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Mifepristone (RU486) in Australian Pharmacies: The Ethical and Practical Challenges
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Abstracts / Research in Social and Administrative Pharmacy 10 (2014) e1–e64
Mifepristone (RU486) in Australian Pharmacies: The Ethical and Practical Challenges B. Chaar, R.Y. Lee, R. Moles, Faculty of Pharmacy at the University of Sydney, NSW, Australia The recent legislation of mifepristone, commonly known as RU486, has given women a new option for termination of pregnancy in Australia. Australian pharmacists are well positioned to supply mifepristone to patients, however, there are ethical and legal complexities regarding the abortefacient. For example, pharmacists may choose to conscientiously object to supplying mifepristone due to personal beliefs. Pharmacists are also subject to differing abortion laws between states and territories in Australia. The objective of this study was to explore Australian pharmacists’ attitudes towards and knowledge about mifepristone. Method: A purposively designed interview protocol was utilised to conduct semi-structured interviews with registered pharmacists working in a pharmacy listed in the Pharmacy Board’s Register of Pharmacies. Interviews were conducted until data saturation, de-identified and transcribed verbatim. Data were thematically analysed using a framework approach for applied policy research and categorised into the themes: contextual, diagnostic, evaluative and strategic. Results: Forty community pharmacists, one hospital pharmacist, representatives from the sole importer/ supplier of mifepristone in Australia [Marie Stopes International Australia], and Family Planning [New South Wales Health Dept] were interviewed. Transcripts were analysed and categorised into four main themes: (1) pharmacists’ contextual view on pregnancy termination, the role of the pharmacist and impact on the workplace, (2) diagnostic reasons for differing views, (3) evaluation of actual and perceived pharmacy practice in relation to the supply of mifepristone and (4) strategies to improve pharmacists’ services, awareness and education. Australian pharmacists in this study perceived themselves to have a potentially important role in medical termination of pregnancy. However, there was a general lack of clinical, ethical and legal knowledge about medical termination of pregnancy and its legislation. Conclusion: This study clearly highlighted that there is a need for pharmacist-specific training, guidelines and discussion within the profession to raise awareness regarding professional
More than respect, role definition and resources: the underlying facilitators to collaborative relationships in health care S.Z. Bosnic-Anticevich, B. Cvetkovski, C.L. Armour This research explores the role of pharmacists working in multidisciplinary teams, describe the nature of their professional relationship and critical factors driving a
change from isolated practice to collaborative relationships. Methods: For the purpose of this study, we focused on the most successful of clinical teams: oncology teams. A qualitative grounded theory research approach was employed. A semi-structured interview guide was developed aiming to comprehensively explore the evolution of professional relationships. Telephone interviews were conducted with oncology pharmacist. Interviews were audiotaped and transcribed verbatim. Content analysis was performed. First level coding was performed and concepts were identified from these interview transcripts by the researchers independently and later grouped into categories by agreement (SBA and BC). Selective, secondary coding then occurred as themes emerged from the conceptual categories. Results: A total of 15 (7 male) oncology pharmacists, from rural and metropolitan hospitals in Australia participated in the study. Data saturation occurred after the tenth interview. Participants had been working in oncology pharmacy for a median of 9 years. Most participants were exclusively located in the oncology ward; a small subgroup were in regional hospitals and were required to also undertake other roles within the pharmacy department. Participants shared many similarities with regards to their job descriptions and inclusion in oncology teams. The pharmacists described their role in the team as the recognized medication expert. Unlike other studies in this field of research, this study identified the importance of a process of evolution within professional relationships and the importance of altruism, clinical needs, immediacy of problem solving capacity, intradisciplinary support and the patient in enabling the professional relationship to develop. Conclusions: Despite the abundance of data in the area of collaborative relationships, the failure to implement collaborative care in the primary care setting may be due to the current lack of acknowledgement of the more fundamental aspects of professional relationships and the failure to recognise the role of the patient in interprofessional relationship building.
My Medicines and Me Questionnaire (M3Q): A novel tool for the assessment of subjective experiences of side effects in mental health consumers D.M. Ashoorian1, D.M. Rowan2, D.J. Rock3, R.M. Clifford1, 1The University of Western Australia, Perth, Australia, 2Health Department of Western Australia, Perth, Australia, 3North Metropolitan Health ServicesMental Health, Perth, Australia To assess the suitability of using the M3Q as a selfreported questionnaire for mental health consumers to express the range and subjective experience of side effects associated with their psychotropic medications. Methods: Following ethics approval, questionnaires were administered amongst six adult mental health clinics, from March to April 2013. The M3Q had been
Abstracts / Research in Social and Administrative Pharmacy 10 (2014) e1–e64
Mifepristone (RU486) in Australian Pharmacies: The Ethical and Practical Challenges B. Chaar, R.Y. Lee, R. Moles, Faculty of Pharmacy at the University of Sydney, NSW, Australia The recent legislation of mifepristone, commonly known as RU486, has given women a new option for termination of pregnancy in Australia. Australian pharmacists are well positioned to supply mifepristone to patients, however, there are ethical and legal complexities regarding the abortefacient. For example, pharmacists may choose to conscientiously object to supplying mifepristone due to personal beliefs. Pharmacists are also subject to differing abortion laws between states and territories in Australia. The objective of this study was to explore Australian pharmacists’ attitudes towards and knowledge about mifepristone. Method: A purposively designed interview protocol was utilised to conduct semi-structured interviews with registered pharmacists working in a pharmacy listed in the Pharmacy Board’s Register of Pharmacies. Interviews were conducted until data saturation, de-identified and transcribed verbatim. Data were thematically analysed using a framework approach for applied policy research and categorised into the themes: contextual, diagnostic, evaluative and strategic. Results: Forty community pharmacists, one hospital pharmacist, representatives from the sole importer/ supplier of mifepristone in Australia [Marie Stopes International Australia], and Family Planning [New South Wales Health Dept] were interviewed. Transcripts were analysed and categorised into four main themes: (1) pharmacists’ contextual view on pregnancy termination, the role of the pharmacist and impact on the workplace, (2) diagnostic reasons for differing views, (3) evaluation of actual and perceived pharmacy practice in relation to the supply of mifepristone and (4) strategies to improve pharmacists’ services, awareness and education. Australian pharmacists in this study perceived themselves to have a potentially important role in medical termination of pregnancy. However, there was a general lack of clinical, ethical and legal knowledge about medical termination of pregnancy and its legislation. Conclusion: This study clearly highlighted that there is a need for pharmacist-specific training, guidelines and discussion within the profession to raise awareness regarding professional
More than respect, role definition and resources: the underlying facilitators to collaborative relationships in health care S.Z. Bosnic-Anticevich, B. Cvetkovski, C.L. Armour This research explores the role of pharmacists working in multidisciplinary teams, describe the nature of their professional relationship and critical factors driving a
change from isolated practice to collaborative relationships. Methods: For the purpose of this study, we focused on the most successful of clinical teams: oncology teams. A qualitative grounded theory research approach was employed. A semi-structured interview guide was developed aiming to comprehensively explore the evolution of professional relationships. Telephone interviews were conducted with oncology pharmacist. Interviews were audiotaped and transcribed verbatim. Content analysis was performed. First level coding was performed and concepts were identified from these interview transcripts by the researchers independently and later grouped into categories by agreement (SBA and BC). Selective, secondary coding then occurred as themes emerged from the conceptual categories. Results: A total of 15 (7 male) oncology pharmacists, from rural and metropolitan hospitals in Australia participated in the study. Data saturation occurred after the tenth interview. Participants had been working in oncology pharmacy for a median of 9 years. Most participants were exclusively located in the oncology ward; a small subgroup were in regional hospitals and were required to also undertake other roles within the pharmacy department. Participants shared many similarities with regards to their job descriptions and inclusion in oncology teams. The pharmacists described their role in the team as the recognized medication expert. Unlike other studies in this field of research, this study identified the importance of a process of evolution within professional relationships and the importance of altruism, clinical needs, immediacy of problem solving capacity, intradisciplinary support and the patient in enabling the professional relationship to develop. Conclusions: Despite the abundance of data in the area of collaborative relationships, the failure to implement collaborative care in the primary care setting may be due to the current lack of acknowledgement of the more fundamental aspects of professional relationships and the failure to recognise the role of the patient in interprofessional relationship building.
My Medicines and Me Questionnaire (M3Q): A novel tool for the assessment of subjective experiences of side effects in mental health consumers D.M. Ashoorian1, D.M. Rowan2, D.J. Rock3, R.M. Clifford1, 1The University of Western Australia, Perth, Australia, 2Health Department of Western Australia, Perth, Australia, 3North Metropolitan Health ServicesMental Health, Perth, Australia To assess the suitability of using the M3Q as a selfreported questionnaire for mental health consumers to express the range and subjective experience of side effects associated with their psychotropic medications. Methods: Following ethics approval, questionnaires were administered amongst six adult mental health clinics, from March to April 2013. The M3Q had been