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Introduction and aim It has been suggested that the employment of pharmacists in general practice might moderate the growth in prescribing costs. However, empirical evidence for this proposition has been lacking. The aim of this study was to evaluate a controlled trial of pharmacist-led intervention in general practice to determine whether intervention practices made savings relative to controls and if so, exactly how these savings were made and whether quality of prescribing was maintained. Since this process of rationalisation has implications for patients, an additional aim was to explore the views of patients on changes made to their medication. Methods The study was an evaluation of an initiative set up by Doncaster Health Authority. Eight practices received intensive input from five pharmacists for one year (September 1996 to August 1997) at a cost of £163 000. Changes in prescribing patterns were investigated using Prescribing Analysis and CosT (PACT) data by comparing these practices with eight individually matched controls for both the year of the intervention and the previous year. A postal survey of 314 patients who had undergone a change in medication between October 1997 and January 1998 was used to explore patient views. Results The evaluation showed that the rise in prescribing costs for intervention practices was significantly lower than for control practices (p=0.02S). Had the cost growth of the intervention group been as high as that of the controls, their total prescribing expenditure would have been around £347 000 higher. Detailed analysis showed that these savings were achieved by controlling both prescribing volume and cost per unit volume in areas believed to be without detriment to patient care. The majority of patients were reasonably satisfied or very satisfied with the way in which they found out about their medication change and satisfaction was positively associated with being told why the change was taking place, being given a choice and being told by the GP, a practice pharmacist or by letter. Conclusions Compared with previous studies, this evaluation has advantages in the fact that a control group was used to compare changes in prescribing patterns. The evaluation has shown that the use of pharmacists controlled prescribing expenditure sufficiently to off-set the costs of their employment. Results of the patient survey indicated that patients were not so much concerned about changes in medication per se, but rather the manner in which it was conveyed to them. These results have important implications for the control of prescribing costs in primary care. However, this study took place in motivated practices that had relatively high prescribing costs and this may limit the generalisability of the results.

Supplying safe, appropriate and effective non-prescription medicines for customers in community pharmacies is a key role of pharmacists and pharmacy assistants in every country. However, in low and middle-income countries, including Vietnam, the quality of professional services from pharmacies is limited, unclear and has often been questioned. There is limited research about the real situation surrounding non-prescription medicine supply in community pharmacies in Vietnam. The factors that influence the supply of non-prescription medicines to customers and to what extent the service provision could be improved for the benefit of pharmacy customers needs to be explored. This study aimed to investigate non-prescription medicines supply in community pharmacies in Hanoi, Vietnam in order to provide scientific evidence about the situation. A mixed method approach was used in this study to provide valuable insights into what occurs during pharmacy staff-customer transactions. Following ethical approval, fieldwork observations were undertaken in five community pharmacies over a five week period from March to May 2011, this was followed by 22 semi-structured interviews with eight pharmacists and 14 pharmacy assistants who had been observed. The interviews enabled participants to express their perceptions and experiences regarding the supply of non-prescription medicines to customers in community pharmacies. Survey research, using a structured questionnaire, was conducted with 505 pharmacy customers who were asked to evaluate the pharmacy service that they had just received. Results from the three sources were triangulated and validated by comparing, contrasting, complementing and confirming in order to provide a better understanding of non-prescription medicines supply and make recommendations for improving the service provision in community pharmacies in Vietnam. The findings from this study indicate that factors influencing the supply of non-prescription medicines in community pharmacies include attitudes of pharmacy staff, their medical and pharmaceutical knowledge and their communication skills. The influence of the pharmacy settings, customer factors such as customers’ complex and diverse demands, the irrational use of medicines, using medicines following the suggestions of others, and tough customers were all factors that impacted on staff-customer transactions. Being conveniently located, the pharmacy offering reasonably priced medicines and being a large pharmacy with a good reputation were also considered important impacting on customer selection of community pharmacy. The results of this research show that there are limitations in pharmacy service provision and there is a discrepancy between pharmacy staff perceptions and actual practice in terms of attitudes. Poor performance, in many situations, did not come from a lack of knowledge; rather it appeared to result from the negative attitudes of pharmacy staff. Such negative attitudes of pharmacy staff are likely to be related to their focus on just short-term profit rather than focusing on a balance between short-term and long-term benefits for both customers and pharmacies. Positive attitudes, taking greater responsibility, customer loyalty and long-term benefits were ignored. Poor performance of pharmacy staff, to some extent, was also affected by their education and training. Some educational organisations have commercialised their training activities and paid too much attention to the quantity of graduated students rather than the quality of their education and training. This study has important implications for the improvement of the responsible supply of non-prescription medicines in community pharmacies in Vietnam including the identified needs for attitude interventions and training. New subjects should be added to the pharmacy students’ curricula and training should be developed for pharmacy assistants in areas such as communication skills, customer psychology, selling skills and patient safety. For pharmacists and pharmacy assistants, gaining treatment experience from customers’ feedback and keeping up to date with new information should be a continuous activity. Close co-operation between health authorities, policy makers and researchers needs to be developed in conducting further research and implementing appropriate policies, in order to improve the service provision in community pharmacies in Vietnam.

Aims of study The overall aim of this study was to investigate factors affecting service delivery within a national pharmacy chain, from the perspective of pharmacists and consumers, using asthma services as an example. Data were collected to explore the current environment and opportunities available to pharmacy, the factors affecting service delivery, and to identify recommendations for future service models. The impact of the design and route of service implementation were studied through two different types of asthma services. Methods The brief intervention in asthma was designed centrally and implemented nationally, whilst the asthma service was designed and implemented locally by a group of pharmacists. A triangulation of qualitative and quantitative methods were used throughout this study, including an omnibus survey, audits, mystery customer research, customer and pharmacist interviews, and a review of the dispensing data. Results A total of 81 facilitators, 45 barriers and 23 motivators were identified. In addition to extending those factors that had been previously recognised within the literature, new factors were also identified. Firstly, the route and design of service implementation to promote local ownership and responsibility for delivery of services was found to be a key factor, as was having flexibility in the length and content of service delivery. Clear and visible benefits to the pharmacists delivering the service, the customers accessing the service, and the pharmacy organisation were also found to play an important role in the delivery of services. Conclusions This is the first large scale study of its kind to look at all the factors involved from the perspective of both customers and pharmacists, and many of the facilitators and barriers identified extend beyond those provided within the current literature. The motivators identified within the previous studies have been from the perspective of pharmacists only. This study has looked at the perspective of not only pharmacists, but also the motivators to customers and the service provider. Based on all the factors identified throughout this study, a number of recommendations have been made for future service delivery.

To improve the outcomes of drug therapy, there is increasing interest in the community pharmacist providing medicines management services (MMS) (Department of Health, 2000b, 2003a). In 2001, the Department of Health funded the Community Pharmacy Medicines Management Project (CPMMP) to evaluate the introduction of a community pharmacy led MMS. This thesis set out to critically assess the views and experiences of community pharmacists and general practitioners (GPs) participating in the CPMMP; exploring how relationships and perceptions of each other could influence community pharmacists carrying out a MMS, from the viewpoint of both community pharmacists and GPs. This is a qualitative study whereby eight focus groups were conducted with thirty five community pharmacists, and semi-structured telephone interviews were carried out with twenty one GPs and twenty eight community pharmacists. Data was analysed using the broad principles of Grounded Theory (Glaser and Strauss, 1967). Almost all pharmacists and GPs stated they had a good working relationship with each other prior to the MMS commencing, although a number of attitudinal barriers were identified. These included professional hierarchy, GPs' lack of awareness of a pharmacist's training and role in health care, and concerns that commercial interests could potentially affect a community pharmacist's advice. However, these data suggested that where there was an established relationship between the two professions, the most positive feedback about the MMS was reported. These data also suggested that some GPs were not supportive for community pharmacists to undertake a MMS and were generally unwillingly for the community pharmacist to have full access to patients' medical records. There were also some concerns around boundary encroachment. The project had a limited impact on improving relationships between community pharmacists and GPs, with relationships and GPs' perceptions remaining unaltered in many instances. This piece of research has highlighted that attitudinal barriers need to be addressed in order to accomplish effective collaborative working between community pharmacists and GPs.

Background: Concern has been raised that the workload of community pharmacists (CPs) is linked to the occurrence of dispensing errors (DEs). One aspect of workload that has not yet been measured in this setting, but has been linked to errors in other industries, is mental workload (MWL). Aims: (1) Measure the relationship between MWL and DEs during a routine pharmacy task, the final accuracy check, which research suggests is critical to DE prevention. (2) Quantify the role that expertise plays in this relationship. (3) Explore CPs and pharmacy students’ experiences of MWL and DEs. Methods: A mixed methods approach was taken and three studies were conducted. In study one, CPs (n=104) and students (n=93) checked dispensed items for DEs. Participants took part in one of four conditions (distraction, no distraction, dual-task or single-task) and their DE detection and MWL was measured. Study two was a diary study of CPs’ (n=40) MWL during a day in their “real-life” practice. Study three presented an interpretative phenomenological analysis of CPs’ (n=14) and students’ (n=15) experiences of MWL and DEs. Main findings: Study one found that high MWL was related to reduced DE detection, but only for students, confirming the important role of expertise. Distractions did not affect DE detection but was linked to increased MWL. Study 2 highlighted specific times of the day when CPs’ MWL was exceptionally high. Study 3 found several factors which increased MWL, including the lack of control CP’s had over their workload, difficulties communicating with prescribers and targets. Conclusions: MWL has been found to be a useful tool for measuring the impact of workload on pharmacy safety. The findings are linked to current work design and human factors theory and suggestions are made for how CPs’ work could be redesigned to reduce their MWL and improve safety.