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PubMed1999

Technicians or patient advocates?--still a valid question (results of focus group discussions with pharmacists).

New legislation went into effect in Iceland in March 1996 making it the first Nordic country to liberate their drug distribution system. The term liberalization implies the abolishment of the professional monopoly in that ownership was not tied to the pharmacy profession anymore. Focus group discussions with community pharmacists in the capital area Reykjavík and rural areas were employed to answer the research question: How has the pharmacists' societal role evolved after the legislation and what are the implications for pharmacy practice? The results showed firstly that the public image and the self-image of the pharmacist has changed in the short time since the legislative change. The pharmacists generally said that their patient contact is deteriorating due to the discount wars, the rural pharmacists being more optimistic, and believing in a future competition based on quality. Secondly, the results showed that the pharmacists have difficulties reconciling their technical paradigm with a legislative and professional will specifying customer and patient focus. This study describes the challenges of a new legislation with a market focus for community pharmacists whose education emphasized technical skills. This account of the changes in the drug distribution system in Iceland highlights some of the implications for pharmacists internationally.

Denmark↗
PubMed2001

The relationship between pharmacists' tenure in community setting and moral reasoning.

OBJECTIVE: To explore the relationship between pharmacists' tenure in the community setting and their moral reasoning abilities. DESIGN: Systematic random sample design. SETTING: A large southeastern city in the United States. PARTICIPANTS: 450 independent and chain community pharmacists identified from the state board of pharmacy list of licensed community pharmacists. INTERVENTIONS: A mailed questionnaire that included a well-known moral reasoning instrument and collected demographic information. MAIN OUTCOME MEASURES: Moral Reasoning abilities and tenure of community pharmacists. RESULTS: As a group, community pharmacists with greater years of tenure in community practice scored significantly lower on moral reasoning than those pharmacists with fewer years of tenure (p=0.016). CONCLUSION: Four plausible explanations for the results are given including: a) a selection of lower ethical reasoners and/or an exodus of higher ethical reasoners from the community setting; b) a retrogression in the moral reasoning skills as community pharmacists obtain tenure in this setting; c) differences between the low and high moral reasoning groups may be due to a cohort effect; and d) the obtained practitioner sample may not have been representative of the population of community pharmacists.

Community Pharmacy Services↗
PubMed2001

The role of the Danish community pharmacist: perceptions and future scenarios.

In recent decades, dramatic changes of the role of the Danish community pharmacist have contributed to widespread uncertainty among professionals about the future content of their job. This case study, which is based on qualitative research interviews and documentary material, describes how key actors belonging to 10 different relevant social groups who have been influential in shaping the role of Danish community pharmacists have different perceptions of the pharmacy profession. These perceptions include: the community pharmacist as a provider of technical, standardised advice, the pharmacist as a drug expert, the pharmacist as a leader, and the pharmacist as a provider of individualized advice. Five future scenarios for the community pharmacist ranging from a role as a pharmacist with no future to a role as the provider of individualized information and future role developer are also described and analysed in the paper. The case study is theoretically based on a specific social constructivist theory, the Social Construction of Technology (SCOT).

Community Pharmacy Services↗
PubMed1997

Pharmacists' opinions and practices related to the sale of cigarettes and alcohol--a follow-up study.

Opinions that pharmacists hold and their practices concerning sale of cigarettes and alcohol are of interest to health experts. As a follow-up to a 1990 statewide survey of pharmacists opinions and practices related to the sale of cigarettes and alcohol, this study was designed (1) to determine current opinions and practices of pharmacists' related to the sale of cigarettes and alcohol; (2) compare these findings with results from the 1990 study; and (3) to gather new information on pharmacists' practice of health promotion activities. A structured survey questionnaire was designed and reviewed by a jury of experts and subsequently administered to half of the 1340 pharmacies in Indiana. Collected data were analyzed by using descriptive and inferential statistical methods. Findings reveal that 64 percent of responding pharmacists sell cigarettes in their stores even though 82 percent think that their stores should not sell cigarettes. Approximately 42 percent of the pharmacies sell alcoholic beverages while more than two-thirds of the pharmacists (68%) think pharmacies should not sell alcoholic beverages. These findings represent a decline of 7.2 percent in pharmacies that sell cigarettes and a 6.8 percent increase in pharmacies selling alcoholic beverages compared to the 1990 study. Study results also revealed that most pharmacists agree the use of cigarettes and alcohol were important causes of morbidity and mortality and that pharmacists should play a role in health promotion and disease prevention to the public. However, the majority do not ask their patients about their smoking and alcohol habits and do not participate in health education/promotion programs for the general community.

Adult↗
PubMed2003

The clinical and economic impact of a secondary heart disease prevention clinic jointly implemented by a practice nurse and pharmacist.

BACKGROUND: A primary care practice in the West of Scotland used clinical governance funding to develop a heart disease prevention clinic to target patients with existing heart disease. The practice nurse enlisted the help of the practice pharmacist and the protocol for the clinic was subsequently developed with the involvement of both practitioners. OBJECTIVE: The aim of this project was to identify and offer health screening and appropriate disease modifying treatment to patients of a primary care (or general medical) practice suffering from cardiovascular heart disease in a clinic run jointly by a practice nurse and pharmacist. METHOD: Patients identified by the practice pharmacist were offered a full health screen. Their clinical parameters were assessed and appropriate disease modifying drug therapy and lifestyle advice was offered in a review clinic with the practice nurse and pharmacist. RESULTS: The practice pharmacist identified over 212 patients over a 30-month period. A majority demonstrated hypertension (91%) and angina (89%), while over half (57%) had suffered a heart attack. Statin therapy was modified in a large number of patients (47%) and the number of patients with satisfactory total cholesterol levels has increased from 30% to 57% (P < 0.001). Aspirin and beta-blocker therapy has been initiated in a significant number of patients (53% and 26% respectively). Twelve patients (6%) stopped smoking; however, many 42% continued to smoke. The general medical doctors (GPs) who demonstrated a change in their own practice readily accepted changes to therapy recommended by the practice nurse and pharmacist. The practice pharmacist offset the additional cost of drug spend on statin therapy by making savings in other therapeutic areas. CONCLUSION: A secondary heart disease clinic can benefit patients by optimising drug and lifestyle therapy. While the inclusion of a pharmacist confers clinical and economic benefits.

Adrenergic beta-Antagonists↗
PubMed1999

Pharmacists' knowledge, attitudes and practices concerning sugar-free medicines.

AIMS: To examine the attitudes of pharmacists to sugar in medicine and sugar-free preparations and their levels of knowledge concerning sugar-free preparations and the implications for dental health. DESIGN: A questionnaire was designed with a mixture of closed and open-ended questions. SETTING: Pharmacists practising in the Greater Belfast area of Northern Ireland. METHOD: Seventy pharmacists were randomly chosen from the list of pharmacists practising in the area and were asked to participate in the study. RESULTS: Responses were obtained from 52 of the 70 selected pharmacists, representing a response rate of 74%. Seventy-five per cent of the pharmacists stated that they had not received formal education concerning sugar in medication and it's effect on dental health. Their main source of information on the subject was dental health literature. Eighty-seven per cent felt that all medication should be available in sugar-free form. Forty-six per cent stated that sugar in medication was definitely an important cause of dental caries in children and 44% felt that it was a possible factor. The major factors influencing the provision of sugar-free medicines were parental request, health promotion literature, reports and media advertising. Thirty-nine per cent of the pharmacists always offered a sugar-free preparation for over-the-counter medication (provided that a sugar-free alternative was available), and 56% sometimes did so. Fifty per cent always offered a sugar-free form for prescribed items wherever possible, the remainder depended on it being specified by the prescriber. CONCLUSION: There is a high level of interest in this issue among pharmacists, but there is a need for an increased educational input on a continuous basis.

Attitude of Health Personnel↗
PubMed2006

Interprofessional health care teams: attitudes and environmental factors associated with participation by community pharmacists.

The purpose of this study was to determine whether community pharmacists are prepared to assume a more active role as members of the primary health care team. A secondary objective was to develop multi-items scales for future studies involving pharmacists, as well as other health professions. This paper reports on rates of participation by community pharmacists as members of interprofessional health care teams, the extent to which this participation was related to pharmacists' attitudes about their preparedness for this role, their relationship with physicians, and their assessment of potential barriers to interprofessional teamwork within their practice setting. A mail questionnaire was sent to community pharmacists across Canada between February and April, 2004. The overall response rate was 35.2% (470/1337) with the highest response rate in the Prairie Provinces (40.6%) and the lowest in Quebec (24.4%). Pharmacists on teams were more likely to agree their training and skills were sufficient to participate, and to report good relations with physicians. Pharmacists on teams were more likely to agree there was more opportunity to meet and get to know other health disciplines, and to see teamwork as part of their role. They were also more likely to agree physicians wanted their input, and less likely to see other disciplines as being too protective of their professional "turf". Pharmacists on teams did not differ from those not on teams in rating lack of time, bad past experiences with teamwork, financial reimbursement or proximity to other health care workers as barriers to being a member of a community-based primary care team.

Adult↗
PubMed2001

Dietary supplement survey of pharmacists: personal and professional practices.

OBJECTIVE: To survey pharmacists about personal/professional practices regarding dietary supplements, specifically personal use and recommendation patterns, reference usage, and desired computerized decision-support features. DESIGN: Anonymous, self-administered survey. SETTING/LOCATION: National pharmacy association meeting. SUBJECTS: Practicing pharmacists who answered questions about dietary supplements. OUTCOME MEASURES: Acceptability of specific references, desired features in computerized decision support, frequency of personal use, and recommendations to patients, family, or friends. RESULTS: Seventy (70) pharmacists completed the survey. A majority (52.9%) reported taking dietary supplements including echinacea, zinc, and chromium picolinate. Fewer than half of pharmacists stated they have recommended a dietary supplement to a patient. Pharmacists stated that the top information sources were: published clinical trials, allopathic health care providers, alternative medicine practitioners, and word of mouth. The Internet was an important source for recommendations although not for personal use. The most highly accepted (>70%) print references included The Review of Natural Products and the World Health Organization Monographs on Selected Herbal Products. More than 90% rates the ability to view reference citations and computerized alerts on drug-dietary supplement interactions "very important" or "important". Interest was high in accessing computerized monographs. CONCLUSIONS: Pharmacists are self-educating about dietary supplements. Among pharmacists surveyed, there was some consensus as to which references were acceptable. There is a demand for dietary supplements information to be included in pharmacy computer systems, specifically to check for interactions against the patient's.drug profile. Although practitioners in Western and alternative medicine, as well as journal articles, are preferred information sources, the Internet and word of mouth are also important sources. Personal use of dietary supplements correlated with a twofold increase in the likelihood that a pharmacist would recommend a dietary supplement to a patient.

Attitude of Health Personnel↗
PubMed2003

Pharmacists' patterns of use, knowledge, and attitudes toward complementary and alternative medicine.

OBJECTIVES: To determine the patterns of use, knowledge, and attitudes toward complementary and alternative medicine (CAM) among pharmacists. DESIGN: Anonymous self-administered survey. SETTINGS: 61st International Congress of International Pharmaceutical Federation (FIP), Singapore Traditional Chinese Medicine (TCM) Research Symposium, and retail and hospital pharmacies in Singapore. SUBJECTS: Pharmacists attending the FIP Congress, TCM Symposium, and pharmacists working in retail and hospital pharmacies. OUTCOME MEASURES: Frequency of use of different types of CAM by demographic attributes, knowledge scores, and attitudinal scores. RESULTS: Of the 430 surveys received, 420 fit the criteria for inclusion. Of the pharmacists, 84.3% reported use of some form of CAM in their lifetime. CAM was used for chronic and acute conditions. There was no difference in use of CAM based on gender and income. The mean score on the knowledge test was 7.23 of 10. Of the pharmacists, 72.6% were moderately satisfied with CAM and 79.4% indicated they would recommend CAM to family and friends. They received information on CAM from books/magazines (64%), friends/family (35.7%), and the Internet (31.4%). Eighty-one percent (81%) of pharmacists felt they had inadequate skills and knowledge to counsel patients on herbal medicine and 90.5% felt the professional curricula should have more components on CAM. CONCLUSIONS: The use of CAM among pharmacists is widespread and prevalent. The increased use of CAM necessitates the need for more education. Pharmacists acknowledge that CAM may have a place in health care and accept their role as information providers. There is also a need for reliable sources of information on CAM.

Adult↗
PubMed1996

Using pharmacists' documentation of clinical activities to reclaim employees and reposition the department.

The use of documentation on pharmacist clinical activities to encourage greater hospital investment in a department is described. From 1983 through 1988, the number of full-time-equivalent (FTE) positions in the pharmacy department at a 468-bed medical center was reduced from 63 to 39.4. To cope with the challenge of a sharply reduced staff, the department established a permanent pharmacy-nursing task force, developed a pharmacy strategic plan, used total quality management, recruited the best staff possible when openings appeared, and held staff retreats. In addition, measures were taken to begin documenting all pharmacist clinical activities online. As data were accumulated, it became clear that more pharmacist involvement in patient care areas was needed and that more resources would be necessary to achieve that. Presentations were made to hospital administration to demonstrate the existing and potential contributions of the department; the presentations drew heavily on the clinical documentation. Formal reports were also submitted. As a result, the department received approval for a pharmacist career ladder, an increase of 1.6 pharmacist FTEs for the evening shift, a large salary-range adjustment for staff pharmacists, and an increase of 1 pharmacist FTE to focus on antimicrobial use. A pharmacy department successfully used documentation of its clinical activities to make a case to administration for reclaiming some of the pharmacist FTEs lost through downsizing.

Computer Systems↗
PubMed1998

Characteristics of ambulatory care clinics and pharmacists in Veterans Affairs medical centers. IMPROVE investigators. Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers.

The type and extent of ambulatory care clinical pharmaceutical services in selected Veterans Affairs medical centers (VAMCs) were studied as part of a larger project. Questionnaires were sent to the 174 VAMCs to determine the extent of clinical pharmacy activity in ambulatory care clinics, characteristics of outpatient pharmacies and clinics, and characteristics of ambulatory care pharmacists in VAMCs and to identify sites for the IMPROVE (Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers) project. Fifty VAMCs responded to the survey. There were 512 ambulatory care clinics within these VAMCs. There was some pharmacist coverage in 75% of the clinics. The highest pharmacist coverage was in walk-in refill, therapeutic drug monitoring, and anticoagulation clinics. Clinical pharmacists at 68% of the VAMCs had prescribing privileges in ambulatory care clinics. Clinical pharmacists managed 29.9% of the clinics. The types of clinics most commonly managed by pharmacists were therapeutic drug monitoring, anticoagulation, walk-in refill, and lipid clinics. Nurse practitioners or physician assistants also were providing primary care in 41% of the clinics. There were 242 ambulatory care clinical pharmacy specialists practicing in the 50 VAMCs. Of these, 41.3% had three years or less of ambulatory care experience. Most pharmacists were in the clinic five days per week. A Pharm.D. degree was the highest degree obtained for 76.9%. Ambulatory care pharmaceutical services are common in VAMCs and are being provided by numerous clinical pharmacists.

Data Collection↗
PubMed1998

Clinical and regulatory concerns in Alzheimer's disease management: role of the pharmacist.

The role of the pharmacist in managing Alzheimer's disease (AD) is discussed. Health-system pharmacists can play a critical role in the management of AD, provided they remain up-to-date on new drug therapies, recent clinical findings, and educational resources for caregivers and families. Pharmacists in a long-term-care setting must know and apply the federal regulations set forth in the Omnibus Budget Reconciliation Act of 1987. Pharmacists have an excellent opportunity to optimize pharmacotherapy by carefully reviewing treatment regimens to identify potential drug-related problems. These might include improper drug selection, inappropriate dosage, adverse drug reactions, and interactions. Pharmacists should encourage the use of cholinesterase inhibitors in patients with mild to moderate AD and should monitor such therapy by interacting with nurses, physicians, and caregivers. AD patients not only suffer cognitive decline but may have psychiatric and behavioral disturbances, which can be especially problematic for the caregiver. When possible, these disturbances should be managed by nonpharmacologic strategies, such as environmental changes and behavior modification. The pharmacist can recommend and monitor the use of psychotropic agents for psychiatric and behavioral symptoms that do not respond to nonpharmacologic strategies. These drugs must be carefully selected and monitored, and gradual dosage reductions must be periodically attempted. Finally, pharmacists should provide caregivers and families with education, emotional support, and referrals. Pharmacists who are well-grounded in the regulatory and clinical issues surrounding AD can play a major role in managing this illness.

Alzheimer Disease↗
PubMed2001

Evaluation of studies investigating the effectiveness of pharmacists' clinical services.

A quantitative evaluation of randomized trials of counseling, education, and other clinical services provided by pharmacists was performed. Data sources were MEDLINE and the bibliographies of published articles. Pharmacists' services were categorized as counseling of patients, counseling of physicians, counseling of both patients and physicians, and patient care. The outcomes extracted were measures of patient behavior, disease, symptoms, and patient knowledge. Thirty-two trials met the inclusion criteria. The pharmacists were specified as clinical pharmacists in 24 trials and as community pharmacists in 2. In six unblinded trials of patient counseling, the outcomes favored the counseled patients over control patients in every trial, and the effects were statistically significant in five trials (the outcome was medication adherence in these five trials). In seven trials of counseling of both patients and their physicians, patient outcomes were significantly better in the intervention group in six trials, four of which were single blind. Two trials in which patients were randomized to either physician counseling or control groups yielded inconsistent results. In one trial in which physicians were randomized to receive counseling from pharmacists, the proportion of prescriptions meeting guidelines was higher in the counseling group than in the control group. Four trials of patient care by pharmacists were inconclusive. These trials demonstrated that counseling of patients and their physicians by pharmacists can improve patient outcomes. The evidence that counseling of patients alone improved patient outcomes was good, though weaker because of suboptimal trial design.

Data Collection↗
PubMed2003

Pharmacist involvement in a multidisciplinary inpatient medication education program.

The development of a multidisciplinary inpatient medication education program is described. A multidisciplinary group designed and implemented a medication education program with defined roles for both nurses and pharmacists. Nurses provided medication education to patients during each medication administration using specially designed assessment and teaching tools. The nursing staff submitted requests for pharmacist consultations for patients with complex medication regimens, who were admitted because of a drug-related problem or who required additional teaching as determined through the medication education assessment form. A complex medication regimen was defined as the administration of oral medication more than five different times per day, the start of at least 5 new medications that would be continued at discharge, or the prescribing of at least 10 medications to be taken daily that would be continued at discharge. Pharmacists provided education for 19% of admitted patients during a six-month period. As a result of pharmacists' interactions with prescribers and nurses, the number of medications was reduced in 12% of these patients, and the number of medication administrations each day was reduced in 19% of patients. In addition, for 33% of patients, pharmacists contacted the prescriber to make recommendations beyond the scope of the medication education program that optimized and simplified the patient's drug regimen. The development of a structured medication education program allowed patients to receive medication education throughout their hospitalization from both nurses and pharmacists. Pharmacists provided education for patients at highest risk for noncompliance or poor outcomes. Full implementation of a medication education program involving staff pharmacists is planned.

Administration, Oral↗
PubMed2004

Influence of time stress and other variables on counseling by pharmacists about antiretroviral medications.

PURPOSE: The medication counseling practices of pharmacists caring for patients with HIV infection and the factors influencing their counseling behaviors regarding antiretroviral medications were examined. METHODS: A questionnaire was mailed in February 2000 to pharmacist-managers of 573 ambulatory care pharmacies providing medications to beneficiaries of the North Carolina AIDS Drug Assistance Program. The frequency of and attitudes about adherence counseling for patients with HIV infection; the time allocated, spent, and needed to provide high-quality care to these patients; and pharmacists' time pressure and time stress were measured. RESULTS: Of the 573 questionnaires mailed, 440 (77%) were usable. Fifty-nine percent of pharmacists reported that they did not have enough time to provide adherence counseling to patients receiving antiretroviral medications, and 45% reported that most of their patients did not receive such counseling. Time-stressed pharmacists were significantly less likely to perform 12 of 22 counseling behaviors, including discussing adverse effects (13% versus 24%, p < 0.0089), drug interactions (13% versus 31%, p < 0.0001), and what to do if a dose is missed (8% versus 23%, p < 0.0001). Multivariate analysis revealed that time stress, perceived skill and interest in adherence counseling, and job satisfaction were significantly associated with the counseling index. CONCLUSION: Time pressure and other barriers appeared to limit the care that some pharmacists offered to patients with HIV infection. Pharmacist age, job satisfaction, and perceived skill and interest in adherence counseling influenced the comprehensiveness of the counseling pharmacists provided for patients receiving antiretroviral medications.

Adult↗
PubMed2006

The pharmacist-physician relationship in the detection of ambulatory medication errors.

BACKGROUND: Expenditures on outpatient prescription drugs have increased enormously in the last decade. Despite this growth in expenditures, prescription medication safety in the ambulatory setting is lacking. Prior research in outpatient care has centered around the physician-patient encounter. What remains unexamined in the ambulatory care literature is the pharmacist's role as interceptor, detector, and reporter of medication errors to the physician. METHODS: Data about the role, responsibilities, and expectations to inform physicians about this subject were collected from pharmacist (N = 30) and patient (N = 31) focus groups conducted between July 2002 and July 2003. Pharmacists in outpatient practices and patients were randomly selected from the state licensure database and the Jackson Metropolitan phonebook, respectively. ANALYSIS: Grounded theory provided the perspective on which data were interpreted. Data patterns were linked using key words and phrases for theme analysis. Arbitration between coders resulted in an inter-rater reliability of 0.85. RESULTS: : Three complementary patterns were identified from the data: 1) patients likely see multiple physicians and only one pharmacist; 2) patients are more likely to report medication errors to the pharmacist than to the physician; and 3) pharmacists are the final interceptors, detecting medication errors before they reach patients. CONCLUSIONS: Ambulatory pharmacists are in a privileged position to gather data regarding adverse responses to prescribed medication or incidents of medication mishaps. The failure of pharmacists to report information back to physicians is a missed opportunity to improve patient safety.

Ambulatory Care↗
PubMed1975

Verbal communications of community pharmacists.

Community pharmacists, by virtue of their location, are thought to be among the most accessible health care workers in the delivery system. To estimate the importance of this assertion it is necessary to understand the communication habits of pharmacists, especially their interactions with patients. Since verbal communication is the most frequent form of patient interaction, this study attempts to specify the type and amount of all pharmacist communication with emphasis on the pharmacist-patient process. Using a modified work sampling technique, communication data were collected on community pharmacists practicing in chain pharmacies. Data are presented in the context of a causal model. The strongest pathway in the model is found to be the inverse relationship of prescription department staffing to the percentage of time pharmacists devote to communication with patients. Prescription volume is seen to have a moderately positive effect on the level of communication. However, further analysis reveals staffing to be the limiting factor. The findings suggest that changes in the environment of the community pharmacists studied would do much to increase pharmacist-patient contact. An educational effort also is indicated to assure that patients receive quality communication.

Administrative Personnel↗
PubMed1995

A field investigation of participant and environment effects on pharmacist-patient communication in community pharmacies.

The objective of this study was to identify participant and environment variables that affect pharmacist-patient communication, and test their effects in a range of community pharmacy practices. Data were collected through unobtrusive observation, patient interviews, and pharmacist interviews in 12 community pharmacies. Random samples of 30 patients who received a prescription from a participating pharmacist were selected at each of the 12 pharmacies, yielding a total sample size of 360 patients. Relationships for Pharmacist Counselor Role Orientation, Patient Counselee Role Orientation, Lack of Time, Patient Privacy, Prescription Transfer by the Pharmacist, and Importance of Information with Occurrence of Communication, were tested using logistic regression analysis. Relationships among the independent variables with Length and Content of Communication were tested using multiple regression analysis. Of the 360 patients who were observed and asked to participate in an interview, 304 (84%) provided usable responses. Significant relationships (P < 0.01) were found for Prescription Transfer by the Pharmacist and Importance of Information with Occurrence of Communication. Prescription Transfer by the Pharmacist was found to be a mediating variable for Counselor Role Orientation, Importance of Information, and Lack of Time with Occurrence of Communication. Multiple regression analysis results showed positive relationships for Importance of Information and Patient Counselee Role Orientation with Length and Content of Communication. The results can be used for improving communication between pharmacists and patients to foster appropriate medication use by patients.

Communication↗