Showing papers in "Research in Social & Administrative Pharmacy in 2017"

Latent Class Analysis: An example for reporting results

Abstract: Objective The purpose of this paper is to provide a brief non-mathematical introduction to Latent Class Analysis (LCA) and a demonstration for researchers new to the analysis technique in pharmacy and pharmacy administration. LCA is a mathematical technique for examining relationships among observed variables when there may be collections of unobserved categorical variables. Traditionally, LCA focused on polytomous observed variables, but recent work has extended the types of data that can be utilized. Included in this introduction are basic guidelines for the information that should be part of a manuscript submitted for review. For the analysis, LatentGold is used, but I also include basic R code for running LCA and LC Regressions with the poLCA package.

Update to core reporting practices in structural equation modeling

Abstract: Summary This paper is a technical update to "Core Reporting Practices in Structural Equation Modeling." 1 As such, the content covered in this paper includes, sample size, missing data, specification and identification of models, estimation method choices, fit and residual concerns, nested, alternative, and equivalent models, and unique issues within the SEM family of techniques.

The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes : A systematic review

Abstract: Background A non-dispensing pharmacist conducts clinical pharmacy services aimed at optimizing patients individual pharmacotherapy. Embedding a non-dispensing pharmacist in primary care practice enables collaboration, probably enhancing patient care. The degree of integration of non-dispensing pharmacists into multidisciplinary health care teams varies strongly between settings. The degree of integration may be a determinant for its success. Objectives This study investigates how the degree of integration of a non-dispensing pharmacist impacts medication related health outcomes in primary care. Methods In this literature review we searched two electronic databases and the reference list of published literature reviews for studies about clinical pharmacy services performed by non-dispensing pharmacists physically co-located in primary care practice. We assessed the degree of integration via key dimensions of integration based on the conceptual framework of Walshe and Smith. We included English language studies of any design that had a control group or baseline comparison published from 1966 to June 2016. Descriptive statistics were used to correlate the degree of integration to health outcomes. The analysis was stratified for disease-specific and patient-centered clinical pharmacy services. Results Eighty-nine health outcomes in 60 comparative studies contributed to the analysis. The accumulated evidence from these studies shows no impact of the degree of integration of non-dispensing pharmacists on health outcomes. For disease specific clinical pharmacy services the percentage of improved health outcomes for none, partial and fully integrated NDPs is respectively 75%, 63% and 59%. For patient-centered clinical pharmacy services the percentage of improved health outcomes for none, partial and fully integrated NDPs is respectively 55%, 57% and 70%. Conclusions Full integration adds value to patient-centered clinical pharmacy services, but not to disease-specific clinical pharmacy services. To obtain maximum benefits of clinical pharmacy services for patients with multiple medications and comorbidities, full integration of non-dispensing pharmacists should be promoted.

Perceptions of pharmacists' roles in the era of expanding scopes of practice

Abstract: Background Alberta was the first province in Canada to enact legislative changes to permit expansion of pharmacists' scope of practice, including allowing pharmacists to prescribe. However, such changes to the scope of practice can blur professional boundaries and obscure the roles of pharmacists. Understanding perceptions about the pharmacist's role may provide insight into recent and historical changes in pharmacy practice. This study clarifies perceptions held by pharmacists and other stakeholders concerning the role of the pharmacist in society. Objective To understand the perceptions of pharmacists, pharmacy students, technicians, other health care professionals, and the public of the pharmacist's role in Alberta. Methods A mixed methods approach was used: focus group sessions (n = 9) and individual interviews (n = 4) of pharmacists and other stakeholders were conducted and analyzed using qualitative-descriptive approach. A web-based survey of Alberta pharmacists (n = 416) explored pharmacists' perceptions of their own roles. Results Data analysis revealed the following: participants perceived that the pharmacist's role was transitioning to focus more on patient care; consistency in pharmacist uptake of this new role shaped the public's expectations; pharmacists with expanded scopes of practice were assuming greater responsibility; collaboration and relationships with other health care professionals were essential. The survey confirmed that changes in the roles of pharmacists were primarily related to patient care. Conclusion Following legislative changes and implementation of a compensation framework for pharmacy services, pharmacists and other stakeholders perceived the pharmacist's role to be shifting toward patient care. Periodic revisiting of pharmacists' roles and professional activities is needed to evaluate changes over time.

Promising roles for pharmacists in addressing the U.S. opioid crisis.

Abstract: Overdoses of prescription or illicit opioids claimed the lives of 116 Americans each day in 2016, and the crisis continues to escalate. As healthcare systems evolve to address the crisis, the potential of pharmacists to make a positive difference is significant. In addition to utilizing available prescription drug monitoring programs to help prevent diversion of opioids, practicing pharmacists can be alert for signs of opioid misuse by patients (e.g., multiple prescriptions from different physicians) as well as inappropriate prescribing or hazardous drug combinations that physicians may not be aware of (e.g., opioid analgesics combined with benzodiazepines). They can also supply patients with information on risks of opioids, proper storage and disposal of medications, and the harms (and illegality) of sharing medications with other people. Increasingly, pharmacies are sites of distribution of the opioid antagonist naloxone, which has been shown to save lives when made available to opioid users and their families or other potential bystanders to an overdose; and pharmacists can provide guidance about its use and even legal protections for bystanders to an overdose that customers may not be aware of. Pharmacists can also recommend addiction treatment to patients and be a resource for information on addiction treatment options in the community. As addiction treatment becomes more integrated with general healthcare, pharmacies are also increasingly dispensing medications like buprenorphine and, in the future, possibly methadone. Pharmacists in private research labs and at universities are helping to develop the next generation of addiction treatments and safer, non-addictive pain medications; they can also play a role in implementation research to enhance the delivery of addiction interventions and medications in pharmacy settings. Meanwhile, pharmacists in educational settings can promote improved education about the neurobiology and management of pain and its links to opioid misuse and addiction.

'If no-one stops me, I'll make the mistake again': Changing prescribing behaviours through feedback; A Perceptual Control Theory perspective'.

Abstract: Background Doctors at all levels make prescribing errors which can prolong patients' hospital stay, increase the risk of death, and place a significant financial burden on the health system. Doctors have previously reported receiving little or no feedback on their prescribing errors. The effectiveness of feedback in modifying future practice varies widely, depending on how feedback is delivered. To date there is little evidence about why and how feedback interventions do or do not work. Behavioural theories can be used to evaluate this process and provide explanatory accounts to inform recommendations for future interventions. Objective To explore the experiences of prescribers receiving different methods of feedback about their prescribing errors. Perceptual Control Theory (PCT) was used as a theoretical framework to explain which aspects of feedback were most likely to influence prescribing behaviour. Methods A secondary analysis of 31 semi-structured qualitative interviews with junior doctors who had taken part one of three studies in which they received feedback on their prescribing errors. A hybrid approach to analysis involved inductive thematic analysis, and deductive a priori template of codes using PCT as a framework to guide data analysis and interpretation. Results Feedback was most useful for learning and most likely to influence future prescribing behaviour when it was timely, and provided a comprehensive, contextualised benchmark to which participants could compare their prescribing behaviours and current level of knowledge. Group discussions and completing directly-observed prescribing event forms were thought most likely to impact future prescribing; email feedback alone was perceived as least effective in changing prescribing behaviour. Conclusion Feedback has the potential to change future prescribing behaviour. Behaviour change can only take place if prescribers are made aware of these discrepancies, either via providing appropriate reference values or benchmarks before mistakes are made, or by providing timely and comprehensive feedback after mistakes are made.

The Active Implementation Frameworks: A roadmap for advancing implementation of Comprehensive Medication Management in Primary care

Abstract: Implementation of evidence-based health services interventions is complex and often limited in scope. The Active Implementation Frameworks (AIFs) are an evidence-based set of frameworks to use when attempting to put into practice any innovation of known dimensions. This article describes the novel application of the AIFs to facilitate the implementation and improvement of Comprehensive Medication Management (CMM) in primary care practices to optimize medication use and improve care for patients.

Defining and identifying concepts of medication literacy: An international perspective

Abstract: Background Multiple concepts to define health literacy in the context of medication use exist, such as medication literacy, pharmacotherapy literacy, pharmacy health literacy; however, no studies have looked at consensus among experts internationally. Method A Delphi process was used to achieve consensus on the statements about medication literacy. Experts for the Delphi were selected from a review of the literature and suggestions from an international survey conducted with members of the International Pharmaceutical Federation on medication literacy. The preliminary Delphi questionnaire was built using the statements about medication literacy found in the scientific literature. Responses and comments were analyzed using a pre-established method and communicated to the experts after each round of Delphi. Statements with an agreement of at least 80% were accepted and used to develop a definition of medication literacy. Results The Delphi process started with 21 experts and included 4 rounds. Overall, 30 statements regarding medication literacy were accepted and divided into 4 clusters representing: (1) type of information necessary for optimal and safe use of medication, (2) skills and abilities, (3) format of information, and (4) outcomes. These statements were used to propose 2 different definitions of medication literacy. One of the definitions was preferred by 75% of the expert panel, which provided further comments for improvements. Of the 11 experts who answered the final questionnaire, nine strongly agreed with the refined definition. Conclusion Medication literacy is the degree to which individuals can obtain, comprehend, communicate, calculate and process patient-specific information about their medications to make informed medication and health decisions in order to safely and effectively use their medications, regardless of the mode by which the content is delivered (e.g. written, oral and visual). Future studies should focus on how this definition can be operationalized to support the role that pharmacists and other healthcare providers.

Documenting the evolution of the relationship between the pharmacy support workforce and pharmacists to support patient care.

Abstract: Since 2009 there has been a focus on the relationship between pharmacy technicians, pharmacy support workforce cadres and pharmacists in the literature. 2009-2011 saw a framework of role evolution develop, with publications from 2012 to 2015 documenting further maturity in the development of practice models for improved patient care and optimal use of personnel. The dominant narrative in the published academic literature has been made by certain high- income countries (mainly Canada, Denmark, United Kingdom and the United States of America). In these countries there are significant numbers of pharmacists available and there has been an increasing interest to utilize pharmacy support workforce cadres to allow the extension of clinical roles of pharmacists in these contexts. This is not a systematic presentation of all the literature available but rather a commentary overview supported by key papers. Key points from this literature include: (To allow the reader to clearly understand the country of origin of the themes presented, care has been taken to note the country of origin of the papers used in this commentary).

Structured pharmacist-led intervention programme to improve medication adherence in COPD patients: A randomized controlled study.

Abstract: Background COPD is characterised by a progressive airflow limitation in the lungs. However, adherence to therapy improves management of symptoms and delays disease progression. Therefore, patients' knowledge and awareness about the disease are important. Hence, pharmacist-led educational interventions could achieve this and improve medication adherence. Objective This study evaluated the effectiveness of a clinical pharmacist-led intervention on medication adherence in COPD patients in a teaching hospital. Methods In an open-labelled randomized controlled study at Kasturba Medical College Hospital, Manipal, India, patients were randomly assigned to two groups (Intervention group [IG] and Control group [CG]), and were matched for socio-demographics and clinical characteristics. Medication adherence was assessed by the Morisky, Green and Levine Medication Adherence Questionnaire (MAQ). In IG, pharmacist intervention placed emphasis on (1) compliance, (2) smoking cessation, (3) exercise, (4) inhaler use and (5) need for timely follow up. The MAQ assessment was repeated at 6, 12, 18 and 24 months. Data were analysed statistically by SPSS version 20.0. Results Out of 328 patients screened during March 2012 to June 2013, 260 were recruited. Of these, 206 completed the follow-up (98 in CG and 104 in IG). Medication adherence improved significantly after pharmacist intervention in IG at all follow-up time points (P Conclusions This is the first randomized controlled trial in India that demonstrates the pivotal role of pharmacist-led educational intervention in improving medication adherence in COPD. Involving non-physician health professionals could be the best strategy, for resource-poor nations like India, because the current physician-centric healthcare has no emphasis on patient education and counselling.

Application of the Consolidated Framework for Implementation Research to community pharmacy: A framework for implementation research on pharmacy services.

Abstract: Background Community pharmacies are an increasingly important health care setting with opportunities for improving quality and safety, yet little is understood about determinants of implementation in this setting. Objective This paper presents an implementation framework for pharmacy based on the Consolidated Framework for Implementation Research (CFIR). Methods This study employed a critical review of 45 articles on professional services provided in community pharmacies, including medication therapy management (MTM), immunizations, and rapid HIV testing. Results The relevant domains and associated constructs for pharmacy services were as follows. Intervention Characteristics ultimately depend on the specific service; of particular note for pharmacy are relative advantage and complexity. The former because implementation of services can pose a cost-benefit challenge where dispensing is the primary role and the latter because of the greater challenge implementing multi-faceted services like MTM compared to a discrete service like immunizations. "In terms of Outer Setting , pharmacies are affected by patient needs and acceptance, and external policies and incentives such as reimbursement and regulations. For Inner Setting , structural characteristics like pharmacy type, size and staff were important as was pharmacists' perception of their role and available resources to provide the service. Key Characteristics of Individuals include training, preparedness, and self-efficacy of the pharmacist for providing a new service. Few studies revealed relevant Process constructs, but if they did it was primarily related to engaging (e.g., champions). Conclusions As pharmacists' roles in health care are continuing to expand, a framework to inform implementation research in community pharmacy (and other) settings is crucially needed.

A systematic review in select countries of the role of the pharmacist in consultations and sales of non-prescription medicines in community pharmacy

Abstract: Background Much has been studied in regard to non-prescription medicines (NPMs), but the impact of greater emphasis toward patient self-selection of such agents is still not well understood, and evidence in the literature might be equivocal. Objective The aim was to examine whether or not pharmacist interventions are important in the sale of NPMs and to summarize the evidence of pharmacists' contribution in maintaining patient safety and improving the quality of consultations involving NPMs. Methods Seven online databases were searched to identify the literature on studies conducted within the UK and in countries comparable to the UK reporting on consultations and selling of NPMs published between 1980 and 2013. All study designs except for quantitative surveys were eligible for inclusion into the review. The data extraction and quality assessment were performed according to the National Institute for Health and Care Excellence guidelines. The data extracted from the studies were analyzed and presented qualitatively. Results Eighty-three studies from an original 12,879 citations were included in this review. Just under half of the studies were published between 2000 and 2009 (n = 38; 46%). Thirty-three (44%) of the studies were conducted in the UK. The review showed that in terms of the contribution of community pharmacy staff in consultations for NPMs, non-pharmacist staff dealt with a large proportion of the consultations and pharmacists were usually involved in the consultation through referral from non-pharmacist staff member. Counseling was not consistently offered to everyone. Where counseling was provided it was not always of sufficient quality. Consultations were performed much better when symptoms were presented compared to when people made a direct product request. Pharmacists were reported to conduct better consultations than non-pharmacist staff. There was evidence to suggest that where counseling was appropriately provided this afforded the person a safe environment to utilize their NPMs. Conclusions Seeking methods to develop better engagement with customers accessing pharmacy services for NPMs is necessary to enhance the interaction between these two parties. Efforts to enhance the community pharmacy environment to bring about a more positive experience for people using pharmacy is needed at present and will be important if the model for the selection of NPMs is modified in the UK. More studies are needed to allow a better understanding of the impact self-selection may have on patient safety in the community pharmacy context.

Use of pharmacy technicians in elements of medication therapy management delivery: A systematic review.

Abstract: Background Documented barriers to Medication Therapy Management (MTM) delivery, such as limited time and inefficient workflow may be overcome by utilizing support staff for administrative services. However, it is unknown how pharmacy technicians have been historically utilized to assist pharmacists in MTM-delivery. Objective To characterize literature describing pharmacy technicians' participation in actions commonly undertaken in the provision of MTM services. Methods In August 2016, a PubMed (MEDLINE) and Journal of Pharmacy Technology search was conducted using the term “pharmacy technician” with services outlined within the MTM Core Elements Version 2.0, and with terms related to administrative actions in the provision of MTM. References were searched using identified studies. Eligible articles described pharmacy technicians' performance and/or assistance in at least one MTM Core Element or related administrative action to the provision of MTM. Data was independently extracted by two researchers; any variation in extraction was reconciled via with discussion until consensus reached. A standardized data extraction template was used. Results Forty-four manuscripts were included. Manuscripts were most likely to describe pharmacy technicians' assistance with medication reconciliation (70%), documentation (41%) and medication therapy review (30%). Actions least likely to be described included personal medication record development (5%), physical assessment (5%), follow-up (2%), and medication action plan development (0%). Most articles were written in the United States (73%), or Europe (16%), while the remaining articles were Canadian (11%); no articles were found originating from Asia, Africa, Australia or the Middle East. Conclusion Pharmacy technicians are utilized most often to support MTM through assistance in medication reconciliation. Standardized training for pharmacy technicians that delineates administrative support from pharmacists' role of clinical decision making could help pharmacists obtain greater efficiency in MTM delivery.

Attitudes and attributes of pharmacists in relation to practice change – A scoping review and discussion

Abstract: Background Multiple barriers and facilitators to the uptake of cognitive services in pharmacy practice have been identified. Pharmacists' attitudes and attributes have been described as barriers and facilitators in relation to the uptake of extended pharmacy services, in addition to those of a more systemic nature. Objectives To systematically scope and review the literature describing pharmacists' attitudes and attributes in relation to the implementation of cognitive services or role extension and to critically analyze and discuss their relevance as barriers or facilitators. Method A scoping review of the literature on attitudes and attributes of pharmacists in relation to pharmacy practice was performed, including 47 articles on attitudes and 12 on attributes, forming the basis for a critical analysis within theoretical frameworks. Results Pharmacists' attitudes toward role extensions and new pharmacy service models are generally positive and their personal attributes and personality traits appear favorable for roles as health professionals. Pharmacists perceived a number of barriers to the uptake of extended roles. Conclusion Pharmacists' attributes, including personality traits, and attitudes favor the implementation of cognitive and patient-focused health care services and should not be regarded as major barriers to the uptake of extended pharmacy practice roles. Framing their attitudes and attributes within the theories of planned behavior and personality trait theories indicates that individual motivation needs to be underscored by systemic support for pharmacy practice change to succeed on a wide scale.

Effect of pharmacist intervention on improving antidepressant medication adherence and depression symptomology: A systematic review and meta-analysis

Abstract: Background Depression is a widespread disease with effective pharmacological treatments, but low medication adherence Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients Purpose The aim of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders Methods A systematic review of controlled trials (both randomized and non-randomized) was conducted Studies were obtained through a search of PubMed, Academic Search Premier, and Cochrane Library databases Studies which included a pharmacist intervention to improve medication adherence in outpatients age 17 and above with a depressive disorder diagnosis and antidepressant treatment were included Twelve publications met inclusion criteria, representing a total of 15,087 subjects: 1379 (9%) intervention and 13,708 (91%) control Results The interventions in each selected publication included some level of in-person counseling and education to promote antidepressant adherence The pooled odds ratio for medication adherence at 6 months was 250 (95% CI 162 to 386) There were no significant differences noted in subgroup meta-analyses except study location (US, Middle East or Europe) and setting Only one of the identified studies reported statistically significant impacts of the pharmacist intervention on patient depression symptoms Conclusions The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms Additional longitudinal research is recommended to investigate the multidimensional relationships between pharmacist interventions, patient adherence, and clinical outcomes Article synopsis Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients The purpose of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders A systematic review of randomized and non-randomized controlled trials was conducted of the twelve studies which met inclusion criteria The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms

The association of health literacy with illness perceptions, medication beliefs, and medication adherence among individuals with type 2 diabetes.

Abstract: Background Beliefs in medications and illness perceptions is associated with medication adherence among individuals with diabetes and several adherence interventions focus on patients' beliefs in medicines and illnesses. Though health literacy is important in medication adherence, the relationship between health literacy and medication adherence remains inconclusive; thus raising the question as to whether health literacy has an amplifying or reducing effect on the relationship between beliefs and adherence. Objective The study examined (1) the association between health literacy, beliefs in medicines, illness perceptions, and medication adherence in individuals with type 2 diabetes and (2) the moderating effects of health literacy (including numeracy and document literacy) on the relationship between illness perceptions, beliefs in medicines, and medication adherence. Methods Adults ≥20 years taking oral diabetes medicines at two family medicine clinics, completed a cross-sectional survey. Participants were assessed on beliefs in medicines, illness perceptions, health literacy, self-efficacy, and medication adherence. Multiple linear regressions examined the effect of health literacy, beliefs and self-efficacy, and the moderator effect of health literacy in the relationship between beliefs and adherence. Results Of the 174 participants, more than half were women (57.5%) and white (67.8%). There was a significant positive association between self-efficacy and adherence (β = 0.486, p Conclusions Health literacy, especially numeracy, needs to be initially addressed before diabetes adherence interventions that address individual concerns about medicines and threatening illness perceptions can work.

Pharmacist prescribing: A scoping review about the views and experiences of patients and the public

Abstract: Background Policy-makers and health professionals' views about pharmacist prescribing have been well studied, but less is known about the views of the public and patients. Objective To describe from existing literature the views and experiences of patients as well as the views of the public about pharmacist prescribing. Methods Sources: Medline, EMBASE, and International Pharmaceutical Abstracts from inception to November 2015; reference lists of included studies. Inclusion criteria: English-language studies describing the views and experiences of patients and the views of the public about pharmacist prescribing. Two reviewers independently screened titles and abstracts and one reviewer charted data. The University of British Columbia Patient Experience Framework was used to categorize and synthesize findings about patients' experience. Views were described using a descriptive thematic synthesis approach. Results Out of 2377 unique records, 35 articles were reviewed in full for eligibility. Three studies were excluded because participants were not patients or the public, eight studies were not about prescribing, and four studies were abstracts. Two articles were identified from the bibliographies of included studies. In total, twenty-two studies met inclusion criteria. Fourteen studies were quantitative (63.6%), six were qualitative (27.3%) and two were mixed design (9.1%) studies. Four studies (18.2%) were conducted in Canada (Saskatchewan, Newfoundland and Labrador, Nova Scotia), one (4.5%) in Australia, one (4.5%) in the United States (Washington) and the remaining in the United Kingdom ( n = 16, 72.7%). The most commonly explored dimensions of patient experiences were access, interpersonal communication, and patient-reported impacts of care. Patients reported high satisfaction with appointment times, communication with the pharmacist prescriber and the services received. The public supported pharmacist prescribing in limited situations (chronic conditions, minor ailments, repeat medications). The public were concerned about privacy during consultations but patients were less so. Both patients and the public shared concerns regarding lack of adequate resources to ensure safe prescribing by pharmacists (e.g., lack of pharmacists' access to medical records, lack of additional staff support to fulfill prescribing responsibilities). Conclusion Patients' experiences with pharmacist prescribing were generally positive. There were shared concerns between patients and the public about pharmacist prescribing. Opportunities for further research include strategies for building public experience with pharmacist prescribing and methods for addressing concerns identified by patients and the public.

A global picture of pharmacy technician and other pharmacy support workforce cadres

Abstract: Introduction Understanding how pharmacy technicians and other pharmacy support workforce cadres assist pharmacists in the healthcare system will facilitate developing health systems with the ability to achieve universal health coverage as it is defined in different country contexts. The aim of this paper is to provide an overview of the present global variety in the technician and other pharmacy support workforce cadres considering; their scope, roles, supervision, education and legal framework. Material and methods A structured online survey instrument was administered globally using the Survey Monkey platform, designed to address the following topic areas: roles, responsibilities, supervision, education and legislation. The survey was circulated to International Pharmaceutical Federation (FIP) member organisations and a variety of global list serves where pharmaceutical services are discussed. Results 193 entries from 67 countries and territories were included in the final analysis revealing a vast global variety with respect to the pharmacy support workforce. Roles and competency From no pharmacy technicians or other pharmacy support workforce cadres in Japan, through a variety of cadre interactions with pharmacists, to the autonomous practice of pharmacy support workforce cadres in Malawi. Responsibilities From strictly supervised practice with a focus on supply, through autonomous practice for a variety of responsibilities, to independent practice. Supervision From complete supervision for all tasks, through geographical varied supervision, to independent practice. Education From on the job training, through certificate level vocational courses, to 3–4 year diploma programs. Legislation, regulation and liability From well-regulated and registered, through part regulation with weak implementation, to completely non-regulated contexts. Conclusion This paper documents wide differences in supervision requirements, education systems and supportive legislation for pharmacy support workforce cadres globally. A more detailed understanding of specific country practice settings is required if the use of pharmacy support workforce cadres is to be optimized.

A comprehensive systematic review of pharmacy perspectives on interprofessional education and collaborative practice.

Abstract: Introduction Pharmacists are key professionals in the collaborative working process and are integral members of the healthcare team. However, there is paucity of information regarding their perspectives towards interprofessional education (IPE) and collaborative practice. Aims The aim of this systematic review is to synthesise, summarise and evaluate the quality of the quantitative and qualitative literature related to the perspectives of pharmacy students, pharmacy faculty and practising pharmacists toward IPE and collaborative practice. The perspectives included their views, experiences and attitudes with a special focus on their perceived benefits and challenges in relation to IPE and collaborative practice. Methods An integrated mixed method systematic review was conducted. Four electronic databases were searched for articles published in English between 2000 and 2015. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the studies. Results Twenty-nine articles were identified meeting the selection criteria from the first initial search of 8512 articles. Seventeen articles (59%) targeted pharmacy students, 11 articles (38%) focused on practising pharmacists and 1 study (3%) was related to pharmacy faculty. The majority of studies were conducted in the United States (n = 13), were published in the last five years (83%, n = 24) and employed quantitative methods (52%, n = 15). The two commonly used survey instruments to measure the perspectives were: different versions of the RIPLS (35%, n = 6) and the IEPS scale (35%, n = 6). Fourteen of the 29 studies were rated as low quality (MMAT = 25%), eight studies were rated as average quality (MMAT = 50%), four were rated as high quality (MMAT 75%) and three were rated as very poor quality (MMAT 0%). No studies were rated with 100% MMAT quality. Overall, the findings suggest that pharmacy students, practicing pharmacists and faculty valued interprofessional education and collaborative practice and had positive attitudes towards it. Five main findings have been identified from this review: heterogeneity in reporting IPE research, traditional professional image of the pharmacist, lack of longitudinal follow-up, lack of IPE research on faculty and paucity in mixed method studies in terms of quality and numbers. Conclusions These findings will provide an opportunity to stakeholders and policy makers to develop and implement IPE activities that are meaningful, comprehensive and unique. Sustained efforts are required not just in undergraduate curricula but also in healthcare settings to improve and promote an interprofessional culture at individual and organisational level.

A conceptual framework toward identifying and analyzing challenges to the advancement of pharmacy

Abstract: Background: Pharmacists and healthcare professionals are faced with increasing and changing health care needs around the world. In order to meet these demands, they are required to continuously upgrade and develop their professions. Reprofessionalization drives are therefore crucial to the successful delivery of health services, but traditional theories of the professions provide little practical guidance to evaluating the overall status of a profession. Objective: This study proposes a new conceptual framework of three interrelated professional sectors: education, regulation and practice, and uses it to identify and analyse challenges facing the pharmacy profession in Jordan. Methods: A multiple-method qualitative study comprised of semi-structured interviews and focus groups was conducted in Amman, Jordan. To explore and identify the challenges, apurposively recruited cross-sector sample of fifty-three key informants, stakeholders and pharmacists were interviewed. Interview transcripts were translated and then analysed using QSR NVivo 10. Thematic analysis identified eight main challenges facing pharmacy in Jordan. The original participants were then invited to participate in focus groups, the purpose of which was to validate the interview findings, map them against the conceptual framework and discuss recommendations for development. Results:The eight validated challenges span the following areas: graduates preparedness for practice, pharmacy education accreditation and quality assurance, pre-registration requirements, workforce development, workforce planning, remuneration and wage rate, pharmacy assistants, and PharmD pharmacists. Focus group participants used the framework to map each of the challenges to the primary sector-to-sector disconnect that they perceived to explain it. A list of recommendations addressing each of the challenges was also devised. Conclusions: The framework was found to offer valuable insight as an explanatory and diagnostic tool in policy-relevant research. By emphasizing the processual and contextual nature of reprofessionalization, the framework presents an alternative approach to traditional theories. This study also raises important questions regarding the status of pharmacy in Jordan and aims to provide guidance for local development and much-needed reprofessionalization drives.

Comparison of the time-to-indexing in PubMed between biomedical journals according to impact factor, discipline, and focus

Abstract: Background Practicing evidence-based medicine requires health care professionals to efficiently retrieve relevant and current literature. Objective The purpose of this study was to compare the time interval between PubMed entry and indexing with Medical Subject Headings (MeSH) between biomedical journals with varying impact factors, focus areas, and health care discipline representation. Methods This was a cross-sectional study of articles entered into PubMed database between January 1 and December 31, 2012. The primary endpoint was the number of days between PubMed entry and indexing with MeSH terms. Results A total of 7906 articles were reviewed across 18 journals. In the first comparison, the time-to-indexing was 177 ± 100 days, 111 ± 69 days, and 23 ± 40 days for articles published in journals with impact factors of 2.0–2.5, 4.5–6.5, and >25, respectively ( P ≤ 0.001). In the second comparison, the time-to-indexing was 111 ± 69 days for general medicine versus 170 ± 74 days for specialty journals ( P ≤ 0.001). In the third comparison, the overall time-to-indexing was 177 ± 100 days, 234 ± 107 days, and 163 ± 58 days for medicine, nursing, and pharmacy journals, respectively ( P ≤ 0.001). Conclusions Study results identified a significant delay between entry of articles into the PubMed database and time-to-indexing with MeSH terms across journals of varying impact factor, discipline, and focus. Results suggest that there may be factors that influence the priority by which articles are indexed with MeSH terms. Future research should focus on determining those journal characteristics and any impact of this delay on clinical practice.

Exploring the link between organizational climate and the use of psychotropic medicines in nursing homes: A qualitative study.

Abstract: Background Research concerning the overprescribing of psychotropic medicines in nursing homes suggests that organizational climate plays a significant role in the use of psychotropic medicines. Organizational climate refers to how members of the organization perceive their work environment as well as interactions with each other or outsiders. Objectives This study aimed to explore the key dimensions of organizational climate and their subsequent influence on the use of psychotropic medicines. Methods Semi-structured interviews were conducted with 40 on-site and visiting staff from eight nursing homes in Sydney, Australia. Purposive sampling was used to recruit participants representing a broad range of health disciplines and roles. Transcripts were content coded for participants' perceptions related to the work environment and descriptions of psychotropic medicines use. Thematic analysis was used to derive key concepts. Results Three salient dimensions of organizational climate were linked to the use of psychotropic medicines in nursing homes: staffing, managerial expectations and teamwork among visiting and on-site staff. Inadequate staffing levels were perceived to influence on-site staff requests for initiation of psychotropic medicines to cope with high workload. Participants reported managers that prioritized the non-pharmacological management of behavioral disturbances led other on-site staff to have a reduced preference for psychotropic medicines. In addition, trust and open communication among on-site and visiting staff facilitated the cessation of psychotropic medicines. Conclusion This study illustrates that organizational climate is an important factor influencing the use of psychotropic medicines. Furthermore, the study highlights what aspects of organizational climate need to be addressed to reduce the inappropriate prescribing of psychotropic medicines.

'What do patients want?' Tailoring medicines information to meet patients' needs.

Abstract: Medicines information leaflets can equip patients to be in control of their own healthcare and support the safe and effective use of medicines The design and content of leaflets influences patients' willingness to read them, and poor examples can cause patient confusion and anxiety Researchers examined the literature over the past 8 years to determine the content and design of medicine information leaflets that patients prefer in order to read, understand, and use them effectively It was found that existing leaflets do not meet patients' needs and appear ineffective Leaflets lack the information patients seek and may contain non-essential material, affecting patients' perception of, and willingness to read them Additionally, the acceptable leaflet length varies between patients Application of good design principles improves readability, comprehension, and ability to locate information Medicine information leaflets must meet patients' needs and be well designed Tailoring information leaflets to patient characteristics and requirements would enhance effectiveness Passive provision of pre-printed leaflets is outdated, unvalued and ineffective Using automated computer systems for leaflet tailoring with the ability to further adapt patients' information might be the best way forward

How to best manage time interaction with patients? Community pharmacist workload and service provision analysis.

Abstract: Background Primary health care disease management models are rooted in multidisciplinary participation; however, implementation of services is lagging behind desires and predictions. Barriers like workload and lack of demand have been described. The aim of this research is to observe the workload and work patterns of Portuguese community pharmacists, and relate it with the demand of pharmaceutical services. Method A time-and-motion observational study was performed to describe community pharmacists' workload in a sample of four pharmacies in the metropolitan Lisbon area. A reference list of activities to be observed was developed by reviewing other studies of community pharmacy work. This study took place during a weekday's 8-h shift, focusing on pharmacists' activities. Data to be collected included the type and duration of the activity, who performed it and where. To estimate the demand of pharmaceutical care services, “thematic-patient scenarios” were developed. These scenarios were based on the defined daily dose and package size of the most consumed medicines in Portugal, combined with data obtained from the four pharmacies' information systems on the day the observational study took place. Results Between 67.0% and 81.8% of the registered activities were pharmacist-patient interactions. These interactions summed 158.44 min, with a mean duration of 3.98 min per interaction. On average, participant pharmacies' professionals handled 4.2 prescriptions and 0.9 over-the-counter (OTC) consultations per hour. About one third of the day was spent performing administrative and non-differentiated tasks. About 54.92 min were registered as free time, 50% of which were “micro pauses” with 1 min or less. The most dispensed therapeutic subgroup was antihypertensive drugs, while the dispensation of antidiabetics was characterized by a high number of packages sold per interaction. From the developed scenarios, one can estimate that a chronic patient may visit the pharmacy 4–9 times per year, depending on the condition presented. Conclusion Workload results are very similar to findings from studies in other countries, which may be an indication of uniformity of community pharmacy practice across countries. The amount of time a pharmacist has at the counter to interact with a patient during a year renders disease management or therapeutic management non-viable. Also, the perception of “lack of time,” many times reported as a barrier for service provision, must be called into question, since substantial available time was found. However, to turn this available time into usable time, redesign of work processes and new role definition are necessary. Both better management and new communication channels should be developed to address this gap and increase patient follow-up services.

Prevalence and predictors of non-evidence based proton pump inhibitor use among elderly nursing home residents in the US.

Abstract: Background Proton pump inhibitors (PPIs) can lead to several adverse effects among the elderly, particularly when used inappropriately or in contrast to evidence suggested protocols. Objective The aim of this study was to examine the prevalence and predictors of non-evidence based PPI use in elderly nursing home residents. Methods A cross-sectional study was conducted using data from the 2004 National Nursing Home Survey (NNHS). The study sample included nursing home residents 65 years and older. Descriptive statistics were used to examine the prevalence of non-evidence based PPI use. Multivariable logistic regression was used to evaluate the patient and facility-level factors associated with non-evidence based PPI use among the elderly nursing home residents. Results A total of 355,600 elderly nursing home residents received at least one PPI for an overall prevalence of 26.99%. Among those elderly receiving PPIs, 48.59% of the use was not evidence based. Multivariable logistic regression revealed that residents with osteoporosis (Odds Ratio (OR): 0.55, 95% CI: 0.45–0.68), SSRI users (OR: 0.81, 95% CI: 0.68–0.97) and those residing in micropolitan area (OR: 0.79, 95% CI: 0.63–0.98) were negatively associated with prescription of PPIs without an indication. Patients with chronic cough (OR: 2.10, 95% CI: 1.12–3.96) and Medicare insurance (OR: 1.23, 95% CI: 1.01–1.50) were positively associated with prescription of PPIs without an indication. Conclusions The current study found that almost half of the elderly nursing home residents used PPIs for non-evidence based indications. Given the safety concerns and high non-evidence based use of PPIs in nursing homes, there is an urgent need to optimize PPI use in the elderly.

Utilization of influenza and streptococcal pharyngitis point-of-care testing in the community pharmacy practice setting

Abstract: Background One way to reduce the complications and costs of influenza like illness and pharyngitis is to improve access to testing and treatment in early stages of infection. Pharmacy-based screening and treatment of group A streptococcus (GAS) infection and influenza has the potential to improve patient care and population health. Objective To improve patient care and population health, the objective of this retrospective study was to assess if a previously validated service model could be implemented by pharmacy chains without mandated standardization. Methods Researchers utilized a certificate program to provide initial training to pharmacists and shared templates from previous validated models. Pharmacy companies were responsible for navigation of all implementation within their company. Researchers analyzed the de-identified data from patients seeking point-of-care testing from the participating pharmacies. Results Participating pharmacies reported 661 visits for adult (age 18 and over) patients tested for influenza for GAS pharyngitis. For the GAS patients, 91 (16.9%) tested positive. For the Influenza patients, 22.9% tested positive and 64 (77.1%) testing negative. Access to care was improved as patients presented to the visit outside normal clinic hours for 38% of the pharmacy visits, and 53.7% did not have a primary care provider. Conclusion A collaborative care model for managing patients with symptoms consistent with influenza or group A streptococcus can be successfully implemented, and improve access to care outside of normal clinic hours and for those without a regular primary care provider.

The complexity of implementation factors in professional pharmacy services.

Abstract: Implementation of professional pharmacy services is a complex process, in which multi-level factors interact and influence implementation process and outcomes at various levels or domains In this paper the terms that have been used to describe the factors that influence implementation of evidence-based services and their domains are presented The complex 'cause-and-effect' interactions by which implementation factors appear to interact throughout the implementation process are also discussed Identifying and understanding these complex and causal relationships between different implementation factors, represents a key process in the implementation of any service, in order to assist in the development of tailored implementation strategies Future research should be directed to gain an understanding of the nature of individual implementation factors, their cause-and-effect interactions, and their relationships Implementation strategies are less likely to succeed unless these are identified and targeted to the causes identified when designing and planning an implementation strategy

Evaluation of the implementation process and outcomes of a professional pharmacy service in a community pharmacy setting. A case report

Abstract: Pharmacist-led medication review services are recognized as a key to medicines management. This case study describes the implementation process of a medication review with follow-up service in a community pharmacy setting and evaluates its initial outcomes. An implementation-effectiveness hybrid study was undertaken in a community pharmacy setting. The implementation process was divided into four different phases: Exploration and adoption, program installation, initial implementation, and full operation. A core set of implementation outcomes was measured, including penetration, implementation costs, feasibility, fidelity, acceptability, appropriateness and efficiency. The penetration rate of the service was nearly 62.5%, and the implementation costs were 57,359.67€. There was a high retention-participation rate of patients. For every month of service provision, there was a 1.27 increase in the number of patients requesting the service, compared to the number of patients being offered the service. The time spent on service provision was 171.7 min per patient. Average patient satisfaction with the service was 4.82 (SD: 0.39, scale 1–5), and the acceptance rate of care plans by patients and general medical practitioners were 96.99% and 96.46%, respectively. There were 408 negative outcomes associated with the use of medications were identified during the study (3.09 per patient), of which 96.3% were resolved. The average time per patient spent on service provision significantly decreased along the 18 months of service provision. This case report can assist individual pharmacists and professional organizations interested in implementing evidence-based services by offering an example on how to approach the implementation process in a systematic way.

A preliminary examination of over-the-counter medication misuse rates in older adults.

Abstract: Background Older adults are the largest consumers of over the counter (OTC) medications. Of the older adults who are at risk of a major adverse drug event, more than 50% of these events involve an OTC medication. Objective To explore how older adults select and hypothetically use OTC medications and if the selected medications would be considered safe for use. Methods Walking interviews were conducted with 20 community-dwelling older adults in a community pharmacy. Each participant selected an OTC medication for a hypothetical pain and sleep scenario. Data were analyzed for four types of misuse: drug–drug interaction, drug–disease interaction, drug–age interaction, and excess usage. Results At least one instance of potential misuse was found in 95% of participants. For sleep medications, drug–drug interactions and drug–age interactions were more common, affecting 50% and 65% of participants respectively. The most common type of misuse noted in the pain products selected was that of drug–drug interaction, with a total of 39 occurrences, affecting 60% of the participants. Conclusions OTC misuse is common among older adults, and it is important for older adults to seek out resources, such as a pharmacist, to help them make safe OTC decisions.