The role of community pharmacists in health education and disease prevention: a survey of their interests and needs in relation to cardiovascular disease

Current Perspectives, Practices, and Barriers Faced by Community Pharmacists Regarding Pharmaceutical Care Services for Diabetes Mellitus in the United Arab Emirates

Background

Providing accurate and sufficient information is a crucial requirement for delivering effective diabetes care, making it essential for community pharmacists to possess adequate knowledge of diabetes mellitus (DM) and its management.

Objective

To investigate community pharmacists' level of expertise and engagement in providing counseling and health promotion services for individuals with DM in the United Arab Emirates (UAE).

Methods

A cross-sectional study design was used. The community Pharmacies were chosen via random sampling and researchers then conducted face-to-face interviews with them using the structured questionnaire. The questionnaire included demographic data, 14 questions on the knowledge and 9 questions about the practice concerning pharmaceutical care for Diabetes Mellitus.

Results

The average age ± SD was 31 ± 6.3. Of the total 516 community pharmacists recruited in the study, 37.2% (n=192) were male and 62.8% (n=324) were female. The average knowledge score about DM prevention and management was 9.7 with a 95% confidence interval (CI) [9.5, 9.9] and the average practice score about DM prevention and management was 7.1 with a 95% confidence interval (CI) [6.9, 7.2]. Better knowledge scores were observed in chief pharmacists (OR 1.29; 95% CI 1.08-1.56), pharmacists with 6-10 Years of experience (OR 6.92; 95% CI 3.43-8.86), pharmacist with > 10 years of experience (OR 1.99; 95% CI 1.67-2.36), when the number of patients the pharmacist serve is 5-10 (OR 1.27; 95% CI 1.06-1.53) and being trained on DM prevention and management (OR 2.18; 95% CI 1.92-2.47). Similarly, better practice scores were observed in older participants (OR1.02; 95% CI 1.001-1.03), chain pharmacies (OR 1.42; 95% CI 1.20-1.68), chief pharmacists (OR 1.56; 95% CI 1.18-2.06), when the number of patients the pharmacists serve was 5-10 (OR 12.26; 95% CI 7.26-16.19), when the number of patients the pharmacists serve was 11-20 (OR 4.23; 95% CI 3.54-5.06) and being trained on DM prevention and management (OR 1.33; 95% CI 1.11-1.59). The most commonly reported barriers to providing counseling and health promotion services for diabetes mellitus (DM) in community pharmacies include a lack of coordination with other healthcare professionals (77%) and insufficient knowledge or clinical skills (68.7%).

Conclusion

Our study revealed that community pharmacy staff members displayed a noteworthy level of involvement in providing pharmaceutical care services for patients with diabetes mellitus. Based on these findings, it is recommended to enhance pharmacy education by incorporating more advanced, evidence-based training and curricula focusing on disease management and appropriate therapies, particularly for diabetes.

Barriers to Medication Review Process Implementation—Cross-Sectional Study among Community Pharmacists in Jordan

The medication review process (MRP) is an extended, vital role of community pharmacists in improving health outcomes of medication use, yet it is neither systematically nor comprehensively provided bycommunity pharmacies in Jordan. This study aimed to identify the potential barriers hinderingMRP implementation bycommunity pharmacists in Jordan. A total of 550 community pharmacists electronically received a previously constructed and validated Arabic questionnaire explicitly developed to assess the current medication review practices and factors hindering the MRP, of whom 417 answered the questionnaire, giving a response rate of 75.8%. Among the investigated six categories’ seventeen barriers tothe implementation of the MRP, the highest rating was found for remuneration barriers (55.8%), followed by barriers related to regulations and patients, which scored 52.3% and 48.8%, respectively. Resource-related barriers were recognizedby 44.6% of participants, while qualifications and barriers related to physicians scored 42.9% and 41.8%, respectively. Although community pharmacists in Jordan are eager to extend their roles from traditional to more patient-centered ones, they encounter various barriers hinderingsuch development. Regulation adjustments accompanied by cost-effective remuneration and proper training are strong facilitators for community pharmacists to initiate the medication review service; make available the needed resources; and invest efforts, time, and money to operate it.

How do Polish pharmacy staff evaluate own qualifications, competences, relevance, motivation, effectiveness in health promotion?

Health promotion programmes are complex and need to engage all health care specialists, including pharmacists. Pharmacies are considered as a potentially ideal place for health promotion and education. To evaluate own qualifications, competences, relevance, motivation and effectiveness of Polish pharmacy staff with regard to health-related information provided to patients, which contributes to health promotion. 308 pharmacy staff from Lublin (Poland) were surveyed with a questionnaire prepared by the researchers and piloted previously. It consisted of 5 domains: qualifications, competences, relevance, motivation, and effectiveness of health promotion. Items in each domain were scored by respondents in 1 − 10 scale where 1 is ‘very low’ and 10 is ‘very high’. Pharmacy staff rated the relevance of health promotion the highest, while the lowest—own competences and effectiveness in health promotion. Female pharmacy staff assessed the relevance of health promotion significantly higher than males (7.1 vs. 6.1, p = 0.005). Higher self-assessments of qualifications, competences, relevance, motivation and effectiveness in health promotion were provided by: the youngest pharmacy staff, those with a short period of employment, and pharmacy staff working in pharmacies employing up to 3 persons. Qualification and competences in health promotion were assessed higher by pharmacy technicians and masters of pharmacy with post-graduate studies or professional specialization, or Ph.D. than by masters of pharmacy. Relevance and effectiveness in health promotion were evaluated higher by pharmacy staff in pharmacies serving more than 100 customers daily. There is a need to improve qualifications, competences, relevance, motivation and effectiveness in health promotion conducted by Polish pharmacy staff.

Feasibility of cardiovascular risk screening in Portuguese community pharmacies

Background:

Cardiovascular disease (CVD) remains the leading cause of human mortality. As highly accessible and qualified health professionals, community pharmacists can be included in the early detection of patients at risk for CVD by implementing CVD screening programs.

Objective:

To assess the feasibility of CVD risk screening services in Portuguese community pharmacies from the evaluation of customers acceptability.

Methods:

A cross-sectional study was conducted in a community pharmacy in Portugal. The purpose of entering the pharmacy was recorded for all customers. Afterwards, the customers were invited to be interviewed by the pharmacist, who registered their willingness to participate and collected the participants’ data and biochemical and physical parameters to assess their CV risk by applying the Systematic COronary Risk Evaluation (SCORE) model. For the participants who were not eligible for the SCORE-based risk assessment, the pharmacist considered the major modifiable CVD risk factors - hypertension, dyslipidemia, smoking habits, obesity, impaired fasting glucose and sedentary behavior - according to the ESC guidelines.

Results:

Picking up medication was the most prevalent reason 69.8% (n=1,600) for entering the pharmacy, and among the contacted customers, 56.4% (n=621) agreed to have their CVD risk assessed. Of the 588 participants, 56.6% (n=333) were already on CV pharmacotherapy and were therefore not eligible for screening. Of the 43.4% (n=255) CV pharmacotherapy-naïve participants, 94.9% (n=242) were screened with at least one CVD risk factor; 52.9% (n=135) were not eligible for the SCORE assessment, of which 92.6% (n=125) presented CVD risk factors. Of the 120 SCORE eligible participants, 80.0% (n=96) were at least at moderate risk of CVD.

Conclusions:

We determined the feasibility of CVD risk screening in Portuguese community pharmacies, as we found high customer acceptability, noted the reasons for nonattendance, and found a high prevalence of CVD risk factors in at-risk patients. This is an opportunity for Portuguese community pharmacists to take a leading role in the early detection of CVD.

Role of pharmacist during the COVID-19 pandemic: A scoping review

BACKGROUND

Since the start of the new Coronavirus (COVID-19) outbreak in December 2019, pharmacists worldwide are playing a key role adopting innovative strategies to minimize the adverse impact of the pandemic.

OBJECTIVES

To identify and describe core services provided by the pharmacist during the COVID-19 pandemic.

METHODS

A literature search was performed in MEDLINE, Embase, Scopus, and LILACS for studies published between December 1st, 2019 and May 20th, 2020 without language restriction. Studies that reported services provided by pharmacists during the COVID-19 pandemic were included. Two independent authors performed study selection and data extraction with a consensus process. The pharmacist's intervention identified in the included studies were described based on key domains in the DEPICT v.2.

RESULTS

A total of 1189 records were identified, of which 11 studies fully met the eligibility criteria. Most of them were conducted in the United States of America (n = 4) and China (n = 4). The most common type of publication were letters (n = 4) describing the workplace of the pharmacist in hospitals (n = 8). These findings showed the different roles of pharmacists during the COVID-19 pandemic, such as disease prevention and infection control, adequate storage and drug supply, patient care and support for healthcare professionals. Pharmacists' interventions were mostly conducted for healthcare professionals and patients (n = 7), through one-to-one contact (n = 11), telephone (n = 6) or video conference (n = 5). The pharmacists' main responsibility was to provide drug information for healthcare professionals (n = 7) as well as patient counseling (n = 8).

CONCLUSIONS

A reasonable number of studies that described the role of the pharmacists during the COVID-19 pandemic were found. All studies reported actions taken by pharmacists, although without providing a satisfactory description. Thus, future research with more detailed description as well as an evaluation of the impact of pharmacist intervention is needed in order to guide future actions in this and/or other pandemic.

Opportunistic screening of cardiovascular disease risk factors in community pharmacies in Nigeria: a cross-sectional study

Background Early identification and treatment of cardiovascular disease (CVD) risk factors through screening are crucial in the primary prevention of CVD and reduction in healthcare-related costs. Use of Non-Physician Healthcare-workers including Community Pharmacists has been advocated as an effective and cost-efficient model of healthcare delivery. In Nigeria the use of community pharmacists for mass screening of CVD risk factors has not been explored. Objective We sought to investigate the possibility of mass CVD risk factor screening in community pharmacies by pharmacists. Setting Lagos, Nigeria. Methods Between October and December 2018 eight hundred and eighty-nine apparently healthy participants were screened for obesity, hypertension, diabetes and hypercholesterolaemia in ten community pharmacies. Diabetes and hypercholesterolaemia were screened for using point-of-care testing modalities. A structured questionnaire was used to obtain the socio-demographic data of the participants. Main outcome measures Prevalence of overweight/obesity, hypertension, diabetes, hypercholesterolaemia, smoking and alcohol intake. Results Mean age of the subjects was 56.8 ± 21.1 years. Majority (57.4%) were females. Prevalence of smoking and alcohol intake were 4.3% and 26.7% respectively. 59.7% and 71.5% of males and females were either overweight (BMI ≥ 25 kg/m²) or obese (BMI ≥ 30 kg/m²) respectively. Prevalence of hypertension was 28.2% in all subjects, 30.9% in males and 26.3% in females, p < 0.001. Using BP > 130/80 mmHg prevalence of hypertension was 55.1%. Diabetes was detected in 3% of the subjects while 45.3% had hypercholesterolaemia. In total, 64.1% of the subjects were diagnosed with CVD risk factors for the first time. Conclusion Opportunistic screening for CVD risk factors is possible in community pharmacies and has the ability to detect previously undiagnosed risk factors. This community pharmacy based model could serve as a cost-effective approach to primary prevention of CVD.

Role of community pharmacists in educating asthmatic patients: A multi-centered cross-sectional study in Ethiopia

Background:

Effective asthma management requires a multidisciplinary approach that includes; the physician, the patient, and the patient’s family.

Objectives:

The current study aimed to assess the roles played by community pharmacists toward asthma control together with the barriers hindering their practice and possible strategies to overcome those barriers.

Methods:

A multi-centered cross-sectional study was conducted. Data was collected using a structured, self-administered questionnaire adapted from previously conducted studies and customized to fit with the current study setup. The collected data was cleaned, coded, and entered into Statistical Package for Social Sciences (SPSS) version 21 for analysis. Descriptive analysis of the collected data was conducted and the results were presented using frequency tables and graphs.

Results:

A total of 122 community pharmacy professionals; 63 from Gondar, 26 from Bahir Dar, 15 from Debre Markos, 14 from Woldia, and 4 from Debre birhan participated in the study. About 96 (78.7%) of the participants reported that they teach their patients the basic facts about asthma. More than two-thirds of the participants 85 (69.7%) also reported that they were able to identify and manage the triggering factors of asthma for their patients. Lack of pharmacist time was reported by 78 (63.9%) of the study participants as a major reason for the inadequacy of the counseling service provided.

Conclusion:

It appears evident that there is a need for continuing professional education and pharmacists to receive additional training to improve their ability to go beyond identifying a problem and suggesting therapeutic options.

Self-assessment of Polish pharmacy staff's readiness to promote health

Background Nowadays, pharmacists are expected to focus not only on dispensing medicines but also on the wellness of the patient. In some developed countries a pharmacist is clearly defined as a health care professional that can make a contribution to improving the general health of the population. Objective To assess the readiness of Polish pharmacy staff to engage in health promotion and educational activities. Setting Community pharmacies in Poland. Method The study group consisted of 308 pharmacy staff (248 pharmacists and 60 pharmacy technicians) employed in Polish pharmacies. The survey questionnaire referred to three domains: systemic solutions for health promotion, readiness of pharmacy staff as a professional group to promote health, personal readiness to promote health. Responses about pharmacy staff’s readiness to promote health were scored using a 10-point scale. Scale reliability for all items (overall readiness), and for items within the three domains separately, were tested using Cronbach’s α and average inter-correlation coefficient among the items. Main outcome measure Pharmacy staff’s readiness to promote health (the questionnaire containing 32 items). Results The overall readiness of pharmacy staff to promote health was rather low (average of 4.6 ± 1.5 in 1–10 scale). The highest scores were obtained for pharmacy staff’s personal readiness to promote health (average of 5.5 ± 1.8) which was neutral on the scale. The lowest scores were obtained for systemic solutions for health promotion (average of 3.6 ± 1.4). Readiness of pharmacy staff as a professional group was ranked in the middle (average 4.8 ± 1.8). Surveyed pharmacy staff rated their readiness to promote health in the work environment significantly higher than promoting health in the local community. Female and younger pharmacy staff as well as those with job seniority of less than 5 years, or pharmacy technicians assessed their readiness to promote health significantly higher than others. Readiness to promote health was higher among pharmacy staff working in pharmacies employing up to 3 staff members and at pharmacies with over 200 customers daily. Conclusions The overall readiness of pharmacy staff to promote health was low, especially in the domain of systemic solutions in health promotion.

Pharmacy students attitude and perception toward working in community pharmacy in Saudi Arabia

Objective

The objective of this study is to determine the level of attitude and perception of Saudi pharmacy students toward working in community pharmacies after graduation and to assess cultural, educational, and job related barriers and limitations that interfere with students and community pharmacy as a favorable workplace.

Methods

A cross sectional questionnaire, was mailed to a random sample of 600 pharmacy students. It included questions on students' future careers, ideal environment and barriers that might face them in community pharmacy.

Results

Four hundreds and twelve (412) completed the survey (response rate was 69%). Mean age was 23 years and 51.2% of respondents were female. Our results revealed low responses toward how interested they are to work in community pharmacy. The study response showed that improvement in salary and money incomes (46%) and culture and society issue (45%) are the two main barrier to make the career in community pharmacy more attractive.

Conclusions

Saudi pharmacy students had a negative attitudes and insufficient knowledge about community pharmacy. Pharmacy school would have an important role to fill the knowledge gap and prepare the student to work in the community pharmacy. In order to successfully “Saudization” the community pharmacy setting, efforts should be made to overcome their perceived barriers.

Annual transition probabilities of overweight and obesity in older adults: Evidence from World Health Organization Study on global AGEing and adult health

Overweight/obesity is becoming increasingly prevalent in sub-Saharan Africa including Ghana. However, transition probabilities, an essential component to develop cost-effective measures for weight management is lacking in this population. We estimated annual transition probabilities between three body mass index (BMI) categories: normal weight (BMI ≥18.5 and <25.0 kg/m2), overweight (BMI ≥25.0 and <30.0 kg/m2), and obesity (BMI ≥30.0 kg/m2), among older adults aged ≥50 years in Ghana. Data were used from a nationally representative, multistage sample of 1496 (44.3% females) older adults in both Waves 1 (2007/8) and 2 (2014/15) of the Ghana WHO SAGE. A multistage Markov model was used to estimate annual transition probabilities. We further examined the impact of specific socio-economic factors on the transition probabilities. At baseline, 22.8% were overweight and 11.1% were obese. The annual transition probability was 4.0% (95% CI: 3.4%, 4.8%) from normal weight to overweight, 11.1% (95% CI: 9.5%, 13.0%) from overweight to normal weight and 4.9% (95% CI: 3.8%, 6.2%) from overweight to obesity. For obese individuals, the probability of remaining obese, transitioning to overweight and completely reverting to normal weight was 90.2% (95% CI: 87.7%, 92.3%), 9.2% (95% CI: 7.2%, 11.6%) and 0.6% (95% CI: 0.4%, 0.8%) respectively. Being female, aged 50-65 years, urban residence, having high education and high wealth were associated with increased probability of transitioning into the overweight or obese categories. Our findings highlight the difficulty in transitioning away from obesity, especially among females. The estimated transition probabilities will be essential in health economic simulation models to determine sustainable weight management interventions.

Cancer health promotion in Ghana: A survey of community pharmacists' perception and barriers

METHODS

A cross-sectional study was conducted using electronic questionnaire to assess the perception and perceived barriers of Ghanaian community pharmacists towards provision of cancer health promotion.

KEY FINDINGS

The majority of community pharmacists (77.30%) believe that cancer health promotion is an important part of their daily practice. The survey participants were more likely to have a positive perception of the role of the pharmacist if they were older, male, Christian, or had completed the PharmD program (p < 0.05 for all parameters). Lack of cancer educational materials (69%) was the major perceived barrier in providing cancer health promotion services.

CONCLUSION

Ghanaian community pharmacists recognise to play an important role in the provision of cancer health promotion service.

The change in pharmacists’ attitude, confidence and job satisfaction following participation in a novel hypertension support service

Objectives

To demonstrate how the confidence, attitude and job satisfaction of pharmacists who provide interventions and lifestyle support services to patients with hypertension are altered.

Methods

This study was a before-and-after study that used data from 50 pharmacists who participated in the Community Pharmacists Assist for Blood Pressure (COMPASS-BP) study, which was an interventional study that was conducted in Japan to evaluate the effects of lifestyle support services provided to hypertension patients. The pharmacists received 4 h of training before the study was initiated to learn how to quickly provide patients with guidance about diet and exercise and tobacco and alcohol consumption. During the interventional period, each pharmacist provided concise lifestyle guidance to 1–3 hypertension patients. The pharmacists met with the patients a total of 5 times. The parameters that were assessed were the pharmacists’ attitudes towards and confidence in their lifestyle support services, as well as their level of job satisfaction. We verified the scores of each parameter assessed before and after the study, as well as changes in the relationships among the different parameters.

Key findings

Significant increases from baseline to the end of the study were observed for Confidence (P &lt; 0.01), Job satisfaction, including ‘Knowledge’ (P &lt; 0.01), ‘Patient counselling management’ (P = 0.04) and ‘Sense of personal growth’ (P &lt; 0.01). Additionally, path analysis results revealed that after the study, the causal relationship between ‘Knowledge’ and ‘Attitude’ disappeared, and a new causal relationship appeared between ‘Patient counselling and management’ and ‘Attitude’.

Conclusions

Providing lifestyle guidance improved pharmacists’ confidence and attitude. Also, ‘Attitude’ tended to improve as the ‘Patient counselling and management’ score increased.

Lebanese community-based pharmacists' interest, practice, knowledge, and barriers towards pharmacy practice research: A cross-sectional study

Objective

To assess the interest, knowledge, practice and barriers of Lebanese community-based pharmacists towards research, and to examine factors associated with interest.

Methods

A cross-sectional survey, conducted between January and May 2017, enrolled community pharmacists using a proportionate random sample of community pharmacies in the five districts of Lebanon, using the list of pharmacies provided by the Lebanese Order of Pharmacists. In the absence of validated questionnaires to answer our objectives, we created a questionnaire based on previous research. The questionnaire was modified based on the experiences and issues raised during focus groups with research active pharmacists and research oriented community pharmacists.

Results

A total of 399 pharmacists was enrolled. The results showed that 231 (72%) were conscious about the important role of research in the community pharmacy setting whereas only 5.6% considered it not important. Over two-thirds (68.5%) of the pharmacists declared being interested in participating in research. There was a statistical difference in the percentage of correct answers between auto-declared and corrected responses for all terms, with all p < 0.001.The most reported barrier was lack of time during hours of work (90.9%), followed by the lack of pharmacy staff (73.7%), lack of financial resources (68.9%), patient's lack of education and resistance to participation (64.8%), and lack of support (63.8%). Age (aOR = 0.92), years of experience (aOR = 1.06), and having been involved in research (aOR = 3.17) were associated with higher interest in research. Having studied in Lebanon (aOR = 3.63), having received previous research courses (aOR = 11.12) and being interested in research (aOR = 2.74) were associated with having participated in research projects during their professional experience.

Conclusion

Lebanese pharmacists have the good will to conduct and participate in research, but are lacking knowledge; this issue needs to be addressed vividly. Addressing the identified barriers could improve the research output of Lebanese community pharmacists.

Detecting persons at risk for diabetes mellitus type 2 using FINDRISC: results from a community pharmacy-based study

Background

This cross-sectional study has been developed within the framework of the Italian project 'We love your heart' ('Ci sta a cuore il tuo cuore') and reports the results of the initial type 2 diabetes mellitus (T2DM) risk assessment carried out in a big network of community pharmacies in Italy and Spain.

Methods

In total 4002 pharmacists from 854pharmacies were specifically trained to collect data and perform the evaluation of the probability of developing T2DM among pharmacy customers. The risk of developing T2DM within 10 years was evaluated using the FINDRISC.

Results

Overall, 7234 (22.1%) subjects were at low risk to develop the disease, whereas 43.3% were at slightly elevated risk (scores 7-11), 19.3% were at moderate (scores 12-14), 13.9% were at high (scores 15-20), and 1.4% were at very high risk (scores > 20). Spanish participants showed higher levels of risk than Italian (16.7 vs. 14.7%) taking the cut-off FINDRISC ≥ 15.

Conclusion

This study shows that considerable percentage of persons is likely to develop diabetes in the next 10 years. Analyses of the risk factors indicate that men were more susceptible to develop this disease, as well as the Spanish participants respect to Italian.

Assessing the Understanding of Pharmaceutical Pictograms among Cultural Minorities: The Example of Hindu Individuals Communicating in European Portuguese

One of the sources of poor health outcomes is the lack of compliance with the prescribed treatment plans, often due to communication barriers between healthcare professionals and patients. Pictograms are a form of communication that conveys meaning through its pictorial resemblance to a physical object or an action. Pharmaceutical pictograms are often associated with a better comprehension of treatment regimens, although their use is still subject to limitations. The main goal of this study was to examine the potential understanding of pharmaceutical pictograms by a cultural minority when providing patient information while comparing the effectiveness of two reference systems (United States Pharmacopeia USP and International Pharmacy Federation FIP) for this purpose. A self-administered questionnaire was developed comprising 30 pictograms, 15 selected from the United States Pharmacopeia Dispensing Information and the equivalent from the International Pharmaceutical Federation. The questionnaire comprised plain instructions, socio-demographic data, self-reported language fluency and pictogram labels in Portuguese presented to conveniently selected members of the Hindu community of Lisbon (Portugal) until reaching a quota of 50. Participants showed difficulties in understanding some pictograms, which was related to the self-reported reduced fluency in Portuguese. Overall, the interpretation of USP pictograms was better than FIP ones, as well as for pictograms composed of multiple images, presenting a negative reading, or when conveying information unrelated to medication instructions. Even using internationally validated pictograms, added care should be taken when community pharmacists use such communication resources with cultural minorities. It is important not to disregard other forms of patient communication and information, considering pictograms as a complement to other forms of patient counselling.

Barriers to promote cardiovascular health in community pharmacies: a systematic review

Community pharmacists play an important role in the provision of health promotion services, and community pharmacies are considered as a potentially ideal site for cardiovascular health promotion. Information based on a systematic review of barriers to promoting cardiovascular health in community pharmacy is currently lacking. We have sought to identify the most important barriers to cardiovascular health promotion in the community pharmacy. We have systematically searched PubMed and International Pharmaceutical Abstracts for a period of 15 years from 1 April 1998 to 1 April 2013, contacted subject experts and hand-searched bibliographies. We have included peer-reviewed articles, with English abstracts in the analysis, if they reported community pharmacists' perceptions of the barriers to cardiovascular health promotion activities in a community pharmacy setting. Two reviewers have independently extracted study characteristics and data. We identified 24 studies that satisfy the eligibility criteria. The main barriers to cardiovascular health promotion in the community pharmacy included pharmacist-related factors; practice site factors; financial factors; legal factors; and patient-related factors. This review will help to provide reliable evidence for health promotion practitioners of the barriers to promoting cardiovascular health in the community pharmacy setting. This knowledge is valuable for the improvement of cardiovascular health promotion in this setting and guiding future research.

Linking pharmacists to the delivery of public health services

OBJECTIVE

To describe components fundamental to the process of linking pharmacy to the delivery of public health services in a sustainable way.

SUMMARY

Pharmacists deliver public health services with varying frequency. A literature review was conducted to create a set of fundamental links necessary for pharmacists to deliver public health services in a sustainable way. The service needed to be in alignment with public health priorities, be incorporated in the pharmacy curriculum, have postgraduate training opportunities, have a policy or legal platform supporting the service, and have a business model for financial sustainability. Immunization delivery was identified as an exemplary public health service delivered by pharmacists. Additional services evaluated were tobacco cessation counseling, transitions of care, hypertension screening, and substance abuse counseling.

CONCLUSION

Pharmacists are well positioned to provide public health services. Although pharmacists can offer these services, their delivery is variable because of unclearly defined links in the process necessary for their implementation. This article identifies actionable steps to establish sustainable methods for community pharmacists to deliver public health services.

The certainty in consumers' willingness to accept pharmacist-provided medication therapy management services

OBJECTIVES

To describe consumers' willingness to accept medication therapy management (MTM) services provided by a pharmacist.

DESIGN

Cross-sectional Internet survey included questions about willingness to use 11 components of MTM services.

PARTICIPANTS

The data of 8352 United States' adults who were on 3 or more medications were obtained from the 2015 National Consumer Survey on the Medication Experience and Pharmacists' Roles, which included 26,173 respondents.

MAIN OUTCOME MEASURES

Respondents used a scale that ranged from "definitely would not accept" to "definitely would accept" to specify their willingness to use each of the MTM components.

RESULTS

The mean age was 53.1 years, with an average of 1.9 health problems and 5.4 prescription medications. About 50% of respondents definitely would accept 6 or more MTM components. The services with the highest rates of "definitely would accept" were "Recommend the use of a generic drug to help save money" and "Provide advice in administering medications as prescribed" (65.4% and 64.2%, respectively). The next highest were "Performing a review of all medications to make sure they are effective, safe, and affordable" and "Recommendation of nonprescription medications to take care of mild ailments or discomforts" (57.0% and 56.4%, respectively). Those who definitely would accept MTM services, compared with those who would not, differed in terms of gender, education level, income, medication insurance coverage, ever having been a pharmacist, and number of health problems.

CONCLUSION

The majority of United States' adults expressed a certain willingness to accept most of the components of MTM services. More research needs to be done to understand why certain groups were less willing to accept MTM services.

The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: a randomized controlled study

Background:

Poor adherence to antidiabetic medications leads to a higher rate of hospital admissions and adverse health outcomes in type 2 diabetes mellitus patients.

Objective:

This study aims to evaluate whether a pharmacist-led medication therapy management, compared to the usual care, could enhance medication adherence and reduce hospital admission in patients with type 2 diabetes mellitus.

Methods:

A prospective randomized controlled study was conducted in patients with type 2 diabetes mellitus from February 1 to July 30, 2016. Patients in the control group (n=65) received the usual care while patients in the intervention group (n=62) received a personalized pharmacotherapeutic care plan and diabetes education. The two groups were compared by repeated measure ANOVA at 3 and 6-months with medication adherence (using Morisky medication adherence scale) and number of hospital admissions as the main outcome variables.

Results:

A total of 127 patients were included in the study. A marked and statistically significant increase in medication adherence from baseline to 3 and 6 months were noted in the intervention group (increased from 9.2% at baseline to 61% at 6 month) compared with the control group (increased from 13.2% at baseline (to 30.2% at 6 month; p-value<0.01). Furthermore, at the 6-month follow-up, only 23 patients in MTM group with poorly controlled blood glucose levels resulted in hospital admissions compared to 48 patients in non-MTM group, resulting in a 52.1% fewer hospital admissions (p< 0.001).

Conclusions:

The findings of this study implied that pharmacist-led medication therapy management might improve medication adherence and reduce number of hospitalizations in patients with type 2 diabetes mellitus. Hence, policies and guidelines should be in place in order for clinical pharmacists to fully engage in patient care and improve the medication therapy outcomes.

The role of community pharmacists in patient counseling and health education: a survey of their knowledge and level of involvement in relation to type 2 diabetes mellitus

PURPOSE

The present study aimed at evaluating the knowledge and level of involvement of community pharmacists in the provision of patient counseling and health education services for patients with DM and perceived barriers that limit the delivery of such services.

MATERIALS AND METHODS

A self-administered questionnaire based-survey was undertaken from January to March, 2017 with 412 pharmacists working in community pharmacies in six cities of Amhara regional state of Ethiopia: Debre Markos, Gondar, Dessie, Bahir Dar, Woldya, and Debre Birhan. Descriptive statistics, ANOVA, and Student's t-test were employed to examine different variables.

RESULTS

Community pharmacists were found to have poor knowledge and low level of involvement, with an overall mean score of 11.54 and 2.06, respectively. A significant number of community pharmacists never practiced promoting smoking cessation (45.2%), counseling on good foot care techniques (33.7%), and counseling on the potential impact of over-the-counter and herbal drugs on DM management (34%). On the other hand, describing the right time to administer antidiabetic medications (46%) and counseling on suitable administration, handling, and storage of insulin (33.7%) were done more frequently. The main reported barriers to the delivery of these services were lack of knowledge or clinical skills, lack of access to additional training programs, and lack of personnel or resources.

CONCLUSION

The present study revealed a poor knowledge and low level of involvement in counseling and health education services for patients with DM. Lack of knowledge or clinical skills was the most commonly reported barrier for providing such services. In order to better integrate community pharmacies into future public health programs and optimize the contribution of pharmacists, interventions should focus on overcoming the identified barriers.

Involvement of community pharmacists in public health priorities: A multi-center descriptive survey in Ethiopia

Located in the heart of the community and widely distributed geographically, community pharmacies provide a platform for a more proactive involvement in public health services. So far, little information has been gathered in Ethiopia on community pharmacists’ level of involvement in public health services. The aim of the present study was, therefore, to document the level of involvement of community pharmacy professionals in the provision of public health services and the barriers to such involvement. This study employed a self-administered questionnaire based survey, which asked participants to indicate their frequency and level of involvement in providing public health services and their perceived barriers in providing such services. Surveys were undertaken from May to July, 2016 with 472 community pharmacy professionals working in community pharmacies in six cities of Amhara regional state of Ethiopia: Debre Markos, Gondar, Dessie, Bahir Dar, Woldya and Debre Birhan. Among 472 community pharmacy professionals approached, 412 (233 pharmacists and 179 pharmacy technicians) completed the survey with a response rate of 87.3%. Most respondents reported as being either “not at all involved” or “little involved” in counselling on smoking cessation (79.3%), and screening for hypertension (86.9%), diabetes (89.5%), and dyslipidemia (88.9%). On the other hand, they reported a higher level of involvement in the management and screening of infectious diseases (72.8%) and counseling with partners when initiating treatment for sexually transmitted diseases (68.9%). Lack of knowledge or clinical skills and lack of personnel or resources were the most commonly reported barrier for expanding such services. This survey revealed a low level of involvement of community pharmacists in public health services. In order to better integrate community pharmacies into future public health programs and optimize the contribution of community pharmacy professionals, interventions should focus on overcoming the identified barriers.

Evaluating the Impact of an Anti-stigma Intervention on Pharmacy Students' Willingness to Counsel People Living with Mental Illness

Third-year pharmacy students (n = 88) participated in an anti-stigma intervention program consisting of presentations, videos, discussion and active-learning exercises. Willingness to counsel (WTC) people with mental illness (MI) was evaluated using immediate pre and post-tests comparing diabetes, depression and schizophrenia. At pre-test, WTC diabetes was highest (higher = increased WTC) while schizophrenia was the lowest. There were no statistically significant differences between pre/post-test WTC for diabetes and depression, while schizophrenia WTC increased significantly (p < 0.05). At post-test, diabetes WTC was significantly higher than depression and schizophrenia (p < 0.0001). Regression results for WTC depression showed that comfortability and gender were significant (p < 0.05) predictors. Regression results for WTC schizophrenia showed that comfortability was a significant (p < 0.05) predictor. As highly accessible healthcare providers, pharmacists have the potential to positively impact healthcare, but this depends on WTC. Colleges of pharmacy may consider instituting policies that support experiential education involving counseling people living with MI, as this may increase comfortability.

Financial aspects of community pharmacies in Slovakia (2009-2014) Finančné aspekty verejných lekární na Slovensku v rokoch 2009-2014

Community pharmacies play an important role in the process of ensuring public health. Pharmacists provide pharmaceutical care that includes acquiring, storing, preparing, reviewing and dispensing medicines, medical devices and dietary food to the inhabitants; providing them with information and advice; acquiring, storing and dispensing additional assortment; carrying out physical and biochemical testing for primary prevention and monitoring of drug efficacy and safety. At present, there are constant changes which have direct or potential and often negative impact on community pharmacies. For providing affordable and good quality pharmaceutical care, it is important to continuously monitor and analyse the developments in the financial data in community pharmacy business management. The data file from 2009-2014 on financial performance of selected community pharmacies were obtained from the Register of Financial Statements at Ministry of Finance Slovak Republic. A group of 194 community pharmacies were selected that represented more than 10 percent of all pharmacies. The selection criteria respected the territorial division of the Slovak Republic on districts, the size of municipalities (cities and villages) and location (at or near health centres, shopping centres, housing estates, etc.). The evaluation parameters were gross profit, net profit, revenue from sales of goods and services, operating expenses, total assets, inventory, short-term receivables, total receivables, financial assets, owner’s equity, total liabilities, current liabilities and their characteristics (25th, 50th, 75th percentile, minimum, maximum, mean). The financial parameters obtained and their characteristics presented the basic information on the management of community pharmacies. The data also provided information for further assessment on factors that might have an impact on their value and direction of evolution.

An analysis of inter-professional collaboration in osteoporosis screening at a primary care level using the D'Amour model

OBJECTIVES

This study describes the perspective of patients, nurses, pharmacists, doctors and policy makers to identify the level of collaboration and the areas for improvement to achieve inter-professional collaboration between doctors, nurses, pharmacists and policy makers in a primary care clinic.

METHODS

Patients (n = 20), Nurses (n = 10), pharmacists (n = 11), doctors (n = 10) and policy makers (n = 5) from a primary care were individually interviewed using a semi-structured topic guide. Purposive sampling was used. Interviews were transcribed verbatim and analysed using thematic analysis informed by constant comparison.

RESULTS

Patients, doctors, nurses, pharmacists and policy makers were eager for pharmacists to be more proactive in creating health awareness and conducting osteoporosis screening at the primary care clinic via inter-professional collaboration. These findings were further examined using the D'Amour's structural model of collaboration which encompasses four main themes: shared goals and visions, internalization, formalization and governance. This model supports our data which highlights a lack of understanding of the pharmacists' role among the doctors, nurses, policy makers and pharmacists themselves. There is also a lack of governance and formalization, that fosters consensus, leadership, protocol and information exchange. Nonetheless, the stakeholders trust that pharmacists have sufficient knowledge to contribute to the screening of osteoporosis. Our primary care clinic can be described as developing towards an inter-professional collaboration in managing osteoporosis but is still in its early stages.

CONCLUSIONS

Inter-professional collaboration in osteoporosis management at the primary care level is beginning to be practised. Efforts extending to awareness and acceptance towards the pharmacists' role will be crucial for a successful change.

On the Front Line of Smoking Cessation: Pharmacists' Practices and Self-Perception

Background:

Pharmacists can be effective in helping patients to quit smoking, and opportunities for such interaction have been facilitated by legislative change making nicotine replacement therapy (NRT) available without prescription in Canada. However, there are no previous studies of Canadian pharmacists' preparation for, perception of, or practices regarding their roles in smoking cessation.

Methods:

Practising community pharmacists in four Canadian provinces were surveyed about their tobacco-related education and knowledge, practice environment, perceptions of their roles and practices related to helping people quit smoking, and factors perceived to facilitate tobacco-related practice.

Results:

A corrected response rate of 72% was obtained, giving a weighted n of 960 responses. Most pharmacists reported good or excellent knowledge of the health effects of smoking and the use of NRT in smoking cessation. Fewer reported being knowledgeable about behavioural approaches to quitting smoking. Advising patients about NRT was seen as a more important role for pharmacists than giving patients pamphlets or behavioural counselling. Pharmacists' reported practices corresponded to their knowledge and judged importance of roles; pharmacists were not proactive in approaching patients about smoking, but when smokers were identified, pharmacists gave brief advice about the use of NRT. Respondents reported that their smoking cessation practice was facilitated by their own knowledge and skills, patients' interest in quitting, opportunities for patient interaction, and the support of pharmacy management for patient counselling.

Conclusions:

Improving pharmacist education in patient counselling and behavioural approaches to smoking cessation would help to develop skills in initiating discussions about smoking and would give pharmacists a wider range of options to help patients quit smoking.

Pharmacists' Self-Assessments regarding Emergency Preparedness Activities in Kansas

Background:

In an emergency, the pharmacists' role lies in obtaining access to pharmaceuticals and other crucial supplies necessary to ensure that injured or ailing people are treated quickly and effectively.

Objective:

To assess pharmacist reactions regarding the emergency preparedness program, “Can it Happen in Kansas: Response to Terrorism and Emerging Infections,” before and after training.

Methods:

A terrorism preparedness questionnaire was developed to self-assess changes in participants' confidence. These were measured before, immediately after, and 3 and 10 months after training.

Results:

At pretest, pharmacists reported feeling more alert to agroterrorist attacks in Kansas, better able to describe their roles in incident response, more alert to symptoms of emerging infections, and better able to recognize radiation symptoms than at posttest (all p < 0.001). Similar statistical patterns can be found in almost all content areas covered.

Conclusions:

It is difficult to measure competencies and skills needed in emergency preparedness training. Future training will involve more objective measures. Since pharmacists are well positioned to detect emerging and unusual patterns of disease or medical conditions, it is imperative that they are included among professionals who are trained to recognize symptoms of exposure to biological, nuclear, or chemical agents.

Role of pharmacist in cardiovascular disease-related health promotion and in hypertension and dyslipidemia management: a cross-sectional study in the State of Qatar

RATIONALE, AIMS AND OBJECTIVES

In Qatar, cardiovascular diseases (CVD) have recently become the leading cause of morbidity and mortality. Prevention, detection and management of CVD risk factors reduce CVD chance. The study objectives were to assess Qatar pharmacists' involvement in CVD health promotion, to identify the activities that they currently provide to patients with CVD risk factors, to describe their attitudes towards their involvement in CVD prevention and to assess their perceived barriers for provision of CVD prevention services

METHOD

We conducted a cross-sectional survey of community and ambulatory pharmacists in Qatar. Pharmacist characteristics, involvement in CVD-related activities along with their attitudes and perceived barriers were analysed using frequency distributions. Bivariate linear regression models were used to test for associations between CVD health promotion activity score and each variable. Variables with a P-value of 0.20 or less were included in the multivariate model.

RESULTS

A total of 141 pharmacists completed the survey (response rate 60%). More than 70% responded with rarely or never to 6 out of the 10 CVD health promotion activities. Eighty-four per cent and 68% always or often describe to patients the appropriate time to take antihypertensive medications and the common medication adverse effects, respectively. Yet, 50% rarely or never review the medication refill history or provide adherence interventions. Lack of CVD educational materials was the top perceived barrier (55%) in addition to lack of having private counselling area (44.6%), and lack of time (38.3%). Females and community pharmacists were more involved in CVD health promotion (P = 0.046 and P = 0.017, respectively) than their counterparts. Health promotion practice increased with increasing attitudes score and decreased with increased barriers score (P = 0.012 and P = 0.001).

CONCLUSION

The scope of pharmacy practice in CVD prevention is limited in Qatar. Efforts need to be exerted to increase pharmacists' involvement in CVD prevention.

A comparison of patients' and pharmacists' satisfaction with medication counseling provided by community pharmacies: a cross-sectional survey

Background

Medication counseling is a critical component of pharmaceutical care to promote the safe and effective use of medications and to maximize therapeutic outcomes. The assessment of patients’ and pharmacists’ satisfaction with medication counseling services could be one of the vital parameters for predicting the quality of pharmacy services. No study has measured and compared both patients’ and pharmacists’ satisfaction with medication counseling. The objectives of this study were to describe and compare patients’ and pharmacists’ levels of satisfaction with medication counseling services offered by community pharmacists in South Korea.

Methods

This was a descriptive, cross-sectional survey. The online survey was distributed to patients and community pharmacists using a structured questionnaire. The questionnaires consisted of 4 main areas: (1) responders’ characteristics (2) current state of medication counseling methods provided by community pharmacies (3) overall satisfaction with medication counseling (4) demand for the development of medication counseling standards. A comparison between patients and pharmacists was made using either a chi-square test or a Fisher’s exact test.

Results

Between June 13, 2014 and July 15, 2014, a total of 252 patients and 620 pharmacists completed the survey. It was found that 47.3 % of pharmacists and 34.0 % of patients were satisfied with the current medication counseling service. Pharmacists showed a higher degree of satisfaction with the medication counseling service compared to patients (p <0.05). A major reason for patients not being satisfied with the medication counseling from community pharmacists was the insufficient time spent on counseling (51.2 %). The pharmacists’ perception of a major barrier to providing appropriate medication counseling for patients was the lack of time (24.3 %). Moreover, a substantial number of patients (88 %) and pharmacists (73 %) supported the development of medication counseling standards to improve community pharmacist counseling services (p < 0.001).

Conclusions

This study showed that both patients and pharmacists have low levels of satisfaction with the current medication counseling service offered by community pharmacists. This study provides baseline data for the development of national guidelines for medication counseling by pharmacists.

Pharmacy and public health: a pathway forward

OBJECTIVE To identify a pathway forward for practicing pharmacists in supporting public health initiatives by applying the five core competencies of public health. SUMMARY The pharmacist is well positioned to improve population health. Until now, increased impact of pharmacists has been based on the expansion of patient services rather than guided by a population approach to health. To increase their effectiveness and breadth of impact, pharmacists would benefit from applying the five core competencies of public health (social and behavioral science, health policy and administration, epidemiology, biostatistics, and environmental health sciences) to the practice of pharmacy. This article aims to explain how each of the core competencies applies to pharmacy practice and how pharmacists might apply public health skills in a more specific manner. CONCLUSION With increased clarity of the role of public health, and mastery of the five core competencies of public health, pharmacists can make unique and valuable contributions to the health of the public.

Relationship between performance barriers and pharmacist competency towards the implementation of an expanded public health pharmacy role

OBJECTIVE

The objective of this study was to examine the relationship between performance barriers and competency, and implementation of an expanded public health role for community pharmacists.

METHODS

A validated questionnaire was utilised for this study whereby three variables of the study (performance barriers, competency and public health role) were measured using a 5-point Likert scale. Three hundred questionnaires were distributed to target respondents of registered community pharmacies in five states (Johor, Negeri Sembilan, Selangor, Perak and Penang) in Malaysia. The data were analysed utilising the principles of structural equation modelling.

KEY FINDINGS

There were 191 completed and usable responses received, which represented a 66.7% response rate. This study showed perceived competency had a direct relationship with delivering a general public health role. A perceived lack of competency was shown to be a barrier to fulfilling a public health role. However, other factors, such as design of premises, IT infrastructure and pay, were not viewed as barriers to carrying out a public health role.

CONCLUSION

Perceived competency is an obstacle for community pharmacists to undertake a public health role in Malaysia. Adequate training programmes in pharmaceutical public health have to be put in place to address this concern and this should therefore be a priority.

Pharmaceutical services and health promotion: how far have we gone and how are we faring? Scientific output in pharmaceutical studies

The objective of this study was to investigate the scientific output on health promotion within the pharmaceutical field and its relation with the development of pharmaceutical services within health systems. A comprehensive review of published scientific articles from the Medline and Lilacs databases was carried out. The review comprised articles published until December 2011, and used combinations of the terms 'health promotion' or 'health education' and 'pharmacy', 'pharmacist' or 'pharmaceutical'. The articles were selected according to inclusion and exclusion criteria. A total of 170 full texts and 87 indexed abstracts were analyzed, evidencing that most described actions of health promotion in community pharmacies and other services. Following the Ottawa Charter, most of the studies dealt with new guidance of the service and the supply of pharmaceutical information and services. It was concluded that there is a lack of theoretical background on health promotion in the pharmaceutical field to sustain the professional education and practice required by the health system and the population.

Community pharmacy as a setting for public health nutrition action: Australian nutritionists' perspectives

OBJECTIVE

To explore public health nutritionists' perceptions of nutrition and its place in community pharmacy (CP) presently and into the future; and to explore perceived opportunities, feasibility and scope of public health nutrition (PHN) interventions in CP, with a focus on maternal and infant nutrition.

DESIGN

Qualitative data were gathered through semi-structured interviews and drew on hermeneutics as the theoretical framework for analysis and interpretation.

SETTING

Queensland, Australia.

SUBJECTS

Public health nutritionists, identified through purposive, criterion sampling, were chosen due to (i) their role as potential stakeholders, (ii) their knowledge and emphasis on nutrition and (iii) their practice experience.

RESULTS

Opportunities for PHN action focused primarily on actions relating to early nutrient supplementation in pregnancy and breast-feeding protection and promotion. Opportunities in CP were constrained by practitioners' perception of (i) conflict between health care and commercial interests in CP, (ii) problematic practices in CP and (iii) values and motivations of practitioners and other stakeholders in the CP sector. Strategies were suggested to improve practices and enhance the setting from a PHN perspective. Participants suggested both collaborative and regulatory approaches to achieve settings-based changes, identifying the need for these to coexist for effective outcomes.

CONCLUSIONS

Public health nutritionists suggest that opportunities for PHN action are constrained by perceived conflicted interests and that consumers need to be adequately protected from the influence of commercial interests. PHN action in this setting needs adequate reflection on evidence as well as ethics ensuring that practices are 'for the good' of mothers and infants.

Pharmacists' perspectives on HIV testing in community pharmacies

OBJECTIVE

To assess the feasibility, readiness, and acceptability of offering rapid human immunodeficiency virus (HIV) testing in community pharmacies.

DESIGN

Qualitative study.

SETTING

Community pharmacies in Indiana from May to September 2012.

PARTICIPANTS

17 licensed community pharmacists.

INTERVENTION

Semistructured interviews among a convenience sample of community pharmacists.

MAIN OUTCOME MEASURES

Community pharmacists' self-reported attitudes toward rapid HIV testing in community pharmacies, perceptions of peer acceptability, and opinions about readiness for implementation of the practice in community pharmacies.

RESULTS

Participants accepted the idea of pharmacy-based HIV testing, describing it as accessible, convenient, and nonstigmatizing. Acceptability was closely linked to positive patient relationships and pharmacist comfort with consultation. Identified challenges to pharmacy-based HIV testing included staffing issues, uneasiness with delivering positive test results, lack of information needed to link patients to care, insufficient consulting space, and need for additional training. Participants indicated that peer beliefs about the acceptability of pharmacist-based HIV testing would vary but that more recently trained pharmacists likely would be more accepting of the practice.

CONCLUSION

Most participants felt that offering HIV testing was a reasonable addition to the evolving role of the community pharmacist, pending resolution of personal and institutional barriers.

Does hospitalization influence patients' medication adherence and community pharmacists' interventions?

BACKGROUND

Medication adherence reduces disease morbidity. Data regarding changes in a patient's adherence before and after hospitalization and how this hospitalization influences a pharmacist's interventions are scarce.

OBJECTIVE

To assess changes in adherence to cardiovascular and respiratory medications in the year preceding and following a hospitalization; explore patients' perceptions about medication adherence and the pharmacist's role; and describe pharmacists' interventions regarding medication adherence.

METHODS

This cohort study included patients hospitalized for acute coronary syndrome, acute worsening of heart failure, or acute COPD exacerbations. Adherence to cardiovascular and respiratory medications was measured by calculating the proportion of days covered (PDC) from prescription refills. Patient interviews were completed to explore their perceptions about medication adherence and the role of the pharmacist. Community pharmacists were invited to complete an online survey and to participate in focus groups to discuss interventions to improve medication adherence.

RESULTS

Medication adherence was assessed for 61 patients; the mean PDC was 69.8% 12 months before hospitalization and 72.4% 12 months following hospitalization. Patients reported that they felt the need to take their medications to prevent worsening of their disease. They were satisfied with current pharmaceutical services. A total of 136 questionnaires completed by pharmacists were analyzed and 9 participants attended the focus groups. Most pharmacists reported monitoring prescription renewals to assess adherence, with no significant influence from the hospitalization itself. The patient's interest was reported to be an important facilitator, whereas a lack of time and face-to-face interaction with patients who had their medication delivered to their home was reported a main barrier to interventions. This study was limited by a small sample size.

CONCLUSIONS

Patient medication adherence did not significantly change following hospitalization. Hospitalization does not appear to significantly influence patient and pharmacist behavior towards medication adherence.

A qualitative study of English community pharmacists' experiences of providing lifestyle advice to patients with cardiovascular disease

BACKGROUND

Cardiovascular disease (CVD) progression is modifiable through lifestyle behaviors. Community pharmacists are ideally placed to facilitate self-management of cardiovascular health however research shows varied pharmacist engagement in providing lifestyle advice.

OBJECTIVE

This study explored community pharmacists' experiences and perceptions of providing lifestyle advice to patients with CVD.

METHODS

Semi-structured interviews were conducted with fifteen pharmacists (1 supermarket; 7 multiple; 7 independent) recruited through multiple methods from community pharmacies across the Midlands, England. A thematic analysis was conducted using a Framework approach.

RESULTS

Pharmacists categorized patients according to their perceptions of the patients' ability to benefit from advice. Many barriers to providing lifestyle advice were identified. Confidence to provide lifestyle advice varied, with pharmacists most comfortable providing lifestyle advice in conjunction with conversations about medicines. Some pharmacists felt lifestyle advice was an integral part of their role whilst others questioned whether pharmacists should give lifestyle advice at all, particularly when receiving no remuneration for doing so.

CONCLUSION

Pharmacists viewed providing lifestyle advice as important but identified many barriers to doing so. Lifestyle advice provision was influenced by pharmacists' perceptions of patients. Professional identity and associated role conflict appeared to underpin many of the barriers to pharmacists providing lifestyle advice. Pharmacists may benefit from enhanced training to: increase their confidence to provide lifestyle advice; integrate lifestyle advice with regular pharmaceutical practice and challenge their perceptions of some patients' receptiveness to lifestyle advice and behavior change. Changes to the way UK pharmacists are remunerated may increase the provision of lifestyle advice.

Pharmacy nonprescription syringe distribution and HIV/AIDS: a review

OBJECTIVE

To summarize current research findings on pharmacy nonprescription syringe distribution to prevent the spread of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) among injection drug users (IDUs), including research on pharmacist attitudes and behavior, drug user attitudes and behavior, and the health impact on HIV/AIDS risk behavior.

DATA SOURCES

Data were collected using PubMed and PsycINFO through July 2011. Search terms used were pharmacist or pharmacy and syringe or syringe exchange or needle or needle exchange. Two journals (Journal of Urban Health and Journal of the American Pharmacists Association) with a high number of hits were manually inspected. Reference sections for each article also were examined.

STUDY SELECTION

Studies were included if they examined attitudes toward, experiences with, or the impact of pharmacy nonprescription syringe distribution for the purpose of preventing the spread of HIV/AIDS among IDUs in the United States. Studies were excluded that mentioned these topics in passing or did not report empirical results.

DATA SYNTHESIS

47 studies were identified that met the inclusion criteria. Studies included a diverse range of perspectives, including pharmacist viewpoints, IDU attitudes, and evaluations.

CONCLUSION

According to the available literature, many pharmacists express willingness to sell and report selling syringes to customers without a prescription. IDUs show willingness to use pharmacies to obtain syringes. Finally, pharmacy syringe sale and the legalization of this practice appear to have a positive impact on HIV risk behavior. Accordingly, the nonprescription sale of syringe should be promoted. However, the literature remains incomplete and future research is required.

The willingness of community pharmacists to participate in a practice-based research network

BACKGROUND

Practice-based research networks (PBRNs) are groups of practitioners and researchers with an interest in designing, evaluating and disseminating solutions to the real-world problems of clinical practices.

OBJECTIVE

To evaluate the level of interest of community pharmacists in participating in a PBRN and to document the services such a network should offer.

METHOD

In a survey of community pharmacists in Montreal, Quebec, and surrounding areas, a questionnaire was mailed to a random sample of 1250 pharmacists. Two of the 28 questions were related to PBRNs: one assessed the pharmacists' interest in participating in a PBRN; the other sought their views on which services and activities this network should offer.

RESULTS

In total, 571 (45.7%) pharmacists completed the questionnaire, but 6 did not answer the questions about the PBRN. Of the respondents, 58.9% indicated they were "very interested" or "interested" in joining a PBRN, while 41.1% reported little or no interest. The most popular potential services identified were access to clinical tools developed in research projects (77.0%), access to continuing education training programs developed in research projects (75.9%), information about conferences on pharmacy practice research (64.1%) and participation in the development of new pharmaceutical practices (56.1%).

CONCLUSION

This study suggests that the level of interest that community pharmacists have in PBRNs is sufficient to further evaluate how such networks may optimize and facilitate pharmacy practice research. Can Pharm J 2013;146:47-54.

The role of community pharmacists in the prevention and management of osteoporosis and the risk of falls: results of a cross-sectional study and qualitative interviews

In a mailed survey and qualitative interviews, it was observed that community pharmacists and public health authorities believe that pharmacists should play a significant role in the prevention and management of osteoporosis and the risk of falls. However, pharmacists acknowledge a wide gap between their ideal and actual levels of involvement.

INTRODUCTION

The aim of this study was to explore perceptions of community pharmacists and public health authorities regarding the role of pharmacists in providing services in relation to osteoporosis and risk of falls and the barriers to providing them.

METHODS

Using a modified five-step version of Dillman's tailored design method, a questionnaire was mailed to a random sample of 1,250 community pharmacists practicing in Montreal (Quebec, Canada) and surrounding areas. A similar questionnaire was sent to public health officers in these regions. Additionally, telephone interviews were conducted with regional and ministry level public health officers.

RESULTS

Of the 1,250 pharmacists contacted, 28 were ineligible. In all, 571 of 1,222 (46.7 %) eligible community pharmacists and all the public health officers returned the questionnaire. Six public health officers (five regional and one at ministry level) were interviewed. Most pharmacists believed they should be involved in screening for osteoporosis (46.6 %) and risk of falls (50.3 %); however, fewer reported actually being involved in such services (17.4 % and 19.2 %, respectively). In their view, the main barriers to providing these services in current practice were lack of time (78.8 %), lack of clinical tools (65.4 %), and lack of coordination with other healthcare professionals (54.5 %). Public health authorities also thought community pharmacists should play a significant role in providing osteoporosis and fall risk services. However, few community pharmacist-mediated activities are in place in the participating regions.

CONCLUSIONS

Although community pharmacists and public health authorities believe pharmacists should play a significant role with regard to osteoporosis and the risk of falls, they acknowledge a wide gap between the ideal and actual levels of pharmacist involvement.

Needs analysis for educating community pharmacists to interface with prehospital stroke chain of survival

BACKGROUND

Awareness of the American Heart Association's Stroke Chain of Survival, and willingness to learn and share this information with the public, was assessed for community pharmacists practicing near a primary stroke center.

METHODS

Twenty-three community pharmacies local to a primary stroke center were identified and surveyed. The surveyor showed each pharmacist a flier with a mnemonic for assessing stroke symptoms, briefly explained steps in the Stroke Chain of Survival, and noted if the pharmacist was available, listened to the entire presentation, read the information on the flier, agreed to post the flier, and if the pharmacist made any comments. The surveyor also assessed whether the Stroke Chain of Survival was new information to each pharmacist.

RESULTS

All subjects read the information on the flier. Twenty-two (95.7%) listened to the entire presentation, and 23 (100%) were willing to post the flier. Two (11%) indicated that the parent company does not allow public posting of noncorporate information but agreed to post the flier internally. Twenty-one (91%) expressed appreciation for receiving the information. Seventeen (74%) indicated that the Stroke Chain of Survival was new information to them, 14 (61%) spontaneously remarked on the importance of the information, and 4 (17%) asked for additional information.

CONCLUSIONS

Community pharmacists surveyed were willing to interface with the prehospital phase of the Stroke Chain of Survival; nearly 75% of them required education to do so. Community pharmacies are potentially a venue for educating the public on the Stroke Chain of Survival. It may be necessary to approach community pharmacy corporate leadership to partner with such efforts.

The MyHealthCheckup study: Training graduate students to implement cardiovascular risk screening programs in community pharmacies

BACKGROUND

Hypertension is a major risk factor for cardiovascular morbidity and mortality. Despite this fact and the development of effective antihypertensive drug therapy, hypertension is often poorly controlled. Community pharmacies are an ideal site for the management of hypertension and other modifiable cardiovascular risk factors. The purpose of the current study was to develop and assess a pharmacy-based cardiovascular risk screening program implemented by graduate students.

METHODS

Four graduate students trained as health coaches screened a convenience sample of adults who were interested in cardiovascular risk assessment in 21 Montreal area pharmacies. On the screening day, we assessed cardiovascular risk factors, including blood pressure, used the Cardiovascular Life Expectancy Model, which includes cardiovascular age, to inform patients of their personalized risk profile, delivered an individualized health coaching intervention and conducted a participant satisfaction survey. This was followed by an individualized health coaching intervention. The intervention program was implemented by trained graduate students and supported by pharmacists.

RESULTS

Among the 238 patients who participated (57% female, mean age 60.6 years), 67% had a body mass index (BMI) greater than 25 kg/m(2), 52% had abdominal obesity, 58% reported insufficient physical activity and 14% were smokers. A total of 120 patients (51%) were taking antihypertensive medication, yet 63 (53%) had blood pressure readings above currently accepted targets. Higher BMI and physical inactivity were associated with increased rates of poorly controlled hypertension.

CONCLUSION

The screening program identified individuals with modifiable cardiovascular risk factors and poorly controlled hypertension. The intervention program was well received by participants and the majority provided contact information for future cardiovascular screening clinics. These findings support the feasibility of screening programs run by graduate students in the pharmacy setting.

Ideal and actual involvement of community pharmacists in health promotion and prevention: a cross-sectional study in Quebec, Canada

Background

An increased interest is observed in broadening community pharmacists' role in public health. To date, little information has been gathered in Canada on community pharmacists' perceptions of their role in health promotion and prevention; however, such data are essential to the development of public-health programs in community pharmacy. A cross-sectional study was therefore conducted to explore the perceptions of community pharmacists in urban and semi-urban areas regarding their ideal and actual levels of involvement in providing health-promotion and prevention services and the barriers to such involvement.

Methods

Using a five-step modified Dillman's tailored design method, a questionnaire with 28 multiple-choice or open-ended questions (11 pages plus a cover letter) was mailed to a random sample of 1,250 pharmacists out of 1,887 community pharmacists practicing in Montreal (Quebec, Canada) and surrounding areas. It included questions on pharmacists' ideal level of involvement in providing health-promotion and preventive services; which services were actually offered in their pharmacy, the employees involved, the frequency, and duration of the services; the barriers to the provision of these services in community pharmacy; their opinion regarding the most appropriate health professionals to provide them; and the characteristics of pharmacists, pharmacies and their clientele.

Results

In all, 571 out of 1,234 (46.3%) eligible community pharmacists completed and returned the questionnaire. Most believed they should be very involved in health promotion and prevention, particularly in smoking cessation (84.3%); screening for hypertension (81.8%), diabetes (76.0%) and dyslipidemia (56.9%); and sexual health (61.7% to 89.1%); however, fewer respondents reported actually being very involved in providing such services (5.7% [lifestyle, including smoking cessation], 44.5%, 34.8%, 6.5% and 19.3%, respectively). The main barriers to the provision of these services in current practice were lack of: time (86.1%), coordination with other health care professionals (61.1%), staff or resources (57.2%), financial compensation (50.8%), and clinical tools (45.5%).

Conclusions

Although community pharmacists think they should play a significant role in health promotion and prevention, they recognize a wide gap between their ideal and actual levels of involvement. The efficient integration of primary-care pharmacists and pharmacies into public health cannot be envisioned without addressing important organizational barriers.

Diabetes and cardiovascular disease interventions by community pharmacists: a systematic review

OBJECTIVE

To systematically review and assess the quality of studies evaluating community pharmacist interventions for preventing or managing diabetes or cardiovascular disease (CVD) and/or their major risk factors.

DATA SOURCES

A comprehensive literature search was performed using MEDLINE (1950-February 2011), EMBASE (1980-February 2011), International Pharmaceutical Abstracts (1970-February 2011), Cumulative Index to Nursing and Allied Health Literature (1982-June 2007), and Cochrane Central Register of Controlled Trials (1898-February 2011). Search terms included: community pharmacy(ies), community pharmacist(s), cardiovascular, diabetes, and intervention. The grey literature was searched using the ProQuest Dissertations and Theses, Theses Canada, and OAlster databases.

STUDY SELECTION AND DATA EXTRACTION

Articles published in English or French with all study designs were considered for the review. Studies were included if they contained interventions designed to reduce the incidence, risk, or mortality of CVD or diabetes; affect clinical indicators of CVD or diabetes mellitus (including hypertension, dyslipidemia, or hemoglobin A(1c)); and/or improve adherence to treatment strategies. Only studies involving interventions carried out primarily by pharmacists in community pharmacy settings were included. Study quality was assessed using a checklist validated for both randomized and nonrandomized studies.

DATA SYNTHESIS

A total of 4142 studies were initially identified, with 40 meeting our inclusion criteria. Eleven studies were randomized controlled trials, 4 were cluster randomized trials, and 2 studies had randomized before-after designs. The remaining studies were controlled before-after (n = 2), cohort (n = 4), and uncontrolled before-after (n = 17) designs. Interventions focused on diabetes (n = 12), hypertension (n = 9), medication adherence (n = 9), lipids (n = 5), evidence-based medication initiation or optimization (n = 3), risk factor prediction scores (n = 1), and body mass index (n = 1). All studies contained interventions focused at the patient level and the majority of studies (34/40) involved interventions directed at both the physician and patient. No specific intervention emerged as superior, and study quality was generally poor, making it difficult to determine the true effect of the interventions.

CONCLUSIONS

Poor study quality, time-intensive interventions, and unproven clinical significance warrant the need for further high-quality studies of community pharmacist interventions for preventing or managing diabetes or CVD and/or their major risk factors.

Pharmacy student perceptions of public health service roles and responsibilities

Background

There is increasing emphasis on pharmacists' assuming responsibility for public health promotion and delivery with formal expansion of public health activities in their practice. A number of pharmacy school accreditation bodies now incorporate public health competencies within expected professional training outcomes. The objective of this study was to characterize pharmacy student perceptions towards pharmacist public health services roles and responsibilities.

Methods

All undergraduate students at the College of Pharmacy at Qatar University were surveyed 1 week following a student-led breast cancer awareness event. A questionnaire was devised from a literature review and comprised of 10 questions assessing pharmacy student motivations, perceptions and anticipated comfort with various pharmacist-conducted public health activities.

Results

Ninety-four per cent of students responded, most having participated in the breast cancer awareness event. They generally felt pharmacist participation in such health promotions would enhance the profession's profile among patients (75.1%) and colleagues (89.6%), but recognized that other health professionals may be unfamiliar with certain pharmacist activities in this regard. Students considered knowledge of disease aetiology and diagnosis necessary for pharmacists (97.9%), as well as the obligation to offer non-pharmacological patient counselling (73.8%). Many (61.7%) anticipated comfort in communicating potentially culturally sensitive health matters both to patients in their own practice site or as a spokesperson to the general public.

Conclusion

Undergraduate pharmacy students in our College of Pharmacy expressed favourable attitudes towards public health roles of pharmacists. Early enthusiasm for participation in public health activities is valuable for building communication skills, promoting leadership and potentially influencing practising pharmacists.

Motivators and barriers to the implementation of pharmacist-run prescription monitoring and review services in two settings

Objectives

To assess the strong motivators and barriers to the implementation of prescription monitoring and review services by community pharmacists either in pharmacies or in general practitioner (GP) surgeries.

Method and setting

A systematic review was used to develop questionnaire statements for a two-part postal Delphi survey to a purposive sample of 120 community pharmacists working in Britain. Responses were analysed, a repeat questionnaire was mailed (including feedback of individual and group response), and respondents re-ranked the statements. The main outcome measure was attainment of consensus as to whether the statements represented motivators or barriers. This was defined as 75 per cent of respondents giving a score of ≥5 (a strong motivator/barrier) or ≤3 (not a motivator/barrier) on a seven-point scale.

Key results

Eighty-four pharmacists (70 per cent) responded to both questionnaires. Consensus was attained that 23 of 24 statements were strong motivators and 14 of 23 statements were strong barriers. There were high levels of agreement that providing a prescription monitoring and review service would improve perceptions of pharmacists, help develop relationships with patients and give pharmacists professional fulfilment. The key barriers to the implementation of these services were their time-consuming nature, locum difficulties, the prohibitive cost and unwillingness of pharmacy owners or GPs to fund services.

Conclusions

The study suggests that these community pharmacists were motivated to participate in prescription monitoring and review schemes by a complex set of personal, professional and altruistic reasons. However, if such services are to be generally successful, adequate remuneration structures, internal rivalries and the structure and culture of the profession itself also need to be considered.

Consumer perspectives of pharmacist-delivered healtn information and screening services

Objective

Community pharmacy has been increasing its involvement in health promotion, especially information provision and screening, over the past decade. Little is known about how consumers view these services and there is a need to evaluate the level of consumer endorsement of this role. The aim of this study was to evaluate consumer attitudes towards pharmacist-delivered health information and screening services over time and with personal experiences of these services, as part of a standardised pharmacy programme.

Method

A validated instrument was administered in 1994 (n=98) and 2000 (n=58) to consumers who had not experienced a pharmacist health information and screening programme, and to a population in 2000 (n=159) who had received such a service. Comparisons of consumer attitudes were made between the unexposed 1994 and 2000 populations to test for the influence of time, and between the exposed and unexposed samples in 2000 to test for the effect of personal experience of the service.

Setting

Data were collected in seven community pharmacies in various non-metropolitan regions of New South Wales, Australia.

Key findings

Even after accounting for demographic variation between cohorts, consumers had a more positive attitude towards pharmacist screening over time, and towards both health information and screening after personal experience of these services.

Conclusion

Community pharmacists should be encouraged to participate more in health information provision and screening in order to take advantage of and further promote consumer endorsement of these pharmacist services.