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PubMed2004

Consumer responses to a pharmacy benefit report card.

As pharmacy benefits become an increasingly important component of rising health care costs, report cards critically need to be developed to inform consumers about the availability of their medications, what these medications cost them, and additional pharmacy benefit services that can enhance the management of their disease. This study is a preliminary step for developing such a card and assessing its impact on health plan enrollment choices in a small employee sample. Findings indicate that while individuals generally had positive comments about the pharmacy benefit report card, the card had little effect on their health plan enrollment decisions. The higher the prescription use reported by individuals, more likely they were to report that the card influenced their health plan enrollment decisions. The pharmacy benefit report card could be an useful tool for specific populations such as those with an increased need for medication.

Consumer Behavior↗
PubMed1978

[Pointe-St-Charles' community pharmacy.].

It was in Pointe St-Charles that was born the first community pharmacy, holding to the objectives of collective responsability for physical and mental health promoted by the health clinic of the same area. The pharmacy seeks to become a means to combatting capitalist system oppression. With a simple material organization, a policy of lowest-price buying, the abolition of a profit margin and information and consciousness raising with regard to the abusive use of medication, the pharmacy hopes to reach the population and facilitate, a regrouping, leading to a collective denunciation! of the exploitation of pharmaceutical companies, seen as able representatives of the present system. Three such pharmacies are now operating in the metropolitan area: in Pointe St. Charles, St. Henri, and at Cooprix in Rosemont; each is concerned with attaining the above-mentioned objectives and each works towards the development of a greater autonomy, both individual and collective, of the population.

English Abstract↗
PubMed1971

The medical library: its function in a clinical pharmacy program.

Because of the many demands currently being made upon physicians, a Clinical Pharmacy Training Program has been established to assist them in a patient-oriented program of drug therapy. This program provides clinical training for students in the College of Pharmacy, North Dakota State University, and for our local hospital pharmacy interns and residents. Our Medical Library enters into this program by providing training in medical literature resources to students and staff involved in this program. Cooperation between the Medical Service, Pharmacy Service and Library Service, serves to promote our Medical Library as the resource and reference center at this hospital.

Journal Article↗
PubMed2005

Implementation of a professional program in Finnish community pharmacies in 2000-2002.

The aim was to assess implementation of a national 4-year project to promote professional strategy in Finnish community pharmacies during the 2.5 years of program's action in 2000-2002. A survey of random sample of 734 community pharmacists in Finland was conducted in 2002 (response rate 51%, n = 376). The questionnaire included an implementation scale and two open-ended questions on patient counselling. Many of the actions were not optimally implemented 2.5 years after starting the project. Some individual actions may have been taken, but the systematic long-term development process has not yet been started in many pharmacies. Future challenges in implementation will be a better commitment of the pharmacy owners to the goals of the national professional strategy and a better access to Internet-based drug information sources while counselling patients.

Adult↗
PubMed2006

The implementation of a harm minimisation model for the identification and treatment of over-the-counter drug misuse and abuse in community pharmacies in Northern Ireland.

OBJECTIVE: This study tested an intervention model which sought to minimise over-the-counter (OTC) drug misuse and abuse in community pharmacies. METHOD: Pharmacists in six community pharmacies in the Greater Belfast area volunteered to participate in the study. The intervention model consisted of client identification and recruitment, treatment and referrals, and finally follow-up data collection and outcome measurements. All pharmacists participated in semi-structured interviews to explore their views and experiences of the study. RESULTS: Pharmacists identified 196 cases of suspected abuse/misuse. Pharmacists approached 70 of the identified clients during the six-month study; some clients agreed to stop using the product of abuse/misuse, used an alternative, or had been switched to a maintenance prescription under general practitioner (GP) supervision. No client proceeded to completion of the follow-up phase (e.g. health-related quality of life). Analysis of the interviews revealed that pharmacists had encountered some difficulties in approaching potential clients, but had used skills gained in the study in other aspects of their practice. CONCLUSIONS: Some difficulties were encountered in implementing the harm minimisation model, but these may be alleviated by further training and greater collaborative working. PRACTICE IMPLICATIONS: Notwithstanding the challenges faced in the study, this approach to harm minimisation should be considered for wider implementation in community pharmacy.

Adult↗
PubMed2026

Identifying stakeholder behaviors for competency-based pharmacy education: A stage 1 behavior change wheel analysis.

INTRODUCTION/OBJECTIVES: Competency-Based Pharmacy Education (CBPE) is a strategic priority for preparing graduates to meet evolving healthcare needs. However, efforts to implement CBPE can stall due to behavioral challenges among faculty, administrators, preceptors, and learners. This study aimed to apply Stage 1 of the Behavior Change Wheel (BCW) to identify stakeholder-specific behaviors and associated determinants needed to implement the five core components of CBPE. METHODS: A multi-method approach grounded in the BCW, the Capability, Opportunity, Motivation - Behavior (COM-B) model, and the Theoretical Domains Framework (TDF) was used. Data were gathered through (1) targeted literature review; (2) structured focus groups with competency-based education experts and pharmacy education stakeholders; and (3) an iterative consensus process. Behaviors were mapped to the five CBPE components: (1) defined competencies, (2) developmental progression, (3) tailored instruction, (4) authentic experiential learning, and (5) programmatic assessment, and then mapped to COM-B and TDF constructs. RESULTS: Over fifty stakeholder-specific behaviors were identified and specified across the CBPE framework. This revealed shared barriers such as limited instructional design knowledge (psychological capability), insufficient assessment of infrastructure (physical opportunity), and misaligned professional identity (reflective motivation). Key TDF domains included knowledge, environmental context, beliefs about capabilities, and professional roles. The behavioral problem statements, specifications, and determinants were identified to support future intervention planning. CONCLUSION: This Stage 1 analysis provides a behaviorally grounded foundation for CBPE implementation by identifying stakeholder behaviors and conditions that enable change. These findings will inform the development of readiness-to-change assessments and targeted interventions (BCW Stages 2 and 3), supporting scalable and sustainable CBPE transformation in pharmacy education.

Education, Pharmacy↗
PubMed2005

Statewide evaluation of a tobacco cessation curriculum for pharmacy students.

BACKGROUND: Previous studies suggest that healthcare professionals are inadequately trained to treat tobacco use and dependence. Because even brief interventions from clinicians improve patient quit rates, widespread implementation of effective tobacco cessation training programs for health professional students is needed. METHODS: Pharmacy students received 7-8 h of comprehensive tobacco cessation training. Participants completed pre- and post-program surveys assessing perceived overall abilities for cessation counseling, skills for key facets of cessation counseling (Ask, Advise, Assess, Assist, Arrange), and self-efficacy for counseling. RESULTS: A total of 493 students (82.3%) completed linkable pre- and post-training evaluations. Self-reported abilities, measured on a five-point scale, increased significantly from 1.89 +/- 0.89 to 3.53 +/- 0.72 (P < 0.001). Twenty-two percent of students rated their overall counseling abilities as good, very good, or excellent before the training versus 94% of students after the training. Eighty-seven percent of students indicated the training will increase the number of patients that they counsel; 97% believed it will increase the quality of their cessation counseling. CONCLUSIONS: Comprehensive training significantly improved pharmacy students' perceived confidence and ability to provide tobacco cessation counseling. The curriculum is applicable to other health professional training programs and currently is being used to train pharmacy, medical, nursing, and dental students.

Adult↗
PubMed2002

Transformation of a pharmacy department: impact on pharmacist interventions, error prevention, and cost.

BACKGROUND: Current medical literature supports the unit-based (UB) pharmacy concept as a best practice. In an effort to determine its feasibility, Huntsville Hospital (Huntsville, Alabama) conducted a pilot study to compare the central-based (CB) model with the UB model and then implemented the new model. IMPLEMENTING THE PILOT STUDY: Data were collected for two high-volume nursing units for 10 days for each model. Pharmacists practicing in the UB setting documented more interventions than the CB pharmacist by a factor of three to one, resulting in an 85% increase in cost avoidance. IMPLEMENTING THE UB MODEL: Converting the pharmacy services to a UB model entailed creating 16 new pharmacist positions. Extrapolation of the savings for the UB model ($520 per day) and the CB model ($280) for 1 year suggested that adoption of the UB model would generate an additional $87,600 in cost avoidance for these two nursing units. Each new pharmacist was trained for at least 3 months before being scheduled to work independently as a UB pharmacist. Clinical interventions by pharmacists greatly increased after implementation of the UB model. The baseline monthly average of interventions for the 6 months before implementation was 239, and the monthly cost avoidance was $21,300. In October 2001, the first full month of implementation, there were 1,315 interventions and a monthly cost avoidance of $130,192. SUMMARY: Converting to the UB model has required a considerable increase in the number of pharmacist positions, yet there has been a dramatic increase in clinical pharmacy interventions, with a corresponding decrease in drug expenditures.

Alabama↗
PubMed2000

Job matching in pharmacy labor markets: a study in four states.

PURPOSE: Reports from various pharmacy labor market sectors suggest that the United States may be experiencing a shortage of pharmacists. To guide policy making and planning with respect to this shortage, it is necessary to develop a better understanding of the process by which pharmacists choose jobs. Using the economic theory of job matching, this study sought to understand how (a) attributes of the practice setting, (b) characteristics of pharmacists, and (c) regional and urbanization variables are associated with pharmacy practice setting choices. METHODS: A secondary database containing information about employment characteristics and work histories of 541 pharmacists in four states was used. The data were augmented with information on the relative number of employment opportunities in each of three practice settings (large chain, institutional, and independent) in the year the respondent's most recent employment change occurred. Practice setting choices were modeled using multinomial conditional logit regression. RESULTS: A total of 477 pharmacists represented in the database met the inclusion criteria for the study. Multivariate analyses showed that the impact of search costs and wage differentials varied with the practice setting chosen. Pharmacists choosing independent settings over large chain settings were more likely to be white and to have worked in an independent setting in their prior job. Pharmacists living in Oregon were less likely to choose institutional settings compared to those living in Massachusetts, whereas those living in areas with populations greater than 50,000 were more likely to choose institutional settings. CONCLUSIONS: Pharmacist job matching appears to be a complex process in which diverse factors interact to produce a final match. Our results suggest that the pharmacy labor market may actually be composed of two distinct labor markets: an ambulatory market and an institutional market.

Adult↗
PubMed2000

A nation-wide study on the practice of euthanasia and physician-assisted suicide in community and hospital pharmacies in The Netherlands.

PURPOSE: In recent years the attitudes and practices of euthanasia (E) and physician-assisted suicide (PAS) among health care workers have been evaluated in different countries. There is, however, still an information gap on the role of pharmacists in these matters. The aim of our study was to study the attitudes and practices of E and PAS among pharmacists. METHODOLOGY: We conducted a nation-wide survey into the practice, including adherence to guidelines, of E and PAS in community and hospital pharmacies (CP and HP) in the Netherlands. Furthermore, the attitude of community pharmacists concerning this subject was evaluated. Anonymous questionnaires were sent to a random sample of 50% (n = 755) of all CP and to all (n = 101) HP. RESULTS: The response rates were 52% and 51% for CP and HP, respectively. Most of the CP-respondents (95%) agreed with the concept of E and PAS and would dispense drugs for these purposes. When the data were extrapolated to all pharmacies, there were 1351 and 340 dispensing of drugs for E and PAS per year in CP and HP (94% of all requests), respectively. In most cases the pharmacist had been notified of the condition of the patient (CP: 93%, HP 87%) and a written request was obtained (CP: 74%, HP: 79%). The drugs were often handed personally to the physician (CP: 98%, HP: 86%). Involvement of pharmacy technicians was more common in HP than in CP (31% versus 6%). The most frequently dispensed drugs were muscle relaxants with barbiturates (CP: 47%, HP 71%), barbiturates only (CP: 19%, HP: 6.1%), and muscle relaxants with benzodiazepines (CP: 14%, HP: 7.6%). CONCLUSION: Most pharmacists are supportive of E and PAS and are prepared to fill prescriptions written for these purposes.

Attitude of Health Personnel↗
PubMed2001

The design and evaluation of a simulated-patient teaching programme to develop the consultation skills of undergraduate pharmacy students.

OBJECTIVES: This study aimed to identify the key skills and knowledge required for the delivery of an ideal patient consultation in order to develop a training programme (using simulated-patients) to teach consultation skills to undergraduate pharmacy students. METHODS: Participants included all third year undergraduate Pharmacy students (MPharm, level III) at the School of Pharmacy & Biomolecular Sciences, University of Brighton (from October 1999 to March 2000). Working in groups of 12, students participated in two 4 hour seminars. A structured questionnaire was designed to assess students' perceptions of the difficulty of conducting a consultation and their confidence in delivering a structured consultation. MAIN OUTCOME MEASURES: Questionnaires were administered before and after delivery of the teaching programme to assess changes in students' confidence and ability to consult with patients. RESULTS: Twelve volunteers satisfied the criteria set to serve as simulated patients and then received appropriate training. Six scenarios were developed which focused on the key skills and knowledge identified from the adherence and consultation skills literature. A total of 91 students participated in the programme (mean age = 23 years, SD = 4.5). Following participation in the programme students' perceived 'confidence' for conducting an effective consultation significantly increased (t = -5.9, p < 0.01) while a statistically significant decrease was seen in students' perceived level of 'difficulty' when conducting a consultation (t = 4.0, p < 0.01). CONCLUSION: This study has shown that the use of a structured teaching programme improves students' perceptions of their ability and confidence in conducting an effective consultation. Providing skills training around the consultation process, using simulated patients, provides pharmacists with a good framework around which to practice pharmaceutical care.

Adult↗
PubMed2004

Changing a profession, influencing community pharmacy.

The authors set out to describe the possible impact of the continuing education activities of the Community Pharmacy Section (CPS) of the International Pharmaceutical Federation (FIP) on the profession in the period from 1980 to 2002 (approximately the last two decades of the 20th century) by reviewing and interpreting documents of the Community Pharmacy Section of the International Pharmaceutical Federation. The educational activities of the CPS have resulted in a high level of satisfaction among the participants. The CPS has also coordinated international practice research and the dissemination of the concept of pharmaceutical care. Additionally, the section's activities have informed the members of national pharmaceutical associations about new concepts, and stimulated projects on the added value of pharmacy. There are reasons to believe that the activities have created agents of change. It seems that the activities of the section have had some effect, although the exact impact remains difficult to measure because no structured evaluation method has been applied from the beginning of the continuing education activities.

Community Pharmacy Services↗
PubMed2000

Pharmacy-based needle exchange (PBNX) schemes in south east England: a survey of service providers.

AIMS: To describe the activities of service providers with regard to (i) the business operation and policies defining pharmacy-based needle exchange (PBNX) in South East England; (ii) the day-to-day work of PBNX outlets from the provider perspective; and (iii) problems encountered by PBNX providers. DESIGN: (i) Postal self-completion questionnaire to all participating PBNX community pharmacies in South East England; and (ii) postal self-completion questionnaire to needle exchange coordinators. SETTING: Community pharmacy needle exchanges. PARTICIPANTS: Pharmacists in charge of needle exchange; and needle exchange coordinators. FINDINGS: Data were collected (i) from 381/440 (86.7%) participating community pharmacists, and (ii) 32/36 (88.9%) of coordinators. The study found that PBNX was reaching injecting drug users (many of whom used PBNX regularly), and providing a wide range of injecting equipment. Although pharmacists reported that problems such as shoplifting occurred relatively frequently, more serious problems such as violence were relatively rare. However, PBNX pharmacists reported needing further training for themselves and their staff. Suggested improvements included better advertising of services and improving returns rates for used injecting equipment. CONCLUSION: Needle exchange can reasonably be provided by non-specialist health care professionals such as community pharmacists. However, attention should to be paid to the educational needs of service providers who also require adequate support.

Education, Pharmacy↗
PubMed1996

Impact of clerkship students on pharmacy-site output.

The development of a theory-based method of estimating the impact of pharmacy clerkship students on clerkship sites is described. A job-analysis approach was used to estimate the impact of pharmacy clerkship activities on the clerkship sites. Two models--an employee model and a nonemployee model--of the student-preceptor relationship were used to evaluate clerkship student activities. Pairs of clerkship students and their preceptors were interviewed about student activities and supervision. Activities were assigned three-digit codes expressing (1) the level of preceptor supervision required, (2) the necessity of the activity to the functioning of the site, and (3) the complexity and amount of patient contact involved. The fit of each activity to the models was determined, and the impact of the clerkship students on a composite clerkship site was estimated. Twelve pairs of clerkship students and preceptors were interviewed. Degree of required supervision was the primary determinant in assigning an activity to a model. Student activities that fit the employee model were determined to have the greatest potential for having a positive or negative impact on the clerkship site. Performance of nonemployee-model activities could represent a net loss to the site because of the demand on preceptors' time. A method of categorizing and evaluating the value of specific student activities at pharmacy clerkship sites was useful in estimating student impact on the productivity of the site.

Education, Pharmacy↗
PubMed1996

Work redesign and role restructuring in a pharmacy department with pharmacist assistants.

A new staffing model for decentralized pharmacists and support staff at a university hospital is described. A new technical support position--the pharmacist assistant--was created, and activities were reallocated among the pharmacists, pharmacist assistants, and pharmacy technicians according to the recommendations of two total quality management teams. Pharmacist assistants were to perform many of the drug distribution and record-keeping functions previously performed by pharmacists. The activities marked for reallocation accounted for about 50% of pharmacist time in the existing staffing model; they would not be performed by experienced pharmacy technicians who received brief training to be pharmacist assistants. Nine pharmacists and nine technicians tested the new staffing model on four patient care units over a four-week period. The reassignment of pharmacist tasks to pharmacist assistants theoretically gave pilot-unit pharmacists more time for providing and documenting patient-specific clinical activities and an additional 12 hours a week to participate in such global patient care activities as critical-pathway and quality improvement meetings. By the end of the study, the pharmacist assistants demonstrated that they could perform the reassigned activities; however, the pharmacists were not yet confident in the assistants' ability to do so. A pilot study of a new decentralized pharmacy staffing model demonstrated that technical support personnel can perform many distributive and record-keeping activities traditionally performed by decentralized pharmacists.

Hospital Restructuring↗
PubMed1996

Pharmacy without walls.

Attributes of excellence in pharmacy management are described: big-picture thinking, the ability to exploit change, and willingness to take risks. Big-picture thinking means understanding trends that are shaping health care in order to determine where pharmacy fits. Health systems look beyond inpatient care and use case managers to maximize resource use; pharmacists might serve as case managers. Managed care has caused physicians to be more receptive to resource-management strategies, such as clinical pathways; pharmacists can collaborate in the development of clinical pathways. Pharmacists can serve as physician extenders; for example, by conducting anticoagulation or hypertension clinics. Pharmacists need flexibility to adapt to changes in the internal organization of acute care institutions; they will need to learn about the clinical, behavioral, operational, and fiscal aspects of managing the total patient. New reporting relationships give pharmacists the opportunity to demonstrate to other members of the health care team their role in preventing, managing, and resolving drug-related problems throughout the continuum of care. Risk-taking can mean setting ambitious goals. By setting and achieving ambitious goals for products and services, pharmacists can raise patients' and other health care providers' expectations for pharmacy services. Pharmacists' success will depend on their willingness to experiment with new services and discard services that do not substantially advance patient care. Pharmacists must monitor changes in the provision of health care, determine the implications for their practice and seek opportunities for participation outside the walls within which they have traditionally practiced.

Delivery of Health Care↗
PubMed1996

Computer software for pharmacy oncology services.

A computer program designed to manage the informational, clinical, and data requirements for a pharmacy oncology service is described. Specialized pharmacy oncology software was developed at Rhode Island Hospital and implemented in a multihospital, integrated health system. The software performs various safety functions, supplies on-screen access to pertinent drug and patient information, manages data, and assists in the product formulation process. The programmed safeguards can be modified to meet changing requirements. The system has been in use for more than seven years and has helped detect prescribing errors and prevent preparation and administration errors. A pharmacy oncology computer program streamlines pharmacists' work and helps prevent errors in antineoplastic drug therapy.

Clinical Pharmacy Information Systems↗
PubMed2002

Writing tasks performed by doctor of pharmacy students during clerkship rotations.

The range of writing tasks undertaken by students during doctor of pharmacy clerkship rotations was studied. Data collection involved a review between August and November 1998 of writing samples selected by postbaccalaureate Pharm. D. students at Albany College of Pharmacy for inclusion in their required writing portfolios. The first 200 samples (accounted for by 35 students each submitting two documents for each of three clerkship rotations) were reviewed. Of these, 198 were coded to identify the four rhetorical components of clerkship location, document type, intended audience, and rhetorical purpose. Institutional sites served as the clerkship location for 164 (82.8%) of the 198 documents analyzed. The documents were placed in 28 categories; 5 of these accounted for 126 (63.6%) of the documents: 45 inservice presentations, 32 summaries, 18 patient case write-ups, 16 formulary reviews, and 15 newsletters. Students wrote most frequently to health care providers (34.8%), other pharmacists (32.3%), and teachers (16.7%), with the most frequent rhetorical purposes being informing (73.2%) and demonstrating (14.6%). Analysis of writing samples prepared by pharmacy students during clerkship rotations revealed a variety of clerkship sites, document types, audiences, and rhetorical purposes.

Data Collection↗