title: A model for assessment and referral of clients with bowel symptoms in community pharmacies.
abstract: BACKGROUND
  To expedite diagnosis of serious bowel disease, efforts are required to signpost patients with high-risk symptoms to appropriate care. Community pharmacies are a recognized source of health advice regarding bowel symptoms. This study aimed to examine the effectiveness of a validated self-administered questionnaire, Jodi Lee Test (JLT), for detection, triage, and referral of bowel symptoms suggestive of carcinoma, in pharmacies.
  
  
  METHODS
  'Usual Practice' was monitored for 12 weeks in 21 pharmacies in Western Australia, documenting outcomes for 84 clients presenting with bowel symptoms. Outcome measures were: acceptance of verbal advice from the pharmacist; general practitioner consultation; and diagnosis. Trial of the JLT involved staff training in the research protocol and monitoring of outcomes for 80 recruited clients over 20 weeks. Utility of the JLT was assessed by post-trial survey of pharmacy staff.
  
  
  RESULTS
  Significantly more referrals were made by staff using the JLT than during Usual Practice: 30 (38%) vs 17 (20%). Clients' acceptance of referrals was also higher for the intervention group (40% vs 6%). Two-thirds of pharmacy staff agreed that the JLT could be incorporated into pharmacy practice, and 70% indicated they would use the JLT in the future.
  
  
  CONCLUSIONS
  A pre-post design was considered more appropriate than a randomized control trial due to an inability to match pharmacies. Limitations of this study were: lack of control over adherence to the study protocol by pharmacy staff; no direct measure of client feedback on the JLT; and loss to follow-up. The JLT was effective in prompting decision-making by pharmacy staff and inter-professional care between pharmacies and general practice, in triage of clients at risk of bowel cancer.
authors.affiliation: a School of Pharmacy, Faculty of Health Sciences , Curtin University , Perth , Australia ;
authors.forename: Deepa
authors.initials: D
authors.lastname: Sriram
authors.affiliation: b Centre of Excellence for Science Seafood & Health, Faculty of Health Sciences ; Curtin University , Perth , Western Australia ;
authors.forename: Alexandra
authors.initials: A
authors.lastname: McManus
authors.affiliation: a School of Pharmacy, Faculty of Health Sciences , Curtin University , Perth , Australia ;
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Emmerton
authors.affiliation: a School of Pharmacy, Faculty of Health Sciences , Curtin University , Perth , Australia ;
authors.forename: Richard W
authors.initials: RW
authors.lastname: Parsons
authors.affiliation: c School of Medicine, Melbourne Clinical School , University of Notre Dame , Victoria , Australia.
authors.forename: Moyez
authors.initials: M
authors.lastname: Jiwa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003157:Community Pharmacy Services / Q000706:statistics & numerical data*; D003657:Decision Making; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis*; D007414:Intestinal Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010594:Pharmacies; D010595:Pharmacists / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014904:Western Australia; D055815:Young Adult
keywords: Bowel symptoms; advice; community pharmacy; questionnaire; referral