title: Pharmacists' response to anaphylaxis in the community (PRAC): a randomised, simulated patient study of pharmacist practice.
abstract: OBJECTIVE
  To evaluate how community pharmacists manage patients with anaphylaxis.
  
  
  METHODS
  A randomised, cross-sectional, simulated patient study of community pharmacist practice.
  
  
  METHODS
  300 metropolitan pharmacies located in Perth Australia, randomised to three groups of 100 pharmacies. Each group corresponded to a different epinephrine autoinjector: original EpiPen, new-look EpiPen or Anapen.
  
  
  METHODS
  300 pharmacies were visited with 271 simulated patient visits included in the final analysis (88=original EpiPen, 92=new-look EpiPen, 91=Anapen).
  
  
  METHODS
  Primary anaphylaxis preparedness (readiness to treat acute anaphylaxis). Secondary anaphylaxis engagement (willingness to engage the patient in a discussion about their anaphylaxis).
  
  
  METHODS
  Simulated patients approached pharmacists, using a standardised scenario, for assistance with epinephrine autoinjector use and advice about the use of antihistamines in anaphylaxis. Scores for each outcome were obtained based on the number of predefined statements addressed by the pharmacist during the consultation (maximum score=5 for preparedness and 8 for engagement).
  
  
  RESULTS
  The mean anaphylaxis preparedness score was 2.39 points (SD 1.17). Scores for new-look EpiPen were significantly higher than for original EpiPen and Anapen (2.75 vs 2.38 points, p=0.027; 2.75 vs 2.03 points, p<0.001, respectively). Overall, 17.3% of pharmacists correctly demonstrated the epinephrine autoinjector. The mean anaphylaxis engagement score was 3.11 points (SD 1.73). Scores for new-look EpiPen were similar to original EpiPen and Anapen (3.11 vs 3.32 points; 3.11 vs 2.90 points, both p=0.42). Engagement was associated with preparedness. For each additional engagement point, preparedness increased by 7% (0.357 points; 95% CI 0.291 to 0.424; p<0.001).
  
  
  CONCLUSIONS
  Pharmacists demonstrated reasonable knowledge of anaphylaxis symptoms and emergency care, but had poor epinephrine autoinjector technique and rarely discussed anaphylaxis action plans. Pharmacists who had a more comprehensive discussion about anaphylaxis with patients, were more prepared for anaphylaxis emergencies. Future research should evaluate the nature and significance of errors in pharmacists' autoinjector technique.
authors.affiliation: Pharmacy Program, Centre for Optimization of Medicines, School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Salter
authors.affiliation: Pharmacy Program, Centre for Optimization of Medicines, School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Brock
authors.initials: B
authors.lastname: Delfante
authors.affiliation: Pharmacy Program, Centre for Optimization of Medicines, School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: de Klerk
authors.affiliation: School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Sanfilippo
authors.affiliation: Pharmacy Program, Centre for Optimization of Medicines, School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Clifford
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy*; D003157:Community Pharmacy Services; D003430:Cross-Sectional Studies; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016544:Patient Simulation; D055815:Young Adult
chemical_list: D004837:Epinephrine
keywords: Anaphylaxis; Pharmacy Practice; Primary CAre; Simulated Patient