Pharmaceutical care in chain pharmacies: beliefs and attitudes of pharmacists and patients

Factors influencing the implementation of the CombiConsultation in Dutch clinical practice: a mixed-methods study

OBJECTIVE

The CombiConsultation is an innovative concise clinical pharmacy service by the community pharmacist for patients with a chronic condition. We aimed to identify relevant factors influencing the implementation of the CombiConsultation in Dutch clinical practice.

METHODS

A mixed-methods study involving interviews and a questionnaire. Content analysis topics within TDF domains were derived from the interview data and were related to the COM-B-model (capability-opportunity-motivation-Behaviour). The relevance of the resulting topics was explored using a questionnaire with 19 statements administered to all 27 pharmacists who performed CombiConsultations.

KEY FINDINGS

Eighteen topics emerged from the interviews. The questionnaire was completed by 23 of the 27 pharmacists. In the domain 'capability', a small number of participants indicated that they need more expertise in pharmacotherapy (13%) and training in consultation skills (35%). In the domain 'opportunity', all participants indicated that an existing good collaboration with the general practitioner/practice nurse and access to all relevant medical data were necessary to implement the CombiConsultation. In terms of motivation, job satisfaction was most important to all participants, followed by adequate reimbursement (83%) and improving collaboration with other healthcare providers and the relationship with patients (78%).

CONCLUSIONS

Capability, opportunity, and motivation were all considered relevant for the implementation of the CombiConsultation. There were crucial factors on the level of the individual pharmacist, on the level of the local collaboration and organization, and on the health system level.

The influence of intervention complexity on barriers and facilitators in the implementation of professional pharmacy services - A systematic review

BACKGROUND

Community pharmacies increasingly offer professional pharmacy services, whose implementation is often influenced by facilitating or obstructive implementation factors. The occurrence and composition of implementation factors vary among different services with discrete characteristics and complexity of the intervention, making it difficult to foresee potential barriers in implementation.

OBJECTIVE(S)

This paper investigates potential associations between intervention complexity and occurring implementation factors.

METHODS

A systematic literature search on the implementation factors and intervention complexity of professional pharmacy services in the community setting was carried out in electronic databases (PubMed, CINAHL, and PsycINFO) throughout December 2018. Implementation factors were extracted from semi-structured interviews, focus groups, and surveys with community pharmacists and categorized using the Consolidated Framework for Implementation Research (CFIR). The complexity of each service was assessed using the following complexity parameters: (I) number of involved healthcare professions, (II) number of service components such as recruiting of patients, screening intervention, and follow-up, (III) frequency of the service, (IV) expenditure of time per patient (encounter), and (V) workflow distortion, i.e. booking appointments for intervention with the patient. Finally, the association between implementation factors and intervention complexity was analyzed by quantifying implementation factors and by relating them to specific intervention characteristics using Fisher's exact test.

RESULTS

15 studies covering a broad spectrum of professional pharmacy services were included. There was a trend that in services with higher complexity more implementation factors occurred (p = 0.094). Single key complexity parameters can trigger specific implementation factors. For instance, general practitioner and pharmacy technician involvement were significantly associated with interprofessional communication and leadership engagement, respectively.

CONCLUSION

Key implementation factors and associated complexity parameters seem to be of similar or more importance than the total number of implementation factors with regard to successful implementation. By assessing various complexity parameters of an intervention, potential key barriers could be identified and subsequently addressed prior to implementation.

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

Contraceptive Desert? Black-White Differences in Characteristics of Nearby Pharmacies

OBJECTIVES

Race differences in contraceptive use and in geographic access to pharmacies are well established. We explore race differences in characteristics of nearby pharmacies that are likely to facilitate (or not) contraceptive purchase.

STUDY DESIGN

We conducted analyses with two geocode-linked datasets: (1) the Relationship Dynamics and Social Life (RDSL) project, a study of a random sample of 1003 women ages 18-19 living in a county in Michigan in 2008-09; and (2) the Community Pharmacy Survey, which collected data on 82 pharmacies in the county in which the RDSL study was conducted.

RESULTS

Although young African-American women tend to live closer to pharmacies than their white counterparts (1.2 miles to the nearest pharmacy for African Americans vs. 2.1 miles for whites), those pharmacies tend to be independent pharmacies (59 vs. 16%) that are open fewer hours per week (64.6 vs. 77.8) and have fewer female pharmacists (17 vs. 50%), fewer patient brochures on contraception (2 vs. 5%), more difficult access to condoms (49% vs. 85% on the shelf instead of behind glass, behind the counter, or not available), and fewer self-check-out options (3 vs. 9%). More African-American than white women live near African-American pharmacists (8 vs. 3%). These race differences are regardless of poverty, measured by the receipt of public assistance.

CONCLUSIONS

Relative to white women, African-American women may face a "contraception desert," wherein they live nearer to pharmacies, but those pharmacies have characteristics that may impede the purchase of contraception.

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

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

Training Pharmacy Technicians in Community Pharmacy about Technical Aspects of Blood Glucose Meters

Objective:

To develop a structured training module for community pharmacy technicians to enhance on-the-job training, with a focus on the technical aspects associated with blood glucose meters.

Methods:

A 3-hour live training session was offered about the technical features of blood glucose meters. A 54-page manual was developed and provided to enhance the training sessions and for later use as a reference. Participation was voluntary and participants answered a 10-item pre-training survey and a 15-item post-training survey. The surveys contained questions about the knowledge and beliefs the technicians had about blood glucose meters.

Results:

Thirty-nine pharmacy technicians from 21 pharmacies participated in the training. Seventy-three percent of the participants expressed that they were very interested in taking an advanced role as a pharmacy technician. Sixty-four percent of the participants strongly agreed that the content of the program added to their knowledge about blood glucose meters. Fifty-two percent of the participants have been employed for >3 years by their employer.

Conclusions:

Community pharmacists today are striving to integrate patient care with the goods and services traditionally associated with pharmacy. Pharmacy technicians are recognized as an important resource in helping pharmacists provide better patient care. The structured training module described in this article is designed to supplement on-the-job training. Formal training through accredited training programs may be required in the future. Structured technician training modules may provide a means for transition from predominantly on-the-job training to formal training.

Assessment of a screening protocol for type 2 diabetes in community pharmacy. The DiabNow Study

The aim of this study was to assess the performance and feasibility of a protocol for screening type 2 diabetes in community pharmacy. Performance was primarily assessed by measuring stakeholders' adherence (pharmacists, patients and physicians) to the protocol's components.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Women's Attitudes and Health Beliefs toward Osteoporosis Screening in a Community Pharmacy

The aim of this study was to examine women's attitudes and health beliefs towards osteoporosis screening in a community pharmacy setting, utilizing the theoretical framework of Health Belief Model. A nonexperimental, cross-sectional research design, examining a convenience sample of women aged 18 and over, from several New York City senior care centers, a church, and a university campus in New York, was employed to assess the study objectives. Osteoporosis Health Belief Scale questionnaire was used to study the attitudes and health beliefs of participants towards bone mineral density screening in community pharmacy. From the study, it was observed that perceptions of severity and susceptibility towards osteoporosis and subjects' demographic characteristics did not seem to significantly influence the decision to screen in a community pharmacy setting. The perceptions of benefits of community pharmacy-based osteoporosis screening and the perceived barriers were found to be of greater importance in women's decisions to engage in osteoporosis-specific preventive behavior.

Patient preferences for community pharmacy asthma services: a discrete choice experiment

BACKGROUND

Specialized community pharmacy services, involving the provision of disease state management and care by pharmacists, have been developed and trialled and have demonstrated very good health outcomes. Most of these services have been developed from a healthcare professional perspective. However, for the future uptake and long-term sustainability of these services as well as for better and sustained health outcomes for patients, it is vital to gain an understanding of patients' preferences. We can then structure healthcare services to match these preferences and needs rather than around clinical viewpoints alone.

OBJECTIVE

The aim of this study was to elicit patient preferences for pharmacy-based specialized asthma services using a discrete choice experiment and to explore the value/importance that patients place on the different attributes of the asthma service. The existence of preference heterogeneity in the population was also investigated.

METHODS

The study was conducted with asthma patients who had recently experienced a specialized asthma management service at their pharmacy in New South Wales, Australia. Pharmacists delivering the asthma service mailed out the discrete choice questionnaires to participating patients at the end of 6 months of service provision. A latent class (LC) model was used to investigate each patient's strength of preference and preference heterogeneity for several key attributes related to asthma service provision: frequency of visits, access to pharmacist, interaction with pharmacy staff, availability of a private area for consultation, provision of lung function testing, type and depth of advice provision, number of days with asthma symptoms and cost of service.

RESULTS

Eighty useable questionnaires (of 170 questionnaires sent out) were received (response rate 47.1%). The study identified various key elements of asthma services important to patients. Further, the LC analysis revealed three classes with differing patient preferences for levels of asthma service provision. Patients in the Minimalistic Model class valued provision of lung function testing and preferred more frequent service visits. Cost of service had a negative effect on service preference for patients in this class. Patients in the Partial Model class mainly derived utility from the provision of lung function testing and comprehensive advice at the pharmacy and also wanted more frequent service visits. The Holistic Model class patients considered all attributes of the service to be important when making a choice. While the majority of the service attributes had a positive effect on preference for patients in this class, cost of service and days with symptoms of asthma had a negative effect on service preference. These patients also preferred fewer service visits.

CONCLUSION

The study identified various key attributes that are important to patients with respect to community pharmacy-based asthma services. The results also demonstrate the existence of preference heterogeneity in the population. Asthma service providers need to take these findings into consideration in the design and development of future service models so as to increase their uptake and ensure their long-term sustainability.

Effect of social influences on pharmacists' intention to report adverse drug events

OBJECTIVES

To identify the groups or individuals that influence pharmacists' decision making to report adverse drug events (ADEs), determine the differences in social influence or subjective norm between intenders and nonintenders, and determine the relationship between subjective norm toward reporting serious ADEs and practice and demographic characteristics.

DESIGN

Nonexperimental cross-sectional study.

SETTING

Texas during June and July 2009.

PARTICIPANTS

1,500 Texas pharmacists.

INTERVENTION

As part of a larger survey, 3 and 18 items were used to assess pharmacists' intentions and subjective norm, respectively, to report serious ADEs to the Food and Drug Administration (FDA).

MAIN OUTCOME MEASURE

Pharmacists' subjective norm toward reporting serious ADEs.

RESULTS

The survey had a response rate of 26.4% (n = 377). Most pharmacists intended to report serious ADEs that they would encounter (15.87 ± 4.22 [mean ± SD], possible range 3-21, neutral = 12). The mean subjective norm scores were moderately high and positive (28.75 ± 9.38, 1-49, 16), indicating that the referents had a moderate influence on pharmacists regarding reporting serious ADEs to FDA. FDA had the greatest (34.82 ± 12.16) and drug manufacturers the lowest (21.55 ± 13.83) social influence. The most important salient referents (important others) in pharmacists' decisions to report serious ADEs were FDA, patients, pharmacy associations, pharmacy managers/bosses, and hospitals and hospital groups. Gender (female equals higher), pharmacists' years of experience (negative correlation), and knowledge of ADE reporting (positive correlation) were associated with subjective norm.

CONCLUSION

Pharmacists had a moderately high subjective norm, suggesting that ADE reporting intentions is influenced by others and that the opinions of others are of great importance in pharmacists' intentions regarding ADE reporting. The main drivers of subjective norm were FDA, patients, pharmacy associations, and managers/bosses.

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

Background

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

Methods

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

Results

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

Conclusions

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

Evaluation of the community pharmacist's behavior towards a prescription of antidiabetic and antiasthma drugs

OBJECTIVE

The objective of this study is to assess the performance of community pharmacist towards antidiabetic and antiasthma prescriptions, and also to assess the lack of information provided by community pharmacists regarding patient counseling and missing data, using a simulated patient technique.

METHODS

A prescription including antidiabetic and antiasthma drugs was used by simulated patient to assess community pharmacist's performance in 194 pharmacies. A performance assessment sheet was used to measure the patient counseling process. A quantitative descriptive and comparative analysis was done for the collected data. Pearson chi-square test (crosstabs) was used with a level of significance 95%).

RESULTS

The analysis of the 194 pharmacies visited revealed that most of the pharmacists were male (61%), Arabs (35%) and Indians (55%) with some other nationalities. The dispensing time in the pharmacy ranged between 2 to 10 minutes. Spending time with patients was not affected by gender (p-value 0.087), slightly affected by nationality (p-value 0.04), and highly affected by age (p-value 0.002) leaning towards older pharmacists who spent more time with patients than younger pharmacists. Most pharmacists (90%) started preparing the prescription once they received the prescription with no actual prescription screening. fifty five percent of the pharmacists asked about the duration of the treatment after preparing the prescription. ninety six percent did not counsel patients about diet, exercise and lifestyle changes. Less than 40% asked if the prescription was intended to be used for the same patient.

CONCLUSION

This study recommends that health authorities consider follow up plans in order to ensure the best pharmaceutical care is provided by community pharmacies.

Privacy in the pharmacy environment: analysis of observations from inside the pharmacy

OBJECTIVE

To measure the extent to which pharmacist-patient conversations are private.

DESIGN

Cross sectional.

SETTING

New York State, April to June 2007.

PARTICIPANTS

No individual participants were enrolled; the study consisted of observations of the pharmacy environment and pharmacy patient-staff interactions.

INTERVENTION

Measurement of privacy-related distances in the pharmacy.

MAIN OUTCOME MEASURES

Distance between patients at the pharmacy counter and staff behind the counter, distance between patient waiting area and pharmacy counter, and distance that a pharmacy counter conversation was audible.

RESULTS

Observational data were recorded from 597 pharmacy staff-patient interactions in 282 pharmacies across New York State. Of the 597 interactions, 167 occurred while a second patient was within 6 ft. Of the 282 pharmacies, pharmacy staff-patient conversations were audible to observers more than 6 ft away in 229 pharmacies; 142 could be heard more than 15 ft away.

CONCLUSION

Most staff-patient conversations in the pharmacy setting are not private and, as a result, have a high potential for incidental protected health information disclosures.

Ask, advise and refer: Hypothesis generation to promote a brief tobacco-cessation intervention in community pharmacies

Objectives

A preliminary qualitative study was conducted to identify key facilitators and barriers for pharmacists' adoption of a brief tobacco-cessation protocol, Ask-Advise-Refer (AAR).

Methods

Ten community pharmacists were interviewed using semi-structured, face-to-face interviews with open-ended questions. Purposive and saturation sampling techniques were applied to identify participants and determine sample size respectively. Interviews were audio-recorded and transcribed. Using thematic analysis, two reviewers independently coded all transcripts to identify prominent themes. Appropriate measures were taken to ensure study rigor and validity.

Key findings

All facilitators and barriers identified were grouped into nine distinct themes. Pharmacists' fear of negative patient reaction was the most prominent barrier to initiating tobacco-cessation discussions with patients. Other themes identified in decreasing order of prevalence were pharmacists perceiving a rationale for initiating tobacco cessation, pharmacy environment, pharmacists' perception of/prior knowledge of patients' willingness to discuss tobacco cessation/to quit, patient initiation of tobacco-cessation or worsening-health discussion, pharmacists' perceptions of AAR characteristics, length of pharmacist-patient relationship/rapport with patients, low expectations of pharmacy patrons and pharmacists' communication ability.

Conclusions

This study highlights the potential fear among pharmacists about negative reactions from patients in response to initiating tobacco cessation discussions. Based on the results of this study it is hypothesized that the following strategies would facilitate adoption of AAR: (1) train pharmacists to initiate cessation discussions; (2) initially target discussions with patients who have a disease or medication adversely affected by tobacco use; (3) encourage patient enquiry about pharmacy cessation services through visual cues; and (4) help pharmacists set up a workflow system compatible with the AAR protocol.

Factors Influencing a Community Pharmacist's Interventions in Asthma Care

Background:

Little is known about current pharmacists' interventions related to drug counselling and monitoring in asthma, along with the barriers and facilitators to these, in the province of Quebec.

Objectives:

To identify and explore organizational, relational and professional factors that influence community pharmacists' interventions in asthma care and propose solutions to overcome the barriers to these interventions.

Methods:

In 2006, a survey and an invitation to participate in a focus group were sent to community pharmacists in Quebec. Three focus groups were held to discuss the results of the survey about community pharmacists' interventions in asthma and the factors influencing these interventions, along with solutions to identified barriers. Each focus group lasted for approximately 120 minutes and was moderated by 2 investigators.

Results:

Seventeen community pharmacists participated in the study. One focus group was held with pharmacy owners, 1 with salaried pharmacists who graduated before 1990 and 1 with salaried pharmacists who graduated after 1996. Owners and salaried pharmacists of different years of graduation generally made the same comments. Most pharmacists reported intervening with asthma patients, especially when initial prescriptions were filled. Lack of time and unclear definition of tasks were reported as barriers. Solutions were proposed to resolve barriers, such as clearly defining tasks and ensuring quick access to support materials for patient education and drug monitoring.

Conclusion:

Community pharmacists report intervening in asthma care mostly when patients fill their initial prescription. Several barriers to follow-up interventions were identified.

Ask, advise and refer: hypothesis generation to promote a brief tobacco-cessation intervention in community pharmacies

OBJECTIVES

A preliminary qualitative study was conducted to identify key facilitators and barriers for pharmacists' adoption of a brief tobacco-cessation protocol, Ask-Advise-Refer (AAR).

METHODS

Ten community pharmacists were interviewed using semi-structured, face-to-face interviews with open-ended questions. Purposive and saturation sampling techniques were applied to identify participants and determine sample size respectively. Interviews were audio-recorded and transcribed. Using thematic analysis, two reviewers independently coded all transcripts to identify prominent themes. Appropriate measures were taken to ensure study rigor and validity.

KEY FINDINGS

All facilitators and barriers identified were grouped into nine distinct themes. Pharmacists' fear of negative patient reaction was the most prominent barrier to initiating tobacco-cessation discussions with patients. Other themes identified in decreasing order of prevalence were pharmacists perceiving a rationale for initiating tobacco cessation, pharmacy environment, pharmacists' perception of/prior knowledge of patients' willingness to discuss tobacco cessation/to quit, patient initiation of tobacco-cessation or worsening-health discussion, pharmacists' perceptions of AAR characteristics, length of pharmacist-patient relationship/rapport with patients, low expectations of pharmacy patrons and pharmacists' communication ability.

CONCLUSIONS

This study highlights the potential fear among pharmacists about negative reactions from patients in response to initiating tobacco cessation discussions. Based on the results of this study it is hypothesized that the following strategies would facilitate adoption of AAR: (1) train pharmacists to initiate cessation discussions; (2) initially target discussions with patients who have a disease or medication adversely affected by tobacco use; (3) encourage patient enquiry about pharmacy cessation services through visual cues; and (4) help pharmacists set up a workflow system compatible with the AAR protocol.

Ontario Family Physician Readiness to Collaborate with Community Pharmacists on Drug Therapy Management: Lessons for Pharmacists

Background/Objective:

Collaboration between community pharmacists and physicians with respect to drug therapy management occurs relatively infrequently. There has been little research on physicians' views about such collaboration. The primary objective of this study was to assess Ontario family physicians' attitudes and readiness to collaborate with community pharmacists on drug therapy management.

Methods:

A 3-page survey instrument inquiring about 3 collaborative behaviours was distributed by fax or mail to a random sample of 848 family physicians and general practitioners across Ontario. Nonrespondents received 2 reminders.

Results:

The survey response rate was 36%. Most physicians reported conversing with a community pharmacist about a patient's drug therapy management 5 or fewer times per week, and very few said they used pharmacists as their primary source of medication information. Eighty-four percent reported that they regularly took community pharmacists' phone calls, while 78% reported that they sometimes sought pharmacists' recommendations regarding patient drug therapy. Only 28% reported that they sometimes referred their patients to community pharmacists for medication reviews, with 44% being unaware that such a service existed. Most comments were favourable, typically providing positive examples of collaboration with pharmacists. The most important identified advantage of collaborating with community pharmacists was more accurate medication lists. The main disadvantage identified was that pharmacists are constrained by not having access to key patient information (e.g., diagnosis, lab results, consultant reports). Additional barriers to collaboration reported by physicians included rotating pharmacists and perceived pharmacist interference with physicians' drug therapy plans.

Conclusion:

Overall, Ontario family physicians were engaged in limited collaboration with community pharmacists. By making an effort to increase the frequency of their direct professional interactions with physicians, pharmacists can enhance physician awareness of their willingness to provide patient-oriented services, thus facilitating collaboration.

General practitioners' and pharmacists' perceptions of the role of community pharmacists in delivering clinical services

BACKGROUND

Because community pharmacists are encouraged to provide clinical services, there is a need to determine the role perceptions of both community pharmacists and general practitioners (primary care physicians). Differing role perceptions are likely to result in barriers to pharmacists expanding their roles in health care.

OBJECTIVES

The purpose of this study was to investigate whether community pharmacists' and general practitioner's perceptions of the role of community pharmacists may be a barrier to pharmacists increasing their role in medication management. Other potential barriers were also explored that could provide a framework for future research.

METHODS

A postal survey to 900 and 1000 randomly selected community pharmacists and general practitioners, respectively, elicited the perceptions of these groups toward the role of community pharmacists. Likert scales were used to quantify the results.

RESULTS

The results revealed a gap in perceptions regarding the role of the community pharmacist, with general acceptance of the technical roles but less acceptance of clinical roles by general practitioners. Barriers to increased involvement of community pharmacists in clinical services included a perceived lack of mandate, legitimacy, adequacy, and effectiveness by both groups. Also observed was a lack of readiness to change by community pharmacists.

CONCLUSIONS

This study suggests that there are significant barriers to community pharmacists increasing clinical services, both from the community pharmacists themselves and from the general practitioners. Attention to change management in a complex environment will be necessary if community pharmacists are to change their role toward more clinical services.

Community pharmacists' interventions in asthma care: a descriptive study

BACKGROUND

Factors influencing community pharmacists' interventions have been identified, but little information is available regarding these factors in asthma care.

OBJECTIVE

To describe the type and frequency of pharmacists' asthma care interventions and to identify factors influencing those interventions.

METHODS

A pretested, self-administered questionnaire was mailed to all community pharmacists registered with the Ordre des pharmaciens du Québec in 2006. The form included questions about the pharmacists' interventions in asthma care in the community setting (21 questions), factors influencing the provision of those interventions (13 questions), and the responders' characteristics (17 questions).

RESULTS

A total of 4587 questionnaires were sent; 917 pharmacists returned the questionnaires (response rate 20%), and 877 were eligible for analysis. Overall, community pharmacists who completed the questionnaire appeared to intervene frequently when the initial prescription for asthma medication was filled. About 98% of responders reported providing verbal information always or often on new asthma medication prescriptions. Furthermore, checking for overuse of rescue medication and underuse of maintenance therapy always or often was reported by 91% and 85.8% of responders, respectively. Other interventions at follow-up were not as frequently reported. For example, only 8.4% of pharmacists reported reassessing inhalation technique always or often. Lack of time was reported to be an important barrier to the type and frequency of intervention, while interest on the part of the patient appeared to be a significant facilitator. About 99% of pharmacists agreed with the statement that they have an important role in asthma care.

CONCLUSIONS

Community pharmacists appear to intervene with patients with asthma mostly at the initiation of treatment, but some interventions at follow-up are not frequently done, which could be attributed to organizational factors.

Factors affecting pharmacists' pediatric asthma counseling

OBJECTIVE

To explore various factors that may influence community pharmacists' pediatric asthma counseling.

DESIGN

Cross-sectional.

SETTING

Maryland from September 2002 through March 2003.

PARTICIPANTS

Random sample of 400 community pharmacists.

INTERVENTION

Mail survey.

MAIN OUTCOME MEASURES

Pharmacists' attitude, subjective norm, perceived behavioral control, intention to provide pediatric asthma counseling, and reported counseling using the theory of planned behavior as a framework; demographic and pharmacy characteristics.

RESULTS

98 of 389 (25%) eligible pharmacists responded. Most acknowledged the importance of providing asthma counseling to children (54%) or caregivers (68%). However, only a small number reported demonstrating to children or caregivers or asking them to demonstrate how to use antiasthmatic medications. Multivariate logistic regressions revealed that intention to counsel was a significant predictor of providing counseling for children or caregivers (odds ratio [OR], 3.95 and 3.09, respectively). Intention to counsel children was significantly associated with subjective norm (OR, 1.88) and perceived ease of counseling (OR, 1.48); intention to counsel caregivers was significantly associated with perceived ease (OR, 1.45). Pharmacists also reported the following barriers that made counseling difficult: lack of time, lack of parent's interest, and lack of placebo devices useful for demonstration of inhalation technique.

CONCLUSION

Despite a positive attitude toward providing asthma counseling, the majority of pharmacists reported not fully engaging in counseling. A number of barriers to counseling were reported that, if targeted, could improve the management of pediatric asthma through pharmacist-initiated counseling.

Impact of an asthma-specific questionnaire on problem identification and clinical and economic outcomes in ambulatory patients with persistent asthma

OBJECTIVE

To determine the impact of an asthma-specific questionnaire on problem identification and patient outcomes.

DESIGN

Prospective, two-group, parallel, randomized, multisite study.

SETTING

Conducted at 10 community pharmacies in suburban Detroit from January 2000 to April 2003.

PATIENTS

60 adult and pediatric patients with persistent asthma receiving daily medication.

INTERVENTION

A 17-item questionnaire designed to query understanding of and response to therapy and confidence in asthma prevention and treatment was completed by all participants at routine visits. Pharmacists reviewed questionnaire results with 31 intervention (group 1) participants during a 5- to 10-minute interaction, while 29 control (group 2) participants received standard care only.

MAIN OUTCOME MEASURES

Number and type of problems identified. Secondary outcomes were use of clinical outcomes, resource utilization, drug use and understanding, missed school or work days, and participant confidence.

RESULTS

Group 1 and group 2 participants were monitored for a mean of 5.4 and 5.2 months, respectively. Overall, 68 problems were identified in group 1 and 4 in group 2. Confidence in preventing asthma episodes improved 29% and confidence in treating symptomatic episodes improved 10% in group 1 participants, whereas there were no improvements in group 2. Symptom frequency, rescue drug use, restricted activity, and patients with more than two nocturnal episodes per month decreased within both groups. There were low incidences of and no statistically significant group differences for frequency of oral steroids, resource use, and missed school or work days. Likewise, group differences in drug use and understanding were not significant.

CONCLUSION

The questionnaire aided pharmacists in problem identification and may be useful in a busy pharmacy. Study limitations such as small sample size, short follow-up period, and liberal enrollment contributed to the lack of group differences in our secondary outcomes. Future studies need to address our study limitations and explore additional practical methods of providing pharmaceutical care in the community pharmacy setting.

Impact of a continuing education program on community pharmacists' interventions and asthma medication use: a pilot study

BACKGROUND

By upgrading the pharmacists' knowledge and skill set through continuing education (CE) programs, they could be better suited to contribute to the enhancement of the management of asthma.

OBJECTIVE

To assess the impact of an asthma CE program provided to community pharmacists on their knowledge, intervention frequency, and the appropriateness of asthma medication use.

METHODS

Community pharmacists were invited to participate in a CE program on asthma. Those who displayed an interest in the program were assigned to either a control or experimental group. Participants in the first group were not offered the CE program until the study was completed; the second group participated in the CE program at the onset of the study period. The knowledge on asthma of both groups of pharmacists was assessed using a questionnaire before the CE program, and the knowledge of the experimental group was reassessed after the CE program. Pharmacists were asked to document their interventions in the study log book over 6 months following the CE program. The appropriateness of asthma medication use was estimated by reviewing the prescription claims for a subgroup of patients covered by Québec's Public Prescription Drug Insurance Plan.

RESULTS

Pharmacists' knowledge improved after the CE program; however, the number of interventions reported during the 6 month period following the program was low and did not differ significantly between the groups, with an average of 3.04 per pharmacy in the experimental group versus 3.26 in the control group. The appropriateness of asthma medication use did not improve once the CE program had been completed.

CONCLUSIONS

Our CE program had little impact on the number of interventions by community pharmacists and the appropriateness of asthma medication use.

Consumers' perceptions about risk of and access to nonprescription medications

OBJECTIVES

To examine how consumers balance the principles of safety with regulatory access to pharmaceuticals and to identify respondent characteristics, including prior misuse of nonprescription medications, that are associated with a preference for nonprescription status.

DESIGN

Cross-sectional survey within-subject attitudinal analysis.

SETTING

Large midwestern metropolitan region of the United States.

PARTICIPANTS

Convenience sample of 553 members of the general public.

INTERVENTIONS

Anonymous self-administered surveys with hypothetical vignettes in which a heartburn or antihypertensive drug could be available without a prescription but in doing so would entail an increased risk (1/100,000, 1/10,000, or 1/1,000 chance of heart attack) to the user that would not be present with the medical care afforded by prescription drug status.

MAIN OUTCOME MEASURE

Proportion of respondents preferring nonprescription availability.

RESULTS

Overall, 33%, 19%, and 11% of respondents preferred nonprescription availability when the additional risks of a heart attack with nonprescription availability were 1/100,000, 1/10,000, and 1/1,000, respectively. Risk tolerance did not differ between the heartburn and antihypertensive vignettes. Although preference for nonprescription status was significantly greater among respondents who were men (42% versus 28%) and white (42% versus 32%), and a statistical trend was evident among respondents with higher self-reported health (37% versus 27%) and a college education (36% versus 28%), most of these differences did not persist on multivariate analysis.

CONCLUSION

A substantial minority of the public appears willing to accept considerable risk to gain greater access to pharmaceuticals. Heterogeneity among the general public with regard to how safety and access to nonprescription medications should be balanced challenges policy makers working to design responsive yet appropriate regulatory policies.

Opportunities for Improving Post-Hospital Home Medication Management Among Older Adults

Effective post-hospital home medication management among older adults is a convoluted, error-prone process. Older adults, whose complex medication regimens are often changed at hospital discharge, are susceptible to medication-related problems (e.g. Adverse Drug Events or ADEs) as they resume responsibility for managing their medications at home. Human error theory frames the discussion of multi-faceted, interacting factors including care system functions, like discharge medication teaching that contribute to post-hospital ADEs. The taxonomy and causes of post-hospital ADEs and related risk factors are reviewed, as we describe in high-risk older adults a population that may benefit from targeted interventions. Potential solutions and future research possibilities highlight the importance of interdisciplinary teams, involvement of clinical pharmacists, use of transitional care models, and improved use of informational technologies.

Pharmacists' participation in an inhaled respiratory medication program: reimbursement of professional fees

BACKGROUND

An intervention (termed Initiative) was initiated to facilitate converting beneficiaries of a public drug insurance program in the province of Nova Scotia from respiratory nebulization medications to inhalers. Community pharmacists provided patient education and billed professional fees for conversions or optimizing inhaled respiratory medication technique.

OBJECTIVE

To determine community pharmacists' self-reported participation rate and identify facilitators and barriers to billing for professional fees.

METHODS

A survey was developed and mailed to Nova Scotia pharmacists. Information on demographics, work environment, professional experience, financial aspects, billing experiences, and the billing process was collected. Quantitative and qualitative data were evaluated using bivariate and multivariate analyses, and a thematic process, respectively.

RESULTS

Two hundred ninety-seven pharmacists responded. Self-reported billing rates for fees were 34% (switching delivery devices), 58% (optimizing AeroChamber use), and 37% (follow-up when replacing Aerochambers). Awareness of fees and the perception of consistent claim reimbursement were associated with billing for each fee (p < 0.05). Predisposing billing factors included awareness of fees, identifying situations requiring education, owner/manager position, male gender, perception that billing for education for optimizing technique is a minimum standard of practice, and prescription volume. Themes identified as barriers included inefficient billing process, inadequate fees, and lack of Initiative awareness.

CONCLUSIONS

Predisposing factors were the most important facilitators of community pharmacists' participation in this program, while a cumbersome and time-consuming billing process was the primary barrier. Further research should determine the impact of the professional fee on patient health outcomes.

Perceptions around concordance--focus groups and semi-structured interviews conducted with consumers, pharmacists and general practitioners

BACKGROUND

Achieving concordance by identifying beliefs about illness, treatment and medicine-taking should impact positively on behaviour and consumer satisfaction with respect to treatment, and health outcomes may be improved.

OBJECTIVE

To explore, in the Australian context, beliefs and expectations of general practitioners (GPs), consumers and pharmacists in relation to concordance to allow further exploration of the implementation of principles of concordance in Australia.

DESIGN

Qualitative analysis of focus group and semi-structured interview data.

SETTING AND PARTICIPANTS

Focus groups were held with seven consumers and nine pharmacists and, in-depth, semi-structured interviews were held with 10 GPs between February and May 2003, in Brisbane (Australia).

RESULTS

This explorative study identified a variety of issues. Consumers expressed the need for more input from health professionals - being given more information on their treatments and conditions, more time spent in discussion, and establishing a system where harmonious relationships between health professionals could take place, which would result in a more consumer-friendly health care system. The main issues voiced by the pharmacists were about the idea of organizing the health care system in a way that would accommodate more quality information sharing between all partners. GPs' issues included better and unlimited information-sharing, having more time to promote quality in health care and receiving remuneration for increased verbal contact with other health care professionals. Suggestions were made about ways to achieve concordance by improved information-sharing and shared decision-making.

CONCLUSION

The data from this study will lead to the development of models to explore and attempt to incorporate principles of concordance in Australian pharmacy and medical practice.

Cost-effectiveness analysis of pharmaceutical care in a medicare drug benefit program

OBJECTIVES

Although there has recently been substantial interest in a Medicare drug benefit program, little attention has focused on ensuring improved access to medication monitoring for Medicare beneficiaries. Using a societal perspective, we evaluated the impact pharmacists could have on inappropriate prescribing, patient compliance, and medication-related morbidity and mortality within a Medicare drug benefits program.

METHODS

A cost-effectiveness analysis from a societal perspective was performed. A comprehensive MEDLINE search for relevant literature identified data sources and model parameters.

RESULTS

In the base case, a pharmaceutical care benefit in the elderly population would cost US dollars 2100 (year 2000 prices) per life-year saved, which is highly cost-effective. Reasonable changes in model parameters did not raise the cost-effectiveness ratio above US dollars 13000 per life-year saved.

CONCLUSION

Despite limitations in both the quantity and the specificity of data available, pharmaceutical care appears to be a highly cost-effective augmentation to a Medicare drug benefit program. This result is robust to model parameter changes. This model is conservative in that it does not include ongoing benefits from medication monitoring or increased elderly drug utilization and polypharmacy as the Medicare drug program is phased in.