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PubMed2006

Flexible working: understanding the locum pharmacist in Great Britain.

BACKGROUND: There is a growing trend in Great Britain (GB) for pharmacists to work as self-employed "locums" rather than as permanent employees. Despite this trend, little is known about their work patterns or why they choose to pursue nonstandard forms of work. OBJECTIVES: The overall aim of the study was to explore why locums choose self-employment over a permanent contract and to explore a number of issues commonly associated with nonstandard working, such as marginalization and job satisfaction. METHODS: A qualitative interview study was undertaken. In-depth telephone interviews were conducted with 34 locum pharmacists randomly selected from the GB register of pharmacists. Locums from a range of age groups, different sectors of practice, and with different work patterns were selected to ensure that a wide range of experiences and views were covered. RESULTS: The need or desire for flexibility was the overriding factor for choosing to work as a locum. A wide range and variety of individual personal circumstances were important drivers, but a desire for work-life balance was fundamental to many. A variety of work patterns were found, ranging from those with more ad hoc working arrangements to those who worked in the same store on a regular basis. Avoiding stress, paperwork, and nonprofessional duties were among reasons for choosing to locum. Disadvantages associated with being a locum included being viewed and treated negatively by peers, and having fewer opportunities for training. No conclusive evidence could be found for locums being marginalized, except for the training issues for some pharmacists. The findings do suggest some cause for concern, with some locums selecting places to work on the basis of attitudes not congruent with socially inclusive approaches to public health care. CONCLUSIONS: The locum workforce is far from homogenous or uniform. Freelance working of this kind has advantages for the individual: freedom and independence. But there may be risks for the profession if nonstandard work practices become more widespread: isolation, lack of social cohesiveness, and amoral attitudes. Improving working conditions and practices may prevent pharmacists from leaving permanent positions.

Career Choice↗
PubMed2004

The role of pharmacists in the delivery of influenza vaccinations.

OBJECTIVES: The purpose of this study is to determine whether influenza vaccine rates have increased in states where pharmacists can give vaccines. METHODS: Secondary analysis of the Behavioral Risk Factor Surveillance System (BRFSS) from the years 1995 and 1999. Information regarding legislation allowing pharmacists to administer vaccines was obtained from the American Pharmaceutical Association. RESULTS: Individuals aged 65 years and older who lived in states where pharmacists could provide vaccines had significantly higher (P < 0.01) influenza vaccine rates than individuals of this age who resided in states where pharmacists could not provide vaccines. CONCLUSIONS: Allowing pharmacists to provide vaccinations is associated with higher influenza vaccination rates for individuals aged 65 years and older.

Adolescent↗
PubMed1995

Prescribing authority: an examination of Ohio pharmacists' opinions.

This study was conducted to determine the opinions of Ohio pharmacists about possible implementation of prescribing authority for pharmacists in the state. Questionnaires designed to determine pharmacists' opinions were mailed to a random sample of Ohio Pharmacists Association members. The overall net response rate was 44%. A majority of respondents preferred dependent prescribing authority under physician supervision. Respondents favored charging a fee for prescribing, although they did not expect the fee to be large enough to increase income substantially. A majority agreed that pharmacists should pass a qualifying exam and receive formal training to prescribe medications. A large number of respondents agreed that prescribing authority will lead to greater use of generic drugs and lower health care costs. For prescribing authority to succeed, it is suggested that appropriate protocols be developed in consideration of state requirements.

Attitude of Health Personnel↗
PubMed1994

Pharmacists' views on health care reform.

This study explored pharmacists' opinions on a reformed health care system. Questionnaires were mailed to 523 pharmacists about the structure, funding, cost control mechanisms, benefits, and features to be covered by a national health plan; 57.2% responded. The pharmacists showed no consensus regarding the basic structure of a national health plan. They favored increased taxes on alcohol and cigarettes to fund the plan and adamantly opposed increased individual income or employer payroll taxes. Pharmacists were not convinced that plan costs could be controlled. They strongly supported benefits for preventive services; however, they ranked coverage of outpatient prescription drugs relatively low. Pharmacists' opinions on health care reform differed according to position (e.g., owner or staff) and age.

Attitude of Health Personnel↗
PubMed1989

Pharmacists recovering from alcohol and other drug addictions: an interview study.

An interview study of 86 pharmacists recovering from alcohol or other drug addiction was conducted to describe their experiences during development of and recovery from the addiction. Patterned after similar studies of other recovering health-care professionals, the study permitted comparisons with these other groups. Many felt inadequately prepared to recognize or deal with warning signs of problems of addiction in themselves or others. Forty-four had been arrested; 45 had experienced unemployment because of drinking or other drug use; 16 lost their licenses. Eighteen reported suicide attempts, 13 by drug overdose. Most reported experiences that are regarded as late-stage events, although 50 had never been subject to board action because of their drinking and other drug use. The use of chemicals interfered with the pharmacists' lives long before they were consciously worried about it. For 18, recovery occurred through the assistance of mutual-help groups alone; others had a variety of treatment experiences. Fewer pharmacists reported addiction to only alcohol than did other health-care professionals. Very few reported addiction to parenteral drugs, a significant deviation from the other groups studied. Pharmacists differed from other groups also in that they were extra scrupulous in reporting acts of dishonesty associated with their addiction, which may make their behavior appear worse than that of the other groups when the opposite may be the case. The profession must begin to answer questions about how recovering pharmacists should be treated, and what the role of professional groups in their recovery is.

Adult↗
PubMed1990

Burnout among pharmacists.

A nationwide mail survey of a random sample of the American Pharmaceutical Association membership was conducted to study the degree of burnout among pharmacists and to identify individual and job characteristics that make a pharmacist susceptible to burnout. Analysis of 1,261 returned questionnaires (57.1% response rate) revealed moderate levels of burnout among pharmacists. The study found that the typical pharmacist who reported the highest level of burnout was a woman less than 40 years old, who works in a chain community pharmacy setting, and who has been in practice and in the same job for less than 10 years. Further work is needed to identify other personal and practice conditions that make pharmacists susceptible to burnout. In the meantime, employees are encouraged to establish interpersonal communications designed to identify and deal with signs of burnout.

Adult↗
PubMed2003

Construct identification and measure development for investigating pharmacist-patient relationships.

To investigate older adults' perceptions of pharmacist-patient relationships, we identified meaningful constructs, developed measures to use in this domain, and explored associations between pairs of constructs. Data were collected via mailed survey to a systematic random sample of 500 non-institutionalized adults in the United States, aged 65 years and older, taking at least one prescription medication. The usable response rate was 66.5% (330/496). Older adults' perceptions that the pharmacist is participating in the relationship and the relationship is patient-centered had the strongest association with perceived pharmacist-patient relationship quality. Older adults' perceptions of relationship quality had a stronger association with medication-related outcome expectations and self-efficacy for medication management, as compared to older adults' perceptions of pharmacist participative behavior/patient-centeredness, patient participative behavior and pharmacist-patient interpersonal communication. Older adults' perceptions of medication-related knowledge were moderately associated with self-efficacy for medication management perceptions. These findings have important pharmacy practice implications.

Aged↗
PubMed2001

Adolescents' use of emergency contraception provided by Washington State pharmacists.

STUDY OBJECTIVE: To increase knowledge about adolescents who obtained emergency contraceptive pills (ECP) directly from a pharmacist without first contacting a physician. DESIGN: Cross-sectional self-administered survey. SETTING: Fifteen randomly selected pharmacies providing ECP in western Washington State. PARTICIPANTS: Adolescents 15-21 years old (n = 126) who obtained ECP directly from a pharmacist. OUTCOME MEASURES: Responses to a 20-item questionnaire examining adolescents' reasons for seeking care from a pharmacist, need for additional medical evaluation, risk for not receiving additional medical care, and satisfaction with care provided by the pharmacist. RESULTS: The most common reasons for using the pharmacy were convenience (44%), lack of knowledge about alternatives (38%), and privacy (31%). If the pharmacy service were not available, 58% said they would see a doctor, 22% said they would wait to see if they got pregnant, and 20% did not know. Based on self-report, 81% of adolescents needed a new method of ongoing contraception, an evaluation for sexually transmitted disease, or both. Among these adolescents, 36% had risk factors for not receiving this care. Adolescents were satisfied with the pharmacy service; 94% said they would recommend the service to a friend. CONCLUSIONS: ECP provision by pharmacists is a useful way to increase access to emergency contraception. However, many adolescents using ECP need additional medical care. Programs designed to increase ECP access should use these opportunities to link adolescents with more comprehensive reproductive health care services.

Adolescent↗
PubMed1996

Response of community pharmacists to potential oral carcinoma.

This survey was performed to determine whether community pharmacists respond appropriately when they encounter an oral lesion of extended duration--which is a sign of potential oral carcinoma. An interviewer visited 101 community pharmacies in the Minneapolis-St. Paul area, Rochester, and St. Cloud, Minn. The interviewer told the pharmacist: "My grandmother has had an ulcer on the floor of her month for two or three months." Two-thirds of the pharmacists recommended purchasing a product available in the pharmacy; only one-third recommended an appointment with a physician or dentist. This finding appears to indicate a substantial deficit in pharmacists' clinical knowledge of oral conditions. To correct this problem, pharmacists' education should address oral conditions and place increased emphasis on clinical presentation.

Carcinoma↗
PubMed1996

The outlook for pharmacist initiation and modification of drug therapy.

Changing state laws to permit an expanded scope of practice for pharmacists is a key step in positioning pharmacists to provide pharmaceutical care. Sixteen states currently allow pharmacists to initiate and/or modify drug therapy; legislation is proposed in 15 other states. Twenty-eight of the 44 states that completed the survey allow pharmacists neither dependent nor independent authority to prescribe. Physician opposition was often cited as a barrier to passage of legislation. The Indian Health Service and the Department of Veterans Affairs extend pharmacists independent prescribing authority.

Drug Prescriptions↗
PubMedDate not supplied

Pharmacists' perceptions of a set of pharmaceutical care practice standards.

OBJECTIVE: This study assessed pharmacists' perceptions of the feasibility and relevance of a set of community-based pharmaceutical care practice standards. DESIGN: Practice standards generated in a Delphi study were rated for feasibility of implementation and relevance to improving therapeutic outcomes by a randomized sample of 315 pharmacists on two 7-point Likert-type scales. These ratings were compared with assessments by Delphi panel experts. RESULTS: Pharmacists judged many of the standards favorably; however, Kruskal-Wallis ANOVA revealed that they were less confident in the standards' feasibility of implementation and relevance to improving patient outcomes than were the Delphi panel experts. CONCLUSION: Pharmacists appear ready to accept a majority of the practice standards used in this study. The lower ratings by respondent pharmacists may be indicative of apprehension about embracing a new practice paradigm and a belief that the provision of pharmaceutical care services has a limited impact on therapeutic outcomes.

Analysis of Variance↗
PubMedDate not supplied

System for exchanging information among pharmacists in different practice environments.

OBJECTIVES: A system for exchanging patient information among hospital, long-term-care (LTC), and ambulatory care pharmacies is described, and the influence of that system on pharmacist interventions is reported. METHODS: Study sites consisted of three ambulatory care pharmacies, one LTC pharmacy, and one hospital in a small Midwestern city. Meetings were held by clinicians, the investigators, and hospital administrators to plan the information-exchange system. From January through June 1996, patients admitted to the hospital were checked to see if they came from a participating (source) pharmacy; if so, they were randomly assigned to experimental and control groups. The hospital requested preadmission information from the source pharmacy for experimental group patients and did not do so for control patients. After the information arrived, the hospital pharmacists could use it to identify and document drug therapy problems. When an experimental group patient was discharged, the hospital sent information to the appropriate source pharmacy. A total of 156 patients were enrolled in the study. RESULTS: Complete information transfer occurred for 75% of experimental group patients. Significantly more experimental group patients than control patients had at least one in-hospital pharmacist intervention recorded. Similarly, in the ambulatory care pharmacies (but not the LTC pharmacy) significantly more interventions per patient were documented for the experimental group. CONCLUSION: Hospital and ambulatory care pharmacists documented more interventions for patients about whom information had been supplied than for patients for whom that information had not been supplied. No difference in intervention rates was observed for LTC pharmacists, who were already being supplied information by the LTC facilities about patients discharged from the hospital.

Continuity of Patient Care↗
PubMedDate not supplied

Situational factors as determinants of community pharmacists' clinical decision making behavior.

OBJECTIVE: To examine the relative contribution of two work-related pressures, workload and perceived normative beliefs of significant others, to community pharmacists' clinical decision making behavior. DESIGN: Systematic random sample design. SETTING: A large southeastern city. PARTICIPANTS: 450 independent and chain community pharmacists identified from the state board of pharmacy list of licensed community pharmacists. INTERVENTIONS: A mailed questionnaire asking about community pharmacists' workload pressures and the perceived beliefs of their patients and employers (significant others) approving or disapproving of them providing pharmaceutical care. MAIN OUTCOME MEASURES: Clinical decision making behavior, as measured using a subset of the Behavioral Pharmaceutical Care Scale. RESULTS: Response rate was 31.8%. Workload was not significantly related to clinical decision making. After controlling for social desirability and workload, perceived normative beliefs of significant others was highly significant; it accounted for 7.6% of the variance associated with clinical decision making behavior. CONCLUSION: Workload pressures did not appear to influence the provision of pharmaceutical care. Community pharmacists' perceived normative beliefs about their patients' and employer's approval or disapproval of the provision of pharmaceutical care should be further examined within the larger context of the pharmacy organization's climate.

Adult↗
PubMedDate not supplied

Availability of primary care providers and pharmacists in the United States.

OBJECTIVE: To determine the rural distribution of primary care providers (primary care physicians, physician assistants, nurse practitioners, and nurse midwives) and pharmacists. DESIGN: Five-digit ZIP code mapping to study the availability of primary care providers and pharmacists, alone and in combinations, in rural areas and ZIP code-based health professional shortage areas (HPSAs). National averages for annual physician visits for hypertension, asthma, and diabetes were used to estimate the sufficiency of the rural physician supply. SETTING: Rural areas of the United States. RESULTS: In rural areas, all providers were present in lower densities than national averages, particularly in HPSAs. The primary care physician supply was insufficient to meet national averages for office visits for hypertension, asthma, and diabetes. Among available providers, the most prevalent co-presence was primary care physician with pharmacist. HPSAs showed very low physician density (1 per 22,122), and the most prevalent providers were pharmacists. States varied widely in provider density. CONCLUSION: Despite longstanding efforts and the expansion of managed care, primary care providers remain in short supply in rural areas, especially ZIP code-based HPSAs. Making the best use of available providers should be encouraged. The continued shortfall of primary care providers in rural areas, particularly HPSAs, makes it logical to use other available providers and combinations to increase health care access. Pharmacists could increase care for patients with conditions treated with medications. Other available providers, based on skills and work site, could also offset shortages.

Asthma↗
PubMed2000

An investigation of the factors affecting community pharmacists' selection of over the counter preparations.

A postal survey of pharmacists in a random sample of community pharmacies in Great Britain was carried out to ascertain the factors which influenced their decisions when recommending a product for Over The Counter (OTC) sale. Six categories of condition which regularly present in community pharmacies were selected and the pharmacists were asked to state which first line product they would recommend for each condition, in an uncomplicated situation with no other relevant problems. Of the 1138 questionnaires sent, 635 were suitable for analysis giving a response rate of 56.7%. The recommendations were found to be appropriate in 99.7% of cases. Factors which had the greatest influence on product selection were active ingredients, evidence of product efficacy, ease of use by patient and patient characteristics such as age and concurrent medication. Economic factors such as profit, pressures of excess stock and product promotion by sales representatives were shown to have a significantly greater influence on proprietor pharmacists than the other categories of pharmacist. The results of this study suggest that in the majority of cases pharmacists' decisions on OTC drug therapy are based on clinical and patient factors and whilst commercial factors may be involved they do not compromise the quality of the recommendations.

Adult↗
PubMed2001

Evidence based information on drug use during pregnancy: a survey of community pharmacists in three countries.

OBJECTIVE: To evaluate whether community pharmacists provide evidence-based information to women inquiring about specific drug use during pregnancy. DESIGN: A trained female student posing as a surrogate shopper requested information about the relative safety/risks of medications during pregnancy in two scenarios. Forty randomly selected pharmacies were surveyed in the Netherlands, Canada and Iceland, and pharmacists' recommendations were noted. Main outcome measures included the type of information that was provided, its presentation, and the source of information used. RESULTS: A relatively small proportion of pharmacists surveyed, provided evidence-based information regarding the drugs in question. Only 14% referred to current medical literature, while 60% consulted the product monograph. Over 90% of pharmacists referred the client to a physician. CONCLUSIONS: Community pharmacists do not disseminate evidence-based recommendations when counseling women on drug use in pregnancy, and need further education on resources concerning drugs in pregnancy that are currently available.

Adult↗
PubMed1997

The Pharmacists' Implementation of Pharmaceutical Care (PIPC) model.

PURPOSE: Study purpose was to develop a theoretical framework that will explain pharmacists' behavior relative to the provision of pharmaceutical care. The model was developed from four attitude models by testing their predictive validity relative to pharmaceutical care implementation. Four hypotheses and one research question were investigated to identify determinants of behavioral intention and behavior. METHODS: 617 community pharmacists in the state of Florida, U.S.A., were surveyed twice using mail survey methodology to collect data. The first survey assessed community pharmacists' attitude, subjective norm, perceived behavioral control, past behavior recency, self-efficacies, instrumental beliefs and affect. The second survey assessed pharmacists' behavior relative to the implementation of pharmaceutical care. After establishing reliability and validity of measures, regression analysis was used to test hypotheses and research question investigated. RESULTS: The Pharmacists' Implementation of Pharmaceutical Care (PIPC) model developed postulates that (i) behavior is directly determined by past behavior recency, behavioral intention and perceived behavioral control; (ii) psychological appraisal processes-instrumental beliefs, self-efficacies, and affect toward means-influence behavior through past behavior recency; and (iii) behavioral intention is determined by attitude, social norm and perceived behavioral control. CONCLUSIONS: The PIPC model provides a formal scientifically validated theoretical framework which can be used to design successful intervention for pharmaceutical care implementation.

Community Pharmacy Services↗
PubMed2003

A longitudinal study of United Kingdom pharmacists' misdemeanours--trials, tribulations and trends.

BACKGROUND: Standards of UK pharmacy practice are maintained by the Royal Pharmaceutical Society of Great Britain, which has the power to take a range of sanctions, including removal of the right to practice, against those found guilty of malpractice. This function is currently under review. OBJECTIVE: To conduct a longitudinal study in order to define trends and identify areas where remedial or preventative support could be focused. METHOD: Case analysis of reports of individuals' misdemeanours published in the British Pharmaceutical Journal over a 12-year period (September 1988-October 2000). Professional and personal misdemeanours were considered. MAIN OUTCOME MEASURE: Nature of misdemeanour, conviction or disciplinary proceedings against individual, practising pharmacists in the study period. Reasons offered for committing the misdemeanour and penalties applied. RESULTS: 344 cases, involving a wide range of personal (162) and professional (590) misdemeanours were found. On an annual basis, the maximum incidence of pharmacists found guilty of any misdemeanour was extremely low (< 0.1 of 1% on the pharmaceutical register). The most common professional misdemeanour was failure to keep adequate written records. The most common personal misdemeanour was fraud. The most common reason cited for committing any misdemeanour was financial gain. Numbers in individual offence categories were persistent but low and there were few obvious trends with time. The odds of involvement ratio for male versus female pharmacists was 7.36 (CI: 5.23-10.35) and for ethnic minority versus Caucasian pharmacists was 3.8 (CI: 3.06-4.72). The most stringent penalties (either imprisonment or removal of the right to practice and frequently both) were applied to cases involving personal use or trafficking of drugs subject to abuse. CONCLUSIONS: The current self-regulation of pharmacy practice in the UK involves a wide range of misdemeanours of varying severity; but the incidence of reports of pharmacists found guilty of malpractice was extremely low. The nature of misdemeanours appeared to change little over the period of the study; this study therefore indicates the spectrum of misdemeanours likely to be encountered by a regulating board in the immediate to medium-term future. If regulatory changes such as competence-based practice rights are introduced, the spectrum may change.

Codes of Ethics↗