Documenting the evolution of the relationship between the pharmacy support workforce and pharmacists to support patient care

Implications of a technician-led pharmacy service on a day case unit in a tertiary oncology centre

INTRODUCTION

Medicines Management Technicians have been shown to be an underused resource in medicines optimisation and medicines waste. In the United Kingdom, there are national recommendations for the clinical pharmacy service in cancer services ambulatory units, despite these recommendations, there was no clinical pharmacy service on the day case unit at a specialist tertiary centre in England. A lot of the patient pathways had been in place for many years and had not progressed with the changes in the clinical pathways. The main objectives of this study were to analyse how a medicines management technician could reduce medicines waste, improve the current pathway, increase medicines optimisation and ultimately improve the patient experience in an oncology day case unit at a specialist tertiary centre in England.

METHODS

A prospective mixed methods study was carried out at Weston Park Hospital. Descriptive statistical analysis was conducted on the quantitative data collected, and thematic analysis was carried out on the qualitative data collected by questionnaire to staff members and patients.

RESULTS

This study has shown that a medicines management technician can complete some of the tasks more traditionally done by the chemotherapy nurses on the day case unit, increasing their capacity for more clinically appropriate tasks. A medicines management technician can work as part of the wider multidisciplinary team on a day case unit contributing to medicines optimisation and cost savings for the oncology directorate.

CONCLUSIONS

This study has shown that a medicines management technician can act as a valued member of the wider multidisciplinary team, improving communication and patient pathways, improving medicines optimisation and contributing to cost saving initiatives. Further studies are required to assess whether a medicines management technician role can be of the same value on a haematology day case unit.

Global overview of pharmacy support personnel training programmes: a scoping review protocol

INTRODUCTION

A global variation in the pharmacy support personnel training programmes has been observed. The objective of this scoping review is to map out global evidence available on the pharmacy support personnel training programme characteristics, and interface between knowledge, practice and regulatory requirements.

METHODS AND ANALYSIS

The scoping review will be undertaken by two independent reviewers. Peer-reviewed journal articles of any study design and grey literature will be included with no publication time limit. All literature published in English focusing on pharmacy support personnel training programmes, entry-level certification requirements, ongoing professional development and apprenticeship will be included. We will search MEDLINE (EBSCOhost), PubMed, CINAHL (EBSCOhost), Web of Science, Academic Search Complete, (EBSCOhost) and Dissertation and Thesis (ProQuest), ProQuest Dissertation and Thesis Global and Google Scholar, and reference list of all included studies. We will also search grey literature from websites of international professional regulatory bodies and associations. All studies that meet the inclusion criteria will be imported into a reference management package (EndNote V.20) that facilitates study selection, screening and de-duplication. Data will be extracted by two independent reviewers using a jointly developed and piloted data charting form. Data items will include skills, knowledge, competencies, admission criteria, content, duration, qualification options, accreditation status, delivery models and approaches. Data extracted from the included studies will be collated, and quantitative results presented using descriptive statistics such as percentages, tables, charts and flow diagrams as appropriate. A narrative account of findings from the literature will be presented following qualitative content analysis of the extracted information using NVivo V.12. Quality appraisal of included studies will not be assessed as the purpose of the scoping review is to give a descriptive global overview of the pharmacy support personnel training programmes, and evidence will also be sourced from grey literature.

ETHICS AND DISSEMINATION

No ethical approval is needed for this study as it does not include animals or human participants. The study findings will be disseminated electronically and in print with presentations done at relevant platforms, that is, in peer-reviewed journals, in print and in conferences.

REGISTRATION

Open Science Framework (ofs.i0/r2cdn; registration DOI: https://doi.org/10.17605/OSF.IO/F95MH; internet archive link: https://archive.org/details/osf-registrations-f95mh-v1; registration type: OSF-Standard Pre-Data Collection Registration).

Cultures of support and resilience are associated with certified pharmacy technicians embracing new roles

BACKGROUND

Various technological, economic, and regulatory factors are creating opportunities for pharmacy technicians to take on additional responsibilities. Technicians in the broader sense have indicated a preference for expanded scope of duties; however, it is not known what drives technicians' greater inclinations to accept these new roles.

OBJECTIVE

The purpose of this study was to determine the association of various work-related factors, such as co-worker support, pharmacist-leadership style, future uncertainty, their own organizational commitment, and personal characteristics of technicians, including their resilience, on pharmacy technicians' willingness to take on emerging responsibilities in pharmacy.

METHODS

A self-administered questionnaire survey was disseminated through email to a national, randomized sample of 3000 technicians certified through the National Healthcareer Association (NHA). The questionnaire solicited data on willingness to participate in either of 13 emerging responsibilities as well as resilience, perceived transformative leadership behaviors of supervising pharmacists, future uncertainty, coworker support, organizational commitment, and various personal and practice-related variables. Following the use of principal component analyses for item purification and summation of various scale responses, inferential analyses were conducted via independent sample t-tests, one way analyses of variance, and Pearson's product moment correlation, as appropriate.

RESULTS

From 2906 surveys delivered, 878 were returned, with 745 of them providing completed responses on willingness to participate in emerging responsibilities. Willingness on most items/responsibilities was highly rated, with many means being at least 4 on a 5-point scale, though some were lower and perhaps a reflection of less exposure to these by way of their personal experience orpractice setting. Technicians' resilience, their coworker support, organizational commitment, and perceived transformative behaviors undertaken by their supervising pharmacists were all highly associated with willingness to engage.

CONCLUSIONS

Pharmacists, pharmacy technician peers, and organizations can contribute to a culture that is supportive for pharmacy technicians and may serve to encourage commitment, resilience, and willingness to embrace new, or emerging responsibilities.

Pharmacy Students' Professional Skill Development through a Scaffolded Internship

Description of the problem: The establishment of hospital pharmacy internships helps promote the growth of student pharmacists alongside the standard pharmacy curriculum. These programs are vital to helping students expand their clinical knowledge, while also benefiting the host institution. Our objective was to characterize the value of a longitudinal internship program to both the institution and its interns. Description of the innovation: The Atrium Health Wake Forest Baptist (AHWFB) Pharmacy Intern Program is a unique program designed with a scaffolded concept that directly complements traditional pharmacy school curriculum and provides interns opportunities to complement tasks of health-system pharmacists. Starting with operational responsibilities in the central distribution pharmacy during the first year of the curriculum, the interns transition to more patient-facing roles during the second and third years. Throughout the course of the program, interns are also given opportunities to participate in research and professional development activities. An IRB-approved, retrospective, observational study was conducted to evaluate the benefits of the program to the institution and interns. Critical analysis: Intern interventions were quantitatively evaluated to determine institutional benefit. From October 2017 to June 2020, 16 interns completed a total of 7,191 interventions, which equates to approximately $1,295,825 of cost avoidance for the institution. A quality assurance survey was also conducted to evaluate the program's benefit to the interns. Fourteen of the 16 eligible interns participated in the survey. Of the 14 participating interns, 85.7% (n=12) strongly agreed with overall satisfaction of the program. Additionally, 71% (n=10) strongly agreed with feeling more professionally prepared than their classmates. Next steps: Implementing a scaffolded internship program has positively benefited AHWFB and the participating interns. The program's design allows for clinical and professional development alongside the pharmacy school curriculum.

Technicians' perception of pharmacist leadership behaviors on their own commitment and turnover intention

PURPOSE

To evaluate technicians' perceptions of how they are supported and supervised by pharmacists through assessment of various components of pharmacists' leadership behaviors in developing the technician workforce. Additional objectives included evaluating levels of pharmacy technician uncertainty about their future, job commitment, and turnover intention in relation to perceived pharmacist leadership behaviors.

METHODS

This study employed a cross-sectional design involving administration of an online questionnaire survey. The target population was technicians certified through the National Healthcareer Association. The questionnaire was disseminated to a random, nationwide sample of 3,000 technicians. It solicited responses to an adapted version of the Multifactorial Leadership Questionnaire (MLQ), a 29-item instrument for measuring the frequency of observed pharmacist supervisory behaviors, which are categorized as transactional, transformative, or both. The questionnaire also inquired as to respondents' levels of future uncertainty, profession commitment, organization commitment, and turnover intentions.

RESULTS

Responses were acquired from 882 certified pharmacy technicians, who reported their observance of pharmacy supervisory behaviors, as measured by the adapted MLQ, with moderate frequency. Higher technician-reported levels of transformative leadership behavior by pharmacists were associated with lower levels of future uncertainty, greater profession and organization commitment, and diminished turnover intentions.

CONCLUSION

Pharmacists' supervisory behaviors, namely transformative leadership behaviors, may be impactful to pharmacy technicians' attitudes and work-related outcomes. The pharmacy profession's leaders and educators might consider these results in educating current and future pharmacists so as to improve the workplace and, potentially, organizational and profession-wide outcomes in the delivery of care.

Using normalisation process theory to understand implementation of integrated multi-sector pre-registration trainee pharmacy technician training

BACKGROUND

The pre-registration trainee pharmacy technician (PTPT) integrated training programme is a workforce intervention designed to train PTPTs in multiple sectors. The programme recruited 35 PTPTs to 2-year training posts which involved employment in one sector, and a minimum of 12 weeks' work-based training in ≥2 further settings each year.

AIM

To identify facilitating and inhibiting factors to implementation of the PTPT integrated training programme and make recommendations on ways to embed and maintain PTPT integrated training in routine practice.

METHODS

Normalisation Process Theory (NPT) constructs were used as a framework for analysis. Semi-structured interviews (14 PTPTs, 15 supervisors) explored PTPTs' learning and practice experiences over their 2-year training. A survey explored training outcomes (confidence and preparedness to practise) of integrated (n = 31) and single sector PTPTs (n = 39).

RESULTS

Whilst some understood the intervention well, others had differing understandings of its purpose and potential benefits (coherence). Educational and practice supervisors acknowledged the importance of regular communication but reported difficulties implementing this due to time constraints (cognitive participation). PTPTs benefitted from having an educational supervisor oversee learning and progress over 2-years, and a practice supervisor for their day-to-day learning. PTPTs' experiences of supervision were inconsistent due to variation in supervisors' availability, knowledge, experience, and level of support (collective action). Participants perceived the PTPT integrated training as supporting development of a flexible pharmacy technician workforce able to work across sectors. The survey found that integrated PTPTs felt significantly more prepared than single-sector PTPTs to work in different settings (reflective monitoring).

CONCLUSIONS

PTPTs on the programme had better ability to work in different sectors. Improving implementation requires clear understanding of the intervention's purpose by all stakeholders; clarity on supervisors' roles/contributions; and effective communication between supervisors to create effective learning opportunities. Findings can inform implementation of future multi-sector education and training globally.

Contribution of supervision to the development of advanced practitioners: a qualitative study of pharmacy learners' and supervisors' views

OBJECTIVE

To apply educational theory to explore how supervision can contribute to the development of advanced practitioners using the example of several postregistration primary care training pathways for pharmacy professionals (pharmacists and pharmacy technicians).

DESIGN

Qualitative semistructured telephone interviews applying Billet's theory of workplace pedagogy for interpretation.

SETTING

England.

PARTICIPANTS

Fifty-one learners and ten supervisors.

PRIMARY OUTCOME

Contribution of clinical and educational supervision to the development of advanced practitioners in primary care.

RESULTS

Findings were mapped against the components of Billet's theory to provide insights into the role of supervision in developing advanced practitioners. Key elements for effective supervision included supporting learners to identify their learning needs (educational supervision), guiding learners in everyday work activities (clinical supervision), and combination of regular prearranged face-to-face meetings and ad hoc contact when needed (clinical supervision), along with ongoing support as learners progressed through a learning pathway (educational supervision). Clinical supervisors supported learners in developing proficiency and confidence in translating and applying the knowledge and skills they were gaining into practice. Learners benefited from having clinical supervisors in the workplace with good understanding and experience of working in the setting, as well as receiving clinical supervision from different types of healthcare professionals. Educational supervisors supported learners to identify their learning needs and the requirements of the learning pathway, and then as an ongoing available source of support as they progressed through a pathway. Educational supervisors also filled in some of the gaps where there was a lack of local clinical supervision and in settings like community pharmacy where pharmacist learners did not have access to any clinical supervision.

CONCLUSIONS

This study drew out important elements which contributed to effective supervision of pharmacy advanced practitioners. Findings can inform the education and training of advanced practitioners from different professions to support healthcare workforce development in different healthcare settings.

Use of research evidence varied in efforts to expand specific pharmacist autonomous prescriptive authority: an evaluation and recommendations to increase research utilization

BACKGROUND

An expanding body of literature shows that pharmacists' interventions improve health outcomes and are cost-saving. However, diverse state regulations of pharmacists' scope of practice create a discrepancy between what pharmacists are trained to do and what they legally can do. This study investigated how stakeholders utilized research evidence when developing expanded scope of practice policies in their respective states.

METHODS

Using autonomous pharmacist prescriptive authority as a surrogate for general pharmacist scope of practice, a general policy document analysis was performed to understand the scope of practice landscape for pharmacists across the United States. Next, semi-structured interviews with policy-makers and pharmacy advocates were conducted to explore how the identified states in the policy document analysis utilized evidence during the policy-making process. Investigators analysed findings from the transcribed interviews through application of the SPIRIT Action Framework. Resulting codes were summarized across themes, and recommendations to researchers about increasing utilization of research evidence were crafted.

RESULTS

Sixteen states with 27 autonomous pharmacist prescriptive authority policies were identified. Public health need and safety considerations motivated evidence engagement, while key considerations dictating utilization of research included perceptions of research, access to resources and experts, and the successful implementation of similar policy. Research evidence helped to advocate for and set terms for pharmacist prescribing. Barriers to research utilization include stakeholder opposition to pharmacist prescribing, inability to interpret research, and a lack of relevant evidence. Recommendations for researchers include investigating specific metrics to evaluate scope of practice policy, developing relationships between policy-makers and researchers, and leveraging pharmacy practice stakeholders.

CONCLUSIONS

Overall, alignment of researcher goals and legislative priorities, coupled with timely communication, may help to increase research evidence engagement in pharmacist scope of practice policy. By addressing these factors regarding research engagement identified in this study, researchers can increase evidence-based scope of practice, which can help to improve patient outcomes, contain costs, and provide pharmacists with the legal infrastructure to practise at the top of their license.

Participation of pharmacy technicians in clinical and patient-centered care practices: A state-wide survey in Nigeria

BACKGROUND

Identifying the involvement of pharmacy technicians (PTs) in nonclinical and clinical duties will provide insight for improved pharmaceutical services.

OBJECTIVES

This study assessed the involvement of PTs in nonclinical tasks, patient-centered services, and more specialized patient care services and the difference in practice between hospital and community PTs.

METHODS

A cross-sectional survey was conducted using a 5-point Likert scale, and an analysis of data was performed using IBM SPSS version 21.0 (IBM). Descriptive statistics was done, and P ≤ 0.05 was considered statistically significant. The study was conducted in community and hospital pharmacies in Ogun State, Nigeria, among 100 PTs. Outcome measures were the involvement of PTs in clinical roles and other pharmaceutical care practices.

RESULTS

A total of 73 (73.0%) participated in the study, 45 (61.6%) and 28 (38.4%) practiced in hospital and community pharmacies, respectively. From the 11 listed nonclinical activities, only stocking of medications 61 (83.6%) and processing clients' or patient's charges 48 (65.8%) were often or very often performed. More than half of the participants often performed each of all 7 listed patient-centered activities, particularly empathy and confidentiality 62 (84.9%), providing information and referrals to patients or clients 56 (76.7%), and identifying patients or clients for counseling 51 (69.9%), respectively. No statistically significant difference was observed between the practice areas (P > 0.05). Only 2 of the 11 listed specialized clinical activities were performed by more than half of the respondents: screening prescriptions for completeness and authenticity 43 (58.9%) and alerting the pharmacist of drug therapy problems 46 (63.0%). Differences in the practice of specialized tasks was statistically significant for consultations (P = 0.002) and resolution of clinical conflict (P = 0.040) between the practice areas.

CONCLUSION

Study participants were less frequently involved in nonclinical activities but often involved in clinical activities. They also participated in specialized clinical tasks at lesser frequencies. Differences were observed between the practice areas in performance of nonclinical and specialized activities. Strategies to fill in the observed gaps should be explored for improved practice.

Analysis of activities undertaken by ward-based clinical pharmacy technicians during patient hospital journey

INTRODUCTION

Previous studies recognise insufficient time as an obstacle to pharmacists expanding their clinical-based activities and services. For such a reason, the role of well-trained ward-based clinical pharmacy technicians (CPTs) is to work as an integral part of the pharmacy team to achieve the best patient outcomes and medicines optimisation, releasing pharmacist time to complete more complex clinical-related activities.

OBJECTIVE

To demonstrate quantitatively the range and extent of daily activities undertaken by CPTs during a patient's hospital journey.

METHOD

A prospective-based study has been designed. All daily working services and activities undertaken by ward-based CPTs within a 450-bed Acute District General hospital were quantitatively collected and documented. Data were collected from five medical, two surgical and one cardiology wards of 30 beds in each over a period of 2 weeks for each ward representing a total of 70 working days (14 weeks, excluding weekends).

RESULTS

Results showed the breakdown of seven different ward-based activities throughout a typical working day with the main working load being reviews of the patients' medication charts in order to supply new medicines and refer medicines-related issues to the ward pharmacist, with an average number reviewed of (23.17±0.85) representing 77.23% of the total patients in a 30-bed ward. The CPTs' highest workload was on Mondays and Fridays, mainly during the morning working hours (09:00-12:00). Also, statistically significant differences (p<0.05; Kruskal-Wallis test) existed between the workload of the three different ward specialties (medical, surgical and cardiology) in five clinical activities out of seven undertaken by CPT per day.

CONCLUSION

CPTs are completing more than seven different ward pharmacy-related activities which enhance medicines optimisation, medicines management and patient care. They are a valuable resource carrying out many roles which were previously completed by junior pharmacists. Their prioritising of patients for review ensures pharmacists focus their efforts on the most vulnerable patients.

Advancing a global pharmacy support workforce through a global strategic platform

The pharmacy support workforce (PSW) is the mid-level cadre of the global pharmacy profession, referring to pharmacy technicians, assistants and other cadres that assist in the delivery of pharmaceutical services in a variety of practice contexts. The PSW undertake technical tasks delegated under the supervision of a pharmacist or performed collaboratively. The PSW are not intended to replace pharmacists, but rather work side-by-side with the pharmacist to achieve a shared goal. However, extensive variation in the PSW exists globally, ranging from an educated, regulated, and highly effective workforce in some countries to unrecognized or non-existent in others. Vast differences in education requirements, specific roles, regulatory oversight, and need for pharmacist supervision, inhibit the development and advancement of a global PSW. As clinical care providers, pharmacists worldwide need for a competent support workforce. Without the confidence to delegate technical responsibilities to a well-trained and capable PSW, pharmacists will be unable to fully deliver advanced clinical roles. A clear vision for the role of the PSW in the expanding scope of pharmacy practice is needed. One organization working to unite global efforts in this area is the International Pharmaceutical Federation (FIP). The FIP Workforce Development Hub Pharmacy Technicians & Support Workforce Strategic Platform was established to address the pharmacy workforce shortage in low and middle-income countries. Further developments were made in 2019, with the creation of a representative global PSW advisory panel, to provide guidance towards the development of the global PSW. Provision of frameworks and strategic input to support quality in education, development of legislative frameworks, guidelines for registration and licensure, and advice on appropriate role advancement are critical to move the PSW forward. In order to produce substantial advancement of roles and recognition of the PSW and advancement of pharmacists as patient care providers, global collaborative work is needed.

Experience of Patients with COPD of Pharmacists' Provided Care: A Qualitative Study

Chronic obstructive pulmonary disease (COPD) is associated with high global morbidity and mortality. Pharmacists are uniquely positioned to provide services which may reduce the burden of this disease on the health system, patients, and their families. The study aimed to understand the perceptions and experiences of patients living with COPD with pharmacists’ provided care in COPD diagnosis and management. The study was guided by qualitative description methodology and reported using the consolidated criteria for reporting qualitative research (COREQ) checklist. We conducted semi-structured interviews with 12 participants who were recruited from community pharmacies, seniors’ centres, a general practice clinic, and a pulmonary rehabilitation centre. Using qualitative content analysis, we identified categories that revealed great variation in participants’ experience of pharmacy care based on the depth of patient–pharmacist engagement. Participants who regarded their pharmacists as an essential member of their healthcare team and those who did not, had contrasting experiences with education, communication, and ability to form connections with their pharmacists. For patients with COPD, it is important that the pharmacist is proactive in engaging patients through effective communication, education/provision of relevant information, identification of patient needs, and consistent provision of care with empathy.

Factors influencing the implementation of pharmaceutical care in outpatient settings: A systematic review applying the Consolidated Framework for Implementation Research

BACKGROUND

Pharmaceutical care in outpatient settings is a type of health service that has been shown to contribute to decreasing drug-related morbidity and mortality rates. However, every process of implementing a new service brings about changes and transformations in the work routine, thus posing challenges.

OBJECTIVES

This systematic review aims to identify barriers to and facilitators for the implementation of pharmaceutical care in outpatient settings by applying the CFIR method, a framework based on the theory of health services, used to analyze and synthesize research data, which can direct strategies for the service to work as planned.

METHODS

A systematic review was conducted exploring the barriers to and facilitators for the implementation of pharmaceutical care in outpatient settings. The MEDLINE, EMBASE, CINAHL, COCHRANE, and LILACS databases were consulted.

RESULTS

Eight studies were included: five qualitative ones, two mixed-method ones, and a quantitative one. The most frequent CFIR constructs identified were Patient Needs and Resources (n = 30, 10.75%), Knowledge and Beliefs about the Intervention (n = 31, 11.11%), Networks and Communications (n = 34, 12.19%), and Available Resources (n = 56, 20.07%). The most cited barriers were: insufficient human resources, patients' unawareness of the existence of the pharmaceutical care service, and pharmacists' resistance to changes. Facilitators included: the opportune presentation of the service to the healthcare team; the use of electronic devices for specific guidance; and the assessment of patient satisfaction.

CONCLUSIONS

This systematic review allowed detecting key guidelines to improve the implementation process, including (1) defining an implementation method and exploring it extensively during the pre-implementation phase, (2) ensuring human and financial resources, (3) determining how the new service will interact with other existing services. More research is needed to understand how these factors can affect the implementation of clinical services.

Scaling technician product verification: Contextual analysis for developing an implementation strategy for a large community pharmacy chain

OBJECTIVE

To identify facilitators and barriers of early implementation of a technician product verification (TPV) program in a large community pharmacy chain.

METHODS

A mixed-methods (surveys, semistructured interviews, and nondisguised direct observation) approach was used to ascertain facilitators and barriers to implementation and to subsequently develop a scalable implementation strategy with the aim to accelerate TPV scalability across a large community pharmacy chain in states where it is permitted. One-on-one staff interviews and observations provided qualitative data to identify facilitators and barriers to TPV. A Web-based survey was used to gather perceptions on a variety of implementation strategies that would make use of identified facilitators and work to overcome identified barriers.

RESULTS

During the mixed-method study, 3 key themes emerged: TPV is a complex intervention whose implementation is facilitated by both adaptability and trialability and is highly dependent on state practice regulations; the implementation climate of the pharmacy organization serves as a facilitator to TPV; and individual beliefs about TPV change over time as implementation experience increases.

CONCLUSION

TPV is an expansion of the technician role that allows the profession of pharmacy to increase the provision of clinical activities by delegation of a nonclinical-based task. Early adopters of TPV recognize that verification is a task that is increasingly automated by mail-order pharmacies and that verification may no longer be considered a pharmacist task. Pharmacies in this study tended to revert to comfortable, traditional workflow at the first sign of distress. To be successful in the future, TPV should be thought of as the primary workflow procedure and not as an option. TPV is a service that will require staff buy-in, patience, and championship.

Patient and pharmacist perspectives on pharmacist-prescribed contraception: A systematic review

OBJECTIVE

Increasingly, states authorize pharmacists to prescribe hormonal contraception to patients without a prescription from another healthcare provider. The purpose of this review is to investigate pharmacist and patient perspectives on pharmacist-prescribed contraception in the United States.

STUDY DESIGN

We searched Medline, Embase, PsycInfo, CINAHL, Scopus, and the Cochrane Library from inception through July 10, 2019. We included qualitative and mixed-methods studies, quantitative surveys, observational studies, and randomized trials in the United States. Risk of bias was assessed using tools for quantitative and qualitative studies.

RESULTS

Fifteen studies met inclusion criteria, including studies on pharmacists and student pharmacists (n = 9), patients (n = 5), and both (n = 1). Study samples ranged from local to national. Studies had moderate to high risk of bias, primarily due to low response rates and lack of validated instruments. Most pharmacists (57-96%) across four studies were interested in participating in pharmacist-prescribed contraception services. Among patients, 63-97% across three studies supported pharmacist-prescribed contraception, and 38-68% across four studies intended to participate in these services. At least half of pharmacists across four studies felt comfortable prescribing contraception, though pharmacists identified additional training needs. Pharmacists and patients identified several reasons for interest in pharmacist-prescribed contraception services, including increasing patient access, reducing unintended pregnancies, and offering professional development for pharmacists. They also identified barriers, including payment, time and resource constraints, liability, and patient health concerns.

CONCLUSIONS

Most pharmacists and patients across 15 studies were interested in expanded access to contraception through pharmacist-prescribed contraception. Findings on facilitators and barriers may inform implementation efforts.

IMPLICATIONS

Pharmacist-prescribed contraception is a strategy to expand patient access to contraception. Reducing barriers to implementation could improve participation among pharmacists and patients.

The role of non-technical skills in community pharmacy practice: an exploratory review of the literature

BACKGROUND

Non-technical skills (NTS) are the cognitive and social skills that complement technical skills in safe and efficient practice, and include leadership, teamwork, task management, decision-making and situation awareness. Other areas within healthcare have heavily invested in producing taxonomies to aid training and assessment of NTS within their disciplines, and have found them to be essential for improving patient safety. In pharmacy, no validated taxonomy has been produced, nor has the existing literature been appraised to aid the future development of a validated taxonomy.

OBJECTIVE(S)

To examine the literature on NTS within a community pharmacy setting and establish the research conducted thus far on each NTS and how they are applied by community pharmacists.

METHODS

A literature search of six electronic databases (EMBASE, PsychINFO, Medline, SCOPUS, CINAHL Plus and HMIC) using the generic list of NTS identified in previous studies. Only empirical studies were included. Examples of behaviours or skills were extracted and categorised within each NTS.

KEY FINDINGS

Seventeen studies were identified that contained one or more examples of NTS specific to community pharmacy practice. Altogether, 16 elements were extracted. Four elements were identified within leadership and task management. A further three were identified within situation awareness and decision-making, and a final two within teamwork and communication.

CONCLUSION

A framework consisting of the skills and how they're applied has been presented which describe the NTS required by community pharmacists from the published literature. This framework can provide a foundation for further investigation into NTS use within pharmacy practice.

Core Values that Influence the Patient-Healthcare Professional Power Dynamic: Steering Interaction towards Partnership

Healthcare has long been marked by the authoritative-physician–passive-patient interaction, with patients seeking help and physicians seeking to restore patients back to health. However, globalisation, social movements, and technological advancements are transforming the nature of this relationship. We aim to identify core values that influence the power dynamic between patients and healthcare professionals, and determine how to steer these interactions towards partnership, a more suitable approach to current healthcare needs. Patients with chronic diseases (10 men, 18 women) and healthcare professionals (11 men, 12 women) were interviewed, sessions transcribed, and the framework method used to thematically analyse the data. Validation was done through analyst triangulation and member check recheck. Core values identified as influencing the patient-healthcare professional power dynamic include: (A) values that empower patients (acceptance of diagnosis and autonomy); (B) values unique to healthcare professionals (HCPs) (acknowledging patients experiential knowledge and including patients in the therapeutic process); and (C) shared capitals related to their interactions (communication, information sharing and exchange, collaboration, and mutual commitment). These interdependent core values can be considered prerequisites to the implementation of the patient-as-partner approach in healthcare. Partnership would imply a paradigm shift such that stakeholders systematically examine each other’s perspective, motivations, capabilities, and goals, and then adapt their interactions in this accord, for optimal outcome.

Evaluating Pharmacist's Patient Care Process in Shiraz, using a newly-validated questionnaire: The First Report from Iran

Background:

The Pharmacists’ Patient Care Process (PPCP) as one of many inter-related foundations for the delivery of evidence-based and outcomes-focused patient care has a positive trend in academic literatures in the world. Unfortunately, PPCP has not been establish well in community pharmacies in Iran, yet. This study was performed to explore the current status of the provision and perception toward patient care services and finally evaluate professional competency of pharmacists about PPCP implementation, in both patients and pharmacist’s perspectives.

Methods:

A cross-sectional study was conducted using two self-administrated Likert-based questionnaires_ one for pharmacists and another one for patients. In total, 121 pharmacists and 479 patients participated to the study. Questionnaires were distributed and collected in the Shiraz during the Oct 2017 till Jun 2018. Obtained data were analyzed through the statistical package for social sciences (SPSS) version 25. In addition, the competency to PPCP implementation was classified to three groups _good, moderate, and weak _ based on achieving ≥75%, 50%-75%, and <50% of the dimensions’ total score, respectively.

Results:

The pharmacist’s age range was 23-76 years (mean age: 40.61±12.85 years). Their Competency to PPCP implementation was good (43.8%), moderate (52%), and just 4% weak. Patient’s response to PPCP was 11.2% good, 50.7% moderate and 35.6% weak.

Conclusion:

Besides promotion of public awareness about PPCP, improvement of pharmacists’ motivation toward these services seems necessary. In addition, the introduced instrument may be useful for practice of pharmacists, but it should be used cautiously until it is tested among clients of pharmacies known to provide all levels of pharmacy care within pharmacy stores. (www.actabiomedica.com)

Expanding Pharmacy Services With an Intern Program at an Academic Medical Center

BACKGROUND

Organizations that implement pharmacy services to provide patient education have reduced hospital readmissions and improved the patient experience. The term "pharmacy extender" has been used to describe pharmacy technicians and pharmacy students who alleviate the workload of a pharmacist, enhance pharmacy visibility throughout an organization, and foster professional development for the individual.

OBJECTIVE

The objective of this pharmacy intern-driven program is to increase pharmacy reach for medication teaching.

METHODS

This is a single-center, IRB-approved retrospective cohort analysis. Pharmacist-led medication teaching is currently available to select high-risk populations including solid organ transplant and bone marrow transplant recipients at our organization. Clinicians working in the pharmacy satellites have structured operational and distributional workflow responsibilities, which precludes them from directly engaging with patients. Pharmacy interns can serve as extenders that can participate in medication teaching. An internally created digital medication teaching tool will be employed to expand the pharmacy reach for medication education.

RESULTS

During the period of study, the pharmacy interns screened 3,993 patients and educated 2,868 patients. Two-thirds of the pharmacy interns that participated in the program pursued post-graduate residency or fellowship training, while the rest assumed hospital pharmacist positions.

CONCLUSION

Deploying pharmacy interns as extenders for distribution of an internally created digital tool that provides general medication teaching has shown positive outcomes including greater pharmacy presence and visibility, better patient experience, and higher patient satisfaction. Continuous data collection and monitoring are warranted to demonstrate the benefits of the program once sustained and potentially justify more resources for further expansion.

Improving efficiency through workflow optimization in a pharmacist-run diabetes clinic

PURPOSE

To evaluate the impact of hiring nonclinical support staff on pharmacist productivity and diabetes control outcomes in internal medicine clinics of an integrated healthcare system.

METHODS

A retrospective, longitudinal cohort study was conducted. Patients were included if they were contacted by telephone for a diabetes consultation with a clinical pharmacist from July 1, 2015, through June 30, 2017. Nonclinical support staff were hired in July 2016 to schedule patient appointments with the clinical pharmacists. The primary outcome was the average rate of completed telephone encounters per month before and after hiring of nonclinical support staff. The secondary outcome was the mean change in glycated hemoglobin (HbA1c) level in patients who had a laboratory assay completed within 90 days of clinical pharmacist outreach. The tertiary outcome was the call completion rate for scheduled appointments vs unscheduled calls.

RESULTS

In total, 6,709 patients were included; their average age was 55 years. After the intervention, the mean (SD) rate of completed telephone encounters increased from 61% (3.8%) to 77% (3.5%) (P < 0.001). Small improvements were noted in glycemic control, as measured by the mean (SD) percentage of patients with an HbA1c concentration of <8%, which increased from 31% (5.2%) to 42% (3.0%) (P < 0.001), and the mean (SD) change in average HbA1c concentration, which increased from 8.9% (0.2%) to 8.5% (0.1%) (P < 0.001). Throughout the study, scheduled calls were more likely to be completed than unscheduled calls (mean [SD] completion rate, 66% [9.0%] vs 74% [6.0%]; P < 0.001).

CONCLUSION

Hiring nonclinical support staff led to greater efficiency among the clinical pharmacist team, yielding a higher volume of telephone interactions, a modest overall decrease in HbA1c values, and an increased likelihood of reaching patients by phone.

Integrating pharmacists into care teams: a qualitative systematic review protocol

OBJECTIVE

This review will systematically examine the qualitative literature reporting on strategies that have been used (or could be developed) by health care services to integrate pharmacists into a multidisciplinary health care team.

INTRODUCTION

Delivery models of pharmaceutical care have been developed, trialed and refined since this concept was first defined more than 30 years ago. Delivery models that integrate pharmacists within a multidisciplinary team allow pharmacists to play a pivotal role in improving health outcomes for patients and contributing to patient self-management. Systematic reviews clearly demonstrate the effectiveness of these models; however, the attitudes, beliefs, expectations, understandings, perceptions and experiences of these multidisciplinary teams is less clear.

INCLUSION CRITERIA

The populations of interest in this review are health care providers, including hospital specialists, general practitioners, nurses, health workers, pharmacists, allied health workers, aged care workers, Indigenous health workers and health promotion workers. The phenomena of interest are attitudes, beliefs, expectations, understandings, perceptions and experiences of the populations of interest arising from experiencing, developing or implementing strategies that have or could support the integration of pharmacists into multidisciplinary health care teams.

METHODS

The databases to be searched include PubMed, Cochrane, EBSCO (CINAHL), Embase, MedNar, Trove and Australian Indigenous Health Infonet. Studies published from 2011 onwards and in English will be considered for inclusion. Selected studies will be assessed for methodological quality by two independent reviewers, using standardized critical appraisal instruments. Where possible, qualitative research findings will be pooled. Where textual pooling is not possible, the findings will be presented in narrative form.

Pharmacist-Pharmacy Technician Intraprofessional Collaboration and Workplace Integration: Implications for Educators

Globally, concerns have been expressed regarding the impact of regulation of pharmacy technicians. After more than a decade of experience with technician regulation in Ontario, Canada, uptake of the full scope of practice for technicians has been sporadic at best. The objective of this study was to examine barriers and facilitators to intraprofessional collaboration between pharmacists and pharmacy technicians for the purpose of identifying possible curricular or educational interventions to enhance workplace integration. A qualitative, interview-based study of 24 pharmacists, technicians, educators, pharmacy managers, and owners was undertaken using a semi-structured interview guide. Key findings of this research include: i) Confirmation of suboptimal utilization of regulated technicians in practice; ii) identification of crucial knowledge and skills gaps for both pharmacists and technicians; and iii) proposals for undergraduate education and training, and continuing professional development learning opportunities to address these gaps. In order to achieve the promise and potential of regulation of pharmacy technicians, system-wide change management-beginning with education-will be required and will benefit from multiple stakeholder engagement and involvement.

Perceived Benefit of Immunization-Trained Technicians in the Pharmacy Workflow

Clinical community pharmacists have continually restructured their workflow to serve the community by optimizing patient care outcomes. Defining the perceived benefits of having an immunizing pharmacy technician in the workflow can help to redefine the way community pharmacists operate during patient immunization. The purpose of this study is to share the opinions of supervising pharmacists that have an immunizing technician within their workflow model and highlight their contributions. Pharmacists involved in this novel workflow model were interviewed two times, once in 2017 and then in 2020, to gauge opinions over time. Findings in the results of this study included such themes as: (1) Pharmacists’ perceived improvement in workflow flexibility; (2) The choice of the correct technician to immunize within the pharmacy; (3) Pharmacists’ perceived improved workflow time prioritization; (4) Limited available training as a barrier to implementation; and (5) The initial apprehension and later acceptance of pharmacists with respect to the innovation. As technician immunization administration spreads beyond early adopter states, further research into the impact on pharmacy workflow is needed.

Practice, Skill Mix, and Education: The Evolving Role of Pharmacy Technicians in Great Britain

Pharmacy technicians’ roles are rapidly evolving in Great Britain (GB) as they undertake more extended activities with increased autonomy across the different pharmacy sectors. This paper compares the GB pharmacy regulator initial education and training standards recently introduced (2017) with the qualifications currently used in practice and discusses whether future qualifications will be ‘fit for purpose’. In this context, knowledge, skills, and competence are reviewed to assess whether they will meet the expectations and underpin the evolving pharmacy technician role as integral to healthcare provision. Based on drivers, policy change, and the changing GB healthcare landscape, effectiveness of skill mix is analysed to establish whether this is being optimised to support person-centred pharmacy in response to the challenges and pressures faced within the NHS. On this basis and given there is a limited evidence base, this review has highlighted a need for larger scale research to reassure the pharmacy and wider healthcare professions, and the public, that the evolving pharmacy technician role presents no increased risk to patient safety and contributes significantly to releasing pharmacists time for person-centred clinical activities.

Pharmacy Technicians' Contribution to Counselling at Community Pharmacies in Denmark

(1) Background: pharmacy technicians are the largest group of staff at Danish community pharmacies and play a vital role in counselling customers on prescription medication, over-the-counter (OTC) medication and non-medical products. This is the first study carried out to specifically analyse how they contribute to counselling and identification of drug-related problems (DRPs) at Danish community pharmacies. (2) Methods: seventy-six pharmacy technicians from 38 community pharmacies registered data on all of their customer visits for five days, over a four-week period, between January and March 2019. Data were analysed in SPSS version 24. (3) Results: 58.9% of all registered customers (n = 10,417) received counselling. They identified DRPs for 15.8% of all registered customers (n = 2800). Counselling by pharmacy technicians solved, or partially solved, problems for 70.4% of customers with DRPs. Pharmacy technicians estimated that 25.2% of customers receiving counselling (n = 2621) were saved a visit to the general practitioner (GP). (4) Conclusions: as community pharmacists get more involved in complex services, it would be necessary to expand the roles of pharmacy technicians. Pharmacy technicians contribute to medication safety via counselling, and identifying and handling DRPs for all customers. This study documents the role of pharmacy technicians in customer counselling at Danish community pharmacies. It provides evidence to researchers and policy makers to support discussions on the future role of pharmacy technicians at community pharmacies.

Status of Pharmacy Ethics Education in Australia and New Zealand

Objective. To explore models of teaching in, resources available to, and delivery of a standardized course in pharmacy ethics. Methods. An email invitation was sent to the educator responsible for teaching pharmacy ethics at each of 19 institutions in Australia and New Zealand. Over a six- to eight-week period, semi-structured interviews were conducted in person, by email, or by phone, and were audio-recorded where possible, transcribed verbatim, and entered into data analysis software. Using an inductive analysis approach, themes related to the topics and issues discussed in the interview process were identified. Results. Of the educators invited to participate, 17 completed an interview and were included in this study. Participants reported a paucity of resources available for teaching pharmacy ethics at schools in Australia and New Zealand. Compounding this issue was the lack of expertise and ad-hoc process educators used to create their courses. Assessment methods varied between institutions. Participants felt schools needed to move toward a more standardized pharmacy ethics course with clear and defined guidelines. Conclusion. This study identified many areas in pharmacy ethics that need improvement and revealed the need to develop resources and course structure that adhere to the highest level of Miller's pyramid, while using known frameworks to evaluate ethical competency.

Barriers to a full scope of pharmacy practice in primary care: A systematic review of pharmacists' access to laboratory testing

Objectives

To describe primary care pharmacists' current scope of practice in relation to laboratory testing.

Method

A 2-tiered search of key databases (PubMed, EMBASE, MEDLINE) and grey literature with the following MeSH headings: prescribing, pharmacist/pharmacy, laboratory test, collaborative practice, protocols/guidelines. We focused on Canada, the United States, the United Kingdom, New Zealand and Australia for this review.

Results

There is limited literature exploring primary care pharmacists' scope of practice in relation to laboratory testing. The majority of literature is from the United States and Canada, with some from the United Kingdom and New Zealand and none from Australia. Overall, there is a difference in regulations between and within these countries, with the key difference being whether pharmacists access and/or order laboratory testing dependently or independently. Canadian pharmacists can access and/or order laboratory tests independently or dependently, depending on the province they practise in. US pharmacists can access and/or order laboratory tests dependently within collaborative practice agreements. In the United Kingdom, laboratory testing can be performed by independent prescribing pharmacists or dependently by supplementary prescribing pharmacists. New Zealand prescribing pharmacists can order laboratory testing independently. Most publications do not report on the types of laboratory tests used by pharmacists, but those that do predominantly resulted in positive patient outcomes.

Discussion/Conclusion

Primary care pharmacists' scope of practice in laboratory testing is presently limited to certain jurisdictions and is often performed in a dependent fashion. As such, a full scope of pharmacy services is almost entirely unavailable to patients in the United States, the United Kingdom, New Zealand and Australia. Just as in the case for pharmacists prescribing, evidence indicates better patient outcomes when pharmacists can access/order laboratory tests, but more research needs to be done alongside the implementation of local guidelines and practice standards for pharmacists who practise in that realm. Patients around the world deserve to receive a full scope of pharmacists' practice, and lack of access to laboratory testing is one of the major obstacles to this. Can Pharm J (Ott) 2019;152:xx-xx.

Organisational factors associated with safety climate, patient satisfaction and self-reported medicines adherence in community pharmacies

BACKGROUND

Evidence suggests that community pharmacy service quality varies, and that this may relate to pharmacy ownership. However little is known about wider organisational factors associated with quality.

OBJECTIVE

To investigate organisational factors associated with variation in safety climate, patient satisfaction and self-reported medicines adherence in English community pharmacies.

METHODS

Multivariable regressions were conducted using data from two cross-sectional surveys, of 817 pharmacies and 2124 patients visiting 39 responding pharmacies, across 9 diverse geographical areas. Outcomes measured were safety climate, patient satisfaction and self-reported medicines adherence. Independent variables included service volume (e.g. dispensing volume), pharmacy characteristics (e.g. pharmacy ownership), patient characteristics (e.g. age) and areal-specific demographic, socio-economic and health-needs variables.

RESULTS

Valid response rates were 277/800 (34.6%) and 971/2097 (46.5%) for pharmacy and patient surveys respectively. Safety climate was associated with pharmacy ownership (F_8,225 = 4.36, P < 0.001), organisational culture (F_{4, 225} = 12.44, P < 0.001), pharmacists' working hours (F_{4, 225} = 2.68, P = 0.032) and employment of accuracy checkers (F_{4, 225} = 4.55, P = 0.002). Patients' satisfaction with visit was associated with employment of pharmacy technicians (β = 0.0998, 95%CI = [0.0070,0.1926]), continuity of advice-giver (β = 0.2593, 95%CI = [0.1251,0.3935]) and having more reasons for choosing that pharmacy (β = 0.3943, 95%CI = [0.2644, 0.5242]). Satisfaction with information received was associated with continuity of advice-giver (OR = 1.96, 95%CI = [1.36, 2.82]), weaker belief in medicines overuse (OR = 0.92, 95%CI = [0.88, 0.96]) and age (OR = 1.02, 95%CI = [1.01, 1.03]). Regular deployment of locums by pharmacies was associated with poorer medicines adherence (OR = 0.50, 95%CI = [0.30, 0.84]), as was stronger patient belief in medicines overuse (OR = 0.88, 95%CI=[0.81, 0.95]) and younger age (OR = 1.04, 95%CI = [1.01, 1.07]). No patient outcomes were associated with pharmacy ownership or service volume.

CONCLUSIONS

This study characterised variation in the quality of English community pharmacy services identifying the importance of skill-mix, continuity of care, pharmacy ownership, organisational culture, and patient characteristics. Further research is needed into what constitutes and influences quality, including the development of validated quality measures.

Factors influencing national implementation of innovations within community pharmacy: a systematic review applying the Consolidated Framework for Implementation Research

Background

To meet emergent healthcare needs, innovations need to be implemented into routine clinical practice. Community pharmacy is increasingly considered a setting through which innovations can be implemented to achieve positive service and clinical outcomes. Small-scale pilot programmes often need scaled up nation-wide to affect population level change. This systematic review aims to identify facilitators and barriers to the national implementation of community pharmacy innovations.

Methods

A systematic review exploring pharmacy staff perspectives of the barriers and facilitators to implementing innovations at a national level was conducted. The databases Medline, EMBASE, PsycINFO, CINAHL, and Open Grey were searched and supplemented with additional search mechanisms such as Zetoc alerts. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis.

Results

Thirty-nine studies were included: 16 were qualitative, 21 applied a questionnaire design, and 2 were mixed methods. Overarching thematic areas spanning across the CFIR domains were pharmacy staff engagement (e.g. their positive and negative perceptions), operationalisation of innovations (e.g. insufficient resources and training), and external engagement (e.g. the perceptions of patients and other healthcare professionals, and their relationship with the community pharmacy). Study participants commonly suggested improvements in the training offered, in the engagement strategies adopted, and in the design and quality of innovations.

Conclusions

This study’s focus on national innovations resulted in high-level recommendations to facilitate the development of successful national implementation strategies. These include (1) more robust piloting of innovations, (2) improved engagement strategies to increase awareness and acceptance of innovations, (3) promoting whole-team involvement within pharmacies to overcome time constraints, and (4) sufficient pre-implementation evaluation to gauge acceptance and appropriateness of innovations within real-world settings. The findings highlight the international challenge of balancing the professional, clinical, and commercial obligations within community pharmacy practice. A preliminary theory of how salient factors influence national implementation in the community pharmacy setting has been developed, with further research necessary to understand how the influence of these factors may differ within varying contexts.

Trial registration

A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42016038876).

Electronic supplementary material

The online version of this article (10.1186/s13012-019-0867-5) contains supplementary material, which is available to authorized users.

Facilitators and strategies to implement clinical pharmacy services in a metropolis in Northeast Brazil: a qualitative approach

Background

Clinical Pharmacy Services (CPS) are a reality in many health systems around the world. However, there are few studies that discuss the facilitators and the strategies to implement CPS in healthcare systems. In this way, the objective of this study was to identify the facilitators and strategies involved in the CPS implementation process in some public health units in a metropolis in the Northeast Brazil.

Methods

A qualitative study was carried out with health-system pharmacists and managers who experienced the implementation of CPS. Therefore, focus groups were conducted with pharmacists, and the interviews with the managers. The discussions were carried out through semi-structured scripts and were recorded in audio and videos, after the signature of the consent form. The recordings were transcribed and analyzed independently through content analysis, followed by consensus meetings between researchers.

Results

Two focus groups were conducted, with an average of seven pharmacists per group, and five interviews with local health managers. Participants reported 39 facilitators who were related to the categories: local healthcare network, healthcare team, pharmacists and implementation process of the CPS. And 21 strategies attributed to the following categories: local healthcare network, pharmacists and implementation process of the CPS.

Conclusions

This study identified facilitators and strategies of the implementation of CPS. Most of the positive experiences were related to the clinical skills and proactive attitudes of pharmacists. These findings may support pharmacists and health managers to implement CPS in health systems.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3403-4) contains supplementary material, which is available to authorized users.

Work Preferences and General Abilities Among US Pharmacy Technicians and Danish Pharmaconomists

INTRODUCTION

The importance of pharmacy support personnel is increasingly recognized. Studies have evaluated workplace issues and evolving roles; however, needed information from technicians themselves is scarce. The purpose of this study was to examine preferences for work activities and the general abilities of US pharmacy technicians and Danish pharmaconomists.

METHODS

Surveys were administered to random samples of US technicians in 8 states and the general population of Danish pharmaconomists. Respondents indicated their preference for involvement in a set of work activities in community or hospital pharmacy on numeric scales. They also self-assessed their level of ability on facets associated with professional practice, in general. Descriptive results were tabulated, and bivariate tests were conducted on total general abilities ratings.

RESULTS

The 494 technicians and 313 pharmaconomists provided similar ratings on many activities. In community pharmacy, US technician ratings for performance of activities were generally higher than those of pharmaconomists; however, pharmaconomists rated certain "higher order" communication activities quite highly, such as discussing lifestyle changes with the patient. In hospital practice, Danish pharmaconomists provided low preferences for medication handling but high preferences for communication activities. General ability ratings were given high self-evaluations, but lower on some components, such as keeping up with the profession. Employer commitment was a strong correlate for both.

CONCLUSIONS

Evaluation of preferred work activities and general abilities were likely reflected in different scopes of practice between the two and could be insightful for education and work redesign in both countries, particularly the United States, as leaders evaluate shifts in technician professionalization.

The caring behaviours of Danish pharmaconomists: insight for pharmacy technician practice around the world

OBJECTIVES

Pharmacy workforce support personnel are being accorded greater scopes of practice, especially Danish pharmaconomists [pharmacy technician, experts in pharmaceuticals with a 3-year degree]. The aims of this study were to assess pharmaconomists' caring behaviours and identify factors related to those behaviours.

METHODS

A self-administered survey was distributed to a random sample of pharmaconomists in Denmark. The survey assessed caring behaviours using the Caring Behaviours Assessment and acquired data to ascertain their employers' culture, respondent's need for achievement, personality traits, commitment and work-related characteristics. Descriptive statistics provided insight into pharmacomomists' predispositions, and bivariate analyses were used to identify associations of pharmaconomists' caring with other variables under study.

KEY FINDINGS

Over 300 pharmaconomists responded (52.2% response rate). Pharmaconomists reported generally high levels (well above the median on the 5-point scale) of caring behaviours. They reported higher levels (upper range of 5-point scale) of empathic behaviours, such as treating patients with respect and seeing things from the patient's point of view but somewhat lower levels of encouraging the patient to talk about how they feel and praising the patient's efforts, which could otherwise help patients cope with and improve their self-efficacy for disease management. Pharmaconomist caring was associated with practice setting, organisational culture and commitment to their employer.

CONCLUSIONS

Pharmaconomists reported performing behaviours that were empathic, but less frequently those associated with facilitating greater patient autonomy. Caring behaviours were associated with a number of variables related to practice setting. The findings can help to inform educational pedagogy and pharmacy personnel management.

Developing a competency framework for pharmacy technicians: Perspectives from the field

BACKGROUND

Within the last decade and given the context of ever-growing complexity in pharmaceutical care the new profession of Pharmacy Technicians (PT) was added to the pharmacy team. Until now, pharmaceutical organizations worldwide are searching for the best way to educate and employ future PTs.

OBJECTIVE

This empirical study set out to gain insight into the knowledge, skills and attitudes required to perform as a PTs. A further aim was to develop a PT competency framework on the basis of experiences and opinions of stakeholders from the Dutch pharmaceutical field.

METHODS

A multi-method qualitative research design was used to develop a competency framework between 2015 and 2017. Data were collected using focus group interviews. Iterative thematic analysis led to an initial framework, which was refined using a modified Delphi-method. A competency domain was considered relevant if a minimum of 70% consensus was reached.

RESULTS

Both PTs (n = 27) and pharmacists (n = 12) participated in the focus groups. The Delphi-panel consisted of PTs (n = 8), pharmacists (n = 12) and representatives of other stakeholders like patient organizations, health policy makers and all levels of pharmacy education (n = 14). The developed competency framework comprises 6 domains: Communication in patient care, Interdisciplinary collaboration, Pharmaceutical expertise, Organization of care practice, Collaborative leadership and Personal development. A detailed description about the practical implications of each domain was added to the framework.

CONCLUSION

The PT competency framework provides a solid foundation for both PT training and curriculum development and is based on several rounds of scientific research. The proposed competency framework may help understand the PT role and how to best prepare for practice within pharmaceutical care.

Evidence for the outcomes and impact of clinical pharmacy: context of UK hospital pharmacy practice

Objectives

The role of clinical pharmacists in hospitals has evolved and continues to expand. In the UK, outside of a few national policy drivers, there are no agreed priorities, measures or defined outcomes for hospital clinical pharmacy (CP). This paper aims to (1) highlight the need to identify and prioritise specific CP roles, responsibilities and practices that will bring the greatest benefit to patients and health systems and (2) describe systematic weaknesses in current research methodologies for evaluating CP services and propose a different approach.

Method

Published reviews of CP services are discussed using the Economic, Clinical and Humanistic Outcomes framework. Recurring themes regarding study methodologies, measurements and outcomes are used to highlight current weaknesses in studies evaluating CP.

Results

Published studies aiming to demonstrate the economic, clinical or humanistic outcomes of CP often suffer from poor research design and inconsistencies in interventions, measurements and outcomes. This has caused difficulties in drawing meaningful conclusions regarding CP's definitive contribution to patient outcomes.

Conclusion

There is a need for more research work in National Health Service (NHS) hospitals, employing a different paradigm to address some of the weaknesses of existing research on CP practice. We propose a mixed-methods approach, including qualitative research designs, and with emphasis on cost-consequence analyses for economic evaluations. This approach will provide more meaningful data to inform policy and demonstrate the contribution of hospital CP activities to patient care and the NHS.

Community pharmacists' opinions on skill-mix and delegation in England

OBJECTIVES

Following the 2005 contractual framework amendment, the expanding role of community pharmacy team members required a shift in entrenched views on roles and duties. This study aimed to report on community pharmacists' opinions on skill mix and explore how they can be addressed so that skill mix may be optimised.

METHODS

An invitation to complete an online questionnaire was distributed via email, marked for the attention of the lead pharmacist. Following a low response, a paper-based questionnaire was sent to all community pharmacies in England (n = 11,816). Questions elicited data about the respondent, the pharmacy (including staffing profile) and opinions on skill mix.

KEY FINDINGS

A total of 1154 returns were received, representing a 10% response rate. Of these, most were pharmacy chains (76%; n = 877), with 5-9 staff (54%; n = 600); commonly open 40-49 hours (42%; n = 487), dispensing <6000 prescriptions per week (41%, n = 533). From 26 statements on skill mix, three factors were identified by principal-components factor analysis: 'working well', 'feeling the pressure' and 'open to development'. Characteristics associated with 'working well': pharmacy owners, single businesses, with pharmacy technician(s), dispensing fewer prescriptions and open shorter hours. Characteristics associated with 'feeling the pressure': pharmacy chains, open longer hours, large numbers of prescriptions and relief pharmacists. Characteristics associated with 'open to development': recently qualified, second pharmacists, working longer hours, chains and dispensing lower numbers of prescriptions.

CONCLUSIONS

Although limited by a low response, results suggest being in a position to influence (more experienced, business owners) may be associated with more positive opinions. Further training (including about legalities and leadership) could contribute to optimising skill mix in community pharmacies.

Optimising workflow processes in an advanced medication dispensary

The workload measurement of an inpatient hospital dispensary is critical to improve efficiency in the face of limited budgets. This single-centre pilot study used work sampling to observe and identify areas to improve efficiency of dispensing prescribed medications at one tertiary level acute care teaching hospital. Workload sampling was conducted at a 1096-bed hospital in Calgary, Alberta, Canada. The dispensary services the entire hospital, 24 h per day, seven days per week. Pharmacists are solely involved in clinical screening. The hospital uses a tech-check-tech practice. The observer was a registered pharmacist who collected data in the dispensary over two-hour blocks during November 14-24, 2017. A pre-made data collection sheet was used to record observations. Pharmacists duplicated tasks performed by dispensary technicians, such as ensuring STAT orders were delivered or identifying floor stock medications. Assistants inconsistently organised orders for filling. The assistant delivering STAT medications was difficult to find. Not all STAT medications were delivered first on a scheduled delivery route. Overall, areas for improvement in the dispensary process may include reinforcing the pharmacist clinical duties, establishing clinical competency baseline, supporting the full scope of practice of registered technicians, and consistent training of assistants, and clarifying communication processes.