Biomedical subjects

James C McElnay

Publications and source records attributed to James C McElnay.

7 recordsLinked to original sources

PubMed2006

The implementation of a harm minimisation model for the identification and treatment of over-the-counter drug misuse and abuse in community pharmacies in Northern Ireland.

OBJECTIVE: This study tested an intervention model which sought to minimise over-the-counter (OTC) drug misuse and abuse in community pharmacies. METHOD: Pharmacists in six community pharmacies in the Greater Belfast area volunteered to participate in the study. The intervention model consisted of client identification and recruitment, treatment and referrals, and finally follow-up data collection and outcome measurements. All pharmacists participated in semi-structured interviews to explore their views and experiences of the study. RESULTS: Pharmacists identified 196 cases of suspected abuse/misuse. Pharmacists approached 70 of the identified clients during the six-month study; some clients agreed to stop using the product of abuse/misuse, used an alternative, or had been switched to a maintenance prescription under general practitioner (GP) supervision. No client proceeded to completion of the follow-up phase (e.g. health-related quality of life). Analysis of the interviews revealed that pharmacists had encountered some difficulties in approaching potential clients, but had used skills gained in the study in other aspects of their practice. CONCLUSIONS: Some difficulties were encountered in implementing the harm minimisation model, but these may be alleviated by further training and greater collaborative working. PRACTICE IMPLICATIONS: Notwithstanding the challenges faced in the study, this approach to harm minimisation should be considered for wider implementation in community pharmacy.

Adult↗

PubMed2005

The impact of depressive symptoms and psychosocial factors on medication adherence in cardiovascular disease.

OBJECTIVE: This study sought to determine the influence of depression and psychosocial factors on medication adherence in cardiovascular disease. METHODS: A questionnaire including measures of depression, beliefs about medicines, health locus of control and adherence to medication (self-report) was completed by 122 outpatients attending a cardiac clinic. RESULTS: Analysis revealed that 14.8% of participants were non-adherent with their cardiovascular medication and 41.7% had scores indicative of depressive symptoms as determined by the Center for Epidemiological Studies Depression Scale (CES-D). Higher scores on this scale and strong concern scores on the Beliefs about Medicines Questionnaire about the potential adverse effects of using medication as prescribed were found to be associated with self-reported non-adherence. DISCUSSION AND CONCLUSION: These findings imply that the relationship between depressive symptoms in cardiovascular patients, together with certain psychosocial factors, could have negative consequences for adherence to medication. PRACTICE IMPLICATIONS: Given that there is emerging evidence to suggest an association between depression and medication non-adherence, healthcare professionals should consider this when dealing with cardiovascular patients.

Attitude to Health↗

PubMed2005

Societal perspectives on over-the-counter (OTC) medicines.

BACKGROUND: Over-the-counter (OTC) medicines are increasingly used for self-medication, but such products can be misused/abused. OBJECTIVES: The aim of this study was to investigate the general public's opinion and perceptions of OTC medicines, including the misuse/abuse of such preparations. METHODS: Data were collected using a survey administered to 1000 members of the public in 10 study sites in Northern Ireland, using a structured interview technique. The questionnaire was divided into four sections addressing: (a) attitudes towards community pharmacy and patients' contact with pharmacies; (b) attitudes towards the use of OTC medicines; (c) views on OTC medicines in terms of safety, potency and effectiveness; and (d) knowledge and opinion of abuse/misuse of OTC medicines. Data were coded and entered into a custom designed SPSS database for statistical analysis. RESULTS: The majority of participants (74.6%) visited a community pharmacy at least once per month. Almost one-third (32.2%) of participants reported buying OTC drugs at least once per month and the majority (86.4%) would always or often follow the directions on the product. The general public in Northern Ireland were highly aware of the abuse potential of some OTC drugs, with the majority naming painkillers as the products most liable for abuse. Almost one third of the participants reported having personally encountered cases of OTC abuse. CONCLUSIONS: This survey revealed that the general public had a high level of awareness of the abuse potential of OTC medicines. These findings indicate that pharmacists could be more proactive in the management of inappropriate OTC drug use.

Attitude to Health↗

PubMed2005

Characteristics associated with neuropathy and/or retinopathy in a hospital outpatient diabetic clinic.

BACKGROUND: The incidence of diabetes is increasing worldwide and with it the risk of diabetic complications. The aim of this study was to characterise parameters associated with neuropathy and/or retinopathy in a hospital outpatient diabetic clinic population. METHOD: A structured questionnaire addressing diabetes related factors and demography was administered to a cross-sectional sample of patients (n = 290) with type 1 and type 2 diabetes attending a hospital diabetic outpatient clinic. Additional clinical measures were obtained from patient medical files and computerised records. Logistic regression analysis was used to identify characteristics associated with the presence of complications. RESULTS: When controlling for other predictors, increasing age (P < 0.01), type 1 diabetes (P = 0.05), longer duration of diabetes (P < 0.01), increased serum triglyceride levels (P = 0.03), HbA1c (>8%; P = 0.03), self-reported low physical activity levels (P = 0.05) and being a smoker (P = 0.01) were positively related to retinopathy and/or neuropathy. Patients within the study population had reasonably well controlled BP and serum lipids, thus explaining the absence of these particular variables from the list of predictor parameters. Other factors including diabetes knowledge, home blood glucose monitoring, gender, body mass index, clinic attendance and occupational status were not significantly associated with retinopathy or neuropathy in the present study population. CONCLUSIONS: Pharmacists and other health practitioners who are in a position to be involved in the care and management of patients with diabetes should raise awareness of complications, particularly amongst patients who present with the above risk factors and provide necessary counselling and advice as required.

Adult↗

PubMed2004

Development of a community pharmacy-based model to identify and treat OTC drug abuse/misuse: a pilot study.

OBJECTIVE: The aim of this study was to develop and pilot a harm-minimisation model for the identification and treatment of over-the-counter (OTC) drug abuse/misuse by community pharmacists. METHOD: Extensive consultation was conducted during the development of the model. This included an exploratory conference involving an interdisciplinary group of delegates and detailed individual consultation with a range of healthcare practitioners. Consultation with a psychologist specialising in communication skills allowed development of the communication aspects of the model. A comprehensive manual detailing the model was prepared. RESULTS: The model is designed to be used by community pharmacists in conjunction with other healthcare professionals. It focuses on the abuse/misuse of opioids, laxatives and antihistamines and can be broadly divided into three phases, namely: patient identification and recruitment, treatment/referrals and data collection/outcome measurement. Client identification is via record-keeping which is implemented alongside an information campaign promoting safe use of OTC medicines. Once identified, the pharmacist aims to recruit clients using the developed communication strategies. Treatment depends on whether the problem is misuse or abuse and on the product. Several treatment paths are available including treatment according to an agreed protocol and referring to the GP or community addiction team (CAT). Two pharmacists were recruited and trained to pilot the model. Of the clients, 18 were identified as abusing/misusing OTC products over a one-month period. The subject of inappropriate OTC use was raised with 14 of these clients. Some success was noted in that clients agreed to stop using the product and/or to try safer alternatives. As expected, some sales had to be refused, as the client was unwilling to accept the pharmacist's intervention. CONCLUSION: This study represents the first reported structured attempt by community pharmacists in the UK to address the abuse/misuse of OTC medication. Work is now ongoing to modify this model in light of the pilot study findings.

Algorithms↗

PubMed2003

Community pharmacy based provision of pharmaceutical care to older patients.

AIM: To measure the outcomes of a harmonized, structured pharmaceutical care programme provided to elderly patients by community pharmacists. METHOD: A randomised, controlled, longitudinal, clinical trial with repeated measures was performed over an 18-month period, involving community pharmacies (5 intervention and 5 control) in Northern Ireland. Elderly, ambulatory patients (> or = 65 years), taking 4 or more prescribed medications were eligible for participation. Patients attending an intervention pharmacy received education on medical conditions, implementation of compliance strategies, rationalizing of drug regimens and appropriate monitoring; patients attending control sites received normal services. A battery of clinical, humanistic and economic outcomes were assessed. RESULTS: A significantly higher proportion of intervention patients were compliant at the end of the 18-month study and experienced fewer problems with medication compared to control patients (P < 0.05). There was little impact on quality of life and health care utilisation. CONCLUSIONS: Pharmaceutical care provision to community-dwelling patients resulted in an improvement in medication compliance and evidence of cost-savings. Future pharmaceutical care studies may benefit from a more focussed selective approach to data collection and outcomes measurement.

Aged↗

PubMed2003

Pharmaceutical care programmes for the elderly: economic issues.

Pharmaceutical care is defined as the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life. It describes the process through which a pharmacist collaborates with a patient and with healthcare professionals in designing, implementing and monitoring a therapeutic plan that will produce specific, desirable therapeutic outcomes for the patient. The elderly are a patient population who could particularly benefit from pharmaceutical care provision as they are at greater risk of experiencing significant drug-related problems such as inappropriate prescribing, noncompliance with prescribed medication and adverse drug reactions/interactions leading to a decrease in health-related quality of life. The extent of economic benefit of pharmaceutical care reported in the literature is variable and its generalisability is suspect due to the lack of trials which have utilised a robust research design. The few studies which have undertaken a rigourous economic evaluation have used a range of data collection methods that is reflective of the difficulty of capturing essential data. Furthermore, even in well-designed studies, the generalisability of economic evaluations to other countries is questionable because of unique national data collection systems and an inability to pool international data because of disparities between different healthcare systems. The use of a suitable measure for health-related quality of life is also problematic in a very diverse and heterogeneous population such as the elderly and, therefore, adds to the difficulties of inclusion of such measures in economic analyses of pharmaceutical care programmes. A more standardised approach to data collection is required to facilitate economic analyses as an essential element in the evaluation of any pharmaceutical care programme for the elderly. Suggestions on such approaches, together with a critical appraisal of studies performed to date, are the focus of this review.

Aged↗