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S. Jarab A, Muflih S, Almomani R, Abu Heshmeh S, Abu Hammour K, L. Mukattash T, Al-Qerem W, Alefishat EA. Hospital pharmacists' knowledge, attitudes and practice of pharmaceutical care and the barriers for its implementation at the hospital setting. Heliyon 2024; 10:e28227. [PMID: 38644867 PMCID: PMC11033057 DOI: 10.1016/j.heliyon.2024.e28227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 04/23/2024] Open
Abstract
Objective To assess hospital pharmacists' understanding of pharmaceutical care and their attitudes regarding the adoption of the patient-centered model, as well as investigate Jordan's current state of pharmaceutical care implementation and the associated barriers. Methods A validated survey was distributed to hospital pharmacists in different major tertiary hospitals in Jordan. The study questionnaire contained five sections to assess sociodemographic characteristics, pharmacists' understanding of pharmaceutical care, attitudes towards pharmaceutical care, potential barriers that may limit the delivery of pharmaceutical care, and the extent of pharmaceutical care implementation in the hospital setting. Results The survey was completed by 152 hospital pharmacists. Participants in this study demonstrated adequate levels of knowledge about pharmaceutical care (Mean = 9.36 out of 11, SD = 1.23) and expressed favorable perceptions of pharmaceutical care (mean = 3.77 out of 5; SD = 0.7). Although more than one-third of the pharmacists practiced pharmaceutical care, the study revealed a number of impediments to the delivery of pharmacological care services. Regression analysis revealed that age (P < 0.05) and years of experience (P < 0.05) were significant predictors of knowledge, while age (P < 0.05), gender (P < 0.05), the graduation university (governmental vs. private) (P < 0.05), and years of experience (P < 0.05) were significant predictors of attitude. Furthermore, Doctor of Pharmacy degree holders had fewer barriers to pharmaceutical care implementation but were more actively involved in pharmaceutical care practice than those with a Bachelor of Pharmacy degree (P < 0.01 and P < 0.05 respectively). Pharmacists with a Master's degree or higher in pharmacy were more actively involved in pharmaceutical care practice than those with a Bachelor of Pharmacy degree (P < 0.05). Pharmacists working in the Ministry of Health and the Royal Medical Services experienced more barriers than those working in teaching hospitals (P < 0.05). Conclusions Although the current study indicated high knowledge and perceptions regarding pharmaceutical care among hospital pharmacists, the provision of pharmaceutical care is not widely practiced in Jordan. Moreover, several barriers to the practice of pharmaceutical care were identified, highlighting the need for effective strategies to be put in place to overcome these obstacles. These strategies should include increasing the number of pharmacy staff, resolving timing issues, providing adequate financial initiatives, improving communication skills, changing the layout of pharmacies to include a private counseling room, developing specific policies that support the role of the pharmacist in patient care, and providing effective training and continuing professional education programs.
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Affiliation(s)
- Anan S. Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. P.O. Box 3030. Irbid, 22110, Jordan
- College of Pharmacy, AL Ain University, P. O. Box: 122612, Abu Dhabi, United Arab Emirates
| | - Suhaib Muflih
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. P.O. Box 3030. Irbid, 22110, Jordan
| | - Rawan Almomani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. P.O. Box 3030. Irbid, 22110, Jordan
| | - Shrouq Abu Heshmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. P.O. Box 3030. Irbid, 22110, Jordan
| | - Khawla Abu Hammour
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, the University of Jordan, Jordan
| | - Tareq L. Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. P.O. Box 3030. Irbid, 22110, Jordan
| | - Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan. P.O. Box 130, Amman, 11733, Jordan
| | - Eman A. Alefishat
- Department of Medical Sciences, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, the University of Jordan, Jordan
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
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Harrington A, Malone D, Doucette W, Vaffis S, Bhattacharjee S, Chan C, Warholak T. A conceptual framework for evaluation of community pharmacy pay-for-performance programs. J Am Pharm Assoc (2003) 2021; 61:804-812. [PMID: 34413002 DOI: 10.1016/j.japh.2021.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent interest in initiating pay-for-performance (P4P) programs indicates an underlying belief that economic incentives will have a direct impact on health care quality and efficiency. Evaluations of the impact of P4P programs on health care organizations and providers have been presented in the literature; however, none have focused on the impact of an incentive targeting community pharmacies. OBJECTIVE To propose a theory-derived conceptual framework of how a financial incentive might work in a community pharmacy. METHODS Studies from the fields of economics (agency theory), psychology (intrinsic and extrinsic motivators; expectancy theory), and organizational theory (ownership, institutional layers, organizational culture, and change management; quality improvement) were reviewed to inform the framework's components. This proposed conceptual framework also integrated and expanded on previous health care-related P4P models. RESULTS P4P programs inherently use financial incentives to catalyze change; however, elements from psychology and organizational theories along with economic theory were identified as important considerations in how a financial incentive may operate when targeting a community pharmacy. Through the incorporation of these theories along with other P4P frameworks in health care, a conceptual framework was derived comprising 4 domains: incentive, pharmacy, other influencing factors, and P4P program measures. Hypothesized relationships among these domains were depicted. CONCLUSION As focus on improving the quality of health care provision develops, opportunities for pharmacists to provide patient care services beyond dispensing will continue to advance, along with expanded reimbursement mechanisms extending beyond traditional product dispensing. The proposed theory-derived conceptual framework serves to depict how the integration of P4P and other factors may affect the pharmacy environment and subsequently affect a pharmacy's capability to perform well on medication-related quality measures. This framework may be used as a foundation on which to design studies to investigate the association between community pharmacy factors and performance in a P4P program.
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Nili M, Shaikh NF, Dwibedi N, Madhavan SS. Association of Entrepreneurial Traits With Interest in Becoming a Pharmacist Provider Among Student Pharmacists. J Pharm Pract 2019; 34:547-552. [PMID: 31690164 DOI: 10.1177/0897190019882874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND With the emerging opportunities for pharmacists to gain provider status, the need for understanding interest to become a pharmacist provider has never been greater. OBJECTIVE To determine which entrepreneurial traits (locus of control, innovativeness, autonomy, risk-taking propensity, proactiveness, achievement motivation, people liking, problem-solving, and leadership) are associated with interest in becoming a pharmacist provider. METHODS A cross-sectional survey was conducted among second- and third-year student pharmacists. Exploratory factor analysis (principal components with varimax rotation) was used to determine any underlying dimensions. Significant differences in interest in becoming a pharmacist provider by demographic and other characteristics were determined using t tests and analysis of variance (ANOVA; P ≤ .05). Multiple linear regression was used to determine the factors associated with interest in becoming a pharmacist provider. RESULTS A total of 137 completed questionnaires were received. Gender (P = .003) and preference of workplace (P < .001) were significantly associated with interest in becoming a pharmacist provider. All factor loadings were more than 0.50 and Cronbach alpha values were more than .68. In the multiple linear regression analysis model, proactiveness (P = .036) and achievement motivation (P = .018) were positive predictors of interest in becoming a pharmacist provider. Females (P = .006) and individuals who preferred to work in a hospital (P < .001) or in specialty care (P = .007) had a significantly greater interest in becoming a pharmacist provider. CONCLUSIONS Proactiveness and achievement motivation can be predictors of interest in becoming a pharmacist provider.
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Affiliation(s)
- Mona Nili
- Department of Pharmaceutical Systems and Policy, 5631West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], Morgantown, WV, USA
| | - Nazneen Fatima Shaikh
- Department of Pharmaceutical Systems and Policy, 5631West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], Morgantown, WV, USA
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, 5631West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], Morgantown, WV, USA
| | - S Suresh Madhavan
- Department of Pharmaceutical Systems and Policy, 5631West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], Morgantown, WV, USA
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Turner K, Trogdon JG, Weinberger M, Stover AM, Ferreri S, Farley JF, Ray N, Patti M, Renfro C, Shea CM. Testing the organizational theory of innovation implementation effectiveness in a community pharmacy medication management program: a hurdle regression analysis. Implement Sci 2018; 13:105. [PMID: 30064454 PMCID: PMC6069858 DOI: 10.1186/s13012-018-0799-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/23/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Many state Medicaid programs are implementing pharmacist-led medication management programs to improve outcomes for high-risk beneficiaries. There are a limited number of studies examining implementation of these programs, making it difficult to assess why program outcomes might vary across organizations. To address this, we tested the applicability of the organizational theory of innovation implementation effectiveness to examine implementation of a community pharmacy Medicaid medication management program. METHODS We used a hurdle regression model to examine whether organizational determinants, such as implementation climate and innovation-values fit, were associated with effective implementation. We defined effective implementation in two ways: implementation versus non-implementation and program reach (i.e., the proportion of the target population that received the intervention). Data sources included an implementation survey administered to participating community pharmacies and administrative data. RESULTS The findings suggest that implementation climate is positively and significantly associated with implementation versus non-implementation (AME = 2.65, p < 0.001) and with program reach (AME = 5.05, p = 0.001). Similarly, the results suggest that innovation-values fit is positively and significantly associated with implementation (AME = 2.17, p = 0.037) and program reach (AME = 11.79, p < 0.001). Some structural characteristics, such as having a clinical pharmacist on staff, were significant predictors of implementation and program reach whereas other characteristics, such as pharmacy type or prescription volume, were not. CONCLUSIONS Our study supported the use of the organizational theory of innovation implementation effectiveness to identify organizational determinants that are associated with effective implementation (e.g., implementation climate and innovation-values fit). Unlike broader environmental factors or structural characteristics (e.g., pharmacy type), implementation climate and innovation-values fit are modifiable factors and can be targeted through intervention-a finding that is important for community pharmacy practice. Additional research is needed to determine what implementation strategies can be used by community pharmacy leaders and practitioners to develop a positive implementation climate and innovation-values fit for medication management programs.
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Affiliation(s)
- Kea Turner
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599-7411 USA
| | - Justin G. Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599-7411 USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599-7411 USA
| | - Angela M. Stover
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599-7411 USA
| | - Stefanie Ferreri
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, 115B Beard Hall, Chapel Hill, NC 27599-7411 USA
| | - Joel F. Farley
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455 USA
| | - Neepa Ray
- Center for Medication Optimization through Practice and Policy, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, 2400 Kerr Hall, Chapel Hill, NC 27599-7411 USA
| | - Michael Patti
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, 115B Beard Hall, Chapel Hill, NC 27599-7411 USA
| | - Chelsea Renfro
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN 38163 USA
| | - Christopher M. Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Chapel Hill, NC 27599-7411 USA
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Maintaining Vitality: Pharmacists' Continuing Professional Education Decision-Making in the Upper Midwest. PHARMACY 2018; 6:pharmacy6010014. [PMID: 29389850 PMCID: PMC5874553 DOI: 10.3390/pharmacy6010014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 11/17/2022] Open
Abstract
Continuing professional education (CPE) plays an important role in continuing professional development of pharmacists for providing quality pharmaceutical care but also to maintain professional and organizational vitality and meet changing community/population needs. The study objective was to describe and understand factors of importance in selection of CPE credit hours among Upper Midwest pharmacists. A cross-sectional study of licensed pharmacists (n = 1239) in Iowa, Minnesota, Nebraska, North Dakota, and South Dakota included completion of a questionnaire on demographics and CPE decision-making. Factor analysis, t-test, and multivariate analyses were performed using Stata 10.1. Pharmacists placed greatest importance on maintaining licensure (mean = 2.72/3.00), personal interest (mean = 2.57), and self-improvement (mean = 2.42). Community/population need (mean = 1.83) was rated as slightly more important (p < 0.01) by retail/community pharmacists, females, and those with a Doctor of Pharmacy degree or pharmacy residency while business growth/development (mean = 1.33) was rated slightly more important (p < 0.01) by retail/community pharmacists. Despite findings that neither community/population need nor business development were among the most important factors in pharmacists’ CPE selection, there exists significant potential for pharmacists to utilize CPE to maintain professional and organizational vitality in the labor market, but more importantly to ensure continued provision of quality pharmaceutical care and patient education.
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Blackburn DF, Evans CD, Eurich DT, Mansell KD, Jorgenson DJ, Taylor JG, Semchuk WM, Shevchuk YM, Remillard AJ, Tran DA, Champagne AP. Community Pharmacists Assisting in Total Cardiovascular Health (CPATCH): A Cluster-Randomized, Controlled Trial Testing a Focused Adherence Strategy Involving Community Pharmacies. Pharmacotherapy 2016; 36:1055-1064. [DOI: 10.1002/phar.1831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- David F. Blackburn
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Charity D. Evans
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Dean T. Eurich
- School of Public Health; University of Alberta; Edmonton Alberta Canada
| | - Kerry D. Mansell
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Derek J. Jorgenson
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Jeff G. Taylor
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | | | - Yvonne M. Shevchuk
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Alfred J. Remillard
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - David A. Tran
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Anne P. Champagne
- Drug Plan and Extended Benefits Branch; Ministry of Health; Government of Saskatchewan; Regina Saskatchewan Canada
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Patterson BJ, Bakken BK, Doucette WR, Urmie JM, McDonough RP. Informal learning processes in support of clinical service delivery in a service-oriented community pharmacy. Res Social Adm Pharm 2016; 13:224-232. [PMID: 26935794 DOI: 10.1016/j.sapharm.2016.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/25/2016] [Accepted: 01/25/2016] [Indexed: 11/18/2022]
Abstract
The evolving health care system necessitates pharmacy organizations' adjustments by delivering new services and establishing inter-organizational relationships. One approach supporting pharmacy organizations in making changes may be informal learning by technicians, pharmacists, and pharmacy owners. Informal learning is characterized by a four-step cycle including intent to learn, action, feedback, and reflection. This framework helps explain individual and organizational factors that influence learning processes within an organization as well as the individual and organizational outcomes of those learning processes. A case study of an Iowa independent community pharmacy with years of experience in offering patient care services was made. Nine semi-structured interviews with pharmacy personnel revealed initial evidence in support of the informal learning model in practice. Future research could investigate more fully the informal learning model in delivery of patient care services in community pharmacies.
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Affiliation(s)
| | | | | | - Julie M Urmie
- College of Pharmacy, University of Iowa, Iowa City, IA, USA
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Guirguis LM, Makowsky MJ, Hughes CA, Sadowski CA, Schindel TJ, Yuksel N. How have pharmacists in different practice settings integrated prescribing privileges into practice in Alberta? A qualitative exploration. J Clin Pharm Ther 2014; 39:390-8. [PMID: 24805908 DOI: 10.1111/jcpt.12165] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/27/2014] [Indexed: 11/28/2022]
Affiliation(s)
- L. M. Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences; University of Alberta; Edmonton AB Canada
| | - M. J. Makowsky
- Faculty of Pharmacy and Pharmaceutical Sciences; University of Alberta; Edmonton AB Canada
| | - C. A. Hughes
- Faculty of Pharmacy and Pharmaceutical Sciences; University of Alberta; Edmonton AB Canada
| | - C. A. Sadowski
- Faculty of Pharmacy and Pharmaceutical Sciences; University of Alberta; Edmonton AB Canada
| | - T. J. Schindel
- Faculty of Pharmacy and Pharmaceutical Sciences; University of Alberta; Edmonton AB Canada
| | - N. Yuksel
- Faculty of Pharmacy and Pharmaceutical Sciences; University of Alberta; Edmonton AB Canada
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Makowsky MJ, Guirguis LM, Hughes CA, Sadowski CA, Yuksel N. Factors influencing pharmacists' adoption of prescribing: qualitative application of the diffusion of innovations theory. Implement Sci 2013; 8:109. [PMID: 24034176 PMCID: PMC3847669 DOI: 10.1186/1748-5908-8-109] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/09/2013] [Indexed: 11/16/2022] Open
Abstract
Background In 2007, Alberta became the first Canadian jurisdiction to grant pharmacists a wide range of prescribing privileges. Our objective was to understand what factors influence pharmacists’ adoption of prescribing using a model for the Diffusion of Innovations in healthcare services. Methods Pharmacists participated in semi-structured telephone interviews to discuss their prescribing practices and explore the facilitators and barriers to implementation. Pharmacists working in community, hospital, PCN, or other settings were selected using a mix of random and purposive sampling. Two investigators independently analyzed each transcript using an Interpretive Description approach to identify themes. Analyses were informed by a model explaining the Diffusion of Innovations in health service organizations. Results Thirty-eight participants were interviewed. Prescribing behaviours varied from non-adoption through to product, disease, and patient focused use of prescribing. Pharmacists’ adoption of prescribing was dependent on the innovation itself, adopter, system readiness, and communication and influence. Adopting pharmacists viewed prescribing as a legitimization of previous practice and advantageous to instrumental daily tasks. The complexity of knowledge required for prescribing increased respectively in product, disease and patient focused prescribing scenarios. Individual adopters had higher levels of self-efficacy toward prescribing skills. At a system level, pharmacists who were in practice settings that were patient focused were more likely to adopt advanced prescribing practices, over those in product-focused settings. All pharmacists stated that physician relationships impacted their prescribing behaviours and individual pharmacists’ decisions to apply for independent prescribing privileges. Conclusions Diffusion of Innovations theory was helpful in understanding the multifaceted nature of pharmacists’ adoption of prescribing. The characteristics of the prescribing model itself which legitimized prior practices, the model of practice in a pharmacy setting, and relationships with physicians were prominent influences on pharmacists’ prescribing behaviours.
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Affiliation(s)
- Mark J Makowsky
- Faculty of Pharmacy and Pharmaceutical Sciences, 3-171 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB T6G 1C9, Canada.
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Kaae S, Christensen ST. Exploring long term implementation of cognitive services in community pharmacies - a qualitative study. Pharm Pract (Granada) 2012; 10:151-8. [PMID: 24155831 PMCID: PMC3780491 DOI: 10.4321/s1886-36552012000300005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 08/15/2012] [Indexed: 12/27/2022] Open
Abstract
Implementing cognitive services in community pharmacies faces certain
obstacles. One approach aimed at improving long-term implementation is to
consider the implementation process as consisting of different stages, all
of which require tailored initiatives. Taking this approach into account,
there is a marked need for increased knowledge regarding the initiatives
necessary to support especially the later phases of the implementation
process. Objective The aim of this project was to develop insight into factors pertaining to the
later phases of implementing cognitive services in community pharmacies. Methods A qualitative study was conducted, consisting of semi-structured interviews
with 12 Danish pharmacy staff members, who were all in charge of improving
the implementation of the Inhaler Technique Assessment Service (ITAS) in the
5 years following its introduction. The interviews were used to explore
which implementation barriers had been identified by the staff and how they
had sought to overcome them. The interviews were analyzed by combining
content and critical common sense analysis with theoretical interpretations
based on Rogers "Diffusion of innovation" theory. Results The most predominant long-term barrier was the staff members' adoption
of the ITAS at very different rates. The problem of laggards was not lack of
competencies, but a lack of self-efficacy in believing that their actual
competencies were sufficient to provide the service. Lack of time and
attention to the service and obtaining support from the more senior members
of the pharmacy were also problematic. Both individual and group activities
were launched to overcome the identified challenges belonging to different
phases of the implementation process. Conclusions Those in charge of ensuring long term implementation of cognitive services in
community pharmacies should consider the necessity to handle several
simultaneous actions of both an individual and collective kind at the same
time. Hence, the implementation process should be perceived as a series of
interrelated stages rather than a linear process where one stage succeeds
the other.
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Affiliation(s)
- Susanne Kaae
- Department of Pharmacology and Pharmacotherapy, The Faculty of Health and Medical Sciences, University of Copenhagen . Copenhagen ( Denmark )
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Doucette WR, Nevins JC, Gaither C, Kreling DH, Mott DA, Pedersen CA, Schommer JC. Organizational factors influencing pharmacy practice change. Res Social Adm Pharm 2012; 8:274-84. [DOI: 10.1016/j.sapharm.2011.07.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 07/07/2011] [Accepted: 07/07/2011] [Indexed: 11/26/2022]
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Hughes CA, Guirguis LM, Wong T, Ng K, Ing L, Fisher K. Influence of pharmacy practice on community pharmacists' integration of medication and lab value information from electronic health records. J Am Pharm Assoc (2003) 2011; 51:591-8. [PMID: 21896456 DOI: 10.1331/japha.2011.10085] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe how an electronic health record (EHR) was integrated into community pharmacists' patterns of patient care and to explore factors that are related to the use of medication and laboratory value information from the EHR. DESIGN Descriptive, exploratory, nonexperimental study. SETTING Edmonton, Canada, between November 2008 and March 2009. PARTICIPANTS 16 pharmacists, 3 pharmacy technicians, and 2 pharmacy interns from primary care networks, long-term care settings, community independent and chain pharmacies, and grocery store pharmacies. INTERVENTION Qualitative interviews. MAIN OUTCOME MEASURE Pharmacists' self-reported use of EHR. RESULTS Pharmacists in a patient-centered care practice (involving medication therapy management activities) were more likely to adopt the EHR for medication history and laboratory values, whereas pharmacists whose practice was focused on medication dispensing primarily used the EHR for patient demographic and dispensing records. Six general factors influenced the use of EHR: patients, pharmacists, pharmacy, other health professionals (i.e., physicians), EHR, and environment. Access to the medical record versus EHR and timeliness were barriers specific to pharmacists in a patient-centered practice. Factors that affected EHR use for pharmacists with primarily a dispensing practice were role understanding, dispensing versus lab records, valid reasons for using EHR, and fear of legal and disciplinary issues. CONCLUSION Many community pharmacists embraced the EHR as a part of practice change, particularly those in patient-centered care practices. Practice type (patient-centered care or dispensing) greatly influenced pharmacists' use of EHR, specifically laboratory values. Because these qualitative findings are exploratory in nature, they may not be generalized beyond the participating pharmacies.
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Affiliation(s)
- Christine A Hughes
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
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Jacobs S, Ashcroft D, Hassell K. Culture in community pharmacy organisations: what can we glean from the literature? J Health Organ Manag 2011; 25:420-54. [PMID: 22039661 DOI: 10.1108/14777261111155047] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this paper is to report on the findings of a systematic literature review-seeking to elicit existing evidence of the nature of organisational culture in community pharmacy organisations. DESIGN/METHODOLOGY/APPROACH This review takes a novel approach to systematically identifying and synthesising the peer-reviewed research literature pertaining to organisational culture in this setting, its antecedents and outcomes. FINDINGS The review provides an overview of the scope of and research methods used in the identified literature, together with a narrative synthesis of its findings, framed within five dimensions of organisational culture: the professional-business role dichotomy; workload, management style, social support and autonomy; professional culture; attitudes to change and innovation; and entrepreneurial orientation. RESEARCH LIMITATIONS/IMPLICATIONS There is a need for more detailed and holistic exploration of organisational culture in community pharmacy, using a greater diversity of research methods and a greater focus on patient-related outcomes. ORIGINALITY/VALUE This paper demonstrates that, whilst little research has explicitly investigated organisational culture in this context, there exists a range of evidence describing aspects of that culture, some of the environmental and organisational factors helping to shape it, and its impact on the pharmacy workforce, services delivered and business outcomes. It highlights the importance of the business-professional role dichotomy in community pharmacy; the influence of individual pharmacists' characteristics and organisational setting; and the impact on pharmacists' wellbeing and job satisfaction and the services delivered. It provides less evidence of the impact of organisational culture on the quality and safety of service provision.
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Affiliation(s)
- Sally Jacobs
- School of Pharmacy and Pharmaceutical Sciences, The University of Manchester, Manchester, UK.
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Kaae S, Nørgaard LS. How to engage experienced medicine users at the counter for a pharmacy-based asthma inhaler service. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011; 20:99-106. [PMID: 22416934 DOI: 10.1111/j.2042-7174.2011.00170.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Recent studies have identified recruitment of customers at the pharmacy counter as a limiter to successful provision of cognitive services in community pharmacies especially that of experienced customers with refill prescriptions. The aim of the paper is to gain insight into current problems of recruiting. METHODS A qualitative study was conducted based on semi-structured interviews with 12 participants in a project in 2010 aimed at optimising recruitment of experienced asthma patients for the Inhaler Technique Assessment Service in Denmark. An ad hoc analysis was applied in order to interpret pharmacy staff perceptions of experienced asthma patients in comparison with newly diagnosed patients and to categorise the types of developed recruitment strategies as to whether they reflected a technical or everyday-life perspective on medicine. KEY FINDINGS Effective recruitment processes were found to follow a generic pattern which consisted of a special type of opening question followed by providing a justification for the service. The participants perceived that the main difference between experienced and newly diagnosed patients was their degree of knowledge about their condition or correct inhaler technique. Most questions, and especially those related to reasons for motivating the customer to accept the service, were dominated by a professional technical understanding of medicine. In particular, follow-up justification based on a life-world perspective needs to be developed further. The identified type of communication might prevent some customers from accepting the service as they are not motivated by technical arguments but rather by how their daily symptoms can be relieved. CONCLUSIONS Pharmacy staff should focus both on adequate opening questions as well follow-up justification when trying to recruit customers for cognitive services. The study might inform future studies on how to create new and more adequate strategies for recruitment of customers for relevant cognitive services in community pharmacies.
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Affiliation(s)
- Susanne Kaae
- Department of Pharmacology and Pharmacotherapy, Faculty of Pharmaceutical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Kaae S, Søndergaard B, Haugbølle LS, Traulsen JM. The relationship between leadership style and provision of the first Danish publicly reimbursed cognitive pharmaceutical service--a qualitative multicase study. Res Social Adm Pharm 2011; 7:113-21. [PMID: 21605846 DOI: 10.1016/j.sapharm.2010.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 03/02/2010] [Accepted: 03/02/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence suggests that leadership style is important to the sustainability of cognitive pharmaceutical services, yet only scarce literature on the relationship exists. OBJECTIVES Support of the sustainability of the first publicly reimbursed cognitive service in Denmark, the Inhaler Technique Assessment Service (ITAS), was ascertained through a qualitative study to explore how leadership style shapes the implementation process of the service. Sustainability in this project was defined as the state where those asthma patients whose symptom status is negatively clinically affected (as defined by Global Initiative for Asthma guidelines) by inappropriate inhalation technique are identified and offered the service by pharmacy staff. METHODS The study was an exploratory qualitative multicase study that used triangulation of both data sources and methods. A theoretical framework of Bolman and Deal inspired the analysis of how leadership style influenced the local process of implementation of the ITAS. Four pharmacies were selected for the analysis because they differed in terms of leadership actions in their implementation process and achievement of ITAS sustainability. The analysis was inductive and linked factors that influence ITAS provision as perceived by employees with the interpreted leadership style of the owner. RESULTS Three main themes emerged: (1) the alignment of the owner and staff values, (2) whether owners perceived ITAS development as being under their own control, and (3) whether owners explicated the responsibilities of employees in the implementation process. The themes were interrelated. CONCLUSIONS Pharmacy owner's leadership style was significant to sustainability of the ITAS. A strong wish by the owner to have ITAS implemented was important, followed by aligning the owner's values and visions with those of the employees. The widespread perception by owners that experienced users are not interested in the ITAS needs to be addressed to achieve sustainability.
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Affiliation(s)
- Susanne Kaae
- Faculty of Pharmaceutical Sciences, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen, Denmark.
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Giam JA, McLachlan AJ, Krass I. Specialized compounding in community pharmacies: Organizational perspective. J Am Pharm Assoc (2003) 2010; 50:354-61. [DOI: 10.1331/japha.2010.09025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Westrick SC, Mount J, Watcharadamrongkun S. College/school of pharmacy affiliation and community pharmacies' involvement in public health activities. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2009; 73:123. [PMID: 19960082 PMCID: PMC2779635 DOI: 10.5688/aj7307123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 04/05/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To examine the relationship between pharmacy college/school affiliation and community pharmacies' involvement in immunization and emergency preparedness activities. METHODS Telephone interviews were completed with 1,704 community pharmacies randomly sampled from 17 states to determine the pharmacies' involvement in immunization promotion, vaccine distribution, in-house immunization delivery, and health emergency preparedness and response, affiliation with college/school of pharmacy, and selected pharmacy and public health-related characteristics. RESULTS Pharmacy college/school-affiliated community pharmacies were more likely than non-affiliated pharmacies to participate in immunization and emergency preparedness when controlling for pharmacy characteristics. College/school affiliation generally became nonsignificant, however, when public health-related characteristics were included in the analysis. CONCLUSIONS Affiliation with a college/school of pharmacy was related to community pharmacies' involvement in immunization and emergency preparedness.
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Kaae S, Søndergaard B, Haugbølle LS, Traulsen JM. Development of a qualitative exploratory case study research method to explore sustained delivery of cognitive services. ACTA ACUST UNITED AC 2009; 32:36-42. [DOI: 10.1007/s11096-009-9337-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 09/24/2009] [Indexed: 11/24/2022]
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Roberts AS, Benrimoj SI, Chen TF, Williams KA, Aslani P. Practice change in community pharmacy: quantification of facilitators. Ann Pharmacother 2008; 42:861-8. [PMID: 18477730 DOI: 10.1345/aph.1k617] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There has been an increasing international trend toward the delivery of cognitive pharmaceutical services (CPS) in community pharmacy. CPS have been developed and disseminated individually, without a framework underpinning their implementation and with limited knowledge of factors that might assist practice change. The implementation process is complex, involving a range of internal and external factors. OBJECTIVE To quantify facilitators of practice change in Australian community pharmacies. METHODS We employed a literature review and qualitative study to facilitate the design of a 43-item "facilitators of practice change" scale as part of a quantitative survey instrument, using a framework of organizational theory. The questionnaire was pilot-tested (n = 100), then mailed to a random sample of 2000 community pharmacies, with a copy each for the pharmacy owner, employed pharmacist, and pharmacy assistant. The construct validity and reliability of the scale were established using exploratory factor analysis and Cronbach's alpha, respectively. RESULTS A total of 735 (37%) pharmacies responded, with 1303 individual questionnaires. Factor analysis of the scale yielded 7 factors, explaining 48.8% of the total variance. The factors were: relationship with physicians (item loading range 0.59-0.85; Cronbach's alpha 0.90), remuneration (0.52-0.74; 0.82), pharmacy layout (0.52-0.79; 0.81), patient expectation (0.52-0.85; 0.82), manpower/staff (0.49-0.66; 0.80), communication and teamwork (0.37-0.65; 0.77), and external support/assistance (0.47-0.69; 0.74). CONCLUSIONS All of the factors demonstrated good reliability and construct validity and explained approximately half of the variance. Implementing CPS requires support not only with the clinical aspects of service delivery, but also for the process of implementation itself, and remuneration models must reflect this. The identified facilitators should be used in a multilevel strategy to integrate professional services into the community pharmacy business, engaging pharmacists and their staff, policy makers, educators, and researchers. Further research is required to determine additional factors impacting the capacity of community pharmacies to implement change.
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Clark BE, Mount JK. Pharmacy Service Orientation: a measure of organizational culture in pharmacy practice sites. Res Social Adm Pharm 2007; 2:110-28. [PMID: 17138504 DOI: 10.1016/j.sapharm.2005.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2005] [Revised: 12/16/2005] [Accepted: 12/19/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND The importance of organizational culture in shaping everyday organizational life is well accepted, but little work has focused on organizational culture in pharmacy. Examining new pharmacists' experiences at various practice sites may help us to understand how these shape their professional ethos and practice habits. OBJECTIVES (1) Present development and assessment of the Pharmacy Service Orientation (PSO) measure, a tool for assessing pharmacists' impressions of pharmacy practice sites. (2) Use data gathered from a sample of new pharmacists to explore potential predictors of PSO, including type of practice site, type of pharmacy work experience, and type of pharmacy degree. METHODS Mail survey of randomly selected class of 1999 pharmacy graduates within 3 months of graduation (response rate: 259 of 1,850; 14%), each of whom reported on up to 6 different pharmacy practice sites for a total of 1,192 pharmacy observations. Pharmacy Service Orientation is scored on a 1-10 semantic differential scale and reliability was assessed using Cronbach's alpha. Predictors of PSO were explored using t test and ordinary least squares regression procedures. RESULTS Reliability of the PSO across all observations was 0.86. When divided according to recency of experience and type of experience, reliabilities ranged from 0.78 to 0.87. Analysis of potential predictors of PSO showed that non-corporate-community sites had significantly greater pharmaceutical care-oriented cultures (mean PSOs of 7.42 and 5.13, respectively; P<.001). The same pattern was seen for academic and nonacademic worksites (mean PSOs of 7.46 and 6.01, respectively; P<.001). The pharmacist's pharmacy degree type was not predictive of PSO. Multivariate regression results showed that type of practice site and type of pharmacy work experience explained more than 25% of the observed variance in PSO. CONCLUSIONS Pharmacy Service Orientation is a reliable measure. Statistically significant differences in PSO comparisons by degree and by experience type are explained by significant differences between the PSOs of corporate-community and non-corporate-community sites.
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Affiliation(s)
- Bartholomew E Clark
- Pharmacy Sciences Department, School of Pharmacy and Health Professions, Creighton Health Services Research Program, Creighton University Medical Center, Omaha, NE 68178, USA.
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Roberts AS, Benrimoj SIC, Chen TF, Williams KA, Hopp TR, Aslani P. Understanding practice change in community pharmacy: A qualitative study in Australia. Res Social Adm Pharm 2005; 1:546-64. [PMID: 17138495 DOI: 10.1016/j.sapharm.2005.09.003] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Much of the research on cognitive pharmaceutical services has focused on understanding or changing community pharmacist behaviour, with few studies focusing on the pharmacy as the unit of analysis or considering the whole profession as an organisation. OBJECTIVES To investigate practice change and identify facilitators of this process in community pharmacy, with specific focus on the implementation of cognitive pharmaceutical services (CPS) and related programs. METHODS Thirty-six in-depth, semistructured interviews were conducted with participants from 2 groups, community pharmacies and pharmacy "strategists," in Australia. The interview guide was based on a framework of organizational theory, with 5 subject areas: roles and goals of participants in relation to practice change; experiences with CPS; change strategies used; networks important to the change process; and business impacts of CPS. Interviews were transcribed verbatim and thematically content analyzed, using NVivo software for data management. RESULTS Five key themes relating to the change process were derived from the interviews: change strategies (process- and behaviorally oriented); social networks (within and beyond the pharmacy); drivers of change (eg, government policy); motivators (eg, professional satisfaction); and facilitators of practice change (remuneration for implementation or service delivery, communication and teamwork, leadership, task delegation, external support or assistance, and reorganization of structure and function). CONCLUSION The use of an organizational perspective yielded rich data from which an understanding of the practice change process in relation to CPS implementation was gained. Current programs for the implementation and delivery of CPS have not taken into account all of the factors that have the ability to facilitate change in community pharmacy. Not only do future programs need to be underpinned by these elements, but policy makers must include them when planning remuneration and dissemination strategies.
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Affiliation(s)
- Alison S Roberts
- Pharmacy Practice Research, Faculty of Pharmacy, University of Sydney, NSW 2006, Australia.
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Puumalainen II, Kause JM, Airaksinen MS. Quality Assurance Instrument Focusing on Patient Counseling. Ann Pharmacother 2005; 39:1220-6. [PMID: 15941817 DOI: 10.1345/aph.1e629] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Patient counseling is a professional service provided by community pharmacists. To assess the quality of these services, specific quality assurance instruments are needed. OBJECTIVE To develop a validated, easy-to-use patient counseling quality assurance instrument for community pharmacists. The development process was part of a national project to enhance patient counseling in community pharmacies (TIPPA 2000–2003). METHODS A modified Delphi method was used with 2 expert panels: Panel 1, consisting of experienced pharmacy practitioners (n = 10), and Panel 2, consisting of academic and professional experts (n = 10). The final consensus was assessed by a Delphi questionnaire round involving both panels, the employers of Panel 1 members (n = 5), and the members of the executive board of the TIPPA project (n = 10), comprising 35 people (response rate 74%; n = 26). RESULTS The first Delphi round yielded a high consensus, with the level of agreement varying between 69% and 100%. All but one item met the predefined criteria for approval. A total of 16 indicators were identified in 3 quality dimensions: patient (4 indicators), process (6), and learning and innovations (6). Strategy and vision of the pharmacy in patient counseling formed the core of the instrument. CONCLUSIONS The modified Delphi method proved to be applicable in the development process of an instrument assessing patient counseling services. The instrument comprehensively takes into account factors related to quality assurance of counseling practices.
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Ramaswamy-Krishnarajan J, Hill DS. Designing Success: Workflow and Design Processes that Support Pharmaceutical Care. Can Pharm J (Ott) 2005. [DOI: 10.1177/171516350513800309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Roberts AS, Hopp T, Sørensen EW, Benrimoj SI, Chen TF, Herborg H, Williams K, Aslani P. Understanding practice change in community pharmacy: a qualitative research instrument based on organisational theory. ACTA ACUST UNITED AC 2004; 25:227-34. [PMID: 14584230 DOI: 10.1023/a:1025880012757] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The past decade has seen a notable shift in the practice of pharmacy, with a strong focus on the provision of cognitive pharmaceutical services (CPS) by community pharmacists. The benefits of these services have been well documented, yet their uptake appears to be slow. Various strategies have been developed to overcome barriers to the implementation of CPS, with varying degrees of success, and little is known about the sustainability of the practice changes they produce. Furthermore, the strategies developed are often specific to individual programs or services, and their applicability to other CPS has not been explored. There seems to be a need for a flexible change management model for the implementation and dissemination of a range of CPS, but before it can be developed, a better understanding of the change process is required. OBJECTIVES This paper describes the development of a qualitative research instrument that may be utilised to investigate practice change in community pharmacy. Specific objectives included gaining knowledge about the circumstances surrounding attempts to implement CPS, and understanding relationships that are important to the change process. METHODS Organisational theory provided the conceptual framework for development of the qualitative research instrument, within which two theories were used to give insight into the change process: Borum's theory of organisational change, which categorizes change strategies as rational, natural, political or open; and Social Network Theory, which helps identify and explain the relationships between key people involved in the change process. RESULTS A semi-structured affecting practice change found in the literature that warranted further investigation with the theoretical perspectives of organisational change and social networks. To address the research objectives, the instrument covered four broad themes: roles, experiences, strategies and networks. CONCLUSION The qualitative research instrument developed in this study provides a starting point for future research to lead to a description and understanding of practice change in community pharmacy, and subsequent development of models for the sustainable implementation of CPS.
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Affiliation(s)
- Alison S Roberts
- Faculty of Pharmacy, A15, University of Sydney, NSW 2006, Australia.
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MacKeigan LD, Marshman JA, Kruk-Romanus D, Milovanovic DA, Jackevicius C, Naglie G, Einarson TR. Clinical Pharmacy Services in the Home: Canadian Case Studies. ACTA ACUST UNITED AC 2002; 42:735-42. [PMID: 12269708 DOI: 10.1331/108658002764653513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe clinical home care services provided by Canadian pharmacists and to identify facilitators of and barriers to the provision of these services. DESIGN Home care practices in Canada were identified using key informant and snowball sampling methods. Case descriptions of each pharmacy were composed using data obtained via a faxed questionnaire and a follow-up telephone interview. SETTING Community and institutional pharmacies across Canada. PARTICIPANTS Sixteen pharmacists with practices that met three criteria: at least one home visit conducted per week, visits conducted specifically for clinical purposes beyond routine prescription counseling, and documentation of home care services. INTERVENTION Faxed questionnaire and follow-up telephone interview. MAIN OUTCOME MEASURES Pharmacist characteristics, pharmacy characteristics, types of clinical home care services, home care-related products and dispensing services, referral system, reimbursement, barriers and facilitators, and evaluative strategies. RESULTS Twelve practices were in community pharmacies, nine of them independents. Home care services were provided primarily to address noncompliance and at the request of other health professionals. Elderly patients were the predominant service recipients. Services provided in most practices included compliance support, medication regimen review, monitoring of new medications, and patient education and training. Less than one-third of practices compiled evaluative data on these services. Most practices did not bill for services rendered. Lack of reimbursement was cited as the most important practice barrier, and having other sources of funding, such as high prescription revenues, was viewed as the major facilitator. CONCLUSION Clinical home care practice is rare in Canadian pharmacy; reimbursement is a major barrier. Practices described in these case studies were initiated to address a perceived important patient need. To enable further dissemination of clinical home care practice, pharmacists need to establish formal linkages with other home care providers, evaluate their services, and use the data obtained to develop marketing and reimbursement strategies.
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Affiliation(s)
- Linda D MacKeigan
- Faculty of Pharmacy and Home Care Evaluation and Research Centre, University of Toronto, Ontario, Canada.
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Pronk MCM, Blom LTG, Jonkers R, Rogers EM, Bakker A, de Blaey KJ. Patient oriented activities in Dutch community pharmacy: diffusion of innovations. PHARMACY WORLD & SCIENCE : PWS 2002; 24:154-61. [PMID: 12227249 DOI: 10.1023/a:1019570804783] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To explore the implementation of patient oriented activities, the perception of an innovation aimed at implementation of patient education and the preconditions for implementation of this innovation among Dutch pharmacists. METHOD A survey, based on Roger's theory of diffusion of innovations, was carried out among a random sample (n = 300) of Dutch managing pharmacists. MAIN OUTCOME MEASURES Reported activities regarding patient education, medication surveillance and drug therapy meetings, as well as perception of the innovation and its perceived compatibility with pharmacy practice. RESULTS The response rate was 49.3%. Hundred (84.7%) respondents reported to provide extra written and verbal information with first prescription medication. Medication surveillance (100% check by computer, and check of the lists by the pharmacist) was reported by 43 (36.4%), and complete participation in drug therapy meetings was reported by 57 (48.3%) respondents. Observability (or results to others) of the new strategy was perceived as important by 90 (77.6%), compatibility (perceived consistency with existing values, past experiences and needs of potential adopters) by 87 (76.4%) and trialability (degree to which an innovation may be experimented with) by 81 (69.8%) respondents. Relative advantages (perception of the innovation as being better) and complexity (relatively difficult to understand and use) of the innovation were perceived as important by less respondents. The preconditions that were met by most pharmacists were 'financial resources' (n = 70; 59.8%), 'enough workspace' (n = 61; 53.1%) and 'enough time' (n = 58; 50%). Fifty-eight (49.2%) respondents intend to adopt the innovation, but this intention would be higher when more time and money and technicians are available, as well as less situations that are experienced as barriers (rush hours, lack of support, illness of employees). CONCLUSION Based on the definitions used, we conclude that the implementation of medication surveillance and drug therapy meetings is relatively low compared to patient education. The development of an implementation tool is justified, but should deal with the experienced preconditions, barriers and needs of pharmacists. Combined, comprehensive pharmacy interventions promise to be a good way to change pharmacy practice.
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Affiliation(s)
- Miranda C M Pronk
- Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, PO Box 80082, 3508 TB Utrecht, The Netherlands.
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