Perceptions of a group of hospital pharmacists and other professionals of the implementation of clinical pharmacy at a high complexity public hospital in Brazil

"Opportunities and responsibilities": how do pharmacists assess their professionalism?

INTRODUCTION

Professionalism is fundamental to the existence of professions. In pharmacy, interest in this theme improved with events that examined the resocialization of pharmacists in care. With this, evaluating professionalism can help the operationalization of the theme and, consequently, the development of strategies for pharmacy consolidation before its challenges. Therefore, this study aimed to evaluate the professionalism of Brazilian pharmacists.

METHODS

To meet the objective, a cross-sectional study was conducted between March 2022 and August 2023. Data were collected using the Brazilian version of the "Modification of Hall's Professionalism Scale for Use with Pharmacists". The scale has 39 items grouped into the domains: autonomy, vocation, professional council, self-regulation, continuing education, and altruism. Data were analyzed using descriptive statistics and an ANOVA analysis of variance with post-hoc Hochberg or Games-Howell tests with Bootstrapping was conducted to verify differences between groups.

RESULTS

600 pharmacists participated in this study. The majority (69%) was female and carried out their professional activities in community pharmacies (50%). Professionalism scores ranged between 14 and 29 points, with an average of 22.8 points. Pharmacists working in outpatient clinics had higher scores in most factors, namely, altruism, continuing education, professional council, vocation, and autonomy. This indicates that the inclination of pharmacists to occupy areas focused on care can be significant to assess professionalism.

CONCLUSIONS

The data obtained indicate that pharmacists working in outpatient clinics had higher professionalism scores compared to others. This corroborates the worldwide trend experienced by pharmacy in recent decades, which is the execution of increasingly patient-centered practice models.

DPD. Formal leadership perceptions about the autonomy of Pharmacy: a SWOT analysis

INTRODUCTION

Autonomy is considered a vital principle of professionalism. In recent years, despite important advances, the Pharmacy and pharmacists' autonomy has been questioned due to conflicts that jeopardize the consolidation of this profession in the division of work in health.

OBJECTIVE

to understand the construct of autonomy based on perceptions of formal leaders associated with professional organizations.

METHODS

A qualitative study was conducted through interviews with key informants. The data obtained were submitted to content analysis.

RESULTS

Perceptions about the autonomy in pharmaceutical practice were categorized according to strengths, weaknesses, opportunities, and threats to this construct.

CONCLUSION

The findings allowed us to understand the autonomy of pharmaceutical practice in Brazil, generate hypotheses about the future of Pharmacy, and build strategies to maintain its occupational status.

The academic formation challenges: what does retail expect from higher education institutions in pharmacy?

BACKGROUND

The drug retail represents the main area of activity for pharmacists worldwide. In Brazil, this sector is responsible for employing around 80% of professionals. Before this reality, the academic training of pharmacists requires specialized skills and knowledge so they can fulfill their tasks. In this sector, considering the influence of managers and mentors on the model of pharmaceutical practice, their perceptions about the demands of the market can help discussions related to the training of pharmacists.

AIM

To analyze the academic training of pharmacists for the drug retail market from the perspective of managers and mentors.

METHOD

This is a qualitative study conducted with managers and mentors of the drug retail market. A semi-structured interview guide was prepared and applied to the intentionally selected participants. The study was approved by the Research Ethics Committee under the number 4,169,752. The interviews were conducted through videoconference by an experienced researcher. The data obtained were analyzed using Bardin's analysis technique, following the steps of categorical thematic content analysis using the ATLAS.ti software.

RESULTS

19 interviews were carried out. Among the reports, the interviewees highlighted the importance of retail in the employability of pharmacists, as well as inconsistency in the academic training for this sector, originating the following categories: curriculum reform to include the market demands, follow-up and career plan, training for entrepreneurship and sales, practical application of knowledge, and encouragement of experience.

CONCLUSION

Pharmaceutical academic training is linked to several challenges, whether organizational, structural, or budgetary. To overcome these challenges, it is necessary to unite the interested parties in the formulation and implementation of a strategy for the professionalization of pharmacists, considering their social role in patient care, aligned with the company's sustainability, so that both coexist.

Perceptions of formal pharmacy leadership on the social role of the profession and its historical evolution: A qualitative study

Background

In recent years, pharmaceutical professionalism has been questioned due to the social role of pharmacy, which is ambiguous in the literature. This raises questions about the purpose of the profession among pharmacists, despite the efforts of their professional organizations and formal leaders to consolidate the occupational status of the profession.

Objective

To understand the social role of pharmacy in Brazil through its historical evolution based on the perceptions of formal leaders of the profession.

Methods

A qualitative study was conducted between July 2020 and February 2021 with pharmacists who held leadership positions in formal and professional pharmacy organizations in Brazil. The data obtained from the interviews were submitted to content analysis.

Results

A total of 17 pharmacists participated in this study. The data analyzed presented perceptions about the social role of the pharmaceutical profession in Brazil, which promotes access to health through different means. These include the manager pharmacist, who facilitates access to public health policies; the caring pharmacist, who promotes health education and the rational use of medicines; and the technologist pharmacist, who researches, develops, and promotes access to safe and cost-effective medicines. The interviewees also discussed the evolution of this social role based on influential factors such as legislation, clinical movement, pharmaceutical education, labor market, behaviors, and attitudes of pharmacists.

Conclusion

In this study, pharmaceutical professionalism was conceptualized based on its social role, which should be centered on the patient. Understanding such issues is part of the evolutionary purpose of the profession in Brazil and should be encouraged in the behaviors and attitudes of pharmacists despite the challenges faced by the profession.

Development of service standards and manpower calculation criteria for hospital clinical pharmacies in South Korea: a survey-based study

BACKGROUND

After the revision of the Korean Pharmaceutical Affairs Act, the certification of specialized pharmacists is scheduled to be legally recognized in 2023. Considering that the specialized pharmacist certification was developed based on the working model of hospital clinical pharmacists, it is necessary to establish standards for clinical pharmacists in hospitals and to calculate appropriate manpower. Through this study, we aim to establish practical standards for clinical pharmacists and propose a method for calculating staffing levels based on an investigation of actual workloads.

METHODS

This survey-based study consisted of two phases. In the first phase, a literature review was conducted to establish standards for clinical pharmacy services, and tasks in relevant literature were classified to identify clinical pharmacy service tasks that are applicable to the practice of Korean hospitals. Additionally, a preliminary survey was conducted to investigate the essential tasks. In the second phase of the investigation, a multicenter survey was conducted targeting pharmacists in facilities with more than 1,000 beds to explore their perceptions and actual workloads related to tasks.

RESULTS

According to the standards for clinical pharmacists in Korea, clinical pharmacy services consist of a total of 23 tasks, of which 16 have been identified as essential tasks. Essential tasks accounted for 93% of the total tasks in clinical pharmacy services. The average full-time equivalent (FTE) through workload calculation was 2.5 ± 1.9 for each field, while the FTE allocated to actual practice was 2.1 ± 1.6. The distribution of each type of clinical pharmacy service was as follows: 77% for medication therapy management, 13% for medication education, 8% for multidisciplinary team activities, and 3% for medication use evaluation.

CONCLUSION

This study identified essential tasks common to clinical pharmacy services across different healthcare institutions. However, the FTE of clinical pharmacists in actual practice was insufficient compared to the required amount. In order to establish and expand clinical pharmacy services in a hospital, it is necessary to ensure an adequate workforce for essential tasks.

Pharmacy professionals' perceptions of their professional duties in the Ethiopian health care system: a mixed methods study

BACKGROUND

Pharmacy professionals are experts in therapeutic knowledge, experience, and skills that are used to ensure desired patient outcomes, utilizing the best available clinical evidence and interventions in collaboration with the health care team. They perceive themselves as a provider of technical, standardized, and individualized advice. The objective of this study was thus to assess the perception of pharmacy professionals towards their current professional roles in the health care system in Dessie, a city in the north-east Ethiopian region.

METHODS

A mixed-methods sequential explanatory study was used to assess the perception of pharmacy professionals towards their professional roles in Dessie city administration from December 15-30, 2019. The study participants were all pharmacy professionals working at health facilities in Dessie. Self-administered questionnaires were used to collect quantitative data, and face-to-face key informant interviews were used for qualitative data collection. Data were entered, processed, and analyzed using SPSS 25.0 statistical software, and thematic analysis was used for the qualitative exploration using QDA Miner Lite software (v2.0.7, free edition version).

RESULT

The study had a 97.7% response rate. Of the 301 participants, 173 (57.5%) were male. Most of the participants had a positive perception, while 38 (12.6%) had a poor perception of their current professional roles. Lack of physical access, poor initiatives, poor communication skills, and a lack of administrative support for pharmaceutical care were statistically significant at a p value of 0.05 and a 95% confidence interval. From the qualitative data, two major themes emerged: perceived roles and determinants (perceived facilitators and barriers).

CONCLUSION

Pharmacy professionals' roles were found to be influenced by a lack of physical access, poor initiatives, poor communication skills, and poor administrator support. Pharmaceutical care requires everyone's involvement in addressing these factors for successful performance and a better outcome and in considering perceived facilitators and barriers.

Multidisciplinary tuberculosis care: leveraging the role of hospital pharmacists

INTRODUCTION

Optimal pharmacological treatment of tuberculosis (TB) requires a multidisciplinary team, yet the hospital pharmacist's role is unclear. We aimed to analyse hospital pharmacist-provided clinical pharmacy services (CPS) implementation in TB care.

METHOD

A nationwide survey-based online cross-sectional study was conducted on hospital pharmacists in Indonesia from 1 November 2022 to 22 November 2022. Outcomes were the extent of pharmacists' involvement in multidisciplinary TB care, TB-related CPS provided and views on TB-related CPS. The probability of pharmacists' involvement in multidisciplinary TB teams was assessed using logistic regression.

RESULTS

In total, 439 pharmacists (mean age 31.2±6.22 years, 78% female) completed the survey. Thirty-six per cent were part of multidisciplinary TB care, and 23% had TB-related tasks. Adherence monitoring (90%) and drug use evaluation (86%) were the most conducted TB-related CPS. Pharmacists' views on TB-related CPS implementation were generally positive, except for financial incentives. Work experience (OR 1.99, 95% CI 1.09 to 3.61), ever received TB-related training (OR 3.51, 95% CI 2.03 to 6.14) and specific assignments to provide TB-related CPS (OR 8.42, 95% CI 4.99 to 14.59) significantly increased pharmacist involvement in multidisciplinary TB care.

CONCLUSION

Around one-third of hospital pharmacists are part of multidisciplinary TB care, with medication adherence and drug use monitoring as primary tasks. Pharmacists' experience, training, assignment to provide TB-related CPS and financial incentives are key elements for further implementation in multidisciplinary TB care. Pharmacists should proactively support current TB care and conduct operational research, sharing data with healthcare peers and fostering a collaborative multidisciplinary TB care team.

Doctor of pharmacy as a career option: a cross-sectional study exploring PharmD students and practitioners expectations in Jordan

OBJECTIVE

This study aimed to (1) investigate the expectations and preferences of PharmD students and practitioners regarding their role in the health care system, and (2) to contrast those expectations and preferences of PharmD practitioners with real-life practice in Jordan.

METHODS

Two cross-sectional descriptive questionnaires were used to collect data from PharmD students and PharmD practitioners in Jordan. A total number of 330 students and 280 practitioners were interviewed. The responses to all questions were encoded, entered, and summarized as frequencies and percentages or as means and standard deviations. Comparisons between groups were performed using Chi-square test. A p-value of < 0.05 was considered significant.

RESULTS

Both PharmD students and practitioners chose working as a clinical pharmacist in a hospital as their first-choice job. However, their second and third jobs choices were significantly different as practitioners opted for income as a main criterion for job selection. Interestingly, salary expectations by PharmD students were significantly higher than the reality as reported by PharmD practitioners. Both students and practitioners placed the work environment as the highest priority criterion for making a work choice on the work environment. In general, both students and practitioners agree on the ideal roles of PharmD graduate with the issues of prescribing and compounding responsibilities being the ones with the highest disparity between practitioners and students. Significant differences were found between the student's and practitioner's perceptions of the ideal role of a PharmD in and the current professional practice in Jordan.

CONCLUSION

Job preferences and salary expectations differ significantly between students and practitioners. Professional orientation of PharmD. students should be implemented to minimize misconceptions of their job nature, availability, and compensations. The fact that students do not prefer to work in a community pharmacy should be addressed by educational institutions and professional organizations. The prescribing and compounding responsibilities of pharmacists should be also emphasized in the curricula of pharmacy schools and worked in by professional organization to achieve optimal implementation in real-life practice.

"Reigns but does not govern": A reflection on professionalism and the autonomy of the pharmacist

INTRODUCTION

In recent decades, the professionalization of pharmacy has been debated worldwide. With the advent of industrialization, pharmacist autonomy has weakened, especially in the retail pharmacy market. Manegers and mentors of pharmacy chains serve as links between the profession and drug users. This study sought to understand the perceptions of retail pharmacy stakeholders regarding pharmacist autonomy and how to improve it, and to reflect on theories of professionalism.

METHOD

19 semi-structured interviews were conducted. The interviews were transcribed and analyzed through analyst triangulation and categorical content analysis, using the ATLAS.ti software.

RESULTS

Interviews were conducted with nine mentors and ten managers in retail medicine. They reported aspects related to managerial and technical autonomy regulated by law, and strategies for enhancing professional autonomy in retail pharmacy. Autonomy was considered limited by pharmacists' dependence on employability and self-devaluation; and market control exposed the weaknesses in pharmaceutical professionalism. Entrepreneurship and ownership attitude strategies were feasible only in a retail micro-political context.

CONCLUSION

The retail medicine continues to have business model centered on the product and controlling the pharmaceutical practice model. To ensure autonomy and professional strengthening, it is necessary that pharmacy recognizes itself as a clinical profession and develops a stable professional identity.

Barriers and facilitators of integration of pharmacists in the provision of clinical pharmacy services in Tanzania

BACKGROUND

Collaboration between medical doctors and nurses in the provision of healthcare services has been there for decades. The concept of clinical pharmacy services as a main goal for pharmacy practice is relatively new and is yielding more positive results for healthcare providers (HCPs), patients, and the health system. This study assessed barriers and facilitators toward the integration of pharmacists in the provision of CPS in Tanzania.

METHODS

A qualitative study was conducted in five tertiary hospitals representing Tanzania mainland. Ten (10) focus group discussions (FGDs) with 83 HCPs and 14 in-depth interviews (IDIs) with hospital administrators in referral hospitals were conducted between August and September 2021. The experienced qualitative researchers moderated the IDIs and FGDs, and all discussions were audio-recorded. Finally, the audios were transcribed verbatim, and analysis was done using a thematic approach.

RESULTS

Limited skills, lack of confidence, poor communication, inferiority, and superiority behaviors among HCPs were among the mentioned barriers. Shortage of pharmacists, lack of in-job training, standard operating procedures (SOPs), and guidelines were also mentioned. The study noted the high acceptability of CPS by other HCPs, the positive perception of pharmacists, and the recognition of CPS by the Tanzania Pharmacy Act and regulation.

CONCLUSION

The facilitators and barriers to the integration of pharmacists in the provision of CPS lie at the individual, health facility, and health system levels. Therefore, the study recommends in-job pharmacists training, fostering teamwork among HCPs, and development of CPS SoPs, and guidelines.

Which factors may influence the implementation of drug dispensing in community pharmacies? A qualitative study

RATIONALE, AIMS AND OBJECTIVES

Implementation of clinical pharmacy services, such as drug dispensing, is a complex process. It is necessary to understand the challenges associated with this practice from the perspective of the actors involved to help ensure optimal service provision. Thus, this study aimed to understand the factors that may influence the implementation of drug dispensing in community pharmacies, according to the perceptions of pharmacists.

METHOD

This qualitative study was based on semistructured, face-to-face interviews. The participants were pharmacists who worked in a chain of community pharmacies in Brazil, selected based on their direct participation in the implementation process. The interview recordings were transcribed full verbatim and were independently analyzed using thematic analysis, followed by consensus meetings between researchers. The factors identified by the participants were classified according to the Apoteca framework. This study was approved by the Committee of Ethics in Research and all participants signed an informed consent form.

RESULTS

We conducted 18 interviews, with 47 factors that may influence the implementation of drug dispensing in community pharmacies being identified. These factors were allocated to seven categories: support from community pharmacy chain (4), pharmacy infrastructure (11), characteristics of the pharmacy, medicines and other health products (4), pharmacist (16), dispensing work process (2), pharmacy team (2) and patient (8). The classification of factors according to the Apoteca framework allocated most of them to administrative (14) and technical (15) domains, followed by attitudinal (13) and political (5) domains.

CONCLUSION(S)

This study identified several factors that can influence the implementation of drug dispensing and classified them according to the domains of the Apoteca framework, highlighting the multifactorial nature of the implementation process. The results of this study can guide the planning of strategies aimed at providing efficient drug dispensing in community pharmacies.

Attitude and perception of pharmacists and healthcare professionals about the criteria used in drug formulary selection in the United Arab Emirates

BACKGROUND

There is lack of both resources and expertise explains the limited extent to which pharmacoeconomic evidence is used in formulary decision-making.

OBJECTIVES

The present study aims to assess attitude and perceptions toward the criteria used to select formulary drugs among UAE healthcare organizations.

METHODS

A descriptive cross-sectional study was conducted amongst the licensed physicians in all specialties, all pharmacists and other healthcare professionals with a minimum of 3 month experience those registered with Ministry of health and prevention and those working in the private sector in the UAE. Participants are sent an email containing a validated web-based electronic link to access the questionnaire. The questionnaire composed of two sections is used to assess the healthcare professionals' attitude and perceptions regarding the criteria used to select formulary drugs. Data analysis were done using SPSS Version 24.

RESULTS

A total of 866 respondents participated in the study and completed the whole questionnaire. The average attitude score about the criteria used in drug formulary selection was 84.5% with a 95% confidence interval (CI) of [83.9%, 85.4%]. Of the total participants, 27 (3.1%) had poor attitude about the criteria used in drug formulary selection, 240 (27.7%) had moderate attitude and 599 (69.2%) had good attitude. The results of statistical modeling showed that education level, area of expertise and age were jointly highly associated with attitude about the criteria used in drug formulary selection.

CONCLUSIONS

The study revealed that pharmacists and Healthcare professionals had a good attitude about the criteria used in drug formulary selection in the United Arab Emirates. This study purposed to provide Emirate pharmacy and therapeutics policy makers with a clear criterion of best practice related to methodological recommendations to help in increasing the utilization and implementation of pharmacoeconomic evidence in the drug formulary selection process.

Implementation of Medication Reconciliation conducted by hospital pharmacists: A case study guided by the Consolidated Framework for Implementation Research

BACKGROUND

Medication reconciliation (MR) implementation in hospital care transitions has proved to be a challenge for health professionals and managers. It points to the need to conduct Implementation Research with a view to understanding the tasks of the real world and knowing how they impact this process. Guided by the Consolidated Framework for Implementation Research (CFIR), this study aims to analyze the factors that influenced the MR implementation process conducted by pharmacists at a hospital setting.

METHODS

A qualitative case study was carried out in the cardiology and gastroenterology units of a teaching hospital in Brazil, involving participant observation and semi-structured interviews with physicians, pharmacists, nurses, nutritionists and a social worker. The CFIR was used to guide data collection and thematic analysis. The constructs were classified according to their influence and strength.

RESULTS

Sixteen health professionals involved directly or indirectly with MR implementation participated in the study. Based on the analysis of the participants' quotes and of the field diary, 18 constructs of the CFIR were identified as influencing MR implementation. The constructs that most strongly influenced MR implementation concerned "Inner Setting", "Characteristics of Individuals" and "Characteristics of Intervention". The participating professionals showed little knowledge of MR and had different points of view on its scope, weakly relating MR to patient safety. The tools used to conduct MR were adapted according to the hospital's needs, thus facilitating its implementation. However, MR proved to be complex and require clinical knowledge and aligned teamwork to identify and resolve undocumented medication discrepancies, being as well intertwined with culture and organizational communication.

CONCLUSIONS

The results point to implementation failures and highlight that MR is a complex intervention, requiring specific knowledge from the multidisciplinary team and alignment with other existing workflows. The barriers and facilitators identified may serve to design and test implementation improvement strategies.

Development and implementation of a medication reconciliation during pediatric transitions of care in a public hospital

OBJECTIVES

To generate effective changes in the work processes of an institution, such as hospitals, strategies are needed for the implementation of services. These should be based on the needs of the practice scenario and evidence that may develop programs applied to the routine of health care. This study aimed to implement medication reconciliation (MR) at the transition of care in the pediatric department of a public hospital located in Northeast Brazil.

SETTING

A step-by-step approach was adopted to implement MR in the studied hospital and conducted from March 2019 to December 2019.

PRACTICE INNOVATION

The implementation of MR used the "Model for Improvement" framework. The processes were built and tested in the Plan-Do-Study-Act (PDSA) cycles. Children admitted to the hospital's pediatrics department were included in the study. The objective of the PDSA cycles was to reach 75% of the patients included, with the service performed in at least one transition of care episode.

EVALUATION

This study used the following indicators: number of steps performed, number of discrepancies identified, and resolution of discrepancies. Descriptive statistical analysis was performed for all variables.

RESULTS

In the first cycle, all patients (n = 34) had the best possible medication history (BPMH) completed, and 26.4% went through all the MR stages. Seventy-two discrepancies were identified and 90.3% of them were resolved. In the second cycle, all patients (n = 35) had the BPMH completed, and 20% went through all the stages. A total of 32 discrepancies were identified and 96.8% of them were resolved. In the third cycle, all patients (n = 30) had the BPMH completed, and 56.6% of patients went through all the stages. Twenty-four discrepancies were identified and resolved.

CONCLUSION

The use of the "Model for Improvement" framework effectively contributed to the implementation of the service according to the characteristics of the studied hospital.

Dose Administration Aid Service in Community Pharmacies: Characterization and Impact Assessment

Adherence to therapies is a primary determinant of treatment success. Lack of medication adherence is often associated with medical and psychosocial issues due to complications from underlying conditions and is an enormous waste of medical resources. Dose Administration Aid Service (DAAS) can be seen as part of the solution, allowing individual medicine doses to be organized according to the dosing schedule determined by the patient’s prescriber. The most recent systematic reviews admit the possibility of a positive impact of this service. In line with this background, the study reported in this paper aimed to characterize DAAS implementation in Portugal and understand the perceptions of pharmacists and owners of community pharmacies regarding the impact of DAAS, preferred methodology types, and State contribution. The study was guided by qualitative description methodology and reported using the consolidated criteria for reporting qualitative research (COREQ) checklist. Data were collected through semi-structured interviews with 18 pharmacists and/or owners of community pharmacies. Using qualitative content analysis, we identified categories that revealed that automated weekly methodology is the preferred methodology, because of its easiness of use and lower cost of preparation. However, the investment cost was felt to be too high by the participants considering the number of potential users for implementation in practice. Participants were also unanimous in recognizing that DAAS has a very positive impact in terms of safety and medication adherence, and the majority agreed that it also helped reduce medication waste. Implications of these findings for medication adherence are discussed.

Food preferences and aversions of patients undergoing chemotherapy, radiotherapy and/or hematopoietic stem cell transplantation

BACKGROUND & AIMS

This longitudinal, qualitative, descriptive, and exploratory study aimed to identify and understand the food preferences and aversions arising from hematopoietic stem cell transplantation (HSCT), chemotherapy, and/or radiotherapy treatment.

METHODS

An open and individual interview was carried out with patients diagnosed with hematological diseases or cancer, submitted to HSCT, chemotherapy, and/or radiotherapy treatment. The participants answered the following questions: "Have you experienced any changes in taste since the beginning of radiotherapy/chemotherapy?"; "Have you experienced any strange taste in your mouth, aversion or preference for a certain food that did not exist before the beginning of radiotherapy/chemotherapy?" The software IRAMUTEQ (R Interface for Multidimensional Analysis of Texts and Questionnaires) version 0.7 alpha 2 was used for textual analysis, with similarity analysis and word cloud.

RESULTS

One hundred and forty six patients were included in the study, 50% (n = 73) female and 73% (n = 50) elderly. The main words reported by the participants in regards to food aversions were "meat", "beef" and "chicken", which are related to dysphagia. Regarding food preferences, the most mentioned words were "fruits", "juices" and "soups", whose consumption was associated with an improvement in gastrointestinal symptoms, especially nausea.

CONCLUSION

Adjustments in the diet plan based on this information can contribute to a better acceptance of the diet, and clinical and nutritional prognosis.

How pharmacists perceive their professional identity: a scoping review and discursive analysis

OBJECTIVES

The objectives of this scoping review were to (a) explore how pharmacists perceive their professional roles and identities and (b) describe factors impacting which professional roles or identities pharmacists embody in different pharmacy practice settings.

METHODS

A scoping review using a deductive approach was undertaken for this study. Systematic searches were conducted in five databases: Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, EBSCO Cumulative Index to Nursing and Allied Health and Scopus (Elsevier). Key words searched included pharmacist, identity, professional role and one variations of these. Results were double-blind screened for relevance by two authors. Data extraction was facilitated by the web-based software platform COVIDENCE. Foucauldian critical discourse analysis was used to deconstruct how pharmacists perceive their professional roles and identities.

KEY FINDINGS

In total, 21 701 articles were retrieved in the search. Following de-duplication and screening, 23 studies from 11 different countries were included. Five major identity themes were identified: Clinician, Dispenser, Business Person, Patient Counsellor and Physician Supporter. The dispenser identity was the most widespread, but it was viewed by many pharmacists as undesirable. The clinician identity also had a strong presence but was viewed as an identity that pharmacists aspire to embody.

CONCLUSIONS

This scoping review illustrates that pharmacists do not uniformly perceive themselves to be clinicians. A significant gap exists between the profession's desired identity and that embodied by practicing pharmacists. The resulting dissonance may be a contributing factor to the lack of wide-scale practice change that the profession has been seeking for decades.

Implementation of clinical pharmacy services using problematization with Maguerez Arc: A quasi-experimental before-after study

RATIONALE, AIMS, AND OBJECTIVES

The growth of clinical pharmacy services (CPS) has positively impacted clinical, economic, and humanistic health outcomes. However, detailed studies on the process of implementing CPS in healthcare systems are incipient. Thus, the present study aimed to evaluate the CPS implementation in certain public health units in a metropolis in northeast Brazil.

METHODS

A quasi-experimental before-and-after study was carried out in Recife City, from July 2015 to March 2016. The study was carried out using the Methodology of Problematization with Maguerez Arc and was divided into: initial evaluation (before), planning, interventions, and preliminary evaluation (after). The participants were pharmacists, patients, health professionals, and local health managers. Descriptive statistics were used to report data. The statistical significance of the comparison between variables was evaluated using the Wilcoxon test (95% CI; P ≤ .05).

RESULTS

Initial evaluation: Identified incipient CPS, a lack of structure and work process of pharmacists. Planning: Sixteen brainstorming meetings were held with the different actors resulting in a strategic plan.

INTERVENTION

Twenty-two political-administrative meetings were held with managers and health teams and 768 hours of theoretical and practical training with mentoring for pharmacists. Preliminary evaluation: Structure indicators presented a statistically significant difference, differently from the process indicators. Pharmacists attended 842 patients and performed 1465 pharmaceutical consultations in 6 months. Regarding the outcome indicators, it was possible to identify changes in the clinical status of the most prevalent diseases among those patients who attended three pharmaceutical consultations.

CONCLUSIONS

It was possible to evaluate the CPS implementation in certain public health units in a metropolis in Brazil, through the Methodology of Problematization with Maguerez Arc. This methodology may be part of models for future implementations of CPS in health systems.

Pharmacy Services beyond the Basics: A Qualitative Study to Explore Perspectives of Pharmacists towards Basic and Enhanced Pharmacy Services in Pakistan

Enhanced pharmacy services have been identified as a mechanism to address medicines and drug-related problems. The aim of the study was to explore the perspectives of practicing pharmacists on the scope of pharmacy service provision in Pakistan. This qualitative study was conducted at the Department of Pharmacy, the Islamia University of Bahawalpur (IUB). Face-to-face, in-depth interviews were conducted with practicing pharmacists at the university who were undertaking postgraduate studies. All interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. A total of 13 pharmacists were interviewed. The analysis of data yielded four themes and 12 subthemes. The themes included the current scenario of pharmacy services, the benefits of pharmacy services, barriers to implementation of pharmacy services, and strategies to improve their delivery. Pharmacist participants reported that patient-oriented pharmacy services have not been properly implemented in Pakistan. Pharmacists appear to be undertaking only conventional roles at various levels within the healthcare system. The participants indicated multiple benefits of patient-oriented pharmacy services, including safe and effective use of medicines, minimization of drug-related problems, and financial benefits to the healthcare system. Based on the findings, policy-makers are required to take the necessary steps to overcome pharmacist-related and policy-related barriers associated with the implementation of patient-oriented pharmacy services in Pakistan.

Perceived barriers to the implementation of clinical pharmacy services in a metropolis in Northeast Brazil

BACKGROUND

CLinical pharmacy services (CPS) are professional services provided by pharmacists, who use their skills and knowledge to take an active role in patient health. These services have expanded in health systems around the world. However, it is important to have a comprehensive understanding of factors that may hinder the implementation of CPS in health systems.

OBJECTIVE

To identify pharmacists' and managers' perceptions of barriers regarding the implementation of CPS in some public health units in a metropolis in Northeast Brazil.

METHODS

This is a qualitative study based on focus groups and semi-structured, face-to-face, in-depth interviews. Participants were health-system pharmacists and managers, selected based on their direct participation in the implementation process. Focus groups were carried out with the pharmacists, and interviews were carried out with managers. The audio and videos were transcribed verbatim in full, and were independently analyzed using content analysis. This study was approved by the Brazilian Committee of Ethics in Research and all participants signed informed consent forms.

FINDINGS

There were two focus groups and five interviews. The discussions generated 240 minutes of recordings. The health-system pharmacists and managers expressed barriers were allocated into five categories to facilitate a comprehensive understanding of the implementation of CPS; these barriers were related to: the local healthcare networks, the healthcare team, the pharmacists, the implementation process, and the patients.

CONCLUSIONS

This study revealed the perceptions of barriers associated with the participants involved in the implementation of CPS in some public health units in a metropolis in Northeast Brazil. The barriers reflect the challenges to be overcome in the CPS implementation process in the health systems.

Evaluation of students' attitudes towards pharmacist-physician collaboration in Brazil

OBJECTIVE

To measure undergraduate pharmacy and medical students' collaborative attitudes regarding Pharmacist-Physician collaboration.

METHODS

A cross-sectional descriptive study was conducted from September 2016 to February 2017 in Northeast Brazil. Pharmacy and medical students from the first and the last year of courses were invited to complete Portuguese version of Scale of Attitudes Toward Pharmacist-Physician Collaboration (SATP2C). Descriptive and comparative analyses were performed using IBM SPSS (22 version). Differences were considered significant when p<0.05.

RESULTS

Three hundred seventy students completed the SATP2C. Overall, the students had positive attitudes towards physician-pharmacist collaboration. There was no significant correlation between age and score (p=0.79). Women showed a more positive collaborative attitude than men (53.1, SD=6.8 vs. 55.1, SD=6.3). Pharmacy students had a higher score than medical students (57.5, SD=4.7, vs. 51.1, SD=6.4). The first-year medical students had a higher score than last-year medical students (52.3, SD=6.0 vs. 49.5, SD=6.6; p<0.007). There was no significant difference in the attitudes between the first and last year pharmacy students (p<0.007).

CONCLUSIONS

Pharmacy and medical students showed positive attitudes towards physician-pharmacist collaboration. However, pharmacy students presented more collaborative attitudes than medical ones. Additionally, the first-year medical students had more collaborative attitudes than last-year medical students. Studies should be conducted to provide recommendations to improve interprofessional education efforts to further enhance the positive attitudes toward physician-pharmacist collaboration.

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

Background

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

Methods

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

Results

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

Conclusions

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

Electronic supplementary material

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