Community pharmacists' knowledge, attitudes and practices towards herbal remedies in Riyadh, Saudi Arabia

There is an increasing trend towards consumption of complementary and alternative herbal products in many parts of the world. A cross-sectional sample of 115 community pharmacists in Riyadh, Saudi Arabia was visited and information on knowledge, attitudes and practices towards herbal remedies was collected using a structured questionnaire. All pharmacists acknowledged dispensing herbal products through their pharmacies. Ginseng was the most widely used product (47%), followed by ginkgo (23%), valerian (17%) and S.t John's wort (3.5%). In general, pharmacists had poor awareness about potential herb-drug interactions. While 56% of participating pharmacists expressed concerns about the safety of herbal remedies, 30% considered them to be harmless. Community pharmacists need to be better informed about herbal products.

A nationwide study on generic medicines substitution practices of Australian community pharmacists and patient acceptance

OBJECTIVES

This study evaluated Australian community pharmacists' rate of generic medicine substitution, patient acceptance of generic substitution and cost-savings achieved for patients from substitution.

METHOD

A national stratified sample of 500 Australian pharmacies was randomly selected from different geographical areas. The data of the first 25 original PBS prescription items dispensed on one working day eligible for generic substitution were collected from each pharmacy.

RESULTS

Responses were received from 82 pharmacies with a response rate of 16.4%. The pharmacists recommended generics for 96.4% (1461/1515) of the prescription items which were eligible for substitution. The generic substitution recommendation rate in urban (98.7%) and rural areas (98.0%) was significantly higher than remote areas (91.6%). Conversely, patients' acceptance in remote areas (84.5%) was significantly higher than rural (78.6%) and urban areas (73.2%). Patients with chronic diseases demonstrated significantly lower acceptability (72.4%) than patients with acute conditions (81.6%). Through acceptance of substitution, the patients' medicines expenditure reduced by around 21%.

CONCLUSION

Australian community pharmacists demonstrated a high rate of recommending generic substitution. However, to optimize the generic medicines utilization, patients' acceptance requires further improvement.

Pharmacists' documentation in patients' hospital health records: issues and educational implications

OBJECTIVES

We aimed to identify potential barriers to hospital pharmacists' documentation in patients' hospital health records, and to explore pharmacists' training needs. Our objectives were to identify the methods used by pharmacists to communicate and document patient care issues, to explore pharmacists' attitudes towards documentation of patient care issues in health records, to identify and examine the factors influencing whether or not pharmacists document their care in health records and to make recommendations to inform development of a training programme to educate pharmacists regarding documentation in health records.

METHODS

Methods included a questionnaire and focus groups. The study poulation was 40 clinical pharmacists in a 900-bed London teaching hospital.

KEY FINDINGS

Thirty-nine pharmacists completed the questionnaire and 32 attended a focus group. Questionnaire responses indicated that 29 (74%) pharmacists did not write in patient health records; most preferred temporary notes. However, most respondents agreed that documenting their input in the health record was important. Few pharmacists believed that writing in health records would affect the doctor-pharmacist or patient-doctor relationship, or felt that health-record availability or time were barriers. Most knew when, how and which issues to document; however, most wanted more training. Focus-group discussions revealed that pharmacists feared litigation and criticism from doctors when writing in health records. Pharmacists' written communication in health records was also influenced by the perceived significance and appropriateness of clinical issues, pharmacists' acceptance by doctors, and pharmacists' 'ownership' of the health record.

CONCLUSIONS

While recognising the importance of documenting relevant issues in health records, pharmacists rarely did so in practice and preferred to use oral communication or temporary adhesive notes instead. Pharmacists need to overcome their fear of criticism and litigation in order to document more appropriately in health records. A trust policy and training may offer pharmacists a sense of protection, enabling more confident documentation in patients' health records.

Reliability and validity of a survey to evaluate attitudes and behaviours of pharmacy staff toward near misses

The purpose of this study was to describe attitudes and behaviours of pharmacy staff toward near misses through a survey and interviews. Themes of an acknowledgment of pharmacy process changes resulting from near miss reporting, feelings of personal responsibility, minimizing the importance of reporting near misses, and a need for further education were evident in both the survey and qualitative discussions. This survey is useful to inform educational efforts and to encourage near miss reporting.

[Protomedicato and pharmacy in Castile at the end of the sixteenth century: "Catálogo de las Cosas que los Boticarios han de tener en sus Boticas" (Catalogue of the things that apothecaries must have in their shops), by Andrés Zamudio de Alfaro, Protomédico General (1592-1599)]

In this article we present a catalogue of medicinal products preserved in a manuscript copy among the papers of a druggist who died in Madrid in 1599. This catalogue, whose title expresses its normative character, contains 423 entries and is signed by Andrés Zamudio de Alfaro, Protomédico General of Castile from 1592 until his death in 1599. It was presumably issued by the Real Tribunal del Protomedicato during the last decade of the sixteenth century for the use of the protomédicos and examiners who carried out official visits to apothecaries under the aegis of the Tribunal, in accordance with the royal decrees of 1588 and 1593, and was also distributed among the apothecaries themselves and their suppliers, such as the druggist who possessed the copy edited here. The document offers valuable evidence of the policy of normalization of medical, and specifically pharmaceutical, practice imposed during this period by the State through the Protomedicato.

A conflict management scale for pharmacy

OBJECTIVES

To develop and establish the validity and reliability of a conflict management scale specific to pharmacy practice and education.

METHODS

A multistage inventory-item development process was undertaken involving 93 pharmacists and using a previously described explanatory model for conflict in pharmacy practice. A 19-item inventory was developed, field tested, and validated.

RESULTS

The conflict management scale (CMS) demonstrated an acceptable degree of reliability and validity for use in educational or practice settings to promote self-reflection and self-awareness regarding individuals' conflict management styles.

CONCLUSIONS

The CMS provides a unique, pharmacy-specific method for individuals to determine and reflect upon their own conflict management styles. As part of an educational program to facilitate self-reflection and heighten self-awareness, the CMS may be a useful tool to promote discussions related to an important part of pharmacy practice.

[Satisfaction of pharmacists in Lebanon and the prospect for clinical pharmacy]

We conducted a questionnaire survey among community and pharmaceutical company pharmacists in Lebanon to evaluate their satisfaction with their professional status and their willingness to work as clinical pharmacists. The majority of community pharmacists were satisfied with their professional situation (> 50%), except for the financial aspect (40%). For pharmaceutical company pharmacists, only 33% thought that their profession had a positive image. However, > 65% were satisfied with social and financial standing. About 25% of pharmacists in pharmaceutical companies were ready to switch to clinical pharmacy with less income. Over 75% of the community pharmacists were prepared to apply clinical pharmacy in their practice and would be ready to attend courses for this purpose.

The extent and characteristics of United Kingdom hospital pharmacists keeping, or not keeping, a professional development portfolio

OBJECTIVES

The aim of this study was to examine the use of continuing professional development (CPD) portfolios by hospital pharmacists. The objectives were to assess the extent to which pharmacists use portfolios in CPD and to examine the attitudes/beliefs which differentiate those who do and do not keep a portfolio.

METHOD

Participants completed two questionnaires: (1) personality traits were examined using the Big-Five questionnaire and (2) a new Pharmacist Portfolio-Engaging Behaviour Questionnaire (PPEBQ) examined the attitudes and beliefs. What constitutes a portfolio was left to the interpretation of the participants, but it was specified that the survey was about participants' views of producing written records of their professional practice for CPD. The setting was hospital pharmacists based in the London area in December 2004.

KEY FINDINGS

Overall, 134 pharmacists (78%) returned both questionnaires, and 80 stated that they kept a portfolio and 52 stated that they did not (two questionnaires were returned spoilt). There was no significant difference in the age or number of years qualified between those with and without a portfolio. Three personality traits were linked to keeping a portfolio (conscientiousness, agreeableness and emotional stability). Pharmacists with a portfolio scored highly on the perceived behavioural control and behavioural intention scales of the PPEBQ.

CONCLUSIONS

The Big-Five personality questionnaire is a useful tool to investigate pharmacists' use of a portfolio. Results of the PPEBQ suggested that hospital pharmacists who had a portfolio were concerned with having control over its production. However, the PPEBQ requires further development to improve its reliability. These findings have implications for the educational support of CPD.

An exploration of work-related stress in Northern Ireland community pharmacy: a qualitative study

OBJECTIVES

The aim of this study was, through qualitative methodology, to explore the factors which contribute to job-related stress in community pharmacy in Northern Ireland.

METHODS

All community pharmacists in Northern Ireland were invited to participate in one-to-one semi-structured interviews. Interview schedules explored pharmacists' attitudes to job-related stress and the situations that may contribute to stress. All interviews took place at participants' work sites between December 2007 and April 2008, were audio-taped, transcribed verbatim, read independently by the authors and analysed using thematic analysis.

KEY FINDINGS

Seventeen pharmacists participated in the interviews. The main themes that emerged in relation to job-related stress were workplace issues, issues regarding professional expansion, recognition and responsibility, and a demanding public. Although there was general support for development in community pharmacy, this was tempered by concerns as to how expectations would be met and how all services would be delivered.

CONCLUSIONS

The themes that emerged from this work reflect what was reported from a survey conducted in 2007 and reinforce the tension between developments in practice and the ability to deliver. Developments in professional practice can be positive; however, commissioners and policy-makers need to consider whether community pharmacists have the infrastructure in terms of environment, personnel and multi-professional support to deliver what is required of them.

Standardization of rotation schedules for pharmacy students' advanced practice rotations and potential impact on rotation site availability

BACKGROUND

Increasing enrollment in pharmacy schools has led to a shortage of adequate advanced pharmacy practice experience (APPE) sites.

OBJECTIVE

We sought to assess our preceptors' support for a standardized rotation schedule for the multiple schools that compete for APPE sites in our area. A secondary objective was to ascertain preceptors' beliefs about the impact a regional standardized rotation schedule might have on the number of students their sites would be able to accept on rotation.

METHODS

A short questionnaire was developed. All APPE preceptors at our institution were invited to participate by e-mail, telephone and/or U.S. mail.

RESULTS

A total of 232 preceptors were contacted; questionnaires were returned by 133 preceptors (57%). A proposed region-wide rotation schedule was supported by 75.2% of respondents. Most (79%) believed that the standardization of schedules will not affect the number of students they will be able to accommodate on rotations, while 18.1% believed the new schedule will allow them to accept more students.

CONCLUSION

APPE preceptors in our area generally support standardization of pharmacy students' community rotation schedules, and this may increase the APPE availability but perhaps for only a minority of sites.

Relationship of pharmacist interaction with patient knowledge of dispensed drugs and patient satisfaction

A prospective survey of pharmacists' tasks and patients' knowledge and satisfaction was conducted in 35 randomly selected community pharmacies in Tabriz, Islamic Republic of Iran. The total pharmacist interaction received a mean score of 3.05 out of 5. Providing written directions for use attained the highest score of 0.98 out of 1. Patients scored 3.18 out of 5 for knowledge about their medicines. There was a close correlation between patients' knowledge of dispensed drugs and pharmacist interaction (r = 0.95). Mean total prescription filling time was 7.6 min, but only 1.4 min was spent on pharmacist-patient counselling. The interaction between pharmacist and patient increases patients' knowledge about dispensed medicines and their satisfaction with the pharmacist's activities.

Barriers to adolescents' getting emergency contraception through pharmacy access in California: differences by language and region

CONTEXT

In California, emergency contraception is available without a prescription to females younger than 18 through pharmacy access. Timely access to the method is critical to reduce the rate of unintended pregnancy among adolescents, particularly Latinas.

METHODS

In 2005-2006, researchers posing as English- and Spanish-speaking females-who said they either were 15 and had had unprotected intercourse last night or were 18 and had had unprotected sex four days ago-called 115 pharmacy-access pharmacies in California. Each pharmacy received one call using each scenario; a call was considered successful if the caller was told she could come in to obtain the method. Chi-square tests were used to assess differences between subgroups. In-depth interviews with 22 providers and pharmacists were also conducted, and emergent themes were identified.

RESULTS

Thirty-six percent of all calls were successful. Spanish speakers were less successful than English speakers (24% vs. 48%), and callers to rural pharmacies were less successful than callers to urban ones (27% vs. 44%). Although rural pharmacies were more likely to offer Spanish-language services, Spanish-speaking callers to these pharmacies were the least successful of all callers (17%). Spanish speakers were also less successful than English speakers when calling urban pharmacies (30% vs. 57%). Interviews suggested that little cooperation existed between pharmacists and clinicians and that dispensing the method at clinics was a favorable option for adolescents.

CONCLUSIONS

Adolescents face significant barriers to obtaining emergency contraception, but the expansion of Spanish-language services at pharmacies and greater collaboration between providers and pharmacists could improve access.

Evaluating user satisfaction with an electronic prescription system in a primary care group

INTRODUCTION

Electronic prescribing has been proposed as an important strategy to reduce medication errors, improve the quality of patient care and create savings in health care costs. Despite these potential advantages, user satisfaction plays a significant role in the success of its implementation. Hence, this study aims to examine users' satisfaction and factors associated with satisfaction regarding an electronic prescription system implemented in the National Healthcare Group Polyclinics in Singapore.

MATERIALS AND METHODS

An anonymous survey was administered in October 2007 to all physicians, pharmacists and pharmacy technicians working in the 9 National Healthcare Group Polyclinics.

RESULTS

Respondents included 118 doctors and 61 pharmacy staff. The overall level of satisfaction with electronic prescribing was high. Doctors and pharmacists reported a high degree of agreement that electronic prescribing reduces prescribing errors and interventions, and they did not want to go back to the paper-based system. Users were generally satisfied with the functionality of the system but there was some degree of workflow interference particularly for the pharmacy staff. Only 56.9% of the pharmacy respondents expressed satisfaction with the review function of the electronic prescription system and only 51.8% and 60% were satisfied when processing prescriptions that included items to be purchased from an external pharmacy or prescriptions with amendments. The results also revealed that satisfaction with the system was more associated with users' perceptions about the electronic prescription system's impact on productivity than quality of care.

CONCLUSION

The survey results indicate that the implementation of the electronic prescription system has gone reasonably well. The survey findings provide opportunities for system and workflow enhancement, which is important as these issues could affect the acceptability of a new technology and the speed of diffusion within an organisation.

Pharmacists on the front line in providing support for nicotine replacement therapy and bupropion purchasers

INTRODUCTION AND AIMS

Increased access for smokers to pharmacotherapies for smoking cessation suggests that pharmacists have a potential role in influencing how these pharmacotherapies are used in the community. This study aimed to identify the extent and type of advice provided by pharmacists to customers purchasing nicotine replacement therapy (NRT) or bupropion and to identify pharmacists' perceptions about the desirability and feasibility of providing such advice.

DESIGN AND METHODS

A sample of 700 pharmacies was selected at random from the NSW Electronic Yellow Pages and a questionnaire was sent by mail, fax or e-mail to the pharmacist in charge.

RESULTS

From 665 eligible pharmacies, 375 pharmacists returned completed questionnaires, giving a response rate of 56.4%. Participants reported providing a mean of 5 minutes of advice to both bupropion and NRT purchasers, with 59.5% reporting the provision of behavioural advice to NRT purchasers. Although over 70% of pharmacists perceived the provision of a brochure about NRT or bupropion as desirable and feasible, brochures were provided to less than one-third of NRT purchasers.

DISCUSSION AND CONCLUSIONS

Pharmacists report providing a sizeable amount of advice to purchasers of NRT and bupropion. Recommendations for enhancing the role of pharmacists in influencing the use of cessation pharmacotherapies are discussed briefly.

The influence of continuing professional development portfolio records on pharmacy practice

OBJECTIVES

The aim of this study was to undertake an in-depth investigation of the influence of continuing professional development (CPD) portfolios on pharmacy practice in the hospital setting. The objectives were to explore the views of pharmacists regarding the contribution of CPD records to professional practice and examine the influence of time and experience on pharmacists' views of recording professional practice.

METHOD

A qualitative design was used to explore the views of pharmacists over 12 months. Pharmacists were stratified according to years of practice in the UK National Health Service (NHS). The methods used involved semi-structured in-depth face-to-face interviews. The interviews were undertaken at three time points. The pharmacists were gathered into three focus groups to test the consistency of the interviews. A purposive sampling method used nine NHS Teaching and Non-Teaching hospital pharmacists in the London area.

KEY FINDINGS

The participants included four males and five females, who had been qualified for between 0.1 and 21 years. Three key themes emerged for how CPD records contribute to practice: (1) lack of contribution to practice, (2) tacit contribution and (3) mentality. Overall, the recording process made little if any change in professional practice. The more experienced participants were less likely to be able to explain any changes in practice and there were no consistent changes in the views expressed over time.

CONCLUSIONS

The contribution of CPD recording to enhancing practice in hospital pharmacists was difficult to demonstrate. This study has also illustrated the power relationships involving control mechanisms used by the NHS, and the UK pharmacists' regulatory body, which are discussed in the context of the Panopticon model of self-regulated behaviour. Further research is needed to establish the value of CPD recording.

Early experiences of the mini-PAT (Peer Assessment Tool) amongst hospital pharmacists in south east London

OBJECTIVES

The aim was to describe early experience of use of the mini-PAT (Peer Assessment Tool) amongst general-level pharmacists working in secondary care, and to capture their views about the method of assessment.

METHODS

General-level pharmacists who had completed two rounds of the mini-PAT assessment in their first year post-qualification were asked to complete a semi-structured questionnaire, assessing the usefulness and acceptability of the assessment method.

KEY FINDINGS

The pharmacists found the assessment method useful and acceptable, with many citing that they found it useful to see how they were doing in relation to their peers. To further improve the assessment method, the general-level pharmacists suggested that any verbatim comments made should have the relevant assessor's name next to it, so the context of the comment can be understood.

CONCLUSIONS

Early experience suggests that the mini-PAT is a useful formative assessment tool for use amongst GLPs.

Views of pharmacist prescribers, doctors and patients on pharmacist prescribing implementation

AIM

The aim of this study was to explore the perspectives of pharmacist supplementary prescribers, their linked independent prescribers and patients, across a range of settings, in Scotland, towards pharmacist prescribing.

METHOD

Telephone interviews were conducted with nine pharmacist prescribers, eight linked independent prescribers (doctors) and 18 patients. The setting was primary and secondary care settings in six NHS Health Board areas in Scotland.

KEY FINDINGS

In general, all stakeholders were supportive of pharmacists as supplementary prescribers, identifying benefits for patients and the wider health care team. Although patients raised no concerns, they had little idea of what to expect on their first visit, leading initially to feelings of apprehension. Pharmacists and doctors voiced concerns around a potential lack of continued funding, inadequate support networks and continuing professional development. Pharmacists were keen to undertake independent prescribing, although doctors were less supportive, citing issues around inadequate clinical examination skills.

CONCLUSIONS

Pharmacists, doctors and patients were all supportive of developments in pharmacist supplementary prescribing, although doctors raised concerns around independent prescribing by pharmacists. The ability of pharmacists to demonstrate competence, to be aware of levels of competence and to identify learning needs requires further exploration.

Community pharmacists' knowledge of and attitudes toward oral chemotherapy

OBJECTIVE

To assess community pharmacists' attitude toward and knowledge of oral chemotherapy (OC) in terms of drug indications, general dosing principles, drug interactions, adverse effects, and special handling precautions.

DESIGN

Descriptive, nonexperimental, cross-sectional survey.

SETTING

Colorado, Kansas, and the southeastern United States in May and June 2005.

PARTICIPANTS

1,080 pharmacists in four divisions of a large community pharmacy chain.

INTERVENTIONS

Web-based survey.

MAIN OUTCOME MEASURES

Pharmacist knowledge of and attitude toward OC.

RESULTS

243 surveys were returned (response rate 22.5%). Overall, pharmacists answered 49.7% of knowledge questions correctly. Pharmacists were most knowledgeable about general dosing principles (69%) and least knowledgeable about adverse effects (45%) and special handling (25%) of OC. Higher scores were seen for pharmacists who dispensed a greater number of OC prescriptions. Percentages of correct responses did not vary based on years of experience or number of OC continuing pharmacy education (CPE) programs attended. On a Likert-type scale of 1 (low) to 5 (high), the average comfort in dispensing OC was 2.4. On average, pharmacists indicated that knowing about OC was important to their practice (3.7) and expressed interest in participating in additional CPE programs on OC (4.2). Of respondents, 94.7% indicated that their pharmacy did not have a counting tray devoted to cytotoxic drugs.

CONCLUSION

This survey identified several areas in which pharmacists' knowledge of OC could be enhanced. Handling of OC is an area of important need, given the low number of pharmacists reporting separate counting trays for cytotoxic drugs.

Impact of perceived innovation characteristics on adoption of pharmacy-based in-house immunization services

OBJECTIVES

An in-house immunization service in which staff pharmacists administer vaccines was conceptualized as an innovation. Prior to making adoption decisions, community pharmacies evaluated characteristics of in-house immunization services. This study examined the impact of three specific characteristics (perceived benefit, perceived compatibility and perceived complexity) of in-house immunization services on community pharmacies' adoption decisions.

METHODS

A multi-stage mixed-mode survey design was used to collect data from key informants of community pharmacies in Washington State, USA. Key informants included pharmacy managers or pharmacists-on-duty who were able to answer questions related to immunization activities in their pharmacies. Perceived characteristics of in-house immunization services and pharmacy adoption decisions were measured in 2004 and in 2006-2007, respectively.

KEY FINDINGS

Each perceived characteristic individually predicted adoption of in-house immunization services. When all three characteristics were included in logistic regression, perceived benefit was the only significant predictor of in-house immunization service adoption.

CONCLUSIONS

Appropriate strategies, particularly promoting the benefit of in-house immunization services, should be implemented. The proposed model and findings may be applicable to other pharmacy-based innovative practices or other public health initiatives. We recommend that organizational leaders, researchers and practitioners consider the impact of perceived benefit and incorporate it when they design strategies to foster adoption of innovative practices. Doing this may increase the number of adopters and also increase diffusion rates for innovative services.