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Pharmacy Practice



Pharmacy Practice
Edited by

Kevin M.G.Taylor
School of Pharmacy, University of London, London, UK
and
Geoffrey Harding
Department of General Practice and Primary Care,
St Bartholomew’s and the Royal London School of
Medicine and Dentistry
Queen Mary, University of London, London, UK

London and New York


First published 2001 by Taylor & Francis
11 New Fetter Lane, London EC4P 4EE
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Contents
Foreword
Contributors
Preface
Acknowledgements
Part One:
The development of pharmacy practice
1. The historical context of pharmacy

Stuart Anderson
2. The pharmacy workforce
Karen Hassell and Sue Symonds
3. Primary and secondary care pharmacy
Catherine Duggan
Part Two:
International dimensions of pharmacy practice
4. Community pharmacy in Europe
Foppe van Mil
5. Pharmacy in North America
Joaquima Serradell and Albert Wertheimer
6. Pharmacy in developing countries
Felicity Smith
Part Three:
Health, illness and medicines use
7. The social context of health and illness
Sarah Nettleton
8. Inequalities in health and health care
Mark Exworthy
9. The supply and consumption of over the counter drugs
Ian Bates
10. Promoting health
Alison Blenkinsopp, Claire Anderson and Rhona Panton
11. Compliance, adherence and concordance
Robert Horne
Part Four:
Professional practice
12. Pharmacy as a profession
Geoffrey Harding and Kevin Taylor
13. Professional judgement and ethical dilemmas

ix
xi
xix
xxi

3
28
43

53
62
71

93
109
124
135
148

169


14.
15.

Richard O’Neill
Effective communication
Norman Morrow and Owen Hargie
Pharmacists and the multidisciplinary health care team

Christine Bond

Part Five:
Meeting the pharmaceutical care needs of specific populations
16. Ethnic minorities
Mohamed Aslam, Farheen Jessa and John Wilson
17. Parents and children
Sally Wyke, Sarah Cunningham-Burley and Jo Vallis
18. Pregnancy and breastfeeding mothers
Lolkje de Jong-van den Berg and Corinne de Vries
19. The elderly and their carers
Ruth Goldstein
20. People with mental health problems
Sally-Anne Francis
21. Injecting drug users
Janie Sheridan and Trish Shorrock
Part Six:
Measuring and regulating medicines use
22. Pharmacovigilance and pharmacoepidemiology
Corinne de Vries and Lolkje de Jong-van den Berg
23. Health economics
Hakan Brodin
Part Seven:
Research methods
24. Measurements of health and illness
Sally-Anne Francis
25. Survey methods
Jill Jesson and Rob Pocock
26. Interviews
Madeleine Gantley

27. Focus groups
Felicity Smith
28. Analysing qualitative data
Geoffrey Harding, Madeleine Gantley and Kevin Taylor
29. Statistical tests
Nick Barber
30 Evaluating community pharmacy services
Felicity Smith
31. Evaluating hospital pharmacy services
Nick Barber and Keith Ridge

184
207
229

250
265
275
286
301
315

336
360

376
396
419
435
445

451
466
478


32.

Professional audit and clinical governance
Carl Martin

491

Index

502



Foreword
The development of pharmacy practice as an academic discipline has been relatively slow
and not without controversy. In the UK it was stimulated in no small part by the 1986
Report of the Nuffield Inquiry into Pharmacy which found a dearth of evidence on what
pharmacists really did and, more importantly, how effective they were in achieving their
goals—if indeed these goals had been defined. Given progress in the field to date, the
appearance of a mature, definitive text is timely and this must be it. Kevin Taylor and
Geoffrey Harding have already made their mark with an introductory text on the social
aspects of pharmacy and an edited collection of essays on pharmacy practice and now
have masterminded the production of this impressive work. There cannot be many topics
in pharmacy practice that are not addressed within the eclectic array of chapters by some
40 authors from 33 departments and institutions. Although the authors are drawn

predominantly from the UK, we learn much about practice and policy in other countries
and it is appropriate that community pharmacy in Europe, pharmacy in North America
and in developing countries is addressed by relevant experts.
I have long believed that we have neglected teaching aspects of our heritage. The
chapters on the historical context of pharmacy and pharmacy as a profession are valuable
backdrops to the sections that deal with issues that are refreshing in their breadth—
compliance, adherence and concordance, health promotion, effective communication and
also that most crucial of areas, professional judgement. Pharmacists have sometimes
hidden behind laws which may paralyse the profession; the application of fine judgement
is increasingly important in interactions with ethnic minorities, the elderly, those with
mental health problems and with drug misusers. All of these topics are given coverage
here.
More and more pharmacists are part of multidisciplinary teams involved in health
economics and measures of health and illness, in evaluating care, in advisory rôles, and in
audit of practice. The discipline of pharmacy practice has grown to an extent not
envisaged all those years ago by the Nuffield Inquiry. Here it all is in one book which, as
Dr Taylor and Dr Harding hope, will be placed on library shelves beside the textbooks of
pharmacology, pharmaceutics and modern pharmaceutical chemistry which provide the
bedrock and uniqueness of the pharmacist. It deserves to be taken down frequently and
consulted so that the unique skills of the pharmacist can be put to their optimal use in this
new century.
Professor A.T.Florence
The School of Pharmacy
University of London



Contributors
Claire Anderson
The Pharmacy School

University of Nottingham
Nottingham
UK
Stuart Anderson
Department of Public Health and Policy
London School of Hygiene and Tropical
Medicine
London
UK
Mohamed Aslam
Department of Pharmaceutical Sciences
School of Pharmacy
University of Nottingham
Nottingham
UK
Nick Barber
Centre for Practice and Policy
School of Pharmacy
University of London
London
UK
Ian Bates
Centre for Practice and Policy
School of Pharmacy
University of London
London
UK
Alison Blenkinsopp
Department of Medicines Management
Keele University

Keele
Staffordshire


UK
Christine Bond
Department of General Practice and Primary
Care
University of Aberdeen
Aberdeen
UK
Hakan Brodin
TNO Prevention and Health
Sector HTA
Leiden
The Netherlands
Sarah Cunningham-Burley
Department of Community Health Sciences
University of Edinburgh
Edinburgh
UK
Lolkje de Jong-van den Berg
Department of Social Pharmacy and
Pharmacoepidemiology
Groningen University Institute for Drug
Studies
Groningen
The Netherlands
Corinne de Vries
Pharmacoepidemiology and Public Health

Postgraduate Medical School
University of Surrey
Guildford
Surrey
UK
Catherine Duggan
Academic Department of Pharmacy
Barts and the Royal Hospitals NHS Trust
St Bartholomew’s Hospital
London
UK
Mark Exworthy


LSE Health
London School of Economics
University of London
London
UK
Sally-Anne Francis
Centre for Practice and Policy
School of Pharmacy
University of London
London
UK
Madeleine Gantley
Department of General Practice and Primary Care
St Bartholomew’s and the Royal London
School of Medicine and Dentistry
Queen Mary

University of London
London
UK
Ruth Goldstein
Medicines Research Unit
School of Health and Community Studies
University of Derby
Derby
UK
Geoffrey Harding
Department of General Practice and Primary Care
St Bartholomew’s and the Royal London
School of Medicine and Dentistry
Queen Mary
University of London
London
UK
Owen Hargie
School of Behavioural and Communication
Sciences
University of Ulster
Jordanstown
Co Antrim
UK


Karen Hassell
School of Pharmacy and Pharmaceutical
Sciences
University of Manchester

Manchester
UK
Robert Horne
Centre for Health Care Research
University of Brighton
Brighton
East Sussex
UK
Farheen Jessa
Department of General Practice
University Hospital
Queens’ Medical Centre
Nottingham
UK
Jill Jesson
Pharmacy Practice Research Group
Aston University
Aston Triangle
Birmingham
UK
Carl Martin
Centre for Practice and Policy
School of Pharmacy
University of London
London
UK
Norman Morrow
Pharmaceutical Branch
Department of Health, Social Services and
Public Safety

Stormont
Belfast
UK
Sarah Nettleton


Department of Social Policy and Social Work.
University of York
York
UK
Richard O’Neill
Centre for Practice and Policy
School of Pharmacy
University of London
London
UK
Rhona Panton
Worcester NHS Community Trust
Worcester
UK
Rob Pocock
M.E.L. Research Limited
Aston Science Park
Birmingham
UK
Keith Ridge
NHS Executive
Department of Health
London
UK

Joaquima Serradell
Serradell and Associates
Blue Bell
Pennsylvania
USA
Janie Sheridan
National Addiction Centre
Institute of Psychiatry
London
UK
Trish Shorrock
Leicester Community Drug Team
Leicester
UK


Felicity Smith
Centre for Practice and Policy
School of Pharmacy
University of London
London
UK
Sue Symonds
Formerly of School of Sociology and Social
Policy
University of Nottingham
Nottingham
UK
Kevin Taylor
Centre for Practice and Policy

School of Pharmacy
University of London
London
UK
Jo Vallis
Department of Geriatrics
University of Edinburgh
Edinburgh
UK
Foppe van Mil
Quality Institute for Pharmaceutical Care
Margrietlaan
Zuidlaren
The Netherlands
Albert Wertheimer
MERCK and Co
West Point
Philadelphia
USA
John Wilson
Nottingham Health Authority
Nottingham
UK


Sally Wyke
Department of Community Health Sciences
University of Edinburgh
Edinburgh
UK

Preface
Pharmaceutical services are increasingly patient-centred rather than drug-centred, as
exemplified by the concept of pharmaceutical care. Pharmacists need to both understand
and meet patients’ specific pharmaceutical requirements. To do this requires a blend of
clinical, scientific and social skills. This shift to patient-centred care comes as health care
is increasingly delivered by an integrated team of health workers. Effective pharmacy
practice requires an understanding of the social context within which pharmacy is
practised, recognising the particular needs and circumstances of the users of
pharmaceutical services, and of pharmacy’s place within health service provision.
With these issues in mind we have aimed to provide pharmacy students with a
background in some of the pertinent issues for effective contemporary pharmacy practice.
We have purposefully avoided clinical pharmacy and therapeutics per se, along with
specific aspects of pharmacy law, because these are already comprehensively covered in
existing texts. Our focus here is the practice of pharmacy in its social and behavioural
context. For instance, how do an individual’s beliefs or social circumstances influence
their decision to use a pharmacy, and how might pharmaceutical services best be
delivered to meet that individual’s specific health needs?
Effective pharmacy practice is based on research evidence and best practice, and
original research is referred to, where appropriate, throughout the text. As practice
becomes more evidence-based, pharmacists increasingly need to evaluate and implement
research findings, and undertake their own research and professional audits. To this end,
we have included sections detailing how medicines use is surveyed and costed, together
with practical guidance on doing pharmacy practice research and evaluating
pharmaceutical services.
Undergraduate pharmacy courses remain rooted in the pharmaceutical sciences. Within
libraries, social and behavioural science texts are segregated from pharmacy texts, and
often found at separate sites. Furthermore, interdisciplinary teaching within pharmacy

schools remains the exception rather than the rule. Consequently, many of the disciplines
and concepts included here will be unfamiliar, perhaps even alien to readers. The
backgrounds of the contributors to this textbook are diverse, including pharmacy,
sociology, psychology, anthropology, history, health economics and communication.
However, they share a common appreciation of how selected aspects of their specialty
inform pharmacy practice. It is hoped that by bringing together disciplines whose
knowledge base can, and should, underpin pharmacists’ activities, this comprehensive
book will equip readers to be effective health care practitioners.



Acknowledgements
We are indebted to all the authors who have contributed to this textbook, for their
diligence, attention to detail and adherence to deadlines. We additionally thank Henry
Chrystyn (University of Bradford), Dai John (University of Wales, Cardiff), Judith Rees
(University of Manchester) and John Varnish (Aston University, Birmingham) for the
assistance and information they provided when this book was in the planning stage. The
secretarial support provided by Marlene Fielder (School of Pharmacy, London) is also
gratefully acknowledged. Our thanks are also due to the editorial staff of Harwood
Academic Press, for their guidance, in particular Matthew Honan who commissioned the
project, and latterly Julia Carrick and Tracy Breakell.
On a personal note, we would like to acknowledge the contribution of Harts the
Grocer, Russell Square, whose cinnamon honey rolls and blueberry muffins provided
relief and sustenance during the long days of planning, writing and editing.
Finally, we acknowledge the forbearance and support of our wives, Pauline and Sally,
throughout the long duration of this project, particularly as we had stated ‘never again’
after our previous book.

PART ONE
The Development of Pharmacy
Practice