A pharmacist could manage an estimated 8% of adult attendances at this A&E department. Efforts should be made to increase the awareness of the general public of the role of a community pharmacist to reduce demand on A&E and GP services.

DRPs account for 4% of attendances at a central London A & E Department.

With older and ageing populations, patients experience multiple chronic diseases at the same time. Individual chronic disease guidelines often recommend pharmacological therapies as a key intervention, resulting in patients being prescribed multiple regular medications for their different diseases. Whilst the term 'polypharmacy' has been applied to the use of multiple medications, there is no consistent definition and this term is now being used all inclusively. To improve both scientific rigor and optimal patient care, it is crucial that a standard terminology is used which reclassifies the term 'polypharmacy' into distinct phenotypes relating to the index chronic disease, additional conditions to the index ('comorbidity') or the experience of multiple chronic conditions at the same time (multimorbidity). Using three exemplar index conditions; heart failure, type 2 diabetes and breast cancer, we propose the reclassification of the term 'polypharmacy' into three distinct phenotypes. First, index drug or multi-index drug therapy, where each index condition creates multiple drug use for that condition; second, co-drug therapy, where addition of other comorbid conditions increases the multiple drug use and may influence the management of the index disease and third, multi drug therapy, where adult population with multimorbidity may be on many drugs. This paper reviews guidelines for the individual exemplars to develop the basis for the new terms and then develops the pharmaco-epidemiology of multiple drug use further by reviewing the evidence on the relationship between the phenotypic classification and important outcomes. The importance of standardising 'polypharmacy' terminology for the scientific agenda and clinical practice is that it relates to an index condition or disease safety outcomes including drug interactions, adverse side effects in hospital admissions and related 'polypill' concept.

Background:The benefits of clinical pharmacy services are established within hospital practice but staff numbers required for service delivery are not well described and staffing levels vary. The need for a consistent, objective method of determining staffing levels was recognised at a UK University Hospital and a Clinical Pharmacy Workforce Calculator (CPWC) was developed.Objective: To develop the Activity Standard (AS) for pharmaceutical care and establish the reliability of the CPWC across acute hospital settings in UK. Setting.Acute hospital in-patient clinical pharmacy services on medical and surgical wards. Method: Using the World Health Organisation's Workload Indicators of Staffing Need (WISN) methodology, a two-round Delphi study was undertaken. This developed the Activity Standard for pharmaceutical care and identified the staff-time unavailable for clinical work. Consenting panel members then tested the CPWC, calculating the staff required for three scenarios to determine whether it could be reliably used by different operators.Results: Thirty-six participants consented to participate. Data were returned from 22 (61%) of whom 20 (56%) supplied analysable data. Consensus was achieved on the tasks required for pharmaceutical care delivery, the mean time each takes, how frequently they should be completed and the time unavailable for clinical work for each grade of staff. The CPWC calculates staffing requirements using these data. Eleven participants (55%) tested the CPWC and analysis of responses demonstrated that 30 of 33 (91%) calculations were accurately completed.Discussion: This study defined the WISN Activity Standard for UK pharmaceutical care delivery to hospital inpatients and showed content validity for the CPWC in acute medical and surgical hospital settings. Different operators used the CPWC reliably and applied it to local sites. Conclusion:The CPWC offers hospital pharmacy managers a useful tool to negotiate adequate staffing to deliver pharmaceutical care. Its development methodology could be applied widely in pharmacy practice.

Tuberculosis is a communicable disease with public health implications and effective treatment is essential for control of the disease and prevention of the emergence of drug resistant strains. Drug therapy for this disease is well established and discussion now surrounds frequency of administration, duration of treatment and methods of improving compliance. Directly observed intermittent therapy of tuberculosis is supported by the World Health Authority and has become the standard of care in the U.S.A. Available dosage guidelines for directly observed therapy are only supported by limited data. A literature review of recent studies with clinical outcome measures was conducted. Following this review evidence based guidelines have been produced.