

a

Division of Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, United Kingdom and bDearing Building, Jubilee Campus, University of Nottingham, Nottingham, United Kingdom

Background Drug pilferage is one of the most serious problems in the pharmaceutical service provision in Malawi[1]. However, implementation of strategies to combat drug pilferage has been hindered by critical shortage of pharmacy workforce. In 2007, there were only 46 pharmacists in the country which has a population of 15 million. To increase the number of locally trained pharmacists, the first school of pharmacy in the University of Malawi was established in 2006. Eight students graduated in 2009. The aim of this paper is to explore the impact of drug pilferage on patients and what roles pharmacists could possibly play to tackle this problem.

Method In-depth, face-to-face interviews are deemed suitable to discuss sensitive issues such as drug pilferage. Interviews were conducted in Malawi with 10 pharmacists, 2 pharmacy technicians, 2 nurses and 1 doctor. An ethnographic approach

Conclusion Drug pilferage is not merely an ethical issue, but also a governance issue. It happened because there were temptations and opportunities to commit such crime. There seemed to be a lack of urgency and collective action amongst stakeholders in tackling this issue. The reliance on future pharmacy graduates might not be realistic, judging from the low number of pharmacists graduating each year; and the possible movement of the new pharmacists to the private sector or out of Malawi altogether[3]. Concerted effort and political will to fight drug pilferage is urgently needed.

References 1. Statement by the Honourable Aleke K. Banda, Ministry of Health and Population, presented to Parliament, 20th June 2000. Lilongwe. 2. Creswell, J. W. Qualitative inquiry and research design: Choosing among five approaches. Thousand Oaks, London, New Delhi: Sage Publications, 2007. 3. Hawthorne, N and Anderson C. The global pharmacy workforce: a systematic review of the literature. Human Resources for Health 2009; 7: 48.


44


Abstract 33 Enhanced prescription label design to improve patients’ understanding of their medication L. Sahma, H. Gallweyb, M. Brennanb, R. Behanb and S. Mc Carthyb a

Pharmaceutical Care Research Group, Room UG01, Cavanagh Pharmacy Building, School of Pharmacy, University College Cork, Cork, Ireland and bPharmaceutical Care Research Group, Cavanagh Pharmacy Building, School of Pharmacy, University College Cork, Cork, Ireland

Background Health literacy (HL) is defined as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions”[1]. This study aimed to; (i) assess the level of inadequate health literacy (HL) among a cohort of patients and (ii) determine the impact of enhanced prescription label design on patient understanding of their medication. Local Ethics committee approval was granted for this study.

Method The study was carried in the outpatient department of the Mercy University Hospital and in a Cork-based care centre for the elderly from 11 to 29 January 2010. All patients were approached and the nature of the study explained. Where verbal consent was obtained, patient demographics were collected eligibility determined. Exclusion criteria (i) aged less than 18 years, (ii) severely impaired vision, (iii) hearing disabilities, (iv) MMSE score less than 18, or (iv) if they did not speak English fluently. Part 1: Patients’ HL was screened using the Rapid Estimate of Adult Literacy in Medicine (REALM)[2]. Part 2: Patients were randomised into one of three groups, to receive either Regimen A, Regimen B or Regimen C prescription labels. Each regimen was composed of standard and enhanced labels so each patient received at least one standard, one patient-centred label (PCL) and one PCL+ Graphic label. The order in which patients received the labels varied between each Regimen, to prevent information carryover. Patients were asked two questions that assessed their interpretation of each instruction. Correct interpretation of the three prescription drug label instructions was evaluated by 1) subjects’ verbatim response to the RA asking “In your own words, how would you take this medicine?”, and 2) subjects’ demonstration of understanding by a second question: “How many pills would you take of this medicine in one day?” Responses to the first question were independently rated as either correct or incorrect by two clinical pharmacists. Patients had to respond correctly to both questions in order to be classified as having correctly interpreted a prescription instruction. Data were analysed using the SPSS Version 15. Chi-squared tests were used to determine any association between correct interpretation and label type. A p value < 0.05 was deemed statistically significant.

Results Part 1: of the 198 participants, 23.2% were found to possess inadequate literacy levels. Part 2 (n = 119): rates of correct interpretation of the prescription label instructions varied among regimens A, B and C (65%, 40% and 67% respectively). PCL labels were more likely to be interpreted correctly compared with standard and PCL+ graphic labels (65.5%, 57.14% and 50.4% respectively) although this finding was not statistically significant. There was no statistical significant association between patients’ literacy levels and their ability to understand prescription medication labels.

Conclusion Patients of all literacy levels had improved understanding of PCL prescription labels. Interestingly the PCL + Graphic label appeared to make information less clear, which may be due to the unfamiliarity of this presentation. Further research is needed to elucidate this further. Prescription label design can influence understanding of medication instructions and thus should be optimized.

References 1. Pecukonis E. Health literacy: A prescription to end confusion. Social Work in Health Care 2008; 46: 101–4. 2. Davis TC, Crouch MA, Long SW, Jackson RH, Bates P, George RB, et al. Rapid assessment of literacy levels of adult primary care patients. Family Medicine 1991; 23: 433–5.

Abstract 35 Undergraduate pharmacy students’ views on plagiarism and academic dishonesty C. Parsons and C.L. Shaw School of Pharmacy, Queen’s University Belfast, Belfast, United Kingdom

Introduction There have been limited studies into academic dishonesty in pharmacy students.[1–4] The aim of this questionnaire study was to investigate attitudes, behaviours and knowledge of academic dishonesty, plagiarism and cheating among undergraduate students in Levels 1 and 3 at a School of Pharmacy in the United Kingdom.

Methods Questionnaires were designed and, following approval from the School of Pharmacy Ethics Committee, distributed to Level 1 and Level 3 students before a scheduled lecture. Students were asked to complete the questionnaire in their own time and to return it to a box at the reception of the School to retain anonymity and to encourage respondents to provide true responses regarding plagiarism and academic dishonesty within the School of Pharmacy. Questions investigated students’ awareness of university policy with


Poster Session

regard to plagiarism, whether students had witnessed or taken part in a range of activities which constitute academic dishonesty, students’ attitudes towards which of a range of scenarios represent cheating, and students’ opinions on how plagiarism should be penalised within the School of Pharmacy. Data were entered into SPSS version 18.0 for analysis.

Abstract 43 What are the reasons for prescribed medicines waste? A cross-sectional survey of individuals returning prescription medicines to community pharmacies

Results

D.N. Johna, S. Leesa, S. Fecb and S.A. Coulmana

46 level 1 and 58 level 3 students completed questionnaires (response rates of 44.2% and 45.7% respectively). 87.5% of respondents were aware of the existence of a university policy regarding plagiarism, but only 34.1% were aware of its content. The most common activity witnessed and undertaken by respondents was “meeting up in a group to discuss answers to an assignment” (94.2% and 81.7% respectively) while the least common was “getting somebody else to write your assignment” (4.8% and 1.0% respectively). There was greatest agreement among students that “bringing hidden notes into an exam” constituted cheating (87.5% of respondents agreed or strongly agreed with this statement) and least agreement that “borrowing another student’s notes from a day you were absent for no reason” constituted cheating (14.2% agreed or strongly agreed). 4.2% of all respondents would report a colleague if they suspected they had cheated and 74.0% felt that those who participated in plagiarism are at an unfair advantage. 91.3% of respondents believed that there should be a penalty for plagiarism; of these, 77.9% agreed or strongly agreed that deducting marks is the most appropriate penalty when a student incorrectly references or invents a resource used in an assignment, while 90.5% agreed or strongly agreed that if a student copies from another student, they should be made to repeat the assignment.

Conclusions This study highlights the lack of knowledge among students as to the content of the university policy regarding plagiarism and confirms that academic dishonesty occurs in pharmacy students. It has implications for educating pharmacy students about plagiarism and academic dishonesty; interventions are required throughout the degree programme to enable students to develop views consistent with academic scholarship and professional behaviour. Further research is also required to ascertain why students engage in such behaviour.

References 1. Whitley HP, Starr J. Academic dishonesty among pharmacy students: does portable technology play a role? Curr Pharm Learning Teaching 2010; 2: 94–99. 2. Austin Z et al. Influences of attitudes toward curriculum on dishonest behaviour. Am J Pharm Educ 2006; 70: Article 50. 3. Ng HWW et al. Academic dishonesty among pharmacy students. Pharm Educ 2003; 3: 261–269. 4. Rabi SM et al. Characteristics, prevalence, attitudes, and perceptions of academic dishonesty among pharmacy students. Am J Pharm Educ 2006; 70: Article 73.

45

a Welsh School of Pharmacy, Cardiff University, Redwood, Cardiff, United Kingdom and bWelsh Assembly Government, Cathays Park, Cardiff, United Kingdom

Background Recent estimates of the cost of waste medicines to the NHS in England are as high as £8 million annually.[1] In addition to costs, unused medicines have potential safety and environmental implications.[1–4] Research is required to determine the current reasons some prescription medicines are not used and thus contribute to medicines waste. The aim of this pilot study was to explore why prescription medicines were returned by individuals to community pharmacies.

Method Ethics approval was obtained. Following a literature review, a questionnaire was developed to determine the reasons medicines were returned to the pharmacy. This data collection tool, consisting of mainly closed questions requiring tick-box responses, was assessed by key stakeholders for face and content validity. In Spring 2010, ten copies of the questionnaire (together with a Freepost envelope) were sent to all 177 community pharmacies with NHS contracts in two primary care organisations comprising rural, urban and sub-urban locations. Pharmacies were requested to supply questionnaires to the first 10 individuals who returned prescription medicines for disposal. Participants were informed that it was not possible to identify them or the pharmacy from their responses. In conjunction with this, all pharmacies were also provided with a covering letter and a form to indicate how many questionnaires they had distributed during the four week study period.

Results Forms were returned by 89 pharmacies, indicating distribution of 508 questionnaires (mean = 5.7/pharmacy, range 0–10). In total, 309 questionnaires were received (60.8%). Females accounted for 60.5% respondents. Ages ranged from 18–94 years (mean 64). Two hundred and forty-two out of the 303 respondents who answered the relevant question (79.8%) stated that they were returning medicines that had been prescribed for themselves or their partner. Other respondents were relatives, health professionals, friends or carers. Fortyfour had returned medication as a result of the death of an individual (14.2%). Other respondents were asked to ‘let us know the reason(s) for bringing in the medicines to the pharmacy on this occasion?’ (n = 263), with respondents able to


46


select more than one option. Reasons given were stopped/ changed by a doctor (149/263, 56.7%), clear out of excess prescribed medication (n = 61, 23.2%), patient stopped due to side-effects (53, 20.2%), medicines went out-of-date (n = 54, 20.5%), patent stopped as condition improved (n = 20, 7.6%), medicines were not requested (n = 14, 5.3%), the wrong medicine was prescribed/ dispensed (n = 6, 2.3%), patient stopped because they were unsure why it was prescribed (n = 4, 1.5%), stopped medication as it was inconvenient to take/use (n = 2, 0.8%) and twenty ticked ‘other’.

Conclusion Although there are accepted limitations of this study, including the short study period, limited geographical location and restriction of the study to persons returning medicines to community pharmacies, the results detail a diversity of reasons for medicines waste. Therefore, despite previous studies and initiatives,[1,2,4] medicines waste remains a challenging issue. Research is needed to identify the quantities and costs of specific unused prescribed medicinal products and the reasons for their waste in order to inform strategies to decrease the notable financial and environmental burden of medicines waste and the associated safety issues.

Acknowledgements The Welsh Assembly Government Pharmacy Practice Development Scheme for funding and Community Pharmacy Wales, staff at participating pharmacies and to those members of the public for completing and returning questionnaires.

References 1. White KW. UK interventions to control medicines wastage: a critical review. Int J Pharm Pract 2010; 18: 131–140. 2. Mackridge AJ, Marriot J. Returned Medicines: Waste or wasted opportunity? J Pub Health 2007; 29: 258–262. 3. Stackelberg PE et al. Persistence of pharmaceutical compounds and other organic wastewater contaminants in a conventional drinking-water-treatment plant. Sci Total Environ 2004; 329: 99–113. 4. Langley C. et al. An analysis of returned medicines in primary care. Pharm World Sci 2005; 27: 269–299.

Abstract 47 Integrating policy with the patient perspective: development of a decisionmaking framework J. Solomona, D.K. Raynorb, P. Knappb and K. Atkinc a

School of Pharmacy, De Montfort University, Leicester, United Kingdom, bSchool of Healthcare, Baines Wing, University of Leeds, Leeds, United Kingdom and cDepartment of Health Sciences, University of York, United Kingdom

prescribing consultations, which in turn can lead to medication non-adherence, disempowered patients and demoralised doctors[1]. Prescribing targets arise from an evidence-based approach. Most tools for increasing patient involvement explain evidence-based information in lay terms, rather than seeking to listen to the patient perspective within its psychosocial context[1]. The aims of this study were to explore the relationship between prescribing policy[2] and patient partnership[3] and to develop a framework to combine these two approaches with the aim of promoting concordance[3]. Research ethical approval was obtained for this study.

Method The study consisted of two phases: an initial qualitative phase in which in-depth interviews were conducted, recorded, transcribed. The participants (14 patients, 8 General Practitioners (GPs) and 2 health service policy-makers) were selected using maximum variation sampling. This was followed by a questionnaire survey of 286 patients (sampling consecutive patients on one day in each health centre) and 142 GPs (sampling all GPs in selected area). The decision-making framework was developed using the stages of framework analysis[4]. Initial thematic coding of the qualitative data on participant decision-making was followed by application of the framework to each participant’s transcript in the indexing stage. The stages of charting and mapping were used to draw together and interpret the results. Themes from the qualitative phase were tested further in the quantitative phase, with the results from the quantitative phase being used to refine the decision-making framework.

Results The framework identified three stages of decision-making necessary for achieving a concordant approach between patients, prescribers and policy: 1. Identification of patient, doctor and policy perspectives – efficacy, costs and communication expectations 2. Identification of power dynamics between perspectives – trust, autonomy, responsibility and identity 3. Evaluation of options and consequences – prescribing and health targets

Discussion The study produced a decision-making framework, which combined the perspectives of patients, family doctors and prescribing policy, in addition to eliciting data from both evidence-based and psycho-social sources. This demonstrates an original approach to clinical decision-making. Future work will develop this framework into a consultation tool, which will give health care professionals greater insight into the patient perspective, thus increasing patient involvement, empowerment and concordance.

References

Background Prescribing policy in the form of prescribing targets have been shown to obscure the relational and psycho-social aspects of

1. Solomon J. An Exploration of the Relationship between Prescribing Guidelines and Partnership in Medicine Taking. PhD Thesis, University of Leeds, 2009.


47

Poster Session 2. Eddy, D. Clinical Decision Making. Sudbury, Jones and Bartlett, 1996. 3. Pollock, K. Concordance in Medical Consultations. Abingdon, Radcliffe, 2005. 4. Ritchie, J and Spencer, L. Qualitative Data Analysis for Applied Policy Research, in Bryman, A. and Burgess, R. Analyzing Qualitative Data. London, Routledge, 1994.

Abstract 52 Comparison of screening tools for calculating risk of cardiovascular disease in an Irish setting D. Óg O’Donovana, S. Byrnea, M. Loughreyb, G. Browneb, I. Perryb and L. Sahma

Table 1 Percentage of study population at CVD risk levels using different screening tools 10-year CVD risk (%)

≤5

≤10