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Health professionals' and consumers' views on the role of the pharmacy personnel and the pharmacy service in Hanoi, Vietnam--a qualitative study.

OBJECTIVES: To explore the views of health professionals and consumers concerning (i) the role of the pharmacy personnel and (ii) the pharmacy service in Hanoi, Vietnam. METHOD: A qualitative approach influenced by both content analysis and phenomenography was used. The different groups of participants were selected by purposive sampling, whereas the representatives from each group were selected based on availability. Data were collected by means of face-to-face interviews. Pre-tested, semi-structured interview guides were used. The interviews were tape-recorded and transcribed. The analysis followed commonly applied procedures in qualitative research. The views of the respondents were categorized and described concerning the main issues. RESULTS: A total of 21 interviews were conducted with six pharmacists, five medical doctors, five pharmacy students and five pharmacy customers. An interpreter was used in 16 cases. The role of the pharmacy personnel was viewed in three different ways, as: counsellor, doctor's assistant or businessman. It was also believed that sometimes the pharmacy personnel might play a double role--both as doctor and pharmacist. They were considered to have a passive or active role in the provision of information to the customers. Some of the subjects put emphasis on the quality of the information given, and some others considered the information given at the pharmacies as merely a reiteration of the doctor's instruction. Concerning the pharmaceutical field in general, three different categories could be discerned, which describe the interviewee's perspective on the main actors influencing pharmacy practice: a mutual, a central and an individual perspective. CONCLUSION: This study describes different ways of viewing the role of the pharmacy personnel and the pharmacy service in Hanoi. The estimation of the impact of the different views on the pharmacy profession in Hanoi requires another kind of study.

Adult↗

A comparison of brand-name drug prices between Canadian-based Internet pharmacies and major U.S. drug chain pharmacies.

BACKGROUND: Many Americans have been purchasing their medications from online Canadian pharmacies. Although it is commonly perceived that medications are less expensive in Canada than in the United States, little research has been done to quantify this difference. OBJECTIVE: To compare the prices of retail brand-name medications between Canadian Internet pharmacies and major U.S. drug chain pharmacies with online pricing. DESIGN: Cross-sectional study. SETTING: 12 Canadian Internet pharmacies and 3 major online U.S. drug chain pharmacies. MEASUREMENTS: The authors calculated the per unit and annual savings (in U.S. dollars) for an American if he or she were to buy the 44 brand-name medications most commonly purchased through the Internet from Canadian Internet pharmacies instead of from an online U.S. drug chain pharmacy. RESULTS: Americans can save a mean of approximately 24% per unit of drug if they purchase their medications from Canadian Internet pharmacies instead of from major online U.S. drug chain pharmacies. Forty-one of the 44 brand-name medications examined were less expensive in Canada. The medications offering the largest mean yearly savings were Zyprexa (olanzapine) (Eli Lilly, Indianapolis, Indiana) (1159 dollars), Actos (pioglitazone) (Eli Lilly, Indianapolis, Indiana) (852 dollars), and Nexium (esomeprazole) (AstraZeneca, Wilmington, Delaware) (772 dollars). Only 3 medications, all in the erectile dysfunction category, were more expensive in Canada. LIMITATIONS: Potential savings may vary because of temporal fluctuations in drug prices. CONCLUSIONS: Brand-name medications are often substantially less expensive when purchased from Canadian Internet pharmacies instead of from major online U.S. drug chain pharmacies.

Canada↗

Qualifications for future hospital pharmacy directors as perceived by pharmacy directors and hospital administrators in Wisconsin.

Hospital pharmacy directors and administrators in Wisconsin were surveyed to determine their perceptions of the responsibilities, skills, postgraduate education, training, and experience necessary for hospital pharmacy directors during the next 10 years. Packages containing two identical questionnaires were mailed in April 1985 to the pharmacy directors at all 159 hospitals in Wisconsin. The pharmacy director and his or her immediate supervisor were asked to use a 5-point Likert-type scale to rate the importance of various responsibilities and skills and also to rank the most important responsibilities, skills, and issues. In addition, respondents answered forced-choice questions about postgraduate education and training and an open-ended question about academic coursework. All responses were compared by respondent characteristics and hospital size. There was a response rate of 48.1% to the questionnaire, representing 60.7% of the pharmacy directors (n = 96) and 34.6% of the administrators (n = 55). Both groups agreed on which responsibilities and issues will be very important (mean importance rating of greater than 4) for future pharmacy directors. However, administrators rated clinical and technical skills as significantly more important than did pharmacy directors. Only 48% of pharmacy directors believed that a residency is essential and preferred either a general or administrative residency coupled with an advanced degree, whereas more than 50% of the responding administrators favored residencies not affiliated with a degree program. The majority of pharmacy directors and administrators believed that both general staff and administrative experience is necessary for future pharmacy directors.(ABSTRACT TRUNCATED AT 250 WORDS)

Education, Pharmacy↗

Legal status and functions of hospital-based pharmacy technicians and their relationship to clinical pharmacy services.

The relationships among (1) laws and regulations governing hospital-based pharmacy technicians, (2) functions pharmacy technicians perform, and (3) pharmacists' provision of clinical pharmacy services were studied. A state-level technician-restriction score was developed, based on state rules and regulations in effect in 1989. Scoring included (1) type of supervision required for hospital-based pharmacy technicians, (2) ratio of technicians to pharmacists, (3) pharmacist-only reconstitution of injectable products, and (4) pharmacist-only counting and pouring. Actual use of hospital pharmacy technicians was measured with the technician-use index, and overall provision of clinical pharmacy services was measured with the pharmaceutical-care index. Based on the technician-restriction scores, 25 states and the District of Columbia were categorized as having less restrictive laws and 25 states as having more restrictive laws. Technician use varied with hospital size, teaching affiliation, owner-ship, type of drug delivery system, and education level of the director of pharmacy. Use of pharmacy technicians increased with the severity of hospital-patient illness treated. A fair correlation was found between the pharmaceutical-care index and the technician-use index. A positive association was found between pharmacy technician use and pharmacists' provision of clinical pharmacy services.

Certification↗

[Historical study of clinical pharmacy education in Japan (part 1). The founding and history of the one-year graduate course of clinical pharmacy practice (yakugaku senkouka) at the Meijo University].

Since there was an increasing demand for highly educated pharmacists with clinical experience, a one-year graduate course in clinical pharmacy practice (Yakugaku Senkouka) was established at Meijo University in 1975. This was aimed to provide pharmacists a training program for clinical skills and hospital settings. The course became a leading school in clinical pharmacy education in Japan. The present study describes what it was like and how it contributed to the development of clinical pharmacy in the country. In this article, the history is divided into five terms ranging from 1975 to 2002. The first term (1975-1979): To introduce the educational system, a system that was modeled on those in USA was introduced. The curriculum of clinical clerkship and the methods for evaluating training process were devised. The second term (1980-1984): Clinical clerkships were systematized and modified to fit to society. A manual textbook for training in clinical pharmacy was edited. The third term (1985-1989): The activities in the course were recognized as a new professional practice of pharmacists in Japan under The New Medical Law and The Law of Healthcare Insurance. The fourth term (1990-1995): Clinical pharmacy became popular nationwide. In Meijo University, a new challenge was made to merge clinical pharmacy skills with scientific backgrounds. The fifth term (1996-2002): To cope with the trends of extending undergraduate pharmacy education to six years, it has been decided that the course will be reorganized into a 2-year master's course in clinical pharmacy and accepted as a graduate course in 2003. The history of the course, a forerunner of clinical pharmacy education in Japan, ended in 2002.

Education, Pharmacy, Graduate↗

Simulated patients in the community pharmacy setting. Using simulated patients to measure practice in the community pharmacy setting.

BACKGROUND: Performance measurement and quality of care in community pharmacy settings is problematic because of the lack of formal patient registration and the resultant risk of selection bias. Although simulated patients have been used for teaching and education purposes, particularly in medical settings, their use as a research tool requires exploration in other health settings. The purpose of this paper is to describe how we used simulated patients to measure professional performance of community pharmacy staff. METHOD: Sixty pharmacies participated in a randomised controlled trial (RCT) to evaluate the effectiveness and efficiency of two guideline implementation strategies in the community pharmacy setting. The primary outcome measure for the study was derived from assessment forms completed by simulated patients following covert visits to participating pharmacies. RESULTS: Of the 420 simulated patient visits scheduled, 384 (91%) were completed. Nine visits were reported by pharmacy staff using reply-paid postcards, four of which concurred with known SP visits. Each detected visit was made by a different SP. In a post-intervention survey, 26 (52%) pharmacists stated they had been apprehensive about the use of simulated patients as part of the study, however, 41 (82%) pharmacists agreed that SP visits were an acceptable research method to use in a community pharmacy setting. DISCUSSION: Simulated patients are a feasible method of assessing professional performance in community pharmacy settings and overcome the methodological problems of other measurement methods. Further research is needed to assess the reliability and validity of simulated patients.

Adult↗

Pediatric pharmacy practice guidelines. Pediatric Pharmacy Administrative Group Committee on Pediatric Pharmacy Practice.

Pediatric patients are unique because of age-specific differences in metabolic capacity, disease processes that may make commercially available pharmaceutical preparations unacceptable for use, a lack of published information on the effects of many new pharmacotherapeutic agents in this population, and changes in population demographics caused by new diseases (e.g., AIDS) and new technologic applications. Comprehensive pharmaceutical services are essential for maximizing the benefits--while avoiding or minimizing adverse effects--of pharmacotherapy and new technologies. Comprehensive pharmaceutical services can help maximize the use of health-care resources in the pediatric population and assist in the development, implementation and evaluation of new methods of treatment that will benefit children everywhere.

Humans↗

Survey of the levels of satisfaction with pharmacy practice among third-year students in the Faculty of Pharmaceutical Sciences, Health Sciences University of Hokkaido--influence of experience in voluntary training at a community pharmacy and plans after graduation.

Pharmacy practice, which is executed in the taught of pharmaceutical sciences in Japan, has been assessed and improved student questionnaires. The levels of student satisfaction with the practice are expected to be influenced by their plans after graduation and their experience of training in pharmacies. However, there are few reports analyzing the information in the questionnaires from these viewpoints. In this report, we surveyed the levels of satisfaction of 148 third-year students in the Faculty of Pharmaceutical Sciences of the Health Sciences University of Hokkaido using questionnaires and analyzed the influence of the students' background on the levels of satisfaction with pharmacy practice. Almost half of the students had received voluntary training in hospital and/or community pharmacies. Concerning plans after graduation, 36.5%, 27.7%, and 21.6% wanted to become community pharmacists, hospital pharmacists, and graduate students, respectively. More than 70% of the students were well satisfied with all the programs of practice. The levels of satisfaction with the overall practice and prescription analysis were significantly higher among students who had experienced training in pharmacies than among those who had not. Students who planned to become hospital pharmacists were more satisfied with manners seminars, one-dose package practice, and practice in a simulated pharmacy than the students who planned to enter the other field. Such surveys are useful for finding points for improvement and the development of new curricula when the assessment of pharmacy practice takes student background into consideration.

Clinical Clerkship↗

Investigation of patients' demand for community pharmacies: relationship between pharmacy services and patient satisfaction.

We performed an investigation on the patients' demand for community pharmacy based on the analysis of questionnaire responses on community pharmacy services from the patients at 32 pharmacies in Tokyo and Osaka. In the previous study, we developed seven evaluation indices for pharmacy services, and showed that the functions most sought by patients in the "ideal pharmacies" were "Attitude of pharmacy/pharmacist", "Convenient hours" and "Information management". The objective of this study is to determine the relationship between these pharmacy functions and patient satisfaction by analyzing responses from the same questionnaire survey. Overall satisfaction score with the "pharmacy used today" was employed as the dependent variable, while the six factors derived from the 26-item evaluation scale in the questionnaire by factor analysis were used as the independent variables. As a result of analysis, it was found that four variables had a significant positive correlation with patient satisfaction, one had a significant inverse correlation, and one showed no significant correlation (p < 0.05). These results suggest that: attitude of the pharmacists such as general attitude and specialized activities of pharmacy/pharmacist such as providing information and explanations, and convenience of hours are not only judged to be important by patients, but also influence their satisfaction; comfortable facilities and availability of OTC drugs, while rated relatively low by patients in terms of importance, do influence their satisfaction; and convenience of location does not influence patient satisfaction. It was also indicated that insufficient inventories of prescribed medications have an impact upon patient satisfaction. This investigation offers evidence to provide patient-based pharmacy services.

Adult↗

Pharmacy students' perceptions of tobacco sales in pharmacies and suggested strategies for promoting tobacco-free experiential sites.

OBJECTIVE: The objectives of this report were to estimate the extent to which pharmacy student perceptions are aligned with the 2003 resolution of the American Association of Colleges of Pharmacy (AACP) addressing the use of experiential sites that sell cigarettes and other tobacco products. METHODS: Pharmacy students participating in a national tobacco cessation training program completed posttraining survey instruments and indicated their opinion about tobacco sales in pharmacies. Responses were examined with respect to students' sex and tobacco use status. RESULTS: Of 3,064 students, 3.5% were in favor of tobacco sales in pharmacies. Opinions varied by students' sex (p < 0.001) and tobacco use status (p < 0.001); in logistic regression analyses, males (OR = 2.62; 95% CI, 1.77, 3.89) and current tobacco users (OR = 2.31; 95% CI, 1.41, 3.76) were most likely to be in favor of tobacco sales. CONCLUSION: Few pharmacy students are in favor of tobacco sales in pharmacies. Given the overall lack of support, and acting in accordance with the 2003 AACP resolution, pharmacy schools are encouraged to use only experiential sites that do not sell tobacco products. Suggested strategies for moving toward this goal are presented.

Female↗

Diagnosis and treatment of presumed STIs at Mexican pharmacies: survey results from a random sample of Mexico City pharmacy attendants.

OBJECTIVES: People in developing countries often seek medical advice for common ailments from pharmacies. As one example, pharmacists routinely diagnose and treat symptomatic sexually transmitted infections (STIs). We aimed to assess the quality of advice provided in Mexico City pharmacies by presenting hypothetical STI related syndromes and recording pharmacy attendants' suggested diagnoses and treatments. METHODS: We interviewed the first available attendant in each of a 5% random sample of Mexico City's pharmacies. We inquired about the training, age, and experience of the attendant and about the typical number of clients coming for treatment of suspected STIs. After considering three hypothetical case studies, attendants recommended diagnoses, treatments, and, sometimes, physician follow up. RESULTS: Most Mexico City "pharmacists" are actually clerks, with trained pharmacists rarely available on the premises. The average pharmacy attendant was 32 years old, with a median of 5 years' experience at that pharmacy, but very limited (if any) training. 62% reported seeing 10 or more clients with genital or vaginal infections per month. Depending on the case study, attendants provided appropriate diagnoses in 0-12% of cases, recommended appropriate treatments in 12-16% of cases, and suggested physician follow up for 26-67% of cases. CONCLUSIONS: In general, surveyed pharmacy personnel were unable to diagnose accurately or offer appropriate treatment advice when presented with classic, common STI symptoms. Given the volume of clients seeking advice from this source, training pharmacy attendants could significantly help to reduce the burden of disease associated with STIs in Mexico City.

Adolescent↗

Evaluation of recent pharmacy graduates' practice patterns, professional lifelong learning, pharmacy organization memberships, and salary.

OBJECTIVES: To document information on recent bachelor of science (B.S.) pharmacy graduates' practice patterns, professional lifelong learning (PLL) methods, pharmacy organization memberships, and salary. The association between advanced training and education on PLL methods, pharmacy organization membership, and salary are explored. DATA SOURCES: Pertinent literature was identified by MEDLINE searches (1966-1992). STUDY DESIGN: The results of a Fall 1991 survey of recent B.S. pharmacy graduates (n = 371) of the University of Wisconsin School of Pharmacy are reported (55 percent response rate). RESULTS: Hospital pharmacists devoted more time to PLL outside of work (18.00 +/- 17.89 h/mo) than community pharmacists (9.93 +/- 8.76 h/mo), t = 5.02, degrees of freedom (df) = 289, p < 0.001. Graduates who had completed an advanced degree program, residency, or fellowship (advanced degree/training [ADT]) spent more time in PLL (17.76 +/- 10.63 h/mo) compared with graduates who had only obtained a B.S. degree (10.63 +/- 8.56 h/mo), t = 3.80, df = 311, p < 0.001. Graduates who had ADT were more likely to belong to multiple pharmacy organizations (2.14 +/- 1.38 organizations) than hospital pharmacists (1.61 +/- 1.27 organizations) and community pharmacists (1.11 +/- 1.06 organizations). Of the pharmacists who graduated in 1989 and 1990 (one to two years postgraduation), 55 percent belonged to the American Pharmaceutical Association. This declined to 19 percent of the graduates from 1984 and 1985 (six to seven years postgraduation), a 62 percent decline in membership. Membership in the American Society of Hospital Pharmacists (ASHP) was held by 19 percent of graduates one to two years after graduation; and 34 percent of graduates belonged to ASHP six to seven years after graduation, an 81 percent increase. Graduates with ADT (compared with graduates with the B.S. degree only) showed the strongest correlation of membership affiliation, which was about equal with ASHP (phi = 0.32) and ACCP (phi = 0.33). Although pharmacists changed their individual pharmacy organization memberships during the first seven years after graduation, there was no evidence of a decline in overall interest in pharmacy organization membership. Pharmacists who had completed ADT had an annual mean salary of $51,112 +/- $10,012; those pharmacists who did not complete an ADT program had an annual mean salary of $46,440 +/- $7802, a difference of $4672 per year. Hospital pharmacists who had obtained ADT had an annual mean salary of $51,840 +/- $9765; B.S. pharmacists without ADT in hospital practice had an annual mean salary of $43,603 +/- $8192, a difference of $8237 per year. CONCLUSIONS: Pharmacists' PLL methods, organization memberships, and salaries varied significantly by their practice site and the completion of an ADT program.

Education, Pharmacy, Continuing↗

Service preferences differences between community pharmacy and supermarket pharmacy patrons.

Differences in service preferences between patrons of supermarket and chain pharmacies were determined. Subjects fell into two groups: patrons of a supermarket chain's pharmacies and patrons of the same supermarket chain who patronized other community chain pharmacies for prescription drug purchases. Subjects were asked to prioritize services in terms of convenience and impact on pharmacy selection. Differences in service preferences emerged. Community pharmacy patrons were more likely to rate easy navigation through a pharmacy and 24 X 7 hours of operation as key services. Supermarket pharmacy patrons were more likely to rate one-stop shopping and adequate hours of operation as priorities. Both groups rated basic services such as maintenance of prescription and insurance information as priorities. Pharmacies should stress the delivery of basic services when trying to attract customers.

Adult↗