Enhancing self care using the evidence based supply of nonprescription medicines NPMs

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Enhancing self care using the evidence based
supply of nonprescription medicines (NPMs)
Watson MC. Department of General Practice and
Primary Care, University of Aberdeen, Westburn
Road, Aberdeen, AB25 2AY. Tel [phone]
email m.c.watson_at_abdn.ac.uk
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Reclassification

• gt 70 POMs reclassified since 1980s.
• EU directive likely to lead to more
  reclassifications.
• Self care major health strategy in the UK.
• Medicine counter assistants (MCAs) are involved
  in 7 out of 10 consultations for these medicines.

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Examples of reclassified medicines
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Source DoH, Self Care - A real choice
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Problems with nonprescription medicines (NPMs)

• Inappropriate supply (e.g. antifungals, Watson et
  al 2002)
• Inappropriate use (e.g. ibuprofen, Sinclair et al
  2000 histamine2-receptor antagonists, Shi et al
  2004 analgesics Porteous et al 2003)
• ADR-related hospital admissions (e.g. aspirin,
  Pirmohammed et al 2004)
• Abuse/misuse

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Educational strategies to promote evidence-based
community pharmacy practice a cluster randomized
controlled trial

• 1Watson MC, 1Bond CM, 2Walker AE, 3Grimshaw
  JM1Department of General Practice and Primary
  Care 2Health Services Research Unit 3Ottawa
  Health Research Institute, Canada.

Watson MC et al. Family Practice
200219(5)529-536.
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Factors predicting the guideline compliant
supply of nonprescription medicines in the
community pharmacy setting Watson MC, Bond CM,
Grimshaw JM, Johnston M. Quality and Safety in
Health Care20061553-57.
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Results

• Guideline-compliant outcome was associated with
  advice requests
• compared with product presentations (plt0.001),
  and increased
• as more information was exchanged (plt0.001)
• when specific questions were used,e.g.
  description of symptoms (OR 3.71, 95 CI 2.08
  to 6.66) (plt0.001) whether other medication was
  currently being used (OR 3.47, 95 CI 1.83 to
  6.59) (plt0.001)
• in consultations involving solely pharmacists
  compared with those involving only MCAs
  (p0.017).

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Barriers to the Evidence Based Supply of NPMs
from Community Pharmacies A Qualitative
Study.1Watson MC, 1Bond CM, 2Walker AE,
3Grimshaw JM1Department of General Practice and
Primary Care 2Health Services Research Unit
3Ottawa Health Research Institute, Canada.

Watson MC, Bond CM. International Journal of
Pharmacy Practice (IJPP) 20041265-72.
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Medicine Counter Assistants Communication
During Consultations For Nonprescription
Medicines

• Watson MC, Garner M
• Patient Education and Counseling (in press)
• School of Language Literature

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The Effect of Communication Skills Training on
Consultations for Non-Prescription Medicines
(NPMs) A Feasibility Study.

• Watson MC, Inch J, Cleland J, Francis J,
  Bond CM.
• Department of General Practice and Primary Care
• Health Services Research Unit

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Development of Training

• Empirical data used to inform content of
  training.
• Theoretical underpinning of delivery and
  evaluation of training using
• Calgary-Cambridge Model of Communication Skills
• Cognitive Behavioural Techniques
• Theory of Planned Behaviour

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• Conducting communication skills training for MCAs
  is feasible.
• Communication skills training appears to change
  some, but not all, target behaviours.
• Communication skills training alone, might not
  enhance the guideline-compliant supply of NPMs.

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Conclusion

• The supply of NPMs is complex.
• The nature and extent of information exchange
  between consumers and pharmacy staff has a strong
  influence on the evidence based (appropriate)
  supply of NPMs.
• Strategies to enhance the communication skills of
  MCAs are needed.
• Consumers need to be made aware of the importance
  of providing specific and sufficient information
  during consultations to maximise their self care
  with NPMs.

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Acknowledgements

• Collaborators
• Christine Bond, Jeremy Grimshaw, Marie Johnston,
  Anne
• Walker, Jen Cleland, Jill Francis, Jackie Inch,
  Mark Garner,
• Jo Hart, Sarah Smith.

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