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Surveys and services: The feasibility of conducting research in Swedish community pharmacies
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

For the past decades, there has been a shift in community pharmacy practice from dispensing and compounding towards provision of pharmacy services. Research is important to generate evidence for new services within pharmacy practice. Pharmacy practice research can be divided in two main themes: research related to pharmacy as a data source and to the pharmacy as the object of research, respectively.

The purpose of this thesis is to increase the understanding of the conditions required for successful involvement of Swedish community pharmacy staff in pharmacy-based research, and to evaluate the data generated through a certain type of research: pharmacy-based patient surveys on drug utilization.

Specific aims were to evaluate if there is a selection bias in drug utilization surveys conducted in Swedish community pharmacies, to explore the experiences of pharmacists either conducting the surveys or recruiting patients to research on adherence-promoting services, and to describe barriers and facilitators to conducting research in community pharmacies.

Data were collected via pharmacy-based patient surveys, dispensing data, individual interviews, a cross-sectional staff survey and focus group interviews.

In community pharmacy-based surveys or services research, with the dispensed drug as the trigger for inclusion, patients aged 75 years or older are underrepresented since they less often visit the pharmacy to redeem their prescriptions themselves. Due to their perceived workload, dispensing pharmacists sometimes avoid including patients perceived as complex due to age, polypharmacy or communication difficulties. These processes contribute to a healthy selection effect in both types of research and pharmacy services not reaching the patients in most need of support with their medication.

The pharmacists were generally positive to conducting surveys and being involved in services research, but reported a perceived lack of sufficient communication and research skills, and a lack of time.

Since competing commercial priorities hamper pharmacists’ research involvement, separate research funding is an important facilitator. For surveys to include all eligible patients, services to be relevant for both practice and patients and to target the patients in most need of support with their medication, research collaboration with healthcare, other professions and across pharmacies is also necessary.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. , p. 67
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Pharmacy, ISSN 1651-6192 ; 244
Keywords [en]
Pharmacy, Community pharmacy, Pharmaceutical services, Drug utilization research, Survey, Patient, Pharmaceutical care, Feasibility, Sweden
National Category
Social and Clinical Pharmacy
Research subject
Social Pharmacy
Identifiers
URN: urn:nbn:se:uu:diva-338811ISBN: 978-91-513-0213-3 (print)OAI: oai:DiVA.org:uu-338811DiVA, id: diva2:1175866
Public defence
2018-03-10, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 10:00 (English)
Opponent
Supervisors
Available from: 2018-02-16 Created: 2018-01-19 Last updated: 2018-03-22
List of papers
1. Selection bias in pharmacy-based patient surveys
Open this publication in new window or tab >>Selection bias in pharmacy-based patient surveys
2014 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 23, no 2, p. 128-139Article in journal (Refereed) Published
Abstract [en]

PurposeTo evaluate if there is a selection bias in drug utilization surveys on prescription drugs regularly conducted in Swedish pharmacies, to describe the direction of this potential bias and discuss the implications for the results. MethodsAge and gender distributions within patient survey samples from drug utilization surveys conducted during 2006-2010 are compared to the age and gender distribution of all Swedish patients, receiving the same drug or drugs, as given by the Swedish Prescribed Drug Register. The differences between the proportions of patients within the age and gender segments of each pair of survey/register data were calculated. ResultsIn 25 (81%) out of 31 included surveys, patients aged 75 years or older are significantly underrepresented, as they are less likely to visit the pharmacy to collect their prescription drugs themselves and thus disqualify for the interviews. Data on women show similar results as overall survey data, whereas the underrepresentation of the oldest age group among men appears in a lower proportion of the surveys, 67%. The general consequence is a selection towards a healthier survey sample, but the consequences in the individual surveys vary, depending on what drug is being studied. ConclusionPharmacy-based patient surveys provide a convenient data collection method for patient self-reported data, but patients aged 75 years or older are consistently underrepresented. In surveys where this may influence the main research question, data should also be collected with other methods reaching the oldest patients.

Keywords
patient survey, pharmacy, selection bias, drug utilization, self-report, pharmacoepidemiology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-219194 (URN)10.1002/pds.3488 (DOI)000329999100003 ()
Available from: 2014-02-25 Created: 2014-02-24 Last updated: 2018-01-19Bibliographically approved
2. Exploring community pharmacists' experiences of surveying patients for drug utilization research purposes
Open this publication in new window or tab >>Exploring community pharmacists' experiences of surveying patients for drug utilization research purposes
2015 (English)In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 37, no 3, p. 522-528Article in journal (Refereed) Published
Abstract [en]

Background Patient self-reported data are important in drug utilization research, but often logistically difficult to collect. During 2006-2012, 72 Swedish community pharmacies regularly collected such data through structured survey interviews at the pharmacy counter, performed by the dispensing pharmacists. This study is part of a validation of that data acquisition method. Objectives (1) To explore the experiences of the pharmacists involved, (2) to explore a random or systematic exclusion of eligible patients by the pharmacists, and (3) to find areas of improvement to the applied method of surveying. Setting 72 Swedish community pharmacies, distributed all over the country. Method (a) A questionnaire was distributed to approximately 400 dispensing pharmacists at the pharmacies conducting the patient surveys; (b) semi-structured telephone interviews conducted with 19 pharmacists at 12 of the pharmacies. Main outcome measure Proportions of pharmacists reporting positive and negative experiences of structured survey interviews, the nature of their experiences, proportion of pharmacists reporting to avoid survey interviews and reasons for doing so, and suggested areas of improvement. Results A total of 126 pharmacists (32 %) completed the questionnaire. A majority (82 %) reported positive experiences of interviewing. In addition to the data generated as the primary goal of surveying, secondary benefits such as an improved patient-pharmacist dialogue and an increased detection and resolution of drug related problems were reported. However, a majority (63 %) of the pharmacists also reported negative experiences related to a perceived lack of time to fulfil one's professional obligations. Almost half of the pharmacists (44 %) in the survey admitted that they occasionally avoided interviewing eligible patients, due to the immediate increase in work load. The limited availability of staff resources was the most apparent area of improvement. Conclusion Under certain conditions, community pharmacies are feasible as a setting for conducting patient surveys in drug utilization research, and dispensing pharmacists suitable for conducting them. When regular dispensing staff perform the survey interviews as a part of the drug dispensing process, additional resources to manage the immediate increase in work load have to be considered. Otherwise, data quality may be compromised.

Keywords
Community pharmacy, Interview, Pharmacist, Survey, Sweden
National Category
Pharmaceutical Sciences
Identifiers
urn:nbn:se:uu:diva-252961 (URN)10.1007/s11096-015-0088-1 (DOI)000353472100016 ()25736386 (PubMedID)
Available from: 2015-05-20 Created: 2015-05-18 Last updated: 2018-01-19Bibliographically approved
3. Utilisation of prescription and over-the-counter triptans: a cross-sectional study in Stockholm, Sweden
Open this publication in new window or tab >>Utilisation of prescription and over-the-counter triptans: a cross-sectional study in Stockholm, Sweden
Show others...
2016 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 72, no 6, p. 747-754Article in journal (Refereed) Published
Abstract [en]

Triptans are widely used in acute migraine, and in some countries, they are also available over-the-counter (OTC). In Sweden, sales have increased for both prescription and OTC triptans. This study aimed to describe current prescribing and utilisation patterns of prescription and OTC triptans in Stockholm, Sweden. Register data from 4759 patients dispensed triptans in 2014 were used to study documented diagnosis of migraine, concomitant acute and preventive treatment for migraine, and contraindications. Survey data from 49 patients purchasing OTC triptans in three pharmacies were used to capture physician-diagnosed migraine, concomitant acute and preventive treatment for migraine, a behaviour of combining or alternating between prescription and OTC triptans, and pharmacy counselling rates. Among the prescription triptan users, 52 % had a recorded diagnosis of migraine, 48 % had no other acute treatment, preventive treatment was rare (12 %) and contraindications were found in 2 % of the patients. Among the OTC triptan users, the majority (63 %) had been diagnosed by a physician and had a history of prescription triptan use, but combining or alternating between OTC and prescription triptans was rare. Concomitant acute treatment was reported in 53 % and preventive treatment was rare (4 %), despite high self-reported migraine frequencies. Some off-label use was detected, despite moderate to high counselling rates. Triptans are prescribed with attention to safety but with poor recording of migraine diagnosis. OTC triptan users generally have a history of prescription triptan use. Preventive treatment rates are low in both groups. Strategies to discern patients who need other treatment options should be considered.

Keywords
Triptans, Over-the-counter, OTC, Drug utilisation, Prescription, Survey
National Category
Pharmaceutical Sciences
Identifiers
urn:nbn:se:uu:diva-298065 (URN)10.1007/s00228-016-2028-y (DOI)000376245600014 ()26922586 (PubMedID)
Available from: 2016-06-30 Created: 2016-06-29 Last updated: 2018-01-19Bibliographically approved
4. Competence, competition and collaboration: Perceived challenges among Swedish community pharmacists engaging in pharmaceutical services research
Open this publication in new window or tab >>Competence, competition and collaboration: Perceived challenges among Swedish community pharmacists engaging in pharmaceutical services research
(English)Manuscript (preprint) (Other academic)
Keywords
community pharmacy, Sweden, cognitive pharmaceutical services, research, patient-centered care
National Category
Social and Clinical Pharmacy
Research subject
Pharmaceutical Science; Social Pharmacy
Identifiers
urn:nbn:se:uu:diva-338726 (URN)
Available from: 2018-01-12 Created: 2018-01-12 Last updated: 2018-01-19

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