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Omnibus Budget Reconciliation Act of 1990 and voluntarism: logistic regression analysis of pharmacist responsibility.

OBJECTIVE: To examine the relationship between pharmacists' willingness to assume further professional responsibilities, as measured by attitudes to the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) requirements, and their attitudes toward voluntarism as their responsibility to society and their level of interest in their jobs. DESIGN: A survey was distributed to a convenience sample of 443 pharmacists who were asked to indicate their responses on a number of items. SETTING: Surveys were distributed to participants in an annual pharmacy continuing education program. PARTICIPANTS: The response rate was 65 percent with completed surveys from 290 Florida pharmacists who were typically male (73 percent) and practicing in the community setting (39 percent) for over 25 years (33 percent). MAIN OUTCOMES: Questions were aimed at gathering the following information: (1) demographics; (2) attitudes concerning the benefits of the three OBRA '90 requirements: patient counseling, prospective drug-use review (DUR), and information recording; (3) attitudes toward voluntarism; and (4) job interest. RESULTS: Pharmacists tended to agree that all three of the OBRA '90 mandates will be beneficial. Fifty-six percent favored the prospective DUR requirements, while 68 percent favored the patient counseling requirements and 66 percent favored the information-recording requirements. Logistic regression analysis showed that unit increases in scaled responses, indicating more favorable attitudes toward believing that voluntarism was one's responsibility, increased the odds of favoring counseling by 38.7 percent and information recording by 32.4 percent. A similar directional relationship was found for the DUR requirement. Job interest did not add to the predictive ability of the variables already in the models. CONCLUSIONS: This study suggests a possible association between pharmacists' attitudes toward social responsibility and their acceptance of expanded professional responsibility.

Attitude of Health Personnel↗

Community pharmacists' experience of over-the-counter medicine misuse in Scotland.

Over the last decade Britain has observed a trend towards the re-regulation of 'prescription only medicines' in favour of pharmacy status drugs. This move towards self-treatment to reduce pressures on general practitioner drug budgets and workloads has focused attention on the need for community pharmacists to extend their patient education and screening roles. In response to these changes, this study was conducted to explore: the type of over-the-counter (OTC) medicine being misused in Scotland; pharmacists' professional attitudes and management of OTC misuse; and the training and support needs of pharmacists. A postal questionnaire was designed. This was informed by an earlier stage of qualitative research and the available literature. It was then piloted and administered to all 110 pharmacies in the study area. A 79% response rate was achieved. The research found that OTC misuse, particularly of certain analgesics, sleeping prescriptions, products containing codeine or pseudoephedrine, caffeine, cough mixtures, and laxatives was common. The estimated mean number of patients suspected of misusing medicines in a typical week was 5.63. Pharmacies in urban areas were more likely than those in rural areas to report suspected misuse. The research identified a number of intervention strategies relating to: patient/pharmacist interaction; information provision; removal of products from the point of sale; sharing of information with other local pharmacists; and referral to other members of the primary care team. Pharmacists expressed a need for support in managing OTC misuse and in organising 'early warning systems' to share information locally.

Ethics, Professional↗

Comparison of methods used for estimating pharmacist counseling behaviors.

OBJECTIVE: To compare the rates reported for provision of types of information conveyed by pharmacists among studies for which different methods of estimation were used and different dispensing situations were studied. DATA SOURCES: Empiric studies conducted in the US, reported from 1982 through 1992, were selected from International Pharmaceutical Abstracts, MEDLINE, and noncomputerized sources. STUDY SELECTION: Empiric studies were selected for review if they reported the provision of at least three types of counseling information. DATA EXTRACTION: Four components of methods used for estimating pharmacist counseling behaviors were extracted and summarized in a table: (1) sample type and area, (2) sampling unit, (3) sample size, and (4) data collection method. In addition, situations that were investigated in each study were compiled. DATA SYNTHESIS: Twelve studies met our inclusion criteria. Patients were interviewed via telephone in four studies and were surveyed via mail in two studies. Pharmacists were interviewed via telephone in one study and surveyed via mail in two studies. For three studies, researchers visited pharmacy sites for data collection using the shopper method or observation method. Studies with similar methods and situations provided similar results. CONCLUSIONS: Data collected by using patient surveys, pharmacist surveys, and observation methods can provide useful estimations of pharmacist counseling behaviors if researchers measure counseling for specific, well-defined dispensing situations.

Behavior↗

Pharmacist-patient relationship development in an ambulatory clinic setting.

We investigated the pharmacist-patient relationship, conceptualizing its interpersonal constructs and dynamics using social exchange principles. The constructs of felt indebtedness (FI), collaborative willingness (CW), interpersonal relationship quality (IRQ), medication use beliefs (MUBs), and critical interpersonal incidents (CII) between pharmacist and patient were proposed, measured, and modeled. Patient responses were collected using interviews and mail surveys in 2 pharmacist-managed anticoagulation clinics. Higher IRQ levels predicted greater FI toward and CW with pharmacists (p < .01). MUBs predicted CW with IRQ mediating the association (p < .01). Patients reporting positive CII gave higher IRQ ratings and expressed greater FI (p < .05). Findings suggested that patients' perceptions of their pharmacists, and not their therapy, may lead to increased interpersonal exchange and patient collaboration in care.

Adult↗

[Improvement of method to estimate guidance by pharmacists and trial to obtain standard pharmaceutical management and guidance services program].

The level of understanding of taking medicine was examined at the start and the end of medicine-taking guidance, based on the estimation by pharmacists and inpatients. Six items for the estimation, such as "the way of taking medicines" were evaluated using a five-grade system. The significant improvement was observed in all items, suggesting that inpatients' understanding is improved by the guidance. A markedly positive correlation was found between the estimation by inpatients and that by pharmacists (p < 0.001). This confirms the appropriateness of estimation by pharmacists. Inpatients whose estimation was significantly different from that by pharmacists (difference of two grades or more) were examined to identify clear and potential problems with taking medicine. The problems were classified into such seven categories as "types of medicine". For each item with differences in estimation (two grades or more), problems were biased in some specific categories. On the basis of such a bias, a flow chart was prepared to clarify problems. In addition, a standard pharmaceutical management and guidance services program was drafted, in which measures in observation, treatment and education against problems by pharmacists were described according to the frequency of occurrence. Information about the program available on the Internet enables its use by other hospitals.

Aged↗

Pharmacists' smoking cessation practices: relationship to their knowledge and skills, attitudes, and perceptions of roles.

OBJECTIVE: To assess factors associated with pharmacists' practices regarding patients' smoking and smoking cessation. DESIGN: Cross-sectional analysis. SETTING: Four Canadian provinces (Ontario, Québec, Saskatchewan, Prince Edward Island). PARTICIPANTS: Practicing community pharmacists (n = 906; weighted n = 897). INTERVENTION: Population-based mailed questionnaire survey with 72% response rate. MAIN OUTCOME MEASURES: Bivariate and multivariate relationships between 12 clinical interventions regarding smoking and smoking cessation and 7 domains: basic pharmacologic knowledge; applied health science knowledge and skills; positive, negative and economic-related attitudes toward smoking cessation; perceptions of pharmacists' roles with patients who smoke: assessing and motivating patients; assisting, referring and following up. RESULTS: Basic pharmacologic knowledge and applied health science knowledge and skills were independently related to 12 and 10 interventions, respectively. Positive attitudes toward smoking cessation were independently related to 8 interventions. Negative attitudes and economic-related attitudes toward smoking cessation were each independently related to only 1 intervention. Perceptions of pharmacists' roles with respect to "assessing and motivating patients," and "assisting, referring, and following up" were independently related to 8 and 3 interventions, respectively. CONCLUSION: Initiatives to increase tobacco-related knowledge and skills and enhance positive attitudes and role perceptions with respect to smoking and smoking cessation may promote interventions by community pharmacists with patients who smoke.

Cross-Sectional Studies↗

Optimizing pharmacists' effectiveness as medication therapy managers through a segmentation approach.

OBJECTIVE: To determine whether older persons could be segmented into meaningful subgroups that shared similar patterns in terms of self-assessments of medication-related knowledge, beliefs, and perceived abilities. DESIGN: Secondary analysis of data previously collected from a cross-sectional, descriptive study. SETTING: United States. PARTICIPANTS: A total of 500 community-dwelling older persons, 65 years and older, using at least one prescription medication. INTERVENTION: Mail survey. MAIN OUTCOME MEASURES: Older persons' self-assessments of medication-related knowledge, beliefs, and perceived abilities, as well as perceptions of pharmacist-patient relationships. RESULTS: The data set contained usable responses from 330 respondents out of 496 surveys presumably delivered (66.5%). Cluster analysis revealed three groups of older persons who showed differences in terms of medication-related beliefs and perceived abilities. Older persons in group 1 reported worse health, used the most prescription medications, sought the most advice from pharmacists, and had the lowest perceived abilities. Older persons in group 2 reported good health, took the fewest medications, sought pharmacists' advice least frequently, and had the lowest beliefs and high perceived abilities. Older persons in group 3 reported the best health, had the highest beliefs, high perceived abilities, and the highest perceptions of pharmacist participative behavior, patient-centeredness, relationship quality, and commitment. CONCLUSION: Pharmacists can use a segmentation approach to target those older persons who are most in need of medication therapy management.

Aged↗

Optimization of inpatient warfarin therapy: impact of daily consultation by a pharmacist-managed anticoagulation service.

OBJECTIVE: To determine the effect of daily consultation by a team of hospital pharmacists on the accuracy and rapidity of optimizing warfarin therapy. DESIGN: Comparison of a historical control cohort with a prospective cohort matched for treatment indication. SETTING: A 400-bed university teaching hospital. PATIENTS: Sixty consecutive patients hospitalized in 1992 and starting warfarin for the first time, with anticoagulation therapy managed by physicians, were compared with 60 patients matched for warfarin indication hospitalized in 1995, but with anticoagulation therapy managed with pharmacy consultation. RESULTS: Pharmacist management of initial warfarin therapy resulted in a significant reduction in the length of hospitalization compared with physician dosing, from 9.5 +/- 5.6 days to 6.8 +/- 4.4 days (p = 0.009). The number of patients and patient-days with international normalized ratio (INR) values >3.5 were reduced by pharmacist dosing from 37 patients and 142 days to 16 patients and 29 days, respectively (p < 0.001). Similarly, the number of patients and patient-days with INR >6.0 were reduced from 20 patients and 50 days to two patients and six days, respectively (p < 0.001). There were six documented bleeding complications in 1992 compared with one in 1995 (p = 0.11). The mean INR at discharge was significantly lower in the pharmacy surveillance group, 2.6 +/- 0.58, compared with the physician cohort, 3.3 +/- 2.1 (p = 0.07). Readmissions after discharge due to bleeding or recurrent thrombosis were reduced from five (at 1 mo) and 10 (at 3 mo) to two and five readmissions, respectively, by pharmacist intervention (p = 0.43). The number of patients with concurrently prescribed drugs known to significantly interact with warfarin was significantly lower (6 vs. 13; p = 0.02) in the pharmacy surveillance group. CONCLUSIONS: Among patients starting warfarin for the first time, daily consultation by a pharmacist significantly decreased the length of hospital stay and the number of patients who received excessive anticoagulation therapy. These findings translate into improved quality of care and potentially significant cost savings.

Anticoagulants↗

The role of the pharmacist in humanitarian aid in Bosnia-Herzegovina: the experience of Pharmaciens Sans Frontières.

BACKGROUND: Founded in 1985, Pharmaciens Sans Frontières (PSF) is a nongovemmental organization of pharmacists involved in humanitarian aid. PSF relied on approximately 100 expatriates in 1998, which included 50 pharmacists distributed throughout 24 missions (i.e., 14 emergency, 7 development, 3 assessment). It is necessary to add 200-250 local staff to this group. OBJECTIVE: To describe PSF's mission in Bosnia-Herzegovina from 1992 to 1999 and to define the pharmacist's impact in the supply of medicines and the development of pharmaceutical care and services. RESULTS: In April 1992, at the beginning of Sarajevo's siege, PSF sent a small team of three volunteer pharmacists to Bosnia-Herzegovina. The objective of the emergency phase (1992-1995) was to set up a massive supply program of essential medicines and medical and biologic materials and to implement a distribution system based on existing health centers. The signing of the Dayton peace agreement and a progressive return to peace and stability marked the beginning of the postemergency phase (1995-1997). This phase pursued previous objectives of establishing a distribution network and added the implementation of logistic centers. PSF widened its involvement to medical laboratory analysis, production of medicines, disposal of expired medications sent during the conflict, and the implementation of a national center for quality control. Currently, the development phase's (1998-1999) objective is to provide adequate support for the reorganization of pharmaceutical care and services by establishing pharmacy work groups and developing and maintaining good relationships with the international community and Bosnia-Herzegovina pharmacists. CONCLUSIONS: Humanitarian aid is essential in major conflicts, as seen in the case of Bosnia-Herzegovina. Although it is difficult to evaluate the impact of the distribution network implemented by PSF, it allowed for a better provisioning of medications to the general population. PSF played an important role in such cases. In fact, PSF provides its pharmaceutical expertise to these embattled areas not only by offering financial support to the logistics or supplying of medications, but by offering professional support to the organization/reorganization of the pharmaceutical practice.

Bosnia and Herzegovina↗

Pharmacists' understanding of patient education on metered-dose inhaler technique.

OBJECTIVE: To assess pharmacists' attitudes, beliefs, and knowledge about assessing and educating patients regarding metered-dose inhaler (MDI) technique; to determine frequency of MDI assessment and teaching behavior; and to assess the effect of an asthma pharmaceutical care educational program on the same variables six months later. DESIGN: Questionnaire completed before and six months after the educational intervention. SETTING: Pharmacies based in clinics owned by a healthcare system located in communities of a large metropolitan area. MAIN OUTCOMES MEASURES: Pharmacists' self-reported frequency of assessment and education; attitudes and beliefs about assessing and educating patients using MDIs; and knowledge of MDI technique. RESULTS: The survey response rate was 53.7% (n = 39) for baseline and 43% (n = 32) for follow-up. Most pharmacists (85.4% at baseline, 87.5% at follow-up; p = 0.79) indicated that they educate patients receiving new MDI prescriptions. In addition, 47.4% at baseline and 68.8% at follow-up indicated they educate patients using inhalers for three months (p = 0.07). Only 21.1% at baseline and 18.8% at follow-up (p = 0.81) indicated that they follow up with long-term users. The mean +/- SD MDI technique knowledge score (steps correct out of 9 possible) at baseline was 7.2 +/- 1.1 and 7.5 +/- 1.3 at follow-up (p = 0.29). Significant changes in level of agreement with some beliefs/attitudes were observed, including the importance of frequently assessing/educating patients, confidence and comfort when assessing/educating patients, and that assessing/educating patients is not the role of only the physician. Respondents continued to acknowledge that MDI education and assessment are important to improving and maintaining control of disease. However, the respondents thought that barriers exist that inhibit this activity, such as not enough time for education and assessment. CONCLUSIONS: Pharmacists reported they frequently educate patients and assess MDI technique for new prescriptions but not very often for patients recently started, as well as for long-term users. Six months after an educational program, attitudes and beliefs toward this activity were either not changed or, in some, improved. Pharmacists perceive that there is not enough time to assess and educate patients who use MDIs.

Adult↗

Development of a pharmacist-managed lipid clinic.

OBJECTIVE: To describe the development of a pharmacist-managed lipid clinic within a primary care medical clinic and review its results after approximately 12 months of operation. METHODS: A pharmacist-managed lipid clinic was developed at Naval Medical Center San Diego. Administrative background, treatment algorithm development, operational issues, clinical activities, and barriers to the clinic are discussed. For intermediate outcomes, data from patients who had at least 1 intervention by the pharmacist and 1 follow-up lipid panel were analyzed for medication use, changes in lipid parameters, and percent reaching the low-density-lipoprotein (LDL) target goal. Modified National Cholesterol Education Program-Adult Treatment Panel II guidelines were used to determine the LDL goal. RESULTS: Following approximately 12 months of operation, the clinic received 204 referrals and consisted of 146 active patients. A brief study was conducted to assess clinical outcomes. Of 115 patients who were seen in the clinic and met inclusion criteria, 57% were receiving treatment with a hydroxymethylglutaryl coenzyme A reductase inhibitor (statin) and 17% were receiving fibrates; 17% of the patients were not receiving lipid-lowering medications. Relative to baseline, LDL cholesterol concentrations decreased 20%, high-density-lipoprotein cholesterol increased 11%, and triglycerides decreased 19%. Overall, LDL goals were reached in 77% of the patients. LDL goals were attained by 63%, 79%, and 93% of patients with targets of <100, <130, and <160 mg/dL, respectively. Results are compared with other studies regarding lipid goal attainment. CONCLUSIONS: A pharmacist-managed lipid clinic can be developed and integrated into a primary care medical clinic. Pharmacists can effectively manage lipid-lowering therapy, helping to achieve LDL goals.

Algorithms↗

Pharmacist intervention program for control of hypertension.

BACKGROUND: Pharmaceutical care programs have been shown to improve outcomes in hypertension. However, most programs required direct access to patient medical chart and patient consultation sessions by appointment. OBJECTIVE: To follow the current practice of community pharmacy, exploring the effect of an intervention program on blood pressure (BP) and factors affecting BP. METHODS: Treated hypertensive patients were enrolled in a 9-month controlled study involving 9 community pharmacies. The PRECEDE-PROCEED model was used as conceptual framework to identify factors affecting BP, to incorporate those factors in an intervention program, and to evaluate the impact of the program. A computerized decision-aid tool was used by pharmacists from 4 pharmacies to provide pharmaceutical care to subjects (n = 41); pharmacists from the 5 other pharmacies performed usual care (n = 59). As there was a statistically significant interaction due to family income in describing the impact of pharmacists' intervention on BP, population was stratified by family income in the analyses. RESULTS: Compared with the control group, the pharmacy program resulted in significant systolic BP reduction (-7.8 vs. 0.5 mm Hg; p = 0.01) and an increase in the proportion of controlled patients only for those with high incomes. In the high-income group, the program also had a positive impact on physical activity, self-reported adherence, health concerns, and information transmitted. The low-income group did not appear to benefit from the program. CONCLUSIONS: Pharmacist intervention can modify factors affecting adherence, improve adherence, and reduce BP levels in patients treated with antihypertensive agents. Impact of pharmacist intervention on BP differed according to patient income status.

Adolescent↗

Pharmacist involvement in primary care improves hypertensive patient clinical outcomes.

BACKGROUND: The practice of pharmaceutical care in primary care settings in Thailand is currently not generally accepted. OBJECTIVE: To evaluate the effect of pharmacist involvement in treatment with hypertensive patients in primary care settings. METHODS: The treatment objective was to stabilize the blood pressure (BP) of hypertensive patients in accordance with the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure guidelines. Patients were randomly assigned to a pharmacist-involved group (treatment) or a group with no pharmacist involvement (control). Pre- and post-test BPs, tablet counts, lifestyle modifications, and pharmacists' recommendations were recorded. The 6-month study was carried out in Mahasarakham University pharmacy and 2 primary care units. Patients were monitored monthly by reviewing their medications and supported by providing pharmaceutical care and counseling. RESULTS: From a total of 235 patients, the treatment group (n = 118) had a significant reduction in both systolic (S) and diastolic (D) BP compared with the 117 patients of the control group (p = 0.037, 0.027, respectively). The 158 patients (76 treatment, 82 control) with BPs >or=140/90 mm Hg at the beginning of the study showed significant BP reductions (p = 0.002 SBP, 0.008 DBP). The proportion of 158 patients whose BP became stabilized was higher in the treatment group (p = 0.017). The treatment group showed significantly better adherence (p = 0.014) and exercise control (p = 0.012) at the end of the study. Physicians accepted 42.72% of medication modifications and 5.34% of the suggestions for additional investigations. CONCLUSIONS: Hypertensive patients who received pharmacist input achieved a significantly greater benefit in BP reduction, BP control, and improvement in adherence rate and lifestyle modification.

Antihypertensive Agents↗

Pharmacists' participation in an inhaled respiratory medication program: reimbursement of professional fees.

BACKGROUND: An intervention (termed Initiative) was initiated to facilitate converting beneficiaries of a public drug insurance program in the province of Nova Scotia from respiratory nebulization medications to inhalers. Community pharmacists provided patient education and billed professional fees for conversions or optimizing inhaled respiratory medication technique. OBJECTIVE: To determine community pharmacists' self-reported participation rate and identify facilitators and barriers to billing for professional fees. METHODS: A survey was developed and mailed to Nova Scotia pharmacists. Information on demographics, work environment, professional experience, financial aspects, billing experiences, and the billing process was collected. Quantitative and qualitative data were evaluated using bivariate and multivariate analyses, and a thematic process, respectively. RESULTS: Two hundred ninety-seven pharmacists responded. Self-reported billing rates for fees were 34% (switching delivery devices), 58% (optimizing AeroChamber use), and 37% (follow-up when replacing Aerochambers). Awareness of fees and the perception of consistent claim reimbursement were associated with billing for each fee (p < 0.05). Predisposing billing factors included awareness of fees, identifying situations requiring education, owner/manager position, male gender, perception that billing for education for optimizing technique is a minimum standard of practice, and prescription volume. Themes identified as barriers included inefficient billing process, inadequate fees, and lack of Initiative awareness. CONCLUSIONS: Predisposing factors were the most important facilitators of community pharmacists' participation in this program, while a cumbersome and time-consuming billing process was the primary barrier. Further research should determine the impact of the professional fee on patient health outcomes.

Administration, Inhalation↗

Caring for poorly controlled diabetes mellitus: a randomized pharmacist intervention.

BACKGROUND: There is limited information from randomized controlled studies about the influence of pharmacist interventions on diabetes control. OBJECTIVE: To evaluate the effect of a pharmacist intervention on improving diabetes control; secondary endpoints were medication appropriateness and self-reported adherence. METHODS: A randomized, controlled, multi-clinic trial was conducted in the University of Washington Medicine Neighborhood Clinics. Seventy-seven subjects, > or =18 years old with a hemoglobin (Hb) A(1c) > or =9% at baseline and taking at least one oral diabetes medication, were randomized to receive a pharmacist intervention (n = 43) or usual care (n = 34) for 6 months followed by a 6-month usual-care observation period for both groups. Subjects met with a clinical pharmacist to establish and initiate a diabetes care plan followed by weekly visits or telephone calls to facilitate diabetes management and adherence. HbA(1c), medication appropriateness, and self-reported adherence were assessed at baseline, 6 months, and 12 months. RESULTS: The mean HbA(1c) did not differ between groups over the 12-month period (p = 0.61). A reduction in HbA(1c) was noted for both groups over time compared with baseline (p = 0.001); however, control subjects relied more heavily on provider visits. Medication appropriateness was not improved for diabetes medications (p = 0.65). Self-reported adherence was not significantly improved by the intervention. CONCLUSIONS: This pharmacist intervention did not significantly improve diabetes control, but did allow for similar HbA(1c) control with fewer physician visits. Medication appropriateness and self-reported adherence compared with usual care in individuals with poorly controlled diabetes were not changed.

Administration, Oral↗

Attitudes of pharmacists toward mental illness and providing pharmaceutical care to the mentally ill.

BACKGROUND: Few studies have examined the attitudes of pharmacists toward mental illness. OBJECTIVE: To study the attitudes of Alabama pharmacists toward both mental illness and the providing of pharmaceutical care to mentally ill patients. METHODS: The survey used in this project was composed of 3 sections. Section 1 collected demographic information, section 2 asked 11 Likert-type questions concerning attitudes toward mental illness, and section 3 asked about attitudes toward providing pharmaceutical care to mentally ill patients. The surveys were distributed to pharmacists attending 3 school-sponsored continuing education programs. RESULTS: One hundred eighty-seven pharmacists participated in the survey. The vast majority (>90%) of participants disagreed or strongly disagreed with statements that mentally ill patients are easily recognizable, unintelligent, and do not care how they look. Approximately 30-50% of participants expressed being "more" or "much more" confident, comfortable, interested, and likely to perform pharmaceutical care activities for mentally ill patients relative to medically ill patients, while only approximately 5-20% of participants expressed being "less" or "much less" so. Several demographic factors, including gender, age, and years in practice, were associated with attitudes toward providing pharmaceutical care to mentally ill patients. CONCLUSIONS: Pharmacists expressed generally positive attitudes toward both mental illness and the providing of pharmaceutical care to mentally ill patients.

Adult↗

Pharmacist critique was ill-informed.

Pharmacists' ability to exercise "professional right of conscience" in dispensing emergency contraception, as well as the professionalism of pharmacists, has fallen under attack recently by the media, by state governments, and even by other healthcare professionals in published commentaries. This editorial discusses the controversy surrounding emergency contraceptives, the right of pharmacists to refuse to fill prescriptions that they consider morally objectionable, and the responsibility of pharmacists to provide medications in a timely and professional manner. The professionalism of pharmacy is also examined in light of the expanded scope of practice in which pharmacists increasingly find themselves practicing.

Attitude of Health Personnel↗

Pharmacist or physician: age differences in satisfaction with medical advice.

Two studies examined predictors of medical care satisfaction in communities in Eastern Canada. Both studies focused on how the roles of pharmacists and physicians are perceived by adults of different ages. Using a survey methodology, Study 1 demonstrated that middle-aged adults, older adults, and community pharmacists differ in the extent to which they rate pharmacists as being important members of the health care team. Specifically, community members value pharmacists as health care providers, and this is especially true for older adults. Using an experimental paradigm, Study 2 examined ratings of medical interaction scenarios, ratings that varied as a function of kind of health professional (pharmacist vs. physician) and type of advice (directive vs. non-directive). Results suggest that older adults may have a more complex set of expectations about their health care interactions than do younger adults and that, for older adults, the factors that determine satisfaction differ across the professions being evaluated.

Adult↗