Health care professionals' perspectives on automated multi-dose drug dispensing

Background:

During the 1980s, manual repackaging of multi-dose medications from pharmacies in Sweden was successively substituted with automated multi-dose drug dispensing (MDD). There are few studies evaluating the consequences of automated MDD with regard to patient safety, and those that investigate this issue are not very extensive.

Objectives:

To investigate Swedish health care professionals’ perceived experience of automated MDD and its effects on patient adherence and patient safety.

Methods:

Three questionnaire forms, one for physicians, nurses, and assistant nurses/nursing assistants, were developed based on reviews of the literature and pilot testing of the questions in the intended target groups. The target groups were health professionals prescribing or administrating MDD to patients. A sample (every sixth municipality) was drawn from the sampling frame of Swedish municipalities, resulting in 40 municipalities, about 14% of all municipalities in Sweden. Email addresses of general practitioners were obtained from county councils, while the municipalities assisted in getting contact details for nurses, assistant nurses and nursing assistants. A total of 915 questionnaires were distributed electronically to physicians, 515 to nurses, and 4,118 to assistant nurses/nursing assistants. The data were collected in September and October 2012.

Results:

The response rate among physicians, nurses and assistant nurses/nursing assistants was 31%, 43% and 23%, respectively. The professionals reported that automated MDD reduces duplication of medication, contributes to correct dosages, helps patients take their medication at the right time, and reduces confusion among patients. Fifteen per cent of the physicians and about one-third of the nurses and assistant nurses/nursing assistants reported that generic substitution makes it more difficult for the patient to identify the various medicines available in the sachets. The physicians did, however, note that prescribing medicine to patients with automated MDD is complicated and can be a risk for patient safety. Both physicians and nurses requested more information on and training in automated MDD. They also asked for more medication reviews.

Conclusions:

The professionals generally had a positive attitude to automated MDD with regard to improved medication adherence, but said they believed that the electronic prescribing system posed a safety risk for patients.

Determining primary care physician information needs to inform ambulatory visit note display

BACKGROUND

With the increase in the adoption of electronic health records (EHR) across the US, primary care physicians are experiencing information overload. The purpose of this pilot study was to determine the information needs of primary care physicians (PCPs) as they review clinic visit notes to inform EHR display.

METHOD

Data collection was conducted with 15 primary care physicians during semi-structured interviews, including a third party observer to control bias. Physicians reviewed major sections of an artificial but typical acute and chronic care visit note to identify the note sections that were relevant to their information needs. Statistical methods used were McNemar-Mosteller's and Cochran Q.

RESULTS

Physicians identified History of Present Illness (HPI), Assessment, and Plan (A&P) as the most important sections of a visit note. In contrast, they largely judged the Review of Systems (ROS) to be superfluous. There was also a statistical difference in physicians' highlighting among all seven major note sections in acute (p = 0.00) and chronic (p = 0.00) care visit notes.

CONCLUSION

A&P and HPI sections were most frequently identified as important which suggests that physicians may have to identify a few key sections out of a long, unnecessarily verbose visit note. ROS is viewed by doctors as mostly "not needed," but can have relevant information. The ROS can contain information needed for patient care when other sections of the Visit note, such as the HPI, lack the relevant information. Future studies should include producing a display that provides only relevant information to increase physician efficiency at the point of care. Also, research on moving A&P to the top of visit notes instead of having A&P at the bottom of the page is needed, since those are usually the first sections physicians refer to and reviewing from top to bottom may cause cognitive load.

A cross-sectional study of applied bioethical reasoning in pharmacy students and preceptors

OBJECTIVE

To compare ethical principles most often utilized by pharmacy students and preceptors to determine plan of action for an ethical dilemma and to determine if ethical principles utilized are the same for individuals in the postconventional range.

METHOD

A two part survey was administered to a convenience sample of pharmacy students and preceptors. The first part was comprised of an original measure, the Pharmacy Ethical Dilemmas Survey (PEDS), that was developed to assess participants' action choices on healthcare-related ethical dilemmas and which moral rule or ethical principle was most influential in their decision. The second part was comprised of the Defining Issues Test.

RESULTS

Patient autonomy and non-maleficience were the primary bioethical principles applied by students but pharmacists applied non-maleficience, patient autonomy, and also pharmacist autonomy. For all scenarios, students were more likely to rely on the principle of beneficence, while preceptors were more likely to rely on the pharmacist's right to autonomy. In the analysis of application of bioethical principles by higher and lower principled reasoning individuals, only in the assisted suicide scenario did the two groups agree on the primary principle applied with both groups relying predominantly on patient autonomy.

CONCLUSION

Students and preceptors utilize different bioethical principles to support how they would handle each ethical dilemma but P-scores do not play a role in determining which bioethical principles were used to justify their action choices.

Medication therapy management clinic: perception of healthcare professionals in a University medical center setting

Objective

To determine the overall perception and utilization of the pharmacist managed medication therapy management (MTM) clinic services, by healthcare professionals in a large, urban, university medical care setting.

Methods

This was a cross-sectional, anonymous survey sent to 195 healthcare professionals, including physicians, nurses, and pharmacists at The University of Illinois Outpatient Care Center to determine their perception and utilization of the MTM clinic. The survey consisted of 12 questions and was delivered through a secure online application.

Results

Sixty-two healthcare professionals (32%) completed the survey. 82% were familiar with the MTM clinic, and 63% had referred patients to the clinic. Medication adherence and disease state management was the most common reason for referral. Lack of knowledge on the appropriate referral procedure was the prominent reason for not referring patients to the MTM clinic. Of the providers that were aware of MTM services, 44% rated care as ‘excellent’, 44% as ‘good’, 5% as ‘fair’, and 0% stated ‘poor’. Strengths of MTM clinic identified by healthcare providers included in-depth education to patients, close follow-up, and detailed medication reconciliation provided by MTM clinic pharmacists. Of those familiar with MTM clinic, recommendations included; increase marketing efforts to raise awareness of the MTM clinic service, create collaborative practice agreements between MTM pharmacists and physicians, and ensure that progress notes are more concise.

Conclusions

In a large, urban, academic institution MTM clinic is perceived as a valuable resource to optimize patient care by providing patients with in-depth education as it relates to their prescribed medications and disease states. These identified benefits of MTM clinic lead to frequent patient referrals specifically for aid with medication adherence and disease state management.

Knowledge, perception and practice of pharmacovigilance among community pharmacists in South India

Pharmacovigilance has not progressed well in India and the concept is still in its infancy. India rates below 1% in pharmacovigilance as against the world rate of 5%.

OBJECTIVE

The aim of our study was to evaluate the knowledge, perception and practice of pharmacovigilance among registered community pharmacists in Hyderabad, India.

METHODS

This was a prospective study to find out the knowledge, perception and practice of adverse drug reaction reporting among community pharmacists. It was conducted by a face to face questionnaire and the convenience factor of the pharmacist was taken into consideration.

RESULTS

From the 650 questionnaire administered to community pharmacists, 347 (53.3%) were returned completely filled questionnaires. A number of 120 (34.6%) pharmacists could define the term 'pharmacovigilance' to an acceptable extent and 119 (34.3%) knew about the National Pharmacovigilance Programme in India. 96 (27.7%) had good knowledge, 36(10.4%) had fair knowledge and 215(61.9%) had poor knowledge about pharmacovigilance. We have found that 196 (56.5%) had good perception, 94(27.1%) had fair perception and 57(16.4%) had poor perception. Only 41(11.8%) pharmacists ever reported an ADR and the other never reported ADR. The majority of pharmacists 223(64.3%) felt that the AE is very simple and non-serious and hence did not report. Pharmacists have poor knowledge, good perception and negligibly low reporting rates.

CONCLUSIONS

Incorporation of ADR reporting concepts in education curriculum, training of pharmacists and voluntary participation of pharmacists in ADR reporting is very crucial in achieving the safety goals and safeguarding public health.

Acceptance or rejection of clinical standardization?: Chilean doctors discuss clinical practice guidelines and benefit packages

This study analyzes the degree to which Chilean doctors accept the standardization of clinical health care associated with the 2005 Health Reform AUGE-GES (from the Spanish Acceso Universal con Garantías Explícitas - Garantías Explícitas en Salud). Using 18 semi-structured interviews, four hypotheses were explored in relation to the level of acceptance of standardization and its variation according to years of clinical experience, the type of instrument (clinical practice guidelines or benefit packages), and the specialty (medical or surgical). Rather than a generalized rejection of the standardization of clinical procedures, the results suggest important differences within the discourse of the doctors. The level of acceptance depends both on years of clinical experience and the type of instrument evaluated. We discuss the implications of these results for the design and implementation of successful health reforms, incorporating the rationale of the medical profession and its emphasis on individual discretion, variability of treatment decisions, and the ability to adjust to the particular circumstances of the practice.

Barriers to medication counselling for people with mental health disorders: a six country study

Provision of medication information may improve adherence and prevent medication related problems. People with mental health disorders commonly receive less medication counselling from pharmacists than people with other common long term and persistent disorders.

The impact of an immunization training certificate program on the perceived knowledge, skills and attitudes of pharmacy students toward pharmacy-based immunizations

Objective

To assess the impact of a national immunization training certificate program on the perceived knowledge, skills and attitudes of pharmacy students toward pharmacy-based immunizations.

Methods

The study design utilized a pre- and post-survey administered to pharmacy students before and after the American Pharmacists Association’s (APhA) Pharmacy-Based Immunization Delivery program. The primary outcome explored was a change in the perceived knowledge, skills, and attitudes of the pharmacy students. A five-point Likert scale (i.e. strongly agree = 5, strongly disagree = 1) was used for measuring the main outcomes, which was summated by adding the individual item scores in each section to form a composite score for each outcome.

Results

The certificate training program resulted in a significant improvement in knowledge (38.5% increase in score, p<0.001) and skills (34.5% increase in score, p<0.001), but not attitudes (1% increase in score, p=0.210).

Conclusions

The national immunization training certificate program had a positive impact on the perceived knowledge and skills of pharmacy students. However, no change was observed regarding students’ perceived attitudes toward pharmacy-based immunizations.

Assessment of attitudes of University of Nigeria pharmacy students toward pharmaceutical care

Objective:

The purpose of this study was to describe the attitude of University of Nigeria pharmacy students towards pharmaceutical care. Method: A survey of pharmacy students in their second to fifth year was conducted. A modified 13-item standard Pharmaceutical Care Attitudes Survey (PCAS) was used for the study. Reliability and factorial validity of the modified instrument were assessed.

Results:

Modification of the instrument did not alter its validity. Students of the University of Nigeria had a positive attitude towards pharmaceutical care as attitude score of all the items were above the midpoint score of 2.5. The mean scale score of second and third year students were significantly lower than that of the fifth year’s (Oneway ANOVA, p<0.001). Females had a higher positive attitude score compared to male students (Students t-test, p=0.005). There was no significant difference in the mean scale score among those that had work experience and those without work experience. Marital status did not influence attitude score.

Conclusion:

University of Nigeria pharmacy students had a positive attitude towards pharmaceutical care. However, it is necessary to provide sites were students could acquire practice experience and these sites should be designed to enable students observe the integration of pharmaceutical care activities into pharmacy practice.

Arkansas pharmacists' perceptions toward emergency contraception and nonprescription Plan B

Objective

This study describes Arkansas pharmacists’ knowledge, attitudes, and beliefs regarding emergency contraception.

Methods

A cross-sectional survey was conducted among a convenience sample of pharmacists prior to a continuing education lecture. The 16-item survey included multiple choice and true/false questions to assess knowledge in addition to Likert-type scale questions regarding attitudes and beliefs. Frequency and descriptive statistics were calculated for all variables.

Results

Eighty-eight pharmacists completed the survey. A majority (73%) knew that Plan B had been FDA-approved for nonprescription use yet 42% believed that it works by disrupting a newly implanted ovum. On a scale from 1-5 where 5=strongly agree, the mean item score was 3.2 for whether emergency contraception should be available for nonprescription use with counseling and 1.6 for nonprescription use without counseling. When asked what they would do if presented with a request for emergency contraception, 45.8% indicated they would dispense the drug, 22.9% would refer the patient to another pharmacist or pharmacy, 3.6% would refuse to dispense, and 27.7% were not sure. Almost half (48.6%) did not believe they were competent instructing patients on the use of emergency contraception.

Conclusions

The results show that pharmacists could benefit from additional training on emergency contraception.

Pharmacists' attitudes and awareness towards the use and safety of herbs in Kuwait

OBJECTIVES

The purpose of this study was to investigate the knowledge and attitudes among pharmacists in Kuwait towards the use of herbs.

METHODS

Self-administered questionnaire was designed as the study instrument and distributed among 100 qualified pharmacists working in government and private pharmacies in Kuwait.

RESULTS

The mean age was 34.2 (SD=7.5) years. About 51% of pharmacists reported they had used herbal therapy in their lifetime. The majority were interested in herbal information, and their herbal information came mainly from their previous classes during college. Although the pharmacists' knowledge about uses of selected herbs was good, their awareness about side effects of those herbs was modest. About 31% of the pharmacists did not have enough information about potential interactions between herbs and conventional medicines.

CONCLUSION

Herbal information is needed for pharmacy students as part of the Pharmacy College curriculum. Continuing education programs for practising pharmacists about the safety of different herbal products should be established in Kuwait.