Pharmacists' involvement in and attitudes toward pharmacy practice research: A systematic review of the literature

Pharmacists' clinical decision making when responding to a self-medication request for a cough in a developing country

BACKGROUND

Some studies have reported that community pharmacies in developing countries, including Indonesia, provided sub-optimal advice when handling patient's self-medication request for cough. The reasons behind such advice, therefore, need to be investigated.

OBJECTIVES

To describe Indonesian pharmacists' clinical decision making when handling self-medication cases for a cough.

METHODS

An open-ended questionnaire consisting of two cough clinical vignettes (case 1: cough due to asthma worsening and case 2: cough as a symptom of common cold) were developed. Pharmacists were interviewed to provide recommendations and reasons for their recommendations for these scenarios. Content analysis was used to analyse participants' statements for the two scenarios. The number of participants who provided appropriate recommendations and reasons were then counted.

RESULTS

A total of 245 community pharmacists participated in the study. In the case of cough due to asthma worsening, recommending a product because the product was indicated to help with the symptoms was the most common recommendation and stated reason (40%). Appropriate recommendation (direct medical referral) with appropriate reasoning (indicating warning symptoms and/or making a symptom diagnosis) was provided by 25% participants. In the case of cough as a symptom of common cold, recommending products to help with the symptoms was also the most common recommendation and stated reason (53%). Appropriate recommendations (recommending product) with appropriate reasoning (providing product to treat the symptoms and/or indicating no warning symptoms and/or making a symptom diagnosis) was provided by 81% participants.

CONCLUSION

The ability of Indonesian community pharmacists to provide appropriate recommendations for cough self-medication requests is dependent on whether triage is required. The inability of most community pharmacists to differentiate between major and minor conditions may lead to serious health implications for patients and therefore educational interventions should be undertaken to improve community pharmacists' differential diagnostic skills for triage.

Comparing the experiences of community and hospital pharmacy learners completing a pre-registrant research training program

BACKGROUND AND PURPOSE

Research training programs in the community pharmacy sector have not been well established. This study showcases a year-long guided research training program undertaken in hospital and community workplaces by pre-registrant pharmacists, and compares the perceived impact on learners in both sectors.

EDUCATIONAL ACTIVITY AND SETTING

A two-year cohort study (2021-2022) of pre-registrant pharmacists enrolled in a research training program requiring them to undertake an individual project at their workplace over one year at either a community or hospital workplace. Outcome measures were pre-registrant perceptions of training impact and type of projects completed.

FINDINGS

The results of this study demonstrate that the year-long guided research training program delivered to 403 pre-registrant pharmacists was perceived to be impactful to both community and hospital pre-registrant pharmacists and gave them the confidence to pursue further research and see research skills as an important attribute for the profession. Barriers to research included lack of time for both sectors but workplace support and lack of project ideas were especially noted in the community sector. Research project designs were mainly cross-sectional surveys or retrospective audits.

SUMMARY

Programs seeking to adopt a similar model may wish to pay particular attention to supporting community pharmacy learners in providing a pre-selection of project ideas, offering training to workplace supervisors, ensuring enough academic support is given and having more check-in points/deliverables to ensure more feedback opportunities.

Exploring the perceptions of faculty members about research courses in undergraduate pharmacy curriculum: A qualitative study

INTRODUCTION AND OBJECTIVE

The commitment of pharmacy graduates to patient care and research is crucial to advancing pharmaceutical science and practice. Consequently, the value of involving undergraduate pharmacy students in research has been increasingly recognized. Given that the College of Pharmacy at Qatar University offers two undergraduate pharmacy research courses, it is relevant to explore the perception of faculty members of the delivery, impact, facilitators, barriers, and suggested improvements in these courses. This exploration will help to improve the existing curriculum and to highlight the prospective impact of student involvement in undergraduate pharmacy research courses on the personal and professional growth of students, as well as on the progressive evolution of the pharmacy profession.

METHODS

A qualitative exploratory case study was performed in which five virtual focus groups were conducted. All eligible faculty members from the clinical pharmacy and pharmaceutical science departments with experience supervising students who had taken one or two undergraduate pharmacy research courses were invited to participate. The focus group questions were based on the Theoretical domain framework of behavioral determinants. Verbatim transcription was performed, and the collected data were thematically analyzed using the computer-assisted coding software NVivo®.

RESULTS

Of the 26 eligible faculty members, 21 participated in this study. Five deductive themes were identified: social professional role and influences, beliefs about capabilities, skills, beliefs about consequences and goals, and environmental resources and behavioral regulations. Overall, faculty members identified themselves as assessors and mentors. Participants expected students to possess independence, responsibility, and motivation. They believed that students generally required more practical research skills. Several benefits of incorporating students into undergraduate research have been highlighted, including increased publication productivity and quality. However, several hurdles to undergraduate research in pharmacy have been identified, including limited resources, limited timeframes, and sometimes delayed ethical approval.

CONCLUSION

Faculty members expressed optimism regarding the undergraduate research courses. However, some logistical concerns, including the lengthy ethical approval process and resource availability, must be addressed to optimize the effectiveness of these courses.

A qualitative study on asthma management experiences of Turkish community pharmacists

INTRODUCTION

Asthma is seen in more than 4 million people in Turkey. Numerous studies have shown the beneficial effects of pharmacist interventions on medication adherence and therapeutic outcomes. The aim of this study was to gain insight into the current situation by examining the experiences of Turkish community pharmacists in relation to the counseling and referral of asthma patients, the responsibilities of pharmacists and the recommendations made by pharmacists to improve asthma management.

METHODS

In this qualitative study, the constructivist-interpretivist paradigm was adopted. To conduct qualitative interviews, a semi-structured interview guide was devised to gather insights from the pharmacists. The interviews were coded verbatim. Subsequently, various themes and sub-themes were developed based on the aim and objectives of the study.

RESULTS

A total of 14 pharmacists engaged in semi-structured interviews conducted between June and August 2023. The wealth of information gathered during these interviews facilitated a meticulous thematic analysis, yielding four overarching themes: 1) Patient-related difficulties, 2) Communication with physicians, 3) Desired traits and responsibilities of pharmacists, 4) Pharmacists' expectations. Pharmacists placed significant emphasis on their challenges in allocating time to patients, primarily due to high workloads and limited collaboration with physicians.

CONCLUSION

Considering the workload and time limitations faced by pharmacists, a collaborative model involving pharmacists and physicians is seen as essential. Enhancing the collaboration between pharmacists and physicians, especially for chronic diseases, holds the potential to enhance public health outcomes while alleviating the workload of pharmacists.

Pharmacists' perceptions and delivery of health behaviour change recommendations: Mapping the COM-B model

BACKGROUND

Pharmacists are trusted and accessible healthcare professionals who are well-positioned to deliver brief health behaviour change technique-based interventions for chronic health conditions. However, little is known about the factors influencing pharmacists' use of behaviour change techniques and their capacity to deliver these interventions within community pharmacy.

OBJECTIVES

This study employed the COM-B model to explore the factors that explain pharmacists' delivery of behaviour change techniques in practice. A secondary objective was to ascertain whether capability, opportunity, and motivation are associated with and explain significant variance in the use of behaviour change techniques during patient interactions.

METHODS

Two-hundred and eleven Australian pharmacists (mean age = 36.1, SD = 10.7) completed a survey on their capability, opportunity, and motivation to deliver behaviour change techniques, and their delivery and frequency of use in practice.

RESULTS

Most pharmacists (91.3%) use behaviour change techniques during patient interactions. Results from a simple linear regression showed that a composite COM score was associated with pharmacists' behaviour change technique use F(1,195) = 47.12, β = 0.44, 95 % CI [0.09, 0.16], p < .001, and their frequency of use (F(1,198) = 44.19, β = 0.43, 95 % CI [0.02, 0.06], p < .001). While capability, opportunity, and motivation were individually associated with the range and frequency of behaviour change technique used, motivation was the only significant variable in the composite model for range (β = 0.35, 95 % CI [0.11, 0.41], p < .001) and frequency of behaviour change technique use (β = 0.22, 95 % CI [0.01, 0.09], p < .05).

CONCLUSIONS

Pharmacist motivation was the most important construct explaining behaviour change technique use. Interventions should seek to foster pharmacist motivation and may benefit from adopting COM-B as a behaviour change framework, to understand the factors influencing the delivery of behaviour change interventions.

Factors influencing French community pharmacists' willingness to participate in research projects: a mixed method study

BACKGROUND

French community pharmacists are facing an increasing demand to provide a wider range of services to meet the needs of the population. These new missions must be evaluated by primary care research studies. This study aims to explore the factors that influence French community pharmacists' willingness to participate in research projects.

METHODS

A mixed-method design was adopted for this study, comprising an initial quantitative online survey followed by semi-directed interviews. The investigation was conducted at two French faculties of pharmacy, Angers and Nantes, involving students in their 6th and final year of pharmacy education, and their community pharmacist tutors. The survey items were based on a study by Saini et al. and participants responded using five-point Likert scales. The semi-directed interviews were conducted after the quantitative analysis, only with volunteer and already graduated community pharmacists.

RESULTS

A total of 131 people participated in the quantitative analysis, comprising 75 students and 56 pharmacists. Pharmacists and students agreed on the significance of two key aspects: the research must possess a clear and meaningful purpose, and researchers must keep the pharmacists informed about the study's results. Among the 27 proposed items, only three showed significantly different results between students and pharmacists. Moreover, 11 semi-structured interviews were conducted. Research in the community pharmacy domain is relatively new for many pharmacists. Despite limited training, their willingness to participate is contingent on being actively involved from the outset, receiving appropriate support and training. However, the research should be seamlessly integrated into their daily practice, without being too time-consuming and administratively burdensome. Time constraints emerged as the main obstacle, along with concerns about the availability of human resources. Pharmacists expressed strong motivation driven by the research topic's relevance, and its potential impact on patients or the profession. While financial compensation is desirable, it did not appear to be the main criterion for participation in a study.

CONCLUSIONS

French pharmacists are willing to participate in research projects to improve patient care and develop the profession. Research teams must guide and involve from the project's inception.

Analysis of factors affecting pharmacists' ability to identify and solve problems

BACKGROUND

Among Japanese pharmacists, there is a gap in their commitment to self-improvement and a possible gap in their ability to identify and solve problems. However, the factors causing this situation have not yet been clarified. This study was conducted to identify factors that influence the abilities of Japanese pharmacists to identify and solve problems, which are skills considered essential for this profession. A prior history of presenting at academic conferences was set as a surrogate outcome to clarify whether having this experience affects the factors.

METHODS

A nationwide internet-based survey was conducted among 300 participating hospitals and 300 community pharmacists. The survey was discontinued when the sample size of each group reached 300. The respondents were categorized into two groups on the basis of their experience of presenting at academic conferences in the survey item "status of self-improvement after employment." Their association with other survey items was determined using univariate and multivariate logistic regression analyses.

RESULTS

The multivariate analysis revealed that 152 (50.7%) hospital pharmacists and 41 (13.7%) community pharmacists had presented at academic conferences. Among the hospital pharmacists, the experience of presenting at academic conferences was significantly associated with the "age 30 s (*references 20 s)," "presence of pharmacists to consult," "experience supervising interns," and "number of types of self-improvement" factors. For the community pharmacists, prior conference presentation experience was significantly associated with "age over 70 s," "highest educational background (doctoral or master's degree)," and "number of types of self-improvement."

CONCLUSION

This pioneering study suggests that having prior experience of presenting at academic conferences as a surrogate outcome of pharmacists' problem-finding and problem-solving skills may be related to the support provided by human environmental factors at the facility, the status of self-improvement, and the highest educational background.

A community pharmacy practice-based research network: A protocol for a realist evaluation

BACKGROUND

Community pharmacists' active participation in research is essential to build a robust, translatable evidence base. Practice-based research networks (PBRNs) have been established to support collaborative research and knowledge translation in community pharmacies. However, PBRNs' effectiveness in supporting research engagement and knowledge translation remains unexplored. A new PBRN will be implemented in southeast Queensland, Australia. This realist evaluation seeks to explain whether, how, why, for whom, in what context and over what duration the PBRN supports community pharmacists to engage in research.

OBJECTIVES

1. to generate transferable knowledge about the different circumstances in which-and the mechanisms by which-a PBRN influences research engagement outcomes for different community pharmacists, in the form of a program theory. 2. To use the program theory to develop evidence-informed recommendations for use by PBRN stakeholders.

METHODS

A realist evaluation will be conducted in four iterative phases: (1) theory development, (2) hypothesis generation, (3) observations, and (4) theory refinement. A two-year multi-method study will be conducted, including interviews with pharmacists, surveys, participatory and observational data collection. The evidence will be used to confirm, refute, and/or refine the program theory. The evaluation will adhere to the Realist And Meta-Narrative Evidence Synthesis (RAMESES) publication and quality standards.

CONCLUSIONS

The evaluation will contribute to the body of knowledge by generating a realist program theory to explain how, why, for whom, in what contexts, to what extent, in what respects, and over what duration the PBRN supports community pharmacists to engage in research. The findings will support the broader implementation of PBRNs and future network activities.

Australian community pharmacy service provision factors, stresses and strains: A qualitative study

Introduction

Despite the desire of pharmacists to provide new and more clinically focused services, strain on the community pharmacist workforce is a known barrier to their service provision. Causes are unclear, although the impact of increased workload, as well as broader role-related and systemic causes have been suggested.

Aims

To (1) explore the role strain, stress and systemic factors affecting Australian community pharmacists' provision of cognitive pharmacy services (CPS), using the Community Pharmacist Role Stress Factor Framework (CPRSFF), and (2) adapt the CPRSFF to the local setting.

Methods

Semi-structured interviews were conducted with Australian community pharmacists. Transcripts were analysed with the framework method to verify and adapt the CPRSFF. Thematic analysis of particular codes identified personal outcomes and causative patterns in perceived workforce strain.

Results

Twenty-three registered pharmacists across Australia were interviewed. CPS role benefits included: helping people, and increased competency, performance, pharmacy financial return, recognition from the public and other health professionals, and satisfaction. However, strain was worsened by organisational expectations, unsupportive management and insufficient resources. This could result in pharmacist dissatisfaction and turnover in jobs, sector or careers. Two additional factors, workflow and service quality, were added to the framework. One factor, "View of career importance versus partner's career", was not apparent.

Conclusion

The CPRSFF was found to be valuable in exploring the pharmacist role system and analysing workforce strain. Pharmacists weighed up positive and negative outcomes of work tasks, jobs and roles to decide task priority and personal job significance. Supportive pharmacy environments enabled pharmacists to provide CPS, which increased workplace and career embeddedness. However, workplace culture at odds with professional pharmacist values resulted in job dissatisfaction and staff turnover.

Perspectives of hospital pharmacists on quality improvement initiatives in patient care: A pilot study from one healthcare system in Canada

Background

Quality Improvement (QI) is any systematic process that seeks to improve patient safety or clinical effectiveness in healthcare. Although hospital pharmacists positively contribute to QI initiatives, there is no information available regarding Canadian hospital pharmacists' involvement and perspectives with QI.

Objectives

The primary objective of the study was to describe the QI experiences (including attitudes, enablers and barriers) of hospital pharmacists employed by the Lower Mainland Pharmacy Services (LMPS) in British Columbia.

Methods

This research study used an exploratory cross-sectional survey. A 30-item survey was developed to measure QI experiences of hospital pharmacists including prior QI experiences, their attitudes towards pursuing QI initiatives, and their perceived enablers and barriers to participating in QI initiatives in hospital settings.

Results

Forty-one pharmacists responded (response rate of 14%). Thirty-eight participants (93%) indicated that they were familiar with the concept of QI. All participants (100%) reported that it was important for pharmacists to be involved with QI despite the general lack of formal QI training among the participants, and 40 participants (98%) agreed that QI was necessary to advance patient care. Moreover, 21 participants (51%) showed interest in leading QI initiatives, while 29 (71%) would participate in QI initiatives. Participants identified several individual and organizational barriers that hindered hospital pharmacists from pursuing QI initiatives.

Conclusion

Our findings suggest that hospital pharmacists in LMPS would like to be actively involved with QI initiatives; however, individual and organizational barriers must be addressed in order to facilitate widespread adoption of QI practices.

Predictors of enablers and barriers to community pharmacists' management of minor ailments in a developing setting: A theory-driven assessment

BACKGROUND

The clinical and financial burdens associated with minor ailments are well documented, but published evidence suggests that minor ailment services led by community pharmacists have a remarkable positive impact, mainly in developed settings. There is a paucity of evidence on community pharmacists' self-perceived enablers and barriers to the effective management of minor ailments.

OBJECTIVES

The objective of the study was to identify community pharmacists' self-perceived enablers and barriers to the effective management of minor ailments as well as their significant predictors.

METHODS

A Kurt Lewin's theory-driven cross-sectional survey of 305 community pharmacists was conducted in Qatar using a pretested 25-item structured questionnaire developed with an adapted conceptual framework focused on 4 key areas: education, regulation, practice, and research. Bivariate logistic regression was used to identify significant predictors of community pharmacists' self-perceived enablers and barriers.

RESULTS

The response rate was 92.5% (282/305). Most of the respondents (68.1%) were males, who were 31-40 years of age (55.3%) and worked for pharmacy chains (77.3%). Community pharmacists identified a higher proportion of enablers (positive force) (82.4%) relative to only 3 barriers (negative force) (17.6%). The barriers identified included insufficient private or semiprivate space for patient counseling, the paucity of invitations to participate in practice-based research, and lack of feedback regarding the results and recommendations of previous research in which they were participants. The significant predictors of self-perceived enablers and barriers were female gender (odds ratio [OR], 2.21; 95% CI, 1.25-3.91; P = 0.007) and age group of ≤40 years (OR, 4.74; 95% CI, 3.50-7.16; P = 0.006).

CONCLUSION

Community pharmacists' perceptions of the factors that enhance their effective management of minor ailments were overwhelmingly positive, as 14 enablers were identified relative to only 3 barriers. Female and young community pharmacists were significantly more likely to perceive enablers than barriers. The insights provided are potentially useful in developing pharmacy-based schemes to improve the effective management of minor ailments.

Are UK pharmacists ready for consultant-level practice? A cross-sectional survey of self-assessed development needs

OBJECTIVES

The four nations of the United Kingdom (UK) have endorsed a new curriculum and credentialing process for consultant pharmacists. This study aimed to measure the self-reported consultant-level practice development needs of pharmacists across the UK.

METHODS

The study was a cross-sectional electronic survey. Inclusion criteria were: pharmacists registered to practice with the General Pharmaceutical Council; working in any professional sector across the UK; and self-identifying as already working at an advanced level of practice or in an advanced pharmacist role. Participants were asked to rate their confidence that their current practice aligns to the level described in the Royal Pharmaceutical Society Consultant Pharmacist curriculum on a 5-point Likert scale. Predictors of overall confidence with the whole curriculum were analysed using binomial regression.

KEY FINDINGS

Nine hundred and forty-four pharmacists participated. Median age was 42 years; 72.6% were female. Research skills and strategic leadership skills had low self-reported confidence. Patient-Centred Care and Collaboration was the domain with the highest reported confidence. 10.2% (96/944) of participants self-reported confidence across the whole curriculum. The strongest predictors of overall confidence across the curriculum were advanced clinical practitioner qualification, research qualifications and self-identifying as a specialist. Increasing age and male gender also predicted confidence. White ethnicity and having an independent prescribing qualification negatively predicted confidence.

CONCLUSION

A small minority of pharmacists self-reported confidence across the whole curriculum. A planned approach to develop research skills across the career spectrum, coupled with better identification of workplace-based experiential strategic leadership opportunities, may help deliver a larger cohort of 'consultant-ready' pharmacists.

Research engagement by British early-career practitioners in nephrology: a multidisciplinary survey

OBJECTIVES

To establish barriers and motivators underlying research engagement among early-career practitioners in nephrology across the UK, in order to guide potential interventions to enhance research involvement in renal units.

DESIGN

Cross-sectional online survey employing a range of free-text, Likert scale and binomial/multiple-choice responses, distributed via mailing lists and social media. Topics covered research experience, research involvement and barriers, impact of COVID-19 and strategies to improve research engagement. Thematic analysis was used to assess free-text responses.

SETTING

Renal units throughout the UK.

PARTICIPANTS

Non-consultant healthcare staff self-identifying as working in nephrology were included (n=211), with responses from non-UK respondents or consultant nephrologists excluded (n=12).

RESULTS

Responses were received from across the multidisciplinary team (physicians (n=83) and nurses (n=83)) and other allied health professionals (n=45). Most were aware of ongoing local research, but under half of them were actively involved. Multivariate analysis indicated employment as a physician, protected time for research activity and provision of appropriate training were associated with greater research experience and output. There was general enthusiasm to undertake research, but perceived barriers included insufficient staffing, lack of time, funding and encouragement. COVID-19 was felt to have further impacted negatively upon opportunities. Among the suggested strategies to promote engagement, mentorship and an online research resource were felt to be of most interest.

CONCLUSIONS

In the first survey of this type in nephrology, we demonstrate differences across the multidisciplinary spectrum in perceived research experience and accessibility, which have been worsened by COVID-19. Our findings will guide strategies to broaden engagement in early-career practitioners and serve as a baseline to assess the impact of these interventions.

Developing a national pharmaceutical research strategy in Lebanon: opportunities to bridge the gaps and reach the goals

Pharmaceutical research can be structured into clear national strategies that optimize patient health and foster innovation. The objectives of this document are to assess the need for a national pharmaceutical research strategy based on the current situation in Lebanon, to identify the strengths and weaknesses of pharmaceutical research in Lebanon, and to suggest a pharmaceutical research strategy for Lebanon, including goals and objectives. In Lebanon, in the absence of a national health research policy, pharmaceutical research is conducted in academia or hospitals, although projects are the result of personal or team initiatives that should be organized to better serve the needs of the country. Many strengths of pharmaceutical research were identified, such as the pharmaceutical workforce and academics who are willing to contribute to research, while the implementation of the national pharmaceutical strategy represents an important opportunity to promote research. Among the weaknesses is the lack of research culture in some institutions and interinstitutional/interprofessional collaborations. Thus, the suggested strategy aims to structure pharmaceutical research in Lebanon, including the priorities towards which research is directed, the process by which research is conducted, and the workforce conducting research. It will mainly rely on the World Health Organization's interrelated goals (organization, priorities, capacity, standards, and translation). The implementation of the suggested pharmaceutical research strategy will only be achieved through the leadership of the pharmaceutical authorities and the collaboration of stakeholders.

Continuing Pharmacy Education: Exploring the Status and Future Prospects in Nepal

Continuing pharmacy education (CPE) is an educational way for pharmacy professionals to develop competency in providing quality pharmaceutical care to patients. The CPE program helps maintain up-to-date knowledge and skills, increase the professionalism of pharmacists, and positively impact patient health outcomes. However, the concept and practice of CPE are still in their infancy in Nepal. Nepal's conventional pharmacy education system involves didactic lectures focusing more on theoretical learning than practical and experiential approaches, leading to the generation of pharmacists theoretically knowledgeable but practically non-competent to deliver pharmaceutical care services in independent practice settings. Additionally, in the absence of CPE, the professionals might miss updated information on new therapies, technologies, and approaches in patient management. The community and hospital pharmacies in Nepal are often business-oriented rather than service, and may not even be staffed by pharmacists, so the CPE programs are rarely conducted for the pharmacy professionals. Hence, the present commentary aimed to explore the status of CPE and its barriers or challenges in implementation and to suggest solutions in Nepal.

Recruitment of participants for dementia research: interprofessional perspectives from primary care-based memory clinics

Aim: To understand clinician attitudes and the barriers that impede research recruitment from specialized primary care-based memory clinics. Materials & methods: Clinicians completed a survey on attitudes and barriers to research recruitment from memory clinics. Results: Comfort and willingness to recruit for research were low to moderate and were lower for drug trials than for observational and non-drug trials. Respondents believed that it is important to have a standardized recruitment process. Identified barriers provide some insights into the factors that contribute to discomfort and lack of willingness to recruit research participants. Discussion: Findings can inform future efforts to develop a recruitment process that addresses identified barriers, while also providing an opportunity to increase participant recruitment in dementia research.

Community pharmacists’ attitudes toward practice-based research and their perceived utilization of scientific evidence

Background

Enhancing the contribution of practicing pharmacists into scientific evidence via practice-based research (PBR) is crucial in maintaining high-quality clinical practice and healthcare delivery. Involving community pharmacists in PBR can potentially can also help break barriers to the utilization of the current best evidence in everyday pharmacy practice. The impact of pharmacists’ attitude towards PBR on their utilization of current best evidence in pharmacy practice is understudied.

Objectives

The aim of the study was to investigate the impact of community pharmacists’ attitudes toward PBR on their utilization of current best evidence, barriers for conducting PBR in clinical practice were also investigated.

Methods

In this cross-sectional study, 169 community pharmacists working across Jordan filled a questionnaire to assess their attitudes towards PBR, barriers to PBR, and their utilization of the current best evidence in clinical practice.

Results

Pharmacists in this study showed a positive attitude toward PBR (attitude mean score >3.5). A positive attitude towards PBR was associated with high utilization of the best current scientific evidence. We also investigated several barriers to PBR and their association with utilization those included; the lack of perceived benefits, lack of institutional support, and lack of self-engagements of community pharmacists to PBR. The lack of perceived benefit was found to be negatively associated with pharmacists’ utilization of the current best scientific evidence.

Conclusion

In this study, pharmacists’ utilization of current best evidence was found to be significantly impacted by their attitude toward PBR. The current study findings highlight the importance of supporting, promoting, and facilitating PBR among community pharmacists which can potentially enhance their utilization of the current best evidence in their everyday pharmacy practice.

Assessing readiness for research: a pilot study of Indonesian pharmacists

Objectives

Readiness is a key factor that influences pharmacists’ willingness to get involved in research, thus promoting evidence-based pharmacy practice. While the data are lacking, this study aimed to assess readiness for research, as well as the associated demographic and attitudinal characteristics of pharmacists in a range of healthcare settings in East Java Province, Indonesia.

Methods

A questionnaire was administered to all pharmacists in a public hospital in Malang (n = 55), pharmacists from primary health centre (PHCs) (n = 63) and community pharmacies (n = 100) in Surabaya in 2017. The questionnaire consisted of three sections: (1) demographic characteristics, (2) attitudinal aspects and (3) readiness for research. Descriptive analysis was used to summarise the data. Spearman correlation tests determined the correlations between ‘demographic characteristics’ or ‘attitudinal aspects’ versus ‘readiness’.

Key findings

A total of 142 pharmacists responded which comprised hospital pharmacists (n = 46), community pharmacists (n = 51) and PHC pharmacists (n = 45), giving response rates ranged from 51.0% to 83.6%. Approximately half of the participating pharmacists demonstrated adequate ‘readiness’ to research [mean 2.53 ± 0.7 (range 0–4)]. Compared with hospital or PHC pharmacists, community pharmacists showed lower ‘readiness’ to research (mean 2.76 ± 0.71 versus 2.53 ± 0.66 versus 2.31 ± 0.68, respectively; P = 0.005). Two demographic characteristics positively correlated with ‘readiness’, that is, prior research training (rs = 0.217; P = 0.010) and prior research experience (rs = 0.221; P = 0.008). Meanwhile, all ‘attitudinal aspects’ were found to be positively correlated with research ‘readiness’ (all P-values &lt;0.001).

Conclusions

Findings from this study provide baseline data to develop strategies to optimise the involvement of pharmacist practitioners in research, thus enhancing evidence-based pharmacy practice and quality use of medications in Indonesia.

Reaching for veterinary pharmacy services: an overlooked routine by community pharmacists?

Objectives

Community pharmacists claim veterinary pharmacy as an integral part of their duties. There a paucity of studies investigating medication and health products’ dispensation for veterinary purposes. This study aimed to probe the Portuguese community pharmacists’ knowledge and behaviour towards veterinary pharmacy practice.

Methods

A cross-sectional exploratory survey, using an online questionnaire, was sent to a sample of academic-related community pharmacists in greater Lisbon, Portugal (N = 349). The questionnaire addressed participants’ specific education and training, counselling of products, and attitudes towards veterinary prescriptions. Logistic regression was used to estimated participants’ propensity for changing veterinary prescriptions independently. Everyday case scenarios were used to ascertain veterinary pharmacotherapy knowledge.

Key Findings

Participation reached 57.6% (N = 201), pointing to the theme’s relevance, with 83.6% females and a mean age of 36 years (SD =10.1). A large proportion (71.6%) declared to have received veterinary pharmacy education, although virtually all pharmacists (99.0%) perceived a skills deficit. The overall level of correct decisions regarding case scenarios reached 54%, although most professionals counsel pets’ treatments (85.6%). 18% of the sample declared to have changed a prescription without contacting the veterinarian. The propensity to independent medication changes was associated with being a male pharmacist, having one to two decades of professional experience, and working in community pharmacies with a permanent supply of prescribed veterinary pharmaceuticals.

Conclusions

Although recognizing limitations in veterinary pharmacy competencies, not all community pharmacists decide to minimize potential hazards to animals’ health as with human health. Present findings reinforce the urgency of further formal education and interprofessional collaboration.

Postgraduate pharmacist development- an evaluation of Jordanian pharmacist experiences to inform and shape an evidence-based professional development policy

Building capacity for developing skills as leadership, teamwork, and continuous academic support has become essential for fulfilling a successful pharmacy career. This study aims to assess Jordanian pharmacists' views on professional development, namely: the continuous education infrastructure, strategies and programs for personal development, leadership skills, incentive schemes, drug information resources and digital services. As well as exploring options for better academic support delivered to pharmacists. To capture participant's views, an online validated and reliable survey was developed. Non-probability sampling design was used. Participants were qualified pharmacists working at Royal Medical Services (RMS) and Community Pharmacists (CP). Comparison and descriptive statistics were used to report the results. A total of 271 pharmacists participated, 144 from RMS (8% more than the needed sample) and 127 CP (7% more than the needed sample). There was a strong desire amongst both RMS and PC groups for continuous educational training particularly in the following areas, first: Advanced counselling and communication skills (means = 8.99±0.145, CI 95% = 3.70-4.28 and 9.37±0.096, CI 95% = 4.18-4.56). Second: Personal development skills (mean = 8.92±0.142, CI 95% = 3.64-4.20 and 9.02±0.145, CI 95% = 3.73-4.30). Third, Pharmaceutical health promotion (mean = 8.05±0.180, CI 95% = 2.70-3.41 and 8.57±0.159, CI 95% = 3.26-3.89). Only 19.4% and 18.1% of the RMS and CPs respectively reported the presence of a written policy for personal development and leadership in their workplace. There were few incentives for pharmacists to participate in research. Few pharmacists used the available drug information and toxicology centers. The professional and continuous personal development of pharmacists support an evolving healthcare system. This study emphasizes the need for a tailored and documented postgraduate educational strategy, personal development, and leadership skills training in Jordan. Implementing a well-defined scheme of incentives should be encouraged to engage pharmacists in continuous professional development programs and pharmaceutical research. Such strategy and training should enhance both professional and personal performance.

Barriers and facilitators to conducting economic evaluation studies of Gulf Cooperation Council (GCC) countries: a survey of researchers

Background

The number of published economic evaluations of Gulf Cooperation Council (GCC) countries is notably scarce. Limited local evidence could have a major impact on the implementation of economic evaluation recommendations in the decision-making process in GCC countries. Little is known about the factors affecting researchers who seek to conduct economic evaluations. Therefore, we aimed to assess researcher barriers and facilitators in conducting such studies of GCC countries.

Methods

A cross-sectional survey of health economic researchers working in GCC countries was conducted online between January and February 2020. The survey instrument collected researchers’ perceived barriers and facilitators and demographic information. For barriers, respondents rated their agreement on a 5-point Likert scale ranging from “strongly disagree” to “strongly agree”. For facilitators, respondents rated the importance of each facilitator on a six-point scale ranging from “extremely important” to “not very important”. Then, participants were asked to select the three most important barriers and facilitators from the lists. The data collected were examined using descriptive analysis.

Results

Fifty-one researchers completed the survey (37% response rate). The majority of participants (more than 80%) agreed that lack of quality of effectiveness data and restricted access to unit cost data are the main barriers to conducting economic research. Availability of relevant local data was reported as an important facilitator, followed by collaboration between health economic researchers, policy-makers and other stakeholders.

Conclusions

The results of this study provide an exploratory view of the issues faced by health economics researchers in GCC countries. Recommendations to GCC countries based on international experiences, such as to use real-world data in economic evaluation research, were provided.

A participatory research approach in community pharmacy research: The case for video-reflexive ethnography

Video-reflexive ethnography (VRE) is a qualitative methodology that explores the complex nature of healthcare 'as it really is'. Its collaborative and reflexive process invites stakeholders (e.g. pharmacists and pharmacy support staff) to participate in analysing their everyday work practices as captured on video footage. Through close collaboration with practitioners and attention to their work contexts, VRE may be a useful methodology to engage a time-poor pharmacy workforce in research about themselves, encouraging more practitioner involvement in practice-based research. Aside from research, VRE has also been used effectively as an intervention to facilitate learning and change in healthcare settings, and could be effective in provoking change in otherwise resistant pharmacy environments. Much like traditional ethnographic approaches, VRE researchers have relied on being present 'in the field' to observe, record and make sense of practices with participants. The COVID-19 pandemic however, has introduced restrictions around travel and physical distancing, which has required researchers to contemplate the conduct of VRE 'at a distance', and to imagine new ways in which the methodological 'closeness' to stakeholders and their workplace contexts can be maintained when researchers cannot be on site. In this commentary, we outline the rationale for participatory methods, in the form of VRE, in pharmacy research. We describe the underlying principles of this innovative methodology, and offer examples of how VRE can be used in pharmacy research. Finally, we offer a reflexive account of how we have adapted the method for use in community pharmacy research, to adapt to physical distancing, without sacrificing its methodological principles. This paper offers not only a new methodology to examine the complexity of pharmacy work, but demonstrates also the responsiveness of VRE itself to complexity, and the potential breadth of future research applications in pharmacy both during and beyond the current pandemic.

Process study within a pilot cluster randomised trial in community pharmacy: An exploration of pharmacist readiness for research

INTRODUCTION

Community pharmacies have an increasingly prominent public health function. This includes addressing alcohol, but guidance on delivery of alcohol interventions in this setting is lacking. We have developed an intervention that integrates attention to alcohol within existing community pharmacy medicine review services. This paper examines the experiences of community pharmacists (CPs) in conducting a pilot trial of the intervention, including the acceptability of the trial patient recruitment procedures and the training and support provided by the research team.

METHOD

The pilot trial was conducted in 10 community pharmacies in Yorkshire, England. One CP from each pharmacy was recruited via a multi-stage process to assess motivation, commitment and capacity to participate. Each CP attended a research training day and received on-going research support to conduct the trial. Semi-structured audio-recorded face-to-face interviews (lasting 40-105 min) were conducted with all the CPs at the end of the trial. Data were also available from three direct observations conducted during trial support visits. Data were analysed thematically.

RESULTS

The CPs were supportive of research in community pharmacy but had little direct experiences of research themselves. They valued the training and support provided, which had quickly identified areas where CPs were deviating from the study recruitment protocol. In some instances, the boundaries between research and practice became blurred with CPs making changes to their usual routines and interactions with patients to accommodate the research.

CONCLUSIONS

The trial procedures were acceptable to CPs, in part because of the training and support provided. There are also identifiable areas where CPs' readiness for research could be enhanced to facilitate participation in future trials in this setting.

Pharmacists' background, interests, barriers, self-perceived competence and confidence to design and undertake pharmacy practice-based research in the GCC geographic area

BACKGROUND

The absence of ability and certainty to design and undertake pharmacy practice-based research (PPBR) was a major issue among pharmacists worldwide as reported in previous literature, despite them having an interest in conducting PPBR. Therefore, this study aimed at highlighting the research background of the Gulf Cooperation Council (GCC) pharmacists which are the six Arab states of the Arabian Gulf, and examining barriers to conducting PPBR. In addition, to determine the self-perceived level of competence and confidence when planning and conducting PPBR.

METHODS

This is a descriptive, cross-sectional questionnaire-based study, performed among pharmacists working in the GCC countries (i.e. Saudi Arabia, United Arab Emirates, Kuwait, Bahrain, Oman and Qatar). A pre-validated questionnaire was distributed to a convenience sample, via distribution of 500 research participation cards to conference attendees. These cards a quick response (QR) code, which should be scanned via mobile phone, to direct all readers to the online survey. All pharmacist delegates attending the conference (i.e. the Saudi International Pharmaceutical Sciences Annual National Conference (SIPHA) and Dubai International Pharmaceuticals and Technologies Conference and Exhibition (DUPHAT) in 2020 and who are working in one of the GCC co. untries as pharmacists were considered. The data were analysed using the Statistical Package for the Social Sciences (SPSS) and Excel software.

RESULTS

Two hundred and fourteen pharmacists were included. Seventy percent of the pharmacists had past PPBR background. Confidence and competence of pharmacists for research skills in regard to employing appropriate inferential statistical test, choosing software for statistical analysis, drafting a comprehensive plan for data analyses and determining appropriate sample size were weak. Highest competence and confidence were seen in preparing a presentation and searching the literature. Pharmacists with previous research experience (K-W: p = 0.001) and training (K-W: p = 0.003) had an overall ability to conduct PPBR. In addition, they had more interest in conducting PPBR (MWU = 3061.500, z = - 4.126, p = 0.000) and in learning about how to do so (MWU = 8698, z = - 1.898, p = 0.050).

CONCLUSIONS

Pharmacists practicing in the GCC geographic area realized the importance of planning and conducting PPBR and were more confident and competent to undertake and contribute to PPBR, except for skills related to statistical analysis. Therefore, training programmes especially for biostatistics and data analysis are mandatory to enhance pharmacists' research capabilities.

Formation of a statewide community pharmacy practice-based research network: Pharmacist opinions on research participation and engagement

OBJECTIVE

To gather the insights and opinions of pharmacist stakeholders to inform the creation of a community pharmacy practice-based research network (PBRN) in Pennsylvania.

DESIGN

A stakeholder advisory board of pharmacists, patients, and researchers was established to guide this research. This was a qualitative study using a semistructured interview guide.

SETTING AND PARTICIPANTS

Community pharmacists from the Pennsylvania Pharmacist Care Network.

OUTCOME MEASURES

Themes were identified that describe pharmacist insights and opinions on research participation and preferences for engagement in the PBRN.

RESULTS

A total of 16 pharmacists participated in the study. The pharmacists believed that participating in research would help demonstrate their value and commitment to improving patients' health. Enhancing patient-pharmacist relationships and driving innovation were additional benefits that were reported. The pharmacists believed that they could effectively leverage their relationships with patients to engage them in research opportunities. The pharmacists reported that they would like to share research ideas and successful research practices with other members of the PBRN.

CONCLUSION

Gathering pharmacists' opinions on participating in research was an important step in developing a community pharmacy PBRN that meets stakeholder needs. The results of this study can help others who seek to form community pharmacy PBRNs that facilitate stakeholder-driven research.

A survey of the European Society of Clinical Pharmacy members' research involvement, and associated enablers and barriers

Background Building research capacity of European Society of Clinical Pharmacy (ESCP) members aligns to the organisation's aim of advancing research. Objective To determine members' aspirations and needs in research training and practice, and to explore ways in which ESCP could provide support. Setting ESCP's international membership. Method Cross-sectional survey of members in 2018, followed by focus groups with samples of respondents attending an ESCP symposium. Survey items were: research activities; interests, experience and confidence; and Likert statements on research conduct. Principal component analysis (PCA) clustering of Likert statements from a previous study was used, with scores for each component calculated. Focus groups discussed barriers to research and how ESCP could provide support. Data analysis involved collating and comparing all themes. Main outcome measures Research interest, experience and confidence; attitudinal items; barriers to research; ESCP support. Results The response rate was 16.7% (83/499), with 89.2% (n = 74) involved in research and 79.5% (n = 66) publishing research in the preceding 2 years. While overwhelmingly positive, responses were more positive for research interest than experience or confidence. PCA component scores (support/opportunities, motivation/outcomes, and roles/characteristics) were positive. Thirteen members participated in focus groups, identifying barriers of: insufficient collaboration; lack of knowledge, skills, training; unsupportive environment; insufficient time; and limited resources. ESCP could support through mentorship, collaboration, education and funding. Conclusion Study participants were highly active, interested, experienced, confident and positive regarding research. There is an opportunity for ESCP to harness these activities and provide support in the form of mentoring, education and training, and facilitating collaboration.

Self-perceived competence and training needs analysis on antimicrobial stewardship among government ward pharmacists in Malaysia

Background

There is a paucity of data on pharmacists' competency and learning needs in antimicrobial stewardship (AMS).

Objectives

To identify and prioritize learning needs based on self-perceived competence of ward pharmacists in AMS, to identify predictors of self-perceived competence, learning methods in AMS and perceived barriers to learning.

Methods

A cross-sectional survey involving ward pharmacists from Hospital Canselor Tuanku Muhriz (HCTM) and hospitals under the Ministry of Health was conducted from May to July 2018.

Results

A total of 553 ward pharmacists from 67 hospitals responded to this survey (71.3% response rate). Knowledge of infections, antimicrobials and AMS systems, confidence to advise on various issues relating to antimicrobial therapy and participation in clinical audit and evaluation were among the learning needs identified (median score 3.00). Meanwhile, knowledge on the epidemiology of infections, off-label use of antimicrobials and pharmacoeconomics relating to antimicrobials had lower median scores (2.00) and were thus prioritized as high learning needs. Significant predictors of self-perceived competence in AMS were: gender (P < 0.001); prior specific training in infections and AMS (P < 0.001); postgraduate degree (P < 0.001); practising in the area of infectious disease (P < 0.05); and years of working experience as a ward pharmacist (P < 0.005). Continuing medical education, seminars, courses and workshops were the most common (78.1%) and preferred (84.6%) learning methods in AMS. Lack of appropriate training (67.8%), time (44.5%) and funding (42.5%) topped the list of barriers to learning in AMS.

Conclusions

Findings in this study suggest the need to establish and intensify standardized training in AMS among government ward pharmacists.

Evaluation of a Web-Based, 'Purchase Event' Intensive Monitoring Method for Pharmacovigilance of Natural Health Products: Lessons and Insights from Development Work in New Zealand

INTRODUCTION

Intensive monitoring methods are used in pharmacovigilance for prescription medicines but have not yet been implemented for natural health products (NHPs).

OBJECTIVES

Our objective was to assess feasibility issues with a new 'purchase event' intensive monitoring method for pharmacovigilance of NHPs, including pharmacy and NHP purchaser recruitment rates, collection of NHP purchaser key patient identifier information for data linkage and quality and completeness of data.

METHODS

For the Ginkgo study, 213 community pharmacies in the Auckland (Aotearoa New Zealand) District Health Board area were invited to participate. Staff in participating pharmacies (n = 3 [1.4%]) recorded ginkgo product sales and gave purchasers a study invitation card (October 2015-January 2016). Ginkgo purchaser participants were emailed links to web-based baseline and follow-up questionnaires about adverse events occurring during/after taking ginkgo. Participating pharmacists and consumers were invited to provide qualitative feedback about the study. For the NHP-Lite study, all NHPs were included for monitoring. Community pharmacies in the Green Cross Health network were invited to participate. Participating pharmacy staff gave all NHP purchasers a study invitation card over a 2-week period (May 2016). NHP purchaser participants were emailed links to web-based baseline, follow-up and feedback questionnaires.

RESULTS

Few community pharmacists (Ginkgo study, n = 3; NHP-Lite study, n = 18) and NHP purchasers (Ginkgo study, n = 0; NHP-Lite study, n = 4) participated. Pharmacists (Ginkgo study, 3/3; NHP-Lite study, 11/18) described several reasons for participating and suggested ways to increase consumer recruitment, including simplifying study procedures.

CONCLUSIONS

These web-based, purchase event, intensive monitoring studies, with cohorts built through NHP purchases in pharmacies, identified substantial issues with recruiting pharmacists/pharmacies and NHP purchasers that, at present, render such studies unfeasible. Future studies need to consider other methods of recruiting NHP purchasers and develop a simple method for recording NHP purchases.

A theoretically based cross-sectional survey on the behaviors and experiences of clinical pharmacists caring for patients with chronic kidney disease

The literature shows a lack of evidence on pharmacists contributing to chronic kidney disease services. The aim was to determine pharmacists' behaviors and experiences and perceptions of barriers and facilitators to implementation of models of care. A theoretically informed survey was developed and sent to pharmacist members of the United Kingdom renal pharmacy group. Sections included: demographics, clinical practice and prescribing practice. Questions were of various types; closed type and some open for comments. Attitudinal items on clinical/prescribing used 5-point Likert scale. Development/implementation items were derived from the Consolidated Framework for Implementation Research (CFIR). Analysis used descriptive statistics and open comments were analysed thematically. Ethical approval was granted by an academic institution. Response rate; 50% (n = 71), seven were incomplete and excluded. Respondents provided; inpatient general pharmaceutical care (n = 56, 87.5%), to those receiving dialysis (n = 54, 84.4%) and transplantation. Non-clinical roles; audits (n = 46, 71.9%), patient education (n = 31, 48.4%), only 7.8% (n = 5) doing academic research. For barrier/facilitators most strongly agreed/agreed with most CFIR items relating to clinical practice. A majority (n = 44, 68.7%) disagreed that they had sufficient time to practice clinically and 44 (68.7%) disagreed there was sufficient cover for services. For prescribing roles, 90.5% (n = 48) were currently actively prescribing. Although prescribing related CFIR items were largely positive, 39.6% (n = 19) disagreed about sufficient time to practice and 18.7% (n = 9) were neutral. Two thirds (n = 33, 68.7%) disagreed that there was sufficient cover for the prescribing. The majority of respondents provided general pharmaceutical care to dialysis and transplant patients, were confident in their abilities and tried new ways of working including independent prescribing. Many expressed that lack of resources was the main barrier to providing more advanced care. Further work is needed to explore these matters in more depth.

The Help for Hay Fever community pharmacy-based pilot randomised controlled trial for intermittent allergic rhinitis

Management of intermittent allergic rhinitis (IAR) is suboptimal in the UK. An Australian community pharmacy-based intervention has been shown to help patients better self-manage their IAR. We conducted a pilot cluster RCT in 12 Scottish community pharmacies to assess transferability of the Australian intervention. Trained staff in intervention pharmacies delivered the intervention to eligible customers (n = 60). Non-intervention pharmacy participants (n = 65) received usual care. Outcome measures included effect size of change in the mini-Rhinoconjunctivitis Quality of Life Questionnaire (miniRQLQ) between baseline, 1-week and 6-week follow-up. Trial procedures were well received by pharmacy staff, and customer satisfaction with the intervention was high. The standardised effect size for miniRQLQ total score was -0.46 (95% CI, -1.05, 0.13) for all participants and -0.14 (95% CI,-0.86, 0.57) in the complete case analysis, suggesting a small overall treatment effect in the intervention group. A full-scale RCT is warranted to fully evaluate the effectiveness of this service.

More than coffee - a World Café to explore enablers of pharmacy practice research

BACKGROUND

Pharmacists are in demand now more than ever to provide high-quality expertise about the effectiveness, safety and use of medications. Amidst an increasingly complex and costly healthcare system, policy makers need robust evidence to justify public spending on pharmacy services. Research on the impact of existing and emerging pharmacy practices is required.

OBJECTIVE

To explore barriers and opportunities to enhance research among pharmacists in Ireland utilising a World Café methodology.

METHODS

A pharmacy research discussion day was held in November 2018, open to all pharmacists in Ireland. A World Café methodology was utilised as a mechanism to facilitate group discussions about pharmacy practice research.

RESULTS

Discussions with 63 attendees identified four themes and seventeen subthemes. The four themes were challenges undertaking research, research motivations, leadership and training. Subthemes included robust evidence, clinical, economic and societal outcomes, alignment with national and international health system priorities, need for incentives from professional training bodies, competitive business model and embed within schools of pharmacy.

CONCLUSIONS

The most commonly discussed barriers inhibiting research were workload, technology limitations and financial considerations. Organisational leadership to prioritise and coordinate research efforts, training to build research capacity, building on existing examples of excellence and initiation of bottom-up community-based research projects were identified in our study as opportunities to enhance pharmacist involvement in research and ultimately patient health outcomes.

The current role and perceived benefits and barriers of secondary care pharmacists facilitating patient participation in Clinical Trials of Investigational Medicinal Products (CTIMPs) conducted within the NHS: A cross-sectional survey

RATIONALE, AIMS, AND OBJECTIVES

Secondary care pharmacists are well positioned within the healthcare system to communicate with patients and provide guidance and advice regarding drug treatments. They are able to broaden the opportunities to raise the profile of Clinical Trials of Investigational Medicinal Products (CTIMPs) and positively influence research. This research aimed to investigate the perceived benefits and barriers of secondary care pharmacists being involved in CTIMPs, their current role, and the perceived benefits and barriers of developing their role in facilitating patient participation for CTIMPs (eg, by identifying or recruiting potential participants).

METHODS

A cross-sectional quantitative online survey circulated to pharmacy professionals within the UK.

RESULTS

Involvement in CTIMPs and the facilitation of patient participation offered several benefits including improved communication and relationships with other healthcare professionals, developing the profession, developing training and knowledge, and exploring a personal interest. The main barriers to involvement included a lack of opportunities or awareness of opportunities, time, and funding or resources. Those employed at sites with a larger number of CTIMPs agreed more with the disadvantages; however, they also showed greater agreeance towards the benefits of pharmacy being involved in facilitating patient participation.

CONCLUSIONS

Most respondents do not currently have a role in identifying or recruiting potential participants. Despite this, being involved in CTIMPs and the facilitation of patient participation was suggested to offer several benefits. Given many participants agreed there are barriers to their involvement, future research should focus on exploring organizational and individual challenges with the aim of enabling pharmacists to support recruitment activities.

The impact of textual and pictorial warnings on tumbac (waterpipe tobacco) boxes on the motivation and intention to quit waterpipe smoking in Lebanon: a cross-sectional study

Few published studies have examined the impact of waterpipe tobacco pictorial health warnings worldwide but none of these papers assessed the motivation and intention to quit among Lebanese waterpipe smokers. To examine factors associated with the motivation and intention to quit waterpipe smoking (WS) in Lebanon, particularly the impact of textual vs. pictorial warnings on tumbac boxes. A cross-sectional study was conducted between January and May 2018, involving 520 participants. Having smokers at work (OR = 0.92) and increasing number of waterpipes per week (ORa = 0.94) were associated with decreased motivation to quit WS. Thinking that shocking images on tumbac packages would have more effect than textual warnings (ORa = 2.96) and those who would change the tumbac if the company decides to change the look of the box with shocking images about health damage (ORa = 1.98) were significantly associated with increased motivation to quit WS. Having a high motivation (ORa = 2.61), thinking that using shocking images on tumbac boxes can have more effect than textual warnings (ORa = 2.12), those who stopped smoking because of the warnings (ORa = 2.62), those who would choose pictorial warnings alone (ORa = 2.11), and both pictorial and textual warnings (ORa = 3.41) on tumbac packages were associated with higher intention to quit WS in two months. Pictorial and textual warnings on tumbac packs were associated with higher intention and motivation to stop WS. Public health education programs for this purpose seem warranted.

Stakeholder-Guided Formation of a Statewide Community Pharmacy Practice-Based Research Network

Community pharmacies across the United States are forming clinically integrated networks (CINs) to facilitate the provision of patient-centered care. These networks need to continually innovate and demonstrate how their patient care services positively impact health outcomes. One way to do this is to develop a practice-based research network (PBRN) in partnership with existing CINs to perform robust outcome evaluations. The objective of this study was to learn pharmacists' opinions on participating in research to facilitate the formation of a community pharmacy PBRN in Pennsylvania. A 20-item survey gathered information on pharmacists' research interests, perceived benefits of research participation, and preferences on communication and patient engagement. Descriptive statistics and Chi-square tests were used to analyze quantitative data. Seventy-three participants completed the survey, with 47% representing independent pharmacies. The majority (96%) were interested in research opportunities and 86% believed improving workflow and patient care was the most valuable benefit. Eighty percent of pharmacists reported it is very important to demonstrate that pharmacists care about making patients' health better. Connecting pharmacists with other health care providers was reported as very important by 75% of respondents. Pharmacists reported face-to-face communication (76%) as their preferred way to approach patients about research and 72% supported using student pharmacists to assist with patient engagement. The results from this study can inform others who are structuring processes and developing communication strategies for community pharmacy PBRNs, particularly in partnership with CINs.

A training program incorporating a diabetes tool to facilitate delivery of quality diabetes care by community pharmacists in Malaysia and Australia

Objectives:

To assess a clinical training program on management of Type 2 Diabetes Mellitus (T2DM) incorporating a diabetes tool, the Simpler™ tool. Subsequently pharmacists’ experience utilising the tool to deliver structured, consistent, evidence-based T2DM care was explored.

Methods:

Full-time non-credentialed diabetes pharmacists providing diabetes medication management services in community settings were purposively recruited. Participants had either face-to-face or online training on diabetes management using the tool which took about two hours and 20 minutes to complete. Their diabetes management knowledge was assessed pre- and post-training using quantitative methodology. They were then required to apply the tool in daily practice for one month. Feedback on both the training sessions and tool utilisation were obtained through semi-structured interviews and analysed using a qualitative approach.

Results:

Twelve pharmacists participated: Six from Australia and six from Malaysia. Before attending the training session, their median test score was 6.5/27, IQR 1.4 (1st marker) and 5.3/27, IQR 2.0 (2nd marker). After training, the scores doubled to 14.3/27, IQR 4.5 (1st marker) and 11.3/27, IQR 3.1 (2nd marker), showing significant improvements (p=0.002). Interview data identified perceived effectiveness factor through use of the tool. Participants found the content relevant, structured, concise and easy to understand; enabled comprehensive medication reviews; focused on achieving glycaemic improvement; facilitated documentation processes and pharmacists’ role in T2DM management; and as a specific aid for diabetes management. Barriers included lack of accessibility to patients’ laboratory data in Australia.

Conclusions:

The targeted training improved pharmacists’ knowledge on diabetes management and supported the Simpler™ tool use in practice as a structured and beneficial method to deliver evidence-based T2DM care.

Pharmacy practitioners' lived experiences of culture in multicultural Australia: From perceptions to skilled practice

OBJECTIVES

The Code of Ethics of pharmacy practitioners in Australia recognises the obligation to provide care to patients in a culturally safe and responsive manner. The aim of this exploratory study was to examine how Australian community pharmacists understand and experience the concept of 'culture' in their everyday practice environment.

METHODS

Voluntary, semi-structured interviews were conducted at community pharmacy placement sites in South-East Queensland, Australia. Pharmacists were asked to recall an incident that evoked their cultural awareness during the course of their practice. The question stated, verbatim: "We are preparing our students to be pharmacists in a highly multicultural community. Can you think of an incident where you learnt something about another person's culture or it made you more aware of your own culture? Please briefly describe the incident." Reportable responses were collected from 59 of the 92 visited pharmacists. These responses were audio-recorded and transcribed. The data were collated and analysed through iterative, reflexive, thematic analysis using constant comparison.

RESULTS AND SIGNIFICANCE

The responses provided a rich selection of lived experiences within Australian multicultural pharmacy practice, describing professional dilemmas, fears and the strategies employed to overcome practice challenges. Six main response categories were identified: (i) Language/communication challenges, (ii) Cultural attitudes and behaviours, (iii) Exposure to culture due to pharmacy location, (iv) Religion, gender, and age, (v) Prejudiced/perceived racist attitudes and discrimination towards 'other' cultures, (vi) Perceived 'sameness' of different cultures. The study has provided valuable insights into community pharmacists' experiences of culture in their day-to-day professional practice, also highlighting the associated strategies used to maintain a high standard of practice. There is merit in ensuring that the pharmacy curriculum and professional development programs are designed to respond to the ethical obligation of pharmacists to practise in a culturally safe, responsive manner that acknowledges and incorporates the importance of culture, cultural differences and intercultural relations, while addressing culturally unique needs in a skilled and professional manner.

Factors Associated With an Interest in Practice-Based Research Among Pharmacists in Nigeria

Background: Practice-based research (PBR) is employed in the pharmacy profession to improve the quality and efficiency of health care delivery. Although widely practiced in developed countries, it is rarely used in developing countries, including Nigeria. Objectives: To determine the factors associated with Nigerian pharmacists’ interest in PBR. Methods: This is a cross-sectional study utilizing an online survey. Pharmacists currently practicing in Nigeria were invited to participate. A hyperlink to the online questionnaire was shared with members of relevant professional bodies via Facebook, WhatsApp, and Twitter. Reminders were sent to facilitate a high response rate. Factors associated with pharmacists’ interest in PBR were determined using multiple logistic regression. Results: Two hundred and three completed responses were received from the survey. The majority, 94.6% (192), expressed an interest in PBR and believed that it would enhance their pharmacy practice and role in patient care. The multivariable analysis showed that pharmacists’ interest in publishing their research findings in peer-reviewed journals (odds ratio = 0.004, 95% confidence interval = 0.00-0.05, P < .001) and their knowledge of the professional relevance of research pertaining to their area of practice within the health care system (odds ratio = 0.02, 95% confidence interval = 0.00-0.47, P = .015) were found to be independent predictors of pharmacists’ interest in PBR. Conclusion: There is an interest in PBR among practicing pharmacists in Nigeria. The provision of evidence-based pharmaceutical services in Nigeria will be enhanced by interventions that encourage the conduct of research and publication of research findings, and by improving knowledge of the professional relevance of PBR in pharmacy practice areas.

Clinical pharmacy practice in the care of Chronic Kidney Disease patients: a systematic review

Background Clinical pharmacy services have potential to contribute significantly to the multidisciplinary team providing safe, effective and economic care for patients. Given recent practice developments (e.g. polypharmacy reviews and pharmacist prescribing) there is a need to provide a current synthesis of the evidence base for characteristics and outcomes of clinical pharmacy practice in chronic kidney disease patients. Aim of the review To critically appraise, synthesise and present the available evidence of the characteristics (structures and processes) and outcomes of clinical pharmacy practice as part of the multidisciplinary care of patients with chronic kidney disease. Method PubMed, International Pharmaceutical Abstracts (IPA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Scopus were searched for peer reviewed papers using improved search strategy. Included studies were quality assessed using Downs and Black tool for controlled studies and the mixed methods appraisal tool for all controlled and non-controlled studies. Data were extracted and synthesised using a narrative approach. Screening, quality assessment and data extraction were performed by two independent researchers. Ethics approval was not required. Results Forty-seven studies were identified from a variety of countries, with 31 based in a hospital setting. Controlled study designs were employed in 20, with only ten of these using randomisation. Resources available for service provision were poorly reported in all papers. Positive impact on clinical outcomes included significant improvement in parathyroid hormone, blood pressure, haemoglobin and creatinine clearance. Pharmacists identified 5302 drug related problems in 2933 patients and made 3160 recommendations with acceptance rates up to 95%. Impact on humanistic outcomes was shown through improvement in health related quality of life and patient satisfaction. Economic benefits arose from significant cost savings through pharmaceutical care provision. Conclusion While there is some evidence of positive impact on clinical, humanistic and economic outcomes, this evidence is generally of low quality and insufficient volume. While the existing evidence is in favour of pharmacists' involvement in the multidisciplinary team providing care to patients with chronic kidney disease, more high-quality research is warranted.

A narrative review of health research capacity strengthening in low and middle-income countries: lessons for conflict-affected areas

Conducting health research in conflict-affected areas and other complex environments is difficult, yet vital. However, the capacity to undertake such research is often limited and with little translation into practice, particularly in poorer countries. There is therefore a need to strengthen health research capacity in conflict-affected countries and regions.In this narrative review, we draw together evidence from low and middle-income countries to highlight challenges to research capacity strengthening in conflict, as well as examples of good practice. We find that authorship trends in health research indicate global imbalances in research capacity, with implications for the type and priorities of research produced, equity within epistemic communities and the development of sustainable research capacity in low and middle-income countries. Yet, there is little evidence on what constitutes effective health research capacity strengthening in conflict-affected areas. There is more evidence on health research capacity strengthening in general, from which several key enablers emerge: adequate and sustained financing; effective stewardship and equitable research partnerships; mentorship of researchers of all levels; and effective linkages of research to policy and practice.Strengthening health research capacity in conflict-affected areas needs to occur at multiple levels to ensure sustainability and equity. Capacity strengthening interventions need to take into consideration the dynamics of conflict, power dynamics within research collaborations, the potential impact of technology, and the wider political environment in which they take place.

Barriers and facilitators for community pharmacists' participation in pharmacy practice research: a survey

OBJECTIVES

The aim of this study was to explore pharmacists' barriers and facilitators regarding participation in pharmacy practice research.

METHODS

We conducted an online cross-sectional survey in 1974 community pharmacies in the Netherlands.

KEY FINDINGS

A total of 252 pharmacists completed the questionnaire. The majority agreed that participation in research should be part of daily practice. Efficient time investment and a clear benefit for general professional knowledge, patient care and pharmacy organisation were the most important facilitating factors.

CONCLUSIONS

To encourage pharmacists' participation, researchers should offer clear instructions, possibilities for flexible time management, simple patient inclusion, task delegation and no additional contacts with healthcare professionals due to the research.

Competence, competition and collaboration: Perceived challenges among Swedish community pharmacists engaging in pharmaceutical services provision and research

Background

Creating evidence of effectiveness is an important part of service development. In an ongoing research project Swedish community pharmacists participate in services research by recruiting patients initiated on statins to an adherence-promoting cognitive pharmaceutical service, jointly run by nurses and pharmacists.

Aims

To explore the pharmacists’ experiences of providing part of the service and their views regarding future participation in practice research aiming at developing cognitive pharmaceutical services.

Methods

Focus group interviews were conducted with community pharmacists from pharmacies participating in the project. A semi-structured interview guide was developed, based on the aim and earlier research.

Results

The domains identified were the service itself, operative conditions, the pharmacists’ role/profession and stakeholders. The research project was thought to promote the local pharmacy to customers, increase job satisfaction and contribute to service development. However, a perceived lack of competence among pharmacists affected both patient communication and project involvement. Additional resources and strengthened collaboration with other local healthcare were requested. Competition among pharmacy chains was identified as a barrier to patient-centred service provision and research.

Conclusion

The current operative conditions in Swedish community pharmacies were perceived by pharmacists as hampering cognitive pharmaceutical services provision and research. Additional resources, improved communication skills and research competence, and increased collaboration with other healthcare and across pharmacy chains are necessary changes. A stronger patient-centred perspective among all stakeholders is required.

Pharmacist-provided services: Barriers to demonstrating value

OBJECTIVES

To describe barriers faced by community pharmacists and recommend strategies to demonstrate the value of community-based pharmacy services.

DATA SOURCES

Not applicable.

SUMMARY

Progress toward the Triple Aim and value-based programs increases opportunities for pharmacists to provide value within the health care system. However, community pharmacists continue to face many barriers to showing their value. A lack of provider status prevents independent billing for services and perpetuates an inability to provide care. Traditional documentation tools focus on dispensing and restrict bidirectional communication and interoperability with other electronic medical records. Finally, a lack of robust quality improvement and research infrastructure limits pharmacists' ability to contribute to evidence demonstrating their value.

CONCLUSION

Barriers to demonstrating the value of pharmacist-provided services can be overcome through ongoing efforts for pharmacist provider status, use of the Pharmacist eCare Plan, and greater quality improvement and research infrastructure in community pharmacies.