Pharmacist involvement with immunizations: a decade of professional advancement

OBJECTIVE

To review achievements in pharmacist-administered immunizations, emphasizing the period 1995 to 2004.

DATA SOURCES

Published articles identified through PubMed (1995-2004) using the search terms pharmacist, pharmacy, and vaccine, immunization, or shots. Additional sources were identified from personal bibliographies collected by the authors during this decade, as well as the bibliographies of the retrieved articles. The later two sources resulted in manuscripts of primarily historical significance.

STUDY SELECTION

More than 300 manuscripts were identified. The authors selected 15 studies that most clearly document the effect of pharmacist-administered immunizations for review.

DATA EXTRACTION

By the authors.

DATA SYNTHESIS

While pharmacists have been involved with vaccines dating back to the mid-1800s and the distribution of smallpox vaccine, only 10 years have passed since pharmacists began routinely immunizing patients in their communities as a standard practice activity. The Washington State Pharmacists Association initiated the first ongoing formalized training of pharmacists in vaccine administration in 1994. On November 1, 1996, the American Pharmaceutical (now Pharmacists) Association (APhA) began its nationally recognized training program for pharmacists, Pharmacy-Based Immunization DELIVERY: A National Certificate Program for Pharmacists. By 2004, an estimated 15,000 pharmacists and student pharmacists had been formally trained through recognized programs as vaccine experts, and the practice of pharmacist-administered immunizations, particularly for adult patients, has become routinely accepted as an important role of the pharmacist. Arguably, few initiatives have done more to move the pharmacy profession forward in direct patient care than the pharmacist-administered immunization movement.

CONCLUSION

Pharmacists have made significant strides in immunizations over the past decade. Limited activities in the hospital sector have been particularly well documented, as have the perceptions of patients regarding acceptance of pharmacists as immunizers. The activities of community pharmacists are less well documented. More research is needed into novel approaches to pharmacist involvement in public health-focused immunization initiatives, along with continued research evaluating the current practice of pharmacist-administered immunizations.

Evaluation of a novel educational strategy, including inhaler-based reminder labels, to improve asthma inhaler technique

OBJECTIVE

To evaluate the feasibility, acceptability and effectiveness of a brief intervention about inhaler technique, delivered by community pharmacists to asthma patients.

METHODS

Thirty-one pharmacists received brief workshop education (Active: n=16, CONTROL: n=15). Active Group pharmacists were trained to assess and teach dry powder inhaler technique, using patient-centered educational tools including novel Inhaler Technique Labels. Interventions were delivered to patients at four visits over 6 months.

RESULTS

At baseline, patients (Active: 53, CONTROL: 44) demonstrated poor inhaler technique (mean+/-S.D. score out of 9, 5.7+/-1.6). At 6 months, improvement in inhaler technique score was significantly greater in Active cf. CONTROL patients (2.8+/-1.6 cf. 0.9+/-1.4, p<0.001), and asthma severity was significantly improved (p=0.015). Qualitative responses from patients and pharmacists indicated a high level of satisfaction with the intervention and educational tools, both for their effectiveness and for their impact on the patient-pharmacist relationship.

CONCLUSION

A simple feasible intervention in community pharmacies, incorporating daily reminders via Inhaler Technique Labels on inhalers, can lead to improvement in inhaler technique and asthma outcomes.

PRACTICE IMPLICATIONS

Brief training modules and simple educational tools, such as Inhaler Technique Labels, can provide a low-cost and sustainable way of changing patient behavior in asthma, using community pharmacists as educators.

Pharmacists' knowledge and attitudes toward herbal medicine

OBJECTIVE

The use and sales of herbal medications have increased dramatically over the past several years. Pharmacists are in an ideal position to educate patients about herbal medicines. This study was intended to determine the knowledge and attitudes of pharmacists regarding herbal medications.

METHODS

A survey was distributed to pharmacists at several state and regional meetings in Virginia and North Carolina between August and October 1998. The survey evaluated demographic data, attitudinal scales, and a 15-item herbal medicine knowledge test. Pharmacists immediately returned the surveys to the distributor on completion.

RESULTS

Of the 217 surveys distributed, 164 met the inclusion criteria for further evaluation. Of the pharmacists surveyed, 68.0% practiced in a community pharmacy, 45.1% had previous continuing education on herbal medications, and 73.6% sold herbal medications in their practice settings. The average score on the herbal knowledge test was 6.3 (maximum score of 15). Pharmacists with previous continuing education scored significantly higher than those without prior continuing education (p < 0.001). Of the 15 questions, the five that pharmacists were most likely to answer correctly assessed the uses of herbal medications. Additionally, pharmacists with prior continuing education or with access to herbal medication information at their practice site were more likely to agree that providing information about herbal medication is a pharmacist's professional responsibility (p = 0.02 and p = 0.01, respectively).

CONCLUSIONS

The findings from this study demonstrate that pharmacists were more likely to answer correctly about the uses of herbal medications than about drug interactions, adverse drug effects, and precautions of herbal medications. Additionally, pharmacists with previous continuing education on herbal medications were more knowledgeable about these products. With the increasing use of herbal medications, there is a greater need for pharmacy training programs in this area.

Pharmacists' attitudes towards the reporting of suspected adverse drug reactions in Norway

BACKGROUND

In Scandinavian countries, pharmacists have not reported adverse drug reactions (ADRs), either due to legislative restrictions or because of lack of tradition. From 1 January 2005, Norwegian pharmacists have been encouraged by the Norwegian Medicines Agency to take a larger role in the reporting of ADRs.

OBJECTIVE

To explore pharmacists' attitudes towards pharmacovigilance and their experiences with ADR reporting, to evaluate the effect of an educational programme and to compare these findings to the attitudes in a control group.

METHODS

From September 2004, pharmacies in two of Norway's five health regions were invited to attend a 3-month ADR reporting study, and 39 pharmacies were recruited. One pharmacist from each pharmacy participated in a 1 day pre-study educational programme and a 1 day post-study evaluation meeting. Pharmacists involved in the study answered a questionnaire (A) regarding their attitudes to ADR reporting (active group). A control group answered the same questionnaire. One reminder was sent. The active group evaluated the study by answering questionnaire A once more and an evaluation questionnaire (B). Qualitative aspects of ADR reporting were discussed with the active group post-study.

RESULTS

The response rate for questionnaire A was 97% (n = 158) in the active group, 74% (n = 184) in the control group and the response rate for questionnaire A and B post-study was 68% (n = 105) in the active group. Pharmacists in the active group had more positive attitudes to ADR reporting after taking part in the study than the control group (p < 0.001). Lack of time, confidence and knowledge of reporting rules could potentially prevent them from reporting ADRs.

CONCLUSIONS

The pharmacists had positive attitudes towards pharmacovigilance, but very little experience with reporting. The educational programme clarified their role and increased their knowledge about the reporting requirements.

Smoking-cessation services in Iowa community pharmacies

STUDY OBJECTIVE

To examine community pharmacy practice with regard to providing smoking-cessation counseling.

DESIGN

Mailed survey.

SETTING

Iowa community pharmacies.

PARTICIPANTS

A stratified random sample of pharmacists statewide.

MEASUREMENTS AND MAIN RESULTS

Descriptive statistics were computed for all study variables. Fisher exact test or chi2 analysis was performed on selected variables to determine the relationship of each item with pharmacists routinely offering smokers suggestions for quitting. Responses from 129 (38.2%) of 338 pharmacists indicated that although most felt it is important to offer smoking-cessation counseling, about half actually offer this service. Most pharmacists indicated they are prepared to provide counseling, but fewer than 25% had received formal training or were aware of national clinical practice guidelines. Those who had received specific training (p=0.020) or recently attended an educational program (p=0.014) on smoking cessation were more likely to counsel smokers. Primary barriers to providing counseling were lack of time, inability to identify smokers, low patient demand, and lack of reimbursement.

CONCLUSION

Our findings suggest that opportunities exist for improving pharmacist education and reducing practice barriers in order to bridge the gap between pharmacists' knowledge and attitudes related to smoking-cessation counseling and their provision of patient counseling in community pharmacy practice.

Effect of a tobacco cessation continuing professional education program on pharmacists' confidence, skills, and practice-change behaviors

OBJECTIVE

To evaluate the impact of a tobacco cessation training program on pharmacists' confidence, skills, and practice-change behaviors.

DESIGN

Quasi-experimental study.

SETTING

Wisconsin during 2002-2003.

PARTICIPANTS

25 community pharmacists.

INTERVENTION

A continuing education training program was developed and implemented using home and live training components consisting of the national tobacco cessation guidelines, including the 5A's counseling process. The home study component included lectures and readings in CD-ROM format. Consistent with self-efficacy theory, the live training was based on exercises that included modeling, rehearsal, and feedback to learners.

MAIN OUTCOME MEASURES

Knowledge assessment, pre- and post-surveys assessing confidence and skill levels, and service provision indicators.

RESULTS

Self-efficacy and perceived ability to counsel patients to quit using tobacco improved significantly after the combined program. No significant change in confidence or perceived skills occurred following home study alone, suggesting value in using a combination of teaching strategies (problem solving, modeling, rehearsal, and feedback). Of participants, 92% received a passing knowledge score and 75% attempted to implement a tobacco cessation service posttraining; more than 50% assisted patients up to 1 year post-training. A relationship between self-efficacy and service provision was found when practice settings were considered.

CONCLUSION

This program increased pharmacists' knowledge and self-efficacy to counsel patients on tobacco use. Further, the majority of pharmacy participants attempted to implement a tobacco cessation service.

Changing acute pain management to improve patient outcomes: an educational approach

The United States Agency for Health Care Policy and Research (AHCPR) Acute Pain Management Guidelines were written to provide a scientific basis for practice. Educational programs designed to promote use of the guidelines may change practice in community hospitals. This article describes the development and implementation of an education program for nurses, physicians, and pharmacists in six community hospitals. Program content addressing the use of continuous quality improvement (CQI) teams, detailed pain histories, application of algorithms and dose calculation is described; direct and indirect outcome measures are reviewed. Six months after the program, all three experimental sites reported use of the AHCPR Guidelines in practice. Nurses reported that assessment and documentation of patients' duration of pain were perceived to be the most important caregiver behaviors providing benefit to patients: Across all respondents' reports of regularly performed activities, the activity performed by the largest proportion was assessing and documenting pain using a 0-10 rating scale.

Design and implementation of an educational partnership between community pharmacists and consumer educators in mental health care

OBJECTIVE

To design and implement an interactive education program to improve the skill and confidence of community pharmacists in providing pharmaceutical services to people with mental illnesses.

DESIGN

A literature review was conducted and key stakeholders were consulted to design a partnership that involved community pharmacists and consumer educators. The partnership was designed so that all participants shared equal status. This facilitated mutual recognition of each others' skills.

ASSESSMENT

Four 2-hour training sessions were conducted over a 2-week period in March 2005. Seven pharmacists, 5 consumer educators, and 1 caregiver educator participated in the partnership. Pharmacists indicated that their participation caused them to reflect on their own medication counseling techniques. Consumer educators reported that speaking about their experiences aided their recovery.

CONCLUSION

Developing a better understanding and improved communication between community pharmacists and people with mental illnesses is an important aspect of facilitating a concordant approach to patient counseling. Implementing mental health education programs utilizing consumer educators in pharmacy schools is a promising area for further research.

Sleep disorders screening, sleep health awareness, and patient follow-up by community pharmacists in Australia

INTRODUCTION

Community pharmacies are well placed to deliver education and counseling to improve sleep health.

OBJECTIVE

To develop, implement and evaluate a pharmacist led sleep health program.

METHODS

Participating pharmacists (n=23) were trained to screen, counsel and follow up patients at risk of sleep disorders. Patients were screened for specific sleep disorders, counseled, provided written information and/or referred to physicians. Patient outcomes were evaluated by questionnaire at 3 or 12 months post screening.

RESULTS

A total of 325 patients were screened, with 142 (44%) patients at risk of one or more sleep disorders. A total of 847 interventions were recorded by pharmacists: verbal counseling (49%), written information (34%), and referrals (16%). A total of 63 patients (of 99 recalling being referred) reported acting on their referral. Positive changes were made with smoking (4%), caffeine intake (10%), alcohol intake (9%) and improved sleep environment (19%).

CONCLUSION

Pharmacists can raise awareness through educating patients on sleep health, and through counseling initiate behavior change in those at risk of having or developing a sleep disorder.

PRACTICE IMPLICATIONS

Further research using this feasibility study can help in understanding the utility of pharmacists screening patients for sleep disorders and educating the public in sleep health.

Diabetes Medication Assistance Service: the pharmacist's role in supporting patient self-management of type 2 diabetes (T2DM) in Australia

OBJECTIVE

To evaluate the capacity and effectiveness of trained community pharmacists in delivering the Diabetes Medication Assistance Service (DMAS) via (1) number and types of self-management support interventions (SMSIs); (2) number of goals set and attained by patients and (3) patient outcomes (glycaemic control, medication adherence and satisfaction).

METHODS

Pharmacists (n=109) from 90 community pharmacies in Australia were trained and credentialed to deliver the DMAS. The training focused on developing pharmacists' knowledge and skills in supporting patients' diabetes self-management.

RESULTS

A total of 387 patients completed the trial. The mean number of SMSIs per patient was 35 (SD ±31) and the majority (87%) had at least one documented goal that was fully or partially attained. There were significant health benefits for patients including improved glycaemic control and a reduced risk of non-adherence to medications. Over 90% of DMAS patients reported improvements in their knowledge about diabetes self-management.

CONCLUSION

The DMAS provides self management support in the community pharmacy for people with T2DM which may result in improved clinical outcomes.

PRACTICE IMPLICATION

Given appropriate training in diabetes care and behavior change strategies, community pharmacists can offer programs which provide self-management support to their patients with T2DM and improve their health outcomes.

Economic impact of increased clinical intervention rates in community pharmacy. A randomised trial of the effect of education and a professional allowance

OBJECTIVE

To determine the economic impact of an interventional programme aimed to increase the rate of clinical interventions undertaken in community pharmacy. STUDY DESIGN AND PERSPECTIVE: A randomised controlled trial of 4 parallel groups of pharmacies, conducted from a government perspective. Economic evaluations were based on savings/costs attributable to healthcare costs avoided, healthcare costs incurred by the pharmacists' actions, change in medication costs, pharmacy time and telephone calls made by the pharmacist. The study was conducted during November and December 1996 and costings were based on 1997 figures.

INTERVENTIONS

A professional fee-for-service [10 Australian dollars ($A; $A1 = 6.50 US dollars) per intervention] and education (an intensive 1-week course or advanced education) were implemented in an attempt to increase clinical interventions by the pharmacists. Group A pharmacies (n = 10) served as a control group and received neither education nor remuneration; group B received education and professional remuneration (n = 9); group C had received prior continued education and now received advanced education and professional remuneration (n = 11); and group D received professional remuneration with no education.

MAIN OUTCOME MEASURES AND RESULTS

The proactive clinical interventions in group C saved a mean of $A85.35 per 1000 prescriptions [95% confidence interval (CI)-$A157.11 to $A24.95). This was 4 times greater than savings generated by pharmacies in group B (mean savings of $A25.65 per 1000 prescriptions) and 6 times greater than control pharmacies. A sensitivity analysis which extrapolated results to Australian prescription figures showed that the control group was capable of generating savings in the order of $A2.4 million per year while pharmacists in group C would save the healthcare system $A15 million per year.

CONCLUSIONS

These results provide the first economic estimates for the provision of clinical interventions in Australian community pharmacies. It is believed that they illustrate the value of pharmaceutical services to the healthcare system and to the Australian community in terms of both quality of care and savings.

Monitoring quality standards in the provision of non-prescription medicines from Australian Community Pharmacies: results of a national programme

INTRODUCTION

Standards of practice have been developed by the pharmacy profession to address the provision of non-prescription medicines, using a consumer-focused and risk management approach. The application of these standards in Australian community pharmacies has been monitored since 2002 by the Quality Care Pharmacy Support Centre (QCPSC).

METHODS

Between September 2002 and September 2005, 7785 standards maintenance assessment visits were conducted in 4282 pharmacies, using pseudo-patient methodology. 1909 were symptom-based requests (SBRs) and 5876 were direct product-based requests (DPRs), of which 2864 were for pharmacist-only medicines (POMs) and 3012 were for pharmacy medicines (PMs). 2756 pharmacies received two visits, and 747 received three visits. A pharmacy's performance was scored out of 10 at each visit (scores 0-3: "unsatisfactory"; 4-6: "satisfactory"; and 7-10: "excellent").

RESULTS

There was wide variation in performance at baseline, with 1453 (34%) of pharmacies scoring

CONCLUSION

Repeated pseudo-patient visits lead to notable improvement in behaviour in the handling of non-prescription medicines in community pharmacies. A range of factors need to be considered when measuring these behaviours, such as scenario or medicine type, as they have considerable influence on performance. Future research should focus on issues of quality control, to better understand what makes some pharmacies perform satisfactorily and others unsatisfactorily, and what is required to shift performance from "satisfactory" to "excellent".

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MESH Headings

• Benchmarking
• Education, Pharmacy, Continuing
• Evidence-Based Medicine
• Government Agencies
• Guideline Adherence
• Humans
• New South Wales
• Nonprescription Drugs/classification
• Nonprescription Drugs/standards
• Patient Simulation
• Pharmacies/classification
• Pharmacies/standards
• Process Assessment, Health Care
• Professional Competence
• Program Development
• Quality Indicators, Health Care

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Promoting skin cancer prevention counseling by pharmacists

OBJECTIVES

This study evaluated the effects of an intervention on rates of skin cancer prevention counseling by pharmacists.

METHODS

Fifty-four pharmacies were randomly assigned to intervention or control conditions. Intervention consisted of training, feedback, and prompts. Counseling rates before and after the intervention were obtained from study confederates.

RESULTS

At pretest, the proportions of control and intervention sites providing counseling at least once were 7.4% and 0%, respectively (NS). At posttest, these proportions were 3.7% and 66.7%, respectively (P < .001).

CONCLUSIONS

The results indicated that the intervention was successful and that pharmacists can play an important role in educating the public about skin cancer prevention strategies.

Private pharmacies in Hanoi, Vietnam: a randomized trial of a 2-year multi-component intervention on knowledge and stated practice regarding ARI, STD and antibiotic/steroid requests

OBJECTIVES

To assess the effectiveness of a multi-component intervention on knowledge and reported practice amongst staff working in private pharmacies in Hanoi regarding four conditions: urethral discharge [sexually transmitted diseases (STD)], acute respiratory infection (ARI), and non-prescription requests for antibiotics and steroids.

METHOD

Randomized controlled trial with staff working in 22 matched pair intervention and control private pharmacies who were administered a semistructured questionnaire on the four conditions before and 4 months after the interventions. The interventions focused on the four conditions and were in sequence (i) regulations enforcement; (ii) face-to-face education and (iii) peer influence. Outcome measures were knowledge and reported change in practice for correct management of tracer conditions.

RESULTS

The intervention/control-pairs (22 after drop-outs) were analysed pre- and post-intervention using the Wilcoxon signed rank test. STD: More drug sellers stated they would ask about the health of the partner (P = 0.03) and more said they would advise condom use (P = 0.01) and partner notification (P = 0.04). ARI: More drug sellers stated they would ask questions regarding fever (P = 0.01), fewer would give antibiotics (P = 0.02) and more would give traditional medicines (P = 0.03). Antibiotics request: Fewer said they would sell a few capsules of cefalexin without a prescription (P = 0.02). Steroid requests: No statistical difference was seen in the numbers who said they would sell steroids without a prescription as numbers declined in both intervention and control groups (P = 0.12).

CONCLUSION

The three interventions in series over 17 months were effective in changing the knowledge and reported practice of drug sellers in Hanoi.

Exploratory survey of Florida pharmacists' experience, knowledge, and perception of HIV pre-exposure prophylaxis

OBJECTIVE

To assess Florida pharmacists' experience, knowledge, and perception of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) and to identify areas for pharmacist training.

DESIGN

Cross-sectional survey.

SETTING

Florida in March through July 2013.

PARTICIPANTS

Florida pharmacists.

INTERVENTION

In-person and online anonymous survey.

MAIN OUTCOME MEASURE

Florida pharmacists' experience, knowledge, and perceptions of PrEP.

RESULTS

225 completed surveys were analyzed. Survey respondents were predominantly community pharmacists with mean age of 45.7 years and less than 20 years of experience. Only 22% of respondents reported dispensing PrEP to patients. Although 75% had completed HIV-related continuing education in the last 2 years, 63% were unaware of Centers for Disease Control and Prevention PrEP guidelines and 71% answered that they did not have sufficient knowledge to counsel patients with PrEP prescriptions. Importantly, 47% of respondents answered they were uncomfortable counseling patients about PrEP. By self-report, most pharmacists agreed PrEP leads to risky behavior (68%) and increased rates of sexually transmitted infections (65%), and is too costly to promote patient access (92%).

CONCLUSION

Surveyed Florida pharmacists reported limited understanding of PrEP. As a widely accessible health care counseling resource, pharmacists are positioned to improve patient understanding, promote medication adherence, and enhance PrEP efficacy. Especially during PrEP implementation, when patients may receive PrEP prescriptions from non-HIV specialist prescribers, improving pharmacists' PrEP education presents a salient opportunity.

Individualized education and competency development of Croatian community pharmacists using the general level framework

OBJECTIVES

To measure Croatian community pharmacists' progress in competency development using the General Level Framework (GLF) as an educational tool in a longitudinal study.

METHODS

Patient care competencies of 100 community pharmacists were evaluated twice, in 2009 and in 2010 in a prospective cohort study. During this 12-month period, tailored educational programs based on the GLF were organized and conducted, new services and standard operating procedures were implemented, and documentation of contributions to patient care in the pharmacist's portfolio became mandatory.

RESULTS

Pharmacists' development of all GLF patient care competencies was significant with the greatest improvements seen in the following competencies: patient consultation, monitoring drug therapy, medicine information and patient education, and evaluation of outcomes.

CONCLUSIONS

This study, which retested the effectiveness of an evidence-based competency framework, confirmed that GLF is a valid educational tool for pharmacist development.

Implementation of targeted medication adherence interventions within a community chain pharmacy practice: The Pennsylvania Project

OBJECTIVE

To identify facilitators and barriers to implementing targeted medication adherence interventions in community chain pharmacies, and describe adaptations of the targeted intervention and organizational structure within each individual pharmacy practice.

DESIGN

Qualitative study.

SETTING

Central and western Pennsylvania from February to April 2012.

PARTICIPANTS

Rite Aid pharmacists staffed at the 118 Pennsylvania Project intervention sites.

MAIN OUTCOME MEASURES

Qualitative analysis of pharmacists' perceptions of facilitators and barriers experienced, targeted intervention and organizational structure adaptations implemented, and training and preparation prior to implementation.

RESULTS

A total of 15 key informant interviews were conducted from February to April 2012. Ten pharmacists from "early adopter" practices and five pharmacists from "traditionalist" practices were interviewed. Five themes emerged regarding the implementation of targeted interventions, including all pharmacists' need to understand the relationship of patient care programs to their corporation's vision; providing individualized, continual support and mentoring to pharmacists; anticipating barriers before implementation of patient care programs; encouraging active patient engagement; and establishing best practices regarding implementation of patient care services.

CONCLUSION

This qualitative analysis revealed that there are a series of key steps that can be taken before the execution of targeted interventions that may promote successful implementation of medication therapy management in community chain pharmacies.

Effect of a training program on community pharmacists' detection of and intervention in drug-related problems

OBJECTIVE

To develop and present a pharmaceutical care training program for pharmacists, and to examine the ability of these pharmacists to provide pharmaceutical care in a community pharmacy setting.

DESIGN

Prospective, randomized study.

INTERVENTION

A 40-hour pharmaceutical care training program was developed and presented to pharmacists, and 1,078 patients were randomly assigned to receive either (1) traditional pharmacy services or (2) pharmaceutical care, consisting of initial patient work-up and follow-up with documentation in a patient record.

MEASUREMENTS

The study period was six months. Pharmacists documented problems identified, actions taken, and time required for all patients.

RESULTS

Pharmacists consistently identified and intervened to address problems in both study groups. Patients receiving pharmaceutical care were more than seven times as likely to have any problems identified (odds ratio [OR] 7.5; confidence interval [CI] 4.2-13.1), more than eight times as likely to have an intervention performed (OR, 8.1; CI 4.7-14.2), and more than eight times as likely to have a drug-related problem identified (OR 8.6; CI 4.8-15.5) than were patients receiving traditional pharmacy services only. Time spent counseling patients was similar for the two groups.

CONCLUSIONS

The training program proved to be an effective way to increase the number of problems identified and addressed by pharmacists.

Health promotion and education activities of community pharmacists in Kuwait

OBJECTIVES

To investigate self-reported practice of pharmacists regarding health promotion and education activities, explore the barriers that may limit their involvement in health promotion and education, and identify their willingness to participate in continuing education programs related to health education.

SETTING

Community pharmacies in Kuwait.

METHOD

A descriptive cross-sectional study was performed using a pre-tested questionnaire on a sample of 223 community pharmacists.

MAIN OUTCOME MEASURES

The extent of the pharmacists' involvement in counselling patients about health promotion and education topics, their preparation to counsel patients in health promotion and education topics, and their perceived success in changing the patients' health behaviour.

RESULTS

The response rate was 92%. Information on medication use was the most frequent reason for consumers seeking community pharmacists' advice. The majority of respondents believed that behaviour related to the proper use of drugs was very important. There was less agreement on the importance of other health behaviours. Respondents indicated they were involved in counselling patients on health behaviours related to use of drugs as prescribed/directed, weight management, medicine contents and side effects, diet modification and stress reduction, but were less involved in counselling on other health behaviours. Respondents' perception of themselves as "most prepared" to counsel patients closely reflected their involvement. Pharmacists reported high levels of success in helping patients to achieve improvements in using their drugs properly compared to low levels in changing patients' personal health behaviours. The majority of respondents believed that pharmacists had a responsibility for counselling consumers on health behaviours (97%, 95% CI 95-99%), and indicated their willingness to learn more about health promotion (84%, 78-88%). Lack of pharmacists' time was reported by about 58% of respondents as the major barrier limiting pharmacists' provision of health promotion.

CONCLUSION

The role of community pharmacists in health promotion and education is primarily focused on pharmaceutical issues rather than health behaviour modification. The majority of respondents have a positive attitude towards counseling the population on health behaviours and indicated their willingness to learn more about health promotion.

Syndromic management of urethral discharge in Ghanaian pharmacies

OBJECTIVES

To evaluate the training of pharmacists in Accra, Ghana, in the syndromic management of STIs.

METHODS

We randomly selected 50 pharmacy outlets that had received the training (intervention) and 50 outlets that had not received the training (no intervention). Simulated clients described the symptoms of urethral discharge to the first pharmacy staff encountered and completed a standardised questionnaire after each encounter.

RESULTS

Correct drug provision for urethral discharge improved with the educational intervention but remained relatively low (no intervention 18%; intervention 39%; p < 0.05). More encouraging, treatment for gonorrhoea was usually correct without the intervention (64%) and improved further in the intervention outlets (76%). The treatment for chlamydia was less often appropriate but also improved (31% and 41%). Condom promotion was poor, with almost no outlets offering condoms.

CONCLUSIONS

The current training led to improvements in the treatment of urethral discharge. Future training needs to be improved, especially with regard to condom promotion. Moreover, since less than one third of simulated clients were seen by pharmacists, the training should be expanded to other pharmacy staff. With enhanced training of all pharmacy staff, the role of pharmacy outlets in STI management and prevention in Ghana and elsewhere can be optimised.

Do community pharmacists have the attitudes and knowledge to support evidence based self-management of low back pain?

BACKGROUND

In many countries, community pharmacists can be consulted without appointment in a large number of convenient locations. They are in an ideal position to give advice to patients at the onset of low back pain and also reinforce advice given by other healthcare professionals. There is little specific information about the quality of care provided in the pharmacy for people with back pain. The main objectives of this survey were to determine the attitudes, knowledge and reported practice of English pharmacists advising people who present with acute or chronic low back pain.

METHODS

A questionnaire was designed for anonymous self-completion by pharmacists attending continuing education sessions. Demographic questions were designed to allow comparison with a national pharmacy workforce survey. Attitudes were measured with the Back Beliefs Questionnaire (BBQ) and questions based on the Working Backs Scotland campaign. Questions about the treatment of back pain in the community pharmacy were written (or adapted) to reflect and characterise the nature of practice. In response to two clinical vignettes, respondents were asked to select proposals that they would recommend in practice.

RESULTS

335 responses from community pharmacists were analysed. Middle aged pharmacists, women, pharmacy managers and locums were over-represented compared to registration and workforce data. The mean (SD) BBQ score for the pharmacists was 31.37 (5.75), which was slightly more positive than in similar surveys of other groups. Those who had suffered from back pain seem to demonstrate more confidence (fewer negative feelings, more advice opportunities and better advice provision) in their perception of advice given in the pharmacy. Awareness of written information that could help to support practice was low. Reponses to the clinical vignettes were generally in line with the evidence base. Pharmacists expressed some caution about recommending activity. Most respondents said they would benefit from more education about back pain.

CONCLUSION

Those sampled generally expressed positive attitudes about back pain and were able to offer evidence based advice. Pharmacists may benefit from training to increase their ability and confidence to offer support for self-care in back pain. Further research would be useful to clarify the representativeness of the sample.

Efficacy of continuing education in improving pharmacists' competencies for providing weight management service: three-arm randomized controlled trial

INTRODUCTION

Weight management is a new public health role for community pharmacists in many countries. Lack of expertise is one of the key barriers to counseling obese patients. We evaluated the comparative efficacy of three alternative continuing education (CE) meetings on weight management.

METHODS

We designed a randomized controlled trial comparing didactic lecture, lecture plus case discussion, and lecture plus small-group training. It was conducted in 2011 in Tehran. Pharmacists' knowledge, attitudes, and competence were evaluated immediately before, immediately after and one month after each meeting via standardized questionnaires and case vignettes. Participants' satisfaction was evaluated after each meeting. Data were analyzed using repeated measure analysis of variance and chi-squared tests.

RESULTS

Sixty pharmacists were randomly allocated to each study arm. There were no demographic differences between the arms at the baseline. The knowledge scores significantly improved for all interventions over time. At the follow-up, the small-group training arm obtained significantly higher knowledge scores (p < 0.001, effect size = 0.54). The competence scores in lecture plus case discussion and lecture plus small-group training meetings improved over time (effect size 0.14 and 0.34; difference nonsignificant). Small-group training resulted in significantly higher satisfaction scores (p = 0.005). The interventions' effects on attitudes were similar.

DISCUSSION

This is the first study on the implementation and efficacy of various types of CE meetings for community pharmacists to provide weight management services. Lecture plus small group training resulted in better learning retention over time and higher satisfaction. Future studies should evaluate the effects of various types of CE meetings on pharmacists' behavior and their cost-effectiveness.

Community pharmacists' preferences for continuing education delivery in Australia

INTRODUCTION

New technologies such as the Internet offer an increasing number of options for the delivery of continuing education (CE) to community pharmacists. Many of these options are being utilized to overcome access- and cost-related problems. This paper identifies learning preferences of Australian community pharmacists for CE and identifies issues with the integration of these into contemporary models of CE delivery.

METHODS

Four focus group teleconferences were conducted with practicing community pharmacists (n = 15) using a semistructured format and asking generally about their CE and continuing professional development (CPD) experiences.

RESULTS

Pharmacists reported preferences for CE that were very closely aligned to the principles of adult learning. There was a strong preference for interactive and multidisciplinary CE. Engaging in CPD was seen as valuable in promoting reflective learning.

DISCUSSION

These results suggest that pharmacists have a strong preference for CE that is based on adult learning principles. Professional organizations should take note of this and ensure that new CE formats do not compromise the ability of pharmacists to engage in interactive, multidisciplinary, and problem-based CE. Equally, the role of attendance-based CE in maintaining peer networks should not be overlooked.

Factors Influencing Participation in Continuing Professional Development: A Focus on Motivation Among Pharmacists

INTRODUCTION

The interest in continuing education (CE) for pharmacists has increased because of patient safety issues, advancing science and the quick changes in the profession. Therefore, contemporary pharmaceutical care requires an effective and sustainable system for pharmacists to maintain and improve competencies. Although motivation plays an important role both as a facilitator (desire to learn) and a barrier (lack of motivation), there is little investigated about this specific factor. The aim of the study was to explore what factors influence pharmacists' participation in CE with a focus on motivation.

METHODS

The theoretical framework was self-determination theory (SDT), which describes autonomous motivation (AM) representing motivation from an internal locus of causality, controlled motivation (CM) originating from an external locus of causality, and relative autonomous motivation (RAM) that measures the AM in an individual after correcting for the CM. The relationship between pharmacists' characteristics, especially their motivation (AM, CM and RAM) in CE, and their participation in CE activities was explored using the AMS-questionnaire and the Dutch online portfolio system.

RESULTS

RAM was positively correlated with CE participation of pharmacists and explained 7.8% of the variance. The correlations between the independent variables AM and CM and CE hours were negative (-0.301 and -0.476, respectively). Other factors influencing CE participation were pharmacy school (6.8%), traineeship (10.9%), and work experience (7.8%). Pharmacists participated for 27.0 hours on average in CE during 11 months and preferred face-to-face-learning (85.5%) above e-learning (13.8%).

DISCUSSION

Our findings show a positive relationship between RAM and CE participation. The current CE system is probably not conducive to stimulation of AM. Further research is needed to understand the factors that stimulate pharmacists' motivation and participation in CE.