Evaluation of a transgender health training program for pharmacists and pharmacy students in Australia: A pre-post study

Background

Disparities in healthcare for transgender and gender diverse (TGD) people are well-recognized, with pharmacists reporting a lack of knowledge impacting confidence in their interactions with TGD people. Therefore, a training program in TGD healthcare was designed to address this knowledge gap.

Objective

To evaluate the impact of the TGD healthcare training program on the awareness, knowledge, and behaviour of pharmacists and pharmacy students in Australia.

Method

An online training program was evaluated by pre-and post-test surveys, which assessed the knowledge and awareness of participants, and three-month post-training interviews, which examined the effect of training on pharmacists' practice when providing care to TGD people. Data were analyzed using paired t-tests, content and thematic analysis.

Result

Fifty-six pharmacists and twenty-one pharmacy students completed the training and pre-and post-test surveys. Ten pharmacists were interviewed post-training. There was a significant improvement in the awareness (pharmacists, p ≤0.001; students, p = 0.006), knowledge (pharmacists and students, p ≤0.001) and total (pharmacists and students, p ≤0.001) post-test scores for both groups. Interviewed participants found the training program comprehensive and relevant to their practice.

Conclusion

This study has demonstrated that educational interventions improve TGD healthcare awareness and knowledge for pharmacists and students with the potential to improve healthcare provision to TGD people and promote inclusivity in society.

Do the attitudes and practices of Australian pharmacists reflect a need for education and training to provide care for people who are transgender?

BACKGROUND

Many transgender and gender diverse (TGD) people access care through community pharmacy in Australia. However, there is limited information available about the role of Australian pharmacists in providing care for TGD people.

OBJECTIVE

To explore the attitudes, practices, and training needs of pharmacists in the provision of care for TGD people in Australia.

METHOD

Pharmacists Australia-wide were invited to participate in an online survey through Facebook, e-newsletters of pharmacy organizations and a professional pharmacy journal. Quantitative data were analysed for descriptive and inferential statistics. A Fisher exact test was used to investigate associations between two variables. Results with P value <0.05 were considered statistically significant. Content analysis was used to analyse data from free-text responses.

RESULT

Of the 169 respondents, the majority were female (75.1%), aged below 40 years (74%) and with less than 10 years of working experience as a pharmacist (58%). Although 95% of the sample agreed that they had an important role in the provision of care for TGD people, only 29.6% were confident about their knowledge of pharmacotherapeutic treatments for gender affirmation. Only 2.4% had received education about TGD care at university, and only 5.3% received any TGD healthcare training over the past 5 years.

CONCLUSION

Although pharmacists had a positive attitude and recognized their role in TGD care, they expressed a lack of confidence in their knowledge to be a barrier to providing quality care. Most recommended the need for more education about TGD healthcare in pharmacy curricula and continuous professional education activities.

Look-alike medications in the perioperative setting: scoping review of medication incidents and risk reduction interventions

BACKGROUND

Look-alike medications, where ampoules or vials of intravenous medications look similar, may increase the risk of medication errors in the perioperative setting.

AIM

This scoping review aimed to identify and explore the issues related to look-alike medication incidents in the perioperative setting and the reported risk reduction interventions.

METHOD

Eight databases were searched including: CINAHL Complete, Embase, OVID Emcare, Pubmed, Scopus, Informit, Cochrane and Prospero and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). Key search terms included anaesthesia, adverse drug event, drug error or medication error, look alike sound alike, operating theatres and pharmacy. Title and abstracts were screened independently and findings were extracted using validated tools in collaboration and consensus with co-authors.

RESULTS

A total of 2567 records were identified to 4th July 2022; however only 18 publications met the inclusion criteria. Publication types consisted of case reports, letters to the editor, multimodal quality improvement activities or survey/audits, a controlled simulation study and one randomised clinical trial. Risk reduction intervention themes identified included regulation, procurement, standardisation of storage, labelling, environmental factors, teamwork factors and the safe administration.

CONCLUSION

This review highlighted challenges with look-alike medications in the perioperative setting and identified interventions for risk reduction. Key interventions did not involve technology-based solutions and further research is required to assess their effectiveness in preventing patient harm.

Pharmacist and student evaluation of a preceptor training program in a regional Australian University: a multi-method study

BACKGROUND

Increased emphasis on workplace-based learning within pharmacy curricula has led to a focus on the quality of preceptors and the provision of preceptor training, with a diverse range of training programs for preceptors being developed across the globe. To ensure that preceptors are trained appropriately and deemed to be competent in their role, it is essential that all training programs are suitably evaluated. This research aimed to evaluate an online preceptor training program at a regional Australian University.

METHODS

Kirkpatrick's four level model for assessment of training was used to evaluate this program. A multi method approach included a preceptor post training survey and interviews and a student survey evaluating the preceptor. Preceptor survey data were analysed using descriptive statistics and content analysis, while inductive thematic analysis was used to analyse the interviews. Student evaluations of trained and untrained preceptors were compared to determine whether training had impacted on student-rated preceptor effectiveness.

RESULTS

Twenty-eight preceptor post-training surveys were received, ten preceptor post-training interviews were conducted, and 35 student surveys were completed. The program was rated positively overall, with notable mention by preceptors of the interactive networking session. Following their first post-training student placement, preceptors found that their overall confidence levels had improved, particularly in relation to student management, evaluating students and providing feedback. Student evaluations of preceptors revealed improved ratings of trained versus untrained preceptors, especially as effective communicators.

CONCLUSIONS

This study demonstrated that training had a positive impact on preceptor attitudes, behaviour and confidence levels. From the perspective of the student, training was also found to improve preceptor performance. These results highlight the beneficial effects of training for preceptors, to optimize the student placement experience and their preparation for future practice.

Answering the Call for Community Pharmacists to Improve Healthcare Delivery to Trans and Gender Diverse People: Guide for Designing, Implementing, and Evaluating an Online Education Program in Australia

BACKGROUND

Trans and gender-diverse people visiting pharmacies may not always receive optimum care due to pharmacists' lack of knowledge and confidence to provide such care. This situation prompts a need for training.

OBJECTIVES

This paper aimed to describe a guide to the design, implementation, and evaluation of a training program on transgender healthcare for pharmacists in Australia.

METHODS

The Implementation Mapping Framework provided a foundation for the design, implementation, and evaluation of this training program. Through active involvement in the program development, trans and gender diverse people and pharmacists guided the program design, ensuring alignment with the cultural, social, and healthcare contexts.

RESULTS

The needs analysis highlighted the necessity for training for pharmacists to improve their cultural awareness and pharmacotherapeutic knowledge about transgender healthcare. Applying a novel Gender Inclusivity in Pharmacy Framework, online modules-(1) Transgender healthcare-language, terminology, and key healthcare issues, (2) Gender-affirming therapies, and (3) Case studies in transgender healthcare-were developed to enable the implementation of a training program.

CONCLUSION

The Implementation Mapping Framework and the Gender Inclusivity in Pharmacy Framework proved effective tools for providing an education program for pharmacists.

How can we help you? A qualitative study of the provision of care to culturally and linguistically diverse clients in community pharmacy

OBJECTIVES

Clients from culturally and linguistically diverse (CALD) backgrounds experience challenges in receiving care from community pharmacies, resulting in poorer health outcomes compared with the majority population. The aim of this study was to explore migrants' and pharmacy staff's understanding of the facilitators for the delivery of care to CALD clients.

METHODS

Focus groups were conducted with predominantly older, female Nepali-speaking migrants. Individual interviews were undertaken with pharmacists and pharmacy assistants. Verbatim and translated transcripts were inductively coded to establish themes.

KEY FINDINGS

Three major themes emerged: getting the message across, building trust, and improving understanding. Key findings included the need to increase the use of professional interpreters, and empathy and patience from pharmacy staff. Modifications to communication using re-phrasing and more detail about the community pharmacy system in post-arrival orientation for migrants are required.

CONCLUSIONS

Multilingual staff is an effective way to overcome the language barrier, but its use is limited by staff resources. Pharmacy staff should be required to use the services of professional telephone interpreters to surmount language barriers. Modification of communication techniques and having an empathetic attitude improve communication and care provision. Pharmacists should liaise with migrant support services to provide orientation for new arrivals.

Pharmacy Students' Perspective on Business Management for the Community Pharmacist

OBJECTIVE

Pharmacy students are important future stakeholders in community pharmacy, with business management being an integral part of practice. Thus, this study aims to determine pharmacy students' perceptions of the business management skills required of the community pharmacist and how these skills should be taught within the pharmacy curriculum.

METHODS

An explanatory sequential mixed-methods design involved the administration of an online survey to pharmacy students in years 1 and 4 across 2 Australian universities, followed by focus groups to gather in-depth perceptions. Survey responses were analyzed using descriptive statistics, and associations between years 1 and 4 and outcomes were explored. A hybrid approach of inductive and deductive thematic analysis was used for focus group transcriptions.

RESULTS

A total of 51 pharmacy students responded to the online survey, with 85% agreeing that business management is an essential part of the community pharmacist's skill set. Students indicated a preference for learning management during their community pharmacy placement, university workshops, and via mentorship. Although thematic analysis of student focus groups revealed a preference for learning clinical skills during their university education, business management was also recognized as important. Enthusiasm for management, however, could be increased by exposure to mentors who display leadership and are passionate about business management.

CONCLUSION

Pharmacy students considered business management as intrinsic to the role of community pharmacists and recommended a multimethod teaching approach to learning these skills. These findings could be used by pharmacy educators and the profession to inform both the content and the delivery of business management in pharmacy curricula.

Pharmacist-Led Interventions for Medication Adherence in Patients with Chronic Kidney Disease: A Scoping Review

BACKGROUND

Patients with chronic kidney disease (CKD) are routinely prescribed complex medication regimes. Medication reconciliation, medicine reviews, patient counselling and disease state and medication education are all key pharmacist-led interventions, which can improve medication adherence in patients with CKD.

AIM

To characterize peer reviewed literature on the role of pharmacists in supporting medication adherence of patients with chronic kidney disease and highlight the impact they might have in the health outcomes for patients.

METHOD

This review was performed in accordance with the Scoping Review Framework outlined in the Joanna Briggs Institute Reviewer's Guide. Four electronic databases were searched (Medline (Ovid), Emcare, Scopus and Web of Science) for all relevant literature published up until November 2022. A total of 32 studies were reviewed against an exclusion and inclusion criteria, with findings from each study categorized into barriers, interventions, perceptions, financial implications and outcomes.

RESULTS

Eight eligible studies were identified, where pharmacists' interventions including medication reconciliation, medicine reviews, patient counselling and disease state and medication education, were all reported to have a positive effect on medication adherence. Although pharmacy services in chronic kidney disease were acceptable to patients and pharmacists, these services were under-utilized and limited by logistical constraints, including staffing shortages and time limitations. Patient education supplemented with education tools describing disease states and medications was reported to increase patient adherence to medication regimes.

CONCLUSIONS

Pharmacist-led interventions play an integral role in improving medication adherence in patients with chronic kidney disease, with their inclusion in renal care settings having the potential to improve outcomes for patients.

Pharmacy preceptor training: addressing the challenges of clinical supervision in community practice

Pharmacist preceptors are fundamental to experiential placements and their training is considered essential to provide a quality and consistent student placement experience. To optimise the impact of training, the views of key stakeholders are required to inform the design of a training program. This commentary aims to synthesise the perceptions of the stakeholders, including community pharmacy preceptors, academic staff and students on preceptor training requirements. Their opinions were sought to gain an understanding of preceptor roles and associated skills and attributes, training and support requirements, and barriers and enablers to training. Responses indicated a preference for a flexible online training program, with content including an overview of the university curriculum and expectations, teaching strategies, how to provide feedback and student management. A role was identified for the university to acknowledge the work of preceptors and ensure that they are included in their plans for future experiential placement activities and curriculum development. Several barriers were identified, which challenged precepting, providing the opportunity for this commentary to focus on preceptor training that will address these key challenges, in the context of a clinical teaching environment.

How Should We Prepare Our Pharmacist Preceptors? Design, Development and Implementation of a Training Program in a Regional Australian University

Increased experiential learning within pharmacy education has highlighted the need for quality preceptors, leading to a recent focus on their development and training. This study describes the design, development and implementation of a pharmacist preceptor training program in a regional Australian University. The design of this program utilized the results of a previously conducted scoping review of preceptor training programs and a comprehensive preceptor training needs analysis. In addition, participation was sought from an expert advisory group, comprising preceptors and pharmacy professional organizations. Program materials were developed and transferred onto a suitable online learning platform for implementation. Post-training program evaluation will follow Kirkpatrick's model of training evaluation criteria, gaining feedback from both preceptors and students. The four flexible online modules that were designed are aligned with the main preceptor roles: role model, educator, mentor and assessor. The program also included a small-group online interactive networking session and an online discussion forum. Following implementation, 28 pharmacist preceptors completed the training. Preliminary feedback on the training program was extremely positive, particularly to the interactive networking activity. Future programs will continue to be adapted to reflect stakeholder feedback and optimize student placement experiences.

Identifying the barriers to kidney transplantation for patients in rural and remote areas: a scoping review

BACKGROUND

Populations in rural and remote areas have higher rates of chronic kidney disease and kidney failure than those in urban or metropolitan areas, and mortality rates for chronic kidney disease are almost twice as high in remote areas compared to major cities. Despite this, patients residing in regional, rural, or remote areas are less likely to be wait-listed for or receive a kidney transplant. The objective of this scoping review is to identify specific barriers to kidney transplantation for adult patients residing in rural and remote areas from the perspectives of health professionals and patients/carers.

METHODS

Studies were identified through database (MEDLINE, CINAHL, Emcare, Scopus) searches and assessed against inclusion criteria to determine eligibility. A descriptive content analysis was undertaken to identify and describe barriers as key themes.

RESULTS

The 24 selected studies included both quantitative (n = 5) and qualitative (n = 19) methodologies. In studies conducted in health professional populations (n = 10) the most prevalent themes identified were perceived social and cultural issues (80%), burden of travel and distance from treatment (60%), and system-level factors as barriers (60%). In patient/carer populations (n = 14), the most prevalent themes were limited understanding of illness and treatment options (71%), dislocation from family and support network (71%), and physical and psychosocial effects of treatment (71%).

CONCLUSIONS

Patients in regional, rural, and remote areas face many additional barriers to kidney transplantation, which are predominantly associated with the need to travel or relocate to access required medical testing and transplantation facilities.

From Identity to Ambugity: Exploring Interprofessional Collaboration Opportunities for Pharmacists in Rural and Remote Australia

Rural and remote populations are predisposed to poorer health outcomes, largely associated with limited access to health services and health professionals. This disparity provides an opportunity for health professionals to work collaboratively in interdisciplinary teams to deliver improved health outcomes for rural and remote communities. This study aims to explore exercise physiologist and podiatrist perceptions of interprofessional practice opportunities with pharmacists. Role theory provided a framework for this qualitative study. Interviews were conducted, recorded, transcribed, and thematically analysed according to the constructs of role theory (role identity, role sufficiency, role overload, role conflict, and role ambiguity). The perceptions of participants varied, largely due to the lack of understanding of the role and scope of the practice of a pharmacist. Participants acknowledged and adopted a flexible approach to the way in which they delivered health services to meet the needs of the community. They also described a more "generalist" approach to care, owing to the high prevalence of disease and disease complexity, along with a lack of staffing and resources. The potential for increased interprofessional collaboration was supported and identified as a strategy to manage significant workloads and provide improved patient healthcare. The application of role theory to this qualitative study provides insight into perceptions of interprofessional practice that may inform future development of remote practice models of care.

“I don't know much about providing pharmaceutical care to people who are transgender”: A qualitative study of experiences and attitudes of pharmacists

Background

Globally, with the increased visibility, the number of transgender people accessing healthcare services has risen in the last decade. Although pharmacists are required to provide equitable and respectful care to all patients, their experiences interacting with trans and gender-diverse (TGD) people and attitudes towards the provision of care are largely unknown.

Objectives

This study aimed to determine the experiences and attitudes of pharmacists providing care to TGD people in Queensland, Australia.

Methods

Within a transformative paradigm, this study used semi-structured interviews conducted in person, over the phone, or through the Zoom app. Data were transcribed and analyzed by applying the constructs of the Theoretical Framework of Accessibility (TFA).

Results

A total of 20 participants were interviewed. Analysis revealed all seven constructs across interview data, with affective attitude and self-efficacy being the most frequently coded constructs, followed by burden and perceived effectiveness. The least coded constructs included ethicality, intervention coherence, and opportunity cost. Pharmacists had positive attitudes towards providing care and interacting professionally with TGD people. Prime challenges in delivering care were being unaware of inclusive language and terminology, difficulty building trusted relationships, privacy and confidentiality at the pharmacy, inability to locate appropriate resources, and lack of training in TGD health. Pharmacists felt rewarded when they established rapport and created safe spaces. However, they requested communication training and education to improve their confidence in delivering care to TGD people.

Conclusion

Pharmacists demonstrated a clear need for further education on gender-affirming therapies and training in communication with TGD people. Including TGD care in pharmacy curricula and continuous professional development activities is seen as an essential step towards pharmacists improving health outcomes for TGD people.

Barriers and facilitators experienced by migrants and refugees when accessing pharmaceutical care: A scoping review

BACKGROUND

Pharmacists in the community are often among the first health professionals encountered by new arrivals. Their accessibility and the longevity of the relationship gives pharmacy staff unique opportunities to work with migrants and refugees to meet their health needs. While the language, cultural and health literacy barriers that cause poorer health outcomes are well documented in medical literature, there is a need to validate the barriers to accessing pharmaceutical care and to identify facilitators for efficient care in the migrant/refugee patient-pharmacy staff interaction.

OBJECTIVE

The purpose of this scoping review was to investigate the barriers and facilitators that migrant and refugee populations experience when accessing pharmaceutical care in host countries.

METHODS

A comprehensive search of Medline, Emcare on Ovid, CINAHL and SCOPUS databases, guided by the PRISMA-ScR statement, was undertaken to identify the original research published in English between 1990 and December 2021. The studies were screened based on inclusion and exclusion criteria.

RESULTS

A total of 52 articles from around the world were included in this review. The studies revealed that the barriers to migrants and refugees accessing pharmaceutical care are well documented and include language, health literacy, unfamiliarity with health systems, and cultural beliefs and practises. Empirical evidence was less robust for facilitators, but suggested strategies included improvement of communication, medication review, community education and relationship building.

CONCLUSIONS

While barriers experienced are known, there is a lack of evidence for facilitators for provision of pharmaceutical care to refugees and migrants and poor uptake of available tools and resources. There is a need for further research to identify facilitators that are effective in improving access to pharmaceutical care and practical for implementation by pharmacies..

Pharmacy Student Perceptions of the Roles and Attributes of Pharmacist Preceptors in Australia

The pharmacist preceptor is key to the success of pharmacy student experiential placements with a recent focus being placed on the quality of preceptors. This study sought to investigate student perceptions of the ideal roles and attributes of pharmacist preceptors to inform the development of a preceptor training program. This was a mixed methods study using an online survey of pharmacy students from levels two to four of an undergraduate pharmacy honours program at a regional Australian university followed by qualitative, semi-structured focus group interviews. Surveys were analysed using descriptive statistics and content analysis while interviews were thematically analysed. Thirty-seven complete survey responses were received, and three student focus groups were conducted. Students identified the key role of preceptors in linking theory to practice and felt that the role of the preceptor in student assessment should focus on practical skills, such as communication and professionalism. There was overall strong agreement between the quantitative and qualitative findings on the ideal preceptor attributes with good communication, enthusiasm for the profession and the provision of clear and honest student feedback thought to be most important. Students regarded these attributes as essential for a good preceptor-student relationship to promote learning in the practice environment.

Perspectives of Complementary and Alternative Medicine use by cancer patients in a regional hospital in North Queensland, Australia

OBJECTIVES

This study aimed to investigate CAMs used, and reasons for and disclosure of this use by cancer patients in a regional hospital in North Queensland, Australia.

METHODS

Patients attending the Day Oncology Unit of the Townsville University Hospital were invited to participate in a self-completed questionnaire or telephone interview regarding perspectives of their CAM use. Data were analysed using descriptive statistics and chi-squared and independent t-tests were performed to allow comparison between the responses by CAM users and non-users.

RESULTS

102 completed questionnaires were used in the analysis, where 40.2 % of respondents were found to be using some form of CAM. Cannabis, magnesium, and massage were the most prominent therapies used, with cannabis use in cancer, not commonly reported in prior literature. The main reasons given for using CAM were to treat symptoms of cancer, side-effects of treatment or to improve general health. Two-thirds of these respondents disclosed their CAM use to health professionals mostly to obtain a professional opinion or due to concerns of interactions with cancer treatment. CAM users were statistically more likely to have used CAM prior to their cancer diagnosis and have lower emotional wellbeing than non-users. Non-CAM users indicated that a lack of knowledge of CAM or concerns regarding interactions with cancer treatment were the most popular reasons for not adopting these therapies.

CONCLUSION

While lower than the averages of previously published CAM use, our study highlights that there is still a significant group of cancer patients in the North Queensland region using CAMs.

Telmisartan Tablets Repackaged into Dose Administration Aids: Physicochemical Stability under Tropical Conditions

Dose administration aids (DAAs) are commonly used to assist patients with chronic disease to manage multiple medications and thus improve adherence. Several brands of telmisartan, commonly prescribed for hypertension, are available in Australia. Manufacturer’s storage advice is to leave tablets in the blister strip until administered to patients. This study aimed to investigate the stability of telmisartan tablets when repackaged and stored in DAAs, to identify a brand, which is sufficiently stable to be repackaged. All available brands of telmisartan tablets in Australia, which contain different excipients, were repackaged into DAAs and stored at 30 °C, 75% RH for 28 days before screening, using visual inspection and physical testing. A candidate brand was then selected for physicochemical and photostability testing using pharmacopoeial methods. Repackaged Mizart^® tablets were shown to be sufficiently stable, when repackaged and stored under tropical conditions (30 °C, 75% RH) for 28 days. Several of the other brands were deemed inappropriate for repackaging, due to physical instability, highlighting the importance of considering not only the drug, but also excipients to ensure the stability of repackaged medicines. Although the repackaging of telmisartan tablets is not advised, this study provides evidence to support the Mizart^® brand as an option for pharmacists to recommend for repackaging.

Exploring the nursing student experience at a remote Australian university campus: a qualitative study

Background

Nurses constitute most of the rural and remote Australian health workforce, however staff shortages in these regions are common. Rural exposure, association, and undertaking rural clinical placements can influence health students’ decision to work rurally after graduation, however attending university in rural and remote regions has been shown to be a great contributor. An improved understanding of these nursing students’ experiences may inform changes to teaching and support strategies for these students, which in turn could improve their retention and completion rates, contributing to a more sustainable rural and remote Australian nursing workforce. This study aimed to explore and describe students’ experiences of studying nursing in the context of a satellite university campus located in a remote town, with a focus on education delivery methods, staff, support, student services, and barriers and enablers to successful study.

Methodology

Nine students participated in this qualitative descriptive study. Semi-structured interviews were undertaken, allowing participants to reflect on their experiences as nursing students in the context of a geographically remote satellite university campus. The resulting data were grouped into common themes and summarised.

Results

Students were generally positive regarding lectures delivered by videoconference or recorded lectures, as they allowed for greater flexibility which accommodated their busy personal lives. Face-to-face teaching was especially valuable, and students were particularly positive about their small cohort size, which enabled the creation of strong, supportive relationships between students, their cohort, and teaching and support staff. However, barriers related to student demographics and some difficulties with course engagement and campus staffing were experienced.

Conclusions

The experiences of nursing students at remote university campuses are different from those experienced by traditional, metropolitan university students. Although these nursing students face additional barriers unique to the remote campus context, they benefit from a range of enabling factors, including their close relationships with other students, staff, family, and their local community.

Scoping the required business management skills for community pharmacy: Perspectives of pharmacy stakeholders and pharmacy students

BACKGROUND

The literature is dearth in identification and categorization of business management skills required by community pharmacists. While community pharmacy stakeholders (predominantly community pharmacy owners, managers, and pharmacists) and pharmacy students are valuable sources for identifying business management skills, no review is currently available that synthesizes their knowledge. By identifying currently known business skills and organizing these into a managerial skills framework, this review provides a foundation skillset for community pharmacist business management.

METHODS

Six electronic databases were searched for published articles, with titles and abstracts screened according to inclusion criteria. Full articles meeting the specified criteria were assessed and skills identified were mapped to the human, conceptual, and technical skills of a business management framework.

RESULTS

Pharmacy stakeholders and students identified 36 business management skills/aptitudes required for community pharmacists. Pharmacy stakeholders most frequently identified the skills of communication, professionalism, general business management, leadership, and teamwork. Although the pharmacy students concurred with many of these skills, they more frequently identified confidence, entrepreneurship, and having prior experience or opportunity in a management role. A substantial number of identified skills/aptitudes were categorized under the human domain of the business management framework.

IMPLICATIONS

Community pharmacists require training in effective business management, with particular emphasis on human domain skills. The tertiary education system should consider implementing the skills/aptitudes revealed in this review into the pharmacy curriculum. Recruiting business minded personalities into the profession, particularly targeting students with an attraction to business management, is one strategy to improve management skills within the field.

Bridging Allied Health Professional Roles to Improve Patient Outcomes in Rural and Remote Australia: A Descriptive Qualitative Study

Purpose

Australia’s rural and remote populations experience inequality of access to healthcare, with demand exceeding capacity for delivery of health services, often due to a maldistribution of the health workforce. A strategy which may overcome barriers to accessing adequate healthcare includes implementation of interdisciplinary collaborative teams, identified as a successful method of healthcare delivery. This study thus aimed to explore interdisciplinary allied health collaborative practice in a rural community.

Methods

Role theory, as a philosophical perspective, was used to explore role perceptions and the potential for interdisciplinary collaboration between pharmacists and allied health professionals including dieticians/public health nutritionists, speech pathologists, occupational therapists, and physiotherapists, by conducting 29 interviews in a rural community. All interviews were transcribed verbatim, coded, and categorised into emerging themes.

Results

Five constructs of role theory were used to describe the data: role identity, role overload, role sufficiency, role conflict, and role ambiguity. Participants identified as rural generalists and health promoters, who work within innovative and adaptive healthcare settings. Role overload was reported as considerable due to high demand for services and a lack of resources in rural and remote regions, resulting in poor role sufficiency. Overall, there was a low level of role conflict, and participants were highly in favor of interprofessional collaboration; however, uncertainty of the pharmacist’s role (role ambiguity) was a major barrier identified. Health professionals with more years in practice provided few examples of how they would utilise a pharmacist in their practice, although these gave valuable insight into the potential integration of a pharmacist into an interdisciplinary health team, with allied health professionals.

Conclusion

This study has applied role theory providing a greater understanding of the enablers and barriers of pharmacists working within interdisciplinary allied health teams and highlighting opportunities to bridge interprofessional roles to improve patient outcomes, especially in rural and remote communities.

Expanded practice for rural community pharmacy: what are we waiting for?

OBJECTIVE

To synthesise stakeholder (consumer, pharmacist and health professional) perspectives of expanded pharmacy practice in rural and remote community pharmacy.

METHODS

Comparison of perspectives of stakeholder groups identified by four studies has highlighted the expected outcomes and anticipated barriers to expanded pharmacy practice. Aligning the studies has identified priority areas of health for which pharmacists may be able to provide expanded service delivery.

KEY FINDINGS

Expanded pharmacy services are supported by consumers, pharmacists and health professionals and are expected to improve health outcomes for rural and remote populations. Barriers will need to be overcome for expanded services to be sustainable in the future.

CONCLUSION

The pharmacy profession will need to undertake a paradigm shift to professional practice and work towards this should begin to reduce the health inequality for rural populations.

Rural pharmacists and stakeholders perspectives of expanded pharmacy practice: A descriptive study

OBJECTIVE

To explore pharmacist and stakeholder perspectives of pharmacists providing expanded services in rural community pharmacies.

DESIGN

A descriptive qualitative study with an ethnographic lens of rural culture collected data via in-depth semi-structured interviews with stakeholder representatives and rural and remote pharmacists.

SETTING

Regional, rural and remote practice settings as defined by the Modified Monash Model MM3-MM7.

PARTICIPANTS

Twelve rural or remote pharmacists and eight stakeholder representatives from various government and professional organisations participated in the study.

MAIN OUTCOME MEASURE

Macro-, meso- and micro-level perspectives of pharmacists providing expanded pharmacy services in rural community pharmacies.

RESULT

At the macro-level, both pharmacists and stakeholders agreed that governance is needed to clarify the terms used to describe expanded practice as a first step to developing an expanded practice framework. The meso-level revealed that pharmacist participants expected expanded practice to improve rural pharmacist recruitment and retention through improved professional satisfaction. The importance of effective collaboration and coordination with other health care providers in a community was described by pharmacists and stakeholders to ensure success of expanded services. All participants agreed that sustainability of these services relied on appropriate remuneration. At the micro-level, expanded pharmacy services are expected to save consumers' time and money as patients are redirected into appropriate health care settings.

CONCLUSION

Enablers and barriers across policy, health professional, consumer and community levels need to be addressed in order to design and develop sustainable expanded pharmacy services to improve health service provision in rural and remote communities.

LISTEN UP (Locally Integrated Screening and Testing Ear aNd aUral Programme): a feasibility study protocol for a community pharmacy-based ear health intervention

BACKGROUND

Ear disease is a major cause of preventable hearing loss and is very common in rural communities, estimated to affect 1.3 million Australians. Rural community pharmacists are well placed to provide improved ear health care to people who are unable to easily access a general practitioner (GP). The purpose of this study is to apply an ear health intervention to the rural community-pharmacy setting in Queensland, Australia, to improve the management of ear disease. The aims are the following: (1) to evaluate the feasibility, potential effectiveness and acceptability of a community pharmacy-based intervention for ear health, (2) to evaluate the use of otoscopy and tympanometry by pharmacists in managing ear complaints in community pharmacy and (3) to evaluate the extended role of rural pharmacists in managing ear complaints, with the potential to expand nationally to improve minor ailment management in rural communities.

METHODS/DESIGN

This is a longitudinal pre- and post-test study of a community-pharmacy-based intervention with a single cohort of up to 200 patients from two rural community pharmacies. Usual care practices pertaining to the management of ear complaints will be recorded prior to the intervention for 8 weeks. The intervention will then be piloted for 6 weeks, followed by a 12 month impact study. Patients aged > 13 years presenting to the pharmacies with an ear complaint will be invited to participate. Trained pharmacists will conduct an examination including a brief history, hearing screening, otoscopy and tympanometry assessments. Patients will be referred to a general practitioner (GP) if required, according to the study protocol. Patients will complete a satisfaction survey and receive a follow-up phone call at 7 days to explore outcomes including prescribed medications and referrals. Pharmacists and GPs will complete pre- and post- intervention interviews. Patient, pharmacist and GP data will be analysed using descriptive statistics and thematic analysis for the qualitative data.

DISCUSSION

This study will demonstrate the implementation of a screening and referring ear health intervention in rural community pharmacy. Feasibility, potential effectiveness and acceptability of the intervention will be assessed.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trial Registry Number: ACTRN12620001297910 .

Prevalence of Substandard Amoxicillin Oral Dosage Forms in the National Capital District of Papua New Guinea

Antibiotics are commonly reported as being substandard or falsified in low- to middle-income countries, having potential to contribute to the development of antimicrobial resistance and drug-resistant infections. Amoxicillin, used to treat a number of infections and listed by the WHO as an essential medicine, presented as a good drug candidate for this study. We aimed to measure the prevalence of substandard and falsified amoxicillin oral products (tablets, capsules, and suspensions) in the National Capital District of Papua New Guinea (PNG). These oral products were surveyed in 2018 and 2019 from retail pharmacies, private and public health facilities, and the Area Medical Store, representing more than 90% of licensed medicine outlets. The product packaging was visually inspected, and the samples were analyzed for amoxicillin content using a validated high-performance liquid chromatography method. Although no falsified products were identified, 15% of the 190 products analyzed contained substandard amounts of amoxicillin. Quality varied with the dosage form (P = 0.002), with capsules exhibiting the lowest incidence of substandard content (4% in 2019) and tablets collected in 2018 experiencing the highest failure rate (50%). Suspension (40%) quality was compromised by failure to achieve homogeneity on reconstitution. A higher incidence of substandard content (P = 0.002) was associated with one major retail group. Routine testing of medicines by resource-poor countries is often unachievable, leading to the circulation of poor quality drugs, which is a global public health concern. Our study highlighted that substandard amoxicillin oral products are indeed prevalent in the NCD of PNG.

Predicting in vivo absorption of chloramphenicol in frogs using in vitro percutaneous absorption data

Background

Infectious disease, particularly the fungal disease chytridiomycosis (caused by Batrachochytrium dendrobatidis), is a primary cause of amphibian declines and extinctions worldwide. The transdermal route, although offering a simple option for drug administration in frogs, is complicated by the lack of knowledge regarding percutaneous absorption kinetics. This study builds on our previous studies in frogs, to formulate and predict the percutaneous absorption of a drug for the treatment of infectious disease in frogs. Chloramphenicol, a drug with reported efficacy in the treatment of infectious disease including Batrachochytrium dendrobatidis, was formulated with 20% v/v propylene glycol and applied to the ventral pelvis of Rhinella marina for up to 6 h. Serum samples were taken during and up to 18 h following exposure, quantified for chloramphenicol content, and pharmacokinetic parameters were estimated using non-compartmental analysis.

Results

Serum levels of chloramphenicol reached the minimum inhibitory concentration (MIC; 12.5 μg.mL^− 1) for Batrachochytrium dendrobatidis within 90–120 min of exposure commencing, and remained above the MIC for the remaining exposure time. C_max (17.09 ± 2.81 μg.mL^− 1) was reached at 2 h, while elimination was long (t_1/2 = 18.68 h).

Conclusions

The model, based on in vitro data and adjusted for formulation components and in vivo data, was effective in predicting chloramphenicol flux to ensure the MIC for Batrachochytrium dendrobatidis was reached, with serum levels being well above the MICs for other common bacterial pathogens in frogs. Chloramphenicol’s extended elimination means that a 6-h bath may be adequate to maintain serum levels for up to 24 h. We suggest trialling a reduction of the currently-recommended continuous (23 h/day for 21–35 days) chloramphenicol bathing for chytrid infection with this formulation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12917-021-02765-5.

A Scoping Review of Pharmacy Preceptor Training Programs

Objective. To review the literature pertaining to pharmacy preceptor training programs. Findings. Preceptor training is becoming increasingly important to maintain the quality of experiential training and professional development of pharmacy students, preregistration trainees, and residents. This review found limited documented examples of preceptor training programs and wide variation in both their design and delivery, which was attributed to the diversity of pharmacy practice workplaces and the different types of trainees. The majority of programs included a significant online component, often supported by a face-to-face orientation, with a focus on developing core competencies and with some tailoring of content to suit the specific workplace environment. Evaluations of these training programs showed high preceptor satisfaction rates, with preceptors appreciating the ease of access of online training and the benefits of interaction with other preceptors in face-to-face training. Preceptors also reported positive changes in their behavior during and attitudes toward precepting and an increased understanding of student learning. Summary. This review has highlighted that a structured and evidence-based approach to preceptor training is needed. Programs should be educationally sound, practically focused, and flexible in meeting the needs of a diverse range of preceptors and practice environments. Prospectively, programs should be evaluated not only in terms of outcomes for preceptors, but also for student, preregistration trainee, and resident engagement and attainment of educational outcomes.

Can models of percutaneous absorption based on in vitro data in frogs predict in vivo absorption?

The primary aim of in vitro testing of chemicals delivered via the percutaneous route is to predict the absorption that would ensue if exposure occurred in live animals. While there is mounting evidence that in vitro diffusion studies in mammalian skin can provide valid information regarding likely in vivo absorption, little is known whether such a correlation exists between in vitro diffusion testing and in vivo blood levels in amphibians. The current study used previously-reported in vitro absorption data for caffeine, benzoic acid, and ibuprofen across isolated skin from the cane toad (Rhinella marina) to produce a series of linear mixed-effect models of the absorption parameters flux and permeability coefficient (K_p). Models investigated the relative impacts of animal weight, physicochemical characteristics of the applied chemical (logP or molecular weight), and site of application. The top models were then used to predict the flux, K_p and serum concentrations of the same three model chemicals. Finally, the absorption of these chemicals was determined in live cane toads, and results compared to the model predictions. LogP and site of application were included in all top models. In vivo absorption rates were lower than predicted for all chemicals, however, the models provided reasonable predictions of serum concentration, with factors of difference (FOD) ranging from 2.5–10.5. Ibuprofen, the chemical with the highest relative lipophilicity, had the poorest predictive performance, consistently having the highest FOD for all predictions. This report presents the first models of percutaneous absorption in an amphibian. These models provide a basic method to establish the approximate in vivo absorption of hydrophilic and moderately-lipophilic chemicals through frog skin, and could therefore be used to predict absorption when formulating such chemicals for treatment of disease in frogs, or for risk-assessments regarding chemical pollutants in frog habitats.

The Rural Pharmacy Practice Landscape: Challenges and Motivators

Background

Health outcome delivery for rural and remote Australian communities is challenged by the maldistribution of the pharmacy workforce. High staff turnover rates, reduced pharmacist numbers, and reliance on temporary staff have placed great strain on both state health services and rural community pharmacies. However, recent changes to the demographic profile of the rural pharmacist including a lower average age and increased time spent in rural practice highlights a more positive future for the delivery of better health outcomes for rural communities. The aim of this study was to investigate the factors that motivate and challenge pharmacists’ choice to practice rurally.

Methods

Rural pharmacists were invited to participate in semi-structured interviews using purposive non-probability sampling. Twelve pharmacists were interviewed with early-, middle- and late-career pharmacists represented. Participants described their experiences of working and living in rural and remote locations. Three themes emerged: workforce, practice environment and social factors, which were examined to determine the underlying challenges and motivators impacting rural and remote pharmacy practice.

Results

Lack of staff presented a workforce challenge, while motivators included potential for expanded scope of practice and working as part of a multidisciplinary team. While social isolation has often been presented as a challenge, an emerging theme highlighted that this may no longer be true, and that notions of “rural and remote communities as socially isolated was a stigma that needed to be stopped”.

Conclusion

This study highlights that despite the challenges rural pharmacists face, there is a shift happening that could deliver better health outcomes for isolated communities. However, for this to gain momentum, it is important to examine both the challenges and motivators of rural pharmacy practice to provide a platform for the development and implementation of appropriate frameworks and programs to better support the rural pharmacy workforce.

Rural pharmacy workforce: Influence of curriculum and clinical placement on pharmacists' choice of rural practice

OBJECTIVE

This two-phase study aimed to explore the influence of a university rural curriculum and clinical placements on pharmacists' choice to practise in a rural or remote area.

DESIGN

A sequential mixed-methods approach involved the design of both a questionnaire and semistructured in-depth interviews to collect quantitative and qualitative data.

SETTING

Regional, rural and remote practice areas according to the Pharmacy Access/Remoteness Index of Australia classifications.

PARTICIPANTS

Ninety-two pharmacists from varied areas of practice, working in rural and remote locations across Australia, participated in the study.

MAIN OUTCOME MEASURES

University curriculum and clinical placements during the degree and their influence on the current rural workforce.

RESULTS

In the survey sample, two-thirds of the current rural pharmacy workforce's choice of practice location was significantly influenced by positive rural placement experiences. Rural practice was, however, not included in the curriculum for 50% of the rural workforce in the sample, although graduates from regional universities experienced up to 80% more exposure to rural curricula. In this sample, rural origin was also not found to be a significant determinant of rural practice, while rural lifestyle, family commitments, remuneration, career opportunities and other contractual agreements have had a greater influence than university education.

CONCLUSION

Although the positive influence of rural placements has been identified, there is still a way to go in terms of the development of a meaningful rural curriculum. This highlights that universities have a role to play in addressing this issue to produce graduates who are better prepared for the opportunities and challenges of rural pharmacy practice.

Percutaneous absorption between frog species: Variability in skin may influence delivery of therapeutics

Frogs have permeable skin, so transdermal delivery provides a practical alternative to traditional dosing routes. However, little is known about how frog skin permeability differs interspecifically, and there are different reported clinical outcomes following topical application of the same chemical in different frog species. This study collated in vitro absorption kinetic data previously reported for two frog species: the green tree frog (Litoria caerulea) and the cane toad (Rhinella marina), and used linear mixed-effects modelling to produce a model of absorption. Histology of skin samples from each species was performed to observe morphological differences that may affect absorption. Absorption kinetics differed significantly between species, with the logP of the applied chemical a better predictor of permeability than molecular weight. Application site also influenced permeability, with dorsal permeability consistently higher in cane toads. Ventral permeability was more consistent between species. Skin thickness differed between species and skin regions, and this may explain the differences in absorption kinetics. Guidelines for selecting chemicals and dosing site when treating frogs are presented. The permeability differences identified may explain the poor reproducibility reported in the treatment of disease across frog species, and reinforces the importance of considering interspecies differences when designing therapeutic treatments for frogs.

Permeability of frog skin to chemicals: effect of penetration enhancers

Rarely do commercial chemical products contain solely the active chemical/ingredient. It is therefore important to consider whether ingredients other than the active may: 1) alter absorption of the active chemical, or 2) be absorbed themselves, resulting in systemic effects. Frogs have highly permeable skin and are routinely exposed to commercial chemical products in the environment or therapeutically. Ethanol and propylene glycol (PG), which have known penetration-enhancing effects, are commonly included in such products. The current study has therefore investigated the in vitro absorption kinetics through Rh. marina skin of three model chemicals – caffeine, benzoic acid, and ibuprofen – formulated individually as solutions containing: 1%, 10% or 30% v/v ethanol, or 20% v/v PG. Differential scanning calorimetry and histology were used to characterise fresh frog skin, investigate the mechanism of these enhancers in frog skin, and to determine whether these enhancers significantly affected skin structure. Results showed that the extent of absorption enhancement was influenced by chemical, enhancer and skin region, and that enhancement was generally not consistent for individual enhancers or skin regions. The exception was 1% v/v ethanol, which did not significantly alter flux across the skin for any of the chemicals evaluated. Caffeine absorption was not enhanced by any of the investigated penetration enhancers, and was in fact significantly reduced by 30% v/v ethanol and PG. Ethanol caused concentration-dependant changes in skin morphology and should be avoided in concentrations ≥10% v/v. PG, however, caused minimal changes to the skin and consistently improved absorption of benzoic acid and ibuprofen through all skin regions. Owing to the significant changes in skin structure following ≥10% v/v ethanol exposure, it is recommended to avoid its use in frogs. For enhancement of penetration of moderately-to-highly lipophilic chemicals, this study has identified 20% v/v PG should to be the enhancer of choice.

Design and Evaluation of a Professional Identity Development Program for Pharmacy Students

Objective. To design and evaluate a professional identity program (PIP) based on self-determination theory (SDT) for entering Bachelor of Pharmacy (BPharm) students. Methods. The PIP, which featured autonomy-supportive teaching approaches, was delivered as 10 workshops that were integrated into existing pharmacy courses over the first four semesters (2 years) of the BPharm program. The program was evaluated using a student satisfaction survey and two previously validated tools for measuring professional identity (MCPIS-9) and motivation to study pharmacy (Pharm-S). Nonparametric statistical techniques were used to compare students' scores before and after introducing the PIP. Results. Students responded positively to the introduction of the PIP in the pharmacy program. Based on survey responses, the students valued opportunities to engage in activities and discussions related to professional development and identity formation. Student scores on the motivation-based tool (Pharm-S) increased by the end of the first year of participation in the PIP, indicating an increase in student autonomy levels. There was no change in students' scores on the professional identity measure (MCPIS-9) after the first year. Conclusion. The use of SDT-based instruction in professional identity education resulted in increased levels of autonomy in pharmacy students, indicating a transition to more intrinsic levels of motivation. This has the potential to positively impact student professional identity and future professional practice.

Effects of skin region and relative lipophilicity on percutaneous absorption in the toad Rhinella marina

Owing to the dynamic interaction between frog skin and the environment, xenobiotics in frog habitats are of particular concern, and knowledge of percutaneous absorption in frog skin is necessary for risk-mitigation purposes. Baseline transdermal kinetics in adult aquatic and arboreal frog species have recently been reported; however, there is little information regarding absorption kinetics in adult terrestrial species. The present study investigated the in vitro absorption kinetics of 3 model chemicals-caffeine, benzoic acid, and ibuprofen-through different skin regions in the terrestrial toad Rhinella marina. Caffeine flux was consistently higher than that of the other 2 chemicals (p < 0.001), whereas the fluxes of the moderately and highly lipophilic chemicals (benzoic acid and ibuprofen) were similar, regardless of skin region. When considering individual chemicals, caffeine demonstrated increased flux through the ventral pelvic skin compared with the ventral thoracic or dorsal skin regions. Flux did not differ between skin regions for either benzoic acid or ibuprofen. These findings have implications for management of environmental contamination in frog habitats, as many environmental xenobiotics are of moderate to high lipophilicity and would be expected to be equally absorbed from all skin surfaces in terrestrial toads. Environ Toxicol Chem 2019;38:361-367. © 2018 SETAC.

Complementary and alternative medicine use in cancer: A systematic review

BACKGROUND AND PURPOSE

Complementary and alternative medicine (CAM) use in cancer is increasing. The purpose of this study was to systematically review the literature to determine demographic profiles and prevalence and reasons for use in cancer patients.

METHODS

In this systematic review, the databases OVID, PubMed, and Scopus were searched for studies on CAM use in cancer between 2009 and June 2018.

RESULTS

The results showed that an average of 51% of cancer patients used CAM. Common independent demographic characteristics associated with CAM use were younger, female cancer patients, having higher education, earning a higher income and having previously used CAM. Frequent reasons for use, grouped into themes were shown to be to influence their cancer and general health and to treat complications of the cancer or therapy.

CONCLUSION

The review provides an insight and will serve to better inform health professionals on how this population is using CAM.

Scoping the impact of curriculum and placement on the rural pharmacy workforce

OBJECTIVE

The objective of this review was to scope the impact of university rural curriculum and rural clinical placements on students' intentions to practise rurally and rural pharmacists' choice of rural practice.

DESIGN

The scoping review used Arskey and O'Malley's methodological framework, searching the following databases: MEDLINE, CINAHL, Informit and Scopus. This scoping review followed PRISMA for article reporting.

SETTING

Studies were selected from those conducted in Australia, USA, Canada and Africa.

PARTICIPANTS

Pharmacy undergraduate students, interns, registered and academic pharmacists were included.

MAIN OUTCOME MEASURE

The pharmacy curriculum at universities and placements undertaken, specifically in rural and remote settings, were evaluated to determine their influence on intention to practise as a rural pharmacist.

RESULTS

The search strategy generated 294 records, 31 of which were included in the scoping review. Key findings were mapped to two domains, which broadly included the impact of rural placements and curriculum on intention to practise rurally. Some universities have attempted to introduce a rural curriculum, but reported resources as a barrier and the lack of resulting evidence of students' intention to practise rurally. Although results indicate rural placements have had a positive influence on students' intention to work rurally, this intention has been measured immediately after exposure to rural practice and might not reflect future intentions.

CONCLUSION

This review highlights significant gaps in the impact particularly of a rural curriculum and rural clinical placements in relation to the current rural pharmacist workforce. A greater understanding of this topic may guide recommendations for future strategies to address rural pharmacy workforce maldistribution.

Australian Pharmacists' Perceptions and Practices in Travel Health

Worldwide, pharmacists are playing an increasing role in travel health, although legislation and funding can dictate the nature of this role, which varies from country to country. The aim of this study was to explore the current and potential future practices in travel health for pharmacists in Australia, as well as the perceived barriers, including training needs, for the provision of services. A survey was developed and participation was sought from a representative sample of Australian pharmacists, with descriptive statistics calculated to summarise the frequency of responses. A total of 255 participants, predominantly female (69%), below 50 years (75%) and registered less than 30 years completed the survey. Although over two-thirds (68%) provided travel-related advice in their current practice, the frequency of advice provision was low (less than 2 travellers per week) and limited to responding to travellers questions. Although Australian pharmacists are currently unable to administer travel vaccines and prescription only medications without prescription, they still consider travel health to be an appropriate role and that their clients would seek travel health advice from pharmacies if offered. Currently, key roles for Australian pharmacists are advising travellers who do not seek advice from other practitioners, reinforcing the advice of other health practitioners and referring travellers needing vaccinations and antimalarials. In order to expand these services, the barriers of workload, time, staffing and the need for training in travel health need to be addressed. In summary, the travel health services provided by pharmacies in Australia still have a way to go before they match the services offered by pharmacies in some other countries, however Australian pharmacist are keen to further develop their role in this area.

Advanced oxidation process-mediated removal of pharmaceuticals from water: A review

Pharmaceuticals, which are frequently detected in natural and wastewater bodies as well as drinking water have attracted considerable attention, because they do not readily biodegrade and may persist and remain toxic. As a result, pharmaceutical residues pose on-going and potential health and environmental risks. To tackle these emerging contaminants, advanced oxidation processes (AOPs) such as photo-Fenton, sonolysis, electrochemical oxidation, radiation and ozonation etc. have been applied to remove pharmaceuticals. These processes utilize the high reactivity of hydroxyl radicals to progressively oxidize organic compounds to innocuous products. This review provides an overview of the findings from recent studies, which have applied AOPs to degrade pharmaceutical compounds. Included is a discussion that links various factors of TiO₂-mediated photocatalytic treatment to its effectiveness in degrading pharmaceutical residues. This review furthermore highlights the success of AOPs in the removal of pharmaceuticals from different water matrices and recommendations for future studies are outlined.

Regional variation in percutaneous absorption in the tree frog Litoria caerulea

Frog skin structure and physiology differs between skin regions, however little is known about how these differences affect transdermal absorption of chemicals. Further, no information is available regarding how the relative lipophilicity of a chemical influences its transdermal pharmacokinetics in frog skin. This study investigated the in vitro percutaneous absorption of three model chemicals - benzoic acid, caffeine, and ibuprofen - through dorsal and ventral skin of the tree frog Litoria caerulea. Flux was significantly higher through the ventral skin for all chemicals. Relative lipophilicity affected flux differently in different skin regions. These differences are likely due to significantly thicker dorsal skin increasing absorption path length, and also possibly owing to lipoid secretions on the dorsum providing an additional diffusional barrier. This knowledge can advise risk mitigation of xenobiotics in agricultural and industrial settings, and also guide selection of chemicals and doses when considering transdermal drug therapy in captive frogs.

Addressing varenicline adherence through repackaging in a dose administration aid

Background

Ensuring adherence to prescribed smoking cessation medications, such as Champix^® (varenicline), is essential during a quit attempt as non-adherence can significantly reduce the likelihood of achieving prolonged smoking abstinence. The use of dose administration aids may improve adherence, though medication stability on repackaging is not guaranteed, due to a lack of available data from manufacturers supporting this practice.

Objective

To determine the suitability for repackaging varenicline tartrate tablets into a dose administration aid, by assessing its physical and chemical stability after being repackaged and stored at ambient conditions for 6 weeks.

Methods

Varenicline tartrate (1.0 mg) tablets were repackaged into commercially available Webster-pak^® blister compartments and stored for 42 days at ambient conditions characteristic of a Zone IVB climate (30 ± 2°C and 75 ± 5% relative humidity) according to the World Health Organization (WHO) guidelines on pharmaceutical stability testing. Physical and chemical tests were performed on the repackaged and control tablets, including an assessment of: tablet thickness, hardness, weight uniformity, friability, dissolution, disintegration, and content uniformity after exposure to ambient conditions and light according to International Council on Harmonisation of Technical Requirements of Pharmaceuticals for Human Use guideline Q1B.

Results

Weight, friability, and thickness of the tablets complied with compendial standards. A validated high performance liquid chromatography method was used to confirm that after exposure to light, and repackaging at 30°C/75% relative humidity, the tablets remained within the required 95%–105% of the stated drug content. However, tablet hardness and disintegration decreased over time, with tablets becoming softer and undergoing more rapid disintegration in water.

Conclusion

Repackaging 1.0 mg varenicline tartrate tablets into a dose administration aid can be undertaken to improve adherence rates and therefore smoking abstinence rates. This can be performed without compromising either the physical or chemical stability of the tablets.

Validation of a motivation survey tool for pharmacy students: Exploring a link to professional identity development

INTRODUCTION

Self-determination theory (SDT), which describes a continuum of motivation regulators, is proposed as an appropriate framework to study pharmacy student motivation. The aim was to develop a Pharmacy Motivation Scale (Pharm-S) to determine motivation regulators in undergraduate students and explore a possible link to professional identity development.

METHODS

The Pharm-S was adapted from the SDT-based, Sports Motivation Scale (SMS-II), and administered to undergraduate students in an Australian pharmacy course. Convergent validity was assessed by conducting a correlation analysis between the Pharm-S and MacLeod Clark Professional Identity Scale (MCPIS-9).

RESULTS

Face, content and construct validity were established for the Pharm-S through the analysis of 327 survey responses. Factor analysis extracted four of the six theoretical subscales as proposed by SDT (variance explained: 65.7%). Support for the SDT structure was confirmed by high factor loadings in each of the subscales and acceptable reliability coefficients. Subscale correlations revealed a simplex pattern, supporting the presence of a motivation continuum, as described by SDT. A moderate positive correlation (0.64) between Pharm-S responses and the validated professional identity instrument, MCPIS-9, indicated a possible link between levels of motivation and professional identity.

DISCUSSION

and conclusions: Content and structural validity and internal consistency of the Pharm-S confirmed the reliability of the Pharm-S as a valid tool to assess motivational regulators. Pharm-S and the MCPIS-9 were positively correlated, lending support to a link between motivation and professional identity. This suggests a potential role for the Pharm-S as a valid tool to measure pharmacy student professional identity development.

“There’s No Touching in Pharmacy”: Training Pharmacists for Australia’s First Pharmacist Immunization Pilot

<p><strong>ABSTRACT</strong></p><p><strong>Background:</strong> Vaccination is a safe, efficient, and cost-effective means of preventing, controlling, and eradicating many life-threatening infections and diseases. Globally, the World Health Organization estimates that vaccination saves between 2 million and 3 million lives annually. However, low immunization rates are a significant public health concern. Individual factors, along with the vaccination process and system, have been reported as perceived barriers and challenges to immunization. Lack of time, on the part of both health care professionals and patients, has also been reported as a key factor influencing patterns of immunization. Despite the accessibility of pharmacists in community pharmacies in Australia, and initiatives by other countries to introduce pharmacist vaccination services, pharmacists in Australia had not previously delivered this service. The Queensland Pharmacist Immunisation Pilot (QPIP), initially implemented for the 2014 influenza season and later expanded, as QPIP2, to include other vaccines, allowed Australian pharmacists to vaccinate for the first time.</p><p><strong>Objectives:</strong> To develop, implement, and evaluate a training program for pharmacists undertaking vaccination services in community pharmacies in Australia.</p><p><strong>Methods:</strong> Background content was developed and delivered through 2 online modules. Pharmacists were required to successfully answer a series of multiple-choice questions related to the background reading before attending a face-to-face workshop. The workshop provided practical training in injection skills and anaphylaxis management. Participants were also asked to evaluate the training program.</p><p><strong>Results:</strong> Of the 339 pharmacists who completed the training program, 286 (84%) provided an evaluation. Participants were satisfied with the training, as indicated by consistently high scores on the “overall satisfaction” question (mean 4.65/5 for the QPIP and QPIP2 training combined). Participants described the background reading as relevant to their practice and stated that it met their expectations. They also valued the opportunity to practise injections on each other during the face-to-face workshop, and this aspect was noted as a key component of the training.</p><p><strong>Conclusions:</strong> QPIP demonstrated that a pharmacist-specific training program could produce competent and confident immunizers and could be used to “retrofit” the profession, to facilitate delivery of vaccination services in Australia.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte :</strong> La vaccination est un moyen sécuritaire et efficient de prévenir, d’endiguer et d’éradiquer bon nombre d’infections et de maladies potentiellement mortelles. L’Organisation mondiale de la santé estime que, dans le monde, la vaccination permet de sauver entre 2 millions et 3 millions de vies par année. Cependant, les faibles taux d’immunisation représentent un enjeu de santé publique important. On a noté que des facteurs individuels ainsi que le processus et le système de vaccination sont perçus comme des obstacles à l’immunisation. Le manque de temps, tant de la part des professionnels de la santé que des patients, a aussi été présenté comme un facteur clé influençant les schémas d’immunisation. Malgré la disponibilité de pharmaciens dans les pharmacies communautaires en Australie et les initiatives lancées par d’autres pays pour mettre en place des services de vaccination offerts par les pharmaciens, les pharmaciens en Australie n’avaient pas prodigué ce service auparavant. L’étude Queensland Pharmacist Immunisation Pilot (QPIP), d’abord mise en place pour la saison de la grippe de 2014, puis reconduite en une version bonifiée nommée QPIP2 afin d’inclure d’autres vaccins, a permis aux pharmaciens australiens de vacciner pour la première fois.</p><p><strong>Objectifs :</strong> Élaborer, mettre en place et évaluer un programme de formation pour les pharmaciens qui offrent des services de vaccination dans les pharmacies communautaires en Australie.</p><p><strong>Méthodes :</strong> La matière du programme a été élaborée et offerte sous forme de deux modules en ligne. Les pharmaciens devaient répondre adéquatement à une série de questions à choix multiples portant sur les lectures préparatoires à un atelier en personne. L’atelier offrait une formation pratique sur les techniques d’injection et sur la prise en charge de l’anaphylaxie. On a aussi demandé aux participants d’évaluer le programme de formation.</p><p><strong>Résultats :</strong> Des 339 pharmaciens ayant terminé le programme de formation, 286 (84 %) ont fourni une évaluation. Les participants étaient satisfaits de la formation, comme l’indiquaient des cotes systématiquement élevées à la question concernant la satisfaction globale (moyenne de 4,65 sur 5 pour la formation des études QPIP et QPIP2 prises ensemble). Les participants ont indiqué que les lectures préparatoires étaient pertinentes pour leur pratique et qu’elles répondaient à leurs attentes. Ils ont aussi apprécié l’occasion de s’exercer à faire des injections les uns sur les autres au cours de l’atelier en personne; on a d’ailleurs noté que cet aspect représentait un élément clé de la formation.</p><p><strong>Conclusions :</strong> L’étude QPIP a permis de constater qu’un programme de formation destiné aux pharmaciens pouvait produire des vaccinateurs compétents et sûrs d’eux et qu’il pouvait servir à « moderniser » la profession afin de faciliter la prestation de services de vaccination en Australie.</p>

"There's No Touching in Pharmacy": Training Pharmacists for Australia's First Pharmacist Immunization Pilot

BACKGROUND

Vaccination is a safe, efficient, and cost-effective means of preventing, controlling, and eradicating many life-threatening infections and diseases. Globally, the World Health Organization estimates that vaccination saves between 2 million and 3 million lives annually. However, low immunization rates are a significant public health concern. Individual factors, along with the vaccination process and system, have been reported as perceived barriers and challenges to immunization. Lack of time, on the part of both health care professionals and patients, has also been reported as a key factor influencing patterns of immunization. Despite the accessibility of pharmacists in community pharmacies in Australia, and initiatives by other countries to introduce pharmacist vaccination services, pharmacists in Australia had not previously delivered this service. The Queensland Pharmacist Immunisation Pilot (QPIP), initially implemented for the 2014 influenza season and later expanded, as QPIP2, to include other vaccines, allowed Australian pharmacists to vaccinate for the first time.

OBJECTIVES

To develop, implement, and evaluate a training program for pharmacists undertaking vaccination services in community pharmacies in Australia.

METHODS

Background content was developed and delivered through 2 online modules. Pharmacists were required to successfully answer a series of multiple-choice questions related to the background reading before attending a face-to-face workshop. The workshop provided practical training in injection skills and anaphylaxis management. Participants were also asked to evaluate the training program.

RESULTS

Of the 339 pharmacists who completed the training program, 286 (84%) provided an evaluation. Participants were satisfied with the training, as indicated by consistently high scores on the "overall satisfaction" question (mean 4.65/5 for the QPIP and QPIP2 training combined). Participants described the background reading as relevant to their practice and stated that it met their expectations. They also valued the opportunity to practise injections on each other during the face-to-face workshop, and this aspect was noted as a key component of the training.

CONCLUSIONS

QPIP demonstrated that a pharmacist-specific training program could produce competent and confident immunizers and could be used to "retrofit" the profession, to facilitate delivery of vaccination services in Australia.