Pharmacists' perceptions of pharmacy technician occupational values

Background

Pharmacy technician scope of practice has expanded in recent years to attempt to alleviate the responsibility burden placed on pharmacists in some states. However, little research has examined the ways in which pharmacists attempt to persuade technicians to take on additional roles. Management literature has identified the importance of understanding employee values in crafting persuasive role expansion messaging. Objectives: Identify the occupational values which pharmacists believe are the most important to pharmacy technicians when attempting to craft messages aimed at increasing technician involvement in advanced roles.

Methods

Semi-structured interviews were conducted with pharmacists across multiple practice settings to identify how important they believe nine selected occupational values are to pharmacy technicians. Average scores for each of the nine values were calculated and examined to identify potential differences between the two overarching types of occupational values: intrinsic and extrinsic.

Results

Pharmacists indicated that they believed that technicians are more extrinsically motivated than intrinsically motivated. Pharmacists believed that technicians had higher levels of extrinsic occupational values as opposed to intrinsic occupational values (3.920 vs. 3.113). The most important values to technicians as perceived by pharmacists were the income of the job and the hours of the jobs (average score of 4.85 and 4.75, respectively). The chance to be helpful to others and society was the only intrinsic value with an average score >3.5. Additionally, pharmacists indicated that technicians were not properly compensated for their work, which furthered illustrated the perceived importance of extrinsic motivators. Finally, when it came to crafting messaging around role expansion, pharmacists believed it was important to tailor their messaging to the technician they were speaking to.

Conclusion

Pharmacists looking to craft role expansion messaging to their technicians are more likely to utilize extrinsic occupational values as motivators instead of using intrinsic values.

A Qualitative Approach to Investigating Developmental Opportunities Among Leaders and Followers

Objective. To understand and identify developmental opportunities by exploring students' evolving views of leadership, including the emergence of leadership and self-identification, among students considered to be leaders and those considered to be followers.Methods. An exploratory qualitative study using semi-structured interviews was conducted, investigating developmental differences among leaders and followers. Fourteen students/residents were selected to participate in interviews. Student responses were analyzed using qualitative thematic analysis.Results. In discissions, four themes surfaced: motivations for exploring and engaging in leadership, perceptions of ideal leaders and followers, the value of coalition building, and a leader's role in sustainability. Leader respondents indicated that a potential barrier to helping others develop was their difficulty in delegation. Further, stress on leaders may contribute to a self-serving perspective on their responsibilities to help others develop.Conclusion. In comparison to their leader counterparts, followers may require a more individualized approach to their development and may become more deeply attached to their responsibilities, giving them a greater desire to promote sustainability in an organization or endeavor. Schools of pharmacy should be poised to support faculty, advisors, mentors, and student leaders with the tools to identify and develop active followers who may not seek out traditional leadership experiences.

The Impact of Two Longitudinal Professionalism Courses on Student Pharmacists' Empathy

Objective. To determine whether empathy increased in first-year student pharmacists after completing longitudinal professionalism courses at two schools of pharmacy, identify potential moderators, and assess whether students' conceptualization of empathy changed with time.Methods. Surveys to assess empathy and other variables were administered to student pharmacists at baseline and at the end of two professionalism courses. Baseline and follow-up scores were compared to detect changes over time. Multivariable analysis was used to identify predictors of empathy scores. Factor analysis was performed to ascertain changes in the dimensionality of empathy.Results. Students' demographics and baseline empathy scores differed between the two schools. Predictors of empathy at baseline included age, female gender, prior health care experience, and altruism score. A small increase in empathy was observed at one school but not in the combined cohort. Empathy was more likely to increase among female students, those with less health care experience, and those who did not work during the school year. Factor analyses suggested that students' conceptual clarity about empathy improved over time and became more consistent with existing models.Conclusion. Although an increase in empathy was not observed in the overall cohort, subgroups of students who may derive greater benefit from empathy-related interventions were identified. Factor analyses suggested that students' conceptual understanding of empathy improved, representing a potential alternative outcome assessment for affective domains. Given differences in demographics, instructional methodologies, and changes in empathy at each school, this study reinforces the importance of replication and multicenter studies to understand the generalizability of educational research.

Autism Prevalence in the Medicaid Program and Healthcare Utilization and Costs Among Adult Enrollees Diagnosed with Autism

As the number of individuals diagnosed with autism increases, there is an increase in demand to provide support throughout their lifespan. This study aimed to: (1) estimate trends in the prevalence of autism diagnoses and medical services use in adults with autism diagnoses; (2) assess predictors of healthcare utilization and costs among adults with autism diagnoses enrolled in Medicaid. A retrospective analysis of 2006-2008 Medicaid claims for 39 states was conducted. There was a 38% increase in the prevalence of autism diagnoses from 2006 to 2008. Total expenditures and outpatient and ER visits varied significantly by demographic variables.

Reporting interpersonal violence and abuse: What pharmacists need to know

Objective

To examine and describe the reporting requirements for pharmacists related to interpersonal violence and abuse in the United States.

Methods

A comprehensive search of state laws related to mandatory reporting of intimate partner violence and domestic violence (IPV), child abuse, and elder abuse was conducted. Identified statutes were reviewed to determine if pharmacists were mandatory reporters for each type of violence.

Results

Pharmacists are specifically identified as mandatory reporters of intimate partner violence in 10 states, of child abuse in 11, and of elder abuse in 20. They may also have reporting requirements in more states as statutes sometimes identify health care providers as mandatory reporters, but do not specify which types of providers. Additionally, many states require reporting of child and elder abuse by anyone who is aware of or suspects abuse. IPV statutes mainly require reporting when treating wounds from gunshots, stabbings, and burns.

Conclusions

Pharmacists are accessible health care providers who should be aware of reporting requirements for their practice location and setting. They have mandatory reporting requirements in much of the United States, especially for child and elder abuse. They should seek specific guidance about their reporting requirements and reporting methods, as well as identify educational and local referral resources for victims they may encounter in practice.

The Current Landscape of Veterinary Compounding in the Pharmacy Setting

Medicating animals poses unique challenges that are often best dealt with via compounding. Pharmacists receive compounding training while in pharmacy school, but this training is not veterinary specific. Pharmacists are expected to have enough knowledge to properly verify prescriptions that are received at their practice site while keeping with the most up-to-date guidelines related to animal and human health. Whether pharmacists have the proper training to verify and/or compound veterinary specific medications is unknown. A self-administered survey was distributed electronically to 4,550 email addresses on record with the American College of Veterinary Pharmacists, the International Academy of Compounding Pharmacists, and the Society of Veterinary Hospital Pharmacists. The survey asked questions about regulations and standards associated with the use of prescription or compounded medications. Of the 4,550 distributed surveys, 153 were received, for a 3.4% response rate. Of the responses received, only 131 were used in the final data analysis. Most respondents correctly answered the assessment question regarding the ability to compound backordered, commercially available products. A majority of respondents incorrectly answered the question regarding the proper flavoring for a medication for a ferret. Those with more training perceived themselves to have a higher level of skill (r = 0.41, P<0.001). Similarly, those with formal veterinary training had better scores on Question 4 of the assessment questions, which requires knowledge of feline toxicities (P=0.029). The most common compounded medications dispensed in practice by pharmacists are methimazole, metronidazole, and gabapentin. Pharmacists mostly recognized that compounding backordered, commercially available products is permitted. Formal training improves familiarity with current compounding rules, regulations, and best practices. Formal training in veterinary pharmacy and veterinary compounding should be promoted and encouraged. Efforts should also be made at improving pharmacists' understanding of both veterinary and compounding laws and regulations.

The Current Landscape of Veterinary Compounding in the Veterinary Setting

Compounding for veterinarians is regulated by the U.S. Food and Drug Administration, but day-to-day regulation is deferred to the state authorities. Veterinarians must meet certain standards when prescribing or dispensing a compounded medication. Veterinarians are expected to maintain current knowledge of the benefit of compounded preparations and prescribe and dispense in keeping with the best evidence related to animal and human health. Whether veterinarians recognize or adhere to these standards is unknown. A self-administered survey was distributed electronically to 30,000 email addresses on record with the Veterinary International Network. The survey asked questions about the regulations and standards associated with the use of or prescription of compounded medications. Of the distributed surveys, 1,520 survey responses were received, for a 5.1% response rate. All surveys were included in the final analysis. Respondents with a higher training level in compounding had a greater perceived skill level regarding compounding of medications (r = 0.26, P<0.0001). Similarly, respondents with a higher training level had a greater knowledge of state laws and regulations (r = 0.14, P<0.0001). Those with formal training had better scores on the assessment questions than those with informal or no training (P=0.01). Approximately one-third of the respondents felt that they were not knowledgeable at all about compounding rules and regulations. The most common compounded medications used in practice by veterinarians are methimazole, metronidazole, and doxycycline. Veterinarians mostly recognized that compounding backordered, commercially available products is permitted. Formal training improves familiarity with compounding rules, regulations, and current practices. Therefore, efforts should be directed at improving veterinary knowledge of laws and regulations surrounding the practice of compounding medications.

An evaluation of the psychometric properties of the sf-12v2 health survey among adults with hemophilia

Background

This study examined the psychometric properties of version 2 of the SF-12 Health Survey (SF-12v2) among adults with hemophilia in the United States.

Methods

This study employed a cross-sectional design using web-based and paper-based self-administered surveys. Hemophilia patients were recruited using an online panel and at a hemophilia treatment clinic. The psychometric properties of the SF-12v2 were assessed in terms of construct validity, internal consistency reliability, and presence of floor and ceiling effects.

Results

A total of 218 adults with hemophilia completed the survey, with most recruited via the online panel (78%). Confirmatory factor analysis using the WLSMV estimator in Mplus supported a two-factor model for the SF-12v2 where the physical functioning, role physical, bodily pain, and general health items loaded onto a latent physical factor (LPF) and the role emotional, mental health, social functioning, and vitality items loaded onto a latent mental factor (LMF). Model fit statistics for the two-factor model were: Chi-square [df] = 172.778 [48]; CFI = 0.972; TLI = 0.962; RMSEA [90% CI] = 0.109 [0.092–0.127]; WRMR = 0.947. Correlated residuals for items belonging to similar domains were estimated and there was a significant correlation between LPF and LMF. All standardized factor loadings were strong and statistically significant, indicating adequate convergent validity. Item-to-other scale correlations were lower than item-to-hypothesized scale correlations suggesting good item discriminant validity. Model testing revealed that LPF and LMF were not perfectly correlated, suggesting adequate construct discriminant validity. Increasing levels of symptom severity were associated with significant decreases in physical component summary (PCS) and mental component summary (MCS) scores, supporting known-groups validity. Internal consistency reliability was satisfactory, with Cronbach’s alpha of 0.848 for the LPF and 0.785 for the LMF items. Finally, none of the participants received the least or maximum possible PCS or MCS score, indicating the absence of floor and ceiling effects.

Conclusions

Overall, the SF-12v2 was found to have adequate psychometric validity in our sample of adults with hemophilia. These results add to the growing evidence of psychometric validity of the SF-12v2 in different patient populations including hemophilia.

Patient centered research to improve community involvement (PaRTICIpate) in diabetes self-management: a conference series for developing collaborations between researchers, stakeholders, and patients

Background

A patient-centered approach to research development is important to the creation of research evidence that is meaningful and beneficial to patients. Collaboration between patients, stakeholders, and researchers, where patients serve an integral role in all aspects of the research development process, is integral to achieving these twin objectives.

Results

This paper presents a unique approach to engaging patients and stakeholders in research by describing a conference series focused on meaningfully integrating patients in each phase of the project. Through three meeting phases, patients were not only introduced to patient-centered research (PCR) concepts, but they also led discussions about diabetes self-management and developed PCR questions. A total of 17 questions were developed represented by four main themes: communication, patient knowledge and perceptions, diabetes prevention, and diabetes management. Through patient feedback, three research questions were each identified as immediate priorities for development into research project proposals.

Conclusion

To our knowledge, the use of a conference series designed to teach patients about research, encourage collaboration across stakeholder groups, and write research questions has not been described in the literature. Moreover, this approach has proven successful in recruiting and retaining patient participation through the life of the project. This project has also identified a number of issues for consideration by future researchers looking to meaningfully engage patients in the development of research proposals.

Work Preferences and General Abilities Among US Pharmacy Technicians and Danish Pharmaconomists

INTRODUCTION

The importance of pharmacy support personnel is increasingly recognized. Studies have evaluated workplace issues and evolving roles; however, needed information from technicians themselves is scarce. The purpose of this study was to examine preferences for work activities and the general abilities of US pharmacy technicians and Danish pharmaconomists.

METHODS

Surveys were administered to random samples of US technicians in 8 states and the general population of Danish pharmaconomists. Respondents indicated their preference for involvement in a set of work activities in community or hospital pharmacy on numeric scales. They also self-assessed their level of ability on facets associated with professional practice, in general. Descriptive results were tabulated, and bivariate tests were conducted on total general abilities ratings.

RESULTS

The 494 technicians and 313 pharmaconomists provided similar ratings on many activities. In community pharmacy, US technician ratings for performance of activities were generally higher than those of pharmaconomists; however, pharmaconomists rated certain "higher order" communication activities quite highly, such as discussing lifestyle changes with the patient. In hospital practice, Danish pharmaconomists provided low preferences for medication handling but high preferences for communication activities. General ability ratings were given high self-evaluations, but lower on some components, such as keeping up with the profession. Employer commitment was a strong correlate for both.

CONCLUSIONS

Evaluation of preferred work activities and general abilities were likely reflected in different scopes of practice between the two and could be insightful for education and work redesign in both countries, particularly the United States, as leaders evaluate shifts in technician professionalization.

The caring behaviours of Danish pharmaconomists: insight for pharmacy technician practice around the world

OBJECTIVES

Pharmacy workforce support personnel are being accorded greater scopes of practice, especially Danish pharmaconomists [pharmacy technician, experts in pharmaceuticals with a 3-year degree]. The aims of this study were to assess pharmaconomists' caring behaviours and identify factors related to those behaviours.

METHODS

A self-administered survey was distributed to a random sample of pharmaconomists in Denmark. The survey assessed caring behaviours using the Caring Behaviours Assessment and acquired data to ascertain their employers' culture, respondent's need for achievement, personality traits, commitment and work-related characteristics. Descriptive statistics provided insight into pharmacomomists' predispositions, and bivariate analyses were used to identify associations of pharmaconomists' caring with other variables under study.

KEY FINDINGS

Over 300 pharmaconomists responded (52.2% response rate). Pharmaconomists reported generally high levels (well above the median on the 5-point scale) of caring behaviours. They reported higher levels (upper range of 5-point scale) of empathic behaviours, such as treating patients with respect and seeing things from the patient's point of view but somewhat lower levels of encouraging the patient to talk about how they feel and praising the patient's efforts, which could otherwise help patients cope with and improve their self-efficacy for disease management. Pharmaconomist caring was associated with practice setting, organisational culture and commitment to their employer.

CONCLUSIONS

Pharmaconomists reported performing behaviours that were empathic, but less frequently those associated with facilitating greater patient autonomy. Caring behaviours were associated with a number of variables related to practice setting. The findings can help to inform educational pedagogy and pharmacy personnel management.

The Professional Culture of Community Pharmacy and the Provision of MTM Services

The integration of advanced pharmacy services into community pharmacy practice is not complete. According to implementation research understanding professional culture, as a part of context, may provide insights for accelerating this process. There are three objectives in this study. The first objective of this study was to validate an adapted version of an organizational culture measure in a sample of United States' (US) community pharmacists. The second objective was to examine potential relationships between the cultural factors identified using the validated instrument and a number of socialization and education variables. The third objective was to examine any relationships between the scores on the identified cultural factors and the provision of MTM services. This study was a cross-sectional online survey for community pharmacists in the southeastern US. The survey contained questions on socialization/education, respondents' self-reported provision of medication therapy management (MTM) services, and the organizational culture profile (OCP). Analyses included descriptive statistics, a principle components analysis (PCA), independent samples t-test, and multivariate ordinal regression. A total of 303 surveys were completed. The PCA revealed a six-factor structure: social responsibility, innovation, people orientation, competitiveness, attention to detail, and reward orientation. Further analysis revealed significant relationships between social responsibility and years in practice, and people orientation and attention to detail and pharmacists' training and practice setting. Significant positive relationships were observed between social responsibility, innovation, and competitiveness and the increased provision of MTM services. The significant relationships identified between the OCP factors and community pharmacist respondents' provision of MTM services provides an important starting point for developing interventions to improve the uptake of practice change opportunities.

Components of a Measure to Describe Organizational Culture in Academic Pharmacy

Objective. To develop a measure of organizational culture in academic pharmacy and identify characteristics of an academic pharmacy program that would be impactful for internal (eg, students, employees) and external (eg, preceptors, practitioners) clients of the program. Methods. A three-round Delphi procedure of 24 panelists from pharmacy schools in the U.S. and Canada generated items based on the Organizational Culture Profile (OCP), which were then evaluated and refined for inclusion in subsequent rounds. Items were assessed for appropriateness and impact. Results. The panel produced 35 items across six domains that measured organizational culture in academic pharmacy: competitiveness, performance orientation, social responsibility, innovation, emphasis on collegial support, and stability. Conclusion. The items generated require testing for validation and reliability in a large sample to finalize this measure of organizational culture.

Community Pharmacists’ Classification of Prescription Drugs into an Expanded Class of Nonprescription Drugs under the FDA's Proposed NSURE Initiative

Objectives: There has been considerable debate over the last few decades about creating a third class of drugs that would not require a prescription or not be available freely over the counter, but require a pharmacist’s consultation upon purchase. These debates reignited again in 2012, when the Food and Drug Administration (FDA) held a hearing about a third class of drugs positioned as an expanded nonprescription drug class under the FDAs Nonprescription Safe-Use Regulatory Expansion (NSURE) Initiative. The objective of this study was to determine which prescription drugs community pharmacists believe are acceptable additions to an expanded definition of nonprescription drugs that would be available pending pharmacists’ consultation with a patient. Methods: This cross-sectional study was conducted using a self-report, web-based survey administered to a national panel of community pharmacists. The survey contained a list of 24 current “prescription-only” drugs which may be potential candidates for an expanded nonprescription drug class, based on criteria outlined by the FDA, and questions related to respondent demographic and practice characteristics. The respondents were asked to indicate whether a particular drug should be marketed as a prescription drug, nonprescription drug or as part of an expanded non-prescription drug class. Descriptive analyses were conducted to determine the drugs that community pharmacists believed would be suitable additions to an expanded non-prescription drug class under the NSURE initiative. Results: 462 completed surveys were received. Most respondents indicated that clopidogrel bisulfate (85.3%) and zolpidem (86.6%) should continue to be dispensed as prescription drugs. Atorvastatin, metformin, and sildenafil (among others) were considered appropriate to be marketed as an expanded nonprescription drug, in other words, dispensed without a prescription but upon pharmacist consultation. Desloratadine (64.6%) and pre-natal vitamins (50.2%) were considered appropriate for nonprescription status (over-the-counter, without pharmacist intervention). Conclusions: Respondents suggested that 18 out of 24 drugs (75%) on the list provided could be categorized into an expanded class of nonprescription drugs. Adding more drugs to an expanded nonprescription drug class has the potential to expand pharmacists’ provision of patient care under the FDA’s proposed NSURE program.   Type: Student Project

Pharmacists' Perceptions of the Economic Value of Compounded Pharmaceuticals: A Comparison of Compounded and Commercial Pharmaceuticals in Select Disease States

Studies have been conducted to assess patient satisfaction with compounded pharmaceuticals and to directly compare compounded pharmaceuticals with their comparable commercial pharmaceuticals. Yet, the economic value of or potential for economic value derived from compounded pharmaceuticals relative to commercial pharmaceuticals is still not known. Therefore, the purpose of this study was to assess and compare compounding and non-compounding pharmacists' perceptions of the economic value of compounded preparations relative to commercial products. In-depth interviews with 10 compounding pharmacists and physicians who prescribe compounded prescription pharmaceutical preparations were conducted to help develop a self-administered questionnaire distributed to 50 compounding and 50 non-compounding pharmacists. Compounding and non-compounding pharmacists' perceptions differed most often in the context of compounded pharmaceuticals for pediatric patients. However, both groups responded with moderate agreement that compounded prescription treatments are more profitable for the pharmacy than commercial prescription treatments in most therapeutic areas. This research sought to understand the perception of pharmacists of areas for potential direct and indirect economic cost savings as a result of compounding. For all items whereby compounding and non-compounding pharmacists' ratings were significantly different, compounding pharmacists more strongly believed that compounding pharmaceuticals offered benefit and vice versa. The differences in ratings that were most common were those that directly compared the economic value of compounding and commercial pharmaceuticals, with compounding pharmacists more strongly agreeing with the potential cost savings associated with compounded pharmaceuticals. Based on these findings, prescription compounds are believed to have a benefit to the health system by those who provide them. Future research should proactively explore the economic benefit of compounded preparations compared to conventionally manufactured products to determine the economic value of compounded pharmaceuticals for patients, pharmacies, physicians, and the healthcare system.

Student pharmacists' perceptions of community pharmacy residency programs

OBJECTIVES

To compare penultimate-year (next-to-last) and final-year student pharmacists' perceptions of the educational value of community pharmacy residency programs (CPRPs) and to compare student pharmacists' perceptions of the educational value of CPRPs and health-system residency programs (HSRPs).

METHODS

A self-administered online survey was sent to administrators at 119 Accreditation Council for Pharmacy Education-accredited schools of pharmacy for ultimate distribution to penultimate- and final-year student pharmacists. The survey included demographic measures and a 20-item residency program "perceived value of skill development" scale developed for this study.

RESULTS

1,722 completed surveys were received and analyzed. Penultimate-year students attributed greater value to CPRPs more frequently than final-year students. Students more often attributed higher value to CPRPs for skills related to business management, practice management, and medication therapy management, while they attributed higher value to HSRPs for skills related to teaching, research, and clinical knowledge.

CONCLUSION

The results of this study suggest students' perceived value of CPRPs may be related to their year of pharmacy school and the pharmacy practice skill in question.

Factors that physicians find encouraging and discouraging about electronic prescribing: a quantitative study

To determine factors that physicians find encouraging and discouraging about e-prescribing and to compare these factors based on physicians' adoption status, a cross-sectional study was conducted using an internet-based survey administered to a national convenience sample of primary care physicians. A scale was developed to measure factors related to the adoption of e-prescribing. Analysis procedures included exploratory factor analysis, multivariate analysis of variance, and Tukey's post-hoc tests. 443 surveys were received and seven e-prescribing factors were identified. Pre-implementation and cost factors were found to be most discouraging, while software features were found to be most encouraging. The fact that current e-prescribers found e-prescribing factors to be more encouraging than future or non-e-prescribers suggests that 'fear of the unknown' may play a role in prescribers' perceptions of e-prescribing and associated software. These findings will enable consultants, vendors, and policymakers to facilitate the adoption of e-prescribing by directly targeting the factors that are most salient to physicians.

Adoption of and experience with e-prescribing by primary care physicians

BACKGROUND

The impetus of electronic prescribing (e-prescribing) is the reduction of preventable medication errors by generating a legible prescription checked via e-prescribing software for drug-drug and other interactions. Although the adoption of e-prescribing among physicians is growing, the Institute of Medicine's recommendations that all prescriptions be routed electronically by 2010 certainly has not been met.

OBJECTIVES

To provide an update on e-prescribing use among primary care physicians (PCPs), describe their experience with e-prescribing, and provide insight into prescribers' decisions to implement e-prescribing in their practices.

METHODS

An Internet-based survey was administered to a national convenience sample of physicians. The respondents were categorized into e-prescribers or non-e-prescribers. Data to describe demographic characteristics, respondents' experiences with e-prescribing, and respondents' decision to implement e-prescribing were collected. Nonparametric tests were used to test differences in the factors influencing e-prescribers' and traditional prescribers' decisions about electronic prescription implementation.

RESULTS

Four hundred forty-three PCPs participated in the study. There were no significant differences in the demographic characteristics of e-prescribers and non-e-prescribers. Most e-prescribers (83%) reported satisfaction with their e-prescribing system and a preference for e-prescribing over traditional prescribing. Although 22% of respondents indicated that they have started and stopped e-prescribing, most have resumed or intended to resume e-prescribing in the near future. More than half of the respondents reported that they are experiencing problems with their e-prescribing software.

CONCLUSIONS

E-prescribing appears to be present in many types of primary care practices and geographic areas of the country. Despite their satisfaction with and preference for e-prescribing, PCPs still appear to be experiencing problems with e-prescribing software. Implications of these study results for the pharmacy profession are discussed.

Instrument to measure psychological contract violation in pharmacy students

OBJECTIVES

To adapt and evaluate an instrument that measures perceived psychological contract violations in pharmacy students by schools and colleges of pharmacy.

DESIGN

A psychological contract violations measure was developed from existing literature and the 1997 ACPE Guidelines and pilot-tested with second-year pharmacy students at 2 schools of pharmacy. A revised measure then was administered to second-year pharmacy students at 6 schools of pharmacy. Using a 5-point Likert-type scale, participants were asked to indicate the level of obligations they received compared to what was promised by the school of pharmacy.

RESULTS

Exploratory factor analysis on the psychological contract violations measure was conducted using principal components analysis resulting in 7 factors, which led to a revised measure with 26 items. Using a sample of 339 students, the proposed 7-factor measurement model was tested using confirmatory factor analysis. In general, the results supported the hypothesized model. The final 23-item scale demonstrated both reliability and validity. Some students perceived certain aspects of the psychological contract that exists with their school of pharmacy were being violated.

CONCLUSION

The psychological contract violations measure may serve as a valuable tool in helping to identify areas where their students believe that schools/colleges of pharmacy have not fulfilled promised obligations.

The Impact of the Internet on Community Pharmacy Practice

The purpose of this study was to forecast the impact of Internet pharmacy commerce on various stakeholders. A panel of experts assembled from a list of academicians in the social and administrative pharmaceutical sciences participated in a three-iteration Delphi procedure. Feedback from the aggregate responses of the panel was used to construct questionnaires employed in subsequent iterations of the Delphi. The panel converged to form a consensus upon a variety of issues. They forecasted the attainment of a 10-15% share in the market of prescription and over-the-counter pharmaceuticals through on-line purchases, the formation of strategic alliances among stakeholders in the drug distribution process, a shift in marketing strategies by brick-and-mortar stores, an increase in the prevalence of niching among pharmacy service providers and a subsequent growth in the implementation of cognitive services throughout the industry. With few exceptions, the forecast produced by the Delphi panel appears to be coming to fruition.

Ratings of journals for the dissemination of pharmacy-related social and administrative science

BACKGROUND

It has been over a decade since a journal quality rating study has been conducted in the social and administrative sciences (SAdS). This study sought to reevaluate perceptions of journal quality.

OBJECTIVES

To develop a list of journals that are suitable publication venues for SAdS scholars and compare the quality of these journals as rated by school of pharmacy deans, SAdS department/division chairs, and SAdS faculty.

METHODS

A list of journals was assembled and presented to a Delphi panel of 15 SAdS scholars. Using a modified Delphi technique, the panel refined the list by judging the suitability of each journal as a publication venue for scholars. This list was used in a survey administered via the Internet. Journal quality was rated on a 7-point Likert-type scale with the option of indicating unfamiliarity with each journal. Differences in quality ratings between faculty, chairs, and deans were explored. Adjusted rating scores were calculated based on familiarity with journals. Ratings from the current study were compared to previous studies.

RESULTS

One hundred and twelve journals emerged from the modified Delphi technique. Kruskal-Wallis analysis of variance found no significant difference in perceived journal quality across all journals evaluated by the 3 groups (KW=3.91). Groups did differ in their familiarity (KW=11.71, P<.01), with faculty being the most familiar with the journals and deans being the least familiar. Journal rankings were highly correlated with journal rankings from previously published studies.

CONCLUSIONS

Results of this study have implications for scholars choosing publication venues and those who make decisions contingent on scholars' publication records. These differences may represent a positive or negative bias that affects hiring as well as tenure and promotion decisions. This study provides guidance for decisions reliant on publication records, but should not be used exclusively as such an indicator.

Specialty compounding for improved patient care: 2006 national survey of compounding pharmacists

Pharmacy compounding is re-emerging as a critical area of pharmacy practice. This re-emergence has generated considerable discussion among stakeholders of the pharmacy profession about how pharmacy compounding is best regulated to ensure the safety and efficacy of compounded preparations. In light of this discussion, the American College of Apothecaries conducted a survey in August 2006 that was sent to compounding pharmacists, the list of which was provided by the International Journal of Pharmaceutical Compounding. The purpose of the survey was to (1)assess the safety and efficacy of compounded preparations as reported by compounding pharmacists, (2)describe the types of compounding and other professional services that are offered by these pharmacists, (3)describe selected business information for compounding pharmacies, and (4)monitor changes in the compounding pharmacy landscape since the 2005 National Survey of Compounding Pharmacists, the results of which were published in the November/December 2006 issue of the International Journal of Pharmaceutical Compounding. State boards of pharmacy were surveyed for reports of problems related to instability of compounded preparations and adverse reactions caused by compounded preparations. Data trends in this study are similar to those reported in the 2005 survey, also conducted by the American College of Apothecaries. Repsondents reported relatively few adverse events caused by compounded preparations. These respondents, many of whom are independent pharmacists, offer a variety of compounding, professional, and patient care services. Of 18 responding state boards of pharmacy, four noted reports of compounding problems in their state.

Structural model of certified pharmacy technicians' job satisfaction

OBJECTIVE

To determine the effects of worklife attitudes on certified pharmacy technicians' job satisfaction.

DESIGN

Cross-sectional descriptive design.

SETTING

United States in January 2004.

PARTICIPANTS

Random sample of 3200 certified pharmacy technicians (CPhTs) acquired from the Pharmacy Technician Certification Board.

INTERVENTION

Mail survey.

MAIN OUTCOME MEASURES

Responses to previously validated instruments measuring quality of worklife attitudes. Hypothesized relationships between these worklife attitudes (job stress, future uncertainty, career commitment, organizational commitment, supervisor support, coworker support, employer support) and job satisfaction were tested with structural equation modeling.

RESULTS

The results provided adequate support for the hypothesized, partially mediated (comparative fit index [CFI] = 0.091, root mean square error of approximation [RMSEA] = 0.073), fully mediated (CFI = 0.091, RMSEA = 0.073) and direct effects (CFI = 0.922, RMSEA = 0.066) models, each exhibiting moderate fit. As predicted, job stress negatively affected job satisfaction among CPhTs. However, the negative effects of job stress were mitigated by supervisor support, which, along with employer and coworker support, was positively related to job satisfaction. Future uncertainty also was found to be negatively related to job satisfaction; this relationship was mediated by organizational commitment.

CONCLUSION

Job stress was present in CPhTs, although not to the degree pharmacists have reported it. Job stress negatively affected job satisfaction, but this was mitigated by supervisor support. CPhTs reported uncertainty about their future career plans. Commitment to their current employer lessened this uncertainty. Pharmacy managers should consider including CPhTs in goal setting and career planning.

Specialty compounding for improved patient care: a national survey of compounding pharmacists

The apparent re-emergence of pharmaceutical compounding as an important part of health care is largely explained by the increasing demand for pharmaceutical preparations that are not commercially available. However, there have been recent discussions among regulatory agencies and various stakeholders of the pharmacy profession as to the safety and efficacy of pharmaceutical compounding, and how compounding should best be regulated. In light of this discussion, the American College of Apothecaries conducted a survey of International Journal of Pharmaceutical Compounding subscribers in July 2005 to (1) assess the safety and efficacy of compounded preparations, (2) describe the types of compounding and other professional services that are offered by pharmacists, and (3) describe selected compounding pharmacies. In general, respondents reported few incidents of adverse events resulting from compounded preparations, and reported having offered a variety of compounding, professional, and patient care specialties services.

"Blogging" about course concepts: using technology for reflective journaling in a communications class

OBJECTIVE

Web log technology was applied to a reflective journaling exercise in a communication course during the second-professional year at the University of Mississippi School of Pharmacy, to encourage students to reflect on course concepts and apply them to the environment outside the classroom, and to assess their communication performance.

DESIGN

Two Web log entries per week were required for full credit. Web logs were evaluated at three points during the term. At the end of the course, students evaluated the assignment using a 2-page survey instrument.

ASSESSMENT

The assignment contributed to student learning and increased awareness level for approximately 40% of the class. Students had few complaints about the logistics of the assignment.

CONCLUSION

The Web log technology was a useful tool for reflective journaling in this communications course. Future versions of the assignment will benefit from student feedback from this initial experience.

Ask the Pharmacist: An Analysis of Online Drug Information Services

BACKGROUND:

The Internet plays a large role in the provision of drug information. Given the growing number of patients seeking consultation on the Internet and the difficulty in regulating online pharmacy providers, an analysis of drug information provided by Internet pharmacies is warranted.

OBJECTIVE:

To assess the response rates and quality of responses to drug information questions submitted to “ask the pharmacist” services on Internet pharmacy sites and determine whether differences exist between National Association of Boards of Pharmacy—approved and nonapproved sites and among free-standing, chain, and independent pharmacy sites in the quality of information provided.

METHODS:

A content analysis was conducted on responses to 5 drug information questions electronically mailed to each of 64 Internet pharmacies identified through a meta-engine search. Three judges rated the quality of response components using a scoring system developed by an expert panel, with inter-rater reliabilities subsequently calculated. Both t-test and ANOVA procedures tested for differences in response quality.

RESULTS:

Responses were received for 51% of all questions submitted to the sites. Few differences in quality were found between approved/unapproved sites and among types of pharmacies. The percentage of correct responses provided for each of 22 response components ranged from 7% to 96%.

CONCLUSIONS:

While few differences were found among sites based on their approval status or type, low response rates and incomplete counseling information among many of the responses are cause for concern.

Strontium-89 therapy for painful osseous metastatic prostate and breast cancer

Strontium-89 chloride is a radiopharmaceutical that localizes to actively forming new bone, such as metastatic bone lesions from prostate and breast cancer. It provides effective systemic endo-osseous local radiation therapy to these painful lesions. Strontium-89 will soon be available to physicians in the United States for use in the palliative management of metastatic bone pain.

Western Polynesia's first home for the aged: Are concept and culture compatible?

In 1975 Western Polynesia's first home for the aged, called Mapuifagalele, was established in a village just outside Apia. The home was operated by the Little Sisters of the Poor and housed 83 elderly Samoans of both Catholic and Protestant faith. This paper outlines the traditional Samoan patterns of aging and the high priority placed on family care for elders. In discussing the home and its residents, we consider ways in which what might appear to be an incompatible institutional concept has been adapted to fit the local cultural configuration. We also speculate on a variety of factors which may or may not be responsible for the acceptance and on-going operation of a facility of this type.

Radionuclide transit: a sensitive screening test for esophageal dysfunction

The purpose of this study was to extend existing nuclear medicine techniques for the diagnosis of esophageal motor disorders. A standard homogeneous bolus of 99mtechnetium sulfur colloid in water was swallowed in the supine position under the collimator of a gamma camera linked to a microprocessor. Bolus transit was recorded at 0.4-s intervals, and the movie obtained was used to analyze transit in an objective manner. Ten normal volunteers and 30 subjects with dysphagia not related to mechanical obstruction were studied with this technique. Radionuclide transit studies detected a higher incidence of esophageal motor abnormality than manometry or radiology in the dysphagia group. In addition a definitive description of the functional problem was possible in most cases. Radionuclide transit is a safe noninvasive test and suitable as a screening test for esophageal motor disorders.

Testicular radionuclide angiography and static imaging: anatomy, scintigraphic interpretation, and clinical indications

Radionuclide testicular angiography and static imaging is an easy, rapidly performed study. Its usefulness in separating acute testicular torsion from acute epididymitis has been confirmed. Increased angiographic perfusion with definition of the testicular and deferential arteries in the spermatic cord and the pudendal artery posteriorly is equated with inflammation. Intense increased vascularity on the blood pool image is seen in abscess and acute inflammation, while cases of tumor and trauma have mild increases. Acute or missed testicular torsion, uncomplicated hydroceles, and spermatoceles show absent vascularity. On the static images, decreased activity is characteristic of the stage and location of the avascular structure, Technical factors are stressed.

An evaluation of bone scans as screening procedures for occult metastases in primary breast cancer

Preoperative bone scans were obtained in 104 patients with operable breast cancer. Areas of increased radioactivity detected by the bone scan were correlated with appropriate radiographs. One of 64 patients (1.5%) with clinical Stage I and Stage II breast cancer had a metastatic lesion detected by the preoperative bone scan. In contrast, 10 of 41 patients (24%) with Stage III breast cancer had occult metastatic lesions detected by the preoperative bone scan. The majority of patients with abnormal bone scans and no radiographic evidence of a benign lesion to explain the cause of the increased radioactivity proved to have metastatic breast cancer on follow-examination. Even though 20% of patients with operable breast cancer will eventually develop bone metastases, our results indicate that preoperative bone scans are not an effective means of predicting which patients with Stage I and Stage II disease will develop metastatic breast cancer. Because of the considerably increased frequency of detection of occult metastases in patients with Stage III breast cancer, bone scans should be obtained routinely in the preoperative assessment of these patients.

Phantom kidney in technetium-99m DTPA studies of renal blood flow: case report

Renal perfusion, filtration rate, and excretion can be evaluated with technetium-99m diethylenetriamine pentaactate (Tc-DTPA) using immediate and delayed imaging. Two cases are presented in which the immediate images reveal a bilateral distribution of radiotracer characteristic of bilateral renal perfusion, but the delayed images showed no evidence of filtration or excretion on one side. There was congenital absence of the kidney on that side in one case and surgical absence in the other. The apparent renal perfusion on the side of the absent kidney was probably attributable to perfusion of small bowel occupying the renal fossa.