Frequency, nature and determinants of pharmaceutical consultations provided in private by Dutch community pharmacists

Pharmacists' preferences for the provision of services to improve medication adherence among patients with diabetes in Indonesia: Results of a discrete choice experiment

Little is known about pharmacists' preferences for services to improve medication adherence in patients with diabetes in Indonesia. Identification of such preferences can provide valuable insights on suitable services from a pharmacist's perspective. This study elicits pharmacists' preferences for services to improve medication adherence among their patients. A discrete choice experiment (DCE) method was used to survey pharmacists in all community health centres and three hospitals in Surabaya, Indonesia. Four attributes of consultation, namely duration of consultation, place of consultation, access to a pharmacist and patient copayment, and two attributes on additional services (educational and behavioural-based services) were included. The 16 profiles generated for DCE were partially balanced and partially without overlap. A random-effect logistic regression was used in the analysis. In total, 99 pharmacists completed the questionnaire, but only 80 were included in the study based on a consistency check. All attributes were found to determine preferences for a pharmacist service package. Pharmacists preferred a consultation with a shorter duration accompanied by flexible access to the pharmacist as well as a private consultation room and a lower patient copayment. Providing the patient with a brochure/leaflet was the most preferred additional service to help improve medication adherence. Patient group discussion and medication review were also preferred in combination with a consultation. Pharmacists' socio-demographic background characteristics influence preferences. These findings can be considered in evaluating current practice and designing pharmacist services to help improve medication adherence among patients with diabetes.

Medication safety in patients with hepatic impairment: A survey of community pharmacists' knowledge level and their practice in caring for these patients

Aims

To study community pharmacists' level of knowledge on medication safety in patients with hepatic impairment and their practice in caring for these patients.

Methods

Pharmacists from Dutch community pharmacies (n = 1545) were invited to participate in an online survey. The survey consisted of 27 questions covering 2 main topics: knowledge and current practice. The level of knowledge was measured by a 6‐item knowledge test. Multiple linear regression was used to identify predictors of correctly answered responses.

Results

In total, 338 pharmacists (22%) completed the questionnaire. The mean knowledge score was 2.8 (standard deviation 1.6). Only 30.3% of respondents were able to appropriately advise on use of analgesics in severe cirrhosis. Postgraduate education on hepatic impairment, knowledge of recently developed practical guidance, and fewer years of practice were associated with a higher level of knowledge. In total, 70.4% indicated to evaluate medication safety in a patient with hepatic impairment at least once weekly. In the past 6 months, 83.3% of respondents consulted a prescriber about a patient with hepatic impairment. Frequently encountered barriers in practice were insufficient knowledge on the topic and a lack of essential patient information (i.e. diagnosis and severity of the impairment).

Conclusion

Community pharmacists regularly evaluate the safety of medication in patients with hepatic impairment, yet their level of knowledge was insufficient and additional education is needed. Pharmacists experienced several difficulties in providing pharmaceutical care. If these issues are resolved, pharmacists can play a more active role in ensuring medication safety in their patients with hepatic impairment.

How pharmacist-patient communication determines pharmacy loyalty? Modeling relevant factors

BACKGROUND

Portuguese community pharmacies provide pharmaceutical services, such as therapeutic outcomes follow-up, supplemented by relevant point-of-care testing that require continuity of provision to be effective.

OBJECTIVES

To identify factors of technical and communication nature that during a patient interview contribute to patients' loyalty.

METHODS

A cross-sectional descriptive study, with a purposive sample of community pharmacies providing pharmaceutical care, was conducted. Patient interviews were taped and transcribed verbatim. Duration, segments and utterances were identified and time stamped, using a previously validated coding scheme. To identify predictors of loyalty, logistic regression analyses were performed.

RESULTS

From 59 interviews, participants' average age was 65.7 years and 42 (71.2%) were female; 45 (76.3%) interviews were classified as outcomes measurements and 14 (23.7%) as pharmaceutical consultations, with 33.2% of the patients booking a following appointment. The significant items to explain loyalty were associated with lifestyle and psychosocial exchange, age of the patient, and the presence of all interview segments (i.e. a complete consultation).

CONCLUSION

Contrary to common professional beliefs and practice orientation it would appear that pharmacists' technical skills are not the essential factors that promote patients' loyalty needed for continuity of care, at least in the same extent as the social and lifestyle-related content of the exchange. Pharmaceutical care education should focus on relational skills as much as on medication-related competencies.

Workload and its impact on community pharmacists' job satisfaction and stress: a review of the literature

Objective

The objective was to identify, review and evaluate published literature on workloads of pharmacists in community pharmacy. It included identification of research involving the measurement of pharmacist workload and its impact on stress levels and job satisfaction. The review focused on literature relating to practice in the UK.

Methods

Electronic databases were searched from 1995 to May 2011. In addition, manual searches were completed for documents not available electronically. The findings were analysed with specific focus on research methodology, workload and its impact on pharmacist job satisfaction and stress levels.

Key findings

Thirteen relevant studies relating to workload in community pharmacy alone or in conjunction with job satisfaction and stress were identified. One utilised both qualitative and quantitative methods to identify differences in pharmacist workload in retail pharmacy businesses before and after the implementation of the 2005 English and Welsh community pharmacy contractual framework. This indicated that pharmacists spend most of their working day dispensing. The majority of studies suggested community pharmacists generally perceived that workload levels were increasing. Several also stated that increased workload contributed to increasing job-related stress and decreasing job satisfaction. No studies reporting dispensing rates for community pharmacies in the UK were identified and there was limited evidence concerning time devoted to non-dispensing services. One study investigated the differences between self-estimated and actual workload.

Conclusions

Whilst there is a clear perception that the type and amount of work output expected from individual community pharmacists has been changing and increasing over the last few decades, pharmacists are viewed as continuing to remain based in the dispensary. The impact of such changes to the practice of community pharmacy in the UK is poorly defined, although links have been made to increasing levels of pharmacist job dissatisfaction and stress.

Pharmaceutical education in patient counseling: 20h spread over 6 years?

OBJECTIVE

To share our experiences with an educational program to increase pharmacy students' patient counseling competency.

METHODS

A description is given of the various steps taken to develop an educational program about patient counseling:

RESULTS

The Health Belief Model has been chosen as the theoretical model to make students understand patients' drug use behavior. A stepwise development of students' communication skills is combined with assessments in which relatively high norms are applied. Actors act as patients in standardized role plays. In total the basic education consists of 20h of training.

CONCLUSION

With a rather small educational investment, 50% of our students achieve the required level of patient counseling. The remaining students succeed to pass the assessments, after having received additional education.

PRACTICE IMPLICATIONS

Pharmacy students differ in their needs for educational support in developing their patient counseling competency. These differences are to be taken into account in educational programs addressed to student's patient counseling competency.

Exploring pharmacists' communication with customers through screening services

OBJECTIVE

To describe pharmacist-customer communication, during blood pressure and capillary cholesterol services, in a community pharmacy setting.

METHODS

Participants were purposively selected and data collected by audio-recording. The encounters' verbal content was transcribed verbatim, utterances identified, time stamped, and classified according to a coding scheme of 15 categories. Four dialogue structures were analyzed: speaker turn, interactivity, turn density and turn duration.

RESULTS

Eighty-three episodes were registered (51 blood pressure, 32 cholesterol). The average blood pressure episode lasted 5:35 min, with 81.2 utterances (55.3% customers), and an interactivity rate of 7 turns/min. The average cholesterol episode took 7:05 min, with 135.3 utterances (52.7% pharmacists), and an interactivity rate of 13.3 turns/min. In both cases, pharmacists asked more questions (mainly closed ones), while customers gave more information. An increased number of speaker turns and closed questions were associated to higher systolic pressure. No correlations were identified with cholesterol values.

CONCLUSION

It would seem that pharmacists tend to control the exchange and its content through closed questioning. Although talk dominance is balanced, hypertensive episodes induce a higher information search.

PRACTICE IMPLICATIONS

Educational interventions, focusing on pharmacists' communication competencies, should be available to favor interaction skills resulting in a customer's augment of proactive information seeking behaviour.

A comparative analysis of remuneration models for pharmaceutical professional services

OBJECTIVES

Pharmacists provide a wide range of professional services to support the appropriate use of medicines by patients. This study aims to conduct an international, comparative analysis of remuneration models for pharmaceutical professional services.

METHODS

Information about remuneration models was derived from a literature review and a semi-structured questionnaire completed by experts.

RESULTS

Remuneration models differ in the way that pharmacists are paid for professional services beyond dispensing medicines. Also, the scope of services that are remunerated varies. The majority of countries regulate remuneration for services only when the medicine is paid for under the reimbursement scheme. Remuneration of services implies a commitment to assure their quality in some countries. Collaborative practice models have been set up where pharmacists work together with other health care professionals to deliver diagnosis-specific services or services based on the patient's use of medicines. The remuneration of services is influenced by the value of services, budgetary constraints, the payer perspective, and the attitude of physicians, pharmacists and patients.

CONCLUSIONS

Professional organisations need to formulate a clear strategy for developing and gaining remuneration for pharmaceutical professional services. This implies that pharmacists not only demonstrate the value of services, but also assure their quality.

Counter design influences the privacy of patients in health care

A re-furnishing of counter areas in primary health care was used to assess patient privacy and its influences on the nature of conversations in a controlled experiment. Patients in two community-based pharmacies in the Netherlands were assigned to enclosed counters and a queue at distance, or to counters that exposed patients mutually and a closer queue. Patients assigned to counters with reduced sight were more satisfied with the privacy than patients at visually exposed counters. However, in comparison with visually exposed pharmacy counters, conversations of patients at enclosed counters could still be overheard and did not have different conversations to other patients. Architectural design of health-care institutions has potential to positively influence perceived patient privacy in areas in where multiple patient-staff communications routinely occur and where patient privacy is an important issue, but enclosed counters with a queue at distance do not prevent incidental disclosure of individually identifiable health information.

The counter and consultation room work explored in the Netherlands

OBJECTIVE

To determine the frequency and nature of conversations at the counter and of private consultations at three Dutch community pharmacies.

METHODS

In a purposive and convenience sample of three Dutch community pharmacies two work categories were investigated: counter work and consultation room work with self-reporting tally. The study took 6 weeks: 2 weeks at each pharmacy.

MAIN OUTCOME MEASURE

The number of care related conversations and consultations emerging in the counter work and consultation room work.

RESULTS

About 43% of all counter conversations consisted of the provision of pharmaceutical information and 72% of the consultations in the separate consultation room dealt with care related activities. However, only 18 consultations were held in this latter room: 0.4% of all reported conversations.

CONCLUSION

The proportion of care related work at the counter and in the consultation room did have significant substance. There are however serious possibilities to change pharmaceutical care for the better. It is suggested that standard procedures at the counter may help increasing care related work. The presence of a separate consultation room may increase the number of consultations held in private, when combined with raising patient awareness of its existence.