Community pharmacists lack understanding of laryngectomy patients' needs, and therefore fail to give vital advice on the use of antifungal drugs, researchers have suggested.   

A qualitative study consisting of interviews with 12 pharmacists in the north of England found they would give no or incorrect advice about the use of antifungal drugs when dispensing to patients with a voice prosthesis.

This could prove detrimental for the patient, the researchers warned, leading to non-adherence, prosthesis failure or even pneumonia. 

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	The researchers, led by Dr Adam Todd at the school of medicine at Durham University, concluded that community pharmacists needed more education and resources on laryngectomy and voice prostheses to better support their patients.

However, they acknowledged that the small sample meant generalising their findings to all community pharmacists in England should be done "carefully".

The study, published online earlier this month (September 13) in the International Journal of Pharmacy Practice, found most of the 12 participating community pharmacists correctly identified that antifungal medication could be used to treat voice prostheses after laryngectomy.

However, many revealed a lack of confidence in their answers about specific drugs and dosage and were confused about the terminology relating to laryngectomy, voice prostheses and stomas.   

One participant, who was 17 years qualified, mistook a stoma – an opening made in the skin in front of the neck to help with breathing – for a plant cell. Another, who was seven years qualified, said that, although they dispensed laryngectomy appliances, they did not know what a voice prosthesis was. 

Some participants felt they had little experience of dealing with this patient group because they were not from a hospital or "clinical" environment and encountering patients in the community who had undergone a laryngectomy was rare. About 570 laryngectomies were performed in England in 2009-10, the study said.

Researchers raised concerns about the uncertainty surrounding the off-label use of the antifungal drug nystatin, which patients with voice prostheses are advised to use twice a day. Community pharmacists "play a crucial role" in the supply of off-label medicines, the researchers said.     

Researchers agreed with participants that an educational leaflet should be supplied to community pharmacists by local departments of speech and language therapy.  

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