Dr Carissa Alderton

Purpose: Models for the diagnosis of obstructive sleep apnoea (OSA) are evolving in many countries to meet public demand. In Australia, the unregulated sleep industry does not provide a framework to govern or review emerging pathways in the community. The objectives of this study were to (1) describe current diagnostic pathways for OSA in Australia as reported by continuous positive airway pressure (CPAP) providers in community pharmacies and (2) obtain stakeholder feedback on pathways and identify potential areas for practice improvement. Methods: Semi-structured telephone interviews were conducted with pharmacy-based CPAP practitioners. Participants described diagnostic pathways used in their setting. Subsequently, an expert forum of stakeholders provided feedback on identified pathways during a focus group. Results: Twenty-two telephone interviews were conducted, identifying six key diagnostic pathways. Pathways varied in terms of the diagnostic test used, the practitioner who initiated or interpreted the test and who discussed results with the patient and made treatment recommendations. A nine-member stakeholder group raised medical, ethical and organisational concerns over certain pathways. Concerns included diagnostic tests initiated or interpreted in the absence of an appropriately trained medical practitioner and potential conflicts of interest for CPAP providers offering both diagnostic and treatment services. A best practice framework was proposed to guide practice and translate study findings. Preliminary practice recommendations were subsequently developed. Conclusions: Diagnostic models have evolved in Australia that raise stakeholder concerns. It is important to address these concerns while still facilitating patient access to services. Development of a practice framework could promote medically appropriate, patient-centred care.

Background: Pharmacists in Australia have pioneered an innovative role in providing obstructive sleep apnea (OSA) services in community pharmacies. A professional practice framework is yet to be established for this novel service area. Objectives: To explore the practices and experiences of Australian pharmacy staff providing OSA services. Method: Semi-structured telephone interviews were conducted using an interview guide to explore a priori areas of interest. Interviews were audio recorded, transcribed verbatim and thematically analyzed using a framework approach. Results: Interviews were completed with 22 practitioners from demographically diverse pharmacies. Key themes emerging from the interviews included motivation for providing the service, current practice frameworks, determinants for sustaining the service and future directions for the profession. Participants reflected on the professional satisfaction they derived from providing the service and being able to contribute to an important public health area. However, numerous impediments to service provision were discussed; these were broadly conceptualized as financial, professional, societal and geographical issues. Important practitioner needs were highlighted, including professional training opportunities and support. The need for a regulatory practice framework to ensure quality and uniformity of service provision within the profession was emphasized. Broader uptake of these services in the absence of such a framework was a key area of concern. Conclusions: This study showcases a novel area of pharmacy service provision. Innovative services need to be explored and defined before being consolidated into professionally recognized areas of practice. For OSA services in Australia, the next key step for the profession is to establish a professional practice framework to support current and future implementers of the service and ensure a minimum standard of care.

Background and objective Little is known about CPAP services offered in the Australian primary care pharmacy setting, despite the potential influence of service quality on patient adherence. The objective of this study was to provide an overview on a nationwide scale of the range and quality of CPAP and sleep apnoea-related services in Australian pharmacies. Methods A paper-based questionnaire was developed and mailed to all pharmacies in Australia that currently provide CPAP services (as identified by manufacturer's distributor lists or Internet search). A point system was devised to score participants on the quality of their CPAP service. Pharmacies were rated against a list of 23 criteria that were determined by consensus, with one point allocated for each criterion met, allowing for a maximum score of 23. Results The study response rate was 55% (110/199), and representation was obtained from all eight Australian states and territories. The mean number of criteria met (total score) for pharmacies was 15.7 ± 3.4 (15.7/23 = 68.3%; score range 2-22). Variability was evident in the range of services offered. Eighty-seven per cent of respondents believed that pharmacies supplying CPAP should adhere to a formalized set of professional guidelines. Conclusions The accessibility of pharmacies may make them a valuable venue for CPAP service provision. However, models of care to guide practice and standardize the variability in services are required. Implementation of such models could improve patient access to quality treatment in the primary care setting. This study is the first to survey the range and quality of CPAP-related services provided in Australian pharmacies. This report provides an overview of a potentially useful venue for the supply of CPAP devices and ongoing treatment support, and highlights areas of clinical practice improvement. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

Background: In Australia, certain pharmacies have undertaken a role in the management of the chronic sleep disorder, obstructive sleep apnea. The perspectives of pharmacy staff involved in this niche clinical service have never been formally collated on a national scale. The experiences of Australian pharmacies could provide a template for pharmacies in other health systems to adopt similar roles. Objective: To provide an overview of the perspectives of pharmacy staff involved in Continuous Positive Airway Pressure (CPAP) and sleep apnea-related services. Specifically, to describe clinical and structural elements, explore benefits and barriers, investigate viability, and gauge perspectives on future directions. Setting: Australian community pharmacies involved in CPAP and sleep apnea-related services. Method: Cross-sectional mail survey. A questionnaire designed to meet the study objectives was developed by the researchers and mailed to all pharmacies in Australia providing CPAP services during the period of study recruitment. Pharmacies were identified through the distributor lists of the major CPAP manufacturers and a comprehensive Internet search. Non-responders were contacted in two subsequent recruitment rounds. Main outcome measure: Self-reported sleep apnea service specifics. Results: A response rate of 55 % was achieved (n = 106 questionnaires valid for data entry). Benefits of providing a CPAP service included meeting patient and community needs, and professional satisfaction. Barriers included the cost of CPAP equipment to patients and lack of time. A majority of pharmacies (71 %) reported the service was financially viable despite most (63 %) not charging a 'fee for service.' Respondents expressed the view that CPAP provision should remain a specialist area of practice within the pharmacy profession. Key areas identified for improvement within the service were: (1) Staff training and knowledge (2) Promotion of the service and increasing public awareness (3) Infrastructure and expansion (4) Inter-professional collaboration and communication (5) Patient follow-up. Conclusion: The provision of CPAP and sleep apnea-related services can be a viable and rewarding experience for pharmacists. The role may need to remain a specialised area for those willing to invest significantly in the service - in time, staff, resources and finances. © 2014 Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie.

Aim: To explore the views of a sample of Australian hospital pharmacists on prescribing privileges. Method: The study involved a questionnaire and a focus group discussion for hospital pharmacists and teacher practitioners. Participants could participate in either or both of these activities. Results: 15 pharmacists completed the questionnaire and 8 participated in the focus group discussion. Several models of pharmacist prescribing (discharge and specialist settings) were seen to be appropriate and useful to Australian practice. 93% of pharmacists noted that prescribing privileges would enable them to provide more efficient/improved pharmaceutical care; 64% that prescribing would result in reduced healthcare costs; and all noted physician opposition as a barrier. Pharmacists indicated that they already prescribed on an 'unofficial' basis. Training and accreditation beyond registration was deemed necessary by all pharmacists. Conclusion: Hospital discharge or specialist settings may be most appropriate to pilot pharmacist prescribing in Australia. Further research on a larger scale is needed to provide a base of evidence before this practice is pursued.