The Impact of Technology on Safe Medicines Use and Pharmacy Practice in the US

The approach of Norm Balance in predicting pharmacists' intention to collaborate with physicians to improve medication therapy

Objective

Norm Balance is an approach under the Theory of Planned Behavior (TPB) where subjective norm is weighted by the relative importance of others and self-identity is weighted by the relative importance of self. The relative importance was measured previously by a trade-off measure. In this study, we developed separate measures for the relative importance. The study objectives were to: 1) assess the construct validity of the separate measures; 2) examine the approach of Norm Balance in predicting pharmacists' intention to collaborate with physicians to improve medication therapy; and 3) establish a modified TPB.

Methods

We selected a random sample of 750 Iowa pharmacists and conducted two surveys. The first survey was to examine intention prediction, and the second survey was to examine behavior prediction by measuring behavior among respondents to the first survey. The relative importance was measured by both the trade-off measure and the separate measures. Exploratory factor analyses were performed for the relative importance of others (separate measures) and subjective norm, and for the relative importance of self (separate measures) and self-identity. Regressions for intention prediction were conducted for TPB with self-identity and the approach of Norm Balance. The same regressions were also conducted for three subgroups according to the median of the relative importance of others (trade-off measure). Moreover, another regression was conducted for behavior prediction.

Results

239 practicing pharmacists responded to the first survey, and 188 responded to the second survey. The separate measures had cross factor loadings, whereas the trade-off measure had low correlations with other constructs. Both regressions for intention prediction explained 75% of the variance, with self-efficacy and attitude being strong predictors. Self-identity was not a predictor in the TPB with self-identify, but self-identity weighted by the relative importance of self was a significant predictor in the approach of Norm Balance. Regression coefficients of subjective norm and self-identify varied across subgroups. The regression for behavior prediction explained 30% of the variance, with intention and self-efficacy being two predictors.

Conclusion

The trade-off measure was better than separate measures. The approach of Norm Balance appears to be a better model than the TPB with self-identity to examine pharmacist-physician collaboration.

The Role of Artificial Intelligence in the Future of Pharmacy Education

Recent developments making an artificial intelligence (AI) large language model available for public use have generated significant interest and angst among educators. Viewed as both a time saver and a threat to academic integrity, several questions have arisen about AI's role in education. Numerous opportunities exist to use AI for teaching and learning, but new questions have also arisen regarding AI's impact on the future of healthcare. The pharmacy Academy should be at the center of these discussions to address the technical, philosophical, and ethical issues that AI presents for the future of pharmacy and pharmacy education.

Impact of the Fourth Industrial Revolution on clinical pharmaceutical services: A scoping review

BACKGROUND

Digital technologies are becoming increasingly sophisticated and integrated, but the scope of the Fourth Industrial Revolution (4IR) is wider: technologies and innovations are diffusing faster and more widely. Despite the extensive use of telepharmacy technology by patients and pharmacists, there is an absence of research that examines the use of telepharmacy.

OBJECTIVE

To investigate the current evidence concerning the impact of the 4IR on the provision of pharmaceutical services.

METHODS

A scoping review based on the PCC (Population, Concept, and Context) mnemonic was conducted in Pubmed, Scopus and Web of Science. Population included pharmacist/clinical pharmaceutical services, the concept referred to the 4IR and the context was open. Electronic searches retrieved 8,694 articles that were screened by titles and abstracts. The search yielded 59 studies that were analyzed in terms of country of focus, publication year, type of publication, main technologies, types of pharmacy services, and the role of the Fourth Industrial Revolution.

RESULTS

Most of the included studies were conducted in the United States and were published between 2005 and 2021, with the highest number of publications in the year of 2021. The majority of included articles were observational studies. Technologies addressed in the studies were those within the scope of telepharmacy, and most of the articles discussed more than one pharmaceutical service, with medication therapy management as the most frequent.

CONCLUSIONS

The Covid-19 pandemic accelerated the use of technologies, identifying promising niches for pharmacists in the field of Pharmaceutical Care. This should encourage pharmacists to fortify their capacity to adopt new technologies in the provision of pharmaceutical services. The frequent use of various technologies has been demonstrated, which indicates the exigency for further health education actions by the pharmacist.

Impact of automated drug dispensing system on patient safety

Objectives

Automated drug dispensing system (ADDs) is an emerging technology positively impacts drug dispensing efficiency by minimizing medication errors. However, the pharmacist perception of the impact of ADDs on patient safety is not well-established. This cross-sectional observational study aimed to evaluate the dispensing practice and pharmacist perception of ADDs towards patient safety through a validated questionnaire.

Methods

A self-designed questionnaire was validated and the pharmacist perception of dispensing practice was compared between two hospitals adopting ADDs and traditional drug dispensing system (TDDs).

Results

The developed questionnaire had an excellent internal consistency (both Cronbach's α and McDonald's ω coefficients were >0.9). Factor analysis retained three significant factors (subscales) that explained pharmacist perception of dispensing system, dispensing practice, and patient counseling (p<0.001 for each factor). The average number of prescriptions dispensed per day, drugs contained in each prescription, average time for labeling each prescription and inventory management were significantly varied between ADDs and TDDs (p=0.027, 0.013 0.044 and 0.004, respectively). The perception of pharmacists using ADDs on three domains were higher than the TDDs. The pharmacists in ADDs agreed that they had enough time to review the medications before dispensing than TDDs and this difference was found to be statistically significant (p=0.028).

Conclusions

ADDs was highly effective in improving dispensing practice and medication review; however, the pharmacists need to emphasize the importance of ADDs to translate the pharmacists' freed-time towards patient care.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Exploring Canadian pharmacy students' e-health literacy: a mixed method study

Background:

While much has been described about technology use by digital natives in general, understanding of pharmacy student’s knowledge and understanding of technology is lacking.

Objective:

This study explores the current state of pharmacy students’ self-rated digital health literacy in British Columbia, Canada, and seeks to identify future opportunities for technology training in pharmacy education and in practice.

Methods:

A mixed methods design using surveys and semi-structured interviews was conducted. An online, validated survey (eHEALS) was conducted among currently enrolled 2^nd to 4^th year pharmacy students at the University of British Columbia. An additional interview was offered to consenting participants to further explore the use of technology in daily lives, pharmacy practicums, and implications on future pharmacy curricula. Both quantitative and qualitative thematic analysis was done of all data.

Results:

A total of 30 pharmacy students completed the eHEALS survey and 5 completed interviews. Most participants were 2^nd year students (50%), were 25 years and younger (80%), and female (87%). Ranking of digital health literacy was lower than expected with participants stating they know what (87%), where (87%) and how to find (77%) health resources on the Internet. Even less students (77%) rated that they have the skills to evaluate the health resources that they find on the Internet and only 53% felt confident in using information from the Internet to make health decisions. Most students mentioned that they had limited technology related training at school and would like more training opportunities throughout their program and connect what they have learned at school to their practice.

Conclusions:

These results expose significant and surprising gaps in student understanding of technology despite modifications seen in the entry-to-practice PharmD curriculum. Regional differences and digital health literacy of practicing pharmacists are areas that require better understanding and hold significant impact as practice evolves.

ASHP national survey of pharmacy practice in hospital settings: Workforce-2018

PURPOSE

Results of the 2018 ASHP national survey of pharmacy practice in hospital settings pertaining to the pharmacy workforce are presented.

METHODS

Pharmacy directors at 4,897 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method of contact by mail and email. Survey completion was online. IMS Health supplied data on hospital characteristics; the survey sample was drawn from the IMS hospital database.

RESULTS

The survey response rate was 16.6%. The results indicate that inpatient staffing has increased for both pharmacists and pharmacy technicians. More than half of the respondents reported shortages of pharmacy managers, experienced technicians, and experienced pharmacy technicians with sterile compounding experience. More than half of the respondents reported an excess of entry-level frontline pharmacists. The perceived shortage of pharmacists is in decline, while the perceived shortage of pharmacy technicians, especially those with years of experience, is increasing. Pharmacists commonly chair multidisciplinary committees within health systems, and pharmacy leaders often report directly to the chief executive officer or chief operating officer; they are often responsible for reporting quality information associated with medication use to the health system's board. The use of a pharmacist credentialing and privileging process beyond licensure has increased over the past 4 years. Attention is being devoted to stress in the work place and addressing burnout among healthcare professionals, including pharmacists.

CONCLUSION

The profession is fostering a workforce that is appropriate in composition, sufficient in number, and has the competence to improve the value and safety of medication use.