Examining influences of pharmacists' communication with consumers about antibiotics

Pharmacist Intention to Provide Medication Therapy Management Services in Saudi Arabia: A Study Using the Theory of Planned Behaviour

Medication therapy management (MTM) is provided by pharmacists and other healthcare providers, improves patient health status, and increases the collaboration of MTM providers with others. However, little is known about pharmacists’ intention to provide MTM services in Saudi Arabia. This study aimed to predict the pharmacists’ willingness in this nation to commit to providing MTM services there. This study used a cross-sectional questionnaire based on the theory of planned behaviour (TPB). The survey was distributed to 149 pharmacists working in hospital and community pharmacies. It included items measuring pharmacist attitudes, intentions, subjective norms, perceived behavioural control, knowledge about the provision of MTM services, and other sociodemographic and pharmacy practice-related items. The pharmacists had a positive attitude towards MTM services (mean = 6.15 ± 1.12) and strong intention (mean = 6.09 ± 1.15), highly perceived social pressure to provide those services (mean = 5.42 ± 1.03), strongly perceived control over providing those services (mean = 4.98 ± 1.05), and had good MTM knowledge (mean = 5.03 ± 1.00). Pharmacists who completed a pharmacy residency programme and had good knowledge of MTM services and a positive attitude towards them usually strongly intended to provide MTM services. Thus, encouraging pharmacists to complete pharmacy residency programmes and educating them about the importance and provision of MTM services will enhance their motivation to provide them.

Knowledge, Perceptions and Practices of Community Pharmacists Towards Antimicrobial Stewardship: A Systematic Scoping Review

The scope of antimicrobial stewardship (AMS) surveys on community pharmacists (CPs) is uncertain. This study examines the breadth and quality of AMS survey tools measuring the stewardship knowledge, perceptions and practices (KPP) of CPs and analyse survey outcomes. Following PRISMA-ScR checklist and Arksey and O’Malley’s methodological framework seven medical databases were searched. Two reviewers independently screened the literatures, assessed quality of surveys and KPP outcomes were analysed and described. Ten surveys were identified that assessed CPs’ AMS perceptions (n = 7) and practices (n = 8) but none that assessed AMS knowledge. Three survey tools had been formally validated. Most CPs perceived that AMS improved patient care (median 86.0%, IQR, 83.3–93.5%, n = 6), and reduced inappropriate antibiotic use (84.0%, IQR, 83–85%, n = 2). CPs collaborated with prescribers for infection control (54.7%, IQR 34.8–63.2%, n = 4) and for uncertain antibiotic treatment (77.0%, IQR 55.2–77.8%, n = 5). CPs educated patients (53.0%, IQR, 43.2–67.4%, n = 5) and screened guideline-compliance of antimicrobial prescriptions (47.5%, IQR, 25.2–58.3%, n = 3). Guidelines, training, interactions with prescribers, and reimbursement models were major barriers to CP-led AMS implementation. A limited number of validated survey tools are available to assess AMS perceptions and practices of CPs. AMS survey tools require further development to assess stewardship knowledge, stewardship targets, and implementation by CPs.

The drivers of antibiotic use and misuse: the development and investigation of a theory driven community measure

Background

Antimicrobial resistance is a global public health concern, with extensive associated health and economic implications. Actions to slow and contain the development of resistance are imperative. Despite the fact that overuse and misuse of antibiotics are highlighted as major contributing factors to this resistance, no sufficiently validated measures aiming to investigate the drivers behind consumer behaviour amongst the general population are available. The objective of this study was to develop and investigate the psychometric properties of an original, novel and multiple-item questionnaire, informed by the Theory of Planned Behaviour, to measure factors contributing to self-reported antibiotic use within the community.

Method

A three-phase process was employed, including literature review and item generation; expert panel review; and pre-test. Investigation of the questionnaire was subsequently conducted through a cross-sectional, anonymous survey. Orthogonal principal analysis with varimax rotation, cronbach alpha and linear mixed-effects modelling analyses were conducted. A 60 item questionnaire was produced encompassing demographics, social desirability, three constructs of the Theory of Planned Behaviour including: attitudes and beliefs; subjective norm; perceived behavioural control; behaviour; and a covariate – knowledge.

Results

Three hundred seventy-three participants completed the survey. Eighty participants (21%) were excluded due to social desirability concerns, with data from the remaining 293 participants analysed. Results showed modest but acceptable levels of internal reliability, with high inter-item correlations within each construct. All four variables and the outcome variable of antibiotic use behaviour comprised four items with the exception of social norms, for which there were two items, producing a final 18 item questionnaire. Perceived behavioural control, social norms, the interaction between attitudes and beliefs and knowledge, and the presence of a healthcare worker in the family were all significant predictors of antibiotic use behaviour. All other predictors tested produced a nonsignificant relationship with the outcome variable of self-reported antibiotic use.

Conclusion

This study successfully developed and validated a novel tool which assesses factors influencing community antibiotic use and misuse. The questionnaire can be used to guide appropriate intervention strategies to reduce antibiotic misuse in the general population. Future research is required to assess the extent to which this tool can guide community-based intervention strategies.

Links Between Perceptions and Practices in Patient Education: A Systematic Review

Background. Two decades after "patient education" was defined by the World Health Organization, its integration in health care practices remains a challenge. Perceptions might shed light on these implementation difficulties. This systematic review aims to investigate links between perceptions and patient education practices among health care professionals, paying particular attention to the quality of practices in order to highlight any associated perception. Method. PubMed, PsycINFO, and Scopus were searched using the following search terms: "perceptions," "patient education," "health care professionals," and "professional practices." PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used. Results. Twenty studies were included. Overall findings supported the existence of links between some perceptions and practices. Links were either correlational or "causal" (generally in a single direction: perceptions affecting practices). Four types of perceptions (perceptions of the task including patient education, perceptions about the patient, perceptions of oneself as a health care professional, and perceptions of the context) were identified as being linked with educational practices. Links can although be mediated by other factors. Results concerning links should, however, be considered with caution as practices were mostly assessed by prevalence measurements, were self-reported and concerned exclusively individual education. When analyzing the quality of practices, the two retained studies highlighted their changing nature and the central role of perceptions with respect to the individual patient. Conclusions. This literature review led us to specify the quality criteria for further research: covering the entire spectrum of patient education, operationalizing variables, exploring specific practices, measuring the quality of practices, developing designs that facilitate causation findings, and considering a bidirectional perspective.

Qualitative Investigation of Community Pharmacy Immunization Enhancement Program Implementation

Background: Despite widely available nonseasonal immunization services in community pharmacies, actual pharmacist-administered vaccines are not yet optimal. A flexible choice multicomponent intervention, the “We Immunize” program, was implemented in Alabama and California community pharmacies, with the goal to enhance pneumococcal and zoster immunization delivery. Limited research has been done to qualitatively understand factors influencing immunization service expansion. Objective: Explore pharmacist perceptions of the We Immunize program in terms of its acceptability, impact, and real-world feasibility, and pharmacist-perceived facilitators and barriers influencing success in immunization delivery enhancement. Methods: This practice-focused qualitative research used semistructured telephone interviews with 14 pharmacists at the completion of the 6-month intervention. Results: Major program implementation facilitators were technician inclusion, workflow changes, training and feedback, goal setting, and enhanced personal selling and marketing activities. Multiple pharmacies increased the number of delivered pneumococcal and zoster immunizations, and increased revenue. Many pharmacists felt professional image, knowledge, skills, roles, and personal satisfaction were enhanced, as were technician knowledge, skills, and roles. Program flexibility, along with multiple perceived benefits, increases the potential for success. Conclusions: The We Immunize program appears to have been viewed positively by participating pharmacists and was seen as having a beneficial impact on immunization delivery in the community pharmacies in which it was implemented.

A qualitative study of pharmacists' perceptions of, and recommendations for improvement of antibiotic use in Qatar

BACKGROUND

Use of antibiotics has been correlated with increasing rates of resistance. Pharmacists are ideally positioned as front line health care providers to limit indiscriminate antibiotic use and promote the safe and effective administration of these medications.

OBJECTIVE

The aim of this project was to assess pharmacists' opinions relating to antibiotic utilization in the community setting.

SETTING

Doha, Qatar.

METHOD

Community and primary care pharmacists were invited to participate in one of three focus groups or a semi-structured interview at Qatar University or at their site of employment. A total of 22 community and primary care pharmacists participated in this study. Interviews were facilitated using a focus group guide, were recorded, and later transcribed. Transcripts were reviewed for recurring themes and coded using Nvivo software for qualitative research.

MAIN OUTCOME MEASURE

Pharmacists' perceptions.

RESULTS

Five major themes emerged from a series of focus groups and interviews. Themes which recurred across interview groups included: misconceptions and inappropriate practices by patients and healthcare providers, currently implemented strategies, perceived barriers, ways to overcome perceived barriers, and targets for improvement of antibiotic use in Qatar. The greatest need, as identified by pharmacists in this study was increased knowledge of the general population about appropriate antibiotic use through various educational interventions.

CONCLUSION

Pharmacists report a number of misconceptions and inappropriate practices relating to antibiotic use in Qatar by patients and healthcare providers. Education to improve knowledge of appropriate antibiotic use is needed. Despite recognition of these issues, barriers are preventing pharmacists from implementing strategies to improve antibiotic use in Qatar.

Community pharmacies automation: any impact on counselling duration and job satisfaction?

BACKGROUND

One key indicator of the quality of health practitioners-patient interaction is the encounters' duration. Automation have been presented as beneficial to pharmacy staff work with patients and thus with a potential impact on pharmacists' and technicians' job satisfaction.

OBJECTIVE

To compare the interaction length between pharmacy staff and patients, as well as their job satisfaction, in community pharmacies with and without automation.

SETTING

Portuguese community pharmacies with and without automation.

METHODS

This cross-sectional study followed a quasi-experimental design, divided in two phases. In the first, paired community pharmacies with and without automation were purposively selected for a non-participant overt observation. The second phase comprised a job satisfaction questionnaire of both pharmacists and technical staff. Practitioners and patients demographic and interactional data, as well as job satisfaction, were statistically compared across automation.

MAIN OUTCOME MEASURE

Interaction length and job satisfaction.

RESULTS

Sixty-eight practitioners from 10 automated and non-automated pharmacies produced 721 registered interaction episodes. Automation had no significant influence in interaction duration, controlling for gender and professional categories, being significantly longer with older patients (p = 0.017). On average, staff working at the pharmacy counter had 45 % of free time from direct patient contact. The mean overall satisfaction in this sample was 5.52 (SD = 0.98) out of a maximum score of seven, with no significant differences with automation as well as between professional categories, only with a significant lower job satisfaction for younger pharmacists.

CONCLUSION

As with previous studies in other settings, duration of the interactions was not influenced by pharmacy automation, as well as practitioners' job satisfaction, while practitioners' time constrains seem to be a subjective perception.

Examination of psychosocial predictors of Virginia pharmacists' intention to utilize a prescription drug monitoring program using the theory of planned behavior

BACKGROUND

Little is known about the main drivers of pharmacists' intention to utilize prescription drug monitoring programs (PDMPs) when making care decisions and the actual contribution of these factors in explaining intention and behavior.

OBJECTIVES

This study examined what theory of planned behavior (TPB) model constructs (i.e., attitude, subjective norm [SN], perceived behavioral control [PBC]), past utilization behavior (PUB) and perceived moral obligation (PMO) were significant predictors of Virginia community pharmacists' intention to utilize a PDMP.

METHODS

A cover letter with a link to a 28-item online survey was e-mailed to 600 members of the Virginia Pharmacists Association. Multiple regression analyses were used to determine the association between pharmacists' intention to utilize the PDMP database and attitude, SN, PBC, PUB and PMO.

RESULTS

Ninety-seven usable responses were received, for a response rate of 16.2%. A majority of the respondents were Caucasian (96.4%), female (50.5%), working in independent community pharmacies (60.4%) with an average age of 49.5 ± 13.4 years. Overall, pharmacists intended to utilize a PDMP (mean = 5.3 ± 4.6; possible range: -9 to 9), had a positive attitude toward utilizing PDMP (mean = 6.3 ± 5.3; possible range: -12 to 12), perceived that others wanted them to utilize a PDMP (SN score = 3.7 ± 2.4; range: -6 to 6), and believed that they had control over utilization behavior (PBC score = 4.5 ± 4.0; range: -9 to 9). Attitude (β = 0.723, P < 0.001), SN (β = 0.230, P = 0.014) and PBC (β = -0.215, P = 0.026) significantly predicted pharmacists' intent, accounting for 56.7% of the variance in intention to utilize the PDMP database (P < 0.001). The addition of PMO (P < 0.001) significantly contributed to explaining the variance in intention but PUB did not.

CONCLUSIONS

Members of the Virginia Pharmacists Association who responded to the survey showed a strong positive intent to utilize PDMP database. Pharmacists' attitudes, subjective norm, perceived behavioral control and perceived moral obligation were significant predictors of intention but past utilization behavior was not. The TPB is a useful theoretical framework when predicting PDMP utilization behavior of community pharmacists, accounting for 56.7% of the variance in intention.

Pharmacy students' attitudes toward reporting serious adverse drug events

OBJECTIVES

To determine pharmacy students' attitude toward and knowledge of reporting serious adverse drug events (ADEs) to the Food and Drug Administration (FDA).

METHOD

A 58-item survey questionnaire constructed to measure respondents' intention to report ADEs (3 items), attitude toward reporting ADEs (20 items), knowledge of ADE reporting (9 items), and demographic data was administered to all third-year (final-year) pharmacy students at the Appalachian College of Pharmacy.

RESULTS

The majority of the 58 students who responded (91% response rate) intended (84%) and planned (85.3%) to report serious ADEs when they encounter them. Most respondents had favorable attitudes toward reporting serious ADEs to the FDA; respondents believed that reporting serious ADEs was valuable (5.6 ± 1.5, mean ± SD), good (3.0 ± 1.7), and beneficial (5.7 ± 1.5). Many students also believed that ADE reporting resulted in increased risk of malpractice, compromised relationships with physicians, broken trust with patients, disruption of the normal workflow, and was time consuming. Many students had inadequate knowledge on reporting ADEs.

CONCLUSION

Although pharmacy students had strong intentions and favorable attitudes toward ADE reporting, they had inadequate knowledge of how to report serious ADEs.

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.

Influence of attitudes on pharmacists' intention to report serious adverse drug events to the Food and Drug Administration

AIM

To investigate the influence of pharmacists' attitudes on intention to report serious adverse drug events (ADEs) to the Food and Drug Administration (FDA).

METHODS

This cross-sectional study used a mail survey to collect data from hospital and community pharmacists practicing in Texas, United States. Three and 16 items were used to measure intention and attitudes, respectively, using a seven-point bipolar scale. Pharmacists' demographic and practice characteristics, and past reporting were also measured.

RESULTS

The response rate was 26.4% (n= 377/1500 pharmacists). Most pharmacists intended (n= 297, 78.8%) to report serious ADEs that they will encounter to the FDA through MedWatch. Overall, pharmacists held favourable attitudes towards reporting serious ADEs (mean = 24.5, SD = 6.7, possible range 1-49, neutral = 16). Pharmacists intending to report serious ADEs had more favourable attitudes than those who did not (P < 0.001). About 90% of the pharmacists believed that reporting serious ADEs would improve patient safety. However, 72.6% indicated that reporting serious ADEs was time consuming and over half (55.5%) of the respondents believed that reporting serious ADEs disrupted the normal workflow. Non-intenders held stronger beliefs that ADE reporting would disrupt the normal workflow and was time consuming compared with intenders. Years of experience, number of hours worked and practice setting were associated with pharmacists' attitudes towards reporting (P < 0.05).

CONCLUSIONS

Most pharmacists held moderately favourable attitudes and high intentions toward reporting serious ADEs to the FDA. This study's findings contribute to an increased understanding of individual factors that influence pharmacists' attitude and intention towards reporting serious ADEs to the FDA.

Understanding medication safety in healthcare settings: a critical review of conceptual models

Understanding medication safety in healthcare settings: a critical review of conceptual models Communication can impact on the way in which medications are managed across healthcare settings. Organisational cultures and the environmental context provide an added complexity to how communication occurs in practice. The aims of this paper are: to examine six models relating to medication safety in various hospital and community settings, to consider the strengths and limitations of each model and to explore their applications to medication safety practices. The models examined for their ability to address the complexity of the medication communication process include causal models, such as the Human Error Model and the System Analysis to Clinical Incidents Model, and exploratory models, such as the Shared Decision-Making Model, the Medication Decision-Making and Management Model, the Partnership Model and the Medication Communication Model. The Medication Communication Model provides particular insights into possible interactions between aspects that influence medication safety practices. The implications of all six models for healthcare practice and future research are also discussed.

A Needs Assessment for Development and Provision of Medication Therapy Management Services in New York City

Objectives: To (1) assess the current extent of medication therapy management (MTM) provision in NYC; (2) investigate New York City pharmacists' attitudes, efforts, interest, and challenges in providing MTM; and 3) examine factors influencing pharmacist interest in providing MTM. Methods: A cross-sectional design was utilized to survey New York City pharmacists attending a continuing education program. The survey questionnaire contained items pertaining to the extent of MTM currently provided by the pharmacists, attitudes, efforts, and interest in providing MTM and challenges to provision of MTM. Results: A total of 93 out of 123 attendees (73.81%) completed the survey. Pharmacists provided an average of 1.65 (±0.36) MTM services as defined by the APhA and NACDS framework. Pharmacists had slightly positive attitudes toward provision of MTM and were very interested in providing some MTM services. There was a positive correlation between pharmacist attitude toward MTM and interest in providing MTM ( r = .31, P = .016). Of all the 6 challenges to provision of MTM listed in the survey, respondents indicated that additional time to be spent with patients and additional pharmacists would be the most difficult to overcome. Conclusions: This study serves as an assessment of the needs of New York City pharmacists with regard to provision of MTM services.

Perceived barriers to provision of medication therapy management services (MTMS) and the likelihood of a pharmacist to work in a pharmacy that provides MTMS

BACKGROUND

Recently, medication therapy management services (MTMS) has gained significant attention as an important type of pharmaceutical care designed to improve patient outcomes with more appropriate medication usage and monitoring. Although the provision of MTMS is increasing in pharmacies across the nation, and pharmacists are well equipped to administer MTMS, many community pharmacists are not currently providing these services.

OBJECTIVE

To determine barriers to provision of MTMS perceived by pharmacists and factors associated with the likelihood of working in a pharmacy that provides MTMS.

METHODS

Surveys were mailed to 906 community pharmacists licensed in West Virginia using a stratified random sample. The instrument was constructed and finalized following a review by experts and pilot tested in a convenience sample of pharmacists. Principal components analysis was performed to determine the factors that describe perceived barriers to provision of MTMS. Discriminant analysis using factor scores and other demographic and practice variables was performed to predict respondents' likelihood to work in a pharmacy that provides MTMS.

RESULTS

A 3-factor model was extracted from the responses, which explained 53.3% of the total variance. The factors included perceived ability to respond to patient interest, pharmacy-related factors, and enabling factors. The discriminant function correctly classified 76.2% of cases and included comfort level with provision of services, perceived value of services to patients, perceived ability to respond to patient interest, and whether they currently offer MTMS. These variables were all positively correlated with pharmacists' likelihood of working in a pharmacy that provides MTMS.

CONCLUSIONS

Comfort level and ability are important factors that influence pharmacists' likelihood of working in a pharmacy that provides MTMS. These findings highlight the importance of advanced practice experiences, certificate programs, and residencies to build pharmacists' confidence, and the role of targeted recruitment to attract pharmacists to community pharmacies that provide MTMS.

Physician-patient and pharmacist-patient communication: geriatrics' perceptions and opinions

OBJECTIVE

Earlier research examined the perceptions of the pharmacist-patient relationship quality using data from a systematic random sample of non-institutionalized elderly in the United States. The purposes of this study were to determine: (1) how the findings of this study, conducted in a culturally diverse urban area in Queens, New York, compare with the earlier study; (2) how community-dwelling elderly patients in a metropolitan area perceive their relationship with the pharmacist compared to the physician; and (3) the extent to which their perceived relationship quality predicts medication-related knowledge, medication-related outcomes, and self-efficacy for medication management.

METHODS

One hundred and twenty-one elderly individuals aged 65 and over who took at least one prescription medication, selected from three senior centers, participated in the study. Of the total responses, 102 were useable.

RESULTS

Our sample demonstrated significantly lower levels of perceived quality of relationship with their pharmacist compared to earlier research. In contrast, the participants in this study perceived a better quality of relationship with their physicians than pharmacists. Further, the quality of relationship with physician predicted medication-related knowledge, medication-related outcome expectations, and self-efficacy for medication management.

CONCLUSION

The findings of this study suggest that pharmacists still have a way to go to fully meet patients' healthcare needs, particularly in culturally diverse urban settings.

PRACTICE IMPLICATIONS

Further research is needed to examine ways to improve pharmacist-patient interactions and, therefore, patients' perceptions of pharmacists.

Strategic use of communication to market cancer prevention and control to vulnerable populations

There are significant challenges to communicating relevant cancer prevention and control information to health care consumers due both to the complexities of the health information to be communicated and the complexities of health communication, especially with vulnerable populations. The need for effective communication about cancer risks, early detection, prevention, care, and survivorship is particularly acute, yet also tremendously complex, for reaching vulnerable populations, those groups of people who are most likely to suffer significantly higher levels of morbidity and mortality from cancers than other segments of the population. These vulnerable populations, typically the poorest, lowest educated, and most disenfranchised members of modern society, are heir to serious cancer-related health disparities. Vulnerable populations often have health literacy difficulties, cultural barriers, and economic challenges to accessing and making sense of relevant health information. This paper examines these challenges to communicating relevant information to vulnerable populations and suggests strategies for effectively using different communication media for marketing cancer prevention and control to reduce health disparities and promote public health.

Conceptualizing and measuring pharmacist-patient communication: a review of published studies

BACKGROUND

Pharmacist-patient communication in community pharmacies has been studied for over 25 years with little effort to evaluate this research comprehensively.

OBJECTIVE

The main objective of this review is to examine and summarize how researchers have conceptualized, defined, and measured pharmacist-patient communication across studies and identify gaps in the literature.

METHODS

Articles were compiled from a search of (1) Medline, IPA, CINAHL, and PubMed databases using the keywords, "counseling", "patient communication", "patient counseling", "patient education", "patient consult( *)", and/or "pharmacists", (2) bibliographies of selected articles. The search generated 56 studies on community pharmacy, of which 39 studies met the inclusion criteria.

RESULTS

Most studies (72%) have used the term patient counseling, although pharmacist-patient communication and patient education were also used. The definition of patient counseling varies across studies. Almost half of the studies (49%) conceptualized pharmacist-patient communication solely as a pharmacist information provision activity. A total of 16 studies (41%) also focused on pharmacists' interpersonal behavior in addition to the information provision activity of the pharmacist. In contrast, patient communication behavior and the exchange process between both parties has been understudied. A total of 16 studies (41%) used a retrospective design. All studies used a cross-sectional design, with varying modes of data collection such as mail surveys, telephone interviews, nonparticipant observation, and shopper studies. Taped encounters are rare. SUMMARY/IMPLICATIONS: This review revealed that most studies have focused on a one way communication of pharmacists to patients. A need for examining the patient-pharmacist dyad is apparent. Future research could explore a greater use of taped encounters to analyze the interactive communication process, affective components of communication such as collaborative problem solving, interpersonal relationship development, and the expertise that patients bring into the encounter.

Stepping back from social norms campaigns: comparing normative influences to other predictors of health behaviors

Recent health campaigns on college campuses have used a social norms approach, which suggests that one's perceptions of others' attitudes and behaviors are the key components in attitude and behavior change. However, the efficacy of social norms campaigns has been mixed. This study was conducted to assess the relationships among sociodemographics, normative perceptions, and individual attitudes on 3 health behaviors. Students at 2 universities (N = 393) completed questionnaires assessing how these variables related to their consumption of alcohol, tobacco use, and exercise behaviors. Regressions indicated that each of these variables was associated with behavior, but varied independent variables emerged as the salient predictors among behaviors. In several conditions the effect of normative perceptions on behaviors was not significant, a finding in direct opposition to social norms marketing. In all 3 behavioral conditions, the variable accounting for the greatest variance was whether or not the individual liked participating in that particular behavior. Thus, although some social norms marketing may be meeting with success, it may be the case that predicted attitudinal and behavioral changes will not be found when applied across diverse health topics.

IV to Oral Conversion Programs for Anti-Infectives in the United States: Prevalence and Characteristics

Purpose

Despite the documented success of IV to oral anti-infective conversion programs, it is still unclear what the current standard of practice is in the US. A survey was conducted to evaluate the prevalence and characteristics of conversion programs throughout the nation.

Methods

A questionnaire was mailed to 890 randomly chosen hospital pharmacy directors. A preset cutoff date of 4 weeks from the initial mailing was set for responses; a second mailing was sent to those directors that did not respond initially.

Results

A total of 237 (27%) institutions responded. Of these, 74% had instituted conversion programs. More programs required prior physician notification compared with allowing pharmacists to proactively transition candidates (70% vs 30%, P < 0.001). The most common anti-infectives converted were the fluoroquinolones and fluconazole. Common conversion criteria included adequate oral intake and fever reduction. Characteristics associated with an increased likelihood of a conversion program were pharmacy residency programs (RR 1.3; 95% CI 1.132 to 1.477), clinical pharmacists (RR 1.6; 95% CI 1.262 to 2.123), ID specialty pharmacists (RR 1.3; 95% CI 1.153 to 1.499), ID physician consult service (RR 1.2; 95% CI 1.028 to 1.459), and teaching hospitals (RR 1.2; 95% CI 1.038 to 1.386). Hospitals with conversion programs employed a greater number of clinical pharmacists (P = 0.02). Multivariate analysis revealed that the presence of a clinical pharmacist was the most significant variable predicting implementation (P < 0.001).

Conclusion

The majority of hospitals responding to this survey had an intravenous to oral conversion program. While most programs still required prior physician notification, the presence of clinical pharmacists significantly influenced the prevalence of implementation and proactive transition.