Objective: To describe the views and practices of community pharmacists regarding services for people with type 2 diabetes. Method: A cross-sectional questionnaire survey of a convenience sample of 317 community pharmacists in the North East of England. The 26-item questionnaire covered the setting of the pharmacy, dispensing medication, and the pharmacist's role in the primary prevention of diabetes, detecting undiagnosed diabetes and prevention of complications. Key findings: There was a 51% response rate. More than 80% of respondents reported that they saw patients with diabetes "very often" or "often" when they collected their prescriptions, but three-quarters reported that they "never/rarely" or only "sometimes" advised patients what to expect from their medication and gave information to help them have a better understanding of their disease. More than 90% of the pharmacists believed that a healthy lifestyle is important, but the majority were "never/rarely" or only "sometimes" involved in its promotion. Around 10 percent of the respondents reported that they "often" or "very often" promoted regular eye examinations. Home blood glucose monitoring was promoted by 50% of the respondents. The majority reported that they checked prescriptions for drug interactions. Conclusion: This study found that community pharmacists' advice and services to people with type 2 diabetes fell short of the standards and objectives set out in the National Service Framework for Diabetes. Our findings can be used to promote discussion in the profession and with stakeholders about the future role of the community pharmacist in diabetes care. ID - 3194 ER - This survey was instigated in response to the 2004 DH 'Hepatitis C Action Plan for England'. It examines the nature and extent of provision of needle exchange, to reduce drug-related harm in England, including blood-borne viruses. It investigates the delivery, commissioning and planning of needle exchange services, and it assesses the levels and quality of data collection. The survey comprised three separate questionnaires, sent to joint commissioners, specialist needle exchange services, and pharmacy needle exchange scheme co-ordinators. It uncovered a 'mixed economy'of needle exchange facilities present in the majority of drug action teams (DATs), with pharmacies constituting 80% of needle exchange facilities. It also discovered wide variations in needle exchange activity and a lack of uniformity between services. The level of data on needle exchange throughput and activity was poor, raising concerns about the strategic planning and commissioning of needle exchange and harm reduction interventions. Cites two references. ID - 3195 ER - Objectives: This study interviewed healthcare professionals to identify strategies enhancing the public health role of community pharmacists in the UK. Methods: Data were collected through telephone interviews, supported by Skype, and recorded using the 'HD Call Recorder for Skype'. The qualitative data software package NVivo (version 10) was used for the storage, retrieval and analysis of data. The constant comparative method of data analysis was used. Key findings: Participants suggested a number of strategies to enhance the public health role of community pharmacists in the UK. They included empowerment through education and awareness, empowerment through direct remuneration of pharmacists, the teaching as well as the use of new technologies and social media in practice, the use of independent pharmacist practitioners (IPPs), teaching communication methods to students and pharmacists, integrating undergraduate healthcare programmes, pharmacists working closely with other healthcare practitioners and changing the undergraduate pharmacy curriculum to increase its public health content. In terms of benefits, enhancing the public health role of community pharmacists could help: enhance preventative care, enhance accessibility, enhance collaboration between healthcare professionals, enhance the knowledge base of practitioners, reduce negative perceptions about pharmacists and bring financial savings and better time management to the NHS. Conclusions: This study has identified strategies that could potentially enhance the public health role of community pharmacists. Enhancing the public health role of community pharmacists could make services more accessible to the public, improve public safety and trust in pharmacists, encourage collaboration between pharmacists, doctors and other healthcare providers and bringing financial savings to the National Health Service. ID - 3196 ER - Objectives: This survey seeks the opinion of UK community pharmacists to identify barriers in the public health role of community pharmacists. Methods: This study took the form of a descriptive, cross-sectional survey that generated mostly quantitative data. Questionnaires were mailed to 524 randomly selected community pharmacists from Barnet, London and its surrounding areas, Bedfordshire, Cardiff and Edinburgh. All statistical analyses including tests for significance and correlation of variables were performed using the Statistical Package for the Social Sciences (spss version 19.0). Key findings: A majority of the respondents identified time pressure and workload (89.7%, C.I. +/-4.94); lack of patients' records (78.6%, C.I. +/-6.66); insufficient funding from the government (75.2%, C.I. +/-7.01); lack of understanding by healthcare providers of the training and skill sets of pharmacists (73.7%, C.I. +/-7.25); and lack of understanding by the public of the training and skill sets of pharmacists (72.7%, C.I. +/-7.29), as the main barriers in enhancing the public health role of community pharmacists in the UK. Male respondents were more likely to agree that 'insufficient funding' was a barrier (P = 0.006; Eta, eta2 = 0.053). There was a negative correlation between 'age of respondents' and respondents agreeing that pharmacists should develop their own expertise in public health (rho = -0.185; P = 0.029). Free text comments also highlighted a number of barriers, which included, among other things, time pressure and workload, commercial pressure from employers, lack of collaboration between healthcare professionals, and inadequate funding. Conclusions: Several barriers associated with the public health role of community pharmacists, mainly time pressure and workload; lack of patients' records; insufficient funding from the government; lack of understanding by healthcare providers of the training and skill sets of pharmacists; and lack of understanding by the public of the training and skill sets of pharmacists have been identified as hindering the enhancement of this role. To enable the profession to evolve fully from product-oriented services to patient-centred care, many of these barriers will need to be tackled. Copyright © 2016 Royal Pharmaceutical Society ID - 3197 ER - Objectives Using qualitative methods (interviews), this study aimed to identify barriers in the public health role of UK community pharmacists. Methods Data were collected through telephone interviews using Skype and recorded using HD Call Recorder for Skype'. The qualitative data software package NVivo (version 10) was used for storage, retrieval and analysis of data. Key findings This study identified a number of barriers hindering the public health role of community pharmacists in the UK. The most frequently cited barriers included: challenges as to the use of new technologies and social media; lack of awareness; pharmacists' lack of confidence in their public health role; commercial pressure from pharmacy owners; lack of time; inadequate funding; government policy on the public health role of pharmacists; inadequate communication skills; lack of integration of UK undergraduate healthcare programmes; logistics; as well as the fact that UK pharmacists qualify as scientists rather than as clinicians. Conclusions Many of the barriers identified in this study have also been confirmed in other studies. A clearer policy by the government on the public health role of pharmacists, supported by Schools of Pharmacy and relevant stakeholders might be a way forward. ID - 3198 ER - OBJECTIVE: To compare a meal replacement (MR) program with a conventional reduced-calorie diet (RCD) for weight management using the pharmacy as the setting and the pharmacist as the point of contact for dietary advice. DESIGN: Randomized, controlled, open-label trial. SETTING: Travis Pharmacy in Shenandoah, Iowa. PATIENTS: Ninety-five patients from southwestern iowa and southeastern Nebraska were enrolled, of whom 88 were considered eligible for comparison (by continuing through week 2 of the study). INTERVENTION: Patients were randomized to an MR plan or a traditional RCD plan. Patients were followed for a 3-month period of active weight loss and a 10-week period of weight maintenance. Patients returned every 3 weeks for follow-up with the pharmacist, for a total of 13 visits. MAIN OUTCOME MEASURE: Weight changes. RESULTS: During the active weight loss phase, the MR (n = 45) and RCD (n = 43) groups lost a significant amount of weight, although no significant difference was found between the groups (mean +/- standard error = 4.90 +/- 0.30 kg MR versus 4.30 +/- 0.30 kg RCD; P = .16). In the weight maintenance phase, the MR group lost 0.70 +/- 0.40 kg and the RCD group lost 0.90 +/- 0.40 kg (P = .60). Significant improvements were observed in waist circumference, systolic and diastolic blood pressure, and triglyceride levels. No significant changes were seen in high-density lipoprotein cholesterol or low-density lipoprotein cholesterol levels in either group. CONCLUSION: Successful weight management can be achieved in a pharmacy setting. Both MR and RCD programs were effective. ID - 3199 ER - Cardiovascular disease (CVD) is the leading cause of death among patients with diabetes. Management and control of CV risk factors in those with diabetes are generally poor. Pharmacists are frontline primary healthcare providers who see patients with chronic diseases frequently. As such, they are in a prime position to systematically identify patients with diabetes, assess their CV risk and assist in their disease management and preventive measures., OBJECTIVE: to evaluate the effect of pharmacist case finding and intervention program on estimated CV risk in patients with diabetes., METHODS: Sub-group analysis of a randomized controlled trial (RxEACH). Patients were randomized to receive intervention or usual care for 3 months. Those who were randomized to the intervention group received a Medication Therapy Management consultation which included patient assessment, laboratory assessment, individualized CV risk assessment. Treatment regimen adjustment, as needed, in order to meet treatment targets., RESULTS: Estimated CV risk was reduced from 26.9 +/- 21% to 26.5 +/- 21.3% in the control group and from 25.8 +/- 19.4% to 20.1 +/- 17.2% in the intervention group over the 3-month follow up period (an absolute reduction of 5.38; 95% confidence interval (CI) 4.24 to 6.52; p <0.001)., DISCUSSION AND CONCLUSION: Community pharmacy-based case finding and intervention program reduced the risk for major CV events by 21% when compared to usual practice. This represents a promising approach to help tackle the major public health problem of diabetes in Canada.Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved. ID - 3201 ER - BACKGROUND: Affecting a substantial proportion of adults, chronic kidney disease (CKD) is considered a major risk factor for cardiovascular (CV) events. It has been reported that patients with CKD are underserved when it comes to CV risk reduction efforts., STUDY DESIGN: Prespecified subgroup analysis of a randomized controlled trial., SETTING & PARTICIPANTS: Adults with CKD and at least 1 uncontrolled CV risk factor were enrolled from 56 pharmacies across Alberta, Canada., INTERVENTION: Patient, laboratory, and individualized CV risk assessments; treatment recommendations; prescription adaptation(s) and/or initiation as necessary; and regular monthly follow-up for 3 months., OUTCOMES: The primary outcome was change in estimated CV risk from baseline to 3 months after randomization. Secondary outcomes were change between baseline and 3 months after randomization in individual CV risk factors (ie, low-density lipoprotein cholesterol, blood pressure, and hemoglobin A1c), risk for developing end-stage renal disease, and medication use and dosage; tobacco cessation 3 months after randomization for those who used tobacco at baseline; and the impact of rural versus urban residence on the difference in change in estimated CV risk., MEASUREMENTS: CV risk was estimated using the Framingham, UK Prospective Diabetes Study, and international risk assessment equations depending on the patients' comorbid conditions., RESULTS: 290 of the 723 participants enrolled in RxEACH had CKD. After adjusting for baseline values, the difference in change in CV risk was 20% (P<0.001). Changes of 0.2mmol/L in low-density lipoprotein cholesterol concentration (P=0.004), 10.5mmHg in systolic blood pressure (P<0.001), 0.7% in hemoglobin A1c concentration (P<0.001), and 19.6% in smoking cessation (P=0.04) were observed when comparing the intervention and control groups. There was a larger reduction in CV risk in patients living in rural locations versus those living in urban areas., LIMITATIONS: The 3-month follow-up period can be considered relatively short. It is possible that larger reduction in CV risk could have been observed with a longer follow up period., CONCLUSIONS: This subgroup analysis demonstrated that a community pharmacy-based intervention program reduced CV risk and improved control of individual CV risk factors. This represents a promising approach to identifying and managing patients with CKD that could have important public health implications.Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. ID - 3202 ER - ...This evaluation of the implementation of the CKD Clinical Pathway by pharmacists was conducted as part of the RxEACH study, a ran- domized controlled study of pharmacist-led car - diovascular risk reduction intervention versus usual care. It was conducted in 55 community pharmacies across the province of Alberta. Pharmacists systematically identified po ID - 3200 ER - Background: The clinical and financial outcomes of annual wellness visits (AWVs) conducted by clinical pharmacists working as part of an accountable care organization (ACO) in a federally qualified health center were evaluated.; Methods: In this retrospective, single-center, chart review study, patients seen for AWVs at El Rio Health Center between October and December 2013 were eligible for study inclusion. Data collected from patient charts included patient demographics, preventive screenings ordered by clinical pharmacists during the AWV and completed within one month after the visit, other screenings completed by clinical pharmacists during the visit, medication changes by clinical pharmacists, and revenues collected from the AWV and preventive screenings. Descriptive statistics were calculated and variables compared; p values were calculated using single-sample Student's t tests.; Results: Three hundred patient records were reviewed. Clinical pharmacists completed 1608 interventions, with a mean of 5.4 interventions per patient. A total of 272 referrals were made, 120 (45%) of which were completed within one month of the visit. Of the 183 laboratory tests ordered for diabetes and lipid screening, 152 (83%) were completed within one month of the AWV (p < 0.001). Of the 370 vaccinations offered during the visits, 182 (49%) were administered (p < 0.001). Twenty-four medication and dosage changes were made by clinical pharmacists during AWVs, and the total revenue for the AWVs conducted by pharmacists and services completed during the visits exceeded $22,000.; Conclusion: Recommendations made by pharmacists during AWVs in an ACO associated with a federally qualified health center had a high acceptance rate and generated substantial revenue.; Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved. ID - 3203 ER - AIMS: To evaluate the impact of a pharmacist-led patient education and diabetes monitoring programme on HbA(1c) and other cardiovascular risk factors in the community setting. METHODS: Patients with Type 2 diabetes (n = 46) attending two community pharmacies in Hertfordshire, UK were randomized to one of two groups. Patients in the intervention group (n = 23) received a programme of education about diabetes, its treatment and associated cardiovascular risk factors. These patients were seen for monitoring/counselling by a community pharmacist on six occasions over a 12-month period. Measures included HbA(1c), BMI, blood pressure, blood glucose and lipid profile. Patients in the control group (n = 23) underwent these measurements at baseline and at 12 months only, without specific counselling or education over and above usual care. RESULTS: HbA(1c) fell from 66 mmol/mol (8.2%) to 49 mmol/mol (6.6%) (P < 0.001) in intervention group, compared with reduction from 65 mmol/mol (8.1%) to 59 mmol/mol (7.5%) in the control group (P = 0.03). Blood pressure fell from 146/87 to 126/81 mmHg in the intervention group (P = 0.01) compared with no significant change in the control group (136/86 to 139/82 mmHg). Significant reductions in BMI (30.8 to 27 kg/m(2), P < 0.001) and blood glucose (8.8 to 6.9 mmol/l, P < 0.001) were also observed in the intervention group as compared with no significant changes in the control group. Lipid profile changes were mixed. In the intervention group, improvements were seen in diabetes-related quality of life (P = 0.001), diabetes knowledge (P = 0.018), belief about the need for medication (P = 0.004) and reduced concerns regarding medication (P < 0.001). CONCLUSIONS: Education and counselling by community pharmacists can result in favourable improvements to the cardiovascular risk profile of patients with Type 2 diabetes.Copyright © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK. ID - 3204 ER - BACKGROUND: Although some studies have demonstrated that pharmacist intervention can improve drug therapy among patients with cardiovascular disease (CVD), more evidence derived from randomized controlled trials (RCTs) is needed, including assessment of the effect of community pharmacist interventions in patients with CVD. OBJECTIVE: To assess the effectiveness of the Dader Method for pharmaceutical care on achieving therapeutic goals for blood pressure (BP), total cholesterol (TC), and both BP and TC (BP/TC) in patients with CVD and/or high or intermediate cardiovascular (CV) risk attending community pharmacies in Spain. METHODS: Patients aged 25 to 74 years attending community pharmacies with a prescription for at least 1 drug indicated for CVD or CV risk factors were randomized to 2 groups: an intervention group that received pharmaceutical care, which was provided by specially trained pharmacists working in collaboration with physicians, and a control group that received usual care (routine dispensing counseling) and verbal and written counseling regarding CVD prevention. Patients were recruited from December 2005 to September 2006, and both groups were followed for 8 months. Study outcomes were assessed at baseline and at 16 and 32 weeks after randomization. The primary outcome measures were the proportions of patients achieving BP, TC, and BP/TC therapeutic goals (BP lower than 140/90 mm Hg for patients with uncomplicated hypertension and lower than 130/80 mm Hg for patients with diabetes, chronic kidney disease, or history of myocardial infarction or stroke; TC lower than 200 mg per dL for patients without CVD and lower than 175 mg per dL for patients with CVD). Secondary outcomes were mean BP and TC values. BP was assessed manually by the pharmacist after a 10-minute rest in the supine position. This measurement was performed twice for every participant, and the average of the 2 measurements was calculated. TC was measured by the pharmacist during the study visit using the enzymatic dry method. Statistical analyses were performed using 2-tailed McNemar tests, Pearson chi-square tests, and Student's t-tests; P < 0.05 was considered statistically significant. RESULTS: 714 patients were included in the study (356 intervention, 358 control), and the mean [SD] age was 62.8 [8.1] years. The 2 groups were similar at baseline in clinical and demographic characteristics, including the proportion of patients at therapeutic goals for BP, TC, and BP/TC. After 8 months of follow-up, there were statistically significant differences in favor of pharmaceutical care in the proportions of patients who achieved therapeutic goals for BP (52.5% vs. 43.0%, P=0.017), TC (56.5% vs. 44.1%, P=0.001), and BP/TC (37.1% vs. 21.8%, P < 0.001). CONCLUSION: Compared with usual care plus written education, pharmaceutical care focused on patient evaluation and follow-up in collaboration with physicians improved the achievement of BP, TC, and BP/TC treatment goals in patients with CVD and/or high or intermediate CV risk attending community pharmacies in Spain. ID - 3205 ER - OBJECTIVES: To determine the ability of community pharmacists within an anticoagulation clinic to keep international normalized ratios (INRs) within therapeutic ranges and, secondarily, to determine the incidence of bleeding and thromboembolic events and patient satisfaction. DESIGN: Retrospective observational study. SETTING: Eckerd PatientCARE Network in Eckerd pharmacies in Tampa Bay area of Florida. PATIENTS: 50 patients taking warfarin and having INR determinations for 6 consecutive months. INTERVENTIONS: Clinical pharmacists monitored patients' anticoagulation status using point-of-care analyzers and making dosage changes as needed under a collaborative agreement. Extensive patient education was provided to patients regarding their anticoagulation. Data were collected from the initial visit through the 6 consecutive months. Patients were surveyed to assess their satisfaction with the clinic. MAIN OUTCOME MEASURES: Percentage of INRs within therapeutic range and, secondarily, incidence of bleeding and thromboembolic events and patient satisfaction with the clinic. RESULTS: During the 6 months of initial therapy with warfarin, 243 of 435 (56%) INRs were in desired therapeutic ranges. A total of 15 bleeding episodes were reported, of which 10 were minor and 5 were significant. No thromboembolic events were reported. There was a 22% response rate to the survey, in which all statements were rated as above average to excellent. CONCLUSION: Community pharmacists in an anticoagulation clinic effectively manage anticoagulation therapy, as the results of this clinic are similar to those of clinics managed by pharmacists in other settings. ID - 3206 ER - Context - In the UK in 1996, the National Pharmaceutical Association collaborated with the Health Education Authority to pilot a resource pack that would enable community pharmacists and their medicines counter assistants to contribute to the promotion of the use of folic acid in planned pregnancy. Objective - To determine the views of pharmacists and medicines counter assistants about the use of the resource pack. Method - Depth interviews were carried out to elicit views, underlying feelings, experiences and attitudes towards staging and managing the project. The data were analysed using the constant comparison as outlined in grounded theory. Themes were identified and quotes from interviewees used to illustrate the themes. Setting - 14 pharmacists and 14 medicines counter assistants in a West London health authority. Key findings - Most pharmacists and medicines counter assistants reported feeling more comfortable when advising regular customers rather than unknown customers. Leaflets, posters and displays were thought to be better ways to target passing trade. The majority of the minority ethnic pharmacists and medicines counter assistants considered that they had an important role in communicating information about folic acid to customers from minority ethnic groups, provided they both spoke the same language. Conclusions - Most pharmacists will only raise sensitive issues, such as the importance of taking folic acid to prevent neural tube defects, with customers with whom they already have a relationship. Stimulating inquiries from passing trade by targeting with leaflets, displays and other health education resources offers an additional benefit. Pharmacies are an important setting for disseminating health messages to people from minority ethnic groups in their own languages. ID - 3207 ER - OBJECTIVE: A major UK Pharmacy chain private Chlamydia screening and treatment service began in October 2006. People pay for a screening kit, send off a urine sample, and are informed of their result directly. Treatment is accessed via the pharmacy chain or the National Health Service. We analysed data from the first 2 years of the service to describe the positivity rate by age and gender, profile of users and to determine if the program succeeded in reaching those who are currently being missed in other clinical settings. SETTING: Three hundred and thirty-eight community pharmacies from a major pharmacy chain in England and Wales. METHODS: Cross sectional study of the first 2 years screening and treatment data. Data was collected on number of tests, test results, age and gender. Data was also collected on treatment uptake by age and gender. Further Data regarding the treatment service including the site, was collected on customer record forms. Positivity data was analysed using chi(2). RESULTS: A total of 14,378 private Chlamydia screening tests were performed in pharmacies during the 2 year period. Overall positivity rates in males (9.8%) were higher than females (6.8%). The positivity rate was significantly higher in the 16-24 age group than in the 25 and over age group. A total of 533 people accessed and paid for treatment from Boots out of a total of 1,131 people who tested positive (47.1%). Hundred and thirty three (25.0%) partners also accessed treatment. CONCLUSIONS: The data further supports the feasibility and acceptability of pharmacy testing and treatment. ID - 3208 ER - BACKGROUND: There is a need to increase flu vaccination rates in England particularly among those under 65 years of age and at risk because of other conditions and treatments. Patients in at risk groups are eligible for free vaccination on the National Health Service (NHS) in England, but despite this, some choose to pay privately. This paper explores how prevalent this is and why people choose to do it. There is moderate to good evidence from several countries that community pharmacies can safely provide a range of vaccinations, largely seasonal influenza Immunisation. Pharmacy-based services can extend the reach of immunisation programmes. User, doctor and pharmacist satisfaction with these services is high. METHOD: Data were collected during the 2012-13 flu season as part of a community pharmacy private flu vaccination service to help identify whether patients were eligible to have their vaccination free of charge on the NHS. Additional data were collected from a sample of patients accessing the private service within 13 pharmacies to help identify the reasons patients paid when they were eligible for free vaccination. RESULTS: Data were captured from 89,011 privately paying patients across 479 pharmacies in England, of whom 6% were eligible to get the vaccination free. 921 patients completed a survey in the 13 pharmacies selected. Of these, 199 (22%) were eligible to get their flu vaccination for free. 131 (66%) were female. Average age was 54 years. Of the 199 patients who were eligible for free treatment, 100 (50%) had been contacted by their GP surgery to go for their vaccination, but had chosen not to go. Reasons given include accessibility, convenience and preference for pharmacy environment. CONCLUSIONS: While people at risk can access flu vaccinations free via the NHS, some choose to pay privately because they perceive that community pharmacy access is easier. There are opportunities for pharmacy to support the NHS in delivering free flu vaccinations to patients at risk by targeting people unlikely to access the service at GP surgeries. ID - 3209 ER - Background There is a need to increase influenza vaccination rates in England particularly among those who are under 65 years of age and at-risk because of other conditions and treatments. Objective To understand the profile of people accessing flu vaccination services within a large pharmacy chain. Method Pharmacists requested people who had been vaccinated in 2014/15 to complete a questionnaire. Data was captured electronically on vaccine delivery levels across 1201 pharmacies. Deprivation profiles were calculated using the Carstairs index. Results 1741 patients from a total of 55 pharmacies completed the survey. Convenience and accessibility remain the key reasons for attending pharmacy. Pharmacy services are accessed by people from all postcode areas, including some from the most deprived localities. Conclusion Pharmacy flu vaccination services complement those provided by general practitioners to help improve overall coverage and vaccination rates for patients in at-risk groups. These services are highly accessed by patients from all socio demographic areas, and seem to be particularly attractive to carers, frontline healthcare workers, and those of working age.; ID - 3210 ER - OBJECTIVE: To implement and evaluate a specialized service for type 2 diabetes mellitus in the community pharmacy. DESIGN: Parallel group, multisite, control versus intervention, repeated measures design, with three different regions in New South Wales, Australia, used as intervention regions, then matched with control regions as much as possible. INTERVENTION: Following training, pharmacists followed a clinical protocol over 9 months, with approximately monthly intervention site visits during which blood glucose readings were downloaded and discussed with the patient, interventions were documented, and goals set with each patient. MAIN OUTCOME MEASURES: Quality of life, well-being, risk of nonadherence, and glycosylated hemoglobin (A1C) values at the beginning and end of the study. Blood glucose levels were measured in intervention patients only. RESULTS: A total of 106 intervention and 82 control patients completed the study. Patient groups were similar at baseline. Pharmacists delivered 1,459 interventions and blood glucose levels were significantly reduced in all intervention regions. The proportion of patients with A1C values greater than 7% was similar in control sites at baseline (54%) and after 9 months (61%). In intervention sites this proportion was significantly reduced, from 72% at baseline to 53% after 9 months. Well-being and the risk of nonadherence were significantly improved in intervention patients. CONCLUSION: Implementation of a specialized service for diabetes in community pharmacy resulted in better diabetes control and health care outcomes for the patient. ID - 3212 ER - Objective: To evaluate the effectiveness and cost of the pan-London pharmacy initiative, a programme that allows administration of seasonal influenza vaccination to eligible patients at pharmacies.; Design: We analysed 2013-2015 data on vaccination uptake in pharmacies via the Sonar reporting system, and the total vaccination uptake via 2011-2015 ImmForm general practitioner (GP) reporting system data. We conducted an online survey of London pharmacists who participate in the programme to assess time use data, vaccine choice, investment costs and opinions about the programme. We conducted an online survey of London GPs to assess vaccine choice of vaccine and opinions about the pharmacy vaccine delivery programme.; Setting: All London boroughs.; Participants: London-based GPs, and pharmacies that currently offer seasonal flu vaccination.; Interventions: Not applicable.; Main Outcome Measures: Comparison of annual vaccine uptake in London across risk groups from years before pharmacy vaccination introduction to after pharmacy vaccination introduction. Completeness of vaccine uptake reporting data. Cost to the National Health Service (NHS) of flu vaccine delivery at pharmacies with that at GPs. Cost to pharmacists of flu delivery. Opinions of pharmacists and GPs regarding the flu vaccine pharmacy initiative.; Results: No significant change in the uptake of seasonal vaccination in any of the risk groups as a result of the pharmacy initiative. While on average a pharmacy-administered flu vaccine dose costs the NHS up to £2.35 less than a dose administered at a GP, a comparison of the 2 recording systems suggests there is substantial loss of data.; Conclusions: Flu vaccine delivery through pharmacies shows potential for improving convenience for vaccine recipients. However, there is no evidence that vaccination uptake increases and the use of 2 separate recording systems leads to time-consuming data entry and missing vaccine record data.; Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ ID - 3213 ER - BACKGROUND: Cancers are one of the leading causes of death in the world and, due to the aging population, incidence rates are set to rise. As such, considerable effort has been placed on initiatives that aid the early detection of cancer, as this may improve patient survival outcome. One such initiative is the development of guidelines that explain how and when patient reported alarm symptoms suggestive of an underlying malignancy should be referred to a specialist. However, despite being conveniently placed to deliver interventions to promote the early detection of cancer, it is not clear what role community pharmacists could have in the development and implementation of these guidelines. OBJECTIVE: To: (1) assess the frequency and mean of patient reported alarm symptoms in a community pharmacy setting; (2) determine the demographics of patients presenting with the alarm symptom; and (3) explore the relationship between deprivation index of the community pharmacy and average frequency of alarm symptoms per pharmacy. SETTING: Thirty-three community pharmacies in the North of England. METHOD: A prospective study from September 2013 to February 2014. Each community pharmacy team was provided training in relation to alarm symptoms to ensure there was consistency in reporting. Deprivation tertiles for each community pharmacy were calculated using the IMD 2010 deprivation index. The data were analysed using a Kruskal-Wallis test in order to determine whether there were any statistically significant associations between average frequency of alarm symptoms presented per pharmacy and the deprivation tertile. MAIN OUTCOME MEASURE: Frequency of patient reported alarm symptoms. ID - 3214 ER - BACKGROUND: Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension., OBJECTIVE: The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges., METHOD: A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control - usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service., RESULTS: Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening., CONCLUSION: A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context. ID - 3215 ER - OBJECTIVE: Healthy lifestyle habits can reduce the risk of developing cardiovascular disease (CVD) and diabetes. However, our communities provide little support for individuals who are attempting to make lifestyle changes such as regular physical activity, weight reduction or smoking cessation. Community pharmacies are well placed to educate Canadians and support health promotion activities. METHODS: The MyHealthCheckUp program was designed to implement CVD and diabetes prevention programs in community pharmacies and educate the professional staff to promote health behaviour change. Web-based training modules were developed and tested to enhance the health coaching skills of pharmacy staff. Topics included personalized risk assessment, healthy eating, weight reduction, promoting physical activity, smoking cessation and health coaching. Onsite clinics were held, where individuals were apprised of their CVD and diabetes risks and individualized treatment plans were then developed. The MyHealthCheckUp program was evaluated in 21 pharmacies. RESULTS: Among the 200 patients who participated (56% female, mean age = 59.8 years), 49% were using antihypertensives, 15% were smokers and there was a family history of diabetes (38%) or CVD (26%). The average body mass index (BMI) was 28.2 and 60% were overweight or obese; only 53.6% reported that they exercised at a moderate level at least 3 hours per week. Using a 5-point Likert scale, patients rated the health coaching sessions as very helpful (79%) or helpful (20%) and 85% provided contact details for future sessions. DISCUSSION: A pharmacy-based health promotion program was well received by patients and effective at identifying high-risk individuals who could benefit from lifestyle changes. ID - 3216 ER - BACKGROUND AND OBJECTIVE: Chlamydia trachomatis infection is a common sexually transmitted infection with serious sequelae. Excellent access to testing, treatment and contact tracing are an essential part of strategies to control it. With traditional sexual health services over-stretched, community pharmacies are well placed to provide this service. They have the potential to improve access by offering chlamydia testing and treatment from high street venues with long opening hours. This study evaluated the feasibility and acceptability to users and pharmacists of this service in independent community pharmacies. METHOD: A chlamydia testing and treatment service was offered in three community pharmacies in two inner London boroughs for a 3-month pilot. Data on the feasibility and acceptability of the new service were collected via a survey of client experience, in-depth semistructured interviews with clients and pharmacists, and structured evaluation reports completed by professional patients paid to visit the pharmacies. RESULTS: 83 tests were taken with eight (9.5%) of these positive for C trachomatis. Of those tested, 94% (n = 73) were women and 71% (n = 56) were from ethnic minorities. 80 clients completed the questionnaires and 24 clients were interviewed. Most clients heard about the service from the pharmacist when requesting emergency contraception and 16% (n = 13) would not otherwise have been tested. Clients valued the speed and convenience of the service and the friendly, non-judgmental approach of the pharmacist. Confidentiality when asking for the service at the counter was suboptimal, and the pharmacist trained to deliver the service was not always available to provide it. CONCLUSIONS: Chlamydia testing and treatment in community pharmacies is feasible and acceptable to users. The service increases access among young women at high risk of sexually transmitted infection but not among young men. ID - 3217 ER - OBJECTIVES: To identify postmenopausal women with risk of osteoporosis through quantitative ultrasound imaging (QUI) and to value the medical intervention after the determination of the bone mineral density (BMD). METHODS: Cross-sectional descriptive study developed in a community pharmacy. During the month of June of 2005 the community pharmacy enrolled postmenopausal women into the study. Women in treatment with calcium, vitamin D, hormone replacement therapy, estrogen receptor modulators, calcitonin or biphosphonates were considered criteria for exclusion. To all the women that consent to participate, the pharmacist measured BMD with the device Sahara Hologic Ultrasound Bone Densitometer at right calcaneus. Following the World Health Organization, women were classified as osteoporotic if their T-Score was less than -2.5 and as osteopenic if their T-Score ranged between -2.5 and -1.0. RESULTS: Of the 100 women screened, 11 (11%) presented risk of osteoporosis and 61 (61%) of osteopenia. The 18.5% postmenopausal women with body mass index lesser than 30 presented risk of osteoporosis and the 63.0% osteopenia. CONCLUSIONS: The QUI constitutes a useful tool in community pharmacy for the screening of osteoporosis and it supposes a greater integration of the community pharmacy within the health care. ID - 3218 ER - This report contains findings from a needs assessment carried out on before of Knowsley Council examining the provision of needle exchange surveys within the local authority. The research considered the views and experiences of injecting drug users in the area and staff from drug services and pharmacies who provide needle exchange services. Findings around perceptions about the extent to which needle exchanges are meeting the needs of the injecting drug user population in Knowsley are considered in the context of recently updated NICE guidelines on the provision of needle and syringe programmes in England. ID - 3219 ER - PURPOSE: The impact of a community pharmacist telephone follow-up intervention (PTFI) on clinical outcomes, pharmaceutical care, and costs for patients undergoing antibiotic treatment was studied. METHODS: Patients receiving usual pharmacist intervention (UPI) were compared with PTFI patients in a multicenter, randomized, controlled trial. RESULTS: Compared with the UPI group (n = 129), the PTFI group (n = 126) had more drug-related problems (DRPs) (PTFI = 53%, UPI = 8%; p < 0.001). Oral recommendations (PTFI = 52%, UPI = 6%; p < 0.001), as well as recognized (PTFI = 10%, UPI = 2%; p = 0.015) and study-specific (PTFI = 5%, UPI = 1%; p = 0.064) pharmaceutical advices, were issued for more patients. The mean difference in the change in the number of infectious symptoms between the two groups (-0.24 symptom, 95% confidence interval [CI] = -1.22 to 0.74) and the change in the infection severity score (mean difference = -0.05 unit, 95% CI = -0.35 to 0.25) were small and not statistically significant. Adherence to treatment and patient satisfaction did not differ across the two intervention groups. The incremental direct costs of the PTFI varied from $2.65 to $5.11 (Canadian dollars) per patient, depending on whether cognitive services were reimbursed. CONCLUSION: A telephone follow-up by community pharmacists during antibiotic therapy was simple and quick and created opportunities to intervene with patients, but it did not create a greater change in the number of infectious symptoms or the infection severity score than did usual care. ID - 3220 ER - OBJECTIVES: To evaluate the impact of an automated phone call by a pharmacy owner on the number of herpes zoster vaccinations given in the independent community pharmacy setting, compare herpes zoster immunization numbers in the 3 months during the previous year to the 3 months during the intervention, and assess patient satisfaction with the automated phone call service., METHODS: This prospective study took place in an independent community pharmacy. A message was recorded by the pharmacy owner using a telephone-message program that notified patients aged 60 and older that the herpes zoster vaccine is recommended for them. This message was sent out monthly for a total of 3 months. Patients who received this vaccine in the 3 months following the initial phone call were surveyed to determine their reason for receiving the vaccine, and to assess satisfaction with the phone call. The total number of herpes zoster immunizations given at the pharmacy during the study period was compared to the total given at the pharmacy during the same period of the previous year., RESULTS: A total of 25 participants received the herpes zoster vaccine at the pharmacy during the study period, compared to 16 during the control period. Receiving the phone call was the most commonly cited reason for receiving the vaccine, followed by doctor recommendation. Of the 18 participants who received the call, 12 stated that they would be very likely to respond to similar phone calls in the future., CONCLUSION: These results demonstrate that using a targeted, automated phone call directed at eligible patients appears to have a positive effect on their willingness to receive the herpes zoster vaccine and may lead to an increase in vaccination numbers among eligible patients. Various factors must be considered before implementation of this service, including cost and added call volume., Copyright © 2017 American Pharmacists Association. Published by Elsevier Inc. All rights reserved. ID - 3221 ER - Using a structured interview technique, the perceptions of 1,000 members of the general public towards current activities and future roles of community pharmacists were investigated. The majority of participants (73.2%) visited a community pharmacy at least once per month and 76.7% of respondents perceived pharmacists as caring healthcare professionals. Over 80% of participants were in favour of pharmacists extending the range of services provided and almost 30% would like to see pharmacists offering more advice on minor ailments, a service which pharmacists presently provide. From answers given by those patients who were receiving prescriptions for repeat medication, it would appear that pharmacists are focused on providing a quick and efficient dispensary service with little attempt to provide pharmaceutical care. Determined efforts must be made to market the services presently provided by community pharmacists to the general public and to further developing the range of services provided. ID - 3222 ER - AIM: To investigate pharmacists' views and experiences of supplying emergency hormonal contraception (EHC) via a group prescribing protocol in community pharmacies in the UK. DESIGN: Qualitative study using depth interviews. SETTING: Community pharmacists in Manchester, Salford and Trafford (Greater Manchester), and Lambeth, Southwark and Lewisham (London) Health Action Zones in the UK. PARTICIPANTS: Forty-four community pharmacists supplying EHC in Manchester, Salford and Trafford, and Lambeth, Southwark and Lewisham (London). RESULTS: Pharmacists were broadly very positive about their experiences supplying EHC via the group prescribing protocol. Pharmacists identified many benefits of the EHC schemes for clients, in particular, improved access to EHC at no cost to clients. The confidential nature of the scheme was also seen as an advantage as was the scope for referral to other service providers. Pharmacists also believed that the scheme had benefits for the profession in terms of enhanced professional standing. However, their concerns included the extent of repeated use of EHC, the possible impact on contraceptive behaviors and sexually transmitted infections and its impact on male coercive sexual behavior. CONCLUSIONS: Although pharmacy supply of EHC may improve access for some clients and is perceived as a popular service, research into the implications of the schemes as identified in this study need to be conducted. ID - 3223 ER - Pasted from text below The evaluation design drew on national guidance[3] and focused on priorities agreed with CPWY. Within the available resources the University team would analyse available data which CPWY would 3 provide. The study had a particular focus on team working and team development in HLP pharmacies following award of HLP status, reflecting CPWY’s commitment to establishing its Community Pharmacy Development Academy to provide resources and training for pharmacy teams. Objectives: The evaluation investigated: • Is participation as a HLP associated with changes in uptake and delivery of services? • What is the effect of HLP services on public-reported experiences? • What is the effect of HLP on pharmacy team performance? • Is pharmacy demography associated with HLP performance? • Are there any other effects of the HLP programme? The specific evaluation questions were: 1. Is the award of HLP status associated with changes in the volume of service provision for MUR and NMS? 2. Is the award of HLP status associated with any changes in the provision of healthy living advice in the MUR and NMS services? 3. Do non-HLP pharmacies show any changes in the volume and content of MUR and NMS? 4. Are the services provided by HLP pharmacies acceptable to the public? 5. What is the level of service user awareness of the HLP concept? 6. If the HLP services had not been available, what alternatives would service users have utilised? 7. What is the demographic profile of HLP service users? 8. Is there any evidence that the HLP programme contributes to reducing health inequalities? 9. Is HLP status associated with any changes in organisational development? ID - 3273 ER - The goal of the initiative was to evaluate the impact of an innovative practice model on identification of unmet vaccination needs and vaccination rates. This was accomplished through a prospective, multisite, observational study in 8 community pharmacy practices with adults receiving an influenza vaccine with a documented vaccination forecast review from October 22, 2015 through March 22, 2016. When patients presented for influenza vaccinations, pharmacists utilized immunization information systems (IIS) data at the point of care to identify unmet vaccination needs, educate patients, and improve vaccination rates. The main outcome measures were the number of vaccination forecast reviews, patients educated, unmet vaccination needs identified and resolved, and vaccines administered. Pharmacists reviewed vaccination forecasts generated by clinical decision-support technology based on patient information documented in the IIS for 1080 patients receiving influenza vaccinations. The vaccination forecasts predicted there were 1566 additional vaccinations due at the time patients were receiving the influenza vaccine. Pharmacist assessments identified 36 contraindications and 196 potential duplications, leaving a net of 1334 unmet vaccination needs eligible for vaccination. In all, 447 of the 1334 unmet vaccinations needs were resolved during the 6-month study period, and the remainder of patients received information about their vaccination needs and recommendations to follow up for their vaccinations. Integration of streamlined principle-centered processes of care in immunization practices that allow pharmacists to utilize actionable point-of-care data resulted in identification of unmet vaccination needs, education of patients about their vaccination needs, a 41.4% increase in the number of vaccines administered, and significant improvements in routinely recommended adult vaccination rates. ID - 3224 ER - BACKGROUND: Obesity is a growing problem in England with one quarter of the adult population being obese and around 60 % being overweight or obese. Given the high costs of treating obesity-related conditions such as coronary heart disease and type-2 diabetes the UK Government aims to reduce obesity through public health services including those provided by community pharmacists. OBJECTIVE: To evaluate the effectiveness of a community pharmacy weight management clinic in assisting obese patients to reduce their weight. SETTING: Community pharmacies across four Primary Care Trusts in England. METHODS: Retrospective analysis of data collected by pharmacies providing weight management programmes. The service involved measurement with provision of advice and support. Data analysis consisted of frequency counts, percentages and means with standard deviations (SD) for demographic and biometric variables. Paired t tests were used to compare weight, waist circumference and blood pressure at 3 and 6 months. MAIN OUTCOME MEASURE: Weight change at 3 months. RESULTS: 281 patients attended the programme across four Primary Care Trusts. Three-quarters were female, mean age 52.8 years (SD +/- 14.4) and mean baseline weight 96.3 kg (SD +/- 15.7). At 3 months patients had lost weight (mean change = -3.07 kg) and waist circumference (mean change = -3.87 cm), but there was no difference in blood pressure. After 6 months weight and waist circumference were further reduced from baseline (mean change = -4.59 kg, -4.79 cm respectively) and there was a reduction in blood pressure (mean change systolic = -9.5 mmHg; diastolic = -4.7 mmHg). CONCLUSION: The study has demonstrated that reductions in weight and waist circumference can be achieved in patients who participate in a community pharmacy weight management programme. ID - 3225 ER - BACKGROUND: Urinary tract infections (UTIs) are one of the most common conditions seen in female patients within primary care. Community pharmacists are familiar with symptomatic UTI management and supplying trimethoprim under patient group direction (PGD) for moderate-to-severe uncomplicated UTIs could improve patient access to treatment. AIM: To compare the care pathway of patients with UTI symptoms attending GP services with those receiving management, including trimethoprim supply under PGD, via community pharmacies. DESIGN AND SETTING: Prospective, cross-sectional, mixed methods approach in 10 community pharmacies within NHS Greater Glasgow and Clyde. METHOD: Pharmacies invited a purposive sample of female patients to participate. Pharmacists had the option of supplying trimethoprim under PGD to patients with moderate-to-severe infection meeting the PGD inclusion criteria. Data from patient (questionnaires and semi-structured telephone interviews) and pharmacist (questionnaires and semi-structured, face-to-face interviews) were quantitatively and qualitatively analysed. RESULTS: Data were recorded on 153 patients, 97 presenting with GP prescriptions and 56 presenting directly in the pharmacy with symptoms suggestive of UTI, of whom 41 received trimethoprim via PGD and 15 received symptomatic management. Both GP adherence to local infection management guidelines and pharmacist application of PGD inclusion/exclusion criteria required improvement. There was demand and support, from patients and pharmacists, for access to antibiotic treatments for UTIs, without prescription, through community pharmacies. CONCLUSION: Operating within PGD controls, antibiotic treatments for UTIs could be provided via community pharmacy to improve patient access to treatment which may also maintain antibiotic stewardship and reduce GP workload. ID - 3226 ER - OBJECTIVE: To investigate the effects of pharmacy based counselling on changes in lifestyle and body weight. METHODS: Three months after screening a stratified sample of 3,800 randomly chosen overweight persons were addressed with questionnaires. Half a year and 1 year later the assessment was repeated. Standard counselling (SC; non-specific recommendations towards lifestyle), intensive counselling (IC; additional advice to reduce body weight) and counselling for persons at high risk for type 2 diabetes (HRC; recommendation to contact a physician) were compared. RESULTS: All counselling groups (SC; n = 557, IC; n = 568, HRC; n = 245) showed significant weight loss three months after screening (0.6-1.9 kg). A further weight reduction was observed at 1 year follow up (1.1-2.4 kg). The HRC group showed a higher percentage of weight loss than the IC or SC group after 3 months (-2.25% vs. -1.20% and -0.67%; P < 0.001) and at 1 year of follow-up (-2.74% vs. -1.54% and -1.29%; P < 0.01). Lifestyle changes in physical activity and/or nutrition were reported by 81.2% in the HRC group, 74.1% in the IC group and 67.0% in the SC group. CONCLUSION: Immediate counselling in community pharmacies after screening for type 2 diabetes can result in significant lifestyle changes and weight loss in overweight individuals. ID - 3227 ER - BACKGROUND: Community-based diabetes screening programs can help sensitize the population and identify new cases. However, the impact of such programs is rarely assessed in high-income countries, where concurrent health information and screening opportunities are common place. INTERVENTION AND METHODS: A 2-week screening and awareness campaign was organized as part of a new diabetes program in the canton of Vaud (population of 697,000) in Switzerland. Screening was performed without appointment in 190 out of 244 pharmacies in the canton at the subsidized cost of 10 Swiss Francs per participant. Screening included questions on risk behaviors, measurement of body mass index, blood pressure, blood cholesterol, random blood glucose (RBG), and A1c if RBG was >7.0 mmol/L. A mass media campaign promoting physical activity and a healthy diet was channeled through several media, eg, 165 spots on radio, billboards in 250 public places, flyers in 360 public transport vehicles, and a dozen articles in several newspapers. A telephone survey in a representative sample of the population of the canton was performed after the campaign to evaluate the program. RESULTS: A total of 4222 participants (0.76% of all persons aged >18 years) underwent the screening program (median age: 53 years, 63% females). Among participants not treated for diabetes, 3.7% had RBG > 7.8 mmol/L and 1.8% had both RBG > 7.0 mmol/L and A1c > 6.5. Untreated blood pressure >140/90 mmHg and/or untreated cholesterol >5.2 mmol/L were found in 50.5% of participants. One or several treated or untreated modifiable risk factors were found in 78% of participants. The telephone survey showed that 53% of all adults in the canton were sensitized by the campaign. Excluding fees paid by the participants, the program incurred a cost of CHF 330,600. CONCLUSION: A community-based screening program had low efficiency for detecting new cases of diabetes, but it identified large numbers of persons with elevated other cardiovascular risk factors. Our findings suggest the convenience of A1c for mass screening of diabetes, the usefulness of extending diabetes screening to other cardiovascular risk factors, and the importance of a robust background communication campaign. ID - 3228 ER - OBJECTIVES: To determine whether community pharmacists using a risk assessment tool could encourage men who were overdue for a physical examination to visit a physician and to calculate the return on investment from the pharmacy perspective for offering a complimentary risk assessment service. DESIGN: 12-week, prospective cohort study using convenience sampling among men who visited participating pharmacies. SETTING: Cross-section of community pharmacies. PATIENTS: 382 men aged 25-74 years with potential health risks that were untreated or uncontrolled, or who had not had a physical examination within the past year. INTERVENTION: Screening for specific health risks with or without telephone follow-up. MAIN OUTCOME MEASURE: Overall male patient response to pharmacist recommendations for follow-up medical care. RESULTS: Of 382 men identified by the Men's Health Risk Assessment Tool (MHRAT) as being at risk for 1,194 significant health conditions (mean, 3.1 conditions per patient), 69% had not received a physical examination from a physician for a period ranging from more than 1 year to 22.6 years. Of men who were recommended to make an appointment, 64% were seen by a physician or were waiting on a scheduled appointment at the end of the study. No differences were seen between the telephone intervention group and the control group in rates of obtaining a physician examination. CONCLUSION: A positive public health initiative involving community pharmacists was demonstrated in this study. Community pharmacists had a significant impact on motivating men to see a physician for follow-up care once a potential health risk was identified. The MHRAT and the pharmacist recommendation or patient education were the motivating factors and not follow-up telephone interventions by the pharmacist. Given community pharmacists' unique accessibility, an enormous opportunity exists for community pharmacists to raise awareness of men's health care and influence men's health behavior. ID - 3229 ER - OBJECTIVES: To investigate whether the use of motivational interviewing (MI) in the community pharmacy improves immunization readiness and rates for hepatitis B, hepatitis A/B combination, herpes zoster, pneumococcal, and tetanus-diphtheria-acellular pertussis immunizations. SETTING: Kroger Pharmacy. PRACTICE DESCRIPTION: Grocery store pharmacies located in the Atlanta, GA, metropolitan area offering a variety of patient care services, including medication therapy management and immunizations. PRACTICE INTERVENTION: Patients were identified during workflow, and MI encounters were initiated to those eligible to receive hepatitis A/B combination, hepatitis B, herpes zoster, pneumococcal and/or tetanus-diphtheria-acellular pertussis vaccines. EVALUATION: Following each encounter, pharmacists completed patient demographic information and responses to 5-point Likert scale questions assessing patient readiness to receive immunizations at the beginning and end of the encounter, and if follow-up occurred, 5-point Likert scale questions assessing pharmacists' perception of using MI. RESULTS: Immunization rates at the intervention site did not significantly increase due to the small sample size and other project limitations. Patient readiness to receive immunizations improved from the beginning to the end of the MI encounter and was statistically significant for hepatitis B (P = 0.001) and pneumococcal (P = 0.033) vaccines. Pharmacists agreed MI was an effective tool to discuss immunizations, agreed they could communicate more effectively about immunizations, and agreed MI could be incorporated into the community pharmacy workflow. CONCLUSION: Motivational interviewing may be a useful tool for community pharmacists to use in discussing immunizations. Larger studies need to be completed to determine the impact MI could have on immunization readiness and rates in the community pharmacy. ID - 3230 ER - BACKGROUND: Broadening the range of services provided through community pharmacy increases workloads for pharmacists that could be alleviated by reconfiguring roles within the pharmacy team., OBJECTIVES: To examine pharmacists' and pharmacy technicians (PTs)' perceptions of how safe it would be for support staff to undertake a range of pharmacy activities during a pharmacist's absence. Views on supervision, support staff roles, competency and responsibility were also sought., METHODS: Informed by nominal group discussions, a questionnaire was developed and distributed to a random sample of 1500 pharmacists and 1500 PTs registered in England. Whilst focused on community pharmacy practice, hospital pharmacy respondents were included, as more advanced skill mix models may provide valuable insights. Respondents were asked to rank a list of 22 pharmacy activities in terms of perceived risk and safety of these activities being performed by support staff during a pharmacist's absence. Descriptive and comparative statistic analyses were conducted., RESULTS: Six-hundred-and-forty-two pharmacists (43.2%) and 854 PTs (57.3%) responded; the majority worked in community pharmacy. Dependent on agreement levels with perceived safety, from community pharmacists and PTs, and hospital pharmacists and PTs, the 22 activities were grouped into 'safe' (n = 7), 'borderline' (n = 9) and 'unsafe' (n = 6). Activities such as assembly and labeling were considered 'safe,' clinical activities were considered 'unsafe.' There were clear differences between pharmacists and PTs, and sectors (community pharmacy vs. hospital). Community pharmacists were most cautious (particularly mobile and portfolio pharmacists) about which activities they felt support staff could safely perform; PTs in both sectors felt significantly more confident performing particularly technical activities than pharmacists., CONCLUSION: This paper presents novel empirical evidence informing the categorization of pharmacy activities into 'safe,' 'borderline' or 'unsafe.' 'Borderline' activities will deserve particular attention, especially where they are part of processes, e.g. dispensing. This categorization could help inform reconfiguration of skill mix in community pharmacy and thus make an important contribution to the rebalancing medicines legislation agenda and pharmacist supervision.Copyright © 2015 Elsevier Inc. All rights reserved. ID - 3231 ER - Objectives To quantify current levels of methadone dispensing and supervised consumption for the treatment of drug misuse in community pharmacies in the south west of England. To compare 2003–2004 data to estimates made in 1995. Setting All community pharmacies in the strategic health authority areas of Avon, Gloucestershire and Wiltshire; Dorset and Somerset; and South West Peninsula (n = 903). Method A self-completion postal questionnaire was addressed to the ‘pharmacist in charge’, with up to three reminders. Descriptive data were collected on demography and drug misuse services provided by the pharmacist. Key findings An overall response rate of 78.3% (707/903) was achieved. Of all respondents, 69.2% (n = 489) dispensed methadone for the treatment of drug misuse, and 70.1% of these pharmacies (n = 343) reported providing a supervised methadone consumption service. The total number of clients receiving methadone through pharmacies in the south west was 3427, with a mean number of 7.0 clients per pharmacy; 49.5% of all clients receiving methadone had their daily doses supervised by the pharmacist. The majority of prescriptions issued for methadone (72.9%, n = 2503) were from general practice. Conclusions The majority of pharmacies (69.2%) in south west England dispense methadone and other drugs to drug misusers with just under half of the clients (49.5%) receiving their methadone by supervised consumption. ID - 3232 ER - Abstract Objective: To evaluate the impact pharmacist-provided screening and education had on patient knowledge of osteoporosis and preventive strategies. Methods: A prospective, randomized, controlled study was conducted at 16 locations of a national supermarket chain pharmacy in the Richmond, Virginia area. Women 30 years and older with no history of osteoporosis were enrolled in the study. Patients selfselected into the study by agreeing to the bone density screening, pharmacist-provided education, and completion of a knowledge survey. Subjects were randomized to complete the osteoporosis-related knowledge survey either before (Group A) or after (Group B) the screening and education session. The survey was developed after guideline and literature evaluation and was pretested with a group of patients for content and clarity. The survey evaluated knowledge of osteoporosis, risk factors for the disease, appropriate age for testing, and preventive strategies. Groups A and B were compared using t-tests. Results: A total of 110 women were enrolled in the study. The mean (±SD) age was 52.5 ± 13.1 years in Group A (n=52) and 52.7 ± 11.5 years in Group B (n=58). Knowledge scores were higher in the group who received pharmacist-provided education prior to completing the survey in each category (knowledge of the disease, risk factors, preventive strategies, and appropriate age for testing) and overall (p<0.001). Conclusions: Community pharmacist-provided osteoporosis screening and education increased patient knowledge about osteoporosis and preventive strategies. Community pharmacist involvement with increasing patient knowledge may empower patients to engage in prevention strategies to improve bone mass. Objective: To evaluate the impact pharmacist-provided screening and education had on patient knowledge of osteoporosis and preventive strategies. Methods: A prospective, randomized, controlled study was conducted at 16 locations of a national supermarket chain pharmacy in the Richmond, Virginia area. Women 30 years and older with no history of osteoporosis were enrolled in the study. Patients selfselected into the study by agreeing to the bone density screening, pharmacist-provided education, and completion of a knowledge survey. Subjects were randomized to complete the osteoporosis-related knowledge survey either before (Group A) or after (Group B) the screening and education session. The survey was developed after guideline and literature evaluation and was pretested with a group of patients for content and clarity. The survey evaluated knowledge of osteoporosis, risk factors for the disease, appropriate age for testing, and preventive strategies. Groups A and B were compared using t-tests. Results: A total of 110 women were enrolled in the study. The mean (±SD) age was 52.5 ± 13.1 years in Group A (n=52) and 52.7 ± 11.5 years in Group B (n=58). Knowledge scores were higher in the group who received pharmacist-provided education prior to completing the survey in each category (knowledge of the disease, risk factors, preventive strategies, and appropriate age for testing) and overall (p<0.001). Conclusions: Community pharmacist-provided osteoporosis screening and education increased patient knowledge about osteoporosis and preventive strategies. Community pharmacist involvement with increasing patient knowledge may empower patients to engage in prevention strategies to improve bone mass. ID - 3233 ER - BACKGROUND: It is widely accepted that excessive drinking contributes to both health and social problems. There has been considerable interest in the potential of community pharmacies as a setting for health advice, and evidence suggests that interventions by pharmacists can be effective. Research on interventions relating to alcohol consumption in primary care has focused on general practice, and although some evidence exists about the efficacy of pharmacy interventions, little research to date has taken place in the UK. The aim of this study was to evaluate the acceptability of alcohol screening and brief interventions to women accessing emergency hormonal contraception (EHC) in community pharmacies. METHODS: An initiative whereby women who accessed community pharmacies for EHC would be asked to complete an AUDIT questionnaire following their EHC consultation was introduced by a Primary Care Trust (PCT) in the North-East of England. The evaluation incorporated three strands: interviewing pharmacists (n = 14) about the implementation and acceptability of the initiative; interviewing clients (n = 22) identified as "low risk" to understand their perceptions of the initiative; conducting online follow-up surveys with clients in the "risky" group (n = 53) to evaluate the impact of the initiative on their alcohol consumption and contraceptive behaviour, as well as their perceptions of the service. RESULTS: Pharmacists' attitudes towards screening were generally positive, although there were organisational obstacles to providing the service. Some felt uncertain about engaging clients in conversation about a sensitive topic. However, clients themselves did not report feeling embarrassed or upset, and most were happy to talk to the pharmacist and be given advice. Most clients felt that the pharmacist was an appropriate person to carry out alcohol screening and advice. CONCLUSIONS: It is feasible for pharmacists to carry out screening and brief advice, and most customers find it acceptable. However, pharmacist take-up of the service and participation in the study was low. Pharmacists were enthusiastic about providing screening and other health promotion services; targeting different population groups for alcohol screening may be more successful. Delivery of the AUDIT tool by pharmacists may not obtain reliable responses from some specific client groups. ID - 3234 ER - Background: Many patients with hepatitis C virus (HCV) infection lie undiagnosed and a significant proportion of patients that have been identified are disengaged from specialist services. The Isle of Wight (IOW) typifies this issue, with an estimated 200 undiagnosed patients with HCV infection and a small number of known cases engaged with specialist services. Aim: To reduce the burden of undiagnosed HCV on the IOW and link new diagnoses directly to specialist care. Service development, design and implementation: Dry blood spot tests were undertaken at community pharmacies for HCV, hepatitis B, HIV and syphilis. Individuals testing positive for HCV RNA or hepatitis B surface antigen were automatically referred to the mainland hepatology service and were seen at a pharmacy 'point-of-diagnosis' consultation with the testing pharmacist and hepatologist. Pharmacy testing activity was compared with the local drug support centre (island recovery integrated service [IRIS]). Service outcomes: Over a period of nine months (September 2014 to May 2015), a total of 88 tests were performed at community pharmacies. Of these, 39 of the individuals tested reported injecting drug use as their main risk factor; 17 of these were not engaged at IRIS and were significantly less likely to have had a previous test (77% vs. 41%, P =0.04). During the same period at the IRIS centre, 34 tests were performed. A greater proportion of individuals had a history of injecting drug use (85%, P <0.01) and were more likely to have had a test in the past three years (56%P, =0.07). Overall, 7% of pharmacy tests and 9% of IRIS tests were positive for HCV RNA (P =0.7); all pharmacy cases were seen at a point-of-diagnosis consultation with a hepatologist Conclusion: Pharmacy-based testing has the potential to reach at-risk individuals who are not tested for HCV elsewhere. When combined with integrated specialist referral, it has the potential to reduce the burden of undiagnosed HCV and engage new diagnoses directly with specialist care. ID - 3235 ER - BACKGROUND: The results of the Asheville Project have shown the success of a community-based, chronic disease management model in improving clinical outcomes in patients with chronic disease while reducing annual costs of care per participant. The question arose whether other programs using a similar management model and implemented in other communities could replicate the success of the Asheville Project in improving clinical outcomes and reducing costs for patients with a chronic disease. OBJECTIVE: To assess the long-term clinical and financial outcomes of a chronic care management model for patients with diabetes, using the Asheville care management model that was successful in the management of several chronic diseases. STUDY DESIGN: Longitudinal, 3-year (2007-2009), quasi-experimental, multisite, pre-/postenrollment study. METHODS: Self-insured health plan members with diabetes agreed to meet on a regular basis (ie, an average of every 3 months) with a healthcare professional. Participants received reduced copayments on diabetes-related medications and supplies as an incentive for participating in the study. Providers utilized a web-based electronic medical record system that provided updated medical and prescription data and highlighted gaps in care based on national standards. Program providers included community pharmacists, population health management company pharmacists, and nurses at on-site clinics, trained in use of evidence-based guidelines of care. Providers assessed patients' medications, knowledge level, and lifestyle; provided patient education and goal setting; and referred patients for physician follow-up and recommendations to physicians. The majority of the encounters were face-to-face. RESULTS: The study included 95 plan members in the clinical cohort participating for 1 year or more, and 54 members in the financial cohort who have been participating in the program for 3 years. At the end of 3 years, the percentages of those achieving guideline goals increased from baseline to the latest follow-up included, respectively, reaching target hemoglobin A1c levels, 38% to 53%; low-density lipoprotein cholesterol, 46% to 67%; systolic blood pressure (BP), 55% to 72%; diastolic BP, 60% to 71%; annual eye examination, 37% to 61%; and self-testing blood glucose, 79% to 97%. Total healthcare costs decreased by an average of $2704 per participant per year. The program's return on investment was $4.89 to every $1 spent (including program costs). CONCLUSION: The Hickory Project shows that it is possible to produce sustained improvements in clinical outcomes and reductions in healthcare costs for patients with diabetes using a chronic care model that provides frequent patient follow-up, a focus on appropriate medication therapy, adherence to clinical practice guidelines, and a reduction in prescription copayments for antidiabetes medications as an incentive for patients to participate in the program. ID - 3236 ER - Background: A large (12,374 financial cohort, 2,623 clinical cohort), multi-year (4 year), multi-site (7 states, 70 communities), multi-employer (10 employers) study to determine if a previously successful single-community chronic care model (Asheville Project®) could be replicated in multiple communities. Objective: Assess long-term clinical and financial outcomes of a chronic disease management model for diabetes, hypertension, and/or dyslipidemia. Design: Observational, longitudinal, retrospective, 4 year, quasi-experimental, multi-site, pre-post and control group study. Setting: Ten self-insured health plans, 70 community locations across the U.S. Patients: Members with eligible condition meet with a “health coach”, pharmacist or health educator, on a regular basis between physician office visits. Participants received reduced co-payments on disease related medications as incentive. Main Outcome Measures: Changes in health plan costs, changes in guideline clinical measures. Results: Financial analysis—Participant group’s total health plan cost decreased by $2,148.83 per person per year (PPPY) diabetes, $414.37 PPPY dyslipidemia, $139.56 PPPY hypertension, $943.86 PPPY combining all programs. In contrast, control group’s total health care costs increased $752.63 PPPY diabetes group, $520.42 PPPY dyslipidemia group, $789.95 PPPY hypertension group, and $690.26 PPPY combining all control group patients. Return-On-Investment (ROI) for participant groups: $5.49:1 (diabetes), $2.36:1 (dyslipidemia), $1.86:1 (hypertension), and $4.05:1 combined programs. Participant’s costs decreased 25.5%, control patient’s costs increased 15.1% (net difference of 40.6%) over 4 year study. Clinical analysis—(2,623 in clinical cohort): Group not at nationally recommended clinical goals at baseline had statistically significant changes (improvements) in clinical measures related to diabetes, hypertension, and dyslipidemia. Group at mean clinical goal at baseline continued to be at goal. Conclusion: A replication of the Asheville Project® chronic care model resulted in reduced net health plan costs and improved clinical measures for diabetes, hypertension, and dyslipidemia, using this model that provided frequent follow-up by pharmacists/health educators, emphasis on appropriate medication therapy, patient education, guideline goals. ID - 3237 ER - No abstract available ID - 3238 ER - This study aimed to assess the effectiveness of a novel, community-based weight management programme delivered through general practitioner (GP) practices and community pharmacies in one city in the United Kingdom. This study used a non-randomized, retrospective, observational comparison of clinical data collected by participating GP practices and community pharmacies. Subjects were 451 overweight or obese men and women resident in areas of high socioeconomic deprivation (82% from black and minority ethnic groups, 86% women, mean age: 41.1 years, mean body mass index [BMI]: 34.5 kg m(-2)). Weight, waist circumference and BMI at baseline, after 12 weeks and after 9 months were measured. Costs of delivery were also analysed. Sixty-four per cent of participants lost weight after the first 12 weeks of the My Choice Weight Management Programme. There was considerable dropout. Mean percentage weight loss (last observation carried forward) was 1.9% at 12 weeks and 1.9% at final follow-up (9 months). There was no significant difference in weight loss between participants attending GP practices and those attending pharmacies at both 12 weeks and at final follow-up. Costs per participant were higher via community pharmacy which was attributable to better attendance at sessions among community pharmacy participants than among GP participants. The My Choice Weight Management Programme produced modest reductions in weight at 12 weeks and 9 months. Such programmes may not be sufficient to tackle the obesity epidemic.Copyright © 2014 The Authors. Clinical Obesity © 2014 International Association for the Study of Obesity. ID - 3240 ER - This report details an evaluation of the My Choice Weight Management Programme undertaken by a research team from the School of Pharmacy at Aston University. The My Choice Weight Management Programme is delivered through community pharmacies and general practitioners (GPs) contracted to provide services by the Heart of Birmingham teaching Primary Care Trust. It is designed to support individuals who are ‘ready to change’ by enabling the individual to work with a trained healthcare worker (for example, a healthcare assistant, practice nurse or pharmacy assistant) to develop a care plan designed to enable the individual to lose 5-10% of their current weight. The Programme aims to reduce adult obesity levels; improve access to overweight and obesity management services in primary care; improve diet and nutrition; promote healthy weight and increased levels of physical activity in overweight or obese patients; and support patients to make lifestyle changes to enable them to lose weight. The Programme is available for obese patients over 18 years old who have a Body Mass Index (BMI) greater than 30 kg/m2 (greater than 25 kg/m2 in Asian patients) or greater than 28 kg/m2 (greater than 23.5 kg/m2 in Asian patients) in patients with co-morbidities (diabetes, high blood pressure, cardiovascular disease). ID - 3239 ER - Increasing public awareness of cancer signs and symptoms can lead to earlier presentation, referral and diagnosis of cancer. Pharmacies provide a key setting for raising public awareness of cancer signs and symptoms and for engaging with symptomatic individuals who have not presented to their GP. This campaign aimed to increase public awareness of the signs and symptoms of cancer within a community pharmacy setting and to encourage appropriate GP presentation............... ID - 3241 ER - OBJECTIVE: Expedited partner treatment (EPT) for uncomplicated Chlamydia trachomatis at the pharmacy is an alternative approach to partner notification that has not yet been evaluated within the UK. The aim of this study was to evaluate EPT for partners using pharmacies in Lothian. DESIGN: A pilot study over 18 months. SETTING: Selected healthcare settings and community pharmacies in Lothian, Scotland, UK. POPULATION: Sexual partners of index cases with uncomplicated C. trachomatis. METHODS: Index cases with uncomplicated C. trachomatis were given a pharmacy voucher to pass onto sexual partners. Partners could redeem vouchers for free treatment (azithromycin) at one of 90 pharmacies in the area. MAIN OUTCOME MEASURES: The main outcome measure was the proportion of vouchers redeemed. Secondary outcomes included patient satisfaction, as determined at a telephone follow-up of a subgroup of female index cases from one study site, 1 month later. RESULTS: In total 577 vouchers were issued to chlamydia-positive index patients of mean age 22.9 years (range 15-47 years). A total of 231 vouchers were redeemed (40%), at a median of 2 days after issue. Only 4% of partners attended a clinic for treatment. Most index patients surveyed reported that partners were satisfied with this method of treatment (48 out of 55; 87%). CONCLUSIONS: Expedited partner treatment for uncomplicated chlamydia at a pharmacy is a popular choice, and increases options on where, when and how partners are treated. ID - 3242 ER - Introduction The “Young Diabetics Project” was a funded health promotion initiative in Wiltshire during 2015. Activity started in June 2015, with the intention of completing all patient interactions by the end of the financial year (ending 3 0 th March 2016) This was an innovative project due to its specific focus on the Young Adult age - group, and targeting patients with diabetes. Despite diabetes being a Public Health and NHS priority nationally, there are few services commissioned in communit y pharmacy with a specific focus on this group. This document will describe the aims and objectives of the project; share the processes and results; describe the challenges of implementation and make recommendations for future initiatives. ID - 3243 ER - OBJECTIVE: To establish low-cost easily conducted health promotion interventions for advanced pharmacy practice experience (APPE) students in community pharmacy settings that would increase women's awareness about health issues using Food and Drug Administration (FDA) educational materials. METHODS: Students distributed fact sheets on medication use, heart disease, and diabetes to women over 45 years of age at 6 community pharmacy APPE sites. Interventions completed were either personal medication records (PMR) to identify medication-related problems (MRP) or heart health screenings followed by completion of an anonymous patient satisfaction survey instrument. RESULTS: Over 1500 fact sheets were distributed. Fifty-eight women (age 61 +/- 15 years) completed PMRs, which identified 57 MRPs in 42 patients. Twenty-four women indicated the screening was "useful/very useful" for increasing medication understanding. Sixty-three women completed heart health screenings. Thirty-one of the 40 who completed the survey instrument indicated the screening was "useful/very useful" for learning heart disease risk. CONCLUSIONS: Community pharmacy APPE students interventions identified MRPs and patients at risk for heart disease. These health promotion interventions enhanced women's awareness of these topics while guiding students to achieve the desired curricular outcomes. ID - 3244 ER - BACKGROUND: Pharmaceutical care programs have been shown to improve outcomes in hypertension. However, most programs required direct access to patient medical chart and patient consultation sessions by appointment. OBJECTIVE: To follow the current practice of community pharmacy, exploring the effect of an intervention program on blood pressure (BP) and factors affecting BP. METHODS: Treated hypertensive patients were enrolled in a 9-month controlled study involving 9 community pharmacies. The PRECEDE-PROCEED model was used as conceptual framework to identify factors affecting BP, to incorporate those factors in an intervention program, and to evaluate the impact of the program. A computerized decision-aid tool was used by pharmacists from 4 pharmacies to provide pharmaceutical care to subjects (n = 41); pharmacists from the 5 other pharmacies performed usual care (n = 59). As there was a statistically significant interaction due to family income in describing the impact of pharmacists' intervention on BP, population was stratified by family income in the analyses. RESULTS: Compared with the control group, the pharmacy program resulted in significant systolic BP reduction (-7.8 vs. 0.5 mm Hg; p = 0.01) and an increase in the proportion of controlled patients only for those with high incomes. In the high-income group, the program also had a positive impact on physical activity, self-reported adherence, health concerns, and information transmitted. The low-income group did not appear to benefit from the program. CONCLUSIONS: Pharmacist intervention can modify factors affecting adherence, improve adherence, and reduce BP levels in patients treated with antihypertensive agents. Impact of pharmacist intervention on BP differed according to patient income status. ID - 3245 ER - The role of community pharmacy (CP) in health promotion has developed over the last decade and a half following the introduction of the new National Health Service (NHS) plan in 2000. CPs have been turned into healthy living centres where individuals can access a variety of services designed to prevent disease and promote health. In 2005, three types of pharmacy service were introduced; essential, advanced and enhanced (currently known as locally commissioned). Enhanced pharmacy services were provided by Primary Care Trusts (PCTs) (until 2010) based on local needs identified by PCTs. In 2010, the Government decided to abolish the PCTs by 1‘"t April 2013; hence, PCTs entered a transition phase between 2010 and April 2013. By February 2011, each PCT was required to publish Pharmaceutical Needs Assessment (PNA) report regarding the provision and need for pharmacy services. The national commissioned vascular and sexual health enhanced pharmacy services in England are Stop Smoking Service (SSS), NHS health check, Emergency Hormonal Contraception (EHC) and chlamydia screening and treatment services. In 2012, the Healthy Living Pharmacy (HLP) scheme, which was piloted in Portsmouth PCT, was expanded to 30 PCTs known as HLP pathfinder PCTs. The aim of this research was to identify the correlation between needs, provision and uptake of vascular and sexual health pharmacy services at a PCT and CP level. It also aimed to investigate whether the provision of those services was cost effective. Finally, it aimed to determine the impact of the introduction of the HLP scheme on the provision and uptake of those services. At a PCT level, the PNA reports were used to identify the CP provision of SSS, EHC service and chlamydia screening service for the financial year 2009/2010. The local need for SSS (prevalence of smoking adults) and EHC services (rates of teenage pregnancy) were obtained from Health Profiles for each PCT. The need for chlamydia screening service (prevalence of positive chlamydia infection) was obtained from the National Chlamydia Service Programme (NCSP). Uptake and cost attributed to provision of those services for the financial year 2009/2010 were obtained from a short questionnaire targeted the public health leads for the related services in PCTs where the provision of services and the needs were identified. Simple cost-effectiveness analyses were performed on CP SSS and CP EHC provision, based on identified uptake and cost. At a CP level, a cross-sectional survey was conducted on 1 249 CPs in 28 PCTs across England in 2013. PCTs were chosen based on provision of SSS, EHC and chlamydia screening service identified in the PNA reports. 7 PCTs out of 28 PCTs were HLP pathfinder PCTs. CPs were allocated to one of five groups based on deprivation. The response rates for SSS, EHC and chlamydia screening surveys were 30% (42/138), 30% (42/139) and 19% (21/111) respectively. Data analysis identified that the need for SSS and EHC services were highly correlated with deprivation, with Spearman's rank correlation coefficients (rho) of 0.76 and 0.83 respectively (both P 0.001). The correlation between deprivation and the need for a chlamydia service was weak (rho = 0.25, P = 0.009). Higher number of CPs per 25 000 population were observed in more deprived PCTs (rho = 0.63, P < 0.001). CP provision (percentage of CPs offering a service out of total CPs in a PCT) of SSS, EHC and chlamydia service did not correlate with needs. The uptake of SSS, EHC and the chlamydia screening service did not correlate with increasing need or deprivation. However, pharmacists in areas of higher need dealt with a greater number of clients in relation to SSS and EHC services to meet their local needs, with rho of 0.4 and P of 0.01 in case of SSS and Pearson's correlation coefficient (R) of 0.36 and P of 0.02 in case of EHC. A cost-effective analysis of CP SSS provision found it to be cost effective when compared to no intervention based on NHS perceptive and the incremental cost per Quality Adjusted Life Year (QALY) gained. was £1 511. Simila ly, the CP EHC service was also found to be cost effective with an NHS saving of £689 per unintended pregnancy prevented. The response rate for the CP survey was 19.3% (241/1 249). No significant differences were identified in terms of provision or uptake of SSS, EHC, chlamydia screening and NHS health check services between CPs with different deprivation neighbourhoods. 18.5% (31/168) of the respondent community pharmacists were working in HLPs. The uptake of SSS through HLPs (median = 6) was higher than that through non-HLPs (median = 4; P = 0.02)._Playing a more active role in health promotion was cited as the main driver for pharmacists to adopt an HLP scheme. Respondent pharmacists indicated that the introduction of an HLP scheme had improved public awareness of vascular and sexual health services available in CPs and they suggested the use of social media websites to further improve public awareness. Lack of time and the provision of similar services via other providers were considered the main barriers. Local Authorities should increase the provision of vascular and sexual health pharmacy services to meet the needs of their localities. They should use the latest technology to improve public awareness regarding availability of those services in CPs. ID - 3246 ER - Pharmacists in the ethnically diverse city of Leicester piloted Healthy Life Checks in inner-city pharmacies, for people aged 40-74. Pharmacists conducted checks including blood pressure, weight and glucose measurement and gave lifestyle advice. We present here the findings from semi-structured telephone interviews conducted with pharmacists and service users. ID - 3247 ER - AIM To assess how well client perceptions of pharmacy-based needle exchange services match the perceptions of the community pharmacists operating such schemes. DESIGN Structured interviews with the client sample. Semi-structured interviews with the pharmacist sample. Needle exchange client respondents were given a voucher which could be redeemed at the pharmacy where the interview took place. SUBJECTS AND SETTING 155 needle exchange clients and 9 community pharmacists within one health authority area in inner city south London. OUTCOME MEASURES Client sample use of needle exchange facilities and pharmacy sample experience of running needle exchange services. Both samples' perceptions of the positive and negative features of needle exchange services. RESULTS Both samples broadly agreed on which were the attractive components of the schemes, but to a much lesser extent on which were the unfavourable aspects. Gaps in perceptions included the amount of privacy in the transaction process. Despite pharmacist-reported difficulties with running schemes, there was a high level of commitment from pharmacists to providing needle exchange. Similarly, notwithstanding client-reported negative attributes, pharmacy-based needle exchanges remained attractive outlets to users and a primary source of their injecting equipment. CONCLUSIONS Pharmacy needle exchange schemes might represent an under-used resource for the delivery of effective harm reduction messages, and questions remain concerning the viability of further expanding interventions with drug users in public retail locations. Collaborative partnerships with agency-based needle exchange services might offer more effective harm reduction and better referral pathways into drug treatment services. ID - 3248 ER - OBJECTIVES: The copper intrauterine device (Cu-IUD) is the most effective method of emergency contraception (EC) and provides ongoing contraception, yet few women choose this option. This study evaluates the impact of an educational initiative involving pharmacists on uptake of Cu-IUDs for EC in an integrated sexual health clinic in the North East of England. METHODS: Since November 2010, local pharmacists have received intensive education detailing EC options including Cu-IUDs. At the same time a rapid access referral pathway for fitting of an emergency Cu-IUD was established. The impact of this initiative has been assessed by analysing case notes of women attending a large city centre sexual health service who received an emergency Cu-IUD during September and October 2010 (prior to the initiative) and the same 2 months in 2011 (9 months after the start of the intervention). RESULTS: The number of women fitted with an emergency Cu-IUD increased by almost three-fold from 11 fitted in September and October 2010 to 30 fitted in these 2 months in 2011. One woman was referred from a pharmacist to the service in the first audit period compared with 17 in the second. No pregnancies occurred in the first month after Cu-IUD insertion in these 41 women. CONCLUSIONS: Educating pharmacists has increased referral and uptake of Cu-IUD used for EC and this has the potential to reduce unintended pregnancies now and in the future. ID - 3249 ER - Aim. To assess the acceptability and safety, and patient's perspectives, of an anticoagulation monitoring service offered by community pharmacists. Design. Patient questionnaires and quantitative methods. Subjects and setting. 16 patients attending an anticoagulation clinic in a community pharmacy in north London. Outcome measures. Patients' measured international normalised ratios before and after transfer of care to community pharmacy clinic; patients' perceptions. Results. Patient satisfaction and perceptions of the pharmacists were high. Patients experienced less disruption to their lives than in a hospital clinic. Control of INR was at least as good as that obtained in the hospital clinic. Over 50% of patients thought they would be able to measure their INRs at home using the same equipment. At the end of the pilot period 14 of the 16 patients (86%) wanted the service established permanently. Conclusion. A safe and effective anticoagulation monitoring service can be delivered in a community pharmacy by community pharmacists. ID - 3250 ER - OBJECTIVE: Healthy Living Pharmacies (HLP) were introduced in the United Kingdom (UK) in a further attempt to deliver public health benefits in community pharmacy settings. Central to the initiative are staff trained as Healthy Living Champions (HLC) and this study sought to explore HLC perceptions of positive and negative aspect of their work and the wider scheme., METHODS: A qualitative study was undertaken with a purposive sample of HLCs working in pathfinder HCPs in the Sheffield area in 2014. Participants were recruited by email to either a focus group (n = 7) held at a training event or later semi-structured one-to-one interviews in pharmacies (n = 6). Four stages of interpretative phenomenological analysis were used to code and identify themes., KEY FINDINGS: Four main themes emerged relating to the positive workforce development impact HLPs had upon HLCs themselves and on perceived customer and patient engagement and benefits. Tensions were identified with existing commercial business demands and negative views overall of the pharmacy setting with a perceived lack of not only integration with other services but also awareness among the public and health care staff. HLCs felt empowered and more confident in initiating conversation about health issues with patients, but identified barriers relating to workload, a lack of time to perform their role, isolation, tensions with non-HLC staff and logistical barriers such as poor Internet access., CONCLUSIONS: Delivering public health activities through the HLC role in UK pharmacies is associated with several perceived benefits for different stakeholders, but may be threatened by well recognised barriers in UK pharmacies related to the commercial setting.Copyright © 2016 Royal Pharmaceutical Society. ID - 3251 ER - BACKGROUND: Community pharmacy is a potentially useful, easily accessed provider of NHS Health Checks. Little published work has reported outcomes or sought views of pharmacy Health Check attenders. This evaluation assessed findings of pharmacy Health Checks plus subsequent attendance after referral to general practices and obtained client views., METHODS: Mixed methods including: data abstraction from Health Check and practice records, questionnaire to all attenders and interviews with sample of questionnaire respondents., RESULTS: Data from 190 pharmacy Health Checks, performed in four pharmacies, showed that the majority of attenders (58%) were female, 53% white, with 80% aged under 55. Seventy five per cent had at least one modifiable cardiovascular risk factor, 8% had a cardiovascular disease risk score of >20%, 30% were referred to their practice for further tests/consultation, but only half of these attended. Lifestyle advice was offered to 74% and referral for support with changing lifestyle accepted by 20%. Survey respondents (66) were unrepresentative and fewer had modifiable risk factors. Many indicated that making lifestyle changes and their views on pharmacy Health Checks were positive, particularly reflecting accessibility., CONCLUSIONS: Pharmacy NHS Health Checks reach people with modifiable risk factors, identify those requiring further investigation and refer appropriately. Greater emphasis and encouragement are required to act on referrals if Health Checks are to maximize benefits.Copyright © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. ID - 3252 ER - BACKGROUND: The Counterweight Programme is a proven model for the management of obesity in the UK, evaluated over 5 years (2000-05) and demonstrating clinical and cost effectiveness. The Scottish Government commissioned three phases of Counterweight implementation during the period 2006-08. The first two phases linked the Counterweight Programme to a primary care cardiovascular disease prevention programme; the third phase was commissioned independent of other interventions. Aim. To assess the implementation of the Counterweight Programme in 13 Health Boards in Scotland and compare 12-month outcomes with published Counterweight data. METHODS: Patients with a body mass index (BMI) > 30 kg/m(2) or BMI > 28 kg/m(2) with at least one co-morbidity were screened for the Counterweight Programme. Patients were asked to attend nine structured appointments with a trained Counterweight Programme practitioner over 12 months. RESULTS: Six thousand seven hundred and fifteen patients from 184 general practices, 16 pharmacies and one centralized community-based service in 13 Health Boards, with a mean BMI of 37 kg/m(2) were enrolled in the Counterweight Programme. Twenty-six per cent had a BMI > 40 kg/m(2). Attendance for patients at 3, 6 and 12 months follow-up was 55%, 37% and 28%. Of those who attended at 12 months, 35.2% had maintained a weight loss of >5% compared to 30.7% in the original evaluation. CONCLUSIONS: Evaluation of the Counterweight Programme in Scotland demonstrated consistency in characteristics of patients enrolled into the programme. There was evidence of higher loss to follow-up in a population not routinely engaging with primary care but evidence of greater weight losses among those who attended. ID - 3253 ER - OBJECTIVE To assess the persistence of outcomes for up to 5 years following the initiation of community-based pharmaceutical care services (PCS) for patients with diabetes. DESIGN Quasi-experimental, longitudinal pre-post cohort study. SETTING Twelve community pharmacies in Asheville, N.C. PATIENTS AND OTHER PARTICIPANTS Patients with diabetes covered by self-insured employers' health plans. Community pharmacists trained in a diabetes certificate program and reimbursed for PCS. INTERVENTIONS Education by certified diabetes educators, long-term community pharmacist follow-up using scheduled consultations, clinical assessment, goal setting, monitoring, and collaborative drug therapy management with physicians. MAIN OUTCOME MEASURES Changes in glycosylated hemoglobin (A1c) and serum lipid concentrations and changes in diabetes-related and total medical utilization and costs over time. RESULTS Mean A1c decreased at all follow-ups, with more than 50% of patients demonstrating improvements at each time. The number of patients with optimal A1c values (< 7 %) also increased at each follow-up. More than 50% showed improvements in lipid levels at every measurement. Multivariate logistic regressions suggested that patients with higher baseline A1c values or higher baseline costs were most likely to improve or have lower costs, respectively. Costs shifted from inpatient and outpatient physician services to prescriptions, which increased significantly at every follow-up. Total mean direct medical costs decreased by $1,200 to $1,872 per patient per year compared with baseline. Days of sick time decreased every year (1997-2001) for one employer group, with estimated increases in productivity estimated at $18,000 annually. CONCLUSION Patients with diabetes who received ongoing PCS maintained improvement in A1c over time, and employers experienced a decline in mean total direct medical costs. ID - 3254 ER - OBJECTIVE To assess the importance of environment, patient characteristics, and health behavior in explaining differences in clinical, economic, and humanistic outcomes of pharmaceutical care services (PCS) for patients with diabetes. DESIGN Quasi-experimental, pre-post cohort-with-comparison group study using multivariate logistic regression. SETTING Twelve community pharmacies in Asheville, N.C. PATIENTS AND OTHER PARTICIPANTS Eighty-five patients with diabetes who were employees, dependents, or retirees from two self-insured employers; community pharmacists who completed a diabetes certificate program and received reimbursement for PCS. INTERVENTIONS Scheduled consultations with pharmacists involving education and training, assessment, monitoring, follow-up, and referral. MAIN OUTCOME MEASURES Change in glycosylated hemoglobin (A1c) value, diabetes diagnosis and all-diagnosis utilization and cost of medical care, quality of life, and satisfaction with pharmacy services. RESULTS The strongest predictors of improvement in A1c following PCS were the patient characteristics baseline glycemie control and type 1 diabetes. All patients with type 1 diabetes had reduced their A1c concentrations at follow-up. Patients in one employer group (an environmental characteristic) were significantly more likely to have a 10% reduction in diabetes diagnosis costs, compared with employees in the other group. They were also more likely to report improved satisfaction with pharmacy services. No other statistically significant relationships were found. CONCLUSION The greatest improvement in A1c occurred among patients with type 1 diabetes and/or higher baseline A1c concentrations. When controlling for other factors, PCS did not emerge as a significant factor in lowering A1c, but it was imprecisely measured, and our proxy measure did not capture the full complement of PCS provided to patients. Success in terms of cost savings and patient satisfaction differed by employer group. ID - 3255 ER - Objective: HIV testing is increasingly available, yet barriers to HIV testing persist for low-income black and Latino people, especially those who use illicit drugs. HIV exceptionalism, or the idea that a positive HIV diagnosis is drastically different from a diagnosis for any other disease, may influence HIV testing-related stigma, resulting in reduced willingness to undergo HIV testing. This pharmacy-based intervention combined HIV testing with less stigmatized chronic disease screening tests (e.g., blood pressure, glucose, and cholesterol) to equate the concept of an HIV diagnosis with other diagnoses.; Methods: Three pharmacies located in low-income, minority neighborhoods in New York City were enrolled in an intervention to provide (1) HIV testing, chronic disease screening, and a healthy lifestyles video that normalized all screening tests and destigmatized HIV as a fatal disease (comprehensive arm); (2) HIV testing and the video (video arm); and (3) HIV testing only (control arm). Injection drug users (IDUs) and pharmacy staff recruited un- and underinsured pharmacy customers, IDUs, and IDU peers from 2010 to 2012. Participants in the control group were compared with those in the comprehensive and video intervention groups.; Results: Participants in the comprehensive arm (prevalence ratio [PR] = 1.61, 95% confidence interval [CI] 1.03, 2.49, p=0.08) and the video arm (PR=1.59, 95% CI 1.00, 2.53, p=0.09) were marginally significantly more likely to receive an HIV test in the pharmacy compared with those in the control arm after adjustment.; Conclusions: These findings suggest that adoption of strategies that destigmatize and normalize HIV testing can improve uptake. Implementation of this strategy in low-access, minority communities with high HIV prevalence and among high-risk populations may help reduce racial/ethnic disparities in HIV.; ID - 3258 ER - Structural interventions may help reduce racial/ethnic disparities in HIV. In 2009 to 2011, we randomized pharmacies participating in a nonprescription syringe access program in minority communities to intervention (pharmacy enrolled and delivered HIV risk reduction information to injection drug users [IDUs]), primary control (pharmacy only enrolled IDUs), and secondary control (pharmacy did not engage IDUs). Intervention pharmacy staff reported more support for syringe sales than did control staff. An expanded pharmacy role in HIV risk reduction may be helpful. ID - 3256 ER - OBJECTIVES: In an effort to reduce HIV transmission among injection drug users (IDUs), New York State deregulated pharmacy syringe sales in 2001 through the Expanded Syringe Access Program by removing the requirement of a prescription. With evidence suggesting pharmacists' ability to expand their public health role, a structural, pharmacy-based intervention was implemented to determine whether expanding pharmacy practice to include provision of HIV risk reduction and social/medical services information during the syringe sale would (a) improve pharmacy staff attitudes toward IDUs (b) increase IDU syringe customers, and (c) increase prescription customer base in New York City neighborhoods with high burden of HIV and illegal drug activity. METHODS: Pharmacies (n = 88) were randomized into intervention (recruited IDU syringe customers into the study and delivered intervention activities), primary control (recruited IDU syringe customers only) and secondary control (did not recruit IDUs or deliver intervention activities) arms. RESULTS: Pharmacy staff in the intervention versus secondary control pharmacies showed significant decreases in the belief that selling syringes to IDUs causes community loitering. CONCLUSIONS: Structural interventions may be optimal approaches for changing normative attitudes about highly stigmatized populations.Copyright © 2014 Society for Public Health Education. ID - 3257 ER - OBJECTIVES: To date, the uptake of chlamydia screening in community pharmacies has been limited. The objective of this cross-sectional study was to determine if a cash reward, offered to both the provider and the consumer of chlamydia screening, increased the uptake of screening in community pharmacies. METHODS: During 4 weeks in 2011, chlamydia screening and education were offered in four city and two suburban pharmacies to people aged 16-30 years. Those who provided a urine sample for testing, contact details, and completed a brief questionnaire were rewarded with $A10. Positive participants, and their nominated contacts, were offered treatment. RESULTS: Over a period of 751.5 h, 979 testing kits were requested, and 900 (93%) urine samples returned. Using probabilistic linkage methods, we determined that 671/900 (75%) urine samples were from unique individuals. 0.9 unique samples were obtained/hour of screening, 63% of which were provided by men. 19/671 (2.8%; 95% CI 1.7% to 4.4%) people tested positive, 5.2% (95% CI 2.8% to 8.8%) of women, and 1.4% (1.4 0.5 to 3.1) of men. 11/19 (58%) people were contacted and treated-two for suspected pelvic inflammatory disease. CONCLUSIONS: Providing a cash reward to encourage chlamydia screening in community pharmacies resulted in greater participation rates than previously reported pharmacy-based studies, particularly among men. Easily implemented mechanisms to reduce inappropriate repeat screening, incorrect contact details and effects on pharmacy work flow may enhance the efficiency of this approach. ID - 3259 ER - Alcohol plays an important role in the economic and social life of countries such as the UK. Yet its excessive consumption creates complications and costs for health and social care systems, along with considerable distress for a significant minority of those who use alcohol, and those who come into contact with them. There is an extensive morbidity burden associated with alcohol use, which is the direct cause of about 10,000 (mainly male) deaths a year in the UK. Problem drinking is often defined in terms of alcoholism, and behaviours and consequences such as domestic and public violence, accidents and loss of employment. However, there are comparatively large numbers of individuals who consume hazardous amounts of alcohol and yet continue to function at work and in their homes. Chronic liver disease and cirrhosis deaths have, uniquely as against most other significant causes of premature death, been rising in the UK over the last 50 years. Further, the NHS in London spends over £250 million a year on alcohol attributable hospital admissions. This is the equivalent of £34 for every resident in the capital. There is an opportunity for community pharmacy to deliver community-based services traditionally provided by GPs or hospital outpatient clinics to individuals who wish to stop or reduce their drinking. This may in future reduce hospital admission rates. The results of a London wide community pharmacy public health campaign, reported here, show that the delivery through pharmacies of a scratch card based (AUDIT-C) alcohol use assessment tool is acceptable to both men and women of all ages and ethnicities in London. In three months over 24,000 scratch cards were distributed across London, with over 23,800 returned to pharmacies and recorded in an online system. Just over four out of every ten (43.5%. n=10,351) pharmacy customers completing the AUDIT-C scratch card recorded a score of five or above, indicative of higher risk drinking. These findings add weight to arguments in favour of enabling community pharmacies to develop further as ‘public health’ or ‘healthy living’ care and support centres. Future work is needed to establish the most cost effective interventions and referral practices for pharmacists seeking to help people who wish to reduce their alcohol related health and allied risk levels. Beyond immediate alcohol hazards, there are linked opportunities for community pharmacists to contribute to public and personal health improvements in areas such as sexual health protection, smoking cessation, weight mangement and the prevention of conditions such as oesophageal cancer (the incidence of which is also increasing in the UK) ID - 3260 ER - Beginning in January 2001, it became legal for pharmacies, health care facilities and certain health care providers in New York State (NYS) to sell or provide syringes (10 maximum) without prescription. Cross-sectional survey data from three research projects recruiting active injection drug users (IDUs) in Harlem and the South Bronx (n=682) were analysed by calendar quarter, from January 2001 through September 2002, to assist in an evaluation of the impact of the program, the Expanded Syringe Access Demonstration Program (ESAP). The outcome variable examined was having used a pharmacy as the source of the last injection syringe. The percent of IDUs who knew that it was legal to buy a syringe from a pharmacy increased over time (25-54%, P<0.001). Pharmacy as the source of the last injection syringe increased to approximately 20%, and syringe exchange programmes (SEPs) remained the most common source (approximately 50%). In a multiple logistic regression analysis, IDUs who knew it was legal were more likely to have purchased their last syringe from a pharmacy (AOR=4.65, CI=2.58-8.36). Pharmacies were more likely to be used by those who were younger (AOR=0.96, CI=0.93-0.99) and those who were White (AOR=2.55, CI=1.30-5.00), and calendar quarter was a significant independent predictor of pharmacy use (AOR=1.22, CI=1.06-1.40). Overall, these data indicate that: (a) knowledge about the option of purchasing syringes from a pharmacy has increased, but enhanced dissemination efforts to IDUs, especially particular sub-groups, are needed; and (b) pharmacies were becoming a supplemental source of syringes for active IDUs (in communities served by SEPs). ID - 3261 ER - Locally-commissioned pharmacy public health services have developed in England over the last 20 years. Few studies have sought pharmacist views on commissioning and provision of public health services in general. This study sought views of community pharmacists (n = 778) in 16 areas of England on services provided, decisions about services, support, promotion and future developments, using a postal questionnaire with two reminders. Response rate was 26.5% (206). Funded public health services provided most frequently were: emergency contraception (71%), smoking cessation (62%), and supervised drug consumption (58%). Blood pressure monitoring was provided by 61% and was considered to be one of the services pharmacists perceived as being most valued by customers, but was not National Health Services (NHS)-funded. Motivation for providing public health services was professional not financial, particularly from those working in independent pharmacies. Only 35% were personally involved in deciding which services to deliver, and fewer than 20% based decisions on local public health reports. Pharmacists had positive attitudes towards providing public health services, but mixed views on support for services and their promotion. Most thought services would increase in future, but were concerned about commissioning. Both national and local support is needed to ensure future commissioning of pharmacy public health services. ID - 3262 ER - BACKGROUND AND AIMS: To undertake the first randomized controlled trial to evaluate the effectiveness of a brief intervention delivered by community pharmacists to reduce hazardous or harmful drinking. DESIGN: This parallel group randomized trial allocated participants individually to brief alcohol intervention (n=205) or a leaflet-only control condition (n=202), with follow-up study after 3 months. SETTING: Sixteen community pharmacies in one London Borough, UK. PARTICIPANTS: A total of 407 pharmacy customers (aged 18years or over) with Alcohol Use Disorder Identification Test (AUDIT) scores 8-19, inclusive. INTERVENTION: A brief motivational discussion of approximately 10 minutes' duration, for which 17 pharmacists received a half-day of training. MEASUREMENTS: Hazardous or harmful drinking was assessed using the AUDIT administered by telephone by a researcher blind to allocation status. The two primary outcomes were: (1) change in AUDIT total scores and (2) the proportions no longer hazardous or harmful drinkers (scoring <8) at 3months. The four secondary outcomes were: the three subscale scores of the AUDIT (for consumption, problems and dependence) and health status according to the EQ-5D (a standardized instrument for use as a measure of health outcome). FINDINGS: At 3 months 326 (80% overall; 82% intervention, 78% control) participants were followed-up. The difference in reduction in total AUDIT score (intervention minus control) was -0.57, 95% confidence interval (CI)=-1.59 to 0.45, P=0.28. The odds ratio for AUDIT <8 (control as reference) was 0.87, 95% CI=0.50 to 1.51, P=0.61). For two of the four secondary outcomes (dependence score: -0.46, 95% CI=-0.82 to -0.09, P=0.014; health status score: -0.09, 95% CI=-0.16 to -0.02, P=0.013) the control group did better, and in the other two there were no differences (consumption score: -0.05, 95% CI=-0.54 to 0.44, P=0.85; non-dependence problems score: -0.13, 95% CI=-0.66 to 0.41). Sensitivity analyses did not change these findings. CONCLUSIONS: A brief intervention delivered by community pharmacists appears to have had no effect in reducing hazardous or harmful alcohol consumption.Copyright © 2015 Society for the Study of Addiction. ID - 3265 ER - INTRODUCTION AND AIMS: Alcohol misuse is the third leading cause of ill health in the UK. Alcohol brief intervention can identify risky drinkers and motivate individuals to take action. Community pharmacists have been identified as having a role in providing brief interventions. This study aimed to evaluate: pharmacists' attitudes towards hazardous/harmful drinkers and knowledge before training and after delivering brief intervention; and their experience of training. DESIGN AND METHODS: Pharmacists' attitudes to alcohol problems were assessed using Short Alcohol and Alcohol Problems Perception Questions before training and after brief intervention delivery. Alcohol misuse knowledge was assessed by questionnaire prior to and immediately after training, and after the delivery period. Following brief intervention delivery, pharmacists' experience of training was obtained using a questionnaire and focus groups. Qualitative thematic analysis identified experiences of brief intervention training. Quantitative data were analysed using spss. RESULTS: One hundred and thirty-nine alcohol interventions were delivered by 19 pharmacists over five months (recruiters). Ten pharmacists completed no interventions (non-recruiters). Both groups improved their alcohol knowledge between baseline and immediately following training; and their knowledge decreased between the end of training and following service delivery. Pharmacists who were initially more motivated recruited more participants and increased their work satisfaction. DISCUSSION AND CONCLUSIONS: This confirmed findings of previous studies that pharmacists unfamiliar with brief intervention could be trained to deliver this service. Pharmacists with positive attitude towards drinkers delivered a greater number of alcohol interventions and experienced increased work satisfaction than those pharmacists with less positive attitudes.Copyright © 2012 Australasian Professional Society on Alcohol and other Drugs. ID - 3264 ER - INTRODUCTION AND AIMS: Community pharmacists have the potential to deliver alcohol screening and brief interventions (SBI) to pharmacy users. However, little is known if SBI would be utilised and views of people who might use the service. Therefore, the aim was to investigate potential barriers and enablers of pharmacy SBI. DESIGN AND METHODS: Purposive sampling was used to select four pharmacies within the London borough of Westminster, UK. Semistructured interview schedule recorded participants' views of pharmacy SBI. The Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) was incorporated to record views of high and low-risk drinkers. Categorical data were analysed and content analysis undertaken. RESULTS: Of the 237 participants (149 female) approached 102 (43%) agreed to be interviewed (63 female). Of these 98 completed AUDIT-C, with 51 (52%) identified as risky drinkers. Risky drinkers were significantly identified among the younger age group (chi(2) =11.03, P=0.004), professional occupations (chi(2) =10.41, P=0.015), with higher qualifications (chi(2)=10.46, P=0.033), were least frequent visitors to a pharmacy (chi(2) =11.58, P=0.021) and more frequently identified in multiple pharmacy establishments than independents (chi(2) =8.52, P=0.004). Most were willing to discuss drinking (97, 96%) and accept written information (99, 98%). Accessibility and anonymity were reported as positive aspects and concerns were expressed about lack of privacy and time (pharmacist and user). DISCUSSION AND CONCLUSIONS: This study reports the first results of pharmacy users' views on SBI. Regardless of drinking status, most were willing to utilise the service and positive about pharmacists' involvement.[Dhital R, Whittlesea CM, Norman IJ, Milligan P. Community pharmacy service users' views and perceptions of alcohol screening and brief intervention.Copyright © 2010 Australasian Professional Society on Alcohol and other Drugs. ID - 3263 ER - OBJECTIVE: To assess the clinical and patient-centered outcomes of health coaching provided in the workplace by community pharmacists. DESIGN: Prospective interventional cohort study. SETTING: 11 independent community pharmacy chain locations in northwest and central Missouri, from January 2010 to January 2011. PARTICIPANTS: 81 benefit-eligible patients and 23 community pharmacy coaches employed by the self-insured pharmacy chain. INTERVENTION: Patients were stratified into monitoring groups according to baseline screening values for cholesterol, blood pressure, fasting blood glucose (FBG), body mass index (BMI), and waist circumference. Patients selected their pharmacist coach. Follow-up appointments occurred monthly to quarterly. Appointments consisted of education, goal setting, and monitoring through evaluation of treatment goals and physical assessment. MAIN OUTCOME MEASURES: Change from baseline in mean total cholesterol, serum triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, systolic blood pressure (SBP), diastolic blood pressure (DBP), FBG, weight, BMI, waist circumference, health-related quality of life (HRQoL), and patient satisfaction. RESULTS: Patients' total cholesterol, LDL cholesterol, HDL cholesterol, DBP, and FBG were reduced significantly. Mean changes in triglycerides, SBP, weight, BMI, and waist circumference were not statistically significant. The 36-Item Short-Form Health Survey version 2.0 showed improvements in both the Physical and Mental Component Summaries but did not reach statistical significance. More than 90% of patients were satisfied with the service and the care they received. CONCLUSION: Wellness coaching by a pharmacist provided in a community pharmacy can result in significant improvements in cardiovascular risk factors, with a trend toward improved HRQoL. In addition, patients were satisfied with the wellness program from the start of the project. ID - 3266 ER - BACKGROUND: The concept of the Healthy Living Pharmacy (HLP) in England was first piloted in Portsmouth in 2010. HLPs proactively promote health and wellbeing, offering brief advice, services or signposting on a range of health issues such as smoking, physical activity, sexual health, healthy eating and alcohol consumption. OBJECTIVES: To explore the views and attitudes of pharmacy support staff on the Healthy Living Pharmacy (HLP) initiative. METHODS: Qualitative semi-structured, face-to-face interviews were conducted with pharmacy support staff recruited from community pharmacies involved in the HLP initiative in the Northumberland region of England. A topic guide was developed which underwent face validity testing and piloting with one participant. Interviews were audio recorded, transcribed verbatim and analyzed using framework technique. RESULTS: A total of 21 pharmacy support staff from 12 HLPs participated in the study. Results suggest that involving pharmacy support staff at very early stages of the HLP planning process drives their motivation for service delivery. Level of engagement with HLP services was often related to support staff roles within pharmacy. Integration of public health roles with routine pharmacy activities was perceived to be more suited to pharmacy counter based roles than dispensing roles. Further training needs were identified around how to proactively deliver public health advice, mainly in service areas perceived 'difficult' by the participants, such as weight management. A total of 19 facilitators/barriers were identified from the data including training, access to information, client feedback, availability of space and facilities within pharmacies, time and competing priorities. CONCLUSIONS: Pharmacy support staff engagement with the HLP initiative can be promoted by involving them from the outset of the service introduction process. Support staff might benefit from targeted training around certain public health areas within the HLP initiative. Facilitators/barriers identified in this study will inform development and further roll out of HLP initiative in wider areas. ID - 3267 ER - BACKGROUND: Pharmacists in various settings have been effective in initiating diabetes treatment. Patients with diabetes require ongoing disease management, and community pharmacists are in a strategic position to provide such extended care. Little is known, however, about the effects of community pharmacist-provided interventions beyond the initial treatment period. OBJECTIVE: To evaluate the effect of community pharmacist-provided extended diabetes care service on primary clinical outcomes, including hemoglobin A(1c) (A1C), low-density lipoprotein cholesterol (LDL-C), and blood pressure, and on patients' reported self-care activities. METHODS: A randomized controlled trial was conducted in patients with diabetes. Participants had already completed at least 2 diabetes education sessions at a local diabetes education center. Nine specially trained pharmacists administered interventions during up to 4 quarterly visits per patient. Interventions included discussing medications, clinical goals, and self-care activities with patients and recommending medication changes to physicians when appropriate. The main outcome measures were 12-month changes in A1C, LDL-C, blood pressure, and self-report of self-care activities. RESULTS: Seventy-eight patients participated in the study (36 intervention, 42 control); 66 were included in the final analysis (31 intervention, 35 control). Compared with changes in the control group, patients who received interventions significantly increased the number of days per week that they engaged in a set of diet and diabetes self-care activities (1.25 and 0.73 more days/wk, respectively). The mean 12-month changes for A1C, LDL-C, and blood pressure were not significantly different between the 2 study groups. CONCLUSIONS: Although pharmacist-provided interventions did not demonstrate statistically significant improvements in clinical outcomes over the study period, study results did show that pharmacists were effective at increasing the number of days that patients spent engaging in healthy diet and diabetes self-care activities. Addressing lifestyle and self-care behaviors can be a beneficial component of a pharmacist-provided extended diabetes care service. ID - 3268 ER - Objective: To determine the extent of service provision by pharmacists in Scotland to patients with diabetes. Also, to investigate pharmacists' perceived education needs and their priorities for future service development to this patient group. Setting: A random sample of pharmacists in Scotland who had previously participated in NHS Education for Scotland (NES) education. Method: Questionnaire survey of pharmacists to estimate extent of provision of 28 defined aspects of diabetes care, educational needs and their professional aspirations. Key findings: Approximately two-thirds of community pharmacists who responded offered the following patient-centred services for patients with diabetes and included education/advice on: lifestyle, smoking cessation, medicines administration times, footcare and self-monitoring of glycaemia. Perceived need for further education was found to be linked with levels of service provision. Priorities for development of future services in this patient group were established, and preferred methods of educational support were also examined. Conclusion: Pharmacists in Scotland are providing services for patients with diabetes although these are not consistent. The profession in Scotland also has clear ideas of future priorities in practice for this patient group. However there is a need to provide further training and education in order to support service development. © 2007 The Authors. ID - 3269 ER - Pasted extract (full text at link below) The HLP pathfinder programme was created in response to this question; the national pharmacy organisations all agreed to support broader roll out of the initiative with the aim of evaluating against the following objectives : Objectives of evaluation 1. Is there better uptake and delivery of services in HLPs compared to baseline (i.e. before being an HLP or against other non -­- HLP pharmacies)? 2. Does geography and demography impact on HLP performance? 3. What is the effect of HLP services on public -­- reported experiences? 4. What are the benefits of HLP implementation for the public, commissioner/NHS, contractor, and employer ? 5. Is each individual service delivered through HLP cost -­- effective? This evaluation was set up to appraise the impact of the HLP concept on community pharmacy practice across England and to determine whether the outcomes achieved in Portsmouth are replica b le i n areas of different demography. This is a practice -­- based evaluation , which may lead to further evaluation or detailed research. The data collected are , by necessity, pragmatic and reflective of the practice setting in which is gathered , and sub ject to a number of limitations, which will be described within the main body of the report. ID - 3270 ER - OBJECTIVE: To evaluate elderly women's knowledge of their skeletal status, assess adequacy of calcium intake, determine the prevalence of low bone density, and determine whether peripheral bone density testing led to medical interventions in a group of rural, elderly Wisconsin women recruited in community pharmacies. DESIGN: Recruiting notices were posted in each pharmacy, and eligible women were enrolled in the order in which they volunteered. Each completed a fracture-risk questionnaire. Calcaneal bone density was measured within the following 6 weeks, using peripheral dual-energy X-ray absorptiometry. Mail surveys were used to assess interventions subsequent to the womens' study participation. SETTING: The study was conducted at 5 community pharmacies in rural Wisconsin. RESULTS: Of 133 women, 20% had calcaneal osteoporosis, defined as a T score < or =2.5 (calcaneal bone density <2.5 SDs below the young reference database). Thirty percent of women met National Osteoporosis Foundation (NOF) treatment criteria based on heel bone density and NOF-designated risk factors. Of those meeting treatment criteria, 75% were unaware of their low bone mass. Half of the women received <1200 mg/d of calcium, the recommended dose for osteoporosis prevention. Those who were taking a calcium supplement were much more likely to receive the recommended amount. Women who had discussed bone density test results with their physicians were more likely to receive central dual energy X-ray absorptiometry (DXA) measurements and/or start antiresorptive therapy than women who did not. CONCLUSIONS: Rural, elderly Wisconsin women are at substantial risk for osteoporosis, based on calcaneal bone density, but most are unaware of their risk. Compounding this risk is low calcium intake. Community screening of rural, elderly women by peripheral bone density measurement can lead to medical interventions in such individuals. ID - 3271 ER - OBJECTIVES: To assess the feasibility of establishing an osteoporosis screening program in rural community pharmacies based on information and resources provided by the National Osteoporosis Foundation (NOF), to survey primary care providers regarding the usefulness of this screening program, and to recommend strategies for pharmacists interested in working with patients at risk for osteoporosis. DESIGN AND PARTICIPANTS: Pharmacists and/or nurses enrolled women 65 years of age and older into the study, measured calcaneal bone density, administered a questionnaire to ascertain subjects' osteoporosis risk factors, and provided NOF literature to subjects. With their agreement, women's bone mass data and risk factor assessments were provided to primary care providers along with NOF's Physician's Guide to Prevention and Treatment of Osteoporosis. These providers were surveyed as to whether they found this information useful. SETTING: Five independent community pharmacies in rural Wisconsin. RESULTS: We enrolled and tested 133 women. Of these, 122 (92%) agreed to have information mailed to their primary health care providers. These 57 providers were surveyed and 24 (42%) responded; of these 24, 20 (83%) found the information they received useful. CONCLUSION: A community pharmacy-based osteoporosis screening program using NOF materials was well accepted by physicians. NOF resources and recommendations can provide a strong foundation for such programs. ID - 3272 ER - Background: Influenza is a significant cause of morbidity and excess mortality, yet vaccine coverage in the UK remains below target. Community pharmacies are increasingly being promoted as an alternative to vaccination by GPs.; Aim: To explore and verify the factors that influence the relative performance of pharmacies providing NHS influenza vaccinations.; Design and Setting: A mixed methods study utilising qualitative, semi-structured interviews and quantitative analysis of predictors of vaccination numbers in community pharmacies in Wales.; Method: Interviews were conducted with 16 pharmacists who participated in the Welsh national pharmacy influenza service in 2013-2014. A purposive sampling strategy was used. Qualitative findings were analysed using framework analysis. Potential predictors of vaccination numbers were identified from interviews and a literature review, and included in a multivariable regression model.; Results: The contribution of community pharmacies towards vaccination in Wales is small. Findings suggest that community pharmacies reach younger at-risk individuals, in whom vaccine uptake is low, in greater proportion than influenza vaccination programmes as a whole. Extended opening hours and urban locations were positively associated with the number of vaccinations given, although pharmacists reported that workload, vaccine costs, unforeseen delays, lack of public awareness, and GPs' views of the service limited their contribution. Pharmacists, aware of the potential for conflict with GPs, moderated their behaviour to mitigate such risk.; Conclusion: Before community pharmacies take greater responsibility for delivering healthcare services, obstacles including increasing pharmacist capacity, vaccine procurement, health service delays, managing GP-pharmacy relationships, and improving public awareness must be overcome.; © British Journal of General Practice 2016. ID - 3274 ER - OBJECTIVE: To assess the economic and clinical outcomes for the Diabetes Ten City Challenge (DTCC), a multisite community pharmacy health management program for patients with diabetes. DESIGN: Quasiexperimental observational analysis, pre-post comparison. SETTING: Employers at 10 distinct geographic sites contracting with pharmacy providers in the community setting. PARTICIPANTS: 573 patients with diabetes who had baseline and year 1 medical and pharmacy claims and two or more documented visits with pharmacists. INTERVENTIONS: Community-based pharmacists provided patient self-management care services via scheduled consultations within a collaborative care management model. MAIN OUTCOME MEASURES: Changes in health care costs for employers and beneficiaries and key clinical measures. RESULTS: Average total health care costs per patient per year were reduced by $1,079 (7.2%) compared with projected costs. Statistically significant improvements were observed for key clinical measures, including a mean glycosylated hemoglobin decrease from 7.5% to 7.1% (P = 0.002), a mean low-density lipoprotein cholesterol decrease from 98 to 94 mg/dL (P < 0.001), and a mean systolic blood pressure decrease from 133 to 130 mm Hg (P < 0.001) over a mean of 14.8 months of participation in the program. Between the initial visit and the end of the evaluation period, influenza vaccination rate increased from 32% to 65%, eye examination rate increased from 57% to 81%, and foot examination rate increased from 34% to 74%. CONCLUSION: DTCC successfully implemented an employer-funded, collaborative health management program using community-based pharmacist coaching, evidenced-based diabetes care guidelines, and self-management strategies. Positive clinical and economic outcomes were identified for 573 patients who participated in the program for at least 1 year, compared with baseline data. ID - 3276 ER - OBJECTIVE: To assess clinical and humanistic outcomes 1 year after initiating the Diabetes Ten City Challenge (DTCC), a multisite community pharmacy health management program for patients with diabetes. DESIGN: Interim observational analysis of deidentified aggregate data from participating employer clients. SETTING: 29 employers at 10 distinct geographic sites contracting for patient care services with pharmacy providers in the community setting. PARTICIPANTS: 914 patients with diabetes covered by self-insured employers' health plans who received 3 or more months of pharmacist care and had an initial glycosylated hemoglobin (A1C) measurement. Community-based pharmacists were trained in a diabetes certificate program and reimbursed for clinical services. INTERVENTIONS: Community-based pharmacists provided patient care services using scheduled consultations, clinical goal setting, a validated patient self-management program tool, and health status monitoring within a collaborative care management model. MAIN OUTCOME MEASURES: Changes in key direct and surrogate outcomes, including glycosylated hemoglobin (A1C), low-density lipoprotein (LDL) cholesterol., blood pressure measurements, and body mass index; influenza vaccinations; foot examinations; eye examinations; numbers of patients with goals for nutrition, exercise, and weight; and patient satisfaction. RESULTS: At initial visit compared with 1 year, mean A1C decreased from 7.6% to 7.2%, mean LDL cholesterol decreased from 96 to 93 mg/dL, and mean systolic blood pressure decreased from 131 to 129 mm Hg. Increases were seen for influenza vaccination rate (from 43% to 61%), eye examination rate (from 60% to 77%), and foot examination rate (from 38% to 68%) for the initial visit to the end of the analysis period. For all patients in DTCC, those who perceived that their overall diabetes care was very good to excellent increased from 39% to 87%. Overall, 97.5% reported being very satisfied or satisfied with the diabetes care provided by pharmacists. CONCLUSION: Employers demonstrated a willingness to offer a voluntary health benefit to employees and their dependents with diabetes that uses pharmacists to help participants achieve self-management goals. Patients participating in the first year of DTCC had measurable improvement in clinical indicators of diabetes management, higher rates of self-management goal setting, and increased satisfaction with diabetes care. Based on results of previous studies, these positive trends are expected to drive a corresponding decline in projected total direct patient medical costs. ID - 3275 ER - BACKGROUND AND OBJECTIVE: Spain has implemented several in-pharmacy HIV testing programmes performed by pharmacists as part of their everyday routine. We aim to assess the feasibility and the main outcomes of three programmes implemented in three Spanish regions with different sociological profiles and also different epidemiology for HIV. METHODS: The characteristics of the 24151 people tested between 2009 and 2013 at 74 urban pharmacies are studied. We compare the main outcomes of the programmes with those of each Regional HIV Surveillance System (RHSS) assessing the contribution to the total new diagnosis in each region and if priority groups are being reached. RESULTS: 45.7% were heterosexual men (MSW), 14.4% men who have sex with men (MSM), and 27% women. The 35% were younger than 30 and 9.6% foreigners. The 52% were previously untested, and women were the most likely to be untested. The three programmes altogether diagnosed 226 people, resulting in a global prevalence of 0.9% (95%CI: 0.8-1.1); 3.4% in MSM (95%CI: 2.8-4.0). The prevalence among Spaniards was 0.8% (0.7-1.0) vs. 2.2 (1.6-2.9) among foreigners. The percentages of MSM diagnosed by all three programmes were higher than the one reported by their respective RHSS. Thirty four percent of the reactive MSM and the 71.4% of the reactive MSW did not have a previous HIV test although big testing history differences were observed across the programmes. Altogether, these services contributed with the 10.6% of all HIV diagnoses in these regions. CONCLUSIONS: In-pharmacy HIV testing programmes are a valuable testing option, having been able to uncover 1 out of 10 the new diagnoses reported in each region. They showed a good capacity of reaching and diagnosing previously untested populations, not only a priority population such as MSM but also heterosexual population who are more affected by delayed diagnosis. They seem to be particularly suitable for regions without large cities and specific HIV diagnostic services. ID - 3278 ER - OBJECTIVES: Spain has been a pioneer in the implementation of rapid HIV testing programmes in pharmacies to increase access to testing. However, no formal evaluation of the effectiveness of these programmes has been carried out to date. Our aim was to evaluate the ability of a novel in-pharmacy rapid HIV testing programme to promote diagnosis and reach vulnerable populations. METHODS: Between 2011 and 2012, 2168 people underwent testing in 16 urban pharmacies in 10 cities of a Spanish region with a low prevalence of HIV infection. The main outcomes of the programme were compared with those of the regional surveillance system for new HIV diagnoses (RHSS-CyL). RESULTS: Overall, 52.8% of those tested were heterosexual men, 15.8% were men who have sex with men (MSM) and 25.3% were women. Nine per cent were immigrants and 41.9% were <30 years old. In total, 59.5% of the heterosexual men, 44.6% of the MSM and 65.3% of the women were previously untested. There were 23 positive results, representing 6% of all new regional diagnoses in 2011. The global prevalence was 1.1% (95% confidence interval 0.6-1.5%) and the prevalence in MSM was 3.8%. Of the reactive results, 60.9% were in MSM, 34.8% in heterosexual men and only 4.3% in women, vs. 35.4%, 37.5% and 15.0%, respectively, reported by the RHSS-CyL. The mean age of those testing positive was 32.7 years vs. 38.7 years in the RHSS-CyL. Fifty per cent of MSM and 75% of heterosexual men testing positive were previously untested. CONCLUSIONS: In Spain, this is the first programme not targeted at the most at-risk populations, and has been shown to be effective in reaching and diagnosing heterosexual men, who are the group most affected by delayed diagnoses. Heterosexual men accounted for over half of those tested and a third of those diagnosed, and most of them were previously untested. Young and previously untested MSM also greatly benefitted from the programme.Copyright © 2015 British HIV Association. ID - 3277 ER - OBJECTIVE To determine the feasibility of implementing a pharmacogenomics service in a community pharmacy. SETTING A single community pharmacy that is part of a regional chain known for offering innovative pharmacy services. PRACTICE DESCRIPTION Community pharmacists at the project site routinely provide clinical pharmacy services, including medication therapy management, immunizations, point-of-care testing, blood pressure monitoring, and diabetes education. PRACTICE INNOVATION The implementation of a pharmacogenomic testing and interpretation service for the liver isoenzyme cytochrome P450 2C19. PARTICIPANTS 18 patients taking clopidogrel, a drug metabolized by CYP2C19. MAIN OUTCOME MEASURES Rate of patient participation, rate of prescriber acceptance of pharmacist recommendation, time to perform genetic testing service, and number of claims submitted to and paid by insurance. RESULTS Of 41 patients taking clopidogrel and meeting project criteria, 18 (43.9%) enrolled and completed testing and interpretation of pharmacogenomic results. The mean time pharmacists spent completing all stages of the project with each participant was 76.6 minutes. The mean time to complete participation in the project (time between person's first and second visit) was 30.1 days. Nine patients had wild-type alleles, and pharmacists recommended continuation of therapy as ordered. Genetic variants were found in the other nine patients, and all pharmacist recommendations for modifications in therapy were ultimately accepted by prescribers. Overall, 17 patients consented to filing of reimbursement claims with their insurers. Five were not able to be billed due to submission difficulties. Of the remaining 12, none was paid. CONCLUSION A pharmacogenomics service can be an extension of medication therapy management services in a community pharmacy. Prescribers are receptive to having community pharmacists conduct pharmacogenomics testing, but reimbursement is a challenge. ID - 3279 ER - PURPOSE: The effect of a protocol-based pharmacist intervention on blood pressure (BP) control among treated hypertensive patients who use community pharmacies was studied. METHODS: A quasi-experimental study with a control group was conducted at 13 community pharmacies in Jaen and Granada in Spain. Hypertensive patients over age 18 years who were receiving antihypertensive treatment were eligible for participation. The protocol-based intervention consisted of three components: (1) patient education about hypertension, (2) home blood pressure monitoring (HBPM), and (3) referral to a physician through personalized reports when necessary. The control group received the standard of care. BP control was assessed at the beginning and end of the study. Results Data were collected from 176 patients. In the intervention group (n = 87), significant baseline-to-endpoint reductions in systolic blood pressure (SBP) and diastolic blood pressure (DBP) were observed: 6.8 mm Hg (p < 0.001) and 2.1 mm Hg (p = 0.032), respectively. The changes in SBP and DBP in the intervention group at the end of the study were significantly greater than those in the control group (difference between adjusted mean change, 5.7 mm Hg for SBP [p = 0.001] and 2.6 mm Hg for DBP [p = 0.013]). The odds of achieving BP control in the intervention group was 2.46 times higher than in the control group (95% confidence interval, 1.15-5.24; p = 0.020). CONCLUSION: A protocol-based community pharmacist intervention in combination with HBPM significantly reduced SBP and DBP and increased the percentage of patients with controlled BP compared with patients receiving the standard of care. ID - 3280 ER - Objectives: Sterile needle and syringe (NS) access may play a significant role in the reduction of disease transmission. This study describes various characteristics of injection drug users' (IDUs) procurement of NS at pharmacies.Methods: IDUs were recruited as part of a two-arm clinical trial with one arm being taught how to purchase NS at pharmacies and the other arm being able to exchange NS at a needle exchange. Data were analysed using descriptive statistics (chi-square and binomial tests for categorical data, t-tests, ANOVA, correlation and Wilcoxon rank sums for interval-level data) and run using SAS [SAS/STAT User's Guide, Version 6, 4th ed., vols. 1 and 2, SAS Institute Inc., Cary, NC].Results: IDUs were able to purchase NS at most Anchorage pharmacies. More IDUs randomised to a syringe exchange programme (SEP) arm of a clinical trial obtained NS from known sterile sources as compared to those IDUs randomised to the pharmacy sales arm.Conclusions: Communities seeking to maximise the proportion of IDUs who obtain sterile NS need to have both legal pharmacy sales and SEPs. ID - 3282 ER - Despite a lack of evidence that needle exchange programs (NEPs) cause an increase in injection drug use, there are still concerns over fostering increased injection behavior with NEPs. The design was a randomized controlled trial conducted from May 1997 to June 2000 comparing injection drug users (IDUs) who are randomly assigned to have access to an NEP versus training in how to purchase needles and syringes (NS) at pharmacies. Of 653 IDUs recruited into the study, 600 were randomized: 426 were followed-up at 6 months, and 369 were followed-up at 12 months. Four hundred ninety were followed up at least once. There was no difference in the number of injections over time between the NEP and the Pharmacy Sales arms of the study or in the percentage of positive urine test results over time between the NEP and the Pharmacy Sales arms of the study for morphine and amphetamine. The decrease in the presence of cocaine was marginally greater between the arms of the study. The results do not support the hypothesis of NEPs causing an increase in injection drug use. This clinical trial provides the strongest evidence to date that needle exchanges do not produce this negative effect. ID - 3281 ER - Objective: The aim was to evaluate the feasibility and acceptability of the provision of brief interventions on alcohol misuse in community pharmacies. The objectives were to: train community pharmacists to initiate discussion of alcohol consumption with targeted pharmacy clients and screen, intervene or refer as appropriate; and to explore with pharmacists and clients the feasibility, acceptability and perceived value of screening and delivering the intervention. Setting: Eight community pharmacies in Greater Glasgow. Method: After a two-day training course for pharmacists (n = 9) and one day for pharmacy assistants (n = 13), the eight pharmacies recruited clients over 3 months. Standardised protocols were prepared to screen clients for hazardous or harmful drinking using the Fast Alcohol Screening Tool (FAST) and to guide the intervention. Clients were recruited from specific target groups and via posters highlighting the service. Following completion of the recruitment phase, pharmacists and clients were followed up by the research team, using a combination of focus groups and semi-structured telephone interviews. Key findings: During the study period 70 clients were recruited, 30 screened as drinking hazardously (42.9%) and 7 (10%) screened positive for harmful drinking. Interventions commonly included explanation of sensible drinking and units in clients' preferred drinks (n = 33), feedback on screening and risks to health (n = 27) and discussion of pros and cons of current drinking pattern and link with presenting issue (n = 23). Of the 40 clients agreeing to be followed up, 19 could be contacted and most were generally positive about the experience. On follow-up the pharmacists were positive and felt the project worthwhile and, importantly, noted no strong negative reactions from clients. Conclusion: This project has been successful in training community pharmacists to discuss alcohol with 70 clients. Further work is required to test the generalisability of our findings and to measure the impact on alcohol consumption. © 2008 The Authors. ID - 3284 ER - This project sought to evaluate for the first time, the feasibility and acceptability of the provision of brief interventions on alcohol in community pharmacies. The objectives were to: (1) Establish a pilot project in which trained community pharmacists initiate discussion of alcohol consumption with targeted pharmacy clients and screen, intervene or refer as appropriate. (2) Explore, with pharmacists and clients, the feasibility, acceptability, perceived value and perceived impact of the provision of such interventions in community pharmacy. (3) Identifymarkersofgoodpracticeandformulaterecommendationsforfuturepractice. Eight community pharmacies in Greater Glasgow participated. A baseline evaluation was carried out to establish pharmacists’ knowledge and attitudes relating to alcohol prevention and education. After a two day training course for pharmacists, the eight pharmacies were asked to recruit clients over a three month period. Standardised protocols were prepared to screen clients for hazardous drinking using the Fast Alcohol Screening Tool, to guide the intervention and to record the whole process for each client. Clients were recruited from specific target groups as well as through posters highlighting the service. Following completion of the recruitment phase, pharmacists and clients were followed-up by the research team. In the baseline evaluation, all pharmacists agreed that they were interested in the responses that could be made to alcohol-related problems but just one regularly raised the issue of drinking with clients. All felt it appropriate for community pharmacists to “opportunistically identify hazardous and harmful drinkers and to deliver a brief intervention” although they had some concerns about client sensitivities. Most were unable to correctly outline the recognised daily limits for alcohol consumption and none was familiar with the concept of brief interventions to address hazardous drinking. Training was rated highly and had an impact on knowledge and attitudes. On follow-up the pharmacists were positive about the project and felt it worthwhile and importantly noted no aggression or strong negative reactions from clients. Seventy clients were recruited to the study, 30 screened as drinking hazardously (42.9%) and 7 (10%) screened positive for harmful drinking. Nineteen clients were followed-up and most were happy to have taken part in the intervention and were generally positive about the experience. In conclusion, this project has been successful in establishing a pilot project in which eight trained community pharmacists conducted a discussion about alcohol with 70 clients. However, the pharmacists and clients researched are not necessarily representative of community pharmacies or clients. Further work is required to test the generalisability of our findings and to measure the impact on alcohol consumption. ID - 3283 ER - Background: Community pharmacy teams are recognised by health agencies as vital to increasing capacity in the provision of public health services. Public awareness and support of these services in general, and relating to safe alcohol consumption in particular, have yet to be established. This study aimed to determine the Scottish general public's views regarding the role and involvement of community pharmacists in reducing alcohol consumption amongst customers and alcohol-related harm. Methods: A cross-sectional survey of 6000 adults in Scotland randomly sampled from the electoral register. The piloted questionnaire contained items on: those health professions which could potentially advise on safer alcohol consumption; areas of safer alcohol consumption on which pharmacists could advise; attitudes towards pharmacist involvement; and demographics. Results: Of the 1573 respondents (a 26.6% response rate), more than half (56.4%, 888) agreed that pharmacists could advise on safer alcohol consumption. Those agreeing expressed high levels of support (>= 70% agreement) for all activities, particularly referring people to other individuals or organisations, discussing recommended alcohol consumption limits and how consumption may affect health. There was a high level of agreement of trust that pharmacists would discuss issues confidentially (68.7%, 1080), with a similar proportion (64.3%, 1011) agreeing that they would be concerned over privacy in a community pharmacy. Conclusion: Public support exists for pharmacist involvement in reducing alcohol consumption amongst customers and alcohol-related harm, with some concern over privacy. These findings warrant consideration as models of practice are developed and evaluated. Given the widespread availability of pharmacies and the ease of access to professional advice, there is potential for pharmacists to impact safer alcohol consumption although the efficacy of alcohol brief interventions remains to be demonstrated. (C) 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. ID - 3285 ER - AIM: The aim of the present research was to establish the current extent of pharmacists' contact with illicit drug users in Northern Ireland, their willingness to provide services for this group and to compare the findings with data from a 1995 national survey of community pharmacies in England and Wales. METHOD: The questionnaire developed by the National Addiction Centre for research in England/Wales was used to collect data. It was mailed on two occasions (March and April 1999) together with a covering letter and a prepaid return envelope to all community pharmacies in Northern Ireland (n = 507). A final reminder letter was included in the local wholesalers' medical delivery for the attention of the pharmacist in May 1999. MAIN OUTCOME MEASURE: The extent to which Northern Ireland pharmacists had contact with and provided services to illicit drug users compared to pharmacists in England/Wales. RESULTS: A response rate of 67.5% was achieved. Respondents in Northern Ireland were providing fewer services to drug users than those in England/Wales. Respondents reported dispensing methadone for the treatment of addiction/misuse to only 9 patients, while only 17 pharmacists had been asked to sell injecting equipment in the previous week and no pharmacist was participating in a needle exchange scheme. However, most respondents indicated their willingness to provide such services. Barriers towards the provision of services were, however, highlighted e.g. the need for training and the establishment of support systems. CONCLUSION: Pharmacists in Northern Ireland are in a position to contribute to the policy agenda in Northern Ireland for drug misuse, prevention, treatment and harm minimisation--roles which the survey indicates they are willing to embrace. However, training programmes, support systems and adequate remuneration packages must be established before they will be in a position to participate fully. ID - 3286 ER - OBJECTIVE: Poor metabolic control and high associated morbidity and mortality among type 2 diabetic patients require a level of care from the pharmacist that goes beyond usual dispensing. The aim of the present study was to evaluate the improvement in metabolic control, the resolution of drug-related problems (DRPs) and the increase in patient awareness of diabetes as outcomes of a pharmacotherapy follow-up program in type 2 diabetic patients. METHOD: Randomized controlled trial conducted in 14 community pharmacies in the province of Pontevedra (Spain) with 112 patients between February 2003 and March 2004. The control group received the usual care, and the intervention group patients were included in a pharmacotherapy follow-up program. This individualized program, which consists of the detection and resolution of DRPs and diabetes education, involves patients in their own care in order to obtain maximum benefit from the medication they use. MAIN OUTCOME MEASURES: HbA(1c), Fasting Blood Glucose (FBG), lipid profile, blood pressure, body mass index (BMI), DRPs and knowledge were evaluated at the onset of the program and periodically until conclusion. RESULTS: There was a significant difference in changes from baseline between the intervention and the control group in DRPs (1.7+/-1.2 versus 3.1+/-1.2 P<0.0001), knowledge (17.9+/-3.7 versus 11.4+/-6.7 points P<0.0001), HbA(1c) (7.9+/-1.7 versus 8.5+/-1.9% P<0.0001), FBG (154+/-61.3 versus 168+/-57.8 mg/dl P=0.0004), total cholesterol (202+/-41.5 versus 217+/-43.5 mg/dl P=0.0054) and SBP (135+/-16.4 versus 150+/-19.9 mmHg P=0.0006). CONCLUSIONS: A substantial number of patients showed an improvement in their outcomes for the chosen metabolic indicators. Pharmacotherapy follow-up programs conducted by community pharmacists can play an important role in achieving therapeutic goals in patients with type 2 diabetes. This study shows that the incorporation of type 2 diabetic patients in a pharmacotherapy follow-up program may contribute to achieve positive clinical outcomes and will contribute to the implementation and progress of pharmacotherapy follow-up programs in community pharmacies. ID - 3287 ER - AIM: To increase vaccination rates in the wealthy industrial nation of Germany. For a variety of reasons there is a substantial deficit in the number of individuals who receive vaccinations in comparison with other industrialized countries. METHODS: In Autumn 2003, a regional vaccination consultation was initiated over a five-week period. Individuals involved in the study provided general information, including their age, health status, and vaccination records, and received an extensive consultation in a pharmacy in Jena, Germany. Participants were provided with a written overview of their vaccination status. After approximately five weeks, the vaccination status of each individual was recorded. RESULTS: 312 of 2500 patients received intensive vaccination education based on their accompanying vaccination documentation. Older individuals, who are known for having the largest vaccination gap in Germany, represented the highest percentage of people who used this service. The five most commonly required vaccinations had increased significantly, five weeks after the consultation. These vaccination rate increases included diphtheria, which rose from 55.8 to 71.2%, tetanus, which rose from 73.1 to 86.5%, influenza, which rose from 46.5 to 74.7%, pneumococcal, which rose from 32.4 to 62.8%, and tick-borne encephalitis, which rose from 31.9 to 42.4% (all p<0.008). CONCLUSIONS: Well structured vaccination consultations help to raise vaccination rates. Thus, pharmacies should consider offering and implementing this preventive measure so as to lower the rates of preventable disease and to save costs. ID - 3288 ER - Introduction: Community pharmacies are well placed to deliver education and counseling to improve sleep health. Objective: To develop, implement and evaluate a pharmacist led sleep health program. Methods: Participating pharmacists (n = 23) were trained to screen, counsel and follow up patients at risk of sleep disorders. Patients were screened for specific sleep disorders, counseled, provided written information and/or referred to physicians. Patient outcomes were evaluated by questionnaire at 3 or 12 months post screening. Results: A total of 325 patients were screened, with 142 (44%) patients at risk of one or more sleep disorders. A total of 847 interventions were recorded by pharmacists: verbal counseling (49%), written information (34%), and referrals (16%). A total of 63 patients (of 99 recalling being referred) reported acting on their referral. Positive changes were made with smoking (4%), caffeine intake (10%), alcohol intake (9%) and improved sleep environment (19%). Conclusion: Pharmacists can raise awareness through educating patients on sleep health, and through counseling initiate behavior change in those at risk of having or developing a sleep disorder. Practice implications: Further research using this feasibility study can help in understanding the utility of pharmacists screening patients for sleep disorders and educating the public in sleep health. ID - 3289 ER - OBJECTIVES: To implement a spirometry-based chronic obstructive pulmonary disease (COPD) screening in a community pharmacy chain, determine whether pharmacists can accurately perform spirometry screenings and interpret results, and determine whether performing screenings improved enrollment in smoking cessation programs. DESIGN: Prospective study. SETTING: Kroger pharmacies in the Cincinnati-Dayton Kroger Marketing Area and off-site screening events in Cincinnati, OH, from March to December 2010. PATIENTS: Consenting individuals older than 35 years who met inclusion and exclusion criteria. INTERVENTION: Specially trained community pharmacists administered a validated COPD screening questionnaire and performed spirometry. The results were interpreted, given to the patient, and faxed to the primary care physician. Any patient who was currently smoking was offered smoking cessation counseling. MAIN OUTCOME MEASURES: Spirometry technical quality and interpretation accuracy, screening questionnaire scores in relationship to spirometry results, number of patients enrolled in smoking cessation programs. RESULTS: Of the 185 patients, 10 were excluded due to inability to perform spirometry. After review, 174 (99%) of the spirometries were judged acceptable and 157 (90%) demonstrated reproducible results. The mean (+/-SD) score on the COPD Population Screener questionnaire was 2.3 +/- 1.6 (range 0-8). Airflow limitation (defined as forced expiratory volume in 1 second/forced vital capacity < lower limit of normal) was detected in 16 (9%) of the patients. Although 12 (75%) of these patients were former or current smokers, only 3 (19%) were at increased risk for COPD based on their screening questionnaire scores. Of the nine current smokers who participated in a follow-up interview, two had successfully abstained from smoking for 6 months after the screening and five others had made an attempt to quit. CONCLUSION: This study demonstrated that pharmacists are able to perform accurate and reproducible spirometry in a community pharmacy setting. ID - 3290 ER - OBJECTIVE: Community pharmacies play a vital role in promoting, maintaining and improving the health of the local community. This study explored community pharmacists' activities and attitudes towards the provision of sexual health services (SHS) in North East Scotland, as well as their needs with regard to the delivery of current and future SHS. SETTING: North East Scotland. METHODS: A questionnaire was conducted of community pharmacists working in community pharmacies in Grampian (n = 128). MAIN OUTCOME MEASURES: Self-reported provision of sexual health services; attitudes towards current and future sexual health services; previous training and perceived training needs; respondent demographics. RESULTS: In total, 73% (94/128) of community pharmacists responded. The average number of SHS/products per pharmacy was six out of a possible 13 (range: 4-10). Respondents expressed positive attitudes towards the provision of current and future SHS. However, they also reported that they had received little or no sexual health training but that they would like to receive training in all areas of sexual health. Barriers to the provision of sexual health included workload, lack of training and the need for payment for additional services. CONCLUSION: Community pharmacists already provide a limited range of sexual health services. Community pharmacists, their staff and their premises could be used in strategies to reduce unplanned pregnancies, the incidence of sexually transmitted infections and to promote respectful and responsible sexual behaviour. ID - 3291 ER - OBJECTIVE: To ascertain patients', providers', and managers' perceptions of the factors that contributed to the success of the Asheville Project. DESIGN: One-time focus groups of patients and diabetes care providers and individual interviews with managers involved in the project. SETTING: The City of Asheville and Mission-St. Joseph's Health System (MSJ), Asheville, N.C. PATIENTS AND OTHER PARTICIPANTS: Twenty-one patients with diabetes who were employees of the two self-insured employers participating in the Asheville Project; four specially trained pharmacists who provided diabetes-related pharmaceutical care and one diabetes educator, all of whom received reimbursement for their services; six managers employed by the City of Asheville or MSJ who were involved in the project. INTERVENTION: A trained facilitator conducted four focus groups and six manager interviews in September 2001. Each session lasted 60 to 90 minutes, and the facilitator used a standard list of open-ended questions. The focus group sessions were recorded for subsequent analysis. MAIN OUTCOME MEASURES: Perceptions of focus group participants and managers of how the Asheville Project enabled patients with diabetes to become more responsible and successful in self-managing their condition. RESULTS: Focus group participants and managers were enthusiastic about their experiences with the project. Patients valued the relationships they established with their pharmacist or diabetes educator; as a result of these providers' support, patients felt more in control of their lives and were healthier. The waived co-payments for diabetes medications and related supplies was the decisive incentive for getting many patients to enroll in the project. For the providers, the project was a source of professional growth and satisfaction. Managers felt the project helped them fulfill their health care responsibilities to their employees, reduced overall costs, enhanced their organizations' reputations in health care delivery, and resulted in less absenteeism. CONCLUSION: Patients, providers, and managers in the Asheville Project believed that aligned incentives and community-based resources that provide health care services to patients with diabetes offer a practical, patient-empowering, and cost-effective solution to escalating health care costs. ID - 3292 ER - WHAT IS KNOWN AND OBJECTIVE: It is often necessary to adjust drug therapy if renal function is impaired in elderly patients taking drugs for diabetes and/or cardiovascular disease that are cleared by the kidneys. Although clinical guidelines recommend regular monitoring of renal function in these patients, in practice adherence to these recommendations varies from 28% to 75%. To determine whether drug dosing is appropriate, pharmacists need have up-to-date information about patients' renal function. In this study, the feasibility of point-of-care creatinine testing (POCCT) in a community pharmacy was evaluated as part of monitoring the drug therapy of ambulatory elderly patients. METHODS: Elderly patients on maintenance therapy with renally excreted drugs for diabetes or cardiovascular disease were eligible for POCCT. After informed consent was obtained, POCCT was performed by trained personnel. A pharmacist assessed the clinical relevance of electronically generated drug alerts based on the patient's calculated renal function and the Dutch guidelines for adjusting drug dosage in patients with chronic kidney disease. If appropriate, the patient's general practitioner (GP) was consulted and adjustments to treatment were communicated to the patient. The feasibility of POCCT was evaluated by means of questionnaires completed by patients and healthcare professionals (GPs and pharmacists). RESULTS: Of 338 potentially eligible patients, 149 (44%) whose renal function was not known were asked, by letter, to participate in the study. Of these individuals, 46 (31%) gave their informed consent and underwent POCCT. Response rates for completing the patient and professional questionnaires were 87% and 100%, respectively. More than half of the patients who underwent POCCT had mild-to-moderate renal impairment. On the basis of information provided by patients and healthcare professionals, POCCT would appear to be feasible in community pharmacies. WHAT IS NEW AND CONCLUSION: POCCT improves the management of drug therapy by community pharmacists and is feasible in daily practice.Copyright © 2013 John Wiley & Sons Ltd. ID - 3293 ER - BACKGROUND: Internationally, community pharmacies have become increasingly involved in providing harm reduction services and health advice to people who use illicit drugs. OBJECTIVE: This paper considers public opinion of community pharmacy services. It discusses attitudes to harm reduction services in the context of stigmatization of addiction and people who use drugs. METHODS: This exploratory study involved twenty-six purposively sampled members of the public, from the West of Scotland, participating in one of 5 focus groups. The groups were composed to represent known groups of users and non-users of community pharmacy, none of whom were problem drug users. RESULTS: Three thematic categories were identified: methadone service users in community pharmacies; attitudes to harm reduction policies; contested space. Harm reduction service expansion has resulted in a high volume of drug users in and around some Scottish pharmacies. Even if harm reduction services are provided discretely users' behavior can differentiate them from other pharmacy users. Drug users' behavior in this setting is commonly perceived to be unacceptable and can deter other consumers from using pharmacy services. The results of this study infer that negative public opinion is highly suggestive of stereotyping and stigmatization of people who use drugs. Participants considered that (1) community pharmacies were unsuitable environments for harm reduction service provision, as they are used by older people and those with children; (2) current drug policy is perceived as ineffective, as abstinence is seldom achieved and methadone was reported to be re-sold; (3) people who use drugs were avoided where possible in community pharmacies. CONCLUSIONS: Community pharmacy harm reduction services increasingly bring together the public and drug users. Study participants were reluctant to share pharmacy facilities with drug users. This paper concludes by suggesting mechanisms to minimize stigmatization.Copyright © 2014 Elsevier Inc. All rights reserved. ID - 3296 ER - OBJECTIVE: To understand members of the public's opinions and experiences of pharmacy services. METHOD: This exploratory study employed qualitative methods. Five focus groups were conducted with 26 members of the public resident in Scotland in March 2010. The groups comprised those perceived to be users and non-users of community pharmacy. A topic guide was developed to prompt discussion. Each focus group was recorded, transcribed, anonymised and analysed using thematic analysis. KEY FINDINGS: Participants made positive comments about pharmacy services although many preferred to see a general practitioner (GP). Participants discussed using pharmacies for convenience, often because they were unable to access GPs. Pharmacists were perceived principally to be suppliers of medicine, although there was some recognition of roles in dealing with minor ailments and providing advice. For those with serious and long-standing health matters GPs were usually the professional of choice for most health needs. Community pharmacy was seen to offer incomplete services which did not co-ordinate well with other primary-care services. The pharmacy environment and retail setting were not considered to be ideal for private healthcare consultations. CONCLUSIONS: This study suggests that despite recent initiatives to extend the role of community pharmacists many members of the general public continue to prefer a GP-led service. Importantly GPs inspire public confidence as well as offering comprehensive services and private consultation facilities. Improved communication and information sharing between community pharmacists and general practice could support community pharmacist-role expansion.Copyright © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society. ID - 3295 ER - OBJECTIVES: To apply sociological theories to understand public trust in extended services provided by community pharmacists relative to those provided by general practitioners (GPs). DESIGN: Qualitative study involving focus groups with members of the public. SETTING: The West of Scotland. PARTICIPANTS: 26 purposively sampled members of the public were involved in one of five focus groups. The groups were composed to represent known groups of users and non-users of community pharmacy, namely mothers with young children, seniors and men. RESULTS: Trust was seen as being crucial in healthcare settings. Focus group discussions revealed that participants were inclined to draw unfavourable comparisons between pharmacists and GPs. Importantly, participants' trust in GPs was greater than that in pharmacists. Participants considered pharmacists to be primarily involved in medicine supply, and awareness of the pharmacist's extended role was low. Participants were often reluctant to trust pharmacists to deliver unfamiliar services, particularly those perceived to be 'high risk'. Numerous system-based factors were identified, which reinforce patient trust and confidence in GPs, including GP registration and appointment systems, GPs' expert/gatekeeper role and practice environments. Our data indicate that the nature and context of public interactions with GPs fostered familiarity with a specific GP or practice, which allowed interpersonal trust to develop. By contrast, participants' exposure to community pharmacists was limited. Additionally, a good understanding of the GPs' level of training and role promoted confidence. CONCLUSION: Current UK initiatives, which aim to implement a range of pharmacist-led services, are undermined by lack of public trust. It seems improbable that the public will trust pharmacists to deliver unfamiliar services, which are perceived to be 'high risk', unless health systems change in a way that promotes trust in pharmacists. This may be achieved by increasing the quality and quantity of patient interactions with pharmacists and gaining GP support for extended pharmacy services. ID - 3294 ER - We tested the hypothesis that an education program addressing breast cancer screening schedules and modalities coupled with a breast cancer risk assessment provided by community pharmacists can increase women's confidence in performing screening practices endorsed by the American Cancer Society (ACS). This randomized, paired, pre-post study was conducted in six community pharmacies and two health-screening fairs; subjects were 140 women over 18 years of age. The pharmacist-administered program used the Breast Cancer Risk-Assessment Tool (Gail model) software provided by the National Cancer Institute of the National Institutes of Health. In addition, pharmacists provided education and training on breast self-examination (BSE), clinical breast examination (CBE), and mammography. Adherence to ACS guidelines for monthly BSE increased from 31% to 56% (p<0.001) for all women 6 months after the program. Performance of monthly BSE by women considered at high risk for developing breast cancer increased from 20% to 60% (p<0.005). The mean number of BSEs performed over 6 months increased from 2.69 to 4.09 (p<0.001). Women's confidence performing correct BSE improved from 6.41 to 7.04 (p<0.001) on a scale of 0-10. Adherence to ACS guidelines for CBE and mammography did not reveal statistically significant improvements except for better adherence to CBE in women aged 40-49 years (81% to 97%, p<0.025). The strength of the pharmacists' intervention may not appear as manipulation of high-risk patients' behavior but as improvement of self-directed behaviors, such as BSE, across all age groups. ID - 3297 ER - pasted extract - full text below The study was designed to answer the research questions: 1. Can a Pharmacist, as part of their usual working day, opportunistically identify Hazardous Drinkers by using a FAST(20) Questionnaire? 2. Similarly, in that setting, can a Pharmacist conduct BRIEF Interventions? The study was conducted by Pharmacists from six differing Community Pharmacies, each with consulting room facilities, and each serving populations with differing social and ethnic background, over a three month period in late 2006. The Pharmacists attended specifically designed tutorials on the health impact of excessive alcohol, and were trained in the use of the FAST Questionnaire and in the nuances of Brief Interventions by one of the Investigators, TG. Regular meetings to discuss progress and impediments, and to share experiences, took place through the study. ID - 3299 ER - OBJECTIVE: (1) To identify patients at risk for osteoporosis through community pharmacy-based bone mineral density (BMD) screening, to refer at-risk patients to primary care and/or specialty practice physicians, and to follow-up with at-risk patients; (2) to treat and manage osteopenic and osteoporotic patients referred to the pharmacy for medication therapy management services; and (3) to test a payment methodology for pharmacists who deliver community health management services to a population at risk for or diagnosed with osteoporosis. DESIGN: Single-cohort observational study. SETTING: Ukrop's Super Markets, Inc. Grocery and Pharmacy, a 29-store chain with 22 pharmacy locations in Richmond, Virginia. PARTICIPANTS: Consumers with one or more known risk factors for osteoporosis in Ukrop's customer service area. INTERVENTION: During the initial phase (health promotion and disease prevention) of the project, pharmacy-based osteoporosis screening with referral and follow-up was provided to consumers who responded to Ukrop's screening promotions. The second phase-provision of collaborative community health management services focused on osteoporosis monitoring and management--is ongoing and includes patients who are at risk for or diagnosed with osteoporosis and are covered by a regional payer. MAIN OUTCOME MEASURES: Results of screenings; responses of patients and physicians to notifications; and long-term results during collaborative care. RESULTS: The pharmacists screened 532 patients and were able to contact 305 of these patients for follow-up interviews 3 to 6 months later. The stratification for risk of fracture was 37%, high risk; 33%, moderate risk; and 30%, low risk. A total of 78% of patients indicated that they had no prior knowledge of their risk for future fracture. In the moderate- and high-risk categories, 37% of patients scheduled and completed a physician visit, 19% had a diagnostic scan, and 24% of those patients were initiated on osteoporosis therapy subsequent to the screening. Participating pharmacies received payment for both the osteoporosis screening and the collaborative health management services. CONCLUSION: Pharmacists can play a useful role in the identification, education, and referral of patients at risk for osteoporosis through pharmacy-based BMD screening. Patients are willing to pay for pharmacy-based osteoporosis screening services. Third-party payers are willing to compensate pharmacists for collaborative community health management services. ID - 3300 ER - see full text for more info: Pasted some text below Aims 1. To characterise, consolidate and optimise both the constant and variable elements of the pharmacy alcohol identification/brief advice (IBA) service in NHS Northwest, and 2. To inform planning for current and future pharmacy based services promoting safe consumption of alcohol. We explored, in some detail, the assumed and actual processes used to provide this service. Data from this multi-strand design have provided us with a better understanding of which elements of the service are at its core, replicable across pharmacies, and which might be adapted to best fit the environment and people involved to generate the best health outcomes for the public. Data obtained from each workstream were mapped across service domains to triangulate findings. ID - 3301 ER - OBJECTIVES: To develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention called Emergency Contraception Mediated Pharmacy Access to Chlamydia Testing (ECOMPACT). DESIGN: Selective, opportunistic and cross-sectional study targeting asymptomatic women requesting emergency contraception (EC). SETTING: 20 community pharmacies in the Perth metropolitan region, Australia. METHODS: ECOMAPCT was developed through literature review and stakeholder consensus. Pharmacists were trained to offer ECOMPACT after the EC consultation. Women with signs and symptoms of sexually transmitted infections (STI) were referred to a physician for a full sexual health check. Asymptomatic women were offered a free ECOMPACT testing kit. The women self-collected a low-vaginal swab and returned their pathological specimen to designated drop-off sites. A pathology service analysed the specimens and sent the results to a sexual health physician. The effectiveness of ECOMPACT was determined by the uptake of the intervention and how well the target population was reached. An effective screening rate was calculated. Qualitative analysis was undertaken to understand acceptability issues from the perspective of the consumer and the pharmacists. RESULTS: Of the 769 EC consultations in a 6-month period, 569 (78%) women were given information on chlamydia screening. All 247 (41%) agreed to participate. 81 (33%) of these women were ineligible. They were either symptomatic (n=33; 41%), or were under 18 years of age (n=48; 59%). Pharmacists successfully requested 166 (67%) pathology tests, of which 46 (28%) were returned to a pathology drop-off site. All tested negative for Chlamydia trachomatis. The effective screening rate was 6%. Consumers and pharmacists considered ECOMPACT to be highly convenient and the time taken to offer a chlamydia test along with an EC consultation as highly appropriate. CONCLUSIONS: ECOMPACT was found to be simple, effective and acceptable. Given the opportunity, adequate training and support, community pharmacists in Australia were capable of requesting direct-to-consumer chlamydia tests. ID - 3302 ER - Aims: To assess the feasibility of keeping a log of diabetes-related communication in a community pharmacy and to explore the potential of the logs to reflect diabetes-related communications within pharmacies. Design: A reflective log-keeping exercise (the log designed by the researchers and provided in a booklet form) in community pharmacies of any diabetes-related communication taking place between pharmacy staff and their service users, and any signposting made to and from other relevant health professionals. The study ran for four weeks. Subjects and setting: Nine community pharmacy branches of the Independent Pharmacy Care Centres PLC based in Hull, East Yorkshire and North & North East Lincolnshire. Outcome measures: A description of the form and nature of diabetes-related communication, taking place within the community pharmacy. The research team also sought feedback on the experience of keeping the log. Results: Twenty-two communications were logged; twenty-one involved direct face-to-face contact and one log involved a telephone conversation. Two-thirds of the communications involved conversations with patients with diabetes, a third were with a partner/family member. The conversations captured fell into five categories: sugar free medicines, blood glucose-testing metre, prescription medicines, diabetes specific education/information and an unclassified category, respectively. The logs demonstrated that communications can involve all members of the staff team, working independently or jointly across their roles in the pharmacy. Conclusion: Community pharmacies in the pilot study were actively involved in providing diabetes health-related information/education and support. Communications involved directly assisting people with diabetes and providing information to people supporting others with a diagnosis of diabetes. We propose that the logs provide a valuable means of acquiring information about the form and nature of diabetes-related communication and signposting within community pharmacy. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract). ID - 3303 ER - Objective: To investigate the attitudes of pharmacists to the provision of needle-exchange services (NES) at community pharmacies and, if barriers exist, explore means by which they may be overcome. Setting: Twenty-one community pharmacies across Grampian in North East Scotland during May and June 2005. Method: Semi-structured face-to-face interviews conducted with 24 pharmacists. Key findings: Newly identified barriers included the negative influence of security staff, a local policy against NES provision and a lack of awareness of other services available for drug users. Conclusion: Training packages for all health professionals working with drug users and awareness training for security staff are required if the identified barriers are to be overcome. 'Hands-on' training and experience of NES for pharmacists and their staff should be available. Suggestions made by pharmacists for NES provision in general practitioner surgeries or community hospitals and the development of automated services should be considered. © 2008 The Authors. ID - 3304 ER - This report brings together final outcomes of two community pharmacy projects. The Number Counts - a proactive service providing alcohol awareness and brief advice, and Emergency Hormonal Contraception and Alcohol - a service providing alcohol awareness and brief advice to young girls accessing existing emergency hormonal contraceptive services. outcomes here: http://www.alcohollearningcentre.org.uk/_library/ABI_projects_report_HantsIOW_LPC_2009_FINAL.pdf More detail on the alcohol project including methods are here: http://www.alcohollearningcentre.org.uk/LocalInitiatives/projects/projectDetail/?cid=6462 ID - 3305 ER - This study investigated several aspects of antimicrobial stewardship by gathering information from community pharmacists and members of the public. The aim was to identify how community pharmacists implement antimicrobial stewardship guidelines and influence patients on the use of antibiotics. This study required and received approval from the University of Huddersfield Ethics Committee. Information and opinions of community pharmacists in the Kirklees and Calderdale areas, and surrounding local areas, and of members of the public in Huddersfield town centre, were gathered using two different questionnaires. These focused on initiatives regarding antibiotic resistance, development of the competencies required for medicines optimisation and antimicrobial stewardship, patient education by pharmacists, monitoring of antibiotic prescribing and pharmacy access to records. The results obtained were then analysed. The study consisted of 50 participating pharmacists and 100 participating members of the public. It was identified that eight pharmacists had undertaken recent professional development regarding antimicrobial stewardship, 11 had made an Antibiotic Guardian pledge and eight monitored antibiotic prescribing. It was also discovered that, when handing out a prescription for antibiotics, five pharmacists (all of whom work in an independent pharmacy) always questioned the indication and seven always provided extra self-care information. Finally, 92 members of the public selected that they would be comfortable allowing their indication (the condition that the antibiotic is being used to treat) to be provided on prescriptions for antibiotics, and 83 selected that they would be comfortable with pharmacies having access to medical records. This study suggests that increased awareness is necessary of the resources that are available to pharmacists regarding antibiotic resistance initiatives and monitoring of antimicrobial prescribing. In addition, an improvement is required concerning patient education by community pharmacists. Finally, the public should be appropriately educated regarding patient confidentiality and the benefits of pharmacies having access to patient information. ID - 3306 ER - Aim To evaluate how community pharmacy counter staff view their role as pharmacy healthy living advisers (PHLAs) as part of a service evaluation to develop community pharmacy’s public health role. Design Qualitative and quantitative evaluation Subjects and setting Counter staff trained to become PHLAs from 10 pharmacies in the south west of England. Results During a six-week period the PHLAs provided a public health intervention to 73 customers, of which 64 were signposted to public health service providers. Customer satisfaction with the service was largely positive. The qualitative aspect identified that PHLAs have considerable (but largely underutilised and unrecognised) experiential skills as health promoters and they perceive themselves to be well placed to perform this role. They do, however, require sustained support and recognition of their extended role as PHLAs from the public, their employers, health professionals and administrative authorities. Conclusion The concept of a trained PHLA role has the potential to impact on the public’s health by promoting uptake of public health services, particularly smoking cessation programmes. ID - 3307 ER - OBJECTIVE: To evaluate a pharmacist-led weight loss program based on the general requirements set forth by the Centers for Medicare & Medicaid Services' (CMS) Decision Memo for Intensive Behavioral Therapy for Obesity. SETTING: Onsite Walgreens pharmacy located inside the main administration building of Maricopa County in downtown Phoenix, AZ. PRACTICE DESCRIPTION: A prevention and wellness behavioral therapy weight loss program was developed for patients of the Maricopa County on-site Walgreens. PRACTICE INNOVATION: Current pharmacy patients were recruited to attend 14 one-on-one, pharmacist-led, face-to-face behavioral therapy sessions during a 6-month period that addressed diet, exercise, and nutrition. Interactive PowerPoint presentations were used throughout the sessions. MAIN OUTCOME MEASURES: The primary outcome was mean weight loss from baseline to the end of the study. Secondary outcomes included changes in body composition, changes in nutritional intake, and participant satisfaction. RESULTS: Of 12 enrolled participants, 11 (92%) completed the program. The mean weight loss from baseline to the end of the program was 5 kg (P <0.001), representing an average 4.5% weight loss. There was a statistically significant decrease in body mass index (BMI), waist circumference, and percent visceral fat from baseline to the end of the study; however, the increase in percent muscle mass, decrease in percent body fat, and change in nutrition intake was not statistically significant. Overall, the participants rated the program highly. CONCLUSION: Pharmacists are accessible health care providers who can effectively provide intensive behavioral therapy for obesity in a manner consistent with the CMS guidelines. ID - 3308 ER - OBJECTIVES: The United States Food and Drug Administration cited an absence of data on young adolescents as the reason the emergency contraceptive, Plan B, could not be moved over-the-counter. This study analyzed data on young adolescents with increased access to emergency contraception. METHODS: We conducted an age-stratified analysis with previously published data from a randomized, controlled trial of Plan B with a sample size of 2,117, including 964 adolescents, 90 of whom were aged younger than 16 years. Participants were randomly assigned to nonprescription pharmacy access, advance provision of 3 packs, or clinic access (control). We measured contraceptive and sexual risk behaviors at baseline and 6-month follow-up and tested for pregnancy and sexually transmitted infections. We used contingency table and logistic regression analysis to measure the effect of the intervention on risk behaviors in young adolescents (< 16 years), compared with middle adolescents (16-17 years), older adolescents (18-19 years), and adults (20-24 years). RESULTS: Adolescents aged younger than 16 years behaved no differently in response to increased access to emergency contraception (EC) from the other age groups. As with adults, EC use was greater among adolescents in advance provision than in clinic access (44% compared with 29%; P < or = .001), and other behaviors were unchanged by study arm, including unprotected intercourse, condom use, sexually transmitted infection acquisition, or pregnancy. Additionally, adolescents with increased access to EC did not become more vulnerable to unwanted sexual activity. CONCLUSION: Young adolescents with improved access to EC used the method more frequently when needed, but did not compromise their use of routine contraception nor increase their sexual risk behavior. Level of evidence: i. ID - 3309 ER - OBJECTIVES: Despite the introduction of new oral anticoagulants, vitamin K antagonists remain the mainstay of the prevention and treatment of thromboembolism. The advent of affordable point-of-care testing presents an opportunity for community pharmacists to provide anticoagulation management services, better utilizing their training, reducing the workload on medical practices and improving accessibility and convenience for patients. This study aimed to determine the effectiveness of anticoagulation management by community pharmacists. METHODS: All patients enrolled in a pilot programme for a community pharmacy anticoagulation management service using point-of-care international normalized ratio testing and computer-assisted dose adjustment were included in a follow-up study, including before-after comparison. Outcomes included time in therapeutic range (TTR), time above and below range, number and proportion of results outside efficacy and safety thresholds, and a comparison of care led by pharmacists and care led by a primary-care general practitioner (GP). KEY FINDINGS: A total of 693 patients were enrolled, predominantly males over 65 years of age with atrial fibrillation. The mean TTR was 78.6% (95% CI 49.3% to 100%). A subgroup analysis (n=221) showed an increase in mean TTR from 61.8% under GP-led care to 78.5% under pharmacist-led care (P<0.001), reflecting a reduction in the time above and, in particular, below the range. The mean TTR by pharmacy ranged from 71.4% to 84.1%. The median number of tests per month was not statistically different between GP- and pharmacist-led care. CONCLUSIONS: Community-pharmacist-led anticoagulation care utilizing point-of-care testing and computerized decision support is safe and effective, resulting in significant improvements in TTR. Our results support wider adoption of this model of collaborative care.Copyright © 2014 Royal Pharmaceutical Society. ID - 3310 ER - This report examines the sexual health services provided to young people by community pharmacies in the London Borough of Southwark. ID - 3325 ER - LINKED with ID 21140553 This report sets out the findings of an independent evaluation by Healthwatch Norfolk of the community pharmacy flu vaccination service offered to eligible patients in Norfolk. The evaluation describes the experience of patients who chose this service for their flu vaccination and provides local evidence to help inform the future commissioning of this service by the NHS England East Anglia Local Area Team and the Anglia and Essex Centre for Public Health England. ID - 3411 ER - PURPOSE: The progestogen-only intramuscular injectable Depo-Provera (depot medroxyprogesterone acetate) is an effective contraceptive method, but users need to attend a clinic every 12-13 weeks for a repeat injection from a doctor/nurse. This limits convenience of the method and may affect continuation rates. We conducted a pilot study to examine the feasibility and acceptability of users receiving the subcutaneous form of the contraception injection from pharmacists in the community pharmacy setting., MATERIALS AND METHODS: Existing users of Depo-Provera, who wished to switch to the subcutaneous preparation with the same active ingredient (Sayana Press) were invited to attend 1 of 11 community pharmacies for up to three repeat injections, given by a pharmacist. Evaluation consisted of (i) self-administered questionnaires of women and (ii) interviews with participating pharmacists, at study exit on their respective experiences., RESULTS: Global unavailability of the product during the study adversely affected recruitment and retention. 50 women were recruited. Only 48 injections were delivered at the pharmacy out of a possible 150 (34%). About 26 participants received no injections at the pharmacy and only seven (14%) participants received all three injections at the pharmacy. Participants reported mixed experiences, with some welcoming the intervention but others experiencing difficulty with pharmacist availability. Pharmacists were enthusiastic about this expansion of their role, and did not view their availability as a barrier to service delivery., CONCLUSIONS: Delivery of the subcutaneous contraceptive injectable from a community pharmacy may be feasible but availability of sufficient numbers of pharmacists trained in this technique is necessary for a robust model of service delivery. ID - 3311 ER - Linked study - already coded with other study OBJECTIVE: For early detection of persons at risk for type 2 diabetes, a combination of risk factor assessment and glucose measurement could be a promising approach and an opportunity for health promotion. The object of this study was to develop a sequential screening concept and to evaluate it in a national pharmacy based screening campaign. METHOD: Community pharmacies of the German speaking part of Switzerland participating in the national Self Care campaign "Stop diabetes--test now" offered a free of charge "sequential screening" with (a) diabetes risk assessment, (b) consecutive capillary blood glucose measurement and (c) assessment of the motivation for lifestyle change based on the Transtheoretical Model (TTM) of behaviour change. A 35 items data sheet served as a structured screening protocol and enabled quick and reliable documentation of all relevant data. Outcomes measures were: age, sex, cigarette smoking, total score of the ADA diabetes risk-factor questionnaire, family history of diabetes, body mass index, insufficient physical activity, blood pressure, capillary blood glucose, motivation for lifestyle change, counselling activities and triage decisions of the pharmacy team. RESULTS: During the 5 weeks of spring 2002, 530 pharmacies screened a total of 93,258 persons (33.1% male, mean age 60.9 years +/- 14.1 (SD)). Risk profile: family history of diabetes 26.4%; BMI > or = 25 kg/m(2) 49.3%; low physical activity 27.2%; elevated blood pressure 45.7%. Stratification into risk groups: < 2 risk factors 21.6%; > or = 2 risk factors 71.5%; borderline glycaemia (FG 5.3-6.1 mmol/l, confirmed in a second measurement) 2.5% and hyperglycaemia (FG > or = 6.1 mmol/1 or NFG > or = 11.1 mmol/1) 4.4%. Of all persons screened, 6.4% were referred to a physician and 73.7% got targeted advice with respect to physical activity and/or nutrition based on their specific risk profile. CONCLUSION: The screening campaign attracted an important part of Swiss German speaking adults (2.4%). The sequential screening could successfully be implemented into pharmacy practice. Of the generally elderly persons screened, 6.9% were detected with suspicion for diabetes type 2 and 71.5% had at least two risk factors. This provided an opportunity to initiate targeted counselling regarding therapeutic lifestyle change. ID - 3312 ER - Summary Background:  In 2003 the Swiss federation of pharmacists organized a campaign ‘sleep disturbances – daytime sleepiness’. The goal was to assist pharmacy clients in detecting likely causes of any sleep disturbance or daytime sleepiness through a free of charge screening, and to deliver targeted counselling. For pharmacy practice there are no screening or triage guidelines to assess the severity of sleep and wakefulness disturbances and potential causes for those disturbances. In this paper the outcome of the campaign in terms of feasibility, participation, observed response patterns, sale of over-the-counter (OTC) sleeping pills, and counselling activities is evaluated. Methods:  The Stanford sleep disorders questionnaire and the Epworth sleepiness scale served to identify patterns of symptoms suggestive of four major categories of sleep disorders. The questionnaires were posted on a web-site and the clients’ data were entered online in the pharmacies. A report was automatically generated and immediately available online to the pharmacists. The pharmacists documented separately their counselling activities in a pharmacist's activity report. Results:  Six hundred and twenty-two (23%) of 2743 pharmacy clients had response patterns suggestive of obstructive sleep apnoea, 418 (15%) of restless-legs-syndrome, 39 (1%) of a sleep disorder potentially associated with a psychiatric condition and 79 (3%) of narcolepsy. An Epworth sleepiness score >10 points was found in 567 (21%). After screening, 2345 (86%) pharmacy clients received targeted counselling. Only 216 (8%) purchased an OTC sleeping pill and 704 (26%) were recommended to consult a physician, but of these, 446 (63%) were already under medical supervision. Conclusions:  The online screening tool for sleep disorders and daytime sleepiness was successfully introduced in Swiss pharmacies. Pharmacies were able to assess the pattern of individual sleep disorders and to identify a possible cause in nearly one-third of the cases. ID - 3313 ER - OBJECTIVES: To describe the acceptance and refusal rates of travel-related vaccine and medication recommendations in a pharmacist-run travel health clinic, to evaluate the change in patient understanding of travel-related issues, to determine patient satisfaction with this clinic, and to determine factors influencing both patient acceptance and satisfaction. SETTING: Southern California (Claremont) between July 2007 and October 2008. PRACTICE DESCRIPTION: Hendricks Pharmacy is an independently owned community pharmacy that is part of the Good Neighbor Pharmacy Provider Network. The pharmacy offers a range of services including home delivery, compounding, and blood glucose, blood pressure, and cholesterol screenings. PRACTICE INNOVATION: Comprehensive pharmacist-run travel health clinic. MAIN OUTCOME MEASURES: Patient acceptance and refusal rates of pharmacist-made recommendations, changes in patient understanding of travel-related issues resulting from pharmacist counseling, and patient satisfaction with this travel health clinic. RESULTS: In a sample of 283 patients, overall patient acceptance of pharmacist-made recommendations was 84.7%. The primary reason for patient refusal of a recommendation was self-perceived low risk for infection. A subsample of patients (n = 82) completing a patient satisfaction survey found that 96% were satisfied with their overall visit. Patient satisfaction with the clinic and pharmacist services was correlated with overall patient acceptance. CONCLUSIONS: The high rate of patient acceptance and satisfaction with this clinic supports adoption of pharmacists as nontraditional providers of travel health services. ID - 3314 ER - OBJECTIVE: To measure the impact of an automated outbound telephone messaging system on herpes zoster (HZ) vaccinations among older adults in the community pharmacy setting. DESIGN: Randomized controlled trial. SETTING: 16 grocery store chain community pharmacies in Georgia and Tennessee, between December 2006 and May 2007. PATIENTS: Adults 60 years or older who filled at least one prescription at a participating study pharmacy. INTERVENTION: A 30-second automated outbound telephone message was delivered to patient households monthly during the first week of March through May 2007. The message advertised that older adults should speak with their pharmacist about the risk for HZ and the availability of a new vaccine. MAIN OUTCOME MEASURE: HZ vaccinations based on pharmacy profile records. RESULTS: After 3 months, 146 and 46 vaccinations were administered to older adults among the study cohort populations, translating into HZ vaccination rates of 2.60% and 0.72% at intervention and control pharmacies, respectively (odds ratio 3.69 [95% CI 2.64-5.15], P < 0.001). CONCLUSION: Use of an automated outbound telephone messaging tool to inform older adults about their risk for HZ and the availability of a vaccine significantly improved vaccination rates in the community pharmacy setting. ID - 3315 ER - Aim: To evaluate a pilot of a community pharmacy-based travel health and vaccination service. Design: A self-completed questionnaire. Subjects and settings: Two community pharmacy pilot sites: one in Aberdeen and one in Aberdeenshire. All patients who attended the pharmacies fortravel advice and services were asked to participate. Results: The median score for the overall service was 10 (interquartile range 9-10). 98% of respondents (n = 84) would use the pharmacy service again and 81.4% thought the pharmacy service provided value for money. Most clients were travelling on holiday and some found the community pharmacy could provide a more convenient venue and appointment times. Only a small number of clients had needed to be referred to other travel health providers, eg, Grampian NHS Travel Clinic. Conclusion: The pharmacy travel health service was well accepted by patients and met their needs. Most patients believed the community pharmacy service provided value for money. ID - 3317 ER - Aim. To investigate a new model for administering influenza vaccine through community pharmacy. Design. Questionnaire Subject and Setting. Under 65-year-old, "at-risk" patients from a community pharmacy in Aberdeen over a 4-week period. Patients' GPs. Results. 56 patients were vaccinated; 55 thought that the injection was administered as well as in the past; 10 patients would not have had the influenza vaccine if not offered by the pharmacist; 55 would use the pharmacy to receive other vaccinations if offered in future. Of the 24 of 32 practices that returned questionnaire, 67% would support the scheme running again and 63% would support the extension to other pharmacies; 29% were happy for the service to be extended to over 65-year-old patients not in the "at-risk" groups; 42% would support community pharmacies providing other vaccination services. Conclusion. The scheme has offered patient choice and a degree of flexibility not available from some general practices. Patients were positive about the scheme. Most GPs were supportive of the scheme. ID - 3316 ER - BACKGROUND: Despite the high prevalence of headache and migraine in the general population, many people do not receive adequate medical attention and treatment. OBJECTIVE: To evaluate the effects of pharmaceutical care (defined as intensified structured counseling between patient and pharmacist, including the use of drug databases), for patients with headache or migraine, on both clinical and psychological endpoints. METHODS: A prospective, randomized, controlled intervention study was conducted using pharmacies in Northern Germany. A total of 112 pharmacies (26% of all pharmacies in the study region) recruited 410 patients with headaches. Pharmacies were randomly assigned to an intervention or control group. Patients were interviewed by telephone prior to the intervention and again after 4 months. Primary endpoints were number of days with headache, number and severity of headaches, self-efficacy, and the patients' perceptions of their health-related quality of life. RESULTS: Each pharmacy treated an average of 4.6 patients (total time effort 9 h). The intervention group consisted of 201 patients who received pharmaceutical care, whereas the control group comprised 209 patients who received standard counseling. In both groups, the number of headache attacks and intensity of pain in treated headache attacks did not change significantly between the first and second interviews. However, a statistically significant improvement in mental health and self-efficacy was shown in the intervention group. Intensity of pain in untreated headache attacks and the number of days with headache decreased in both groups. Most participants described this intervention as helpful and effective and 90% reported that they would recommend pharmaceutical care to other patients with headache. CONCLUSIONS: A short-term pharmaceutical care intervention improved patients' mental health and self-efficacy, although it did not significantly change the number and severity of headaches. The increase in self-efficacy and mental health associated with pharmaceutical care may be instrumental in improving long-term pharmacotherapy of patients with migraine and headache. To fully assess the effects of pharmaceutical care, a longer study may be required. ID - 3318 ER - Gaining access to diabetes education can be a challenge for many people with diabetes, particularly those who reside in rural or underserved communities. Community pharmacies are accessible to patients and serve as an ideal setting for the delivery of health education. This article describes the pooled results of a community pharmacy-based diabetes education program offered in three cities in the northeastern United States and demonstrating a positive impact on patients' overall metabolic control. CVS Health Connection is a health education resource center that was developed in three CVS/Pharmacy stores located in New Bedford, Mass.; Philadelphia, Pa.; and Washington, D.C. Each center offers health information, monitoring services, wellness classes, and referrals to local health resources. The diabetes education program offered through CVS Health Connection is a 12-month, individualized care program based on the American Diabetes Association National Standards for Diabetes Self-Management Education Programs. This study included 381 patients enrolled into the program at all three sites. As a population, the clinical profile of these patients improved significantly after enrollment in the program. In those patients with follow-up measurements, hemoglobin A1c results; fasting blood glucose levels; LDL cholesterol, total cholesterol, and triglyceride levels; systolic and diastolic blood pressure measurements; and diabetes knowledge scores all improved statistically (P < 0.05). Only HDL cholesterol levels and quality of life scores did not improve significantly. While data for this study were gathered using a real-world collection approach, its results have important implications for community pharmacy-based programs to be developed in the future. ID - 3319 ER - BACKGROUND: Community pharmacy has become a major access point for several types of vaccinations. Despite the success of vaccination programs like influenza, pneumococcal, and herpes zoster, the rates of human papillomavirus vaccination continue to lag., OBJECTIVES: The primary objective is to describe and report on the impact of a multimodal series of pharmacist-led educational interventions on human papillomavirus vaccination rates in a community pharmacy setting. The primary outcome of this study was change in pharmacist-delivered human papillomavirus vaccination throughout a corresponding 8-week period in 2014 and 2015., METHODS: A single-center, quasi-experimental interrupted time series mixed-methods pilot study was used to investigate a pharmacist-led, multimodal educational intervention approach to improve human papillomavirus vaccination rates in the community., RESULTS: During the 2014 control period, there were no human papillomavirus vaccines dispensed or administered according to the internal prescription dispensing software. In 2015, a total of 10 patients indicated that they were vaccinated, with 9 patients receiving their first dose and 1 patient receiving his or her second dose at the pharmacy. Pharmacist recommendation was the most reported education method for increasing patient awareness of the human papillomavirus vaccine (n=10)., CONCLUSION: This study demonstrates pharmacist designed, educational interventions may impact human papillomavirus vaccination rates in the community. Further community-based research with larger sample sizes is warranted to verify these results. Due to the unique barriers to human papillomavirus vaccination, a multimodal and inter-professional approach such as the one presented here is warranted. ID - 3320 ER - see full paper ID - 3321 ER - BACKGROUND: Cardiovascular risk-based screening is proposed as a key intervention to reduce premature cardiovascular disease (CVD) in the UK and internationally. This study evaluated a targeted cardiovascular (CVD) assessment pilot in 23 community pharmacies in Birmingham, UK. METHODS: The CVD risk assessment service used near-patient testing and the Framingham risk equations administered by pharmacists to screen clients aged 40-70 without known CVD. Outcomes assessed included volume of activity, uptake by deprivation and ethnicity and onwards referral. RESULTS: Complete data were available for 1130 of 1141 clients; 679 (60%) male, 218 (19%) smokers and 124 (11%) had a family history of CVD. Overall, 792 (70%) of clients were referred to their general practice: 201 (18%) at CVD risk of 20% or more, remainder with individual risk factor(s). Greater representation from Black (7.4%) and Asian (24.8%) communities and from average and less deprived quintiles than the affluent and most deprived was observed. CONCLUSIONS: Community pharmacies can provide a CVD risk assessment service in a UK urban setting that can attract males and provide access for deprived communities and Black and Asian communities. A pharmacy service can support GP practices in identifying and managing the workload of around 30% of clients. ID - 3322 ER - A pharmacist-delivered health promotion and screening service for cardiovascular risk factors in rural community pharmacy was implemented in the Upper Hunter Valley, New South Wales (NSW). We describe the development of the service and profile 204 participants at their initial screening. A standardised clinical protocol guided the pharmacist through delivery of the service. The mean age of participants was 44 years (SD +/- 13). Over half (54%) had a Body Mass Index (BMI) > 25, 54% had cholesterol > 5.0 mmol L-1 and 18% a systolic BP> or = 140 mmHg and/or diastolic BP >or = 90 mmHg. Most (80%) received lifestyle information (dietary, exercise or smoking cessation). One third required referral to a general practitioner. Provision of the service through community pharmacy increased the community's access to screening, 28% reported that they had never had their cholesterol measured. Since this new service was able to identify, educate and refer people at risk of cardiovascular disease in a rural community, we recommend a broader adoption through rural pharmacies. ID - 3323 ER - BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death globally. Vascular risk assessment is recognized as playing a key role in reducing premature CVD-related morbidity and mortality. The current study evaluated the effectiveness of a pharmacy-led risk assessment service in Leicester City, UK. METHODS: The vascular risk assessment was offered opportunistically to individuals between 40 and 70 years without any prior diagnosis of CVD on attending their community pharmacist. Individuals were risk stratified using the Framingham score and those classified as high risk were referred to their general practitioner (GP). RESULTS: Overall, 2521 individuals were recruited from 39 pharmacies consisting of 1059 (42%) males, 1696 (67%) South Asians and 199 (7.9%) individuals not registered with a GP. A total of 462 (18%) individuals were referred to primary care and 52.6% of a representative subset were subsequently recorded as having attended an appointment with their GP; diagnoses and treatments commenced were recorded. CONCLUSIONS: Cardiovascular risk assessment led by community pharmacies can successfully assess people from large, multi-ethnic UK populations and identify those at high cardiovascular risk or with undiagnosed cardiovascular disease. The service may improve rates of assessments undertaken by individuals who do not access health care through traditional routes. ID - 3324 ER - Objective: To determine Scottish community pharmacists' present involvement with 'extended' service provision, as outlined in The right medicine' policy document, as well as an insight into the attitudes of pharmacists in delivering such services. Setting: All community pharmacists working in Scotland. Method: A questionnaire was developed, piloted and refined before mailing to all community pharmacists working in Scotland (n = 1621). Two reminders were sent to non-responders. Data on current service provision was analysed using SPSS version 11 for windows. Key findings: An overall response rate of 56.4% (914/1621) was achieved for pharmacists. The survey revealed that the majority of respondents either agreed or strongly agreed with the 'key service areas' being provided from community pharmacies. Some services were obviously agreed with more than others. In particular repeat dispensing and emergency hormonal contraception (EHC) were rated highly. Least agreement was provided for needle exchange and schemes for supporting carers. Conclusion: There appears to be wide variation in current service provision in the 'key service areas' considered. The highest involvement included EHC and methadone supervision. The lowest involvement was for needle exchange and schemes for supporting carers. Community pharmacist's attitudinal ratings were generally positive towards the 'key service areas' suggested. © 2005 The Authors. ID - 3326 ER - DESIGN: Descriptive analysis of the components of pharmacists' work in the Collaboration Among Pharmacists and Physicians to Improve Outcomes Now (CAPTION) study, a prospective, cluster randomized trial.MEASUREMENTS AND MAIN RESULTS: This analysis was intended to provide policymakers with data and information, using the CAPTION study model, on the time and intensity of pharmacists' work to understand pharmacists' relative value contributions in the context of CMS financing and population management aims. The CAPTION trial was conducted in 32 community-based medical offices in 15 U.S. states and included 390 patients with multiple cardiovascular risk factors. Blood pressure was measured by trained study coordinators in each office, and patients were included in the study if they had uncontrolled blood pressure. Included patients were randomized to a 9-month intervention, a 24-month intervention, or usual care. The goal of the pharmacist intervention was to improve blood pressure control and resolve drug therapy problems impeding progress toward blood pressure goals. This intervention included medical record review, a structured assessment with the patient, collaboration to achieve goals of therapy, and patient follow-up. The two intervention arms (9 and 24 mo) were identical the first 9 months, and that time frame is the focus of this workload evaluation. Pharmacists completed study encounter forms for every patient encounter and estimated time spent in pre-visit, face-to-face care, and post-visit activities. Among the 390 patients, there were 2811 encounters with pharmacists that involved 3.44 hours/patient for face-to-face care visits plus 1.55 hours/patient for pre-visit and post-visit work. Intensity of work was reflected in interventions to resolve drug therapy problems with patients (43% of encounters) and with physicians (1169 recommendations, of which physicians accepted 1153 [98.6%]), resulting in improvement of patients' blood pressure goals achieved (from 0% at baseline to 43% at 9 months based on the primary study end point).CONCLUSION: Pharmacists provided extensive interventions to patients with hypertension. This analysis provides a framework for health systems, provider groups, and payers to measure pharmacists' work in value-based financing and population management.STUDY OBJECTIVE: Physician-pharmacist collaborative models have been shown to improve the care of patients with numerous chronic medical conditions. Team-based health care using integrated clinical pharmacists provides one opportunity to improve quality in health care systems that use population-based financing. In November 2015, the Centers for Medicare and Medicaid Services (CMS) requested that the relative value of pharmacists' work in team-based care needs to be established. Thus the objective of this study was to describe the components of pharmacists' work in the management of hypertension with a physician-pharmacist collaborative model. ID - 3327 ER - BACKGROUND: The extension of the role of the community pharmacist in the UK has been under discussion for several years. Professional opinions have been reported. It is important to investigate consumer attitudes towards the acceptability of the proposed new role of the pharmacist. OBJECTIVES: This pilot study investigated the attitudes of consumers to the proposed extended role of the community pharmacist. METHODS: A total of 173 printed questionnaires were mailed to a random sample of patients stratified by age and sex, registered with an urban general practice in the north east of Scotland. The questionnaire asked subjects their views on ideas for new services to be provided by community pharmacists. RESULTS: A total of 96 questionnaires were returned (response rate 55%). Respondents were in favour of community pharmacist involvement in non-medicine-related roles such as 'healthy living' advice but less in favour of roles where the pharmacist would have access to selected information from medical records. CONCLUSION: This pilot study has indicated a range of attitudes towards the extended role of the community pharmacist. It is important to investigate fully consumer attitudes towards the acceptability of the new role of the pharmacist. ID - 3328 ER - OBJECTIVES: Feasibility of pharmacist delivered motivational interviewing (MI) to methadone patients has been demonstrated, but its efficacy is untested. This study aimed to determine whether pharmacists trained in MI techniques can improve methadone outcomes. METHODS: A cluster randomised controlled trial by pharmacy, with community pharmacies across Scotland providing supervised methadone to >10 daily patients, aged >18 years, started on methadone <24 months. Pharmacies were randomised to intervention or control. Intervention pharmacists received MI training and a resource pack. Control pharmacists continued with normal practice. Primary outcome was illicit heroin use. Secondary outcomes were treatment retention, substance use, injecting behaviour, psychological/physical health, treatment satisfaction and patient feedback. Data were collected via structured interviews at baseline and 6 months. KEY FINDINGS: Seventy-six pharmacies recruited 542 patients (295 intervention, 247 control), mean age 32 years; 64% male; 91% unemployed; mean treatment length 9 months. No significant difference in outcomes between groups for illicit heroin use (32.4% cf. 31.4%), although within-groups use reduced (P < 0.001); treatment retention was higher in the intervention group but not significantly (88% cf. 81%; P = 0.34); no significant difference between groups in treatment satisfaction, although this improved significantly in intervention (P < 0.05). More intervention than control patients said pharmacists had 'spoken more,' which approached statistical significance (P = 0.06), and more intervention patients found this useful (P < 0.05). CONCLUSIONS: Limited intervention delivery may have reduced study power. The intervention did not significantly reduce heroin use, but there are indications of positive benefits from increased communication and treatment satisfaction.Copyright © 2013 Royal Pharmaceutical Society. ID - 3330 ER - This work aimed to: evaluate impact of a community pharmacy-led intervention on appropriateness of treatment and quality of life of CHD patients; describe opinions and experiences of community pharmacists and GPs and use management of change literature as an explanatory framework for the findings.

Review of pharmacy interventions revealed only small-scale studies demonstrating benefit for CHD patients. The change review revealed use of change management theories to implement change and as explanatory frameworks for change initiatives, in the NHS, but not in the pharmacy setting. The RCT recruited 1493 patients (980 intervention, 513 control), 70 pharmacies (102 pharmacists) and 48 practices (208 GPs). No significant differences were found in primary outcomes (appropriateness of treatment or quality of life). Questionnaires revealed positive attitudes to the service but need for pharmacist access to patient records and improved GP/community pharmacist relationships. Qualitative interviews indicated more divergent views. Attitudes were influenced by understanding and previous experience of medicines management, change drivers and implementation processes. Themes conceptualised into a `change readiness¿ model, had similarities with Lewin¿s planned change approach and Pettigrew¿s receptivity model. All three models identified areas of sub-optimal intervention implementation and delivery.

The new service did not improve appropriateness of treatment or quality of life because it was implemented and delivered sub-optimally. There is a need for greater use of an evidence based systematic approach to introduce new services, but research is required to confirm this approach would confer the hypothesised benefits. ID - 3329 ER - OBJECTIVE: To report experiences of the New Mexico pharmacist tuberculosis (TB) testing program. SETTING: Community pharmacies in New Mexico interested in participating in the TB testing initiative from March 2011 to August 2013. PRACTICE INNOVATION: To expand accessibility of TB testing, New Mexico pharmacists were granted the authority to prescribe, administer, and read tuberculin skin tests (TSTs) in March 2011. To receive this special prescriptive authority, pharmacists had to complete a New Mexico Department of Health training program in accordance with the Centers for Disease Control and Prevention guidelines. EVALUATION: Data were collected on the number of TSTs performed and the TST reading follow-up rate. Patient data collected were demographic information, reason for obtaining a TST (e.g., immigration, school, or work), TB risk factors, and TST results. RESULTS: In New Mexico, 43 pharmacists were certified for TB testing during the evaluation period, 25 of whom were actively prescribing and performing TB testing at eight community pharmacies. There were 606 tests administered to 578 patients; 70.9% women, median age 31 years (4-93 years). Employment and school were the main reasons for obtaining a TB test. A total of 578 of 623 (92.8%) patients followed up to have their TSTs read. A total of 18 positive tests (3.1% positivity rate) were identified and appropriate referrals were made. CONCLUSION: New Mexico expanded the scope of practice for pharmacists. Pharmacist-performed TB testing had a valuable public health benefit. TB testing follow-up rates at community pharmacies in New Mexico were high, most likely due to convenient hours, accessible locations, and no required appointments. ID - 3331 ER - This annual report provides details of the Frontline Social Care Workers Flu Vaccination Scheme 2014/15 which ran from 1 October 2014 to 31 January 2015. Following a procurement process 19 community pharmacies were commissioned by public health to deliver vaccinations to frontline social care staff working in the Wakefield District. Pharmacies were commissioned on a one year contract with the opportunity to extend annually for two further years (see appendix 1 for list of pharmacies). Eligible staff included those working within the Council, independent care homes and independent care contractors, who provide personal care. The scheme operated on a voucher basis as an incentive for staff which also allowed for the accurate data capture, providing details of teams and organisations accessing the scheme. The scheme involved partnership working across departments. The scheme was a project managed by public health and overseen by a steering group comprising of representatives from public health, human resources, care and support commissioning, adult services and children and young people’s services. The procurement process was managed by the procurement team with contract expertise provided from legal services. ID - 3332 ER - Objective: Characterize the impact of a pharmacist-led diabetes self-management program on three key metabolic parameters: glycosylated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C), and mean arterial blood pressure (MAP) among employee health program participants.; Methods: A self-insured company in the Kansas City metropolitan area began offering a pharmacist-led diabetes self-management program to eligible company employees and their dependents in 2008. A retrospective pre-post analysis was conducted to determine if the program affected key metabolic parameters in participants by determining mean change after one year of participation.; Results: Among 183 program participants, 65 participants met inclusion criteria. All three key metabolic parameters were significantly reduced from baseline to one year of program participation: HbA1c decreased from 8.1 % to 7.3% (p=0.007); LDL-C decreased from 108.3 mg/dL to 96.4 mg/dL (p=0.009); and MAP decreased from 96.1 to 92.3 mm Hg (p=0.005).; Conclusions: The pharmacist-led diabetes self-management program demonstrated significant reductions in HbA1c, LDL-C, and MAP from baseline to one year of program participation. Improvements were statistically significant and clinically relevant for each parameter. Previous studies indicate these reductions may cause reduced overall healthcare costs.; ID - 3334 ER - OBJECTIVE: To identify women 60 years of age or older at risk for osteoporosis, provide education, and refer at-risk women to physicians through a community pharmacy screening program and to develop a model in community pharmacies for this service. DESIGN: Cross-sectional study. SETTING: Northwest Iowa between August 2005 and October 2005. PARTICIPANTS: 159 women 60 years of age or older screened at five pharmacies. INTERVENTIONS: Five pharmacies completed education on osteoporosis, received training on use of the Achilles InSight by GE Lunar, and screened women 60 years of age or older for osteoporosis. Patients received education on osteoporosis and risk factors during the screening and were stratified as low, moderate, or high risk based on a T-score. Patients at risk were referred to their physician for further evaluation. Pharmacists telephoned patients at 3 and 6 months after screening to determine self-initiated or provider-initiated changes in their treatment plan. MAIN OUTCOME MEASURES: Descriptive population characteristics, proportion of participants with medical risk factors for osteoporosis, proportion of patients screened at risk, and proportion of physician or patient self-initiated changes instituted as a result of the screening. RESULTS: Of the 159 women screened, 53% were rated as moderate or severe risk and referred to their physicians. Three- and 6-month follow-up results revealed a high proportion of self-initiated lifestyle or medication changes and a small proportion of physician-initiated changes. CONCLUSION: The majority of women 60 years of age or older who attended a community pharmacy osteoporosis screening were at moderate or high risk for osteoporosis. A fee-for-service model was created for community pharmacists to improve recognition and treatment of patients at risk. A toolkit will be created for pharmacists to promote their role in improving the bone health of older patients. ID - 3333 ER - OBJECTIVE: To assess the effectiveness of a range of weight management programmes in terms of weight loss. DESIGN: Eight arm randomised controlled trial. SETTING: Primary care trust in Birmingham, England. PARTICIPANTS: 740 obese or overweight men and women with a comorbid disorder identified from general practice records. INTERVENTIONS: Weight loss programmes of 12 weeks' duration: Weight Watchers; Slimming World; Rosemary Conley; group based, dietetics led programme; general practice one to one counselling; pharmacy led one to one counselling; choice of any of the six programmes. The comparator group was provided with 12 vouchers enabling free entrance to a local leisure (fitness) centre. MAIN OUTCOME MEASURES: The primary outcome was weight loss at programme end (12 weeks). Secondary outcomes were weight loss at one year, self reported physical activity, and percentage weight loss at programme end and one year. RESULTS: Follow-up data were available for 658 (88.9%) participants at programme end and 522 (70.5%) at one year. All programmes achieved significant weight loss from baseline to programme end (range 1.37 kg (general practice) to 4.43 kg (Weight Watchers)), and all except general practice and pharmacy provision resulted in significant weight loss at one year. At one year, only the Weight Watchers group had significantly greater weight loss than did the comparator group (2.5 (95% confidence interval 0.8 to 4.2) kg greater loss,). The commercial programmes achieved significantly greater weight loss than did the primary care programmes at programme end (mean difference 2.3 (1.3 to 3.4) kg). The primary care programmes were the most costly to provide. Participants allocated to the choice arm did not have better outcomes than those randomly allocated to a programme. CONCLUSIONS: Commercially provided weight management services are more effective and cheaper than primary care based services led by specially trained staff, which are ineffective. Trial registration Current Controlled Trials ISRCTN25072883. ID - 3335 ER - Lothian Health Board envisaged a pharmacy-based chlamydia testing and treatment (CT&T) service to be able to reach deprived population. This research project set out to evaluate the implementation of the CT&T in Lothian, Scotland. Four studies were undertaken towards the evaluation, and these employed diverse methods, as follows: (i) A training need survey of pharmacists and their support staff was undertaken in 166 community pharmacies in Lothian, to inform the training session held prior to the CT&T service launch. (ii) A survey of 33 strategic stakeholders in Lothian was undertaken to provide input to the evaluation objectives and to identify their perceptions and concerns in relation to the CT&T initiative and its evaluation. (iii) A survey of potential service users, young people aged 15-24 years, was carried out at the Genito-Urinary Medicine (GUM) clinic and two other sexual health drop-in clinics in Lothian. The survey ascertain their preferences regarding specific aspects of the CT&T service, and their views on issues identified in previous literature as facilitators or barriers with regard to utilising of such a service. (iv) In order to understand the service provider¿s perspective on setting up and delivering of the CT&T service, in-depth interviews were undertaken with participating and nonparticipating pharmacists.

The Lothian CT&T service had been designed to improve access to chlamydia services for young people living in deprived areas in Lothian, which generally are more geographically distant from existing (non-GP) chlamydia services that are available in Lothian. The enthusiasm found among pharmacists to deliver the CT&T service, and the acceptability to potential service users of the various characteristics of the service, suggests that as part of a multi-faceted approach to chlamydia service, a pharmacy-based testing and treatment would be a useful additional choice for young people to such a service. Despite this, the uptake of the service was very low. It is possible that this is due to the virtual absence of advertising for the service. Furthermore, the service was short lived, being cancelled after 10 months. Both these circumstances might reflect the fact that the initial impetus for the service was at Government level, not within Lothian Health Board, and the service being supported by special central government funding that ceased after 10 months. This highlights the importance of robust commitment to any new service initiative that is being considered, in particular among key policy-makers / budget-holders. Nevertheless the research findings of this thesis are useful to inform planning of future initiatives in provision of chlamydia testing to young people in community pharmacies, and as such will enhance the chances of successful outcomes. Furthermore, many of the findings will be of considerable utility in developing chlamydia services in other health care settings, and even for other public health programmes in pharmacies. ]]> ID - 3336 ER - OBJECTIVE: To investigate the general public's perceptions of the community pharmacist's (CP) role in Wales by exploring understanding, awareness of services provided and potential interventions for promoting the role of CPs., METHODS: Qualitative methodology using focus group (FG) discussions exploring opinions, facilitated by a moderator (pharmacist) and an assistant. Topics discussed included the following: what a CP does; reasons for visiting; from whom they seek advice on medicines or lifestyle issues; use of traditional and newer services and promotion of services. The groups, totalling 32 participants, represented non-users and users of pharmacy services, that is pupils from a local secondary school (x1 group), people from the local community (x3) and patients plus carers from a Parkinson's disease group (x1). FG discussions were recorded and transcribed verbatim, and analysis was undertaken to identify themes., KEY FINDINGS: Traditional dispensing and supply of medicines roles were clearly recognised, but poor awareness of the newer services emerged, particularly in public health roles. CP's professionalism was acknowledged, but there was confusion over where they 'fit' within the National Health Service or with General Practitioners, with concerns or misconceptions raised over the impact of commercialism on professionalism., CONCLUSIONS: Based on these findings, the public is accepting of the extended role of CPs and would engage with CPs for a wider range of services. However, there is a lack of awareness of what public health services are available. Considerable work is needed to increase public awareness, during the strategic development of these services in Wales., Copyright © 2017 Royal Pharmaceutical Society. ID - 3337 ER - ID - 3338 ER - BACKGROUND: Studies indicate that community pharmacy-based alcohol brief intervention (BI) is feasible. However, few studies report significant reductions in post-BI alcohol consumption and customer experience. Cost-effectiveness has not been previously examined. OBJECTIVES: This 5 month study adopted a single group pre- and post-experimental design to: (1) assess uptake of the community pharmacy alcohol BI service; (2) establish post-BI changes in alcohol consumption for hazardous drinkers; (3) report the acceptability of the service to customers who received it; and (4) undertake a preliminary economic evaluation of the service through establishing whether pharmacy-based alcohol BI affected health and social care costs, including lost employment costs, and whether it was cost-effective. SETTING: 26 community pharmacies in south London, UK. METHOD: Trained pharmacists used the AUDIT-C and a retrospective 7-day Drinking Diary to identify risky drinkers and inform feedback and advice. Harmful drinkers were referred to their general practitioner and/or specialist alcohol services. A confidential service feedback questionnaire was completed by alcohol BI recipients. Baseline and 3-month follow-up telephone interviews were conducted with hazardous and low risk drinkers to assess post-BI alcohol use change and service cost-effectiveness. MAIN OUTCOME MEASURES: AUDIT-C, 7-day alcohol unit consumption, drinking days, cost utilisation data. RESULTS: Of the 663 eligible customers offered alcohol BI, 141 (21 %) took up the service. Three-quarters of customers were identified as risky drinkers. Follow-up interviews were conducted with 61 hazardous/low risk drinkers (response rate = 58 %). Hazardous drinkers were found to significantly reduce their 7-day alcohol unit consumption and drinking days, but not AUDIT-C scores. The majority of harmful drinkers (91 %, n = 10) who were contactable post-BI had accessed further alcohol related services. Customer feedback was generally positive. Over 75 % of customers would recommend the service to others. The cost of delivering the service was estimated to be 134. The difference in service costs pre-BI and post-BI was not statistically significant and remained non-significant when calculated on 500 customers receiving the intervention. CONCLUSION: Community pharmacy-based alcohol BI is a low cost service that may not have immediate beneficial impact on health and social service use, but can be effective in reducing drinking in hazardous drinkers. ID - 3339 ER - Aims and Objectives • Explore feasibility of using community pharmacy to offer Fluenz vaccine to children who were not able to receive it in school; • Examine the operational challenges of this option; • Evaluate feedback from LPT staff, parents and pharmacists; • Analyse uptake, including preferred days, times and use of holiday period; • Suggest improvements and changes for future; ID - 3340 ER - BACKGROUND: Since 2007, the Australian Know your numbers (KYN) program has been used in community settings to raise awareness about blood pressure and stroke. In 2011, the program was modified to include assessment for type 2 diabetes risk. However, it is unclear which approach for assessing diabetes risk in pharmacies is best. We compared two methods: random (non-fasting) blood glucose testing (RBGT); and the Australian type 2 diabetes risk assessment tool (AUSDRISK); according to 1) identification of 'high risk' participants including head-to-head sensitivity and specificity; 2) number of referrals to doctors; and 3) feasibility of implementation. METHODS: 117 Queensland pharmacies voluntarily participated and were randomly allocated to RBGT and AUSDRISK or AUSDRISK only. Although discouraged, pharmacies were able to change allocated group prior to commencement. AUSDRISK is a validated self-administered questionnaire used to calculate a score that determines the 5-year risk of developing type 2 diabetes. AUSDRISK (score 12+) or RBGT (>5.6 mmol/I) indicates a high potential risk of diabetes. Median linear regression was used to compare the two measures. Staff from 68 pharmacies also participated in a semi-structured interview during a site visit to provide feedback. RESULTS: Data were submitted for 5,483 KYN participants (60% female, 66% aged >55 years, 10% history of diabetes). Approximately half of the participants without existing diabetes were identified as 'high risk' based on either RBGT or AUSDRISK score. Among participants who undertook both measures, 32% recorded a high RBGT and high AUSDRISK. There was a significant association between RBGT and AUSDRISK scores. For every one point increase in AUSDRISK score there was a half point increase in RBGT levels (coefficient 0.55, 95% CI: 0.28, 0.83). Pharmacy staff reported that AUSDRISK was a simple, low cost and efficient method of assessing diabetes risk compared with RBGT, e.g. since management of sharps is not an issue. CONCLUSIONS: In a large, community-based sample of Australians about half of the participants without diabetes were at 'high risk 'of developing diabetes based on either AUSDRISK or RBGT results. AUSDRISK was considered to be an acceptable method for assessing the risk of diabetes using opportunistic health checks in community pharmacies. ID - 3341 ER - The progression of cardiovascular disease (CVD) is largely modifiable through lifestyle behaviours. UK pharmacists are contractually obliged to facilitate patient self-management of chronic conditions such as CVD. Pharmacists are easily accessible health professionals who are well placed to identify “at risk” patients through medication regimes. Research has identified varying attitudes towards and levels of involvement in pharmacist-led health promotion activity. Given the diverse and exploratory nature of the work, a pragmatic, mixed methods approach was used to explore community pharmacists’ role in facilitating patient self-management of CVD. The thesis presents four studies: a qualitative study with pharmacists; a cross sectional questionnaire of community pharmacists; a systematic review and a qualitative study with patients with CVD. The qualitative study with pharmacists gave an insight into pharmacists’ experiences of giving patients with CVD lifestyle advice and the factors underpinning commonly cited barriers to providing public health services. This informed the development of the cross-sectional questionnaire which identified the predictors of pharmacists’ intentions to give two different types of advice to facilitate patient self-management. The systematic review identified a small number of interventions to prepare pharmacists to facilitate patient lifestyle behaviour change and evaluated the theories and behaviour change techniques used in successful interventions; however due to poor study quality and poor reporting of the interventions limited conclusions about the efficacy of the interventions could reliably be drawn. Finally, the qualitative study gave an insight into the experiences of patients with CVD using community pharmacy services and their expectations of the service they receive from community pharmacists. Recommendations about changes to pharmacy policy and practice in order to support pharmacists’ provision of CVD self-management advice are made. ID - 3343 ER - BACKGROUND: In January 2001, emergency hormonal contraception was made available for women over the age of 16 years directly from a pharmacist without prescription. It is of interest whether this change in the UK has led to any improvements or deterioration in the service provided for the women who need it. METHODS: Self- completed, anonymous questionnaires were distributed to women requesting emergency hormonal contraception through a single group of pharmacies located throughout England, Wales and Scotland. RESULTS: A total 419 women returned completed questionnaires. A greater proportion of women were able to take emergency contraception within 24 h when they obtained their tablets directly from a pharmacy without a prescription (64% versus 46%, P = 0.029). Women who obtained their drugs directly from the pharmacist were just as well informed, just as likely to arrange regular follow-up and generally preferred this system, although they disliked having to pay. CONCLUSION: Making emergency hormonal contraception available without prescription has improved services to women who need them, but these improvements are quantitatively minimal, preventing only five additional pregnancies per 10,000 users. ID - 3342 ER - BACKGROUND: Skin cancer accounts for one third of all cancers. Prognosis is inversely related to identification stage., OBJECTIVES: To describe a novel service, mole scans, performed in community pharmacy, the findings from the first 3.5 years it was in place, and to explore patient acceptability of the service., METHODS: Norwegian Boots' pharmacies offer a mole scanning service in cooperation with ScreenCancer. Scans are undertaken within pharmacy consultation rooms. Image interpretation is undertaken remotely by a specialist. Number and result of scans performed from 2010 to 2014 are reported. A satisfaction questionnaire was returned by 10% of participants., RESULTS: A total of 25836 scans were performed on 15777 individuals. Of these, 83.6% had normal scans, 1% had melanoma, and 15.4% had another skin condition. In 2014 the service identified 4.1% of melanoma cases registered in the Norwegian Cancer Registry. Most responders (88%) would use a similar service again. Nearly all (99%) felt the pharmacy was a suitable venue, and 95% would recommend the service to others. In total, 99% of respondents scored their overall satisfaction as "good" or higher., CONCLUSIONS: This approach was acceptable among participants who provided feedback. Providing mole scanning through pharmacies enables individuals to obtain a rapid check of moles causing concern, in an acceptable environment with a high level of satisfaction.Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved. ID - 3344 ER - Objectives: To describe patient outcomes associated with a community pharmacy-based, collaborative physician-pharmacist group A Streptococcus (GAS) management program.; Setting: Fifty-five chain and independent community pharmacies in Michigan, Minnesota, and Nebraska.; Practice Innovation: Pharmacists screened clinically stable adult patients who presented with signs and symptoms consistent with GAS pharyngitis from October 1, 2013, to August 1, 2014, by means of Centor criteria, and performed a physical assessment followed by a rapid antigen detection test (RADT) for eligible patients. Patients were treated according to a collaborative practice agreement (CPA) with a licensed prescriber or a physician consult site model. Pharmacists followed up with patients 24-48 hours after the encounter to assess patient status and possible need for further intervention.; Evaluation: Number of patients screened, tested, and treated, and health care utilization.; Results: Of 316 patients screened, 43 (13.6%) were excluded and referred for care. Of 273 patients (86.4%) eligible for testing, 48 (17.6%) had positive test results and 46 (16.8%) received amoxicillin or azithromycin per the CPA. Of those tested, 43.2% had no primary provider and 43.9% visited the pharmacy outside of traditional clinic office hours.; Conclusion: Pharmacists demonstrated the ability and capacity to provide care for patients seeking treatment for pharyngitis. The number of patients without a primary care provider and seen at the pharmacy outside of normal office hours highlights the improved access that community pharmacy-based care offers.; Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved. ID - 3345 ER - OBJECTIVE: To assess the impact of pharmacist counseling on empowering people with diabetes to better self-care. INTRODUCTION: Community-based pharmacists can play a key role in educating and empowering people in such programs. METHODS: A randomized trial compared the effects of pharmacist counseling (intervention group) with printed materials (control group) in diabetic beneficiaries of several employer-based health care plans. All participants also received waiver of out-of-pocket expenses for diabetic-related medications and supplies. Clinical, humanistic, and claim outcomes were evaluated at baseline and at 1 year follow-up. RESULTS: Sixty-seven beneficiaries participated in this study. The 0.50% decrease from baseline in glycosylated hemoglobin (A1c) was statistically significant (P = .0008) in the intervention group and the difference between the groups approached statistical significance (P = .076). Beneficiaries in both groups had greater claim costs for diabetic-related medications and supplies during the study year. Both groups also improved in ability to manage their diabetes with the counseling group showing a significantly better understanding of diabetes (P = .0024). CONCLUSION: There was a trend toward improvement in A1c in patients counseled by pharmacist with an increased utilization of diabetes-related medications and supplies. Counseling also improved diabetes knowledge and empowered patients to better diabetes management. ID - 3346 ER - AIM: To assess the impact of a community pharmacy diabetes service model on patient outcomes in Type 2 diabetes. METHODS: The study utilized a multisite, control vs. intervention, repeated-measures design within four states in Australia. Fifty-six community pharmacies, 28 intervention and 28 control, were randomly selected from a representative sample of urban and rural areas. Intervention pharmacies delivered a diabetes service to patients with Type 2 diabetes, which comprised an ongoing cycle of assessment, management and review, provided at regular intervals over 6 months in the pharmacy. These services included support for self monitoring of blood glucose, education, adherence support, and reminders of checks for diabetes complications. Control pharmacists assessed patients at 0 and 6 months and delivered no intervention. RESULTS: A total of 289 subjects (149 intervention and 140 control) completed the study. For the intervention subjects, the mean blood glucose level decreased over the 6-month study from 9.4 to 8.5 mmol/l (P < 0.01). Furthermore, significantly greater improvements in glycaemic control were seen in the intervention group compared with the control: the mean reduction in HbA(1c) in the intervention group was -0.97% (95% CI: -0.8, -1.14) compared with -0.27% (95% CI: -0.15, -0.39) in the control group. Improvements were also seen in blood pressure control and quality of life in the intervention group. CONCLUSION: A pharmacy diabetes service model resulted in significant improvements in clinical and humanistic outcomes. Thus, community pharmacists can contribute significantly to improving care and health outcomes for patients with Type 2 diabetes. Future research should focus on clarifying the most effective elements of the service model. ID - 3348 ER - Issues addressed: The implementation and evaluation of a standardised cardiovascular health promotion and screening service in community pharmacy.Method: The service was implemented in two phases. Training was provided in the use of the health promotion and screening protocol and testing equipment to measure blood pressure (BP), total cholesterol (TC), and body mass index (BMI). The null hypothesis tested was that there would be no difference in mean clinical parameters between cohorts at initial screening and within cohorts at baseline and three month follow-up.Results: 389 participants were screened. At baseline, similar prevalence of risk factors were present in both cohorts (54% had a BMI>25 kg/m2; 53% cholesterol>5.0 mmol/L; 17% systolic BP>/=140 mmHg +/- diastolic BP>/=90 mmHg; 28% required referral to a GP; 54% participated in less than the recommended level of physical activity). 79% received lifestyle advice (diet, physical activity, smoking cessation). At three months post screening, there was a reduction of 0.26 mmol/L (95% CI 0.10-0.42) in mean TC within both cohorts (p< 0.003) and a reduction of 10.5 mmHg (95% CI 4.0-16.9) in mean systolic BP within cohort one (p=0.012). In general, consumers were satisfied with the health promotion and screening service offered in community pharmacy.Conclusion: The service identified a significant proportion of participants who were at risk of cardiovascular disease. This resulted in early intervention and/or referral for further assessment and management. ID - 3347 ER - ISSUE ADDRESSED: Asthma awareness in a rural community and the involvement of the community pharmacist in proactive health promotion. METHODS: Between September 2002 and May 2003, seven community pharmacists from Orange, a rural town in New South Wales, were trained to provide two asthma outreach programs: one targeting adolescents in high schools (Year 11 students) using Triple A training; and a public forum on asthma for the wider community. RESULTS: There was a significant increase in the mean asthma knowledge scores of Year 11 students in each high school after Triple A training. From the multivariate analysis, although there was a significant increase in mean asthma knowledge scores over time (F=101.09, df=1, p<0.001), there were no differences between high schools (F=2.79, df=2, p>0.05). There was a significant increase in the proportion of asthma-related pharmacy visits involving requests for information on asthma and on asthma devices at the four different time points. CONCLUSIONS: The study provided a unique opportunity for community pharmacists to increase asthma awareness in a rural setting. The study demonstrated that it is feasible for rural community pharmacists to become involved in proactive health promotion and effectively provide asthma outreach programs. ID - 3349 ER - Community pharmacies are one venue for delivery of the NHS Health Check, aimed at assessing the risk of developing coronary heart disease, stroke, diabetes and chronic renal disease in the population aged between 40 and 74. Of the 17 pharmacies in Lewisham delivering the Health Check, four were commissioned as a pilot to offer spirometry testing to attenders who were current or recent smokers to assess their risk of lung disease. This study was designed to evaluate the provision of both NHS Health Checks and the additional spirometry testing service, from the perspectives of clients, pharmacist providers and general practice staff. ID - 3351 ER - OBJECTIVES: To explore the views of community pharmacy staff, the general public and other stakeholders towards pharmacy-based alcohol screening and advice services. To involve all relevant stakeholders in designing an acceptable and feasible pharmacy-based alcohol screening and advice service. To evaluate a pilot service from the user perspective. STUDY DESIGN: Mixed methods study involving a range of populations, designed to explore multiple perspectives and enable triangulation of results, to develop an optimal service design, prior to service commissioning. METHODS: Telephone interviews were conducted with relevant stakeholders and a street survey undertaken with the public to explore views on the desirability and feasibility of pharmacy-based alcohol services. Following this, a stakeholder working group was held, involving a nominal group technique, to develop and refine the service design. Finally a pilot service was evaluated from the user perspective through telephone interviews and direct observations by a trained researcher. RESULTS: All stakeholder groups (pharmacy staff, public, commissioners, alcohol treatment service staff) viewed pharmacy-based alcohol screening services as acceptable and feasible with the potential for integration and/or combination with existing public health services. Privacy was the main concern of the public, but 80% were comfortable discussing alcohol in a pharmacy. These views were not influenced by drinking status age or gender, but people recruited in areas of high deprivation were more likely to accept a pro-active approach or alcohol-related advice from a pharmacist than those from areas of low deprivation. Stakeholder groups were in agreement on the acceptability of a pharmacy screening service, but alcohol treatment service staff viewed direct referral to alcohol support services less beneficial than other stakeholders. Posters in pharmacies and GP surgeries were viewed as most likely to encourage uptake of screening. Involvement of non-pharmacist pharmacy staff was seen as essential. The working group considered accessibility of pharmacies as the key facilitator for alcohol services, but agreed that an optimal service must ensure that poor pharmacy environment did not create a potential barrier, that clear information about the service's availability was necessary. Plus good use of quiet areas. Use of AUDIT-C as a prescreening tool by pharmacy staff, followed when appropriate by completion of full AUDIT by the pharmacist in a private room/quiet area was agreed as optimal to ensure accessibility plus privacy. Direct referral was viewed as desirable. Five pharmacies piloted this service for two months and recruited 164 people for alcohol screening, of whom 113 were low risk (AUDIT score 0-7), 24 increasing risk (8-19) and 28 high risk/possibly dependent drinkers (20 or above). Observations showed that pharmacy support staff were involved in proactively approaching customers, that 20 of the 72 customers observed (28%) during two hours in each pharmacy were invited for screening and that 14 (19%) accepted screening. Promotion of the service was variable dependent on company policies, but was shown to have a positive effect, as two of the ten service users interviewed requested screening. The environment was judged suitable for alcohol services in all pharmacies, but some quiet areas were not audibly discrete. Ten service users interviewed all considered the experience positive and all would recommend the service, but most wanted the service to be delivered in a private area. CONCLUSION: The methodology enabled the development of pharmacy-based alcohol screening to be assessed for acceptability and feasibility from multiple perspectives, prior to full service commissioning. Results suggest that the pharmacy environment and concerns about privacy need to be recognized as potential barriers to service delivery. Good promotion is required to maximize service uptake and pharmacy staff need to be involved in both this and in service delivery.Copyright © 2013 The Royal Society fo Public Health. Published by Elsevier Ltd. All rights reserved. ID - 3350 ER - Introduction It is estimated that there are 4.6 million individuals in the US that have been exposed to the hepatitis C virus (HCV) and are antibody positive (AB+). Baby boomers born between 1945 and 1965 have been identified as having higher prevalence of HCV leading to screening recommendations by the Centers for Disease Control and Prevention (CDC). The aim of this study is to identify the prevalence of HCV AB+ using birth cohort and high risk factors in individuals screened at retail pharmacies and to link HCV AB+ individuals with a pathway to care. Methods This is an ongoing IRB-approved screening study involving 45 retail pharmacies located in 9 US metropolitan areas. A full time phlebotomist was assigned to each city and he/she screened individuals at a different store within the given city each day of the week. Individuals were recruited by direct advertising at the pharmacies. After obtaining informed consent, demographic data and a risk factor assessment were collected. A finger stick blood sample was screened for HCV antibody (HCV AB) using the OraQuick HCV Rapid Antibody Test. Within 3 business days of testing, HCV AB- individuals were given their results via email or phone. HCV AB+ individuals were contacted by a designated HCV Management Specialist who provided the test results as well as specific information for a pathway to care. The same HCV Management Specialist followed up with all HCV AB+ individuals approximately 21-28 days after initial contact to determine whether the individual followed up with their primary care provider or through the pathway provided by the HCV Management Specialist. Results Between September 15, 2015 and November 6, 2015, 502 individuals were screened in 45 Walgreens retail pharmacies throughout the United States. 46 individuals (9.2%) were HCV AB+. The percentage of individuals testing AB+ varied by city with New York City, New York reporting the lowest rate (3.9%) and San Antonio, Texas reporting the highest rate (16.5%) of HCV AB+ individuals. Of the 46 HCV AB+ individuals, 39/46 (85%) were contacted via telephone by an HCV Management Specialist and given their test results. Follow up telephone contacts between the HCV Management Specialist and HCV AB+ individuals to confirm follow up with a healthcare provider for confirmatory testing and evaluation are underway and will be available for presentation. Discussion The overall prevalence with pharmacy customers was higher than predicted with 9.2% (46/502) individuals testing HCV AB+; however, there still remain barriers to care for infected individuals even with the assistance of a dedicated HCV Management Specialist. ID - 3352 ER - Background and Aims: Approximately half of adults with hepatitis C in the United States do not know their infection status, and the majority of persons who know they are positive for hepatitis C virus (HCV) antibodies fail to receive care. We conducted a screening program in retail pharmacies and calculated the percentages of anti-HCV-positive individuals and how many subsequently entered a pathway to care. Methods: At 45 Walgreens retail pharmacies in 9 US cities, direct store advertising was used to recruit individuals for HCV antibody testing. Participants were at least 18 years old with at least 1 HCV risk factor, such as being born between 1945 and 1965. One day per week at each site, a phlebotomist obtained consent from interested participants and performed the testing. Within 3 business days, an HCV management specialist contacted anti-HCV-positive individuals and provided test results and a pathway for obtaining HCV RNA testing. During the following 21 to 28 days, the same HCV management specialist telephoned individuals to determine whether they underwent an HCV RNA test. Results: Between September 2015 and February 2016, 1298 individuals consented. Two patients withdrew consent after testing. In all, 8% (103/1296) were HCV antibody-positive; of them, 91 (88%) were contacted by an HCV management specialist. During the 21- to 28-day follow-up, 56 individuals (62%; 56/91) were reached by an HCV management specialist, and 29 (52%; 29/56) confirmed that an HCV RNA test was ordered. Conclusions: These results provide evidence in support of point-of-care HCV screening in retail pharmacies for at-risk individuals in the United States. ID - 3353 ER - OBJECTIVE: To evaluate if the community, pharmacy-based hypertension disease-management (DM) program significantly improved patient's clinical outcomes and health-related quality of life (HRQOL) in a Latino/Hispanic-American community. DESIGN: Quasi-experimental time-series study. SETTINGS: The study was implemented at two primary-care clinics in health maintenance organizations and two community pharmacy settings located in South Florida. PARTICIPANTS: Patients who have a long-term history of uncontrolled hypertension were identified and referred by their primary care physicians. INTERVENTION: A nine-month, community pharmacy-based hypertension disease-management program. MAIN OUTCOME MEASURES: HRQOL was assessed via SF-12 questionnaire and analyzed by norm-based scoring methods. Wilcoxon signed rank tests with 0.05 alpha levels were used to compare the differences in systolic blood pressure (SBP)/diastolic BP (DBP), medication compliance, and frequency of BP screenings between baseline and endpoint of the intervention. RESULTS: A total of 53 patients (50.5%) completed the program. SBP/DBP significantly declined from 150.5/95.5 mmHg to 133.8/83.3 mmHg on the second month and remained consistent throughout the study period. Quality of life and mental component summary/physical component summary scores slightly increased from 48.58/46.68 to 50.39/51.51. The number of patients monitoring BP at home and medication compliance also significantly increased after nine months of intervention. CONCLUSIONS: The key factor in accomplishing this DM program is meeting the health care needs of a unique population-the Hispanic-American community. Clinicians, administrators, and public health officials should note that understanding the broad parameters of a culture is essential to providing quality care to individuals, families, and communities. ID - 3354 ER - INCLUDE screened full text report ID - 3355 ER - This report details the findings from a review of the implementation of Healthy Living Pharmacies within HoBtPCT. Data on service provision for four healthcare services (early pregnancy testing, emergency hormonal contraception, minor ailments scheme, and smoking cessation) were analysed, along with data from a series of interviews with service providers and from a service-user questionnaire deployed via touchscreen kiosks located within the ten HLPs included in this study. ID - 3356 ER - RATIONALE, AIMS AND OBJECTIVES: There is a need to increase screening and awareness of osteoporosis risk in order to prevent fractures and related morbidity. Although one in two women are at risk of developing the condition, only one in five receives bone mineral density screening. The purpose of the current study was to investigate the effectiveness of an osteoporosis screening and awareness programme directed by a pharmacist in the community setting. METHODS: The study design to test for improved awareness was a prospective, pre-post trial with no control group. The level of awareness of risk was assessed both before the screening and following an educational intervention on osteoporosis provided in the pharmacy. Based on assessed risk level, a recommendation was made for follow-up with a doctor for a dual-energy X-ray absorptiometry (DEXA) scan and/or pharmacotherapy. Patients at medium or high risk were also surveyed as to their intention to follow-up with lifestyle modification recommendations. RESULTS: There was a significant improvement in tested awareness from pre- to post-intervention at 26 per cent; as well in self-rated awareness. There was also a significant correlation between self-rated and tested awareness. Participants indicated satisfaction with the pharmacist interaction and with their role in improving awareness. A large percentage of participants indicated that they intended to follow-up with the pharmacist's recommendation for calcium intake, exercise and/or consulting with their doctor. CONCLUSION: The results indicate that the community pharmacist can successfully screen individuals for risk of osteoporosis and improve their awareness about steps to prevent or delay fractures. 1 fig. 4 tables 28 refs. [Abstract] ID - 3357 ER - Community pharmacists contribution to the management of drug problems is considerable. As the use of illicit drugs has increased, pharmacists have come under increasing pressure to offer services to problem drug users. However, there is concern among some pharmacists that offering such services may deter other customers. There is particular concern among some pharmacists about needle exchange services. Only 9.5% of Scottish pharmacies offer needle exchange services compared to 69% which are dispensing methadone (57% of which supervise methadone consumption). Qualitative interviews were used in a purposive sample of 10 pharmacies in Scotland. Eight customers were interviewed in each pharmacy to ascertain pharmacy customers' views on these services. The majority of customers were supportive of these services. Customers were often unaware that the pharmacy they were interviewed in was offering services for people with drug problems. Pharmacy customers were more knowledgeable about, and more supportive, of needle exchange services than they were of methadone. This was because they believed needle exchange services helped to reduce the amount of discarded needles in public places. Pharmacy customers also recognised that needle exchange helped reduce the spread of disease. These findings should be used to encourage more pharmacists to offer needle exchange services. ID - 3358 ER - This study aimed to determine whether pharmacy customers are deterred from using a pharmacy that offers services to drug misusers. If patients are deterred, what are their specific concerns? The study was qualitative and three different groups were interviewed about their views on pharmacies providing services to drug misusers (i) pharmacy customers, (ii) local community councils and (iii) local drug forums. This paper focuses on pharmacy customer interview results. Interviews were conducted in 10 pharmacies, five in Aberdeen and five in Glasgow, both areas of high drug misuse. The pharmacy customers were attending pharmacies with high, medium and low involvement with drug misusers and were located in city centre, suburban and rural locations. Pharmacy customers were generally supportive of pharmacies offering services to drug misusers. However, their support was often qualified by a wish to see a private area provided for methadone consumption. Pharmacy customers were more knowledgeable of the rationale for and supportive of needle exchange services compared to methadone maintenance and supervised consumption. The results of the study demonstrate that the majority of pharmacy customers are supportive of drug misuse services, provided there is adequate privacy in the pharmacy. These results should be used to encourage more pharmacists to provide drug misuse services. ID - 3359 ER - OBJECTIVE: To document the cost of implementing point-of-care (POC) human immunodeficiency virus (HIV) rapid testing in busy community pharmacies and retail clinics. Providing HIV testing services in community pharmacies and retail clinics is an innovative way to expand HIV testing. The cost of implementing POC HIV rapid testing in a busy retail environment needs to be documented to provide program and policy leaders with adequate information for planning and budgeting. DESIGN: Cost analysis from a pilot project that provided confidential POC HIV rapid testing services in community pharmacies and retail clinics. SETTING: The pharmacy sites were operated under several different ownership structures (for-profit, nonprofit, sole proprietorship, corporation, public, and private) in urban and rural areas. We included data from the initial six sites that participated in the project. We collected the time spent by pharmacy and retail clinic staff for pretest and posttest counseling in an activity log for time-in-motion for each interaction. PARTICIPANTS: Pharmacists and retail clinic staff. INTERVENTION: HIV rapid testing. MAIN OUTCOME MEASURES: The total cost was calculated to include costs of test kits, control kits, shipping, test supplies, training, reporting, program administration, and advertising. RESULTS: The six sites trained 22 staff to implement HIV testing. A total of 939 HIV rapid tests were conducted over a median time of 12 months, of which 17 were reactive. Median pretest counseling time was 2 minutes. Median posttest counseling time was 2 minutes for clients with a nonreactive test and 10 minutes for clients with a reactive test. The average cost per person tested was an estimated $47.21. When we considered only recurrent costs, the average cost per person tested was $32.17. CONCLUSIONS: Providing POC HIV rapid testing services required a modest amount of staff time and costs that are comparable to other services offered in these settings. HIV testing in pharmacies and retail clinics can provide an additional alternative venue for increasing the availability and accessibility of HIV testing services in the United States. ID - 3360 ER - AIMS: To evaluate differences in the time taken to access progestogen-only emergency hormonal contraception (EHC) by young women from family planning (FP) or community pharmacy settings. METHODS: An observational study of 203 women requesting EHC from FP clinics and community pharmacies in South-west Kent Primary Care Trust (PCT) from December 2002 to October 2003. RESULTS: Access to EHC from community pharmacy was significantly faster than from FP clinics (16 h vs. 41 h, P<0.001). Older teenagers tended to seek EHC more quickly and were more likely to have had a contraceptive failure rather than have used no contraception at all. CONCLUSION: The results provide further support for pharmacist involvement in the supply of EHC. ID - 3361 ER - BACKGROUND: Pharmacy syringe access may be an opportunity to provide HIV prevention resources to persons who inject drugs (PWID). We examined the impact of a pharmacy-randomized intervention to reduce injection risk among PWID in New York City. METHODS: Pharmacies (n=88) were randomized into intervention, primary control, and secondary control arms. Intervention pharmacies received in-depth harm reduction training, recruited syringe customers who inject drugs into the study, and provided additional services (i.e., HIV prevention/medical/social service referrals, syringe disposal containers, and harm reduction print materials). Primary control pharmacies recruited syringe customers who inject drugs and did not offer additional services, and secondary control pharmacies did not recruit syringe customers (and are not included in this analysis) but participated in a pharmacy staff survey to evaluate intervention impact on pharmacy staff. Recruited syringe customers underwent a baseline and 3-month follow-up ACASI. The intervention effect on injection risk/protective behavior of PWID was examined. RESULTS: A total of 482 PWID completed baseline and follow-up surveys. PWID were mostly Hispanic/Latino, male, and mean age of 43.6 years. After adjustment, PWID in the intervention arm were more likely to report always using a sterile syringe vs. not (PR=1.24; 95% CI: 1.04-1.48) at 3-month follow-up. CONCLUSIONS: These findings present evidence that expanded pharmacy services for PWID can encourage sterile syringe use which may decrease injection risk in high HIV burdened Black and Latino communities.Copyright © 2015 Elsevier Ireland Ltd. All rights reserved. ID - 3362 ER - Background: In recent years community pharmacies have emerged as strategically important settings to deliver services aimed at promoting public health. In order to develop evidence-based approaches to public health interventions that exploit the unique accessibility of community pharmacies, it is important to determine how people experience care in this context. This study, therefore, aimed to describe how care is perceived and experienced in community pharmacies with particular focus on community pharmacy access., Methods: In-depth semi-structured interviews were used to explore the perceptions and experiences' of people using community pharmacies., Results: A total of 30 participants were interviewed. Themes specifically emerged in relation to community pharmacy access; these fell into four main categories: relationships; time; lack of awareness; and empowerment., Conclusions: The experience of developing a trusting relationship with the pharmacist is an important consideration in the context of community pharmacy accessibility. This could be an important consideration when a person uses a community pharmacy to access a public health service. There is also a perceived lack of awareness among the general public about the extended role of community pharmacy; this is a potential barrier toward people using them. ID - 3363 ER - OBJECTIVE: To describe a pharmacist-managed health screening as a tool to identify patients who were at risk for cardiovascular disease (CVD). DESIGN: Descriptive nonexperimental study. SETTING: A community pharmacy, a health benefit consulting company, and two local unions of plumbers and electricians in the Quad Cities area (Mid-Mississippi Valley) in fall 2006. PATIENTS: Union members and their dependents who received any one of the following pharmacist-managed screening services: systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, and high-density lipoprotein (HDL). INTERVENTION: Pharmacist-managed CVD risk screening program coordinated by a health benefit consulting company. MAIN OUTCOME MEASURES: Risk levels of CVD according to SBP, DBP, total cholesterol, and HDL. RESULTS: 452 patients 20 years of age or older were screened. A total of 137 participants (45.2%) had an SBP of 140 mm Hg or more and 73 (24.1%) a DBP of 90 mm Hg or more. Among patients who checked their total cholesterol or HDL, 81 (24.0%) had high total cholesterol and 55 (16.4%) low HDL. CONCLUSION: A pharmacist-managed health screening program was a tool to identify patients at risk of CVD. At-risk individuals could be potential participants in a cardiovascular risk management service. ID - 3365 ER - OBJECTIVE: To determine 10-year coronary heart disease (CHD) risk for union workers and their dependents in a pharmacist-managed health screening program. METHODS: Two local unions of plumbers and electricians contracted with a community pharmacy to provide health screening services for union workers and their dependents. Patients chose any one or any combination of three clinical tests: blood pressure, total cholesterol, and HDL cholesterol. At the end of the screening, which took approximately 35 minutes, the participants received brief patient education from pharmacists and a printout of their results. Pharmacists provided the services based on their in-store screening experience and, before the screening, received training on 10-year CHD risk calculation and guidelines regarding cholesterol treatment. Framingham scoring was applied to calculate 10-year CHD risk for participants who chose all three clinical tests. RESULTS: 265 patients (55.8% men, average age 57.7 years) participated in the screening program. Frequency of cardiovascular disease (CVD) risk factors ranged from 25.5% (diastolic blood pressure) to 52.5% (total cholesterol). Using Framingham scoring, 10-year CHD risk was calculated for 226 patients, with 119 (52.7%) patients having less than 10% risk with zero to one CVD risk factor, 73 (32.3%) having 10% to 20% risk with two or more CVD risk factors, and 34 (15%) having greater than 20% risk with two or more risk factors. CONCLUSION: Pharmacists provided intermediate- and high-risk participants with guideline-based recommendations such as referring them to physicians for further assessment, therapeutic lifestyle changes, and medication treatment. Community pharmacists were able to identify individuals with intermediate or high 10-year CHD risk. Based on 10-year CHD risk assessment, further pharmacist-managed interventions, such as a cardiovascular risk management program, can be conducted. ID - 3364 ER - OBJECTIVES: The provision of emergency hormonal contraception (EHC) through community pharmacies was introduced in Hambleton and Richmondshire, North Yorkshire, UK in December 2001 to contribute to the Teenage Pregnancy Strategy. The study aimed to establish how well the service is used, whether it is reaching the original target group, why people use the service and where it is accessed. METHODS: This was a descriptive study conducted in a rural primary care trust. RESULTS: From 1 January 2001 to 31 December 2003, there were 1412 pharmacy consultations for EHC and 1260 courses of EHC provided. General practitioner (GP) prescribing of EHC decreased but there was an overall increase in provision of EHC from pharmacies, GPs, family planning clinics, and accident and emergency departments. By December 2003, community pharmacies had become the largest provider of EHC. CONCLUSIONS: The supply of EHC through community pharmacies provided clients with wider choice and improved access to services, which resulted in increased overall provision of EC in this rural area. ID - 3366 ER - The effect of an intervention programme to improve health education leaflet uptake in community pharmacies was conducted with a small convenience sample of 12 community pharmacies in North Staffordshire, UK. The intervention consisted of four different modes of leaflet provision. Modes 1 and 2 (without and with overt offer of advice from pharmacist respectively) relied upon the pharmacy client to actively obtain a leaflet, whereas Modes 3 and 4 (without and with offer of advice from pharmacist respectively) relied upon pharmacy staff to actively provide a leaflet. All 12 community pharmacies received 50 copies of a purposefully designed leaflet. The intervention extended over one calendar month. Data was collected during the intervention via monitoring forms completed by the pharmacist on a day to day basis, and interviews were conducted with the pharmacists at the end of the study. The overall uptake or distribution rate of leaflets was 64%. In both modes which offered advice (Modes 2 and 4), approximately one of every five leaflet recipients sought advice. The community pharmacists considered the intervention to be feasible, effective and enabled the utilisation of their skills. ID - 3367 ER - LINKED with 21751280 (coded 21751280) see file ID - 3211 ER - LINKED WITH 21751281 (COMMUNITY PHARMACY DELIVERY IN CUMBRIA & THE NORTH EAST) To improve patient choice when accessing NHS seasonal flu vaccination with the intended outcome of increasing uptake - particularly in the under 65 at risk groups with the aspiration of building upon the success of earlier seasons. Providers Community pharmacies throughout CANE were eligible to participate as long as they met the premises standard specified in the SLA and the pharmacists administering vaccines had completed appropriate training, also as specified. see full text ID - 3370 ER - BACKGROUND: Atrial fibrillation (AF) is associated with a high risk of stroke and may often be asymptomatic. AF is commonly undiagnosed until patients present with sequelae, such as heart failure and stroke. Stroke secondary to AF is highly preventable with the use of appropriate thromboprophylaxis. Therefore, early identification and appropriate evidence-based management of AF could lead to subsequent stroke prevention. This study aims to determine the feasibility and impact of a community pharmacy-based screening programme focused on identifying undiagnosed AF in people aged 65 years and older. METHODS AND ANALYSIS: This cross-sectional study of community-based screening to identify undiagnosed AF will evaluate the feasibility of screening for AF using a pulse palpation and handheld single-lead electrocardiograph (ECG) device. 10 community pharmacies will be recruited and trained to implement the screening protocol, targeting a total of 1000 participants. The primary outcome is the proportion of people newly identified with AF at the completion of the screening programme. Secondary outcomes include level of agreement between the pharmacist's and the cardiologist's interpretation of the single-lead ECG; level of agreement between irregular rhythm identified with pulse palpation and with the single-lead ECG. Process outcomes related to sustainability of the screening programme beyond the trial setting, pharmacist knowledge of AF and rate of uptake of referral to full ECG evaluation and cardiology review will also be collected. ETHICS AND DISSEMINATION: Primary ethics approval was received on 26 March 2012 from Sydney Local Health District Human Research Ethics Committee-Concord Repatriation General Hospital zone. Results will be disseminated via forums including, but not limited to, peer-reviewed publication and presentation at national and international conferences. Clinical trials registration number: actrn12612000406808. ID - 3368 ER - ID - 3369 ER - Objective: The aim of this study was to investigate university students and pharmacists attitudes towards weight control products. Method: Semi-structured interviews with twenty university students and eight community pharmacists in the East Midlands of the United Kingdom. Results: Young adults were more concerned about long-term effects of weight loss products; whereas pharmacists perceived that these products might be beneficial to overweight patients. Most of the pharmacists had a limited role in promoting weight management services. Conclusion: Further research should focus on how to promote healthy lifestyle among young adults and how to encourage pharmacists to be proactively involved in weight management. ID - 3371 ER - Non-compliance with therapeutic guidelines represents a potential public health risk, given that it contributes to bacterial resistance. One of the strategies used to improve compliance to such guidelines is to provide the patient with better information in written form. The objectives of the present investigation were the following; To evaluate the influence that written information, provided by the community pharmacist, has on compliance with antibiotic therapy, to verify the consequences of degree of compliance on patient health, and to discover other factors influencing patient compliance. The experimental study was carried on patients that attend a community pharmacy for antibiotic prescriptions. Members of the control group were given information in verbal form only, while members of the experimental group were given the same information in both verbal and written form. The degree of compliance was determined through telephone interviews, carried out the day after having finished treatment. 214 patients completed the study. A 14% increase in compliance among members of the experimental group was achieved. Patients that had completed treatment, had a better perception of their own health than those that had not. Another factor found to have a significant influence on compliance was the number of daily dosages. In conclusion, the written information provided by the pharmacist improves therapeutic compliance. Therapeutic compliance improves patients' perception of their state of health. The number of daily dosages also have an influence to bear, but contradict appropriate antibiotic administration policies. ID - 3372 ER - Objectives: To determine the extent of pharmacists' participation in methadone services, type of services provided, views on current service provision and suggestions for future service developments.Methods and setting. An anonymous postal questionnaire was distributed to all community pharmacies in the greater Dublin area (n = 291) and in Glasgow (n = 200), excluding 12 pharmacies in each city that had participated in the pilot study.Key findings: The response rates were 50% (146/291) and 56% (112/200) for Dublin and Glasgow respectively. Participation in methadone services was considerably higher in Glasgow (80%, 90/112, of respondents) than in Dublin (38%, 55/146) and the number of patients per pharmacy was higher. A majority of pharmacists participating in methadone services (76% in Dublin, 92% in Glasgow) felt they had a professional responsibility to provide such services. In both cities the most common grounds for lack of service provision were business reasons, including risk to staff or property and theft. Current non-participants identified increased demand for the service and improved security measures as two factors that may encourage their participation in the future.Conclusion: Pharmacists in Dublin and Glasgow differed significantly in the extent and types of services provided. This may be because a structured scheme was in place in Glasgow but not in Dublin at the time of the study. Despite these differences in service provision, views were very similar in both cities. ID - 3373 ER - Background: Community pharmacies are established service providers for problematic drug users (PDUs). PDUs have many unmet health needs, which pharmacists may be able to help resolve. This paper aims to qualitatively explore the feasibility and desirability of further developing community pharmacy services to meet the wider health needs of problematic drug users. Methods: Semi-structured interviews and focus group discussions were used to explore current and future pharmacy service provision to PDUs. Views were sought from 20 PDUs, 12 staff from community pharmacies, and seven stakeholders and commissioners from relevant agencies. Data were thematically analyzed and potential services including possible barriers identified. Results & Discussion: Data highlighted variability in current services in the study area in terms of availability and quality. Good rapport between users and regular staff was highlighted as an important factor in good quality services. Pharmacies were consistently identified as having key opportunities to make useful health interventions within a range of therapeutic areas including nutrition, dentistry, wound care, and infectious diseases. The most widely supported roles were based around information provision and signposting. However, there was support for direct interventions to be delivered within the pharmacy, by a regular member of staff or a visiting specialist. ID - 3374 ER - Background: Previous studies have demonstrated positive outcomes from a range of pharmacy public health services, but barriers to delivery remain. This paper explores the processes of delivering an alcohol screening and intervention service, with a view to improving service delivery.; Methods: A mixed-methods, multi-perspective approach was used, comprising in-pharmacy observations and recording of service provision, follow-up interviews with service users and interactive feedback sessions with service providers.; Results: Observations and recordings indicate that staff missed opportunities to offer the service and that both availability and delivery of the service were inconsistent, partly owing to unavailability of trained staff and service restrictions. Most service users gave positive accounts of the service and considered pharmacies to be appropriate places for this service. Respondents also described positive impacts, ranging from thinking more about alcohol consumption generally to substantial reductions in consumption. Key facilitators to service provision included building staff confidence and service champions. Barriers included commissioning issues and staff perception of alcohol as a sensitive topic.; Conclusions: Findings support expansion of pharmacies' role in delivering public health services and highlight benefits of providing feedback to pharmacy staff on their service provision as a possible avenue for service improvement.; © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. ID - 3375 ER - STUDY OBJECTIVES: To develop a model for osteoporosis screening and education in community pharmacies using a team approach, compare bone mineral density T-scores between quantitative ultrasound (QUS) and dual-energy x-ray absorptiometry (DXA), and determine patient satisfaction with this pharmacist-provided osteoporosis screening and education program. DESIGN: Prospective, cross-sectional study. SETTING: Community pharmacies and outpatient family medicine, internal medicine, and obstetrics and gynecology clinics in Amarillo, Texas. PATIENTS: Women aged 55 years or older with no previous diagnosis of osteoporosis or osteopenia who had at least one additional risk factor for osteoporosis and had not been screened in the previous 3 years. INTERVENTION: Patients were referred from family medicine, internal medicine, and obstetrics and gynecology clinics to a community pharmacy. Osteoporosis screening using heel QUS and education regarding disease prevention and treatment were provided by pharmacists. Screening results, recommendations for confirmatory DXA, and potential treatments options were provided to the referring physicians. MEASUREMENTS AND MAIN RESULTS: A total of 100 patients (mean age 66.2+/-7.9 yrs) were enrolled in the study; three were subsequently excluded. Of the 97 study patients who were screened using QUS, 45 (46%) patients were at moderate risk (T-score<-1 to>-2.5) and nine (9%) were at high risk (T-score30.0) in 25%. At 6 months the QI pass rate was significantly higher for those in the intervention arm compared to the control arm (diff = 61%, 95% CI (52.1, 70.2), p < 0.0001). Significant improvements occurred in the WOMAC total, pain and function scores (all p < 0.01), the PAT-5D pain and daily activity scores (both p < 0.05) and the LEF (p = 0.012). DISCUSSION: A pharmacist-initiated multidisci-plinary strategy to improve the quality of care for knee OA improves care, function and pain. ID - 3377 ER - Objective: Knee osteoarthritis (OA) is a commonly undiagnosed condition and care is often not provided. Pharmacists are uniquely placed for launching a multidisciplinary intervention for knee OA. METHODS: we performed a cluster randomized controlled trial with pharmacies providing either intervention care of usual care (14 and 18 pharmacies, respectively). The intervnetion included a validated knee OA screening questionnaire, education, pain medication management, physiotherapy-guided exercise, and communication with the primary care physician. Usual care consisted of an educational pamphlet. The primary outcome was the pass rate on the Arthritis Foundation's quality indicators for OA.Secondary outcomes included the Western Ontario ad McMaster Universities Osteoarthritis Index (WOMAC), the Lower Extremity Function Scale (LEFS), the Paper Adaptive Test-5D (PAT-5D), and the Health Utilities Index Mark 3 (HUI3). RESULTS: One hundred thirty-nine patients were assigned to the control (n = 66) and intervention (n = 73) groups. There were no differnces between the groups in baseline measures. The overall quality indicator pass rate was significantly higher in the intervneiton arm compared to the control arm (difference of 45.2%; 95% confidence interval 34.5, 55.9). Significant improvements were observed for the intervention care group as compared to the usual care group in teh WOMAC global, pain and function scores at 3 and 6 months (all P< 0.01); the PAT-5D daily activity scores at 3 and 6 months (both P < 0.05); the PAT-5D pain scores at 6 months (P = 0.05); the HU13 single-atribute pain scores at 3 and 6 months (all P < 0.05); and the LEFS scores at 6 months (P< 0.05). CONCLUSION: Pharmacists can launch a multidisciplinary intervention to identify knee OA cases, improve the utilization of treatments, and improve function, pain and quality of life. ID - 3378 ER - Objective. To determine if a pharmacist-initiated multidisciplinary strategy provides value for money compared to usual care in participants with previously undiagnosed knee osteoarthritis. Methods. Pharmacies were randomly allocated to provide either 1) usual care and a pamphlet or 2) intervention care, which consisted of education, pain medication management by a pharmacist, physiotherapy-guided exercise, and communication with the primary care physician. Costs and quality-adjusted life-years (QALYs) were determined for patients assigned to each treatment and incremental cost-effectiveness ratios (ICERs) were determined. Results. From the Ministry of Health perspective, the average patient in the intervention group generated slightly higher costs compared with usual care. Similar findings were obtained when using the societal perspective. The intervention resulted in ICERs of $232 (95% confidence interval [95% CI] - 1,530, 2,154) per QALY gained from the Ministry of Health perspective and $14,395 (95% CI 7,826, 23,132) per QALY gained from the societal perspective, compared with usual care. Conclusion. A pharmacist-initiated, multidisciplinary program was good value for money from both the societal and Ministry of Health perspectives. ID - 3380 ER - BACKGROUND: Influenza is a major cause of morbidity and mortality in Canada, with up to 7000 influenza-related deaths occurring every year. The elderly and individuals with chronic diseases are at increased risk for influenza-related morbidity and mortality. METHODS: We conducted a 2-year, community cluster-randomized trial targeting elderly people and at-risk groups to assess the effectiveness of pharmacy-based influenza vaccination clinics on influenza vaccination rates. Small rural communities in interior and northern British Columbia were randomly allocated to the intervention or control. In the intervention communities, pharmacy-based influenza vaccination clinics were held and were promoted to eligible patients using personalized invitations from the pharmacists, invitations distributed opportunistically by a pharmacist to eligible patients presenting to pharmacies during the flu season and community-wide promotion using posters and the local media. The main outcome measure was a difference in the mean influenza vaccination rates. The immunization rates were calculated using the number of immunizations given in each community divided by the population size estimated from the census data. RESULTS: Baseline influenza immunization rates in the population >65 years of age were the same in the control (n = 10, mean 85.6% [SD 16.6]) and intervention (n = 14, mean 83.8% [SD 16.3]) communities in 2009 (p = 0.79). In 2010, the mean influenza immunization rate was 56.9% (SD 28.0) in the control communities (n = 15) and 80.1% (SD 18.4) in the intervention communities (n = 14) (p = 0.01) for those >65 years of age. However, in 2010, for those 2 to 64 years with chronic medical conditions, the immunization rates were lower in the intervention communities (mean 16.3% [SD 7.1]) compared with the control communities (mean 21.2% [SD 5.8]) (p = 0.04). CONCLUSION: Clinics were feasible and well attended and they resulted in increased vaccination rates for elderly residents. In contrast, vaccination rates in the younger population with comorbidities remained low and unchanged. ID - 3379 ER - Background Chlamydia screening uptake rates in Australian and overseas pharmacies vary widely (11% to 58%). Aim To determine the effect on the uptake of chlamydia screening in community pharmacies when a cash reward is offered to young people and participating pharmacies. Methods The study was advertised in print and electronic media. People aged 16-30 years requested, or were offered, chlamydia testing kits by pharmacy staff (assistants and pharmacists). Participants who provided a urine sample and completed a questionnaire received AUD$10; pharmacies received AUD$10 per person recruited. Urine specimens were tested in pools using PCR, with reflex testing of individual samples when the pool tested positive. Positive cases were notified by sexual health nurses and offered treatment. Results Six urban community pharmacies took part in the study, each for 15 days. 979 testing kits were given out and 970 sample pots returned (99.1%); 66 (7%) did not contain urine. 74% (670/904) of the urine samples were determined to be from unique individuals, 65% of whom were male. 19 people (13 females and 6 males) tested positive; positivity rates were 5.2% (95% CI 2.8 to 8.8) for females and 1.4% for males. 11 (61%) of those testing positive were contacted and eight attended a local sexual health centre for treatment, three were treated elsewhere. Of the eight people treated at the sexual health centre, two females aged 15 and 20 years were diagnosed with pelvic inflammatory disease. Contact with the remaining eight positive individuals was not possible due to disconnected, incorrect or non-existent telephone numbers. Conclusion The 68% specimen return rate found in this study significantly exceeds those reported elsewhere. Strategies to prevent repeat testing, non-urine specimens and incorrect contact numbers are needed to ensure good clinical care and optimum use of resources. ID - 3382 ER - AIMS: To assess current levels of participation of community pharmacists in needle exchange provision, assess participation in dispensing any drugs for drug misuse, explore methadone dispensing practice, assess involvement in health promotion for drug misusers, assess levels of training in drug misuse and compare all of the above with data from 5 years previously. DESIGN: A cross-sectional postal questionnaire. SETTING: All community pharmacies in Scotland (n = 1162). PARTICIPANTS: A total of 969 pharmacists managing community pharmacies on a day-to-day basis (response rate 83.4%). MEASUREMENTS: Descriptive data were collected on demography, drug misuse services provided and training. Data were combined with a dataset from an identical survey conducted 5 years previously for statistical comparison. RESULTS: Levels of needle exchange provision has not changed significantly (9.7% in 2000 compared to 8.6% in 1995). Of all respondents, 71.5% now dispense drug for the management of drug misuse, 68.9% dispense methadone and 56.7% provide a supervised methadone consumption service. The number of methadone clients receiving methadone through pharmacies has increased from 3387 in 1995 to 8792 in 2000 and the mean number of clients dispensed methadone per pharmacy has increased from 7.3 in 1995 to 13.2 in 2000; 65.1% of all methadone clients now consume their methadone under pharmacist supervision. The proportion of pharmacists dispensing methadone who provide a supervised consumption service has increased significantly from 37% to 82.8%. Considerable changes in pharmacy practice are evident with significant increases in the number of pharmacists who always lay down ground rules, ask for identification on first visits, make up prescriptions in advance and provide verbal advice and leaflets on the management of drug misuse. Training in drug misuse doubled from 31.8% to 66.8%. CONCLUSIONS: Community pharmacy involvement with drug misusers has increased dramatically in the last 5 years. However, this increase is largely in methadone dispensing and supervision. Pharmacists appear to be more proactive in providing advice and information, perhaps as a result of greater training. ID - 3383 ER - Background: In Scotland community pharmacies are heavily involved in service delivery for people with drug problems (PWDP) as documented through surveys of all community pharmacies in 1995, 2000 and 2006. A further survey in 2014 enabled trends in service demand/provision to be analysed and provides insight into future development.; Methods: The lead pharmacist in every Scottish pharmacy (n=1246) was invited to complete a postal questionnaire covering attitudes towards PWDP and service provision and level of involvement in services (needle exchange, dispensing for PWDP and methadone supervision). Additional questions covered new services of take-home naloxone (THN) and pharmacist prescribing for opioid dependence. Telephone follow-up of non-responders covered key variables. A comparative analysis of four cross-sectional population surveys of the community pharmacy workforce (1995, 2000, 2006 and 2014) was undertaken.; Results: Completed questionnaires were returned by 709 (57%) pharmacists in 2014. Key variables (questionnaire or telephone follow-up) were available from 873 (70%). The proportion of pharmacies providing needle exchange significantly increased from 1995 to 2014 (8.6%, 9.5%, 12.2%, 17.8%, p<0.001) as did the proportion of pharmacies dispensing for the treatment of drug misuse (58.9%, 73.4%, 82.6% and 88%, p<0.001). Methadone was dispensed to 16,406 individuals and buprenorphine to 1777 individuals (increased from 12,400 and 192 respectively in 2006). Attitudes improved significantly from 1995 to 2014 (p<0.001). Being male and past training in drug misuse significantly predicted higher attitude scores (p<0.05) in all four years. Attitude score was a consistently significant predictor in all four years for dispensing for the treatment of drug misuse [OR=1.1 (1995 and 2006, CI 1.1-1.3, and 2014 CI 1.1-1.4) and 1.2 (2000), CI 1.3-1.5] and providing needle exchange [OR=1.1 (1995 and 2006), CI 1.1-1.2, 1.1-1.3 and 1.2 (2000 and 2014), CI 1.1-1.3 and 1.1-1.5]. In 2014, 53% of pharmacists felt part of the addiction team and 27.7% did not feel their role was valued by them. Nine pharmacists prescribed for opioid dependence.; Conclusion: It is possible for pharmacy workforce attitudes and service engagement to improve over time. Training was key to these positive trends. Communication with the wider addiction team could be further developed.; Copyright © 2015. Published by Elsevier B.V. ID - 3384 ER - Background: The pressure on healthcare services worldwide has driven the incorporation of disease state management services within community pharmacies in developed countries. Pharmacists are recognised as the most accessible healthcare professionals, and the incorporation of these services facilitates patient care. In Australia, the opportunity to manage pharmacy patients with mental illness has been underutilised, despite the existence of service models for other chronic conditions. This paper is an independent evaluation of a novel service developed by a community pharmacy in Perth, Western Australia. The service represents collaboration between a nurse practitioner and community pharmacy staff in the management of mental health patients with metabolic risks.; Methods: We applied practice service standards for Australian community pharmacies to develop an evaluation framework for this novel service. This was followed by semi-structured interviews with staff members at the study pharmacy to explore service processes and procedures. Descriptive analysis of interviews was supplemented with analysis of patients' biometric data. All data were evaluated against the developed framework.; Results: The evaluation framework comprised 13 process, 5 outcomes, and 11 quality indicators. Interview data from eight staff members and biometric data from 20 community-dwelling mental health patients taking antipsychotics were evaluated against the framework. Predominantly, patients were managed by the pharmacy's nurse practitioner, with medication management provided by pharmacists. Patients' biometric measurements comprised weight, blood pressure, blood glucose levels, lipid profiles and management of obesity, smoking, hypertension and diabetes. Positive outcomes observed in the patient data included weight loss, smoking cessation, and improved blood pressure, blood glucose and lipid levels.; Conclusions: The developed framework allowed effective evaluation of the service, and may be applicable to other pharmacy services. The metabolic clinic met key process, quality and outcomes indicators. The positive patient outcomes may assist in securing further funding.; ID - 3385 ER - Objective: To assess the frequency of community pharmacists' advice-giving to women and to determine pharmacists' attitudes and perceived knowledge, confidence and embarrassment in providing such advice. Method: A postal questionnaire was sent to a random sample of 600 Northern Ireland community pharmacists for self-completion. One reminder was sent. The questionnaire asked pharmacists to rate their knowledge on a list of women's health topics and to rate their confidence in dealing with women's health issues. Pharmacists were asked what actions they took to increase women's comfort in discussing potentially sensitive topics. They were also asked about the availability of women's health services locally. Closed response data were entered into SPSS for analysis while open question responses were collated and analysed separately. Key findings: Pharmacy customers were predominantly female and the majority of pharmacists reported providing advice on women's health on a daily basis. Most pharmacists reported being confident and knowledgeable on women's health issues. Pharmacists had strategies to ensure that women felt comfortable discussing personal problems and they were not embarrassed dealing with such problems. Respondents felt more comfortable responding to, rather than initiating, such discussions. Personal views made it difficult for some respondents to provide advice on emergency contraception. Male pharmacists considered themselves to be less confident, less knowledgeable, more embarrassed and to have greater difficulty initiating a conversation on sensitive issues compared with female pharmacists. Conclusion: Pharmacists on the whole were confident when dealing with requests for advice. Counselling confidence was related to counselling frequency. Initiation of conversations on women's health issues was difficult for some pharmacists. More active collaboration with the providers of other professional services available to women may enhance pharmacists' overall service provision for women customers. ID - 3386 ER - The primary focus of this study was to find out to what degree an incentive promotion would affect HIV testing rates of injection drug users in Grand Island, Hall County, Nebraska. Additionally, the proportion of injection drug users who returned to the testing site to obtain their test results was also examined in order to determine the effectiveness of the incentive promotion. Eight retail pharmacies in Grand Island distributed incentive information to syringe purchasers during the twelve-month information period. Persons obtaining HIV tests and returning for test results were given monetary incentives at the testing site. The number of HIV tests given and the number of HIV test results obtained were compiled for the twelve-month intervention period and compared to the number of HIV tests given and test results obtained during the forty-eight months prior to the initiation of the intervention. The number of injection drug users seeking HIV testing significantly increased during the twelve-month intervention period, when compared to the number of injection drug users seeking HIV testing during the twelve-month period immediately preceding the initiation of the intervention. A significant increase was not seen when comparing the number of injecting drug user HIV tests given during the intervention period to the yearly average number of tests given to this population during the preceding four years. No significant difference was found relative to test return rates. Although the results of this study are mixed, it does add information to the body of evidence that supports the use of incentives in promoting and marketing health behavior changes. This is particularly significant when the intervention attempts to connect with an unusually difficult-to-reach population, such as injection drug users who are at greatly increased risk for HIV and AIDS. The success of interventions such as the subject of this study may result in improved health for injection drug users and their partners by informing them of their HIV status, encouraging them to practice lower risk behaviors where HIV transmission is concerned, and connecting them with HIV and substance abuse treatment services, especially when an HIV-positive test result occurs. ID - 3387 ER - OBJECTIVE: To assess the impact of risk management activities on patient risk of glucocorticoid-induced osteoporosis. METHODS: Ninety-six adult patients taking chronic glucocorticoid therapy in 15 community pharmacies. Patients in the control group received usual and customary care. Patients in the treatment pharmacies received education and an educational pamphlet about the risks of glucocorticoid-induced osteoporosis. In addition, the treatment group pharmacists monitored the patients' drug therapy, to identify and address drug-related problems. Data including the glucocorticoid taken by the patient, medications, and osteoporosis risk factors were collected at baseline and after 9 months of monitoring, via Web-based survey completed in the pharmacy. Using an intent to treat approach, the pre-post frequency changes were compared with contrasts for presence of bisphosphonate therapy, presence of estrogen therapy, presence of calcium supplement, discussion of glucocorticoid-induced osteoporosis risk, discussion of bone density test, presence of bone mineral density test, reported inactivity, and reported low calcium diet. RESULTS: The contrast was significant in favor of the treatment pharmacies for the frequency of patients taking a calcium supplement (Control [-6.9%] vs. Treatment [17.1%], P < 0.05). No other contrast was significant. CONCLUSIONS: Community pharmacists are capable of increasing calcium supplementation among patients at risk for glucocorticoid-induced osteoporosis. Pharmacists who educate at-risk patients can impact the self-care of these patients. ID - 3388 ER - SCRIP-HTN is an ongoing, randomized, multicentre trial that is evaluating a unique program of community pharmacist and nurse intervention, within a multidisciplinary team, to improve the management of BP in patients with diabetes. Treatment and control of hypertension is major public health problem and a key goal of the Canadian. Hypertension Society. Novel ways of identifying and treating this patient population to the BP targets set by the guidelines are urgently needed. ID - 3389 ER - Linked study - already coded with other study BACKGROUND: Blood pressure (BP) control in patients with diabetes mellitus is difficult to achieve and current patterns are suboptimal. Given increasing problems with access to primary care physicians, community pharmacists and nurses are well positioned to identify and observe these patients. This study aimed to determine the efficacy of a community-based multidisciplinary intervention on BP control in patients with diabetes mellitus. METHODS: We performed a randomized controlled trial in 14 community pharmacies in Edmonton, Alberta, Canada, of patients with diabetes who had BPs higher than 130/80 mm Hg on 2 consecutive visits 2 weeks apart. Care from a pharmacist and nurse team included a wallet card with recorded BP measures, cardiovascular risk reduction education and counseling, a hypertension education pamphlet, referral to the patient's primary care physician for further assessment or management, a 1-page local opinion leader-endorsed evidence summary sent to the physician reinforcing the guideline recommendations for the treatment of hypertension and diabetes, and 4 follow-up visits throughout 6 months. Control-arm patients received a BP wallet card, a pamphlet on diabetes, general diabetes advice, and usual care by their physician. The primary outcome measure was the difference in change in systolic BP between the 2 groups at 6 months. RESULTS: A total of 227 eligible patients were randomized to intervention and control arms between May 5, 2005, and September 1, 2006. The mean (SD) patient age was 64.9 (12.1) years, 59.9% were male, and the mean (SD) baseline systolic/diastolic BP was 141.2 (13.9)/77.3 (8.9) mm Hg at baseline. The intervention group had an adjusted mean (SE) greater reduction in systolic BP at 6 months of 5.6 (2.1) mm Hg compared with controls (P = .008). In the subgroup of patients with a systolic BP greater than 160 mm Hg at baseline, BP was reduced by an adjusted mean (SE) of 24.1 (1.9) mm Hg more in intervention patients than in controls (P < .001). CONCLUSION: Even in patients who have diabetes and hypertension that are relatively well controlled, a pharmacist and nurse team-based intervention resulted in a clinically important improvement in BP. Trial Registration clinicaltrials.gov Identifier: NCT00374270. ID - 3390 ER - BACKGROUND: There is insufficient evidence for the efficacy of comprehensive multiple risk factor interventions by pharmacists in the primary prevention of cardiovascular disease (CVD). Given the proven benefits of pharmacist interventions for individual risk factors, it is essential that evidence for a comprehensive approach to care be generated so that pharmacists remain key members of the health care team for individuals at risk of initial onset of CVD. OBJECTIVE: To establish the feasibility of an intervention delivered by community pharmacists to reduce the risk of primary onset of CVD. METHODS: A single-cohort intervention study was undertaken in 2008-2009. Twelve community pharmacists from 10 pharmacies who were trained to provide lifestyle and medicine management support to reduce CVD risk recruited 70 at-risk participants aged 50-74 years who were free from diabetes or CVD. Participants received a baseline assessment to establish CVD risk and health behaviors. An assessment report provided to patients and pharmacists was used to collaboratively establish treatment goals and, over 5 sessions, implement treatment strategies. Follow-up assessment at 6 months measured changes in baseline parameters. The primary outcome was the average change to overall 5-year risk of CVD onset. RESULTS: Sixty-seven participants were included in the analysis. The mean participant age was 60 years and 73% were female. We observed a 25% (95% CI 17 to 33) proportional risk reduction in overall CVD risk. Significant reductions also occurred in mean blood pressure (-11/-5 mm Hg) and waist circumference (-1.3 cm), with trends toward improvement for most other observed risk factors. CONCLUSIONS: Findings support previous evidence of positive cardiovascular health outcomes following pharmacist intervention in other patient groups; we recommend generating randomized controlled trial evidence for a primary prevention population. ID - 3391 ER - Background: Delivery of cardiovascular disease (CVD) prevention programs by community pharmacists appears effective and enhances health service access. However, their capacity to implement complex behavioural change processes during patient counselling remains largely unexplored. This study aims to determine intervention fidelity by pharmacists for behavioural components of a complex educational intervention for CVD prevention. After receiving training to improve lifestyle and medicines adherence, pharmacists recruited 70 patients aged 50-74 years without established CVD, and taking antihypertensive or lipid lowering therapy. Patients received five counselling sessions, each at monthly intervals. Researchers assessed biomedical and behavioural risk factors at baseline and six months. Pharmacists documented key outcomes from counselling after each session. Most patients (86%) reported suboptimal cardiovascular diets, 41% reported suboptimal medicines adherence, and 39% were physically inactive. Of those advised to complete the intervention, 85% attended all five sessions. Pharmacists achieved patient agreement with most recommended goals for behaviour change, and overwhelmingly translated goals into practical behavioural strategies. Barriers to changing behaviours were regularly documented, and pharmacists reported most behavioural strategies as having had some success. Meaningful improvements to health behaviours were observed post-intervention. Findings support further exploration of pharmacists' potential roles for delivering interventions with complex behaviour change requirements.; © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com. ID - 3392 ER - BACKGROUND: In England and Wales, the Department of Health introduced a primary prevention programme, NHS Health Checks, to provide screening for cardiovascular risk amongst people aged 40-74. The aim of this programme is to offer treatment and advice to those identified with an increased risk of cardiovascular diseases (CVD).The North East of England has some of the highest rates of CVD in the UK and prevention is therefore a priority. NHS Tees funded this programme of work under the local branding of Healthy Heart Checks (HHC). These were initially implemented principally through GP practices from October 2008 but, in order to mitigate the possibility that some hard to reach communities would be reluctant to engage with some primary care settings, plans were also developed to deliver the programme through workplace settings and through community pharmacies. This paper reports specifically on the findings from the evaluation in respect of the setting up of HHCs in community pharmacies and aims to offer some lessons for other service settings where this option is seen as a way of providing low threshold services which will minimise inequalities in intervention uptake. METHODS: In assessing the community pharmacy component of HHCs, a selection of staff having direct involvement in the process was invited to take part in the evaluation. Interviews were carried out with representatives from community pharmacy, staff members from the commissioning Primary Care Trusts and with Local Pharmaceutical Committee members. RESULTS: Evaluation and analysis identified challenges which should be anticipated and addressed in initiating HHC in community pharmacies. These have been categorised into four main themes for discussion in this paper: (1) establishing and maintaining pharmacy Healthy Heart Checks, (2) overcoming IT barriers, (3) developing confident, competent staff and (4) ensuring volume and through flow in pharmacy. CONCLUSIONS: Delivering NHS health checks through community pharmacies can be a complex process, requiring meticulous planning, and may incur higher than expected costs. Findings from our evaluation provide insight into possible barriers to setting up services in pharmacies which may help other commissioning bodies when considering community pharmacy as a location for primary prevention interventions in future. ID - 3393 ER - BACKGROUND: Community pharmacists are increasingly acknowledged as under-utilized, important and accessible health providers in providing harm reduction support to drug users via needle and syringe programmes (NSP), provision of advice, HIV/Hepatitis testing and as referral mechanism to social, medical and treatment services. We report here on qualitative findings as part of the evaluation of the pilot Pharmacy Needle Exchange (PNEX) programme in Ireland., OBJECTIVES: The aim was to understand and illustrate pharmacist experiences of providing NSP., METHODS: Of the 107 eligible pharmacies, a total of 70 participated in the national evaluation. Telephone interviews (n = 17) and one-to-one interviews (n = 13) using a semi-structured guide were conducted with 30 pharmacists. Analysis of data was conducted using the Empirical Phenomenological Psychological (EPP) five step protocol., RESULTS: Pharmacist experiences illustrated the largely positive nature of providing NSP, and highlighted needs to develop harm reduction training for pharmacists and appropriate strategies to raise awareness, provide exchange packs to meet the specific needs of the diverse populations of people who inject drugs and ensure the development of trusting relationships and opportunities to engage within a confidential service., CONCLUSIONS: Further enhancement of NSP coverage and targeted service delivery within national care pathways for drug and alcohol services is warranted., Copyright © 2016 Elsevier Inc. All rights reserved. ID - 3394 ER - WHAT IS KNOWN AND OBJECTIVE: There is little evidence from well-designed randomized controlled trials of the impact of community pharmacist intervention on the clinical management of patients with type 2 diabetes. It is also not known how sustainable any observed effects on glycaemic control are, over time. This study was initiated to address both these issues. METHODS: A 6-month, randomized, controlled parallel-group trial in 66 community pharmacies was conducted in Belgium. Patients were randomly assigned to receive usual pharmacist care (n = 135) or a predefined pharmacist intervention (n = 153). The intervention mainly focused on correct medication use, medication adherence and healthy lifestyle promotion. Primary outcome was glycaemic control, as measured by fasting plasma glucose and HbA1c. Sustainability of changes in glycaemic control was assessed by additional glucose measurements 18 months after the end of the study. RESULTS AND DISCUSSION: The intervention significantly reduced HbA1c (between-group difference: 05%, P = 0.009). The largest impact on HbA1c was observed when pharmacotherapy changes (i.e., type and/or dose of hypoglycaemic agents) initiated by the physician were sustained with pharmaceutical care: HbA1c was reduced by 105% in the intervention group, whose medication was changed, compared with a reduction of 002% in the therapy-modification only, group. It was also found that the diabetes education program resulted in improved self-management and better knowledge of diabetes. Eighteen months after the end of the formal study period, the mean HbA1c of the intervention group did not differ significantly from the control group (74% vs. 72%). WHAT IS NEW AND CONCLUSION: This study provides new evidence, from a randomized controlled trial, of the beneficial effect of community pharmacist intervention in the clinical management of type 2 diabetic patients. However, questions remain about the sustainability of the observed improvements.Copyright © 2010 Blackwell Publishing Ltd. ID - 3395 ER - OBJECTIVES: Community pharmacies in the United Kingdom (UK) provide sexual and reproductive health (SRH) services such as emergency contraception (EC), although there is scope for provision of additional services. We conducted a pilot study of pharmacy based interventions for initiating effective contraception after EC. By determining the views of participating women and pharmacists we aimed to identify barriers and facilitators to providing interventions from pharmacies routinely., STUDY DESIGN: In the pilot study, women presenting for levonorgestrel EC to community pharmacies, were provided with either standard care or one of two interventions: one packet of progestogen-only pills (POPs); or an invitation to present the empty EC packet to a local family planning clinic for contraception. A sample of women participating were asked to undergo a further interview. Operational difficulties with research in the community pharmacy were also documented by the research team., METHODS: Semi-structured interviews were conducted with 12 women, four from each arm of the pilot study, using a standardised topic guide. Pre- and post-study interviews were conducted with the pharmacists involved., RESULTS: All women welcomed the interventions indicating the benefit of having different options available. They also identified possible advantages and disadvantages of each intervention. All pharmacists were positive about their involvement in the study. Methodological problems included difficulty in retention of participating pharmacists, slow recruitment and failure to accurately complete study paperwork., CONCLUSIONS: Women welcomed the interventions offered. Pharmacists viewed their participation in the study positively. The problems encountered provide valuable feedback to inform the development larger scale studies of such interventions.Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. ID - 3397 ER - OBJECTIVES: In Scotland most women get emergency contraception (EC) from pharmacies. Pharmacists currently cannot provide effective ongoing contraception after EC. In this pilot study, we aimed to determine the feasibility of a larger study designed to ascertain if pharmacy-based interventions can increase the uptake of effective contraception after EC. STUDY DESIGN: This is a pilot study of women presenting for levonorgestrel EC to community pharmacies in Edinburgh, UK, in 2012. Pharmacies were cluster randomized to provide either standard care or one of two interventions: (a) one packet of progestogen-only pills (POPs), giving women 1 month to arrange ongoing contraception; (b) invitation to present the empty EC packet to a family planning clinic (FPC) for contraceptive advice (rapid access). RESULTS: One hundred sixty-eight women were recruited from 11 pharmacies to POP (n=56), rapid access (n=58) and standard care (N=54) groups, respectively. Telephone follow-up was conducted successfully in 102 women (61%) 6-8 weeks later to determine current contraceptive use. In the POP arm, 35/39 (90%) women used the pills provided, and 9/28 women (32%) in the rapid access arm attended the FPC. The proportion of women using effective contraception at follow-up was significantly greater in both POP [56% (22/39), p=<0.001] and rapid access [52% (13/25), p=0.006] groups compared to standard care [16% (5/31)]. The relative probability of a woman using an effective method of contraception versus barrier/no method, after use of EC, was 3.13 [95% confidence interval (CI), 1.90-5.13] in the POP group and 2.57 (95% CI, 1.55-4.27) in the rapid access group. CONCLUSIONS: This promising pilot study suggests that simple pharmacy-based interventions may increase the uptake of effective contraception after EC. A larger study is required to provide further validation of these findings. IMPLICATIONS STATEMENT: For women obtaining EC from a pharmacy, simple interventions such as supplying 1 month of a POP, or offering rapid access to a FPC, hold promise as strategies to increase the uptake of effective contraception after EC.Copyright © 2014 Elsevier Inc. All rights reserved. ID - 3396 ER - ID - 3398 ER - OBJECTIVES: To assess patient knowledge about H1N1 influenza pandemic and vaccine availability, evaluate the effectiveness of student pharmacist education about H1N1 influenza, assess patient comfort with pharmacists as immunization providers, and identify patients preferred location for H1N1 vaccination. DESIGN: Descriptive, nonexperimental, cross-sectional study. SETTING: 18 community pharmacy advanced pharmacy practice experience (CP-APPE) sites located across New York State, from September 2009 to February 2010. PARTICIPANTS: Convenience sample of adult (>18 years of age) patients of CP-APPE sites. INTERVENTION: Student pharmacists delivered an education intervention to patients and patients completed anonymous surveys. MAIN OUTCOME MEASURES: Patient knowledge and comfort with pharmacists as immunizers. RESULTS: 19 student pharmacists at 18 CP-APPE sites engaged in 215 interventions. The majority of respondents were women (60.9%) who were older than 60 years (43.7%) and white (83.7%). Patient knowledge and comfort with pharmacists as immunizers improved significantly. Compared with baseline, student pharmacist education interventions significantly increased the number of patients who were comfortable receiving the H1N1 influenza vaccination from a pharmacist (from 69.3% to 81.4%, P = 0.012). CONCLUSION: Student pharmacists served as an effective education resource for patients regarding the H1N1 pandemic. Patient comfort with pharmacist provision of the H1N1 vaccination can enable pharmacists to serve as frontline health professionals in the time of a pandemic outbreak. ID - 3399 ER - Since 2008 five NHS Health Boards have piloted approaches to delivering a wider range of walk-in health and health improvement services within a community pharmacy setting. The pilot programme – known as Pharmore+ - aimed to increase the flexibility and availability of primary care services and complement other local healthcare services such as those provided by GP practices and local A&E departments. 1.2 A study of the pilots was conducted by the Scottish Government Health Analytical Services in spring 2012 with a view to drawing out key lessons for future development of community pharmacy based walk-in services. Pilots demonstrated they were able to offer a wider range of health and health improvement services on a walk-in basis............................. ID - 3400 ER - Aim: To determine how primary care organisations might better support community pharmacies in delivering contractual essential services. Design: Postal questionnaire. Subjects and setting: All 111 community pharmacies in one Yorkshire primary care trust. Results: 43% of pharmacies responded. Around 80% believed that PCT communication was adequate. One-fifth reported not having staff fully trained to provide repeat dispensing and 54% reported problems with implementing this service, including multidisciplinary communication issues. Problems conducting the Community Pharmacy Patient Questionnaire were reported by 24% and 38% did not feel adequately supported in this by the PCT (significantly more independents than multiples). Clinical audit remains an area in which pharmacists and staff would like more support/training. A need was expressed for more flexible pharmacist/staff training. Two-thirds of pharmacies felt adequately supported by the PCT for public health campaigns. Conclusion: Many independent pharmacies require more support than their multiple pharmacy counterparts and these differences may need to be recognised and addressed by commissioning PCOs. Good working relationships between pharmacists and GPs are essential and PCOs can help to facilitate this. Raising awareness of community pharmacy with patients and the public is also key and PCOs should support this. PCOs should be clear with community pharmacy providers regarding their roles and boundaries as commissioners of services. ID - 3401 ER - BACKGROUND: Community pharmacies may offer an accessible way of delivering weight-management programmes but there have been few trials that use clinically significant weight loss outcomes, objective measures of weight and follow-up to 12 months. We aimed to evaluate weight change among patients who used the Counterweight weight management programme delivered by community pharmacies. METHODS: The Counterweight Programme was introduced into community pharmacies in Fife, Scotland in 2009 for patients with a BMI > 30 kg/m(2) or a BMI > 2830 kg/m(2) with a co-morbidity in localities in which Counterweight was not available at GP practices. The aim was to achieve an energy deficit of 500-600 kcal per day. Counterweight specialist dietitians delivered training, support and patient information materials to community pharmacies. Patient weight was measured by pharmacy staff at each weight management session. Weight data recorded at each weight management session were used to estimate weight change and attendance at 3, 6 and 12 months. RESULTS: Between March 2009 and July 2012, 458 patients were enrolled by the community pharmacies. Three-quarters of patients were women, mean age was 54 (SD 7.4) years and mean BMI 36.1 (SD 5.9) kg/m(2). Of 314 patients enrolled for at least 12 months, 32 (10.2% on an intention to treat basis) had achieved the target weight loss of >5%; this was 41.6% of those who attended at 12 months representing a mean weight loss of 4.1 kg. Using Last Observation Carried Forward, 15.9% achieved the target weight loss within 12 months of enrolling. There was no significant effect of sex, baseline BMI or age on weight loss. CONCLUSIONS: The Counterweight pharmacy programme has a similar effectiveness to other primary care based weight management programmes and should be considered as part of a range of services available to a community to manage overweight and obesity. ID - 3402 ER - BACKGROUND: Cardiovascular disease (CVD) progression is modifiable through lifestyle behaviors. Community pharmacists are ideally placed to facilitate self-management of cardiovascular health however research shows varied pharmacist engagement in providing lifestyle advice. OBJECTIVE: This study explored community pharmacists' experiences and perceptions of providing lifestyle advice to patients with CVD. METHODS: Semi-structured interviews were conducted with fifteen pharmacists (1 supermarket; 7 multiple; 7 independent) recruited through multiple methods from community pharmacies across the Midlands, England. A thematic analysis was conducted using a Framework approach. RESULTS: Pharmacists categorized patients according to their perceptions of the patients' ability to benefit from advice. Many barriers to providing lifestyle advice were identified. Confidence to provide lifestyle advice varied, with pharmacists most comfortable providing lifestyle advice in conjunction with conversations about medicines. Some pharmacists felt lifestyle advice was an integral part of their role whilst others questioned whether pharmacists should give lifestyle advice at all, particularly when receiving no remuneration for doing so. CONCLUSION: Pharmacists viewed providing lifestyle advice as important but identified many barriers to doing so. Lifestyle advice provision was influenced by pharmacists' perceptions of patients. Professional identity and associated role conflict appeared to underpin many of the barriers to pharmacists providing lifestyle advice. Pharmacists may benefit from enhanced training to: increase their confidence to provide lifestyle advice; integrate lifestyle advice with regular pharmaceutical practice and challenge their perceptions of some patients' receptiveness to lifestyle advice and behavior change. Changes to the way UK pharmacists are remunerated may increase the provision of lifestyle advice.Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved. ID - 3403 ER - This project was designed to tackle the issue of under-diagnosis of coeliac disease in the UK population, by making use of the accessibility and capacity of community pharmacies to provide point-of-care tests for people buying prescription or over-the-counter medications that indicate the potential for coeliac disease. The project was commissioned by Coeliac UK, and supported by the National Association for Primary Care and the Practice Innovation Network. Over 500 people were tested in sixteen community pharmacies across England. This report This report summarises the background to the project, its methodology and implementation, and its results. ID - 3469 ER - To assess the ability of community pharmacists to identify managed care patients with diabetes who are not achieving therapeutic goals, a network of independent community pharmacists conducted laboratory assessments of patients' glycemic control., The indices were measured during scheduled appointments in the pharmacy by a pharmacist who had completed a certificate program in diabetes care. Fifty-four persons were enrolled in the pharmacist program and complete clinical data were obtained for 47 patients. The following percentages of patients were identified as not achieving the therapeutic goal for a particular measure: HbA\IF/1c\BS/: 63.9%, blood pressure: 56.3%, total cholesterol: 38.3%, low density lipoprotein: 69.8%, high density lipoprotein: 76.5%, triglycerides: 57.4%, body mass index: 61.9%. Patients who were not reaching the therapeutic target were referred to their physicians for additional evaluation. ID - 3404 ER - OBJECTIVES: Evaluate a community pharmacist-based diabetes patient-management program by examining the pharmacists' impact on five intermediate outcomes: glycosolated hemoglobin (HbA1c), blood pressure, body mass index, lipid levels, and medication use in patients with diabetes., SETTING: A network of community pharmacies in West Virginia and southeastern Ohio., PATIENTS: The program was available to all patients with diabetes who attended the network pharmacies regardless of baseline glycemic control. Of the 47 patients initially enrolled, 32 stayed in the program for at least 6 months during the year-long study (median time in program was 9 months)., INTERVENTION: Pharmacists provided a basic, standardized diabetes education program during three 1-hour sessions. This was accompanied by a clinical assessment and a report to the patient's primary care physician. The patients met with the pharmacist every 3 months for continued monitoring. After each visit, the patient's primary care physician was sent a report along with recommendations for drug therapy modification when appropriate., MAIN OUTCOME MEASURES: HbA1c, blood pressure, total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL), triglycerides, body mass index, and the number of drug therapy modifications. RESULTS: There was significant improvement in total cholesterol (t=-2.58, p=0.015) and LDL (t=-2.56, p=0.017) for the 32 participating patients. HbA1c, BMI, blood pressure, HDL and triglycerides did not change significantly across all patients. For a subgroup of 10 patients with baseline HbA1c>8%, average HbA1c declined significantly from 9.8% to 8.6% (t=-3.00, p=0.015). During the study, the 32 patients had a total of 53 modifications to their medication regimens. The most common was a change in dose of oral diabetes medications., CONCLUSIONS: The pharmacist-based diabetes patient-management program was associated with improvements in total cholesterol and LDL across all patients who maintained enrollment in the program for at least 6 months. Improvements in HbA1c were also demonstrated for a subgroup of patients who had poor glycemic control at baseline. J Manage Care Pharm ID - 3405 ER - BACKGROUND: Osteoporosis is underdiagnosed, and rural communities often have limited technical resources for the assessment of osteoporosis. OBJECTIVE: To evaluate the impact of a pharmacist, trained in the use of a portable heel ultrasound device, in screening elderly rural women for risk of osteoporosis and determine whether those found to be at risk seek further help and treatment from their general practitioner (GP) following screening. METHODS: Following promotion of the service, 345 women were recruited from 6 rural community pharmacies in Tasmania, Australia, and underwent quantitative heel ultrasound screening. Women were comprehensively educated on risk factors for osteoporosis and completed a calcium intake questionnaire. Results were forwarded to each woman's GP, and the participants were followed up 3 months later to assess outcomes from the screening procedure. RESULTS: Approximately 20% of women were shown to be at high risk for osteoporosis; 201 (58%) of these were referred to their GP for further assessment. Sixty-eight percent of women who were screened discussed their results with their GP, and 11% underwent further investigation. Over one-third of women screened began medication (30% calcium, 6% bisphosphonate, 6% vitamin D) for osteoporosis. CONCLUSIONS: Pharmacist-provided screening for osteoporosis in rural areas is a potentially useful method to identify women at risk for fracture and a convenient time point for discussion of preventive therapy. ID - 3406 ER - OBJECTIVES: The extent to which community pharmacists contribute to the management of the global obesity epidemic is unclear. Local, regional and national obesity management schemes need to be informed by existing services which will be influenced by health professionals' attitudes and willingness to engage in service provision. The purpose of this study was to derive an accurate account of community pharmacists' activities and attitudes towards the provision of current and future Healthy Weight Management (HWM) services. METHODS: A postal survey was developed and disseminated to all 128 community pharmacies in Grampian, north-east Scotland. KEY FINDINGS: The response rate was 64.8% (83/128). A range of HWM services was already being provided. The most common services offered were the supply of weight-loss medication (n=69, 84.1%) and advice about its use (n=68, 84.0%). Other services commonly offered were dietary advice (n=59, 72.8%), physical activity advice (n=53, 66.3%) and body mass index (BMI) calculation (n=56, 68.3%). Most pharmacists were confident in measuring weight (n=78, 93.9%), height (n=78, 93.9%) and BMI (n=78, 93.9%). Many pharmacists perceived a need for HWM services in their local area (n=56, 67.5%) as well as a need to extend these services within their pharmacies (n=48, 57.9%). Barriers to the provision of HWM services included workload (n=77, 92.8%) and the need for additional reimbursement (n=63, 75.9%) and additional staff (n=49, 59.7%). The pharmacists' perceived training needs included estimation of body fat (n=67, 81.7%), one-to-one consultation skills (n=60, 73.2%), advice on weight-loss products (n=52, 63.4%), measurement of blood cholesterol (n=51, 63%) and advice on weight-loss drugs (n=49, 60.5%). CONCLUSIONS: Community pharmacies could be an ideal setting for the provision of HWM services. The barriers to service provision need to be addressed. Furthermore, the development of appropriate undergraduate and postgraduate training is required to equip pharmacists and their staff with appropriate knowledge and skills to deliver these services effectively.Copyright © 2011 The Authors. IJPP © 2011 Royal Pharmaceutical Society. ID - 3407 ER - OBJECTIVES: Effective strategies are needed to translate knowledge (evidence) into practice to improve the quality of community pharmacy services. We report the first step of a novel knowledge translation process which involved the systematic identification and prioritisation of community pharmacy services in Scotland which were perceived to require improvement and/or guideline development., METHODS: This process involved three stages and a stakeholder group comprising community pharmacists, policy makers, lay and pharmacy organisation representatives. A modified nominal group technique (NGT) was used for topic generation (August 2013) followed by an electronic Delphi survey (eDelphi), October-December 2013) and topic rationalisation (December 2013) based on feasibility, acceptability, and potential impact for practice improvement., KEY FINDINGS: In total, 63 items were identified during the modified NGT which were categorised into 20 topics to form the starting point of the eDelphi. In total, 74 individuals (mostly community pharmacists) indicated an interest in the eDelphi, which achieved response rates of 63.5%, 67.6%, and 70.3%, respectively in Rounds 1, 2, and 3. Consensus was achieved with six topics: promoting the appropriate sale and supply of over-the-counter medicines; patient counselling for prescribed medication; pharmaceutical care to promote medication adherence; promotion and delivery of a Minor Ailment Scheme; pharmaceutical care of vulnerable patients; and effective use of community pharmacy workforce. Of these, the priority topic selected for the next stage of the programme was promoting the appropriate sale and supply of over-the-counter medicines., CONCLUSIONS: This study adopted a systematic, inclusive, and rapid approach to identify priorities for community pharmacy practice improvement in Scotland., Copyright © 2017 The Authors. International Journal of Pharmacy Practice published by John Wiley & Sons Ltd on behalf of Royal Pharmaceutical Society. ID - 3408 ER - Background: Osteoporosis is an exceedingly common, morbid, and potentially fatal disease. Efforts to improve the prevention, diagnosis and treatment of osteoporosis in people living in Central Pennsylvania were instituted in 1996 by the Geisinger Health System. With a catchment of over 2 million people, over 600 physicians and 50 primary care sites, this physician-led system of healthcare is uniquely positioned to influence the delivery of healthcare.Objective: To determine whether the pilot Community Pharmacist Osteoporosis Education Program, a specific project of the osteoporosis disease management program by the Geisinger Health System, improved bone health behavior.Methods: The Community Pharmacist Osteoporosis Education Program, focused on physician and allied healthcare provider guidelines, community intervention, bone density testing, and outcomes analysis, can improve bone health. A group of highly motivated community-based pharmacists were educated about menopause and osteoporosis prevention, diagnosis, and treatment. They were provided with a uniform educational program and held classes in the community. Baseline, satisfaction, and follow-up questionnaires were administered. High risk participants received a follow-up telephone encounter. Primary care physicians were notified about the program and their patients' participation.Results: Approximately 350 women attended the classes. The mean age was 54 years, 99.4% were Caucasian, and 47% had some education beyond high school. One-third had a family history of osteoporosis or fracture. Participants were uniformly satisfied with the course content and class delivery: 74% rated the class as 'excellent', 26% as 'good'. Follow-up questionnaires at 4 to 6 months demonstrated that of those who were not previously doing so, 58% began taking calcium supplements, 32% exercised more, 50% sought the counsel of their primary care physician, 29% obtained a test of bone density, and 33% started a prescription medication for osteoporosis therapy as a result of attending the class. High risk participants were more likely to obtain a test of bone density after the program than were low risk participants.Conclusion: This program demonstrates that community-based pharmacists can serve as a valuable member of the healthcare provider team. An organized program that provides a standard and consistent educational approach, physician communication, and a reminder system led to better bone health behavior in women in the community. ID - 3409 ER - Long-term conditions (LTCs) such as diabetes, cardiovascular diseases, respiratory diseases and cancers are recognised as the greatest challenge facing public healthcare systems globally in the 21st century. Healthcare provision for people with LTCs is shifting towards a model that puts patients at the centre of their own care through supported self-care. Self-care support has emerged as a distinct concept in the management of LTCs and is now considered an inseparable component of high quality healthcare provided by healthcare professionals. People with LTCs are regular users of community pharmacy where dispensing and other services provide opportunities for self-care support. While self-care support as a concept has been explored extensively in health disciplines like nursing, medicine and health psychology, there is a paucity of published literature in community pharmacy. The main aim of this programme of work was to explore the place and contribution of community pharmacy in self-care support of LTCs. A preliminary scoping literature review captured and synthesised the overarching components of self-care support of LTCs into a single theoretical framework consisting of collaborative care planning, self-care information and advice, self-care skills support and training, self-care support networks and self-care technology. The research programme of work employed a mixed methods design consisting of three Work Streams. The qualitative arm of the programme consisted of semi-structured interviews with 24 patients with LTCs and 24 community pharmacists in England and Scotland; these informed the quantitative arm, which was a cross-sectional, online survey of 10,000 community pharmacists in England. The survey instrument was informed and developed from the findings of the pharmacists’ interviews in combination with existing literature. Data collection and analysis in the three work streams incorporated the theoretical framework of self-care support. The qualitative data analyses were undertaken thematically, while quantitative data were analysed using a range of descriptive and inferential statistics. Interviews with patients explored their ‘lived experience’ with LTCs and found that self-care was an integral part of daily living; patients engaged in self-care in a variety of ways to attain normality in their lives. Patients used a wide range of resources for self-care support; family/carers, friends and healthcare professionals (mainly doctors and nurses). Patients viewed and used community pharmacy mainly for the supply of prescribed medicines and suggested that community pharmacy played minimal roles in self-care support. The interviews and survey of community pharmacists showed that pharmacists recognised the broad range of activities and principles of self-care. However, in terms of pharmacists’ contributions to self-care support, their perspectives were narrower and focussed on providing information and advice on medicines-use to patients, while other activities such as lifestyle advice were provided opportunistically. They indicated that they were already providing medicines-focussed self-care support through the services available in community pharmacy. The theoretical framework allowed detailed exploration of how community pharmacists operationalised the different elements of self-care support of LTCs. Collaborative care planning was viewed as important but not within the remit of community pharmacy. Self-care information and advice was unidimensional and provided opportunistically and one-off, using the paternalistic biomedical model. Pharmacists valued the roles of patients’ personal communities but were not proactive in signposting to other support networks. Self-care skills training and support and the use of self-care technologies were limited. Barriers to providing self-care support were priority accorded to dispensing activities, the structure of the community pharmacy contract, lack of incentives to provide self-care support and patients’ expectations and lack of awareness of community phar acy’s role in LTCs management. The theoretical framework of self-care support of LTCs provided novel insights into the perspectives of patients and community pharmacists. The findings highlighted the need for a coherent LTC strategy if community pharmacy is to align with the self-care support paradigm. Recommendations are made for a comprehensive package of care, underpinned by self-care support. A case is also made for incorporating the often ‘unheard’ patient voice into community pharmacy research and interventions. ID - 3412 ER - Background Self-care support is an 'inseparable' component of quality healthcare for long-term conditions (LTCs). Evidence of how patients view and use community pharmacy (CP) to engage in self-care of LTCs is limited. Objective To explore patients' perspectives of engaging in self-care and use of CP for self-care support. Setting England and Scotland. Method Qualitative design employing semi-structured interviews. LTCs patients were recruited via general practitioners (GPs) and CPs. Interviews were conducted between May 2013 and June 2014; they were audio-recorded, transcribed verbatim and analysed thematically. Results Twenty-four participants were interviewed. Three main themes emerged: engaging in self-care, resources for self-care support and (limited) use of community pharmacy. Participants' LTC 'lived experience' showed that self-care was integral to daily living from being diagnosed to long-term maintenance of health/wellbeing; self-care engagement was very personal and diverse and was based on beliefs and experiences. Healthcare professionals were viewed as providing information which was considered passive and insufficient in helping behavioural change. Non-healthcare sources (family, carers, friends, internet) were important in filling active support gaps, particularly lifestyle management. Participants' use of, and identified need for, community pharmacy as a resource for self-care support of LTCs was limited and primarily focussed on medicines supply. There was low awareness and visibility of CPs' potential roles and capability. Conclusion CP needs to reflect on patients' low awareness of its expertise and services to contribute to self-care support of LTCs. Rethinking how interventions are designed and 'marketed'; incorporation of patients' perspectives and collaboration with others, particularly GPs, could prove beneficial. ID - 3413 ER - OBJECTIVES: To explore community pharmacists' contributions to self-care support of long-term conditions by; investigating their conceptual understanding of self-care principles; identifying self-care support activities they considered important and their engagement in them; and examining barriers and enablers., METHODS: A questionnaire was developed using existing literature and qualitative interviews, piloted and distributed online to a random sample of 10 000 community pharmacists in England between August and November 2014. The questionnaire contained sections addressing the above objectives. Data were analysed using descriptive statistics; free text comments were analysed using content analysis., KEY FINDINGS: A total of 609 responses were received; 334 completed all sections of the survey. Responses to statements exploring conceptual understanding showed that respondents were more likely to agree with self-care principles about patients taking responsibility and being more actively involved in their health and care; they agreed less with self-care principles promoting patient autonomy and independence. Respondents considered medicines-related self-care support activities as a lead role for community pharmacy, which they said they engaged in regularly. Whilst many agreed that other self-care support activities such as supporting self-monitoring and collaborative care planning were important, they indicated only limited engagement. Respondents identified access to patient records and availability of private consultation rooms as their main barriers and enablers, respectively; working relationship with GPs and skill-mix in community pharmacy were viewed as both barriers and enablers., CONCLUSIONS: Community pharmacists in this study conceptualised and operationalised self-care support of long-term conditions (LTCs) from a narrow, medicines-focussed perspective, rather than from a multifaceted, patient-focussed perspective. A concerted and coherent strategy that builds on the strengths, and tackles the identified barriers is needed if community pharmacy is to improve contributions to self-care support of LTCs.Copyright © 2016 Royal Pharmaceutical Society. ID - 3414 ER - OBJECTIVES: To implement a comprehensive service to screen for metabolic syndrome, assess the prevalence of metabolic syndrome, determine the 10-year risk of developing coronary heart disease (CHD), and measure the effectiveness of patient education on lifestyle modifications. DESIGN: Cross-sectional study. SETTING: Community pharmacy in Pennsylvania between February 2006 and August 2007. PATIENTS: 239 patients 18 years of age or older with no history of CHD. INTERVENTION: Participating patients were screened for metabolic syndrome, Framingham risk assessment, and medication use. Test results were discussed and patients were educated on metabolic syndrome and lifestyle recommendations. A follow-up survey was administered. MAIN OUTCOME MEASURES: Prevalence of metabolic syndrome in the study population, Framingham risk assessment of those with metabolic syndrome, proportion of patients with self-reported lifestyle modifications. RESULTS: The prevalence of metabolic syndrome in our study population was 36%. The Framingham risk assessment of patients with metabolic syndrome and no known history of diabetes revealed that 65.3% were at low risk, 26.4% were at moderate risk, and 8.3% were at high risk for CHD. Of the study population with no known history of prediabetes or diabetes, 26% had an abnormal glucose reading. Of those with metabolic syndrome, 87% self-reported a lifestyle modification in the area of diet, exercise, or weight loss in the following 3- to 6-month follow-up period. CONCLUSION: Pharmacists have an important role in screening patients for risk factors associated with metabolic syndrome. By providing education on lifestyle modifications, pharmacists can increase the likelihood that patients with metabolic syndrome implement lifestyle changes. A metabolic syndrome screening and education program can be successfully implemented in a community pharmacy setting. ID - 3415 ER - Background This summary presents the findings from an evaluation of the Anticipatory Care Community Pharmacy (ACCP) programme. Funded in seven Health Board areas, ACCP aims to support the delivery of Keep Well, Scotland’s flagship anticipatory care programme, by offering people anticipatory care health checks in pharmacies. These checks aim to identify people at risk of developing a cardiovascular condition, and to refer them to appropriate treatment and/or give advice about lifestyle change. The checks include both clinical tests (e.g. cholesterol and blood glucose) and a broader assessment of lifestyle factors (e.g. alcohol, smoking, physical activity and diet) and related needs. Evaluation aims and objectives The overall aim of the evaluation was to ‘generate information that will inform and develop anticipatory care health check service delivery as part of the routine activity of community pharmacies’. It focused on short-term outcomes from the programme and addressed four key research questions: 1. How can community pharmacies enhance the delivery of the H8 target in terms of the development of efficient referral pathways, e.g. between community pharmacies and primary health care, and other services? 2. How can community pharmacies enhance the delivery of the H8 target in terms of: a. Access by target groups b. Client numbers, and c. The acceptability of community pharmacies as a location for health checks? 3. To what extent has the programme helped the Health Boards to achieve the HEAT target? 4. To what extent is the programme transferable? Method This mixed method evaluation combined quantitative analysis of monitoring and cost data with qualitative interviews with service users and staff in three case study Health Boards (NHS Borders, Grampian and Lanarkshire). Local ACCP leads in all seven participating Boards were also interviewed at the beginning and the end of fieldwork. Full details of the methods used are included in the main report and appendices, along with a discussion of the scope and limitations of the research methods. ID - 3416 ER - OBJECTIVE: To assess the impact of community pharmacists on clinical outcomes in Hispanic patients with type 2 diabetes. METHODS: 126 patients were enrolled in this longitudinal pre/post cohort study that took place in nine community and four workplace pharmacies in San Antonio, TX. Pharmacists provided education, point-of-care testing for glycemic and metabolic parameters, clinical assessment, goal setting, and drug therapy management with physicians. Study outcomes were changes in glycosylated hemoglobin (A1C) and accompanying metabolic parameters (blood pressure, lipid parameters, and body mass index) during a 1-year time frame. RESULTS: In the overall cohort, A1C was not reduced significantly from baseline to 12 months (7.8% vs. 7.6%, P = 0.516). However, statistically significant reductions occurred for fasting plasma glucose, triglycerides, and diastolic blood pressure. None of the other parameters was affected significantly. In the subgroup of patients not at target values at baseline, significant reductions occurred for A1C (9.2% vs. 8.6%, P = 0.001), systolic blood pressure (147 vs. 143 mm Hg, P = 0.031), diastolic blood pressure (91 vs. 87 mm Hg, P < 0.001), triglycerides (259 vs. 219 mg/dL, P < 0.001), LDL cholesterol (139 vs. 123 mg/dL, P < 0.001), and total cholesterol (237 vs. 222 mg/dL, P = 0.008). CONCLUSION: Interventions performed by community pharmacists are effective in improving clinical outcomes in a Hispanic cohort with diabetes. Pharmacists' efforts were most successful in patients not at target glycemic and metabolic levels. ID - 3417 ER - OBJECTIVES To describe Wellness Initiative of the Northland (WIN) screening events; present participant results from those events; discuss the benefits of pharmacist-conducted, community-based point-of-care (POC) testing to medically underserved patients and to the profession of pharmacy; and describe logistical considerations in launching disease screening services. SETTING Pharmacist-led community health fairs in a variety of settings, including shopping malls, churches, community pharmacies, senior residence facilities, critical-access hospitals, and clinics. PRACTICE DESCRIPTION Disease screenings for economically disadvantaged residents of northeastern Minnesota and northwest Wisconsin, held between 2005 and 2012, through WIN. PRACTICE INNOVATION Mobile POC screenings for dyslipidemia, diabetes, hypertension, and osteoporosis. MAIN OUTCOME MEASURE Percentage of screenings with out-of-range readings. RESULTS Since 2005, WIN screenings have served more than 2,000 individuals, providing 4,152 POC screenings. Out-of-range readings were obtained for 40.3% of fingerstick cholesterol tests, 24.8% of fingerstick blood glucose tests, 24.3% of blood pressure tests, and 38.7% of quantitative ultrasound heel bone density readings. CONCLUSION Community-conducted POC testing functions both as an important public health service and a mechanism by which pharmacists and student pharmacists can become involved in civic engagement. ID - 3418 ER - This dissertation explored the experiences of Suffolk and Cambridgeshire - based CP in promoting the health and wellbei ng of YP (16 - 24 years old). The study’s objectives were to: - Explore community pharmacists understanding of health promotion and how this influences their health promotion practices - Explore the practical/experiential reasons for seeing this age group and consequently what are the benefits and challenges of engaging with this age group - Explore awareness of the policies (local and national) that aids the health promotion of this age group ID - 3419 ER - Linked with 18418886 (an earlier pilot study). This one is coded. Objectives: Point-of-care HbA1c screening devices are a valuable tool that community pharmacists can use to monitor patients with diabetes and improve their overall management. We previously reported our experiences using these devices to assess glycaemic control in diabetic patients at three community pharmacy locations in Toronto, Ontario. Here, we report data from screening of over 1000 patients at clinics held across Canada.; Methods: Community pharmacies across Canada offering A1c screening as part of their professional programmes were invited to upload screening data to a central database. A1c analysis was performed using the Bayer A1c Now. Patient recruitment and approach to A1c screening were at the discretion of the participating pharmacies and were not standardized. Data collection took place over a period of 8 months.; Key Findings: The majority of patients screened (59.1%) had A1c values above target, indicating inadequate glycaemic control. Glycaemic control was generally poorer among patients on more intensive treatment regimens. A total of 1711 clinical interventions were performed by pharmacists. An average of two interventions were performed per patient, and we observed a trend towards increased numbers of interventions in patients with poorer glycaemic control. The prevalence of specific types of interventions showed an apparent shift from predominantly pharmacist-directed interventions in patients with better glycaemic control towards an increased prevalence of physician-directed interventions in patients with poorer glycaemic control.; Conclusions: These results illustrate the prevalence of suboptimal glycaemic control among diabetic patients in the community, which represents a significant opportunity for pharmacists to use point-of-care screening to detect hyperglycaemia and intervene to improve disease management when warranted.; © 2015 Royal Pharmaceutical Society. ID - 3421 ER - Linked with 21137861 (an earlier pilot study). That one is coded. Diabetes is one of the fastest growing diseases in Canada. It is estimated that 2 million Canadians have type 2 diabetes and that there are more than 60,000 new cases of this disease diagnosed each year. ID - 3420 ER - OBJECTIVES: The safety and efficacy of medications can vary significantly between patients as a result of genetic variability. As genomic screening technologies become more widely available, pharmacists are ideally suited to use such tools to optimize medication therapy management. The objective of this study was to evaluate the feasibility of implementing personalized medication services into community pharmacy practice and to assess the number of drug therapy problems identified as a result of pharmacogenomic screening., SETTING: The study was conducted in 2 busy urban community pharmacies, operating under the brand Shoppers Drug Mart, in Toronto, Ontario., PRACTICE INNOVATION: Pharmacists offered pharmacogenomic screening as part of their professional services program. Eligible patients received a buccal swab followed by DNA analysis with the use of Pillcheck. Pillcheck is a genotyping assay that translates genomic data and generates a personalized evidence-based report that provides insight into patients' inherited drug metabolic profile. After receiving the report, pharmacists invited patients back to the clinic for interpretation of the results. Clinically significant drug therapy problems were identified and recommendations for medication optimization forwarded to the primary care physician., RESULTS: One hundred patients were enrolled in the study. Average age was 56.7 years, and patients were taking a mean of 4.9 chronic medications. Pharmacists cited the most common reasons for testing as ineffective therapy (43.0%), to address an adverse reaction (32.6%), and to guide initiation of therapy (10.4%). An average of 1.3 drug therapy problems directly related to pharmacogenomic testing were identified per patient. Pharmacist recommendations included change in therapy (60.3%), dose adjustment (13.2%), discontinuation of a drug (4.4%), and increased monitoring (22.1%)., CONCLUSION: These results highlight the readiness of community pharmacists to adopt pharmacogenomic screening into practice and their ability to leverage this novel technology to positively affect medication therapy management. Community pharmacists are ideally suited to both offer personalized medication services and interpret genomic results.Copyright © 2017 American Pharmacists Association. Published by Elsevier Inc. All rights reserved. ID - 3422 ER - INTRODUCTION: In the UK half of all pregnancies are unplanned and half of teenage pregnancies terminated. Southwark and Lambeth have the highest teenage conception rates in London. In 2009, many teenage pregnancies in Southwark led to terminations. A contraception service was established where qualified pharmacists supplied oral contraception (OC) using a patient group direction (PGD). This service evaluation aimed to assess this service delivered in five community pharmacies. METHODS: Monthly data were submitted by each pharmacy to the Primary Care Trust on consultations, pills supplied, initial or subsequent supply and client referral. For specified periods consultation time was collected and a clinical notes audit undertaken. Client satisfaction was determined using a structured questionnaire returned to the pharmacy. Mystery shoppers were employed to assess the service. RESULTS: A total of 741 consultations were undertaken by seven pharmacists at five community pharmacies (October 2009-June 2011) with many (45.5%) occurring following emergency contraception supply. The mean consultation time was 19 minutes . Combined OC was most commonly supplied with nearly half (46.1%) of initial supplies to first-time pill users. Most consultations (92.2%) were with women aged under 30 years, with 22.5% aged under 20. Most consultations were with black or black British clients. Of the 99 women who completed the satisfaction questionnaires, most clients were very satisfied or satisfied with the service and felt comfortable talking to the pharmacist about contraception. CONCLUSIONS: Trained pharmacists were clinically competent and provided OC in community pharmacy according to a PGD. This service was accessed by the target population; young women using emergency hormonal contraception who had not previously used OC. Clients were largely very satisfied with the service. ID - 3423 ER - Background/introduction STI screening via community pharmacies (CPs) has traditionally been very low. Aim(s)/objectives To increase STI screening in young people (15-24 years) in a London Borough with high rates of infection using a new self-test kit (testing for Chlamydia and Gonorrhoea (CT/GC), and HIV) alongside condom distribution via the pan- London condom scheme. Methods Nine CPs were selected based on high rates of Emergency Contraception provision and condom distribution in 2013. Frontline staff were trained and care pathways established. Ongoing monthly support was provided by site-visit and phone. Results were notified by text. Positive results, partner notification and follow-up were managed by a Level 3 GUM clinic. Evaluation was by user/CP survey. Results * 8 CPs were active during the pilot which ran January-December 2014. * 214 self-test kits were distributed; 108 CT/GC tests and 96 HIV tests were returned/tested (return rates of 50.5% and 44.9% respectively). At the start 1 CP removed HIV tests from packs. * 4,476 condoms were distributed. * 7 Chlamydia positives were identified (positivity 6.5%). * Quarter 1 2014 saw a 700% increase in numbers of STI tests processed) in the 9 CPs compared to Quarter 3 2013 (prepilot levels). This significantly increased activity continued throughout 2014. * All users were very or quite satisfied with the service and were very or quite likely to use the service again. * 66% were very likely to recommend the service to others Discussion/conclusion With adequate training and support, community pharmacies provide an engaged, accessible and convenient venue for STI testing (including HIV) and condom distribution. ID - 3424 ER - The use of community pharmacies to deliver health improvement campaigns is well established. Cancer incidence is closely related to increasing levels of deprivation. Because community pharmacies are more prevalent in deprived areas there is potential for them to make an important contribution to health improvement by delivering interventions aimed at reducing cancer incidence amongst those at greatest risk., OBJECTIVES: The aims of the study were: to examine the association between high risk behaviour and deprivation and contribute evidence to the case for or against targeting cancer prevention campaigns at specific risky behaviour in areas of high deprivation., METHODS: This study has an ecological design and involved retrospective analysis of data derived from 5739 sun-safety quizzes completed by pharmacy users at 714 community pharmacies in Wales during May 2014., RESULTS: Levels of participation in the campaign and high risk sun-safety behaviours were higher in more deprived areas. Respondents from deprived areas had significantly lower sun-safety knowledge. 3802 (66.2%) respondents reported 'excellent' or 'good' knowledge of behaviours which promote sun-safety but this did not necessarily translate into how individuals behaved. 3787 (66.1%) respondents considered community pharmacies an acceptable location for the campaign and for discussing the signs and symptoms of skin cancer., KEY FINDINGS: Results show association between high risk behaviour and geographically defined deprivation adding to the case for targeting cancer prevention campaigns at specific behaviours and geographies., CONCLUSIONS: Community pharmacies appear to be acceptable locations from which to deliver health improvement campaigns in terms of participant recruitment, ease of delivery, and pharmacy user feedback.Copyright © 2016 Royal Pharmaceutical Society. ID - 3425 ER - Despite its high prevalence and major public health ramifications, obstructive sleep apnea syndrome (OSAS) remains underdiagnosed. The aim of this study was to determine whether the involvement of a community pharmacist (CP) in the care pathway of a patient at risk of OSAS, through the implementation of a community pharmacist (CP) intervention, was effective, i.e. increased the use of diagnostic tests in this population. We compared a cohort of patients included in a research protocol (exposed to a CP intervention) with patients having the same characteristics taken from a general population database who did not receive the intervention (unexposed group). The aim of the CP intervention was to educate patients about the risk of untreated OSAS, encouraging them to consult their general practitioner, and urging the doctor to continue investigations. We included 782 patients at risk of OSAS, i.e. taking one or more anti-hypertensive drugs, being overweight (body mass index > 25) and snoring almost every night (88 in the exposed group and 694 in the unexposed group). After a 6-month follow-up, the number of patients who underwent an OSAS diagnostic test was significantly higher in the exposed group compared to the unexposed group (22.7 versus 11.4%, P = 0.003). Being exposed to the pharmacist intervention was associated with a higher chance of undergoing a diagnostic test for OSAS, adjusted odds ratio: 2.24 (1.25-4.01). In conclusion, these findings provide arguments for the implementation of a CP OSAS screening intervention in CP routine practice. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract). ID - 3426 ER - OBJECTIVE: To assess the suitability of Australian community pharmacies as cardiovascular disease risk profile screening centres and evaluate whether community pharmacists can play an important role in detecting, educating and referring screened individuals at high risk of cardiovascular disease. SETTING: 14 Australian community pharmacies. METHOD: Opportunistic cardiovascular disease risk profiling for members of the public aged greater than 30 years with no existing cardiovascular diseases was performed. All major cardiovascular risk factors were measured. Exercise habits, existing conditions and therapy, and family history were also assessed. The results were used to calculate each subject's 10-year risk of developing cardiovascular events, based on Framingham Risk Equations (New Zealand tables). Each subject's knowledge of cardiovascular risk factors was assessed using a multiple-choice questionnaire. Written educational materials and verbal counselling were provided. Referral to a doctor for further assessment was recommended as appropriate. The screened individuals were followed up via mailed out questionnaire. A random sample of individuals at elevated risk was phoned to assess for outcomes of the screening and referral process. MAIN OUTCOME MEASURES: Risk of developing cardiovascular disease and knowledge of cardiovascular risk factors. RESULTS: A total of 655 individuals (71.4% female) were screened for cardiovascular disease risk factors. Ages ranged from 30 to 90 years (median: 54 years) and 14.2% were smokers. Of the individuals screened, 28.1% had a 10-year risk of developing cardiovascular disease greater than 15%, including 6.9% who had a 10-year risk above 30%. The median calculated 10-year risk of developing cardiovascular disease was 9.5%. Approximately one-third of the individuals had elevated blood pressure, and almost two-thirds were either overweight or obese. The mean total serum cholesterol was 5.31 mmol/l, with 40% of individuals having a level above 5.5 mmol/l and 20% having a high-density lipoprotein cholesterol level below 1.0 mmol/l. There was a statistically significant improvement in the knowledge of cardiovascular disease risk factors at follow-up. Almost half of the contacted high-risk subjects reported lifestyle changes or started drug therapy following re-testing by their general practitioner. CONCLUSION: A pharmacy-based cardiovascular disease risk profile screening and education program has the potential to identify and refer many undiagnosed individuals at high risk of cardiovascular events, and help contain the burden of heart disease. ID - 3427 ER - The aim of this evaluation is to review the influenza vaccination service provided by pharmacists in retail pharmacy businesses during the 2014/2015 season, to ensure that the service is operating safely and effectively and identify any improvements that could be made to the service for the 2015/2016 Influenza Vaccination Campaign. ID - 3428 ER - OBJECTIVE: To evaluate the efficacy of a community-based, pharmacist-directed diabetes management program among managed care organization enrollees using National Committee for Quality Assurance (NCQA)-Healthcare Effectiveness Data and Information Set (HEDIS) performance measures. DESIGN: Randomized controlled trial. SETTING: Regional community pharmacy chain in Tulsa, OK, from November 2005 to July 2007. PATIENTS: 52 participants with diabetes and hypertension who were enrolled in a managed care organization. INTERVENTION: Diabetes management versus standard care. MAIN OUTCOME MEASURES: Comprehensive diabetes care measures of glycosylated hemoglobin (A1C <7.0%), blood pressure (<130/80 mm Hg), and low-density lipoprotein (LDL) cholesterol (<100 mg/dL). A composite research outcome of success was created by determining whether a participant achieved two of the three HEDIS goals at the end of 9 months. RESULTS: 46.7% of intervention group participants achieved the A1C goal, while 9.1% of control group participants achieved the goal ( P < 0.002). More than one-half (53.3%) of intervention participants achieved the blood pressure goal compared with 22.7% of control participants ( P < 0.02). Among control group participants, 50% achieved the LDL cholesterol goal compared with 46.67% of intervention group participants. The odds of the intervention group attaining the composite goal were 5.87 times greater than the control group. CONCLUSION: A community pharmacy-based diabetes management program was effective in achieving A1C and blood pressure goals measured by NCQA-HEDIS performance standards. Program participants were statistically significantly more likely to achieve two of three HEDIS standards during a 9-month period. ID - 3429 ER - Objective: To explore the influence of bone mineral density (BMD) tests in osteoporosis risk categorisation in community pharmacies, and to develop a simple tool for pharmacists to use as a pre-BMD test screen. Method: A secondary data analysis was conducted on the responses of 193 participants to a risk-assessment questionnaire, used in previous osteoporosis research that included a BMD test. To explore the impact of the BMD test on pharmacists' categorisation of risk, the researchers made an independent assessment based on responses of the questionnaire. The influence of risk factors on BMD scores/bone status was explored using multiple and logistic regression respectively. Key findings: Atotal of responses of 193 participants were available for study, with 113 in the BMD group and 80 from the non-BMD group. In the BMD group, both researchers and pharmacists identified a similar proportion of patients in the moderate/high-risk category when BMD results were incorporated in the risk assessments (x 2=0.78, degrees of freedom (df)=1, 0.3=30 kg/m2. The crude prevalence of diabetes mellitus (DM) was 7%, hypercholesterolaemia was identified in 57%, and 44% had elevated BP. Among fasting individuals (n=1814), DM was found in 18%. In total, 30% were confronted with a CVRF they were previously unaware of, and pharmacists recommended 45% of all participants to actively consult a physician. A first-time diagnosis of a CVRF was most frequent in the age groups between 25 and 64 (32% of participants)., CONCLUSIONS: This pharmacy-based approach for cardiovascular risk screening found similar overall prevalences of CVRFs as reported by national surveys, but revealed underdiagnoses, particularly in lower age groups. A previously unknown CVRF was identified in every third individual, frequently prompting the pharmacists to recommend the consultation of a physician. An active screening approach at pharmacies might therefore serve as an effective alternative to the public preventive medical examination, particularly in younger age groups. ID - 3447 ER - Objective: The aim of this study was to investigate the nature of community pharmacists' services to opiate misusers in a metropolitan area. Method and Setting: Data were collected via a self-completed postal questionnaire, sent to the pharmacist in charge of all 167 community pharmacies in the East London and City Health Authority. This Health Authority has responsibility for one of the most economically deprived and ethnically diverse areas in England. Key findings: The overall response rate was 52 per cent. Forty-nine per cent of respondents sold injecting equipment whilst 11 per cent participated in a needle exchange scheme. Eighty-four per cent of the pharmacists dispensed methadone and 41 per cent supervised methadone consumption. A number of logistical, social and economic factors were highlighted by those not providing such services. Pharmacists reported being prepared to dispense large volumes of methadone liquid, raising concerns about safety and "leakage" onto the illicit drug market. Many pharmacists had previously contacted general practitioners and drug misusers' key workers regarding issue relating to controlled drugs and drug leakage. Conclusion: Community pharmacists were involved in providing a broad range of services to opiate misusers. The provision of extended services such as the supervision of methadone consumption and surveillance of possible drug "leakage", potentially make them effective key members of a multi-disciplinary approach to services for drug misusers. ID - 3448 ER - This thesis is a policy analysis of the Pharmacy In A New Age (PIANA) initiative launched by the Royal Pharmaceutical Society of Great Britain (RPSGB) in 1995. It leads to an understanding of how pharmacy services develop as a part of the Welfare State. The chosen interpretation was to explore the pharmacy policy sub-system using the Advocacy Coalition Framework (ACF), the Systems Approach and the dimensions of power associated with decision-making. The PIANA initiative identified five areas where pharmacists' input into future healthcare systems would be valued: o the management of prescribed medicines; e the management of long-term conditions; the management of common ailments; the promotion and support of healthy lifestyles; and, advice and support for other healthcare professionals. Research was conducted using both qualitative and quantitative methods to ascertain pharmacists' perceptions towards the implementation of the PIANA initiative. From the interviews it was determined that isolation, remuneration, skill mix and competitive retail environment were factors thought to impede the implementation of new pharmacy services in the community setting. Hypotheses were generated and subsequent questionnaire based research explored pharmacists' views relating to the development of the extended pharmacy services and which organisations were trusted to influence the policy process. The study group comprised 2359 pharmacists living in Great Britain who were registered With the RPSGB on March 12 th 1999. The response rate was 50.1 % (n= 1182). Statistical analysis demonstrated that the management of prescribed medicines was ranked most important role and that pharmacists employed in GP surgeries were thought best placed to carry out this role. The author suggests that clinicallytrained pharmacists based in GP surgeries would be best placed to manage prescribed medicines. Community pharmacists ranked the management of common ailments as their second most important role and were perceived to be best located by all pharmacists. Hospital ranked the advice and support of health care professionals as the second most important; community pharmacists ranked this as the fifth most important. The conclusionsd raw on the literaturea ssociatedw ith implementationT. he author considers that the methods employed, were appropriate to analyse the pharmacy policy process. The analysis identified that the RPSGB was unable to unilaterally influence the policy process and that the plethora of pharmacy organisationsm ay be detrimentatl o policy implementationT. he authorc oncludes that local leadersw ho are associatedw ith severalp harmacyo rganisationsfu rther compromise the situation. Employees of Primary Care Organisations were found to possess the triple dimensions of power associated with decision-making and are key policy brokers for emerging pharmacy services. Future policy implementation research should focus upon this group. The majority of pharmacists were unable to identify a legitimate organisation to support the local implementation of pharmacists' non-dispensing roles, this may impede the implementation process. The majority of pharmacists agreed that they would have to change the skills that they used in order to survive. Educators and trainers should ensure that pharmacists develop competencies to the expected professional standards required to develop and deliver new roles. 16 ID - 3449 ER - Background: Prior to this project, patients were required to drive up to 2 hours to a diabetes education centre. As a result, many patients were not receiving diabetes education, and there was little or no follow-up of patients. Significant opportunity exists for pharmacists to fill such gaps in chronic disease management services., Methods: Patients were randomly assigned to the intervention or usual care arm. Laboratory data (glycosylated hemoglobin, fasting blood glucose, lipid panel, microalbumin, systolic and diastolic blood pressure) and Diabetes Empowerment Scale short form (DES-SF) score were collected at baseline and at 6 months. Intervention patients received a medication review, 3 one-on-one education sessions with one of the study pharmacists and follow-up phone calls. Usual care patients did not receive medication reviews or education sessions, and received follow-up phone calls only if drug-related problems were detected. Drug-related problems were tracked for all patients. Referrals to other health care professionals (dietitian, homecare, public health) were made as required. Paired-sample t-tests were used to compare baseline and 6-month data., Results: Forty-five patients were enrolled in the study (intervention: 23; usual care: 17). Five patients were lost to follow-up (intervention: 2; usual care: 3). There was a statistically significant improvement in DES-SF score in the intervention group (p < 0.001) and a decline in DES-SF score in the usual care group (p < 0.04). There was a significant decrease in glycosylated hemoglobin in the usual care group (p < 0.04). Referrals to other health care professionals were higher in the intervention group (I: 36; UC: 0). The number of drug-related problems detected was also greater in the intervention group (I: 83; UC: 8). The overall acceptance rate of pharmacist recommendations for drug-related problems was high in both arms (I: 81%; UC: 100%)., Conclusions: Most outcome measures were not statistically significant. Further study is needed to evaluate the change in clinical outcomes. However, greater involvement of a pharmacist in diabetes management resulted in greater detection of drug-related problems and referral to other health care professionals, and promoted diabetes-related self-efficacy and appropriate self-care behaviour. Pharmacists can play an important role in the management of diabetic patients. Can Pharm J (Ott) ID - 3450 ER - OBJECTIVE: To develop, implement, and evaluate a depression screening program performed by pharmacists in the community setting; to determine the ability of this screening to identify and refer patients with symptoms of depression; and to determine whether physician referral results in initiation or modification of treatment. DESIGN: Prospective study. SETTING: 32 locations of a large grocery chain pharmacy in the Cincinnati and Dayton, OH, area from February 8, 2010, to March 30, 2011. PATIENTS: 3,726 patients 18 years or older. INTERVENTION: Patients were screened for depression using the Patient Health Questionnaire (PHQ). Patients who screened positive on the two-item PHQ (PHQ-2) then were given the nine-item PHQ (PHQ-9). Patients who screened positive on the PHQ-9 were referred to their physician. Pharmacists followed up with these patients to determine the action that was taken following the screening. MAIN OUTCOME MEASURES: Number of patients with a positive PHQ-9, number of patients referred to their physician, and number of patients for whom treatment was initiated or modified as a result of screening. RESULTS: 3,726 patients were screened for depression by pharmacists during the study period. A total of 67 (1.8%) patients screened positive on the PHQ-2. Of the patients who completed the PHQ-9, approximately 25% met the criteria for consideration of diagnosis and were referred to their physician. Five patients presented with suicidal thoughts and were referred for urgent treatment. Approximately 60% of patients with a positive PHQ-9 had initiated or modified treatment at the time of follow-up. CONCLUSION: A screening program for depression was successfully developed and implemented in the community pharmacy setting. Using the PHQ, pharmacists were able to quickly identify undiagnosed patients with symptoms of depression. The majority of patients with a positive screening had initiated or modified treatment at the time of follow-up. ID - 3451 ER - BACKGROUND: We performed a multicentre randomised controlled trial to evaluate the effect on participation in organised screening programmes of a self-sampling device mailed home or picked up at a pharmacy compared with the standard recall letter. METHODS: Women aged 30-64 non-responding to screening invitation were eligible. Response rate to first invitation ranged from 30% to 60% between centres. The control was the standard reminder letter to undergo the test used by the programme (Pap test in three centres and HPV DNA test in three other centres). Home mailing of the self-sampler was preceded by a letter with a leaflet about HPV. The analysis was intention-to-treat. RESULTS: In all, 14041 women were randomised and recruited: 5012 in the control arm, 4516 to receive the self-sampler at home, and 4513 to pick up the self-sampler at a pharmacy. Participation was 11.9% in the control, 21.6% (relative participation: 1.75; 95% CI 1.60-1.93) in home, and 12.0% (relative participation: 0.96; 95% CI 0.86-1.07) in the pharmacy arms, respectively. The heterogeneity between centres was high (excess heterogeneity of that expected due to chance, i.e., I(2), 94.9% and 94.1% for home and pharmacy arm, respectively). The estimated impact on the overall coverage was +4.3% for home mail self-sampling compared with +2.2% for standard reminder. CONCLUSIONS: Home mailing of self-sampler proved to be an effective way to increase participation in screening programmes, even in those with HPV as primary testing. Picking up at pharmacies showed effects varying from centre to centre. ID - 3298 ER - This report identifies a number of opportunities and challenges for community pharmacy teams to further support the public's health. The report is based on research conducted in early 2016 and provides a snapshot of the extent to which pharmacy teams are supporting the public's health, the opportunities and challenges they may face and what can be done to address the challenges. ID - 3452 ER - Studies suggest that community-based approaches could help pharmacies expand their public health role, particularly pertaining to HIV prevention. Thirteen pharmacies participating in New York's Expanded Syringe Access Program, which permits nonprescription syringe sales to reduce syringe-sharing among injection drug users (IDUs), were enrolled in an intervention to link IDU syringe customers to medical/social services. Sociodemographics, injection practices, beliefs about and experiences with pharmacy use, and medical/social service utilization were compared among 29 IDUs purchasing syringes from intervention pharmacies and 66 IDUs purchasing syringes from control pharmacies using chi-square tests. Intervention IDUs reported more positive experiences in pharmacies than controls; both groups were receptive to a greater public health pharmacist role. These data provide evidence that community-based participatory research aided in the implementation of a pilot structural intervention to promote understanding of drug use and HIV prevention among pharmacy staff, and facilitated expansion of pharmacy services beyond syringe sales in marginalized drug-using communities. ID - 3453 ER - Objective - To investigate community pharmacy managers' perceptions of their role in providing health care to patients and to compare these with their aspirations for the future. Method - Fourteen pharmacist managers from one regional area of a UK national multiple pharmacy chain participated in two focus groups. Key findings - Participants voiced a shared vision of wanting to play a more integral part in the health care of patients. Strategies put forward to embrace a more participative role included delegation of health screening and minor illness clinics from the prescriber to the pharmacist, having more formalised and open channels of communication with prescribers and moving away from performing technical duties, such as the physical assembly of medicines. Participants in both groups showed awareness that apathy and inaction would result in potential opportunities for pharmacy to be lost or passed over to another profession within the primary health care team (PHCT). Two key external obstacles that currently prevented attainment of desired roles were identified: First, a lack of awareness among other health care professionals and the general public about the pharmacist's skills and attributes and, secondly, current UK legislation that limits the potential for community pharmacists to expand their role away from the pharmacy premises. Conclusions - Participants believed that they could provide a more comprehensive pharmaceutical service if given the chance. However, they believed that implementation of change would be difficult considering the obstacles that needed to be surmounted for change to occur. ID - 3454 ER - To report the views and experiences of community pharmacists and general practitioners (GPs) who participated in a 5-month feasibility study exploring the ways in which community pharmacists could contribute to the management of patients with stable angina when working in partnership with GPs, 5 pharmacists who delivered a specified model of care were surveyed., The pharmacists reported high levels of satisfaction and success in relation to the study interventions and more professionally satisfying relationships with patients and GPs. Successes with therapeutic interventions were described, both within and external to the study protocol. The GPs expressed a high level of satisfaction with the conduct and outcome of the pharmacist delivered care and heightened awareness of the need to examine their approach to preventive care for ischemic heart disease patients. ID - 3455 ER - Masked uncontrolled hypertension (MUCH) is associated with an increased cardiovascular risk. This condition is frequent in the community pharmacy (i.e., CP-MUCH), but there is no evidence on the factors associated with its presence in that setting. The aim of this analysis was to explore these factors. A sample of 98 treated hypertensive patients from the MEPAFAR study, with normal community pharmacy blood pressure (CPBP <135/85mmHg), were analyzed. Blood pressure (BP) was also measured at home (4 days) and monitored for 24h. CP-MUCH was identified when either ambulatory (daytime) or home BP averages were equal to or higher than 135/85mmHg. A multivariate logistic regression analysis was carried out to identify the factors associated with CP-MUCH. The prevalence of CP-MUCH tends to be higher as systolic and diastolic CPBP increase, reaching 47% in patients with both systolic and diastolic CPBP equal to or higher than 123 mmHg and 79 mmHg, respectively. The multivariate regression analysis showed only systolic CPBP as an independent factor of CP-MUCH [>123mmHg: odds ratio=16.46 (P=0.012); from 115 to 122.9mmHg: odds ratio=10.74 (P=0.036); systolic CPBP <115mmHg as the reference]. Further assessment, using ambulatory and/or home BP monitoring, is recommended in patients with normal CPBP, but systolic CPBP equal to or higher than 115mmHg. A more feasible approach would be evaluating patients with systolic CPBP equal to or higher than 123mmHg and diastolic CPBP equal to or higher than 79mmHg. ID - 3456 ER - BACKGROUND: Population-based screening for atrial fibrillation (AF) is a promising public health strategy to prevent stroke. However, none of the published reports have evaluated comprehensive screening for additional stroke risk factors such as hypertension and diabetes in a pharmacy setting., METHODS: The Program for the Identification of 'Actionable' Atrial Fibrillation in the Pharmacy Setting (PIAAF-Pharmacy) screened individuals aged >=65 years, attending community pharmacies in Canada, who were not receiving oral anticoagulation (OAC). Participants were screened for AF using a hand-held ECG device, had blood pressure (BP) measured, and diabetes risk estimated using the Canadian Diabetes Risk Assessment Questionnaire (CANRISK) questionnaire. 'Actionable' AF was defined as unrecognised or undertreated AF. A 6-week follow-up visit with the family physician was suggested for participants with 'actionable' AF and a scheduled 3-month visit occurred at an AF clinic., RESULTS: During 6 months, 1145 participants were screened at 30 pharmacies. 'Actionable' AF was identified in 2.5% (95% CI 1.7 to 3.6; n=29); of these, 96% were newly diagnosed. Participants with 'actionable AF' had a mean age of 77.2+/-6.8 years, 58.6% were male and 93.1% had a CHA2DS2-VASc score >=2. A BP>140/90 was found in 54.9% (616/1122) of participants and 44.4% (214/492) were found to be at high risk of diabetes. At 3 months, only 17% of participants were started on OAC, 50% had improved BP and 71% had confirmatory diabetes testing., CONCLUSIONS: Integrated stroke screening identifies a high prevalence of individuals who could benefit from stroke prevention therapies but must be coupled with a defined care pathway. ID - 3457 ER - Background: Diabetes is the third most expensive physical health condition for US employers. Thus, there is a need for employers to engage in disease management programs for their diabetic employees in order to ensure long-term benefits. Objectives: To evaluate the clinical outcomes of successful implementation of an employer-initiated pharmacist-based disease management program for diabetic patients. Methods: This was a longitudinal retrospective study analyzing clinical indicators in diabetic employees after a community pharmacistDSbased diabetes disease management (DDM) program in a rural setting. The program involved comprehensive drug therapy assessment and individualized disease management education. Outcomes measured in this study were fasting serum glucose (FSG) levels, glycated hemoglobin (A1C) levels, diastolic blood pressure (DBP), systolic blood pressure (SBP), body mass index (BMI), and complete lipid profiles including high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), and total cholesterol (TC) levels. Results: A total of 137 patients were enrolled in this program. Significant improvement in mean clinical outcome scores was achieved for FSG (p = 0.004), DBP (p = 0.018), and SBP (p = 0.044). At the end of the 1-year intervention, targeted FSG and A1C goals were attained by 39.1% (p = 0.029) and 39.4% of patients, respectively. Also, targeted DBP, SBP, BMI, LDL, HDL, TG, and TC levels were achieved by 54.8% (p < 0.001), 38.5%, 38.3%, 56.8%, 38.2%, 37.5%, and 52.4% of patients, respectively. CONCLUSIONS: This study establishes a need for implementation of long-term employer-initiated pharmacist based DDM programs that improve clinical outcomes for employees. Further studies evaluating outcomes for a longer time period would provide more conclusive results. ID - 3458 ER - BACKGROUND: Blood pressure (BP) is poorly controlled among a large proportion of hypertensive outpatients. Innovative models of care are therefore needed to improve BP control. The Team-Based Care for improving Hypertension management (TBC-HTA) study aims to evaluate the effect of a team-based care (TBC) interprofessional intervention, involving nurses, community pharmacists and physicians, on BP control of hypertensive outpatients compared to usual care in routine clinical practice., METHODS/DESIGN: The TBC-HTA study is a pragmatic randomized controlled study with a 6-month follow-up which tests a TBC interprofessionnal intervention conducted among uncontrolled treated hypertensive outpatients in two ambulatory clinics and among seven nearby community pharmacies in Lausanne and Geneva, Switzerland. A total of 110 patients are being recruited and randomized to TBC (TBC: N=55) or usual care group (UC: N=55). Patients allocated to the TBC group receive the TBC intervention conducted by an interprofessional team, involving an ambulatory clinic nurse, a community pharmacist and a physician. A nurse and a community pharmacist meet patients every 6 weeks to measure BP, to assess lifestyle, to estimate medication adherence, and to provide education to the patient about disease, treatment and lifestyle. After each visit, the nurse and pharmacist write a summary report with recommendations related to medication adherence, lifestyle, and changes in therapy. The physician then adjusts antihypertensive therapy accordingly. Patients in the UC group receive usual routine care without sessions with a nurse and a pharmacist. The primary outcome is the difference in daytime ambulatory BP between TBC and UC patients at 6-month of follow-up. Secondary outcomes include patients' and healthcare professionals' satisfaction with the TBC intervention and BP control at 12 months (6 months after the end of the intervention)., DISCUSSION: This ongoing study aims to evaluate the effect of a newly developed team-based care intervention engaging different healthcare professionals on BP control in a primary care setting in Switzerland. The results will inform policymakers on implementable strategies for routine clinical practice., TRIAL REGISTRATION: ClinicalTrials.gov registration: NCT02511093 . Retrospectively registered on 28 July 2015. ID - 3459 ER - BACKGROUND: Community pharmacists (PHs) in England are increasingly providing a range of public health services. However, the general public view pharmacists as drug experts and not experts in health, and therefore, services may be underutilized. OBJECTIVES: To explore experiences and views of 4 groups of participants, the general public, PHs, general practitioners (GPs), and other stakeholders (STs) on pharmacy-based public health services, and identify potential factors affecting service use. METHODS: The study was undertaken in a locality of North West England. Three focus groups were conducted with the general public (n=16), grouped by socioeconomic status. Fourteen semistructured interviews were undertaken with PHs (n=9), GPs (n=2), and STs (n=3). Discussions/interviews were audio recorded, transcribed verbatim, and analyzed thematically. RESULTS: All 4 groups of participants agreed that community pharmacies are a good source of advice on medicines and minor ailments but were less supportive of public health services. Six factors were identified affecting utilization of pharmacy services: community pharmacy environment, pharmacist and support staff, service publicity, general public, GP services, and health care system and policies. Crucial obstacles that could inhibit service utilization are perceptions of both the general public and other health providers toward pharmacists' competencies, privacy and confidentiality in pharmacies, high dispensing workload, and inadequate financial support. Networking between local health professionals could enhance confidence in service delivery, general awareness, and thus utilization. CONCLUSIONS: Community pharmacy has the potential to deliver public health services, although the impact on public health may be limited. Addressing the factors identified could help to increase utilization and impact of pharmacy public health services.Copyright © 2014 Elsevier Inc. All rights reserved. ID - 3460 ER - OBJECTIVES: To explore the experience of and willingness to use seven pharmacy public health services related to cardiovascular risk among the general public in England. STUDY DESIGN: Mixed-methods study. METHODS: A mixed-methods study, involving a cross-sectional survey using multiple distribution methods followed by a focus group discussion (FGD) with a sample of survey respondents. RESULTS: From 3596 approachable individuals, 908 questionnaires were completed (response rate 25.3%). Few respondents (2.1-12.7%) had experienced any of the seven pharmacy public health services. About 40% stated they would be willing to use health check services, fewer (9.3-26.3%) were willing to use advisory services. More females, frequent pharmacy users and those in good health were willing to use services in general (P < 0.05). Smokers, overweight individuals and those with alcohol-related problems were most willing to use specific advisory services supporting their problems (P < 0.05). FGD identified barriers to service use; for example, frequent staff changes, seeing pharmacist as medicines suppliers and concerns about competence for these services. CONCLUSION: The general public are receptive to pharmacy public health services. Pharmacists must consider barriers if uptake of services is to increase.Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. ID - 3461 ER - We performed field testing of a previously described group education program for type 2 diabetes. HbA(1c) levels at start, 6 and 12 months were collected and demographic factors examined to identify predictors of long-term glycemic control on individual and group levels. "Glycemic success" comprised of (1) achieving target values of HbA(1c) < or =6.5% and/or (2) decreasing HbA(1c) progressively, depending on initial values. Groups in the field test and previous pilot-study (N=105) decreased their mean HbA(1c) significantly after 6 months, implying that diabetes mass education led by pharmacists could be possible in the future. Target HbA(1c) < or =6.5% was seen in 51% at start and 63% after 12 months (P=0.023). Initial HbA(1c) and BMI were the most important success predictors; age, sex, duration, and civil status showed no effects. Overweight individuals relapsed after initially decreasing their HbA(1c), emphasizing the need for long-term support in weight management. Experienced loneliness affected outcomes, indicating interaction between diet self-care and social relations. ID - 3462 ER - Few studies have demonstrated an effect of educational interventions on glycaemic control in persons with Type 2 diabetes longer than 3-6 months after baseline. We aimed to investigate the effectiveness of an experience-based group educational programme 24 months after baseline and to pinpoint mediators that might play a role in achieving desired metabolic outcomes. We conducted a randomised controlled trial inviting self-referred persons with Type 2 diabetes (N = 77 randomised). The pharmacist-led, year-long intervention was based on participants experiences of glucose regulation during the monthly group discussions. We measured HbA(1c) at 0, 6, 12, and 24 months and a questionnaire was administered at baseline and final follow-up. Our findings indicated that participating in the intervention programme significantly decreased HbA(1c) by 0.4% at 24 months after baseline. Initial HbA(1c), satisfaction with own diabetes-related knowledge, and treatment were found directly related to glycaemic outcomes. The intervention group exercised more in order to lower blood-glucose levels and was also more able to predict current blood-glucose levels before measuring it. Experience-based group education was effective in decreasing participants' HbA(1c), 1-year after completed intervention. Early effect of the intervention was followed by relapse after 12 months and a new, significant decrease at 24 months; this dual course implies that follow-up of educational interventions should involve several consecutive measurements to capture possible late effects. Both biomedical and subjective factors played a role in accounting for the variance of HbA(1c) at 2-year follow-up after baseline. (C) 2004 Elsevier Ireland Ltd. All rights reserved. ID - 3463 ER - We investigated the demographic, biomedical, and perceptional factors influencing HbA1c2 years after baseline in an educational program for persons with type 2 diabetes. Patients (N = 259) participated in a year-long group educational program led by specially trained pharmacists. There was a significant reduction of HbA1c2 (-0.15% unit;p < 0.05) on the group level after 24 months. Answers to open-ended questions on self-perceived role in diabetes management and occasions for testing blood glucose were analyzed qualitatively and used in a regression equation. Belonging to the "active" category of self-perceived role in diabetes management was associated with better outcomes compared to having a "passive" role. In addition, testing blood glucose levels for different purposes identified by the respondents was better than not to test blood glucose levels at all. The influence of these variables was striking; of the range of demographic and biomedical factors tested, only initial HbA1c2 and treatment entered the model. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract). ID - 3464 ER - OBJECTIVES: Rates of sexually transmitted infections (STIs) in UK young people remain high in men and women. However, the National Chlamydia Screening Programme has had limited success in reaching men. The authors explored the acceptability of various medical, recreational and sports venues as settings to access self-collected testing kits for STIs and HIV among men in the general population and those who participate in sport. METHODS: A stratified random probability survey of 411 (weighted n=632) men in Great Britain aged 18-35 years using computer-assisted personal and self-interviews. RESULTS: Young men engaged well with healthcare with 93.5% registered with, and 75.3% having seen, a general practitioner in the last year. 28.7% and 19.8% had previously screened for STIs and HIV, respectively. Willingness to access self-collected tests for STIs (85.1%) and HIV (86.9%) was high. The most acceptable pick-up points for testing kits were general practice 79.9%, GUM 66.8% and pharmacy 65.4%. There was a low acceptability of sport venues as pick-up points in men as a whole (11.7%), but this was greater among those who participated in sport (53.9%). CONCLUSIONS: Healthcare settings were the most acceptable places for accessing STI and HIV self-testing kits. Although young men frequently access general practice, currently little STI screening occurs in this setting. There is considerable potential to screen large numbers of men and find high rates of infection through screening in general practice. While non-clinical settings are acceptable to a minority of men, more research is needed to understand how these venues could be used most effectively. ID - 3465 ER - OBJECTIVE: The aim of this study was to assess the efficacy of a 12-month prevention program conducted in 42 community pharmacies in reducing the risk for diabetes. RESEARCH DESIGN AND METHODS: In a cluster-randomized controlled trial in 1,092 participants, mean change in the risk for diabetes (indicated by the Finnish Diabetes Risk Score [FINDRISC]) between intervention and control groups was calculated. In the intervention program GLICEMIA, three appointments with individual counseling and five educational group sessions were combined, whereas in the control group, only information about the participants' health was obtained in three assessments. RESULTS: After adjusting for cluster structure and differences in baseline characteristics, improvement in FINDRISC in the intervention group was 0.74 points (95% CI 0.42-1.04) above the control group. CONCLUSIONS: The GLICEMIA program shows the feasibility of a pharmacy-based intervention and leads to a significant modest reduction in diabetes risk score but does not reduce the rate of diabetes progression over 1 year.Copyright © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. ID - 3466 ER - BACKGROUND: Major changes in the roles and responsibilities of pharmacists across the world are occurring. A new Scottish Community Pharmacy contract was introduced in April 2006, following the introduction of a similar contract in England in 2005. This contract encourages greater involvement in medicines management and other clinical cognitive roles, whilst retaining a supply function. OBJECTIVE: To use a discrete choice experiment (DCE) to examine the strength of preference of community pharmacists for existing and potential new roles, prior to the introduction of the new contract. STUDY DESIGN: The DCE was a component of a larger questionnaire, which assessed demography, workload, attitudes to, and satisfaction with, proposed new roles, and current levels of activity. Attributes and levels for the DCE were based on the recent policy document for Scotland, The Right Medicine, and informed consensus, respectively. Scenarios were organised into pairs, and pharmacists were asked "Which job would you prefer?" The questionnaire was mailed to all pharmacists working in the community setting in Scotland (n = 1621), as identified from a telephone survey. The questionnaire was totally anonymous, and two reminders were sent. RESULTS: There was an overall response rate of 56.4% (914/1621). Community pharmacists preferred to work in an extended pharmacy team, to have strong integration with secondary care, and to provide a minor illness advice service. In 2003, they would forgo an annual income of 3443 pounds, 2183 pounds and 2798 pounds, respectively to achieve this. However, overall, the pharmacists preferred more income to less. Repeat dispensing, chronic disease management, offering health promotion services, and the number of prescriptions dispensed per month were not significant predictors of job choice. CONCLUSION: Community pharmacists placed the highest value on organisational aspects of their work, and having a first contact primary care role. Although total income was important, there were indications that they would be prepared to forgo income to attain their preferred job. ID - 3467 ER - Objective: This study aimed to examine involvement of pharmacy support staff in delivering services to drug misusers; to quantify their participation in related training; and to examine relationships between attitudes, practice experience and training. Methods: The setting was a random sample of 10% of UK community pharmacies (n = 1218) using a postal questionnaire with two reminders. Pharmacy managers were used as gate-keepers to access pharmacy support staff, which included dispensary technicians and medicines counter assistants. Key findings: Six hundred and ninety (56.7%) pharmacies responded, and 1976 completed questionnaires were returned from 610 (50.1%) pharmacies. A further 80 (6.6%) opted out. Three-fifths of staff had no input into decisions about whether their pharmacy provided services for drug misusers. One-third working in pharmacies that provide services were uncertain or negative about whether their pharmacy should do so. Staff were more involved in needle exchange (91%) and decisions to sell needles (95%) than supervising consumption of therapies (64%) or handing out dispensed medicines to drug misusers (73%), suggesting managers perceive needle exchange and sales as appropriate roles. Three-quarters of those working in pharmacies that provide services had not received any training to do so. Those who had undertaken training and who worked in pharmacies that provided services had significantly more positive attitudes compared to those had not undertaken training but also worked in pharmacies that provided services, or those who had undertaken training but did not provide services. Conclusions: Pharmacy support staff were involved extensively in drug-misuse services but the majority had not been trained to do so. Attitudes were more positive in those who were involved in service provision and had undertaken training. The findings suggest a need for more extensive training and for further exploration of the views of managers on appropriate roles, particularly the clinical versus supply nature of needle exchange. This is timely given the recent publication of guidelines by the National Institute of Health and Clinical Excellence (NICE) on needle exchange. © 2009 The Authors. ID - 3468 ER - To assure NHS Sheffield around the patient opinion and feedback to the service, pharmacies were required to ask patients to complete a questionnaire during the required post vaccination 10-minute observation period. 504 patients completed the anonymous questionnaire (Figure 3), which represented 87% of patients that received the seasonal flu vaccination, allowing confidence in the views and opinions given. ID - 3470 ER - US national elections, which draw sizable numbers of older voters, take place during flu-shot season and represent an untapped opportunity for large-scale delivery of vaccinations. In 2012, Vote & Vax deployed a total of 1585 clinics in 48 states; Washington, DC; Guam; Puerto Rico; and the US Virgin Islands. Approximately 934 clinics were located in pharmacies, and 651 were near polling places. Polling place clinics delivered significantly more vaccines than did pharmacies (5710 vs 3669). The delivery of vaccines was estimated at 9379, and approximately 45% of the recipients identified their race/ethnicity as African American or Hispanic. More than half of the White Vote & Vax recipients and more than two thirds of the non-White recipients were not regular flu shot recipients. ID - 3471 ER - AIM . To investigate a model of health promotion with regard to increasing drug users' access to dental health services.To compare referral rates between drug users and non drug users. DESIGN . Drug users and non drug users, attending community pharmacies had, their dental health reviewed by pharmacists and were referred if necessary for dental treatment. An audit trail was set up to monitor uptake of treatment by drug users. Satisfaction with service was measured using a self-completion questionnaire. SUBJECTS AND SETTING . 12 5 drug users, accessing methadone dispensing services or, sterile needles and syringes, and 129 non drug users accessing prescription dispensing services or health care advice services in community pharmacies. OUTCOME MEASURES . Referrals for treatment; uptake or referrals; satisfaction. RESULTS . For drug users, 44 (36.1.%) were referred to a dentist participating in the project, of whom 13.6% made an appointment. Only 27 (22.1%) did not require a referral, the remainder being referred to their own dentist or refusing treatment. With regard to non drug users, 63.8% did not require a referral to a dentist. Satisfaction with the service was high. CONCLUSIONS . Differences in need for referrals were noted between the two groups, with drug users in greater need of referral. The number of drug users making appointments to see a dentist in the study was small, but not unexpected considering drug users' fear of dental treatment and prior experiences of stigmatisation. This study shows that this model of health promotion can work in community pharmacy setting and could be extended to other groups of patients. ID - 3474 ER - AIM . To investigate (i) the feasibility and acceptability to pharmacists of a supervised self-administration of methadone service in community pharmacies in East London and City Health Authority and (ii) patient compliance. DESIGN . Collection of data on patient compliance and behaviour, and self-completion questionnaires for pharmacists at start and end of study period. SUBJECTS AND SETTING 9 Selected community pharmacists and methadone patients in City and East London Health Authority. OUTCOME MEASURES . Patient compliance and adherence to patient agreement within pharmacies, attitudes towards service provision before and after study period, contact with prescribers and police. RESULTS . There was a high level of compliance with prescribed supervised doses of methadone. Pharmacists reported few serious incidents. Contact with prescribers related mainly to prescription-related issues. Contact with police was minimal and did not change significantly after the introduction of the supervised administration of methadone service. Pharmacists had some concerns about support available to diem, and these were similar at the end of the study. Pharmacists became more positive about the contribution they could make to treatment. CONCLUSION . From the pharmacists' perspective, the supervised self-administration of methadone service was introduced to East London and City Health Authority in a relatively trouble-free manner. Pharmacists reported few problems with patients and compliance with supervised doses was high. ID - 3473 ER - AIMS: To describe the activities of service providers with regard to (i) the business operation and policies defining pharmacy-based needle exchange (PBNX) in South East England; (ii) the day-to-day work of PBNX outlets from the provider perspective; and (iii) problems encountered by PBNX providers. DESIGN: (i) Postal self-completion questionnaire to all participating PBNX community pharmacies in South East England; and (ii) postal self-completion questionnaire to needle exchange coordinators. SETTING: Community pharmacy needle exchanges. PARTICIPANTS: Pharmacists in charge of needle exchange; and needle exchange coordinators. FINDINGS: Data were collected (i) from 381/440 (86.7%) participating community pharmacists, and (ii) 32/36 (88.9%) of coordinators. The study found that PBNX was reaching injecting drug users (many of whom used PBNX regularly), and providing a wide range of injecting equipment. Although pharmacists reported that problems such as shoplifting occurred relatively frequently, more serious problems such as violence were relatively rare. However, PBNX pharmacists reported needing further training for themselves and their staff. Suggested improvements included better advertising of services and improving returns rates for used injecting equipment. CONCLUSION: Needle exchange can reasonably be provided by non-specialist health care professionals such as community pharmacists. However, attention should to be paid to the educational needs of service providers who also require adequate support. ID - 3472 ER - AIMS: In England, the role of community pharmacy in service provision to drug misusers was studied in 1995. Extensive involvement was identified, and considerable underused capacity was noted. This study explores these and potential new roles 10 years on. DESIGN: Cross-sectional national study. Postal survey (three mailshots), plus a fourth telephone follow-up using a structured questionnaire based on the 1995 questionnaire. SETTING: Community pharmacies in England. MEASUREMENTS: Involvement in opioid substitution therapy services (e.g. methadone, buprenorphine) and related activities. Attitudes towards service provision and novel services. FINDINGS: A 95% response rate was obtained. This was higher than in 1995, due largely to the use of a telephone follow-up. There had been an increase in the proportion providing substitution therapy dispensing services from 51% to 63% and in the average current case-load (from 5.9 to 9.2); and consequently a large increase in the numbers being treated (approximately x 1.9). Similarly, supervised consumption of methadone and buprenorphine was being provided more widely (increasing from 0 to 59% of all responding pharmacists). Attitudes towards existing roles were more positive than in 1995, and providers tended to be more positive than non-providers. For newer roles (e.g. supervise medications for comorbidity; provide hepatitis B vaccination), there was support from around one-quarter of respondents. CONCLUSION: Community pharmacy continues to play an important role in delivering treatment, including prescribing services, to drug misusers. There still appears to be untapped capacity, and moderate support for newer roles. ID - 3475 ER - Study Objective. To determine the effect of enhanced pharmacist care on cholesterol management in patients with and without diabetes mellitus., Methods. We conducted a planned subgroup analysis of the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP), a 54-center randomized trial of pharmacist intervention compared with usual care in patients at high risk for cardiovascular events. The patients involved had atherosclerotic disease or diabetes. We compared the effect of pharmacist intervention in patients with and without diabetes. The primary end point was a composite of performing a fasting cholesterol profile, or adding or increasing the dosage of a cholesterol-lowering drug. Secondary end points were individual components of the primary end point and change in 10-year risk for cardiovascular events, using the Framingham risk equation., Results. Of the 675 patients enrolled in the SCRIP study, 294 (44%) had diabetes. Enhanced pharmacist care had a more beneficial effect on cholesterol management in those with diabetes (odds ratio [OR] 4.8) than without diabetes (OR 2.1), p=0.01. Secondary end points showed similar trends, and reduction in Framingham risk was greater in patients with diabetes than without., Conclusion. Pharmacist intervention for dyslipidemia appears to have a greater impact in patients with diabetes. Results of this substudy suggest that pharmacists should target this patient group for interventions in cholesterol risk management. Pharmacotherapy ID - 3477 ER - The Study of Cardiovascular Risk Intervention by Pharmacists, a randomized, controlled trial in over 50 community pharmacies in Alberta and Saskatchewan, Canada, demonstrated that a pharmacist intervention program improved cholesterol risk management in patients at high risk for cardiovascular disease. In a substudy, costs and consequences were analyzed to describe the economic impact of the program. Two perspectives were taken: a government-funded health care system and a pharmacy manager. Costs were reported in 1999 Canadian dollars. Incremental costs to a government payor and community pharmacy manager were $6.40/patient and $21.76/patient, respectively, during the 4-month follow-up period. The community pharmacy manager had an initial investment of $683.50. The change in Framingham risk function for the intervention group from baseline also was reported. The 10-year risk of cardiovascular disease decreased from 17.3% to 16.4% (p<0.0001) during the 4 months. The intervention program in this study led to a significant reduction in cardiovascular risk in the intervention group during the 4-month follow-up period. The incremental cost to provide the program appeared minimal from both government and pharmacy manager perspectives. It is hoped that these results could support negotiations for reimbursement of clinical pharmacy services with payors. ID - 3476 ER - BACKGROUND: This cluster-randomised controlled trial determined the effectiveness of an evidence-based, pamphlet intervention in improving low back pain (LBP)-related beliefs among pharmacy consumers. METHODS: THIRTY FIVE COMMUNITY PHARMACIES WERE RANDOMISED TO THREE GROUPS: pamphlet+education intervention [n = 11]; pamphlet only intervention [n = 11]; control: usual care [n = 13]. Eligibility requirements for clusters included: community-based pharmacies and proprietor participation consent. Pharmacy consumers (N = 317) aged 18-65 years currently experiencing LBP participated. Intervention group allocation depended on the pharmacy attended. Individual-level outcomes were measured at pre-intervention (T0), at two (T1) and eight (T2) weeks post-intervention and included beliefs about LBP [Back Pain Beliefs Questionnaire (BBQ); Fear Avoidance Beliefs Questionnaire (FABQ)]. Secondary outcomes included pain severity, activity impairment and pamphlet perceived usefulness. Blinding to group allocation included primary investigators, outcome assessors and the statistician. Pharmacy staff and consumers were un-blinded. RESULTS: Of 35 pharmacies recruited (317 consumers), no clusters were lost to follow-up. Follow-up was available for n = 24 at 2 weeks only; n = 38 at 8 weeks only; n = 148 at both time points, with n = 148+24+38 = 210 analysed (107 excluded: no follow up). Adjusting for baseline scores demonstrated no significant differences in beliefs (2 or at 8 weeks) between pamphlet (with or without education) versus control, or between 'pamphlet with' versus 'without' education. Work-related fear (FABQ) was significantly lower in consumers receiving pamphlet (with or without education) versus control (difference -2.3, 95%CI: -4.4 to -0.2). There was no significant difference between "pamphlet with" versus "pamphlet without" groups. Consumers receiving the "pamphlet with" reported greater perceived usefulness than consumers receiving the "pamphlet without" (difference 0.9 (95%CI: 0.0 to 1.8)). CONCLUSION: Community pharmacies provided a feasible primary care portal for implementing evidence-based information. The associated improvement in work-related LBP-beliefs for consumers receiving the pamphlet suggests this simple intervention may be a useful component of care. TRIAL REGISTRATION: ACTR.org.au ACTRN12611000053921. ID - 3478 ER - OBJECTIVES: To determine which types of vaccine recommendations were accepted and acted upon by patients after an immunization check-up at a pharmacist-provided employee health screening, and to evaluate if there was a difference between influenza and non-influenza vaccines., DESIGN: Retrospective, observational., SETTING: Supermarket chain., PATIENTS: Employees and covered spouses., INTERVENTION: Immunization check-up., MAIN OUTCOME MEASURES: Acceptance rate of immunization recommendation., METHODS: This retrospective observational study evaluated the impact of an immunization check-up in individuals who participated in one of the 252 pharmacist-provided health screenings in central Virginia in 2015. All employee health screenings were completed from July 1, 2015, to September 30, 2015. Because immunization status was assessed 6 months after each person received his or her health screening, data were collected from January 1, 2016, to March 30, 2016, and analyzed to collect the number and type of vaccines recommended during the immunization check-up. Each eligible participant's profile was evaluated to determine if he or she received the vaccines at any Kroger pharmacy within 6 months. Patient identifiers were not collected; however, demographics including age, relevant disease state history, and smoking status were collected with immunization recommendations and uptake. Data were analyzed with the use of descriptive statistics., RESULTS: A total of 349 immunization recommendations were made, including 248 influenza; 42 pneumococcal polysaccharide (PPSV23); 40 tetanus, diphtheria, and pertussis (Tdap); 12 herpes zoster; 4 pneumococcal conjugate (PCV13); and 3 hepatitis B. Both influenza and PCV13 had acceptance rates of 50%, and herpes zoster, Tdap, hepatitis B, and PPSV23 had 42%, 35%, 33%, and 24% acceptance rates, respectively. Influenza recommendations had a 50% acceptance rate compared with a 32% acceptance rate of non-influenza recommendations (P = 0.002)., CONCLUSION: An immunization check-up performed at a pharmacist-provided employee health screening can lead to patient acceptance of recommendations and receipt of needed immunizations., Copyright © 2017 American Pharmacists Association. Published by Elsevier Inc. All rights reserved. ID - 3479 ER - Background To expedite diagnosis of serious bowel disease, efforts are required to signpost patients with high-risk symptoms to appropriate care. Community pharmacies are a recognized source of health advice regarding bowel symptoms. This study aimed to examine the effectiveness of a validated self-administered questionnaire, Jodi Lee Test (JLT), for detection, triage, and referral of bowel symptoms suggestive of carcinoma, in pharmacies. Method 'Usual Practice' was monitored for 12 weeks in 21 pharmacies in Western Australia, documenting outcomes for 84 clients presenting with bowel symptoms. Outcome measures were: acceptance of verbal advice from the pharmacist; general practitioner consultation; and diagnosis. Trial of the JLT involved staff training in the research protocol and monitoring of outcomes for 80 recruited clients over 20 weeks. Utility of the JLT was assessed by post-trial survey of pharmacy staff. Results Significantly more referrals were made by staff using the JLT than during Usual Practice: 30 (38%) vs 17 (20%). Clients' acceptance of referrals was also higher for the intervention group (40% vs 6%). Two-thirds of pharmacy staff agreed that the JLT could be incorporated into pharmacy practice, and 70% indicated they would use the JLT in the future. Conclusion A pre-post design was considered more appropriate than a randomized control trial due to an inability to match pharmacies. Limitations of this study were: lack of control over adherence to the study protocol by pharmacy staff; no direct measure of client feedback on the JLT; and loss to follow-up. The JLT was effective in prompting decision-making by pharmacy staff and inter-professional care between pharmacies and general practice, in triage of clients at risk of bowel cancer.; ID - 3480 ER - BACKGROUND: The involvement of community pharmacists in oral health promotion is being increasingly recognised and studied. However, a large proportion of interactions in community pharmacies take place with pharmacy counter assistants rather than the pharmacist, and the role of pharmacy counter assistants in oral health promotion has received little or no attention until now. AIMS: To clarify the current state of affairs on pharmacy counter assistants' involvement with oral health promotion. DESIGN AND METHODS: A postal-questionnaire-based survey of pharmacy counter assistants across East Yorkshire, North Lincolnshire and the Doncaster area. One hundred addresses were included and 35 responses were received. RESULTS: Pharmacy counter assistants are infrequently approached by the public for advice on matters of oral health and advice is not often volunteered despite a reasonable knowledge of the subject. Respondents identified a role for themselves in educating patients/customers, which they are keen to expand. CONCLUSIONS: The expansion of the pharmacy counter assistant's role in oral health promotion would be of value to patients/customers. This should include increased opportunistic education and a more integrated position of pharmacy within a holistic health promotion strategy. ID - 3481 ER - Introduction Poor oral health is a significant public health concern, costing the NHS in England 3.4 billion annually. Community pharmacies are easily accessible, frequently visited by patients and the community pharmacy contractual framework requires pharmacies to provide healthy living advice to patients - therefore offering a little explored avenue for the delivery of oral health interventions.Methodology A pilot oral health promotion intervention was introduced in five pharmacies in deprived areas of County Durham between September and December 2016. A mixed methods approach to the evaluation was performed, utilising a patient evaluation questionnaire and semi-structured qualitative interviews with pharmacy staff.Results One thousand and eighty-nine participants received the intervention. Following the intervention 72% of participants perceived their knowledge of oral health as much better, 66% definitely intended to change their oral health habits and 64% definitely thought a pharmacy was the right place to receive advice about oral health. Three themes emerged from the qualitative data: (1) intervention feedback, (2) knowledge gap and (3) service development.Discussion The data demonstrated the acceptability of patients to a community pharmacy based oral health intervention, with most patients reporting intentions to change their oral healthcare habits after receiving the intervention. Previous literature has identified a willingness of pharmacy staff to become involved with oral health; this study provides evidence that patients are also receptive to such services being delivered in the community pharmacy setting. Further work is required to assess the benefits of a community pharmacy based oral health intervention and the potential for further growth of this role.Conclusion A community pharmacy is perceived by patients as an acceptable provider of oral health interventions and has the potential to provide positive changes to the oral health of the population. ID - 3482 ER - BACKGROUND: Osteoporosis-associated fractures burden both individuals and the overall healthcare system. Bone mineral density (BMD) screening remains the gold standard measure for identifying patients at risk. OBJECTIVE: To determine the impact of convenient, pharmacist-led BMD screening and counseling sessions on identification and education of patients at risk for or with osteoporosis. METHODS: Nonpregnant persons >18 years of age were eligible for enrollment in this descriptive study. At an urban retail pharmacy, participants underwent risk factor assessment, peripheral BMD scanning, and personalized counseling. At 3 and 6 months after screening, subjects were questioned by telephone regarding any subsequent primary care provider (PCP) interactions, as well as any behaviors initiated and/or medications modified. RESULTS: Of the 102 subjects screened, 22.6% and 11.7% were identified as being at medium risk (T score -1.0 to -2.5) and high risk (T score -2.5 or less) for osteoporosis, respectively. By 6 months, 42.5% of the participants reported increasing their dietary intake of calcium, 29.3% began or increased calcium supplements, and 54.9% positively modified smoking status, exercise level, alcohol consumption, or caffeine intake. Additionally, 24 of 52 subjects who had discussed their results with a PCP by 6 months also received a treatment recommendation. Eighty-nine participants reported the community location increased their likelihood of receiving a BMD scan. CONCLUSIONS: Overall, pharmacist-led BMD screenings that include individualized counseling sessions appear convenient, accessible, and beneficial for patients. With the establishment of clinical benefit of and positive reception to such screenings, pharmacists can now look toward securing consistent reimbursement for this vital pharmaceutical care service. ID - 3483 ER - BACKGROUND: Older adults and persons with chronic conditions are at increased risk for pneumococcal disease. Severe pneumococcal disease represents a substantial humanistic and economic burden to society. Although pneumococcal vaccination (PPSV) can decrease risk for serious consequences, vaccination rates are suboptimal. As more people seek annual influenza vaccinations at community pharmacies, pharmacists have the ability to identify at-risk patients and provide PPSV. OBJECTIVES: The objective of this study was to evaluate the impact of pharmacists educating at-risk patients on the importance of receiving a pneumococcal vaccination. METHODS: Using de-identified claims from a large, national pharmacy chain, all patients who had received an influenza vaccination between August 1, 2010 and November 14, 2010 and who were eligible for PPSV were identified for the analysis. Based on the Advisory Committee on Immunization Practices recommendations, at-risk patients were identified as over 65 years of age or as aged 2-64 with a comorbid conditions. A benchmark medical and pharmacy claims database of commercial and Medicare health plan members was used to derive a PPSV vaccination rate typical of traditional care delivery to compare to pharmacy-based vaccination. Period incidence of PPSV was calculated and compared. RESULTS: Among the 1.3 million at-risk patients who were vaccinated by a pharmacist during the study period, 65,598 (4.88%) also received a pneumococcal vaccine. This vaccination rate was significantly higher than the benchmark rate of 2.90% (34,917/1,204,104; p<.001) representing traditional care. Patients aged 60-70 years had the highest vaccination rate (6.60%; 26,430/400,454) of any age group. CONCLUSIONS: Pharmacists were successful at identifying at-risk patients and providing additional immunization services. Concurrent immunization of PPSV with influenza vaccination by pharmacists has potential to improve PPSV coverage. These results support the expanding role of community pharmacists in the provision of wellness and prevention services.Copyright © 2011 Elsevier Ltd. All rights reserved. ID - 3484 ER - BACKGROUND: Screening for undiagnosed atrial fibrillation may lead to treatment with oral anticoagulation therapy, which can decrease the risk of ischemic stroke. The objective of this study was to conduct an economic evaluation of the Program for the Identification of 'Actionable' Atrial Fibrillation in the Pharmacy Setting (PIAAF-Pharmacy), which screened 1145 participants aged 65 years or more at 30 community pharmacies in Ontario and Alberta between October 2014 and April 2015., METHODS: We used a 2-part decision model to evaluate the short- and long-term costs and quality-adjusted life-years (QALYs) of a pharmacy screening program for atrial fibrillation compared to no screening. Data from the PIAAF-Pharmacy study were used for the short-term model, and the relevant literature was used to extrapolate the benefits of the PIAAF-Pharmacy study in the long-term model. Costs and QALYs were calculated from a payer perspective over a lifetime horizon and were discounted at 1.5%/year., RESULTS: Screening for atrial fibrillation in pharmacies was associated with higher costs ($26) and more QALYs (0.0035) compared to no screening, yielding an incremental cost per QALY gained of $7480. Univariate and probabilistic sensitivity analyses confirmed that screening for atrial fibrillation in a pharmacy setting was a cost-effective strategy., INTERPRETATION: Our results support screening for atrial fibrillation in Canadian pharmacies. Given this finding, efforts should be made by provincial governments and pharmacies to implement such programs in Canada. The addition of atrial fibrillation screening alongside screening and management of other cardiovascular conditions may help to reduce the burden of stroke.Copyright 2017, Joule Inc. or its licensors. ID - 3485 ER - OBJECTIVES: To determine whether pharmacy-based cardiovascular disease (CVD) screening reached the desired population, the local population's awareness of pharmacy screening and the views of service users and the general public about CVD screening. METHODS: Pharmacy staff, located in one English Primary Care Trust providing a CVD screening service, issued questionnaires to service users who had undergone screening. Face-to-face street surveys were conducted with members of the general public within the vicinity of each participating pharmacy. KEY FINDINGS: A total of 259 people were screened within the first 6 months of service provision, 97 of whom (37.4%) completed the evaluation questionnaire. In addition, 261 non-service users participated in street surveys. Most respondents among both service users and non-users had at least one risk factor for cardiovascular disease, including smoking and lack of exercise. Responses to statements regarding CVD screening showed a high level of agreement with the need for screening in both groups. However, significantly more service users (90.7%) agreed that a pharmacy was a good place for screening compared to the non-users (77.4%; P < 0.005). Likewise significantly fewer service users agreed that screening should be only carried out by doctors (10.3 compared to 25.3% of non-users; P < 0.005). The overall majority of service users 96 (99.7%) had a positive experience of the screening service, agreeing that they were given enough time and pharmacists made them feel at ease. Only 9% of non-users were aware of the pharmacy service and, although the majority (78.4%) were willing to be screened at a pharmacy, this was significantly lower among males than females (69.9 compared to 82.7%; P < 0.005). Perceived concerns about confidentiality and lack of privacy were among barriers identified to taking up screening. CONCLUSION: Pharmacy-based CVD screening is acceptable to the public. Its uptake could be improved through increased awareness of the service and by addressing concerns about privacy and confidentiality in promotional activities.Copyright © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society. ID - 3489 ER - UNLABELLED: Evaluation of a community pharmacy disease management program for type 2 diabetes, 'SugarCare', was conducted. Compared with the standard care offered by pharmacists, this enhanced program offered patients closer monitoring of blood glucose levels, counselling about lifestyle, etc. The SugarCare study was funded by a grant but if the care is to continue some other method of financing must be found. OBJECTIVES: This study aimed to measure consumer preference for one of the two types of care offered in the SugarCare study, the control/standard and the intervention/enhanced service; the strength of that preference; and participants' willingness to pay (WTP) for their preferred care. METHODS: SugarCare was a parallel groups, control versus intervention, repeated measures design conducted in three areas of NSW, Australia. Patients in the Intervention group (enhanced care) had one initial visit to the pharmacy with six follow up visits over approximately 9 months. At these visits blood glucose was downloaded and patient care issues addressed. At the end of the service, a survey instrument was mailed to the intervention and control participants who were asked to read it and then expect a telephone call within 2 weeks of receipt. Responses were requested over the phone and the survey instrument completed by the researcher. WTP data were collected using a modified payment card method. RESULTS: Overall, 44/75 (59%; 47%-70% 95%CI) respondents expressed a preference for Scenario B (the enhanced care) while 31/75 (41%; 31%-52% 95%CI) preferred Scenario A (standard care) however, the difference was not statistically significant. The median maximum WTP was AUD10 for the enhanced care and AUD3.50 for the standard care (p<0.03). CONCLUSIONS: While the WTP values expressed were significantly higher for the enhanced care they did not match with the cost providing that diabetes care. Discrete choice analysis has the potential to overcome some of the difficulties encountered with the contingent valuation technique used here. Further research is required before WTP values such as these could be used with confidence to determine funding policy. ID - 3488 ER - Objective To conduct an economic evaluation of a community pharmacy-delivered disease state management (DSM) service for type 2 diabetes mellitus. Setting The study was a parallel groups design, with control and intervention groups matched on demographic and diabetes-related characteristics, and was conducted in New South Wales, Australia. Three different settings were included — rural and metropolitan community pharmacy settings and hospital diabetes clinics. Method A cost-effectiveness analysis of the specialised service was conducted. The economic perspective adopted in the present analysis is that of the healthcare sector in general, taking into account the viewpoint of both the Commonwealth Government of Australia and the New South Wales State Government. Key findings Glycosylated haemoglobin (HbA1c) levels decreased by 0.46% (P = 0.02) in the intervention group compared with a change of 0.03% (P = 0.81) in the control group after 9 months. To obtain the 0.43% (95% confidence interval (CI) 0.34-0.52) reduction in HbA1c achieved by the specialised service, the cost to the healthcare sector was $A383 (Australian dollars; 95% CI $A46.16–717.46) per patient per 9 months. Conclusion This service has resulted in a significant reduction in HbA1c which should translate into improved health outcomes long term, since each 1% reduction in HbA1c has been associated with reductions in risk of 21% from any endpoint related to diabetes. Given the annual costs for the management of each patient with diabetes in Australia, the additional $A383 invested in the first 9 months of this service is likely to result in a saving to the healthcare system long term. ID - 3486 ER - ID - 3487 ER - This was a qualitative study to understand why pharmacists, asked to offer free chlamydia postal screening to Emergency Hormonal Contraception clients, had not offered screening to all eligible women. Twenty-six pharmacists completed exit interviews and 12 agreed to semi-structured in-depth interviews. Although pharmacists were keen to expand their services, they were reluctant to offer chlamydia screening to women who were married or in a long term relationship. To avoid offence they selected women based on age, education and ethnicity. The rationale for chlamydia screening in pharmacy-based EHC schemes is compromised if pharmacists do not offer screening comprehensively. ID - 3490 ER - OBJECTIVES: The UK 5 year antimicrobial resistance strategy recognizes the role of point-of-care diagnostics to identify where antimicrobials are required, as well as to assess the appropriateness of the diagnosis and treatment. A sore throat test-and-treat service was introduced in 35 community pharmacies across two localities in England during 2014-15., METHODS: Trained pharmacy staff assessed patients presenting with a sore throat using the Centor scoring system and patients meeting three or all four of the criteria were offered a throat swab test for Streptococcus pyogenes, Lancefield group A streptococci. Patients with a positive throat swab test were offered antibiotic treatment., RESULTS: Following screening by pharmacy staff, 149/367 (40.6%) patients were eligible for throat swab testing. Of these, only 36/149 (24.2%) were positive for group A streptococci. Antibiotics were supplied to 9.8% (n = 36/367) of all patients accessing the service. Just under half of patients that were not showing signs of a bacterial infection (60/123, 48.8%) would have gone to their general practitioner if the service had not been available., CONCLUSIONS: This study has shown that it is feasible to deliver a community-pharmacy-based screening and treatment service using point-of-care testing. This type of service has the potential to support the antimicrobial resistance agenda by reducing unnecessary antibiotic use and inappropriate antibiotic consumption.Copyright © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. ID - 3491 ER - OBJECTIVE: To evaluate the implementation of a lipid testing service across an entire market of a large chain pharmacy. DESIGN: Observational study using a validated satisfaction scale. SETTING: Nine Osco Drug pharmacies in Des Moines, Iowa. MAIN OUTCOME MEASURES: Number of patients choosing to participate in a fee-for-service lipid screening program, type of test chosen, effects of marketing on service volume, and patient satisfaction. RESULTS: A total of 159 screenings were performed in the 9 pharmacies. The majority of patients (79.7%) chose the more expensive fasting lipid profile, and service volume seemed to correspond to the number and intensity of marketing efforts. There was a trend toward increased patient satisfaction with the services represented by the Managing Therapy and Friendly Explanation dimensions addressed in the survey. CONCLUSION: Patients were willing to pay out-of-pocket for lipid screening. More efforts need to be devoted to marketing this service to create value for the customer and to establish it as a viable component of pharmacy business. ID - 3492 ER - OBJECTIVES: To (1) establish the extent of opportunities for members of the public to check their own blood pressure (BP) outside of healthcare consultations (BP self-screening), (2) investigate the reasons for and against hosting such a service and (3) ascertain how BP self-screening data are used in primary care., DESIGN: A mixed methods, cross-sectional study., SETTING: Primary care and community locations in Oxfordshire, UK., PARTICIPANTS: 325 sites were surveyed to identify where and in what form BP self-screening services were available. 23 semistructured interviews were then completed with current and potential hosts of BP self-screening services., RESULTS: 18/82 (22%) general practices offered BP self-screening and 68/110 (62%) pharmacies offered professional-led BP screening. There was no evidence of permanent BP self-screening activities in other community settings.Healthcare professionals, managers, community workers and leaders were interviewed. Those in primary care generally felt that practice-based BP self-screening was a beneficial activity that increased the attainment of performance targets although there was variation in its perceived usefulness for patient care. The pharmacists interviewed provided BP checking as a service to the community but were unable to develop self-screening services without a clear business plan. Among potential hosts, barriers to providing a BP self-screening service included a perceived lack of healthcare commissioner and public demand, and a weak-if any-link to their core objectives as an organisation., CONCLUSIONS: BP self-screening currently occurs in a minority of general practices. Any future development of community BP self-screening programmes will require (1) public promotion and (2) careful consideration of how best to support-and reward-the community hosts who currently perceive little if any benefit., Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/. ID - 3493 ER - OBJECTIVES: To evaluate health outcomes and acceptance of pharmacists' recommendations of travel health including prevalance of immunizations, sunburn, insect-borne diseases, traveler's diarrhea, and altitude sickness, and assess patient satisfaction with the pretravel health clinic. DESIGN: Retrospective cross-sectional study design. SETTING: Central Virginia, July 2011 to June 2012. PARTICIPANTS: Patients 18 years and older who had an appointment with the pharmacist for pretravel health. INTERVENTION: Interview/survey administered to patients by telephone. MAIN OUTCOME MEASURES: Health outcomes, acceptance rates of pharmacist's travel health recommendations, and patient satisfaction. RESULTS: Of 356 patients eligible to participate in the study, 103 patients participated, 30 patients declined, and 223 patients could not be reached by telephone (29% response rate). Pharmacists' recommendations for travel immunizations (100% acceptance rate for yellow fever and 82% for Typhoid) and nonpharmacologic preventive measures (prevention of sunburn, traveler's diarrhea, insect bites, and altitude sickness) were well accepted by respondents, and occurrence of these adverse events was low. Patients were satisfied overall with the education and services that the pharmacist delivered in the pretravel health clinic. CONCLUSION: Pharmacists providing services in pretravel health clinics can have substantial impact on the health of patients traveling internationally. ID - 3494 ER - BACKGROUND: Despite the cardiovascular disease (CVD) risk associated with hypertension, diabetes, dyslipidemia, and smoking, these risk factors remain poorly identified and controlled., OBJECTIVES: The study sought to evaluate the effectiveness of a community pharmacy-based case finding and intervention on cardiovascular risk., METHODS: The RxEACH (Alberta Vascular Risk Reduction Community Pharmacy Project) study was a randomized trial conducted in 56 community pharmacies. Participants were recruited by their pharmacist, who enrolled adults at high risk for CVD. Patients were randomized to usual care (usual pharmacist care with no specific intervention) or intervention, comprising a Medication Therapy Management review from their pharmacist and CVD risk assessment and education. Pharmacists prescribed medications and ordered laboratory tests as per their scope of practice to achieve treatment targets. Subjects received monthly follow-up visits for 3 months. The primary outcome was difference in change in estimated CVD risk between groups at 3 months. CVD risk was estimated using the greater of the Framingham, International, or United Kingdom Prospective Diabetes Study risk scores., RESULTS: We enrolled 723 patients (mean 62 years of age; 58% male, and 27% smokers). After adjusting for baseline values and center effect, there was a 21% difference in change in risk for CVD events (p < 0.001) between the intervention and usual care groups. The intervention group had greater improvements in low-density lipoprotein cholesterol (-0.2 mmol/l; p < 0.001), systolic blood pressure (-9.37 mm Hg; p < 0.001), glycosylated hemoglobin (-0.92%; p < 0.001), and smoking cessation (20.2%; p = 0.002)., CONCLUSIONS: The RxEACH study was the first large randomized trial of CVD risk reduction by community pharmacists, demonstrating a significant reduction in risk for CVD events. Engagement of community pharmacists with an expanded scope of practice could have significant public health implications. (The Alberta Vascular Risk Reduction Community Pharmacy Project: RxEACH [RxEACH]; NCT01979471)., Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ID - 3497 ER - BACKGROUND: Despite the risk associated with hypertension, diabetes, dyslipidemia, and smoking, these cardiovascular disease (CVD) risk factors remain poorly identified and controlled., OBJECTIVES: To evaluate the effectiveness of a community pharmacy-based case finding and intervention on cardiovascular risk., METHODS: RxEACH was a randomized trial conducted in 56 community pharmacies across Alberta, Canada. Participants were recruited by their pharmacist, enrolling adults at high risk for CVD: those with diabetes, chronic kidney disease, previous vascular disease and/or Framingham Risk > 20% with >1 uncontrolled risk factor (blood pressure, LDL-cholesterol (LDL-c), HbA1c, or smoking). Patients were randomized to intervention or usual care groups. Intervention group received a Medication Therapy Management review from their pharmacist with CVD risk assessment and education. Pharmacists prescribed medications and ordered laboratory tests as per their scope of practice to achieve treatment targets. Subjects received monthly follow-up visits for 3 months. Usual care group received usual pharmacist care with no specific intervention. Primary outcome was difference in change in estimated CVD risk between intervention and usual care groups at 3 months. CVD risk was estimated using the greater of Framingham, International Score, or United Kingdom Prospective Diabetes Study risk engines., RESULTS: We enrolled 723 patients. Mean age was 62 (standard deviation, SD 12) years, 58% male and 27% smokers. After adjusting for baseline values and center effect, there was a 21% difference in CVD risk (p<0.001) between intervention and usual care groups. Intervention group had greater reductions of 0.2 mmol/L in LDL-c (p<0.001), 9.37 mmHg systolic blood pressure (p<0.001), 0.92% HbA1c (p<0.001), and 20.2% in smoking cessation (p=0.002)., CONCLUSIONS: RxEACH was the first large randomized trial of CVD risk reduction by community pharmacists, demonstrating a significant reduction in the risk for CVD events. Engagement of community pharmacists with an expanded scope of practice could have significant public health implications.Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ID - 3498 ER - BACKGROUND: Despite clear evidence for the efficacy of lowering cholesterol levels, there is a deficiency in its real-world application. There is a need to explore alternative strategies to address this important public health problem. This study aimed to determine the effect of a program of community pharmacist intervention on the process of cholesterol risk management in patients at high risk for cardiovascular events. METHODS: A randomized controlled trial conducted in 54 community pharmacies (1998-2000) included patients at high risk for cardiovascular events (with atherosclerotic disease or diabetes mellitus with another risk factor). Patients randomized to pharmacist intervention received education and a brochure on risk factors, point-of-care cholesterol measurement, referral to their physician, and regular follow-up for 16 weeks. Pharmacists faxed a simple form to the primary care physician identifying risk factors and any suggestions. Usual care patients received the same brochure and general advice only, with minimal follow-up. The primary end point was a composite of performance of a fasting cholesterol panel by the physician or addition or increase in dose of cholesterol-lowering medication. RESULTS: The external monitoring committee recommended early study termination owing to benefit. Of the 675 patients enrolled, approximately 40% were women, and the average age was 64 years. The primary end point was reached in 57% of intervention patients vs 31% in usual care (odds ratio, 3.0; 95% confidence interval, 2.2-4.1; P<.001). CONCLUSIONS: A community-based intervention program improved the process of cholesterol management in high-risk patients. This program demonstrates the value of community pharmacists working in collaboration with patients and physicians. ID - 3495 ER - The purpose of this study was to access the effect of a community pharmacist intitiated management programme on cholesterol levels in patients at high risk of cardiovascular events. ID - 3496 ER - Objective The aim of this study was to explore pharmacist and medicine counter assistant (MCA) perceptions of community pharmacy management of patients pre- senting with symptomatic skin problems. Methods The study involved semi-structured telephone interviews with 10 phar- macists and 15 MCAs from seven pharmacies. Interviews focused on perceptions of their role in managing symptomatic skin problems and views on why people sought pharmacy advice and any barriers to management.Advice from the local ethics com- mittee was that approval was not required for the study. We analysed the interviews using the framework approach. Key finding Pharmacists identified two key themes that defined their role; triage and reassurance. In contrast, MCAs defined their role as information gatherers and independent advisors. Themes identified by both pharmacists and MCAs relating to the use of pharmacy as a source of advice were convenience, the perceived non- serious nature of conditions and inaccessibility of the GP. Additionally, MCAs believed familiarity with the pharmacist was important. Both pharmacists and MCAs identified their lack of dermatological knowledge as a barrier with pharma- cists reporting insufficient time to deal effectively with patients.MCAs identified the potential for misdiagnosis by pharmacists as another potential barrier. Conclusion Our findings suggest that the role of pharmacists and MCAs is comple- mentary; MCAs screen and provide the necessary information to pharmacists who then decide upon an appropriate course of action for the patient. Nevertheless, a major barrier to pharmacy-supported self-care of symptomatic skin problems is a perceived lack of knowledge and training in dermatology ID - 3499 ER - BACKGROUND: The majority of patients with psoriasis have mild to moderate disease which can be managed in primary care with topical therapies. The supportive role of pharmacists for patients with long-term dermatological conditions is largely unknown., OBJECTIVE: To assess the impact of an educational intervention delivered by community pharmacists to improve self-management for people with psoriasis., METHOD: The study involved a pre- and post-intervention design. Seven community pharmacies were selected based on their location (urban, rural etc.) and the pharmacists recruited via local comprehensive research networks. Patients with mild to moderate psoriasis were recruited either opportunistically or via a letter of invite by pharmacists who undertook a face-to-face consultation with one follow-up visit after 6 weeks. The primary outcome was the change in person-centred dermatology self-care index (PEDESI) score and secondary outcomes were the self-assessed psoriasis and severity index (SAPASI), measuring disease severity and the dermatology quality of life index (DLQI)., KEY FINDINGS: A total of 47 patients were recruited. At 6 weeks, 42/47 (89.3%) patients completed the follow-up consultation. There was a significant increase in mean PEDESI scores (25.15 versus 17.78, P < 0.001) at 6 weeks compared to baseline. Similarly, SAPASI (11.60 versus 7.74, P < 0.001) and DLQI (7.21 versus 4.14, P < 0.001) scores improved significantly., CONCLUSION: Pharmacist-assisted support for patients with psoriasis improved knowledge, reduced disease severity and the impact on quality of life. These results suggest that community pharmacists might have an important role to play in facilitating self-management for patients with psoriasis.Copyright © 2016 Royal Pharmaceutical Society. ID - 3500 ER - BACKGROUND: Preparatory work suggests that there may be a role for the pharmacist in managing sub-optimal medication adherence and dose titration of prescribed medicines in patients with type 2 diabetes. Patients have reported that they are receptive towards pharmacists becoming involved in their care providing that this is integrated into the care received from their medical practice. OBJECTIVE: To determine whether a community pharmacy diabetes drop-in clinic is feasible and acceptable to patients with poorly controlled type 2 diabetes. SETTING: Five community pharmacies in Norfolk, UK. METHOD: Poorly controlled patients, as defined by a national general practitioner incentive scheme, were invited to participate in the study by a letter posted by their medical practice. One 4-h, pharmacist clinic, where participants were able to "drop-in", was conducted in five pharmacies every week for 4-6 weeks. Questionnaires before and after the consultation were used to determine the clinic's effect on satisfaction with, and beliefs about, medicines and adherence along with participant satisfaction. Pharmacists had the opportunity to provide feedback via "debrief" interviews. MAIN OUTCOME MEASURE: As a feasibility study, a combination of outcomes were explored including information satisfaction and adherence. RESULTS: Thirty-three (9.6 %) of the 342 paients with type 2 diabetes posted letters were recruited from four pharmacies. Follow-up questionnaire completion rate was 88 %. The clinic demonstrated little change in the parameters measured over 3 months. All of the participants rated their general impression of the service as good or very good and all would be happy to recommend the service to others with diabetes. Sixteen participants (59 %) stated that it would make them more likely to consult their pharmacist in the future. Pharmacists enjoyed providing the service as it allowed them to interact more formally, and for longer, with patients. CONCLUSION: This research has demonstrated that a community pharmacy drop-in clinic is feasible and likely to be acceptable to both patients and pharmacists; however, cost effectiveness of such a service should be explored in future studies. ID - 3503 ER - BACKGROUND: The current UK government agenda is for community pharmacists to assume greater responsibility for medication management in patients with chronic conditions. This agenda may require a significant change in the way patients currently interact with their community pharmacist. OBJECTIVES: To explore the experiences and views of patients with type 2 diabetes regarding the current and proposed future role of community pharmacists. METHODS: This study used focus groups to collect experiences and views of patients with type 2 diabetes. A National Health Service (NHS) ethics committee approved this study. Pharmacists identified all patients with type 2 diabetes to whom they provided an information sheet and a consent form which included a request to supply basic demographic details. Focus group members were purposively sampled to gain a diverse range of opinions. Two researchers independently coded and thematically analyzed the transcripts. The researchers discussed the emergent themes to ensure all valid themes had been identified. RESULTS: Twenty-five participants attended one of 4 focus groups. Two broad themes were identified: the place of pharmacy in the wider primary care team and pharmacy as a healthcare destination. Participants who had been living with diabetes for a long time and those who felt they had received a lower level of care from the medical practice were more likely to acknowledge contributions of pharmacists in their care for advice on side effects, drug interactions and supply than participants with a good relationship with their general practitioner (GP) or practice nurse and whose diabetes was well controlled. CONCLUSIONS: Participants with type 2 diabetes identified a role for pharmacists in their care linked to their perceived expertise on medicines. However, the extent to which they would engage with the pharmacist depended on the quality of relationship with their GP or practice nurse.Copyright © 2013 Elsevier Inc. All rights reserved. ID - 3501 ER - Background Many patients with atrial fibrillation (AF) are asymptomatic and diagnosed via opportunistic screening. Community pharmacy has been advocated as a potential resource for opportunistic screening and lifestyle interventions. Objective The objective of this evaluation is to describe the outcomes from an AF service, in terms of referrals and interventions provided to patients identified as not at risk. Methods Eligibility was assessed from pharmacy records and the completion of a short questionnaire. Once consented, patients were screened for AF and their blood pressure was measured. Results Of 594 patients screened, nine were identified as at risk of having AF and were referred to their GP. The service also identified 109 patients with undiagnosed hypertension, 176 patients with a Body Mass Index >30, 131 with an Audit-C score >5 and 59 smokers. Pharmacists provided 413 interventions in 326 patients aimed at weight reduction (239), alcohol consumption (123) and smoking cessation (51). Conclusion This evaluation characterises the interventions provided to, not only those identified with the target condition-in this case AF-but also those without it. The true outcome of these additional interventions, along with appropriate follow-up, should be the focus of future studies. ID - 3504 ER - OBJECTIVES: To determine the demographics and risk results of patients accessing a community pharmacy diabetes risk assessment service. METHOD: Participating patients underwent an assessment using a validated questionnaire to determine their 10-year risk of developing type 2 diabetes. Patients were given appropriate lifestyle advice or referred to their general practitioner if necessary. KEY FINDINGS: In total, 21302 risk assessments were performed. Nearly one-third (29%) of 3427 risk assessments analysed yielded a result of moderate or high chance of developing the condition. CONCLUSIONS: Community pharmacies can identify a significant number of patients at risk of developing type 2 diabetes in the next 10 years. Further follow-up work needs to be done to determine the cost-effectiveness of such a service and the consequences of receiving a risk assessment.Copyright © 2014 The Authors. International Journal of Pharmacy Practice published by John Wiley & Sons Ltd on behalf of Royal Pharmaceutical Society. ID - 3502 ER - see full report http://www.cpwy.org/doc/916.pdf ID - 3505 ER - see full text: METHOD OF EVALUATION All data inputted on to PharmOutcomes was evaluated from 1st October September 2014 to January 31st 2015. Data was extracted into Excel and reported using descriptive statistics. The age of the patient entered into PharmOutcomes was used to determine whether the patient was categorised as under 65 or 65 and over. ID - 3506 ER - see full report link ID - 3508 ER - ID - 3507 ER - Setting Fifteen community pharmacies in the UK. Objective Proof of concept study to test the use of community pharmacies for active case finding of patients with coeliac disease. Methods Customers accessing over-the counter and prescription medicines indicated in the treatment of possible symptoms of coeliac disease over a 6 month period were offered a free point of care test. All patients were given advice regarding the test results and those who tested positive were advised to make an appointment with their general practitioner. Patients and pharmacists involved in service provision were asked to complete a satisfaction survey. Pharmacists were additionally invited to undertake interviews to better understand their views on the service. Main outcome measures Feasibility of service, acceptability to stakeholders and proportion testing positive for coeliac disease. Results Of the 551 individuals tested, 52 (9.4 %) tested positive. 277 (50.3 %) were tested for accessing irritable bowel syndrome treatment, 142 (25.8 %) due to presenting for diarrhoea. The proportion of patients testing positive with different symptoms or for different treatments were similar. Of 43 customers who returned the satisfaction survey, all would recommend the service to others, believing the community pharmacy to be a suitable location. Community pharmacists believed that it enabled them to improve relationships with their customers and that medical practices were receptive to the service. Conclusion This proof of concept study has shown that community pharmacies using a point of care test can effectively recognise and refer patients for confirmatory coeliac disease testing with high levels of customer and service provider satisfaction. ID - 3509 ER - From April 2015, community pharmacies in Forth Valley agreed to provide patients receiving opiate replacement therapy with a holistic Recovery Focussed Pharmaceutical package of care. Oral health was included within this service agreement and pharmacies agreed to “provide information and advice (with appropriate signposting) on oral health” to increase patients health outcomes and access to dental services under the Smile4life programme. Aim: To gain an understanding of how Smile4life interventions are delivered to ORT patients, within the Community Pharmacy setting, in Forth Valley ID - 3410 ER - Objective: Suboptimal adherence in chronic obstructive pulmonary disease (COPD) patients is associated with decreased clinical and economic outcomes. Intervention programs, targeted at patients with suboptimal adherence and exacerbations, offer opportunities for cost-effective COPD care. We have aimed to assess the effects of the Medication Monitoring and Optimization (MeMO) targeted COPD intervention.; Methods: Twenty community pharmacies participated in this 1 year real-world study with a pre-test/post-test design. Patients with a physician-confirmed COPD diagnosis, oral corticosteroid use, suboptimal adherence and Clinical COPD Questionnaire (CCQ) score ≥1 were selected by pharmacists. Pharmacy interventions included inhalation instruction, medication information and motivational interviewing regarding adherence and smoking cessation. Proposals for dose, medication and/or inhaler change and physical activity or diet recommendations were discussed with the general practitioner (GP), physiotherapist or dietician, when deemed relevant. Primary endpoint was the change in CCQ score. Secondary outcomes were adherence, exacerbations, healthcare utilization, quality of life (EQ-5D), modified Medical Research Council (mMRC) dyspnea score and cost-effectiveness.; Results: Interventions were performed in 88 patients (mean age: 69; 52% male; mean CCQ: 2.10). The most often performed interventions were inhalation instruction (89%), medication education (98%) and adherence counseling (58%). Respectively 9%, 45% and 16% were referred to GP, physiotherapist or dietician. After 1 year, mean CCQ decrement was 0.12 and 38% showed a clinically relevant improvement. There was a significant decrease in exacerbations (-0.82) per patient per year. Adherence, mMRC and EQ-5D hardly changed. Per patient, annual medication costs were €26 higher, interventions cost €33, but total healthcare costs were €333 lower. The small sample size and lack of a control group were the main limitations.; Conclusion: By specifically targeting COPD patients with potential room for improvement, the MeMO COPD program has the potential to be an effective and cost-saving method for preventing exacerbations. However, no effects on quality of life have been observed. Larger studies are therefore recommended.; ID - 3510 ER - AIM: This paper reports a study whose aims were (1) to examine whether it is possible to determine participants' self-management profiles using three open-ended questions about their self-perceived role in diabetes management; and (2) to analyse whether such self-management profiles have any bearing on haemoglobin A(1c) levels. BACKGROUND: The behavioural and educational aspects of self-management in type 2 diabetes have been the topic of a number of investigations. The individual's role in maintaining health and a satisfying everyday life with chronic conditions is increasingly becoming the focus of secondary prevention. METHOD: Participants (n = 259) were recruited from those attending a year-long health educational programme for people with type 2 diabetes at Swedish pharmacies. A questionnaire was distributed 24 months after baseline. The health outcome, haemoglobin A(1c) was measured on four occasions. Three open-ended questions were used to explore self-management profiles based on perceived role, goal, and need of support in treatment. Data were collected during the period 1997-2002. FINDINGS: The following profiles of participants emerged: Disease Manager, Compliant, and Disheartened, with no initial differences in metabolic control. However, during the programme Disease Managers achieved good glycaemic control and succeeded in maintaining the reduction in their blood glucose for a longer period than those in other categories: their haemoglobin A(1c) level was reduced by -0.35 at 6 months (P = 0.000), -0.30 at 12 months (P = 0.001), and -0.28 at 24 months (P = 0.001) after baseline. Compliant participants had a good everyday routine and a -0.18 reduction at 6 months (P = 0.028) but no statistically significant haemoglobin A(1c) level reduction later. A smaller group of people, the Disheartened, reported difficulties in living with diabetes and did not succeed in decreasing their haemoglobin A(1c) by statistically significant amounts. CONCLUSION: Healthcare professionals could use our three open-ended questions to assist in understanding people's views of their role in disease management so that health promotion and education can be tailored to individual needs. ID - 3511 ER - OBJECTIVE: To evaluate the effectiveness of community pharmacy-based interventions in increasing vaccination rates for the herpes zoster vaccine. DESIGN: Prospective intervention study with a pre-post design. SETTING: Three independent community pharmacies in Tennessee, from December 2007 to June 2008. PATIENTS: Patients whose pharmacy profiles indicated that they were eligible for the vaccine and patients presenting to receive the vaccine at study sites. INTERVENTION: Pharmacists promoted the herpes zoster vaccine through a press release published in local newspapers, a flyer accompanying each prescription dispensed at participating pharmacies, and a personalized letter mailed to patients whose pharmacy profiles indicated that they were eligible for the vaccine. MAIN OUTCOME MEASURES: Comparison of vaccination rates for the herpes zoster vaccine during the control and intervention periods and patients' indication for their sources of education and influence in receiving the vaccine. RESULTS: Vaccination rates increased from 0.37% (n = 59 of 16,121) during the control period to 1.20% (n = 193 of 16,062) during the intervention period ( P < 0.0001). Cochran-Armitage trend analyses, including the months before and after the interventions, confirmed a significantly higher vaccination rate during the intervention month than other months analyzed. More patients indicated that they were educated about the herpes zoster vaccine by one of the pharmacist-driven interventions than by a physician, family/friend, or other source during the intervention period ( P < 0.0001 for all comparisons). Also, more patients were influenced to receive the vaccination as a result of one of the pharmacist-driven interventions than influenced by a physician ( P = 0.0260) or other source ( P < 0.0001). No difference in the effectiveness of patient influence was found when the pharmacy interventions were compared with family/friends ( P = 0.1025). CONCLUSION: Three pharmacist-driven interventions were effective in increasing vaccination rates for the herpes zoster vaccine. ID - 3512 ER - OBJECTIVE: Influenza vaccination rates achieved by general medical practice on the Isle of Wight, England, have been consistently lower than regional and national averages despite practices pursuing an active programme of patient engagement. The objective of this work was to determine whether inclusion of community pharmacies in an influenza vaccination programme improves vaccination rates and is acceptable to patients. METHODS: The Isle of Wight Primary Care Trust commissioned a community pharmacy seasonal influenza vaccination service to augment that offered by general medical practice. Vaccination rates were monitored as well as determining patient perception of a pharmacy-based service by self-administered survey. KEY FINDINGS: Eighteen community pharmacies vaccinated 2837 patients and accounted for 9.7% of all patients vaccinated on the island. The pharmacy service contributed to improved patient vaccination rates in both the over- and under-65age groups and increased the number of patients receiving a vaccination for the first time. Pharmacies vaccinated proportionately more carers and frontline healthcare workers than medical practices. Patient satisfaction with the pharmacy-based service was high, with access seen as a major advantage over general medical practice. The pharmacy-based service also vaccinated patients that ordinarily would not have accessed medical services. CONCLUSIONS: Involvement of community pharmacies in the seasonal influenza vaccination programme can help increase vaccination rates and is associated with high levels of patient acceptability.Copyright © 2013 Royal Pharmaceutical Society. ID - 3513 ER - BACKGROUND: Prevention of infection with the blood-borne pathogens (BBPs) HIV and hepatitis B and C remains a major public health challenge. The aim of this study was to assess the activity, knowledge and attitudes of community pharmacists in Grampian in prevention of HIV and hepatitis B and C. METHOD: A questionnaire survey of community pharmacies was carried out in Grampian, a mixed urban-rural Health Board area in NE Scotland with a population of 532,432. RESULTS: Ninety-nine out of 128 (77 per cent) community pharmacies responded. Many pharmacies were providing services for drug misusers. Nearly all pharmacies stocked condoms, 57 pharmacists stated that they stocked extra-strong condoms, and two stocked dental dams. Two-thirds had leaflets relating to safer sex, HIV or hepatitis. Less than half stated that they had lists of local agencies dealing with drug-related or sexual health problems. Knowledge of the BBPs, and confidence in giving advice, were greater for HIV than for hepatitis B and C. Few were aware of recommendatons for hepatitis B vaccination. The majority felt that in the future pharmacists could have a greater role in prevention of these infections. Principal barriers to preventive activity were described as time pressure, lack of a private area and lack of training. CONCLUSIONS: There is untapped potential for community pharmacists to be a focus for advice and information relating to prevention of HIV and hepatitis B and C; however, resources are needed to address the current barriers identified field. ID - 3514 ER - Objective: Prevention of infection with blood-borne pathogens (BBPs) HIV and hepatitis B and C, remains a major public health challenge. The aim of this study was to assess the activity, knowledge and attitudes of community pharmacy assistants in Grampian in prevention of HIV and hepatitis B and C. Method: A cross-sectional postal questionnaire survey of community pharmacy assistants. Outcome measures were practice, knowledge and barriers to practice. Setting: Grampian, a mixed urban-rural health board area in North-East Scotland with a population of 532 432. Key findings: Forty out of 78 (51%) assistants responded. Many were based in pharmacies that provided services for drug misusers, and/or stocked condoms. Twenty-four assistants stated that the pharmacies stocked extra-strong condoms but none was aware of dental dams being stocked. Two-thirds had leaflets relating to safer sex, HIV or hepatitis. Twenty assistants were confident that they could give advice on safer sex. Knowledge of BBPs and the infectivity of hepatitis B was relatively low. Few assistants were aware of recommendations for hepatitis B vaccination. The majority felt that in the future pharmacy assistants could have a greater role in the prevention of these infections. Principal barriers to preventive activity were described as lack of a private area, lack of training and time pressure. Conclusions: Pharmacy assistants have the potential to be a focus for advice and simple information relating to prevention of HIV and hepatitis B and C. Resources are needed to address the current barriers identified. © 2006 The Authors. ID - 3515 ER - OBJECTIVE: To test the feasibility of offering rapid point-of-care human immunodeficiency virus (HIV) testing at community pharmacies and retail clinics. DESIGN: Pilot program to determine how to implement confidential HIV testing services in community pharmacies and retail clinics. SETTING: 21 community pharmacies and retail clinics serving urban and rural patients in the United States, from August 2011 to July 2013. PARTICIPANTS: 106 community pharmacy and retail clinic staff members. INTERVENTION: A model was developed to implement confidential HIV counseling and testing services using community pharmacy and retail clinic staff as certified testing providers, or through collaborations with organizations that provide HIV testing. Training materials were developed and sites selected that serve patients from urban and rural areas to pilot test the model. Each site established a relationship with its local health department for HIV testing policies, developed referral lists for confirmatory HIV testing/care, secured a CLIA Certificate of Waiver, and advertised the service. Staff were trained to perform a rapid point-of-care HIV test on oral fluid, and provide patients with confidential test results and information on HIV. Patients with a preliminary positive result were referred to a physician or health department for confirmatory testing and, if needed, HIV clinical care. MAIN OUTCOME MEASURES: Number of HIV tests completed and amount of time required to conduct testing. RESULTS: The 21 participating sites administered 1,540 HIV tests, with 1,087 conducted onsite by staff during regular working hours and 453 conducted at 37 different HIV testing events (e.g., local health fairs). The median amount of time required for pretest counseling/consent, waiting for test results, and posttest counseling was 4, 23, and 3 minutes, respectively. A majority of the sites (17) said they planned to continue HIV testing after the project period ended and would seek assistance or support from the local health department, a community-based organization, or an AIDS service organization. CONCLUSION: This pilot project established HIV testing in several community pharmacies and retail clinics to be a feasible model for offering rapid, point-of-care HIV testing. It also demonstrated the willingness and ability of staff at community pharmacies and retail clinics to provide confidential HIV testing to patients. Expanding this model to additional sites and evaluating its feasibility and effectiveness may serve unmet needs in urban and rural settings. ID - 3516 ER - BACKGROUND: Obesity has reached pandemic levels, with more than 1.5 billion adults being affected worldwide. In Scotland two-thirds of men and more than half of women are either overweight or obese, placing Scotland overall third behind the United States of America and Mexico. All community pharmacies in Scotland are contracted to provide public health services such as smoking cessation and there is increasing interest in their contribution to weight management. Researching this area in Scotland may provide valuable information to facilitate the development of community pharmacy services in other parts of the UK and internationally. OBJECTIVES: To describe the views of the Scottish general public on the provision of weight management services via community pharmacies. SETTING: General public in Scotland. METHODS: A cross-sectional postal questionnaire survey of 6,000 randomly selected members of the Scottish general public aged 18 years and over. MAIN OUTCOME MEASURES: Views on community pharmacy led weight management services. RESULTS: Questionnaires were returned by 20.6% (n = 1,236). Over half 60.1% (n = 751) agreed or strongly agreed that they had easy access to pharmacy services in general and around one-third agreed (35%; n = 438) that it was more convenient to obtain weight management advice from a pharmacist than it is to make an appointment with a GP. Most respondents however lacked awareness of the types of health services available through community pharmacy (13.2%; n = 162) and would not feel comfortable speaking to a pharmacist or medicines counter assistant about weight related issues (25%; n = 320). Concerns over privacy (47.3%; n = 592) and perceived lack of pharmacists' specialist knowledge (open comments) were identified as potential barriers to service uptake by the general public. CONCLUSION: Overall, respondents appear to be receptive to the idea of accessing weight management services through community pharmacy but a perceived lack of privacy, poor knowledge of pharmacists' skill level and of public health services available to them may explain the reluctance in the uptake of such services to date. The general public's views expressed in this study may help to shape future community pharmacy led weight management service provision. ID - 3517 ER - BACKGROUND: Obesity has reached pandemic levels with more than 1.4 billion adults affected worldwide. While there is a need to systematically develop and evaluate community pharmacy based models of weight management, it is imperative to describe and understand the perspectives of pharmacy staff. In the UK, trained and accredited community pharmacy medicines counter assistants (MCAs) are commonly the front line staff involved in patient consultations and sale of over-the-counter medicines. OBJECTIVE: To explore the beliefs and experiences of pharmacists and MCAs in the North-East of Scotland on community pharmacy weight management. SETTING: All 135 community pharmacies in the North-East of Scotland. METHOD: A qualitative approach of semi-structured telephone interviews with 31 pharmacists and 20 MCAs in the North-East of Scotland. The semi-structured interview schedule was developed with reference to key domains describing professional practice (i.e. awareness and knowledge, skills, practicalities, motivation, acceptance and beliefs) and contextualised with policy documents and published research on community pharmacy based weight management. Interviews were audio-recorded, transcribed and analysed thematically. MAIN OUTCOME MEASURE: Pharmacists' and MCAs' beliefs and experiences with delivering weight management services in community pharmacy. RESULTS: There were mixed responses from pharmacists and MCAs around pharmacy based weight management services from positive views of providing the service in community pharmacy to those more reticent who would always favour patients visiting their physician. While all described similar services e.g. measurement of weight, healthy eating advice, supply of products, they acknowledged that support was often opportunistic at the request of customers, with little integration of other providers. Roles described varied from pharmacist only functions to any staff member. While pharmacists generally felt comfortable and confident, MCAs gave more diverse responses. Both Pharmacist and MCAs highlighted the need for a practice model which is systematically developed and suggested a scheme akin to the successful smoking cessation 12-week nicotine replacement therapy service already available in community pharmacies in Scotland. CONCLUSION: Pharmacists and MCAs interviewed in this study reported their perceptions of benefits to providing community pharmacy based weight management as part of a wider public health function. They described services as opportunistic and customer driven based on ease of access. There was a notable variation in pharmacist and MCA training, reflected in their levels of comfort and confidence. There is a clear need to systematically develop and provide evidence of effectiveness and cost effectiveness for a pharmacy based practice model with key roles and functions for the full pharmacy team. ID - 3518 ER - Objectives: To explore users' views on increased availability of emergency contraception (EC) from two new providers of EC. Context: EC was previously available from general practitioners (GPs), Family Planning Centres, Accident and Emergency Departments and Brooke Advisory Centres. Recently, EC has also become available from pharmacies and Walk-in Centres (WiCs). Design: Qualitative study using in-depth interviews. Setting and Participants: Twenty-nine women from two (WiCs) and two pharmacies in Avon. Results: Women selected their provider on the basis of convenience and accessibility. WiC users valued the advice and personal nature of the contact with WiC nurses. Women who accessed EC from a pharmacy were amenable to answering questions to obtain EC but did not see this as a time to receive contraceptive advice. Women's attitudes to pharmacy supply of EC may be related to its associations as a place of business. Phrases such as over-the-counter may reinforce this notion, reflecting the business-like nature of the questioning and the impersonal nature of the interaction. While women considered the increased availability of EC to be generally positive, some had concerns about younger women accessing EC, particularly from a pharmacy. Conclusions: Women had a favourable view of their provider of EC, whether from a pharmacy or WiC. Concerns about pharmacy access may be related to its associations as a place of business where consumers have more power in the encounter. For some, this type of 'easier' access was considered inappropriate for younger users. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract). ID - 3519 ER - The purpose of this pilot study was to demonstrate that an ADA-recognised, diabetes self management training programme in a community pharmacy is effective at improving clinical and behavioural outcomes in patients with type 1 or type 2 diabetes mellitus. ID - 3520 ER - Objectives: To evaluate the impact of the RxVaccinate program on the structure, process, and outcome measures and to assess team leaders' perceptions of the program.; Design: Cluster-randomized experimental design.; Setting: Community pharmacies.; Participants: Community pharmacists.; Interventions: The RxVaccinate program consisted of (a) two self-directed training webinars and practice development and implementation tools and (b) expert and peer coaching sessions through an in-person 4-hour workshop and optional e-community and monthly teleconferences. One group received only the self-directed training (self-directed learning group), and the other group received both self-directed training and coaching sessions (coaching group).; Main Outcome Measures: Both groups provided data on (a) completion of structure and process indicators at 3, 6, and 9 months after the in-person workshop, (b) number of pneumococcal vaccinations administered in pharmacy during the 12-month period preceding and following the in-person coaching workshop, and (c) team leaders' perceptions of the RxVaccinate program.; Results: Greater proportions of pharmacies in the coaching group completed structure and process indicators than pharmacies in the self-directed learning group. Both groups showed an increase in the number of pneumococcal vaccinations administered (P < 0.001). The increase was significantly greater among pharmacies in the coaching group than among pharmacies in the self-directed training (P = 0.032). Team leaders in both groups were generally satisfied with the RxVaccinate program.; Conclusion: Although significant increases in the number of pharmacist-administered pneumococcal vaccinations were observed in both groups, the increase was greater in the group receiving both self-directed training and expert and peer coaching than the group without the coaching strategy. This could be because pharmacies in the coaching group were more likely to complete structure and process indicators than their counterparts. Future studies should examine key structure and process indicators affecting the success of pneumococcal vaccinations.; Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved. ID - 3521 ER - Background - This case study describes the evaluation of a primary care intervention in the Isle of Wight, United Kingdom, arising from the decision to move a medical practice from its town location into a new health centre in a nearby village. The new centre incorporated a new community pharmacy within the practice. Aim - To determine stakeholders' views on whether there was any perceived benefit resulting from the location of a pharmacy within the new health centre, over and above that of supply. Method - The evaluation explored both process and outcome features by means of self-completion questionnaires with patients and semi-structured interviews with health centre staff. The first phase of the study was undertaken prior to the medical practice move into the new health centre in July, 1996, and the second phase 12 months after the move. An interim report was used to influence change by making recommendations to the health authority to provide support and resources for the new pharmacist. Key findings - Prior to the move: three-quarters of medical practice patients surveyed expected to use the new pharmacy, and 55 per cent expected to receive a better service. The health centre staff and pharmacist were enthusiastic about the potential for service development in the pharmacy. The general practitioners (GPs) had the dearest ideas about possible additional services but there was no implementation strategy. Based on these findings, the evaluators made specific recommendations on action to be taken by the health authority. After the move: 88 per cent of patients surveyed had used the pharmacy and considered that the service was better. The perception was based on matters of convenience, Health centre staff and GPs considered that the pharmacy was providing services beyond supply and had raised awareness of prescribing issues. Conclusion - A pharmacy located within a health centre can, given appropriate support, enhance the pharmacist's contribution to primary health care over and above supply, and provide a mechanism for developing pharmaceutical support for the prescribing function. Evaluation can help to provide insight into ways of ensuring a more satisfactory outcome following organisational change. ID - 3522 ER - Objective: To evaluate the quality of oral anticoagulant monitoring by means of point-of-care testing in a community pharmacy, performed under the supervision of staff in a specialized hospital oral anticoagulation clinic. Methods: Participants consisted of patients receiving long-term warfarin therapy who were expected to require treatment for at least 3 months and who were patients of the hospital anticoagulation clinic or customers of the designated community pharmacy. The primary endpoint was the proportion of time for which international normalized ratio (INR) was within the expanded therapeutic range (within 0.2 INR units above or below the target therapeutic range) for 2 groups: patients who were managed through the community pharmacy and historical controls, whose treatment had been managed through oral anticoagulation clinics. Rates of thromboembolic and major hemorrhagic events and of patient satisfaction in the 2 groups were determined. Results: Nineteen patients were enrolled in this study and had their warfarin therapy managed by community pharmacists. The INR level was within the expanded therapeutic range 84% of the time (95% confidence interval [CI] 75% to 93%) for these patients and 82% of the time (95% CI 78% to 85%) for the historical controls managed through oral anticoagulation clinics (p = 0.58). No thromboembolic or bleeding events occurred in any of the 19 study participants. There was no difference between the groups in responses on patient satisfaction questionnaires. Conclusions: Community pharmacists using point-of-care testing under the supervision of staff in a hospital oral anticoagulation clinic provided warfarin management that was similar to warfarin management for historical controls attending oral anticoagulation clinics. The development of satellite anticoagulation clinics in community pharmacies may lead to a more individualized approach to therapy and eliminate the inconvenience of INR testing in hospital laboratories. Further studies of longer duration are required to determine whether community pharmacy management improves patient outcomes and is cost-effective. ID - 3523 ER - OBJECTIVES: To explore older people's opinions of current community pharmacy provision and identify potential areas for improvement. METHODS: A pilot focus group was conducted to finalise the topic areas for discussion. Three focus groups and three small group interviews were held with a total of 25 people aged over 65years. A purposive sampling approach was used to maximise variation in likely responses. All focus group discussions were transcribed and analysed for emerging themes. Data collection continued until saturation was reached. Finally, the themes were taken to a further five community groups to discuss and confirm the findings. KEY FINDINGS: Two main interlinked themes emerged around 'personal and relational factors' and 'service factors'. The participants valued continuity of personalised pharmaceutical care and described receiving this care in small community pharmacies. The ability to build a trusting relationship over time was important to the people in this study. There was a lack of awareness of services already available from community pharmacies. Ongoing disruption in the supply of medicines caused problems for this client group, and the complexity of prescription ordering, collection and delivery systems presented challenges for participants. Good communication from the community pharmacy helped to improve the experience. CONCLUSION: This study contributes some qualitative data on the opinions of older people about community pharmacies. There may be planning implications for the size of future community pharmacies and the range of services provided. Community pharmacies may need to take a more proactive role in promoting innovative services to older people who may benefit from these services.Copyright © 2014 Royal Pharmaceutical Society. ID - 3524 ER - OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is a progressive chronic condition that can be effectively managed by smoking-cessation, optimising prescribed therapy and providing treatment to prevent chest infections from causing hospitalisation. The government agenda in the UK is for community pharmacists to become involved in chronic disease management, and COPD is one area where they are ideally located to provide a comprehensive service. This study aims to evaluate the effect of a community pharmacy-based COPD service on patient outcomes. METHODS: Patients in one UK location were recruited over a 10-week period to receive a community pharmacy-based COPD support service consisting of signposting to or provision of smoking-cessation service, therapy optimisation and recommendation to obtain a rescue pack containing steroid and antibiotic to prevent hospitalisation as a result of chest infection. Data were collected over a 6-month period for all recruited patients. Appropriate clinical outcomes, patient reported medication adherence, quality of life and National Health Service (NHS) resource utilisation were measured. KEY FINDINGS: Three hundred six patients accessed the service. Data to enable comparison before and after intervention was available for 137 patients. Significant improvements in patient reported adherence, utilisation of rescue packs, quality of life and a reduction in routine general practitioner (GP) visits were identified. The intervention cost was estimated to be off-set by reductions in the use of other NHS services (GP and accident and emergency visits and hospital admissions). CONCLUSIONS: Results suggest that the service improved patient medicine taking behaviours and that it was cost-effective.Copyright © 2014 Community Pharmacy Futures. International Journal of Pharmacy Practice published by. John Wiley & Sons Ltd on behalf of Royal Pharmaceutical Society. ID - 3525 ER - OBJECTIVES: This study aims to pilot a community pharmacy chronic obstructive pulmonary disease (COPD) case finding service in England, estimating costs and effects. METHODS: Patients potentially at risk of COPD were screened with validated tools. Smoking cessation was offered to all smokers identified as potentially having undiagnosed COPD. Cost and effects of the service were estimated. KEY FINDINGS: Twenty-one community pharmacies screened 238 patients over 9 months. One hundred thirty-five patients were identified with potentially undiagnosed COPD; 88 were smokers. Smoking cessation initiation provided a project gain of 38.62 life years, 19.92 quality-adjusted life years and a cost saving of 392.67 per patient screened. CONCLUSIONS: COPD case finding by community pharmacists potentially provides cost-savings and improves quality of life.Copyright © 2014 The Authors. International Journal of Pharmacy Practice published by John Wiley & Sons Ltd on behalf of Royal Pharmaceutical Society. ID - 3526 ER - STUDY OBJECTIVE: To determine the effect of a community pharmacist intervention in patients at high risk for coronary heart disease on low-density lipoprotein cholesterol (LDL) levels 1 year after completion of the Second Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP- plus ). METHODS: Patients who completed the original study were invited to make a single return visit to their community pharmacy so that the pharmacist could measure their fasting LDL level using a point-of-care device. The primary outcome was change in LDL level from the 6-month (final) visit to the extended follow-up evaluation. RESULTS: Of the 359 patients who completed the original 6-month visit, data were collected for 162 (45%) patients. The mean +/- SD LDL level at completion of the original study was 107.9 +/- 33.6 mg/dl (2.79 +/- 0.96 mmol/L) (an increase of 2.7 mg/dl [0.07 mmol/L], 95% confidence interval -19.3-7.3 [-0.5-0.19]). Sixty-one (38%) patients were at the target LDL level (< 96.7 mg/dl [< 2.50 mmol/L]). CONCLUSION: The LDL reduction was maintained 1 year after completion of the extended follow-up. Since most patients were still not at the target LDL level, this finding suggests that continuing intervention is necessary to help patients reach this target. ID - 3527 ER - SUMMARY: This study evaluated the effect of a multifaceted intervention (screening and patient education) by community pharmacists on testing or treatment of osteoporosis. One hundred and twenty-nine patients randomized to receive the intervention were compared to 133 patients who did not receive the intervention. Twice as many patients who got the intervention received further testing or treatment for osteoporosis. INTRODUCTION: The objective of this study was to determine the effect of a community pharmacist screening program on testing and treatment of osteoporosis. METHODS: In this randomized, controlled trial, 262 patients meeting bone mineral density (BMD) testing guidelines [men or women aged > or = 65 years or 50-64 years with one major risk factor including previous fracture, family history of osteoporosis, glucocorticoids for > 3 months, or early menopause] were allocated to intervention (129) or control (133). Intervention consisted of printed materials, education, and quantitative ultrasound. Primary outcome was a composite endpoint of BMD or prescription for osteoporosis medication within 4 months. RESULTS: Primary endpoint of BMD or osteoporosis treatment was achieved by 28 intervention patients (22%) compared with 14 controls (11%) (RR 2.1, 95% CI 1.1-3.7). This was driven by BMD testing (28 (22%) vs. 13 (10%) for controls, p = 0.011). Calcium intake increased more among intervention patients than controls (30% vs. 19%, RR 1.6, 95% CI 1.0-2.5). There was no effect on knowledge or quality of life. CONCLUSION: A pharmacist screening program doubled the number of patients tested for osteoporosis. Nevertheless, many patients eligible for BMD did not receive appropriate care suggesting more intensive interventions are needed. ID - 3528 ER - In a randomized trial, we demonstrated that a community pharmacist osteoporosis screening intervention doubled the rates of bone mineral density (BMD) testing in high-risk patients. The purpose of this secondary analysis was to evaluate the potentially modifiable factors associated with BMD testing. From 2005 to 2007, 15 pharmacies randomized 262 patients to intervention (education, pamphlets, point-of-care quantitative heel ultrasound [QUS]) or usual care. The main outcome was BMD testing within 4mo. Multivariate regression was used to determine independent correlates of BMD testing. The median age of the cohort was 62yr, 65% were women, and 49% (n=129) were randomized to intervention. Compared with patients who were not tested, those with BMD were more likely to be women (p=0.007) and have excellent or very good health (p<0.001). Postrandomization correlates of BMD test were intervention (p=0.017), greater osteoporosis knowledge (p=0.004), and osteoporosis-specific physician visits (p<0.001). In adjusted analyses, only female sex (adjusted odds ratio [aOR]: 3.0; 95% confidence interval [CI]: 1.3-7.4) and osteoporosis-specific visits (aOR: 3.2; 95% CI: 1.4-7.8) were independently associated with BMD testing. In analyses restricted to intervention patients, abnormal QUS (aOR: 3.7, 95% CI: 1.4-9.1) was the only independent predictor of BMD test. Future interventions should incorporate the finding that osteoporosis-specific visits and abnormal QUS results were strongly associated with getting a BMD testing and should give greater attention to men.Copyright © 2012 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved. ID - 3529 ER - OBJECTIVE: This study examined the effect of a community pharmacy-based menopause education program on scores of the Management of Menopause (MoM) survey. The MoM survey is a tool administered to managed care organization members by the National Committee for Quality Assurance to determine the level of menopause-related education offered by their health care providers. The primary outcome was comparison of the median MoM survey scores of participants at baseline, 3 months, and 1 year posteducation. METHODS: Women aged 47 to 55 years who were able to provide informed consent were enrolled. Subjects completed a baseline MoM survey. Trained pharmacists working in 7 pharmacies conducted one-on-one education sessions regarding the consequences of menopause, treatment options, and the known risks and benefits of each option. Follow-up MoM surveys were administered by mail at 3 months and 1 year posteducation. The survey is scored on a 100-point scale for an overall composite score and includes 3 subsections: exposure, breadth, and personalization of counseling. RESULTS: A total of 31 subjects were enrolled, with 24 and 16 completing both baseline and 3-month or 1-year MoM follow-up surveys, respectively. Median 3-month composite MoM survey scores (86.1; 95% CI, 61.1-93.1) were significantly improved from baseline (54.2; 95% CI, 36.1-62.5; P<0.001). Scores on each subsection of the MoM survey also improved at 3 months, and median 1-year composite scores were significantly improved from baseline. (54.2 to 89, P = 0.001). Patient satisfaction with the education session was high, with a median satisfaction rating of 5 (a range of 4 to 5) on a 5-point satisfaction rating scale. CONCLUSION: A community pharmacy-based menopause education program significantly increased scores on the MoM survey, and subjects were satisfied with this program. ID - 3530 ER - OBJECTIVE: To evaluate the effectiveness of a community pharmacist-based home blood pressure (BP) monitoring program. DESIGN: Trial of a high-intensity (HI) versus low-intensity (LI) intervention randomized in 12 community pharmacies. The HI intervention comprised 4 face-to-face visits with a trained pharmacist. Pharmacists provided patient-specific education about hypertension. Following the first and third visits, patients were provided with a home BP monitoring device and instructed to measure their BP at least once daily for the next month. Home BP readings were used by the pharmacists to develop treatment recommendations for the patient's physician. Recommendations were discussed with the physician and, if approved, implemented by the pharmacist. In the LI intervention, pharmacists measured patients BP in the pharmacy and referred them to their physician for evaluation. PARTICIPANTS: Patients with uncontrolled BP at baseline. MEASUREMENTS: The main outcomes were the differences in systolic and diastolic BP (SBP and DBP) from baseline to follow-up between the HI and LI patients. RESULTS: The study enrolled 125 patients, 64 in the HI and 61 in the LI group. From baseline, SBP declined 13.4 mmHg in the HI group and 9.0 mmHg in the LI group. At the final visit, the difference in SBP/DBP change between the HI and LI group was -4.5/-3.2 mmHg (P=.12 for SBP and P=.03 for DBP). CONCLUSIONS: The HI intervention achieved a lower DBP and this model could be a strategy for patients with hypertension. ID - 3531 ER -