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PubMed2006

Revisiting pharmacists' refusals to dispense emergency contraception.

Pharmacists' refusals to fill prescriptions for emergency contraceptives for reasons of conscience have contributed to a national debate regarding the permissibility of such actions. Some in the medical community assert that pharmacists ought not to refuse to dispense emergency contraceptives on this basis. Three lines of argument have become prominent in defense of that position: 1) the professional status of pharmacists does not allow for refusal to dispense legitimately written prescriptions, 2) the medical facts regarding the mechanism of action of emergency contraception are often misunderstood, misrepresented, or both, and 3) refusals by pharmacists to fill legitimate prescriptions undermine patient care. In this commentary, these arguments are rejected as missing the central point of the issue, which is that pharmacists are autonomous, moral agents who are accountable for their choices and entitled-within limits-to decide in which activities they will participate. Pharmacists' professionalism is defended, their responsibilities in the provision of drug therapy are set forth in the context of pharmaceutical care, and these lead to the conclusion that pharmacists' refusals may be ethically justified. There are important limits on how pharmacists may respond when they are being asked to participate in actions they find morally objectionable. Notably, they must ensure that these prescriptions are filled by someone else in a timely manner and must refrain from any abusive or demeaning treatment of patients, as summed up in our Principle of Conscientious Refusal to Dispense.

Contraceptives, Postcoital↗

PubMed2007

Effect of clinical pharmacists on utilization of and clinical response to antiretroviral therapy.

OBJECTIVE: To determine the association of clinical pharmacists with health outcomes and utilization measures among HIV-infected patients. METHODS: Observational study of 1571 HIV-infected patients prescribed their initial highly active antiretroviral therapy (HAART) regimen in clinics with and without a clinical pharmacist. Outcomes analyzed were changes in plasma HIV RNA level, CD4 T-cell counts, and service utilization (hospital days, emergency department visits, and office visits) over 24 months based on exposure to a clinical pharmacist. RESULTS: Patients exposed to a clinical pharmacist tended to be more likely to achieve an HIV RNA level <500 copies/mL at 12 months (adjusted odds ratio [OR] = 2.01, 95% confidence interval [CI]: 0.92 to 4.37). At 24 months, however, results depended on the provider panel size; the ORs for panel sizes < or =50 and >50 HIV-infected patients were 1.67 (95% CI: 0.60 to 4.62) and 0.97 (95% CI: 0.39 to 2.41), respectively. CD4 T-cell counts were modestly but nonsignificantly higher for the patients exposed to a clinical pharmacist. Utilization also depended on the provider panel size; pharmacist exposure was associated with 64% (95% CI: 30% to 108%) and 9% (95% CI: -11% to 33%) increases in total hospital days for panel sizes < or =50 and >50 HIV-infected patients, respectively. Pharmacist exposure was also associated with a 19% (95% CI: -13% to -24%) decrease in office visits for panel sizes < or =50 HIV-infected patients, with minimal effect for larger panel sizes. CONCLUSION: Clinical pharmacists seem to contribute to lower office visit rates in antiretroviral-naive patients initiating HAART.

Adult↗

PubMed1996

Residential differences in the use of pharmacies by older adults and their communication experiences with pharmacists.

This investigation compares adults (65 and older) living in two different types of communities on the characteristics of the pharmacies they use and their patterns of communicating with pharmacists. Telephone interviews were conducted with a random sample (N=400) of respondents, half residing in six nonmetropolitan counties (containing no towns of more than 4,000) and the other half in a single city (population approximately 130,000) located within a metropolitan county. Elders living in the sparsely populated nonmetropolitan areas were more apt to purchase their medications from an independent neighborhood pharmacy than their counterparts who lived in the large city. These pharmacies, however, were more likely to be located in another town. Differences between residential groups were also observed in the communication patterns that older patients had with their pharmacists. Elders residing in sparsely populated areas reported more frequent conversation with their pharmacists about general topics, although not about medicines or other health-related topics. The elders living in small and remote places also reported that they talked with their pharmacists longer, that communication about medications were more often initiated by the pharmacist, and that they were more likely to talk about their medications directly with their pharmacist rather than a non-pharmacist employee. The overall greater frequency of contact and communication between nonmetropolitan elders and their pharmacists would seem to be precursors to establishing a positive provider-client relationship and may increase the probability of more personal, medication-related discussions. Further research is needed, however, to determine if these potentials are transformed into realities and if they lead to more positive medical outcomes for older persons.

Aged↗

PubMedDate not supplied

Effects of computer-based prescribing on pharmacist work patterns.

OBJECTIVE: To measure the effect of computer-based outpatient prescription writing by internal medicine physicians on pharmacist work patterns. DESIGN: Work sampling at a hospital-based outpatient pharmacy. Data were collected from pharmacists wearing silent, random-signal generators before and after the implementation of computer-based prescribing. MEASUREMENTS: The type of work performed by pharmacists (activity), the reason for their work (function), and the people they contacted (contact) were measured. RESULTS: Total staff hours and prescriptions handled were similar before and after computer-based prescribing. Pharmacists recorded 4,687 observations before and 4,735 observations after implementation of computer-based outpatient prescription writing. After implementation, pharmacists spent 12.9 percent more time correcting prescription problems, had 3.9 percent less idle time, and spent 2.2 percent less time in discussions with others. Pharmacists also spent 34.0 percent less time filling prescriptions, 45.8 percent more time in problem-solving activities involving prescriptions, and 3.4 percent less time providing advice. Over 80 percent of pharmacist time was spent working alone both before and after computer-based outpatient prescription writing. CONCLUSION: Computer-based prescribing results in major changes in the type of work done by hospital-based outpatient pharmacists and in the reason for their work and small changes in the people contacted during their work.

Clinical Pharmacy Information Systems↗

PubMed1983

The pharmacist as a member of the CPR team: evaluation by other health professionals.

Physician and nurse evaluation of the pharmacist's participation on the cardiopulmonary resuscitation (CPR) team was studied, in an attempt to justify the pharmacist's role. A pharmacist-evaluation questionnaire was prepared, based on the Likert Method. This questionnaire contained ten statements related to organizational and mechanical contributions, drug information contributions, and overall contribution and desire, by other health professionals, for continuance of this service. Pharmacists attended all CPRs during a six-month period and distributed a questionnaire to one physician and one nurse in attendance. Verification was obtained that these individuals had attended previous arrests where pharmacists were not in attendance. Only those evaluations that were completed and returned by the physician or the nurse, to the Department of Pharmaceutical Services, were evaluated. Results indicated that physicians and nurses are in agreement with the pharmacist's organizational and mechanical contribution. Both physicians and nurses tended toward agreement with the pharmacist's drug information contribution. Finally, physicians and nurses are in agreement with the pharmacist's overall contribution to the CPR team and desire continuance of this service.

Humans↗

PubMed1983

Toward a rational approach to the issue of prescribing authority for pharmacists.

The issue of expanded prescriptive authority for pharmacists has been gaining momentum for some time and has resulted in legislation in California and Washington and clarification of legislation in Oregon allowing expanded prescribing prerogatives for pharmacists. In April 1982, the American Pharmaceutical Association Policy Committee on Professional Affairs recommended that a policy statement be adopted endorsing the concept that pharmacists have the independent authority to select and dispense pharmaceutical and therapeutic alternates. The importance of the pharmacist as a health professional strategically placed and generally qualified to contribute significantly to the optimization of drug therapy outcomes cannot be denied. The advocacy of independent authority for all pharmacists to select pharmaceutical alternates, and particularly therapeutic alternates, appears to be premature, however. Orderly transition and constructive evolution of expanded prescriptive authority for pharmacists requires: (1) a comprehensive, introspective self-analysis of the current status of pharmacy practice; (2) establishment of a communication system between pharmacist and physician that will optimize drug therapy; (3) improved recognition by pharmacy of the complexity involved in drug selection and patient monitoring; and (4) development of a process for establishing credentials that would certify the competency of pharmacists to perform defined prescribing functions.

Communication↗

PubMed2003

[The expected role of community pharmacist in society].

With recent advances in the separation of dispensing and prescribing drugs (Bungyo), the social role of community pharmacists has expanded. Therefore we carried out a questionnaire survey on the "image of community pharmacists" among patients/the public, physicians, and community pharmacists. The understanding of their role by community pharmacists differed slightly from that by patients/the public or physicians. Better mutual understanding among the three parties is necessary for smooth communication. Dispensing and handing over drugs to patients are not the only tasks required of community pharmacists. Evaluation of records of telephone drug counseling by the Japan Pharmaceutical Association revealed that many callers desired not only drug information but also the opinions and judgments of pharmacists. Providing drug information is an important task for community pharmacists. In addition, counseling on anxiety and worries about health may be necessary. Bungyo has also affected drug distribution. In this field, the role of community pharmacists in providing drug information may markedly change in the future.

Community Pharmacy Services↗

PubMedDate not supplied

The Aggregate Demand Index: measuring the balance between pharmacist supply and demand, 1999-2001.

OBJECTIVE: To describe the development and 2-year performance of the Aggregate Demand Index (ADI) survey, a tool for longitudinally tracking the difficulty of filling open pharmacist positions throughout the United States. DESIGN: From August 1999 through July 2001, panelists completed a monthly survey on the difficulty of filling open pharmacist positions by state. Results are reported on the Web (www.pharmacymanpower.com). SETTING: Panelists estimated difficulty filling pharmacist vacancies in the community, institutional, both community and institutional, and nonpatient care pharmacy settings. PARTICIPANTS: A panel of individuals involved in the direct hiring of pharmacists. INTERVENTION: A monthly survey. MAIN OUTCOME MEASURES: Monthly indices reflecting the level of difficulty filling open pharmacy positions at the state, regional, and national levels and by pharmacy position type. Over time, these data formed a longitudinal record of the balance between the supply of and demand for pharmacists. RESULTS: Cumulative data from 50 states and the District of Columbia showed, on average, excess demand over available supply. The five states with the highest unmet demand level (i.e., where it was most difficult to fill open positions) were Minnesota, California, Wisconsin, Iowa, and Kentucky. The only states in which demand was in balance with supply were Hawaii and Rhode Island. Over 2 years, at least 92% of the U.S. population each month resided in areas where demand for pharmacists exceeded supply. The demand level in the Northeast was significantly lower than in other regions. Unmet demand was greatest for organizations with both community and institutional positions and least for organizations with primarily community positions. CONCLUSION: For the study period, the demand for pharmacists exceeded the available supply in the United States; ADI survey data indicated than open pharmacist positions were "somewhat difficult" to "difficult" to fill. Substantial but unexplained differences were noted by state, by region, and by type of pharmacy position. Other health care professions could use the ADI survey methodology to study workforce issues.

Pharmacies↗

PubMedDate not supplied

Community pharmacists' work activities in the United States during 2000.

OBJECTIVES: To describe community pharmacists' work activities in the United States during 2000 and to investigate the effects of position, pharmacy type, and prescription volume on work activities. DESIGN: Cross-sectional descriptive survey of a systematic sample of 4,895 U.S. pharmacists, of which 2,250 responded. SETTING: United States. PARTICIPANTS: A sample of 832 community pharmacists working full-time (at least 30 hours per week) out of the total of 2,250 who responded to the survey. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Workload (hours worked and proportion of prescriptions dispensed at the site with which the pharmacist was personally involved) and professional responsibilities (proportion of time spent in medication dispensing, consultation, business management, and drug use management). RESULTS: As of 2000, the typical community pharmacist in the United States devoted 56% of his or her time to medication dispensing responsibilities, 19% to consultation responsibilities, 16% to business management responsibilities, and 9% to drug use management responsibilities. These results were consistent for pharmacists regardless of pharmacy type or prescription volume; however, position did significantly affect the proportion of time spent in the various activities. CONCLUSION: Pharmacists are still devoting the majority of their time to medication dispensing responsibilities. However, our findings also show that pharmacists would prefer to devote more of their time to professional responsibilities, such as consultation and drug use management, and less time to medication dispensing and business management.

Adult↗

PubMedDate not supplied

Implementing personal digital assistant documentation of pharmacist interventions in a military treatment facility.

OBJECTIVE: To describe the use of personal digital assistants (PDAs) in documenting pharmacists' clinical interventions. SETTING: Evans Army Community Hospital (EACH), a 78-bed military treatment facility, in Colorado Springs. PARTICIPANTS: Pharmacists on staff at EACH. PRACTICE DESCRIPTION: All pharmacists at EACH used PDAs with the pilot software to record interventions for 1 month. The program underwent final design changes and then became the sole source for recording pharmacist interventions. The results of this project are being evaluated every 3 months for the first year and yearly thereafter. PRACTICE INNOVATION: Visual CE (Syware Inc. Cambridge, Mass.) software was selected to develop fields for the documentation tool. This software is simple and easy to use, and users can retrieve reports of interventions from both inpatient and outpatient sections. The software needed to be designed so that data entry would only take a few minutes and ad hoc reports could be produced easily. MAIN OUTCOME MEASURES: Number of pharmacist interventions reported, time spent in clinical interventions, and outcome of clinical intervention. RESULTS: Implementing a PDA-based system for documenting pharmacist interventions across ambulatory, inpatient, and clinical services dramatically increased reporting during the first 6 months after implementation (August 2004-February 2005). After initial fielding, clinical pharmacists in advanced practice settings (such as disease management clinic, anticoagulation clinic) recognized a need to tailor the program to their specific activities, which resulted in a spin-off program unique to their practice roles. CONCLUSION: A PDA-based system for documenting clinical interventions at a military treatment facility increased reporting of interventions across all pharmacy points of service. Pharmacy leadership used these data to document the impact of pharmacist interventions on safety and quality of pharmaceutical care provided.

Computers, Handheld↗

PubMedDate not supplied

Perception of managerial and administrative competencies of professional pharmacists in the U.S. Department of Defense.

OBJECTIVE: To determine whether executive and junior pharmacists perceive skills, knowledge, and abilities (SKA) items differently. DESIGN: Two-factor split-plot analysis of variance (ANOVA) mixed design with repeated measures. SETTING: U.S. Department of Defense (DoD). PARTICIPANTS: One hundred fifty-one active duty pharmacy officers in DoD, classified as either executive pharmacists (serving in the military grades of lieutenant colonel/commander [0-5] and colonel/captain [0-6], as well as pharmacists selected for promotion to those grades) or junior pharmacists (serving in the military grades of second lieutenant/ensign [0-1], first lieutenant/lieutenant junior grade [0-2], and captain/lieutenant [0-3], as well as pharmacists selected for promotion to those grades). INTERVENTION: Seven-point relative importance rating scales, with 1 = extremely unimportant to 7 = extremely important, were used to assess respondents' judgments of SKAs. MAIN OUTCOME MEASURES: Main effects of group membership (executive versus junior pharmacists), differences among items within eight specific domains, and assessment of potential interaction effects for the dependent variable of SKA item importance ratings. RESULTS: No main effects for overall rating differences between pharmacist groups were found for any of the eight domains; however, statistically significant and systematic within-main-effect differences were detected for SKA items in all domains. Additionally, statistically significant interaction effects emerged in five of the eight domains. CONCLUSION: The importance ratings given SKAs in the domains of human resources, pharmacy operations and business practices, drug therapy management, and leadership were highly similar between the two groups. However, executive pharmacists tended to place a much greater emphasis on the importance of SKAs within the financial resources and the pharmacy benefit management domains.

Adult↗

PubMedDate not supplied

North Carolina family practice physicians' perceptions of pharmacists as vaccinators.

OBJECTIVE: To determine whether family practice physicians are aware that pharmacists can administer vaccines and assess their support of pharmacists as vaccinators. DESIGN: Cross-sectional study. SETTING: North Carolina. PARTICIPANTS: 571 family practice physicians. INTERVENTIONS: Mail survey. MAIN OUTCOME MEASURES: Physician attitudes toward pharmacists' involvement with a variety of vaccines and patient populations. RESULTS: A total of 25% of physicians correctly reported that pharmacists could administer vaccines in North Carolina, a state that had recently passed legislation permitting this practice. Almost 50% of the physicians supported pharmacists administering the influenza vaccine. Pharmacist administration of other vaccines received less support. Physicians who were newer to family practice had more positive attitudes than physicians who were in practice for longer periods of time. CONCLUSION: While agreeing that the role of the pharmacist in patient care is becoming more important, physicians were neither very knowledgeable about nor supportive of pharmacists as vaccinators.

Aged↗

PubMedDate not supplied

Patient evaluations of pharmacist performance with variations in attire and communication levels.

OBJECTIVE: To determine whether the attire of a pharmacist has any effect on how he is evaluated when a patient also considers the pharmacist's performance and to assess whether attire and performance interact to influence patients' evaluations. DESIGN: Randomized, cross-sectional, three-factor design. SETTING: Community pharmacy settings were portrayed. PARTICIPANTS: 179 university staff members. INTERVENTIONS: Videos of pharmacist-patient interactions were encoded and placed on a Web site to be viewed by participants. MAIN OUTCOME MEASURES: Service encounter satisfaction, perceptions of overall service quality, trust in the service provider, and behavioral intentions based on two levels of pharmacist communication performance (high or adequate), three levels of dress style (casual, business casual, formal), and two levels of white coat (wearing or not). RESULTS: Of the three independent variables, only communication performance was found to significantly influence the dependent variables. High communication performance resulted in higher satisfaction scores, higher perceptions of quality, higher levels of trust, and behavioral intention scores that reflected a greater willingness to use and recommend the pharmacist. CONCLUSION: Style of dress or whether the pharmacist was wearing a white coat did not significantly influence participants' evaluations of the pharmacist in this study. Rather, the level of the pharmacist's communication performance was the most important cue used by participants in their ratings of service encounter satisfaction, perceptions of overall service quality, and trust in the service provider.

Adult↗

PubMedDate not supplied

Pharmacists' attitudes toward diabetes and their involvement in diabetes education.

OBJECTIVE: To determine the relationship between pharmacists' attitudes toward diabetes and their involvement in diabetes patient education in the community setting. METHODS: Registered pharmacists in Arizona were mailed surveys regarding their attitudes toward diabetes and their involvement in diabetes patient education. Attitudes were measured using the Diabetes Attitude Scale (DAS); the types of educational skills evaluated were based on those recommended by the American Diabetes Association's Standards of Medical Care. RESULTS: Pharmacists' attitudes were significantly positive toward the need for special training for diabetes care, the importance of tight glycemic control, the team approach to care, and the preference for diabetes education in an outpatient setting (p < 0.001). The majority of the time, pharmacists provided basic patient education (52%) rather than intermediate or advanced patient education (26% and 27%, respectively). There was a negative correlation between the attitude that diabetes is a difficult disease to treat and pharmacists' involvement in diabetes patient education (p < 0.05). This indicates that, although pharmacists believe that diabetes is a treatable disease, they infrequently provide diabetes patient education. CONCLUSIONS: Overall, pharmacists had positive attitudes toward diabetes. These attitudes did not correlate with the degree of their involvement in diabetes patent education. More diabetes patient education through community pharmacists is needed.

Adult↗

PubMed1998

Management of patients with type 2 diabetes by pharmacists in primary care clinics.

OBJECTIVE: To determine the impact of clinical pharmacists involved in direct patient care on the glycemic control of patients with type 2 diabetes mellitus. DESIGN: Eligible patients included those with type 2 diabetes who received insulin or were initiated on insulin therapy by the pharmacists and were willing to perform self-monitoring of blood glucose. The pharmacists provided diabetes education, medication counseling, monitoring, and insulin initiation and/or adjustments. All initial patient interactions with the pharmacists were face-to-face. Thereafter, patient-pharmacist interactions were either face-to-face or telephone contacts. SETTING: Two primary care clinics in a university-affiliated Veterans Affairs Medical Center. PARTICIPANTS: Study subjects were patients with type 2 diabetes who were referred to the pharmacists by their primary care providers for better glycemic control. OUTCOME MEASURES: Primary outcome variables were changes from baseline in glycosylated hemoglobin, fasting blood glucose, and random blood glucose measurements. Secondary outcomes were the number and severity of symptomatic episodes of hypoglycemia, and the number of emergency room visits or hospitalizations related to diabetes. Twenty-three veterans aged 65-9.4 years completed the study. Fifteen (65%) patients were initiated on insulin by the pharmacists; 8 (35%) were already using insulin. Patients were followed for a mean-SD of 27-10 weeks. Glycosylated hemoglobin, fasting blood glucose concentrations, and random blood glucose concentrations significantly decreased from baseline by 2.2% (p = 0.00004), 65 mg/dL (p < 0.01), and 82 mg/dL (p = 0.00001), respectively. Symptomatic hypoglycemic episodes occurred in 35% of patients. None of these episodes required physician intervention. CONCLUSIONS: This study demonstrates that pharmacists working as members of interdisciplinary primary care teams can positively impact glycemic control in patients with type 2 diabetes requiring insulin.

Aged↗

PubMed2004

Pharmacist and physician collaboration in the patient's home.

OBJECTIVE: To review the historical perspective and current incidence of home visits by physicians and pharmacists, discuss the concept of pharmacists providing care "incident-to" the physician, and introduce a new endeavor of collaborative, incident-to home visits by a pharmacist and physician. DATA SOURCES: A literature search was performed using MEDLINE (1966-May 2003). The search terms used were home visit, house call, incident-to, collaborative care, physician, and pharmacist. STUDY SELECTION AND DATA EXTRACTION: All pertinent articles were evaluated. DATA SYNTHESIS: Home visits were once considered a hallmark of patient care, but have decreased to an average of 0.4 home visits per week for primary care physicians. Home visits are essential for patients unable to commute to the office due to a disability or illness. However, home visits also allow the physician to determine how conditions affect a patient's everyday life, in addition to assessing the living environment. Minimal documented evidence exists of pharmacists making home visits and no documented evidence exists of pharmacists and physicians collaboratively making home visits. The pharmacist complements the value of the visit by assessing medication appropriateness as well as medication administration, storage, accessibility, and adherence. CONCLUSIONS: Current practice styles often compromise services that were once paramount to patient care, as evidenced by a decline in home visits. Recent trends in health care attempt to compensate for high-volume practices and managed care restrictions. A collaborative relationship between a pharmacist and physician with visits into the patient's home is a movement toward improved continuity of care.

House Calls↗

PubMed2004

Evaluation of community pharmacists' recommendations to standardized patient scenarios.

BACKGROUND: Recent trends in the global nonprescription drug market show a massive increase in medicine availability to the general public. This places greater responsibility on community pharmacists to ensure that patients exercise self-care appropriately. This small study examined pharmacist performance in facilitating patient self-care. OBJECTIVE: To determine whether an appropriate course of action was taken by UK community pharmacists practicing in one geographic area when presented with 1 of 2 case scenarios: headache or abdominal pain. METHODS: A covert researcher, posing as a patient, spoke with the pharmacist on duty at each of 30 pharmacies, asking for advice on one of the scenarios. The pharmacist was interviewed and their responses were examined by an expert panel. RESULTS: Thirty pharmacies were visited resulting in 28 consultations, 14 each for both scenarios. Pharmacists performed better when counseling the "patient" with abdominal pain than headache. The majority of questions asked were categorized as being relevant by the panel (66% for headache, 89% for abdominal pain), although in both scenarios, the expected outcome of referral was observed only in 7 of the consultations for headache and in 8 cases for abdominal pain. Questioning centered on quantification and clarification of the presenting problem and rarely on questions related to history taking. CONCLUSIONS: Performance levels of the community pharmacists varied considerably. For all pharmacists to perform well, greater emphasis should be placed on eliciting information from the patient to ensure that the appropriate course of action is taken.

Abdominal Pain↗

PubMed2004

Attitudes of Finnish community pharmacists toward concordance.

BACKGROUND: Concordance is a new model of interaction between healthcare professionals and patients. The work of pharmacists and patients in the consultation is a negotiation between equals, and the aim is therapeutic alliance between them. OBJECTIVE: To assess Finnish community pharmacists' attitudes toward concordance and its perceived impact on pharmacist-patient consultations during a 4-year Finnish project (TIPPA Project 2000-2003) aimed at promoting patient counseling. METHODS: A survey of a random sample of 734 community pharmacists in Finland was conducted in 2002. The questionnaire included an attitudinal scale and 2 open-ended questions on the impact of the TIPPA Project on patient counseling. Attitudes toward concordance were measured using a modified version of the LATCon scale. The construct validity and internal consistency of the scale were evaluated using factor analysis and Cronbach's alpha. Mean summative factor scores (MSS) and 95% confidence intervals were calculated for each factor. The responses to the open-ended questions were content analyzed. RESULTS: A response rate of 51% (n = 376) was obtained. Almost 80% of the respondents strongly agreed that the highest priority in patient counseling was to establish a therapeutic alliance between the pharmacist and patient. Factor analysis of the attitudinal scale yielded 3 primary factors explaining 37.6% of the variance, interpreted as respecting patients' beliefs (alpha = 0.60; MSS = 1.90; 95% CI 2.25 to 2.40), establishing a therapeutic alliance (alpha = 0.65; MSS = 1.36; 95% CI 1.31 to 1.40), and sensitivity to patients' reactions (alpha = 0.66; MSS = 2.33; 95% CI 1.83 to 1.96). Results of the open-ended questions indicated that the TIPPA Project had a positive impact on pharmacists' attitudes toward concordance. CONCLUSIONS: Respondents to our survey were supportive of concordance. The TIPPA Project elicited a positive impact on pharmacists' attitudes toward counseling. Pharmacist education through programs such as TIPPA can aid in the implementation of a concordance-based counseling practice.

Adult↗