ObjectiveTo use data from the UK electronic transmission of prescriptions (ETP) pilot to examine how and why choice and use of pharmacy services differ between patients, and how introduction of new services might impact on patient choice. MethodPatients were invited to participate in the ETP pilot in three consortia across the UK. A postal questionnaire was distributed to 276 participating patients, and 211 (76%) were returned. Questionnaires were also completed by 64 patients who had actively chosen not to take part in the ETP pilot. Semi-structured telephone interviews were conducted with 26 questionnaire respondents who had opted to use a mail order pharmacy participating in ETP. Key findings54% of patients participating in ETP could have their prescription collected by pharmacy staff, but only half of these (52%) had made use of the service. Patients found it convenient to collect the prescription themselves (35%) and/or preferred to collect it themselves (34%). These patients were however still happy to use the new service offered by ETP. Reasons for using the same pharmacy centred on practical aspects, such as proximity to the GP practice (65%) and short waiting times (27%). Patients also positively rated their experiences of obtaining their prescription from their GP practice (80%) and the medication from their pharmacy (82%). Patients who were offered both ETP and mail order pharmacy but chose not to participate (nˆ31) were more opposed to the mail order aspect than to ETP (70% vs 14% respectively). Patients not participating who were offered ETP without mail order pharmacy (nˆ33) most frequently stated that they found the current system to be convenient (23%). Interviewees using the mail order pharmacy found not having to visit either the GP practice or pharmacy to be convenient and a repeat prescription reminder service to be advantageous. Conclusion

BackgroundAlthough funding has supported the scale up of routine, opt-out HIV testing in the US, variance in implementation mechanisms and barriers in high-burden jurisdictions remains unknown.MethodsWe conducted a survey of health care organizations in Washington, DC and Houston/Harris County to determine number of HIV tests completed in 2011, policy and practices associated with HIV testing, funding mechanisms, and reported barriers to testing in each jurisdiction and to compare results between jurisdictions.ResultsIn 2012, 43 Houston and 35 DC HIV-testing organizations participated in the survey. Participants represented 85% of Department of Health-supported testers in DC and 90% of Department of Health-supported testers in Houston. The median number of tests per organization was 568 in DC and 1045 in Houston. Approximately 50% of organizations in both DC and Houston exclusively used opt-in consent and most conducted both pre- and post-test counseling with HIV testing (80% of organizations in DC, 70% in Houston). While the most frequent source of funding in DC was the Department of Health, Houston organizations primarily billed the patient or third-party payers. Barriers to testing most often reported were lack of funding, followed by patient discomfort/refusal with more barriers reported in DC.ConclusionsGiven unique policies, resources and programmatic contexts, DC and Houston have taken different approaches to support routine testing. Many organizations in both cities reported opt-in consent approaches and pre-test counseling, suggesting 2006 national HIV testing recommendations are not being followed consistently. Addressing the barriers to testing identified in each jurisdiction may improve expansion of testing.

Context: Nationally, the child lead poisoning prevention strategy focuses on children in low-income communities living in old housing with lead paint. In Alaska, however, only about 3% of existing homes were built before 1950 and 38% were built during 1950-1979. As such, lead paint in old housing is a less frequent source of exposure for Alaska children with elevated blood lead levels (EBLLs). Program: The Alaska Department of Health and Social Services collects and maintains data for all blood lead level (BLL) tests in the state and is responsible for following up on EBLLs. Implementation: The Alaska Department of Health and Social Services conducts telephone interviews with parents of children with an EBLL to identify and remove possible sources of lead from the child's environment and prevent subsequent exposure. Evaluation: This review summarizes the surveillance data on BLLs in Alaska children for 2011-2015 and describes the most commonly identified possible sources of childhood lead exposure statewide since 2011. Discussion: While the proportion of children in Alaska who received a BLL test during these years is low compared with other states and EBLL prevalence is low among children tested, several possible sources of exposure were identified among children with EBLLs, including nonpaint sources. This report summarizes the challenges of combatting childhood lead exposure in a rural state where housing is a less common exposure source and describes ongoing work to prevent childhood lead exposure in Alaska.

Focal points Advice is given to almost one fifth of pharmacy customers presenting National Health Service prescriptions Pharmacy staff offer advice more frequently than patients request advice There is substantial variation in levels of advice giving between individual pharmacies Patients using prescription collection services are less likely to receive advice compared with those customers presenting their own prescription