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Kruijtbosch M, Floor-Schreudering A, van Leeuwen E, Bouvy ML. Fostering moral reflectivity in community pharmacists through moral case deliberation using the dilemma method. Int J Clin Pharm 2025; 47:676-687. [PMID: 39754671 DOI: 10.1007/s11096-024-01854-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 12/07/2024] [Indexed: 01/06/2025]
Abstract
BACKGROUND Moral case deliberation has been successfully implemented in multidisciplinary groups of secondary care professionals to support ethical decision making. It has not yet been reported for community pharmacists. AIM This study investigated whether moral case deliberation fosters moral reflectivity in community pharmacists. METHOD Two moral case deliberations with 14 community pharmacists were guided by two facilitators. One session was described and illustrated with participants' quotes, detailing each reflection step of the method. An adapted version of the Maastricht evaluation questionnaire was used to understand the effects of the moral case deliberation on participants' moral reflectivity skills both quantitatively and qualitatively. RESULTS In a 2-h session, pharmacists reflected on a moral dilemma concerning double anticoagulant therapy of one presenter pharmacist. Participants discussed the pros and cons of two potential actions: dispensing the medication as prescribed without contacting the patient or contacting the patient first. Deliberation highlighted the importance of understanding the patient's perspective, leading the presenter and two others to shift towards the latter action. The evaluation questionnaire revealed that all 14 participants felt supported by the deliberation and the facilitator in recognising the dilemma's moral dimension and understanding their own and others' values behind arguments and how these influenced different perspectives. They all felt encouraged to critically reflect, to ask open questions and to delay judgements. The method helped all to morally justify their final decision, with six participants arriving at a decision different from their initial perspective towards the dilemma's resolution. CONCLUSION This study demonstrates that moral case deliberation enables pharmacists to critically examine their reasoning and reach morally sound resolutions, supporting pharmacists' professionalism and ethical decision-making.
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Affiliation(s)
- M Kruijtbosch
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, The Netherlands.
- Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands.
| | - A Floor-Schreudering
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, The Netherlands
| | - E van Leeuwen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences (RIHS), 148 RIHS, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - M L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands
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Aljadeeah S, Borek A. The role of community pharmacists with Syrian migration background in addressing healthcare needs of migrant population in Germany: a qualitative study. BMC Health Serv Res 2025; 25:598. [PMID: 40275336 PMCID: PMC12023471 DOI: 10.1186/s12913-025-12654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2024] [Accepted: 03/25/2025] [Indexed: 04/26/2025] Open
Abstract
BACKGROUND Migrants often face various barriers to their access to healthcare services. Community pharmacists play a crucial role in offering accessible, patient-centred healthcare services. However, little is known about the unique role of migrant pharmacists in addressing the healthcare needs of migrants. Therefore, this research aimed to investigate the role of migrant pharmacists in providing access to healthcare for migrant populations in Germany. METHODS This exploratory qualitative study used semi-structured interviews with Syrian migrant pharmacists working in Germany. Participants were recruited through contacts from the author's professional network. All interviews were remotely conducted, recorded, transcribed verbatim, and analyzed using inductive thematic analysis to ensure that findings are grounded in the original data. RESULTS Ten Syrian migrant pharmacists were interviewed. The findings highlighted the multifaceted role of migrant pharmacists, extending beyond medicine dispensing to bridging gaps in healthcare access through culturally appropriate services. Their ability to communicate in patients' native languages and provide tailored advice positioned them as key facilitators in addressing migrants' healthcare challenges. Participants described their proactive involvement in health promotion, particularly in raising awareness about preventive measures such as vaccinations. However, they also faced significant challenges, including regulatory constraints and resource limitations, which they navigated through various adaptive strategies. CONCLUSIONS This study explored the role of migrant pharmacists, particularly those from Syria, in addressing the healthcare needs of migrants in Germany. Their ability to communicate in both Arabic and German and to understand cultural nuances is a key asset that helps overcome language barriers, making them an invaluable resource for migrant patients. The research highlighted the multifaceted nature of the pharmacists' roles, which extend beyond dispensing medicines, bridging gaps in healthcare access through culturally sensitive and linguistically appropriate services. The study also shed light on the adaptive strategies and recommendations for strengthening the role of migrant pharmacists.
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Affiliation(s)
- Saleh Aljadeeah
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, 2000, Belgium.
- Department of Continuing Education, University of Oxford, Oxford, UK.
| | - Aleksandra Borek
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
- Institute of Psychology, SWPS University, Warsaw, Poland
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Fatehi-Firouzabadi N, Keshmiri F. Situational judgment test in pharmacy education: assessing professionalism capability among students. BMC Res Notes 2025; 18:128. [PMID: 40140931 PMCID: PMC11948762 DOI: 10.1186/s13104-025-07183-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Accepted: 03/13/2025] [Indexed: 03/28/2025] Open
Abstract
OBJECTIVE Situational Judgment tests are recognized as a valid predictor of job performance. In the present study, the students' professionalism capabilities were investigated using the situational judgment test. This cross-sectional study was conducted in 2023-2024. The situational judgment test includes four scenarios in the faculty situation (classroom) and six scenarios in the workplace situation in the field (hospital and urban pharmacy) with the format of "selected-response format" examined. 160 pharmacy students in different academic years participated. The cut-off scorer of situational judgment test was determined using the Cohen method and the norm-reference method of standard-setting. RESULTS The results showed that the scores of students in the situational judgment test were reported as 14.13 ± 6.07. According to Cohen's method, the score of 60 pharmacy students (50%) is lower than the cut-off score. The cut-off score based on the norm-reference method of standard-setting showed that 33 students (20.6%) scored below the cut-off score. The results showed that the students who participated in the professionalism course scored an average of 2.62 higher than the students who did not participate in these training courses. (p-value = 0.015). The development of professional education as a longitudinal program in the pharmacy curriculum is suggested.
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Affiliation(s)
| | - Fatemeh Keshmiri
- Medical Education Department, Education Development Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Wernecke K, Nadolny S, Schildmann J, Schiek S, Bertsche T. Ethical conflicts in patient care situations of community pharmacists: a cross-sectional online survey. Int J Clin Pharm 2024; 46:1500-1513. [PMID: 39240277 DOI: 10.1007/s11096-024-01797-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Community pharmacy practice is rarely considered in ethical research, although various ethical conflicts are known for this setting. Data on the actual frequency and perceived burden of ethical conflicts occurring in the community pharmacy setting are required. AIM The survey aimed at investigating the frequency and perceived burden of ethical conflicts, reasons for the perceived burden and influences on decision-making in ethical conflicts in German community pharmacists. METHOD An online survey was conducted among community pharmacists. It contained 15 ethical conflicts in which the ethically required action conflicts with another principle (e.g. law). Basing on these conflicting principles, 12 considerations relevant for decision-making were defined (e.g. solidarity principle). Participants were asked to rate the ethical conflicts in terms of frequency and perceived burden and to rate the influence on decision-making for the considerations. Results were analysed descriptively. RESULTS Five hundred and thirty-five questionnaires were evaluated. The participant's median age was 39 (min-max: 20-78) years, 378 (71%) were female. Seven of the 15 predefined ethical conflicts were rated as occurring predominantly at least once a week. "Generic drug is not most suitable" was rated as the most frequent. Three ethical conflicts were rated mainly with a (very) strong burden. "Concerns for an unborn child" was rated as the most burdensome. Three of the 12 predefined decision-making considerations: pharmaceutical knowledge, legal requirements and personal values were rated primarily as having a very strong influence on decision-making. CONCLUSION Pharmacists in community pharmacies are frequently affected by burdensome ethical conflicts in patient care situations.
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Affiliation(s)
- Kathrin Wernecke
- Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstrasse 32, 04103, Leipzig, Germany
- Drug Safety Center, Leipzig University and Leipzig University Hospital, Bruederstraße 32, 04103, Leipzig, Germany
| | - Stephan Nadolny
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
- Institute for Educational and Health-Care Research in the Health Sector, Hochschule Bielefeld -University of Applied Sciences and Arts, Interaktion 1, 33619, Bielefeld, Germany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
| | - Susanne Schiek
- Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstrasse 32, 04103, Leipzig, Germany
- Drug Safety Center, Leipzig University and Leipzig University Hospital, Bruederstraße 32, 04103, Leipzig, Germany
| | - Thilo Bertsche
- Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstrasse 32, 04103, Leipzig, Germany.
- Drug Safety Center, Leipzig University and Leipzig University Hospital, Bruederstraße 32, 04103, Leipzig, Germany.
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Raimundo R, Cavaco A. "I Solemnly Swear": A Comparative Study of Codes of Professional Ethics amongst Pharmacists from Culturally Diverse European Countries. PHARMACY 2024; 12:143. [PMID: 39452800 PMCID: PMC11510965 DOI: 10.3390/pharmacy12050143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 09/07/2024] [Accepted: 09/18/2024] [Indexed: 10/26/2024] Open
Abstract
Ethical practice is a universal concern for healthcare professionals, independent of their social, cultural, or religious background. This study aimed to assess and categorise statements published in codes of ethics for pharmacists from three diverse societies within the wider European area. The study followed a qualitative exploratory and triangular design, comparing the leading professional and ethical statements between three geographically apart countries (Portugal, Lithuania, and Turkey) and using the International Pharmaceutical Federation Code of Ethics proposal as a gold standard. Common core values such as honesty, integrity, and professional autonomy were identified across the countries' codes, suggesting that shared recognised core values underpin pharmacists' practice and policies in culturally diverse settings. None of the codes fully correspond to the framework the International Pharmaceutical Federation proposed. The analysis elicited significant inconsistencies between the codes for analogous practice models within the same continent. Further studies are needed to gain a more profound and comprehensive understanding of the underlying reasons for these discrepancies so that ethical weaknesses can be improved and harmonisation towards best-practice principles can benefit patients and healthcare systems.
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Affiliation(s)
- Raquel Raimundo
- Faculdade de Farmácia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal
| | - Afonso Cavaco
- Departamento de Farmácia, Farmacologia e Tecnologias em Saúde, Faculdade de Farmácia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal
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McCleery N, Caze AL, Winckel K, Hattingh HL. Evaluation of an interactive education workshop on hospital pharmacists' ethical reasoning: an observational study. BMC Med Ethics 2024; 25:81. [PMID: 39039490 PMCID: PMC11264360 DOI: 10.1186/s12910-024-01082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 07/11/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Pharmacists are often faced with scenarios in practice that require application of ethical reasoning and decision-making skills. There is limited research on the ethical decision-making processes of hospital pharmacists. Pharmacists who are compassionate and put the interests of their patients first are thought to positively impact on patient care, but there are often complex health-care system pressures in the hospital setting that cause pharmacists to behave in ways that may conflict with professional values and behaviours. This multisite study aimed to evaluate an interactive education workshop on hospital pharmacists' ethical reasoning skills and explore the need for ongoing training and support. METHODS This mixed-methods study was carried out across two health services including three hospitals. It incorporated a pre-workshop survey, a feedback survey immediately post-workshop and a third survey four weeks after the workshop. Semi-structured interviews were conducted with hospital pharmacists at least four weeks after the ethics workshop. RESULTS In total, 32 participants completed the pre-workshop survey, nominating peers/colleagues as the most common source of support they would consult to inform ethical decision-making (17/118 sources of support). Almost all (n = 31/33; 94%) strongly agreed/agreed that the education session provided them with ethical reasoning skills and a process/framework which they could use when faced with an ethical issue. Pre- and post-survey responses showed increased self-confidence in identifying the regulatory frameworks applicable to pharmacy privacy requirements (p = 0.011) and ethical issues applicable to pharmacy privacy requirements (p = 0.002), as well as applying ethical reasoning to scenarios that involve pharmacy privacy dilemmas/issues (p = 0.004). Participants' self confidence in knowing where to find support when faced with clinical and non-clinical ethics questions was improved (p = 0.002 and p = 0.003 respectively). Participants supported the introduction of quarterly ethics cafes after the workshop, compared to before the workshop (p = 0.001). CONCLUSION Hospital pharmacists rely on discussions with colleagues to brainstorm how to address ethical issues. This study showed that a targeted interactive education workshop facilitated familiarity with ethics resources and decision-making processes. It also demonstrated that this approach could be used to enhance hospital pharmacists' readiness, confidence, and capabilities to recognise and respond to challenging ethical issues.
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Affiliation(s)
- Nallini McCleery
- Pharmacy Department, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD, 4215, Australia.
| | - Adam La Caze
- School of Pharmacy, University of Queensland, Level 4, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
| | - Karl Winckel
- School of Pharmacy, University of Queensland, Level 4, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
- Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia
| | - H Laetitia Hattingh
- School of Pharmacy, University of Queensland, Level 4, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
- Allied Health Research, Gold Coast Health, Southport, QLD, 4215, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Southport, QLD, 4215, Australia
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Dosea AS, de Castro Araújo-Neto F, Fonseca FL, Gois Dos Santos L, Pimentel DMM, de Lyra DP. "Reigns but does not govern": A reflection on professionalism and the autonomy of the pharmacist. Res Social Adm Pharm 2023; 19:1061-1072. [PMID: 37105775 DOI: 10.1016/j.sapharm.2023.04.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION In recent decades, the professionalization of pharmacy has been debated worldwide. With the advent of industrialization, pharmacist autonomy has weakened, especially in the retail pharmacy market. Manegers and mentors of pharmacy chains serve as links between the profession and drug users. This study sought to understand the perceptions of retail pharmacy stakeholders regarding pharmacist autonomy and how to improve it, and to reflect on theories of professionalism. METHOD 19 semi-structured interviews were conducted. The interviews were transcribed and analyzed through analyst triangulation and categorical content analysis, using the ATLAS.ti software. RESULTS Interviews were conducted with nine mentors and ten managers in retail medicine. They reported aspects related to managerial and technical autonomy regulated by law, and strategies for enhancing professional autonomy in retail pharmacy. Autonomy was considered limited by pharmacists' dependence on employability and self-devaluation; and market control exposed the weaknesses in pharmaceutical professionalism. Entrepreneurship and ownership attitude strategies were feasible only in a retail micro-political context. CONCLUSION The retail medicine continues to have business model centered on the product and controlling the pharmaceutical practice model. To ensure autonomy and professional strengthening, it is necessary that pharmacy recognizes itself as a clinical profession and develops a stable professional identity.
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Affiliation(s)
- Aline Santana Dosea
- Health Sciences Graduate Program, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Fernando de Castro Araújo-Neto
- Health Sciences Graduate Program, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Francielly Lima Fonseca
- Graduate Program in Pharmaceutical Sciences. Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Lívia Gois Dos Santos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | | | - Divaldo Pereira de Lyra
- Health Sciences Graduate Program, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
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Azeez Al-Jumaili A, Elhiny R, Thomas D, Elbarbry F, Khdour M, Sherbeny F, Hamad A. Factors Impacting Job Satisfaction among Pharmacists in the Arab World: A Qualitative Study. Saudi Pharm J 2023; 31:578-584. [PMID: 37063440 PMCID: PMC10102404 DOI: 10.1016/j.jsps.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose This study was undertaken to investigate in-depth the factors impacting job satisfaction among pharmacists in the Arab world and the challenges they encounter in their career path. The outcome of this study should help the local policymakers to take corrective actions to improve pharmacist's satisfaction and therefore enhance quality of patient care. Method This qualitative study collected responses of pharmacists from 12 Arab countries, as part of a large quantitative survey. Participants added comments to an optional open-ended question regarding work satisfaction. The Qualtrics Survey Software was used to collect the responses. The survey was distributed from March to May 2021 through multiple online channels for filling. The responses collected were analysed to develop themes. An inductive constructivist approach was used for the conceptual thematic analysis as the methodological orientation. Results A total of 110 responses/comments were received from the study participants. The two largest practice settings of the participants were from hospitals (44.5%) and community pharmacies (28.2%). Almost 40% of responses came from pharmacists practising in Qatar (21.8%) and UAE (18.1%). The survey data demonstrated several reasons impacting job satisfaction among pharmacists practising in the Arab countries. Underestimation of the pharmacists' role, low salaries, lack of motivation and excessive workload were reported as major contributors to job dissatisfaction. On the other hand, professional commitment and the culture of the work setting were the major contributors to job satisfaction. Conclusions The study provides valuable insights into the aspects concerning pharmacists' satisfaction in the Arab world. Policymakers and other stakeholders need to act upon aspects of pharmacists' job satisfaction and dissatisfaction to ensure potentially better working environment and patient outcomes.
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Alsayed AR. Illustrating How to Use the Validated Alsayed_v1 Tools to Improve Medical Care: A Particular Reference to the Global Initiative for Asthma 2022 Recommendations. Patient Prefer Adherence 2023; 17:1161-1179. [PMID: 37143905 PMCID: PMC10153448 DOI: 10.2147/ppa.s403239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/07/2023] [Indexed: 05/06/2023] Open
Abstract
Purpose The current research aimed to illustrate a real case using the validated Alsayed_v1 tools as tutorial training to improve the knowledge and skills of healthcare practitioners in the clinical problem-solving process necessary to implement medical and pharmaceutical care. Patients and Methods The Alsayed_v1 instruments consist of principal components: data collection, assessment of treatments, the medical problem oriented plan (MPOP), as well as a care plan and patient education. Results This study illustrated a real case of asthma patient using the validated Alsayed_v1 tools. These validated and clinically tested tools provide a coding system for the MPOP that permits easy documentation with an open hierarchical structure where higher levels are broad and lower levels are particular, and the possibility to enter free text. The section dedicated to treatment assessments is intended to synthesize patient information to facilitate the identification of the MPOPs. Effective management requires the development of a partnership between the patient with asthma (or the patient's caregivers) and his healthcare professional(s). This partnership aims to allow the patient to control his condition with guidance from the healthcare professional(s), discuss and agree on therapy goals, and develop a personalized, written, self-management asthma care plan. Conclusion By implementing Alsayed_v1 tools, the clinical practitioner can actively give the best practice for optimal patient outcomes.
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Affiliation(s)
- Ahmad R Alsayed
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, 11937, Jordan
- Correspondence: Ahmad R Alsayed, (PharmD, MSc, PhD in Therapeutics and Precision Medicine), Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan, Tel +962786770778, Email ;
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Forsyth P, Radley A, Rushworth GF, Marra F, Roberts S, O'Hare R, Duggan C, Maguire B. The Collaborative Care Model: Realizing healthcare values and increasing responsiveness in the pharmacy workforce. Res Social Adm Pharm 2022; 19:110-122. [DOI: 10.1016/j.sapharm.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 10/14/2022]
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Jairoun AA, Al-Hemyari SS, Shahwan M, Godman B, El-Dahiyat F, Kurdi A, Al Ani M, Habeb M. Top unresolved ethical challenges and dilemmas faced by community pharmacists in providing pharmaceutical care: Drawing the line between ethical challenges and the quality of the pharmaceutical care. Res Social Adm Pharm 2022; 18:3711-3713. [DOI: 10.1016/j.sapharm.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
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Esmalipour R, Larijani B, Mehrdad N, Ebadi A, Salari P. The ethical challenges in pharmacy practice in community Pharmacies: A qualitative study. Saudi Pharm J 2022; 29:1441-1448. [PMID: 35002382 PMCID: PMC8720823 DOI: 10.1016/j.jsps.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Pharmacists as a group of health care professionals, face different types of ethical challenges in their everyday routine that may impede pharmaceutical care. Objectives In this study, we aimed at evaluation and recognition of the ethical challenges of pharmacy practice in community pharmacies. Methods This exploratory study was conducted as a qualitative study consisting of open-ended in-depth interviews and focus group discussions followed by content analysis. The study participants were chosen from pharmacists with PharmD degree who had at least 4 years work experience and were the founders or technical managers of community pharmacies, either as governmental or private. Interviews continued until data saturation and transcribed verbatim. The content analysis was done by Graneheim and Lundman method. The codes were generated, and categorized. After assessment and final modifications, the results of the study were discussed and confirmed in a focus group discussion conducted by 7 experts who teach medical ethics and/or pharmacy ethics. Results Overall, 40 pharmacists were interviewed (mean age 46 ± 11.3 years). The extracted ethical challenges of pharmacy practice were categorized into 3 main themes, 11 subthemes and 102 codes. The themes were achieved as challenges related to professionalism and professional practice, challenges related to professional communications and challenges related to regulations and policies. Conclusion Taken together, it seems that most of the challenges of pharmacy practice are related to professionalism and professional commitment; however, the regulations and policies provide serious obstacles for pharmacy practice and pharmaceutical care. More efforts towards teaching professionalism and modification of regulations and policies are recommended.
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Affiliation(s)
- Rasool Esmalipour
- Medical Ethics and History of Medicine Research Center, and School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, And Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Pooneh Salari
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Fino LB, Alsayed AR, Basheti IA, Saini B, Moles R, Chaar BB. Implementing and evaluating a course in professional ethics for an undergraduate pharmacy curriculum: A feasibility study. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:88-105. [PMID: 35125200 DOI: 10.1016/j.cptl.2021.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 07/23/2021] [Accepted: 11/28/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Pharmacy practice today mandates "patient-centered care", thereby assigning higher levels of professional responsibility for pharmacists leading to ethical challenges. These challenges often involve ethical principles, institutional, personal, or other constraints that can pull practitioners in incompatible opposite directions, creating "ethical dilemmas" in many circumstances. Pharmacists are expected to handle challenges competently and in the best interest of patients. Literature underlines the positive impact of educational interventions focusing on ethical awareness and competence, and that "gaps" existed in pharmacy training/curricula for Jordanian pharmacists. The objective of this study was to develop, implement, and evaluate the utility of a tailored ethics education component in the pharmacy curriculum for students enrolled at a well-ranked Jordanian university. EDUCATIONAL ACTIVITY AND SETTING Fifth-year pharmacy students attending summer school at a university in Jordan from July to September 2020 were invited to participate in an educational intervention (suite of didactic online lectures and skills-based workshops). This study was delivered in four parts, with a pretest administered immediately before and a posttest survey immediately after the educational intervention, the educational intervention (three phases), and focus-group discussions to elicit students' feedback. FINDINGS Findings indicated enhanced levels of confidence in students' decision-making. The development of students' moral reasoning and decision-making skills were also observed to be improved. SUMMARY This study highlighted the importance of the implementation of an ethics course in pharmacy undergraduate curricula. It emphasized the positive impact this course made on the students' learning experiences and provided a strong environment for discussion and group learning.
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Affiliation(s)
- Leen B Fino
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney NSW, 2006, Australia; President of Applied Science Private University, Amman, Jordan.
| | - Ahmad R Alsayed
- President of Applied Science Private University, Amman, Jordan.
| | - Iman A Basheti
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney NSW, 2006, Australia; President of Applied Science Private University, Amman, Jordan.
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney NSW, 2006, Australia.
| | - Rebekah Moles
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney NSW, 2006, Australia.
| | - Betty B Chaar
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney NSW, 2006, Australia.
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Simegn W, Weldegerima B, Endeshaw A, Sisay G, Mohammed A, Wondimsigegn D, Dagne H. Assessment of Community Pharmacy Professionals' Attitude and Perception Towards Ethical Issues in Amhara Region, Ethiopia: A Cross-Sectional Survey 2020. Risk Manag Healthc Policy 2021; 14:4127-4139. [PMID: 34629917 PMCID: PMC8495226 DOI: 10.2147/rmhp.s328328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The objective of this study was to assess the attitude and perception of community pharmacy professionals' towards ethical issues. Methods We have undertaken a cross-sectional study among community pharmacy professionals in three selected towns (Gondar, Bahir Dar, and Debra Markos) of Amhara region in Ethiopia from February to March 2020. All community pharmacy professionals who were giving services during the data collection period were the study population. We used a pretested, semi-structured questionnaire developed from a review of previous study. Epi-info 7.1 was used for data entry, and SPSS version 20 was used for data analysis. Logistic regression was done, and a variable with a p-value < 0.05 with 95% confidence interval was considered to be associated with outcome variable. Results A total of 305 community pharmacy professionals participated in the study with a response rate of 95.3%. About 252 (82.6%) of respondents received education regarding professional ethics. Majority (89.8%) of the participants had ever accessed ethical information at their work site. Only 145 (47.5%) participants had ever recorded ethical issues in their working site. The most common reasons that obstruct to explain ethical issues to customers were shortage of time (85.9%), unavailability of reliable resources (40.0%), and poor ethical knowledge (37.7%). The reporting rate of respondents is less than 50% for most ethical scenarios. Sex, age, educational status, work experience, number of customers per day, working site, information about ethics, and training about ethics were observed to have a significant association with attitude and perception of community pharmacy professionals towards ethical issues. Conclusion Community pharmacy professionals had poor attitude and perception towards ethical issues. Interventions should be devised to uphold ethical awareness of community pharmacy professionals. A large-scale study is also recommended.
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Affiliation(s)
- Wudneh Simegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Berhanemeskel Weldegerima
- Department of Social and Administrative Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Alem Endeshaw
- Department of Social and Administrative Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Gashaw Sisay
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Abdulwase Mohammed
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Dawit Wondimsigegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, University of Gondar, Gondar, Amhara Region, Ethiopia
| | - Henok Dagne
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Amhara Region, Ethiopia
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Rajiah K, Sivarasa S, Maharajan MK. Impact of Pharmacists' Interventions and Patients' Decision on Health Outcomes in Terms of Medication Adherence and Quality Use of Medicines among Patients Attending Community Pharmacies: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4392. [PMID: 33918990 PMCID: PMC8122322 DOI: 10.3390/ijerph18094392] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022]
Abstract
Community pharmacists are responsible for providing the appropriate information on the use of medications to patients, which may enhance their medication adherence. The extent of control that patients have on their health care preferences creates many challenges for community pharmacists. This study aimed to determine the impact of pharmacist interventions and patient decisions on health outcomes concerning medication adherence and the quality use of medicines among patients attending community pharmacies. Appropriate studies were identified in a systematic search using the databases of Medline, Scopus, Google Scholar, and PubMed. The search included literature published between 2004 and 2019. The database searches yielded 683 titles, of which 19 studies were included after the full-text analysis with a total of 9313 participants. Metaprop command in Stata software version 14 was used for the analysis. This study was undertaken based on the general principles of the Cochrane Handbook for Systematic Reviews of Interventions and subsequently reported according to the Preferred Reporting Items for Systematic Reviews (PRISMA) extension. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was directly used to rate the quality of evidence (high, moderate, low, or very low). The results revealed the effective interaction between patients and community pharmacists, the importance of pharmacist intervention on medication adherence and quality use of medicine, and the role of community pharmacists in counselling patients. Decision/choice of patients in self-care and self-medication is a factor contributing to health outcomes. Effective interaction of community pharmacists with patients in terms of medication adherence and quality use of medicines provided a better health outcome among patients. The community pharmacists influenced the decision/choice of patients in self-care and self-medications.
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Affiliation(s)
- Kingston Rajiah
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57200, Malaysia;
| | - Shreeta Sivarasa
- Student, Master in Pharmacy Practice, School of Postgraduate Studies, International Medical University, Kuala Lumpur 57200, Malaysia;
| | - Mari Kannan Maharajan
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57200, Malaysia;
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16
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Hospital pharmacists’ ethical exposure and decision-making. Res Social Adm Pharm 2021; 17:372-380. [DOI: 10.1016/j.sapharm.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 03/06/2020] [Accepted: 03/22/2020] [Indexed: 11/18/2022]
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17
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Schofield G, Dittborn M, Huxtable R, Brangan E, Selman LE. Real-world ethics in palliative care: A systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice. Palliat Med 2021; 35:315-334. [PMID: 33302783 PMCID: PMC7897798 DOI: 10.1177/0269216320974277] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Ethical issues arise daily in the delivery of palliative care. Despite much (largely theoretical) literature, evidence from specialist palliative care practitioners about day-to-day ethical challenges has not previously been synthesised. This evidence is crucial to inform education and adequately support staff. AIM To synthesise the evidence regarding the ethical challenges which specialist palliative care practitioners encounter during clinical practice. DESIGN Systematic review with narrative synthesis (PROSPERO registration CRD42018105365). Quality was dual-assessed using the Mixed-Methods Appraisal Tool. Tabulation, textural description, concept mapping and thematic synthesis were used to develop and present the narrative. DATA SOURCES Seven databases (MEDLINE, Philosopher's Index, EMBASE, PsycINFO, LILACS, Web of Science and CINAHL) were searched from inception to December 2019 without language limits. Eligible papers reported original research using inductive methods to describe practitioner-reported ethical challenges. RESULTS A total of 8074 records were screened. Thirteen studies from nine countries were included. Challenges were organised into six themes: application of ethical principles; delivering clinical care; working with families; engaging with institutional structures and values; navigating societal values and expectations; philosophy of palliative care. Challenges related to specific scenarios/contexts rather than the application of general ethical principles, and occurred at all levels (bedside, institution, society, policy). CONCLUSION Palliative care practitioners encounter a broad range of contextual ethical challenges, many of which are not represented in palliative care ethics training resources, for example, navigating institutional policies, resource allocation and inter-professional conflict. Findings have implications for supporting ethical practice and training practitioners. The lack of low- and middle- income country data needs addressing.
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Affiliation(s)
- Guy Schofield
- Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mariana Dittborn
- Paediatric Bioethics Service, Great Ormond Street Hospital, London, UK
| | - Richard Huxtable
- Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emer Brangan
- Health and Applied Sciences, University of West England, Bristol, UK
| | - Lucy Ellen Selman
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
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18
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Stratton TP. Incorporating Ethics Content Throughout an Integrated Pharmacy Curriculum. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2020; 84:7865. [PMID: 34283748 PMCID: PMC7712732 DOI: 10.5688/ajpe7865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 06/22/2020] [Indexed: 06/13/2023]
Abstract
Objective. To incorporate ethics content into nine courses across three years of the didactic pharmacy curriculum and in introductory and advanced pharmacy practice experiences to ensure Doctor of Pharmacy (PharmD) students are prepared to address ethical issues.Methods. A free-standing, one-credit ethics course from the existing curriculum was eliminated. Partnering with course directors from nine required PharmD courses across all three years of the didactic curriculum and with the Office of Experiential Education, an Integrated Ethics syllabus was created that provided each class of approximately 170 students with at least one credit of didactic ethics instruction and added ethics activities to the experiential curriculum. Learning approaches included lecture, case analysis, and discussion with preceptors. Assessment approaches included written case analyses, tests with multiple-choice and true/false questions, case vignette-based short-answer essay questions, and student discussions with preceptors.Results. The newly integrated curriculum provided students with opportunities to discuss and apply ethics concepts several times throughout their coursework. The integration also ensured that ethics topics were relevant to the material students were learning in the host course at the time. The majority of students consistently rated the ethics sessions as useful, but some found the repeated application of the ethics problem-solving framework to be tedious and duplicative.Conclusion. It is possible to embed ethics topics within different courses in the PharmD curriculum rather than offering a stand-alone ethics course at a single point in the curriculum. Challenges remain to assessing students' ability to apply ethics principles once they are presented.
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19
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Fino LB, Basheti IA, Chaar BB. Exploring Ethical Pharmacy Practice in Jordan. SCIENCE AND ENGINEERING ETHICS 2020; 26:2809-2834. [PMID: 32533448 DOI: 10.1007/s11948-020-00231-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/30/2020] [Indexed: 06/11/2023]
Abstract
Patient-centered pharmacy practice involves increased pharmacist engagement in patient care. This increased involvement can sometimes require diverse decision-making when handling various situations, ranging from simple matters to major ethical dilemmas. There is literature about pharmacy ethics in developed Western countries. However, little is known about pharmacists' practices in many developing countries. For example, there is a paucity of research conducted in the area of pharmacy ethics in Jordan. This study aimed to explore the manner in which ethical dilemmas were handled by Jordanian pharmacists, the resources used and their attitudes towards them. Semi-structured, face to face interviews were carried out with 30 Jordanian registered pharmacists. The transcribed interviews were thematically analysed for emerging themes. Four major themes were identified: legal practice; familiarity with the code of ethics; personal judgement, cultural and religious values; and Experience. Findings showed that ethical decision-making in pharmacy practice in Jordan was decisively influenced by pharmacists' personal moral values, legal requirements and managed by exercising common sense and experience. This pointed to gaps in Jordanian pharmacists' understanding and application of basic principles of pharmacy ethics and highlighted the need for professional ethics training, incorporating pharmacy ethics courses in pharmacy undergraduate curricula, as well as professional development courses. This study highlighted that paternalism, personal values and legal obligations were major drivers influencing decision-making processes of Jordanian pharmacists. Findings also highlighted an inclination towards lack of respect for patient autonomy. This illuminated the need for increasing pharmacists' literacy in professional ethics.
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Affiliation(s)
- Leen B Fino
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan
| | - Iman A Basheti
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan
| | - Betty B Chaar
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
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20
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van Loon WEE, Borgsteede SDS, Baas GWG, Kruijtbosch MM, Buurma HH, De Smet PAGMP, Egberts ACGT, Bouvy MM, Floor-Schreudering AA. Nature and frequency of prescription modifications in community pharmacies: A nationwide study in the Netherlands. Br J Clin Pharmacol 2020; 87:1455-1465. [PMID: 32901959 PMCID: PMC9328355 DOI: 10.1111/bcp.14548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 11/27/2022] Open
Abstract
AIMS To investigate the nature and frequency of prescription modifications in Dutch community pharmacies. METHODS In this cross-sectional study, Dutch community pharmacists documented prescription modifications in their pharmacy during 1 predetermined day. Pharmacists from all Dutch community pharmacies were invited to participate. A prescription modification was defined as any modification in a prescription for a medicine or other healthcare product because of an administrative problem, logistic issue or potential drug-related problem (DRP). All documented modifications were assessed to establish the nature and frequency of prescription modifications. RESULTS Pharmacists in 275 pharmacies completed the study. A modification was performed in 5.5% of all prescriptions. 1.3% of the prescriptions contained an administrative problem, of which insufficient specification of the dosing regimen was most common (63.1%). A modification was performed due to a logistic issue in 2.4% of the prescriptions. The most frequently recorded issues were unavailability of medication (40.9%) and obligatory product substitutions due to reimbursement policies (33.2%). A modification was performed in 1.8% of the prescriptions to solve or prevent potential DRPs. Of these, 69.2% was potentially clinically relevant according to the pharmacist concerned. The most frequently prevented potential DRP was an incorrect strength or dose (31.9%). CONCLUSION Dutch community pharmacists modified almost 1 in 20 prescriptions per pharmacy. The nature of the modifications reflects current community pharmacy practice, in which pharmacists frequently deal with logistic issues and intervene to solve or prevent for DRPs several times a day. The majority of the DRPs were considered to be potentially clinically relevant.
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Affiliation(s)
- W E Ellen van Loon
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands.,Pharmacy de Drie Stellingen, Oosterwolde, the Netherlands
| | - S D Sander Borgsteede
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands.,Department of Clinical Decision Support, Health Base Foundation, Houten, the Netherlands
| | - G W Gert Baas
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - M Martine Kruijtbosch
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - P A G M Peter De Smet
- Department of Clinical Pharmacy, University Medical Centre St Radboud, Nijmegen, the Netherlands
| | - A C G Toine Egberts
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.,Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Marcel Bouvy
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - A Annemieke Floor-Schreudering
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
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21
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Iranmanesh M, Yazdi-Feyzabadi V, Mehrolhassani MH. The challenges of ethical behaviors for drug supply in pharmacies in Iran by a principle-based approach. BMC Med Ethics 2020; 21:84. [PMID: 32873312 PMCID: PMC7466816 DOI: 10.1186/s12910-020-00531-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background Pharmacists as the trustee of pharmacy services must adhere to ethical principles and evaluate their professionalism. Pharmacists may sometimes show different unethical behaviors in their interactions, so it is essential to understand these behaviors. The present study aimed to determine the challenges of ethical behaviors based on a principles-based approach in the area of drug supply in pharmacies. Methods This qualitative content analysis was conducted in Kerman in 2018. A number of key players in the field of medication supply were selected using snowball sampling to interview. An effort was made to select samples with maximum variation. Exclusion criteria include having less than 3 years of work experience in pharmacy and supervision, not willing to participate in the interview, and not participating in the interview for 3 times. The participants in this study consisted of pharmacy technicians (n = 5), patients (n = 6), pharmacists (n = 8), inspectors of insurance companies (n = 4), and inspectors of food and drug administration (n = 3). Data were analyzed using directed content analysis by Maxqda software version 10 (VERBI Software, Berlin, Germany). The principles of “Beauchamp and Childress Ethics” theory including autonomy, beneficence, non-maleficence, and justice were selected as the main principles. Results After data analysis, 8 main categories and 26 subcategories were obtained. The main categories include patient privacy, patient independence, communication principles, patient-centered services, drug supplier, patient harm avoidance, supervision, and distributive, procedural, and interactional justice. The subcategories include increasing patient awareness, culturizing prescription, and rational drug use, confidentiality and privacy, and pharmacist-patient relationship/communication, which were the main ethical challenges in the area of drug supply at pharmacies. Conclusions According to a principle-based approach, the greatest challenges were related to two principles of autonomy and beneficence. The policymakers in the healthcare system should emphasize patient independence, patient privacy, and patient-centered services. The results of this study can be used as a tool to introduce ethical challenges to policymakers and develop educational contents, the chart of professional ethics in pharmacies, and accreditation measures of pharmacies.
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Affiliation(s)
- Mahla Iranmanesh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Haft-Bagh Highway- Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Yazdi-Feyzabadi
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Hossein Mehrolhassani
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Haft-Bagh Highway- Kerman University of Medical Sciences, Kerman, Iran.
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22
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Woods P, Schindel TJ, King MA, Mey A. Pharmacy practice in the domain of assisted dying: A mapping review of the literature. Res Social Adm Pharm 2020; 16:267-276. [DOI: 10.1016/j.sapharm.2019.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/15/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
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23
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Schommer JC, Gaither CA, Goode JV'KR, Owen JA, Scime GM, Skelton JB, Cernasev A, Hillman LA. Pharmacist and student pharmacist views of professional and personal well-being and resilience. J Am Pharm Assoc (2003) 2019; 60:47-56. [PMID: 31669419 DOI: 10.1016/j.japh.2019.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the views of pharmacists and student pharmacists regarding (1) aspects of life and experiences that provide professional and personal satisfaction and fulfillment, (2) causes of stress, and (3) needs related to maintaining satisfaction and fulfillment. DESIGN A generic qualitative research design was used for collecting data from 380 pharmacists and 332 student pharmacists who wrote responses to an online survey hosted by the American Pharmacists Association (APhA) from November 17 to December 2, 2018, using standard data collection procedures applied by that organization. APhA uses its member and affiliate data files as its sampling frame and limits the number of contacts per year for each person in those files. De-identified responses from those who volunteered to write comments were sent to the research team for analysis. A conventional content analysis approach was applied for analysis of the text. Analysts convened to discuss emergent themes and develop operational descriptions. Key segments of text that best represented each theme were identified. Personal presuppositions were disclosed and were useful for developing group consensus for theme identification and description. Rigor was supported through assessment of credibility, confirmability, intercoder checking, transferability, inductive thematic saturation, and authenticity. SETTING AND PARTICIPANTS Participants are in the design since data already collected. OUTCOME MEASURES Not applicable. RESULTS Findings showed that pharmacists and student pharmacists are able to recognize and pursue achievement, recognition, responsibility, advancement, relationship, esteem, self-actualization, meaning, and accomplishment in both their professional and personal lives. However, external factors such as "workism" and individual factors such as "moral distress" were identified as areas of improvement that are needed for well-being and resilience. CONCLUSION Pharmacists' basic human needs are being met, but to improve well-being and resilience for pharmacists in both their professional and personal lives, there is a need for addressing both the external factors and individual factors that they encounter.
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Rajiah K, Venaktaraman R. The Effect of Demographic and Social Factors on the Decision-Making of Community Pharmacists in Ethical Dilemmas. J Res Pharm Pract 2019; 8:174-177. [PMID: 31728350 PMCID: PMC6830021 DOI: 10.4103/jrpp.jrpp_19_15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/26/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The objective of the study is to investigate the effect of demographic and social factors on the decision-making of community pharmacists when confronted with ethical dilemmas during their professional practice. METHODS This was a questionnaire-based, cross-sectional study. A total of 1057 community pharmacists were approached. The final participants were 742. Independent-sample t-test and one-way analysis of variance were used to analyze the factors (age, gender, work experience, education qualification, number of pharmacists per pharmacy, and pharmacy location). FINDINGS Older pharmacists, experienced pharmacists, and urban pharmacists have less ethical dilemma compared to the younger pharmacists, less work experience pharmacists, and rural pharmacists, respectively. CONCLUSION Individual factors such as age, gender, work experience, and educational level and organizational factors such as the number of pharmacists in a pharmacy and location of pharmacy may influence the ethical dilemma of community pharmacists.
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Affiliation(s)
- Kingston Rajiah
- Department of Pharmacy Practice, Institute of Pharmacy, Shri Jagdishprasad Jhabarmal Tibrewala University, Jhunjhunu, Rajasthan, India
| | - Rajesh Venaktaraman
- Department of Pharmacy Practice, Adichunchanagiri College of Pharmacy, Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
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25
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Athiyah U, Setiawan CD, Nugraheni G, Zairina E, Utami W, Hermansyah A. Assessment of pharmacists' knowledge, attitude and practice in chain community pharmacies towards their current function and performance in Indonesia. Pharm Pract (Granada) 2019; 17:1518. [PMID: 31592292 PMCID: PMC6763301 DOI: 10.18549/pharmpract.2019.3.1518] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/11/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The introduction of universal healthcare coverage in 2014 has affected the practice of community pharmacies in Indonesia. Studies regarding the practice of pharmacist in the chain community pharmacy setting in Indonesia are very limited. The chain community pharmacies in Indonesia are operated and controlled by the same management. The chain community pharmacies usually show better services compared to independent community pharmacies in Indonesia. OBJECTIVE The study aimed to assess the knowledge, attitude and practice (KAP) of pharmacist working in chain community pharmacy towards their current function and performance in delivering pharmacy services. METHODS A cross-sectional study using questionnaires was conducted between January and March 2017 in KF, one of the largest chain community pharmacies in Indonesia. The total sampling method was used in the recruitment process. The data were analyzed using descriptive statistics, independent t-Test and one-way ANOVA. The KAP scores were assessed and categorized as "poor", "moderate" and "good" based on the standardized scoring system. RESULTS A total of 949 KF's pharmacists (100% response rate) were participated in the study. The majority of pharmacists showed a good score in terms of knowledge and attitude, which is in contrast to practice as majority only obtained a moderate score. Working experience, age and the availability of standard operating procedures (SOP) for both dispensing and self-medication services were found to be statistically significant (p<0.005) aspects to KAP of pharmacists in delivering pharmacy services. CONCLUSIONS This study identified several important aspects that could affect the KAP of pharmacists working in chain community pharmacies in Indonesia. Specific policies should be conceived to improve the competencies of pharmacist and to ensure the compliance with the SOP and standardization system within pharmacy sector.
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Affiliation(s)
- Umi Athiyah
- Faculty of Pharmacy, Airlangga University. Surabaya (Indonesia).
| | - Catur D Setiawan
- Faculty of Pharmacy, Airlangga University. Surabaya (Indonesia).
| | | | - Elida Zairina
- Faculty of Pharmacy, Airlangga University Surabaya (Indonesia).
| | - Wahyu Utami
- Faculty of Pharmacy, Airlangga University. Surabaya (Indonesia).
| | - Andi Hermansyah
- Faculty of Pharmacy, Airlangga University. Surabaya (Indonesia).
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26
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Kruijtbosch M, Göttgens-Jansen W, Floor-Schreudering A, van Leeuwen E, Bouvy ML. Moral reasoning among Dutch community pharmacists: testing the applicability of the Australian Professional Ethics in Pharmacy test. Int J Clin Pharm 2019; 41:1323-1331. [PMID: 31254151 PMCID: PMC6800840 DOI: 10.1007/s11096-019-00869-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
Background Moral reasoning competency is essential in healthcare practice, especially in situations of moral dilemmas when a professional has to choose a morally justifiable action among several suboptimal action options. The Australian Professional Ethics in Pharmacy test (PEP test) measures moral reasoning among pharmacists. In Australia three levels of moral reasoning (schemas) were measured (1) business orientation (2) rules and regulations, and (3) patient rights (i.e. most advanced schema). Objective To test the applicability of the PEP test to pharmacists working in the Netherlands. Setting Dutch community pharmacy. Methods The PEP test consists of 36 statements (items) accompanying 3 moral dilemma scenarios. It was translated into Dutch and completed by 390 pharmacists. Principle component analysis (PCA) was used to investigate construct validity and Cronbach's Alpha was used to indicate internal consistency of the Dutch version of the PEP test. The eligible grouped statements and perceived possible moral reasoning schemas were compared to the Australian findings. Main outcome measure Moral reasoning schemas. Results The PCA analysis resulted in 3 components (i.e. possible moral reasoning schemas) that together accounted 27% variance in the data. The statements that represented the moral reasoning schemas 'business orientation' and 'rules and regulations' were somewhat similar when comparing these with the statements that represented these schemas in the PEP test study. The most advanced moral reasoning schema identified in Dutch pharmacists contained different statements compared to the statements that represented that schema among Australian pharmacists. This schema was labelled 'professional ethics'. Conclusion The PEP test needs further adaptation to the Dutch pharmacy practice context: especially the statements that should reflect the most advanced moral reasoning schema, need more accurate representations of professional pharmacy ethics that guide pharmacists in the Netherlands. Moral reasoning tests for a specific professional setting or country should be developed and adapted by experts who share the same professional values and practice as the respondents.
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Affiliation(s)
- M Kruijtbosch
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5b, 2331 JE, Leiden, The Netherlands. .,Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands.
| | - W Göttgens-Jansen
- Department of Primary and Community Care, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 120, ELG, 6500 HB, Nijmegen, The Netherlands
| | - A Floor-Schreudering
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5b, 2331 JE, Leiden, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands
| | - E van Leeuwen
- Department of Primary and Community Care, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 120, ELG, 6500 HB, Nijmegen, The Netherlands
| | - M L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands
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Hattingh HL, King MA, Hope DL, George E. Pharmacy ethical reasoning: a comparison of Australian pharmacists and interns. Int J Clin Pharm 2019; 41:1085-1098. [PMID: 31093939 DOI: 10.1007/s11096-019-00815-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/22/2019] [Indexed: 10/26/2022]
Abstract
Background Ethical reasoning informs decision making and professional judgement, is guided by codes of ethics and conduct, and requires navigation through a regulatory framework. Ethical reasoning should evolve throughout the pharmacy internship year and prepare interns for independent practice. Objective To explore the ethical reasoning and processes of Australian pharmacists and pharmacy interns. Setting Queensland community pharmacists and interns. Method A survey to determine use of resources to guide ethical decisions, management of ethical dilemmas, and exposure to potential practice privacy breaches. Participants were recruited at pharmacy intern training events, a pharmacist education session and through telephone contact of randomised community pharmacies. Main outcome measure Comparison between pharmacist and intern responses using 5-point Likert scales, listings and prioritising. Results In total 218 completed surveys were analysed: 121 pharmacy interns and 97 pharmacists. The Code of Ethics was identified as the resource most frequently consulted when faced with ethical dilemmas. Interns were more likely to consult legislation and regulatory authorities whereas pharmacists with colleagues. Responses to ethical vignette scenarios and exposure to privacy breaches varied between interns and pharmacists, with some scenarios revealing significant differences. Most participants had been exposed to a variety of potential privacy breaches in practice. Conclusion Interns focussed on legislation and guidelines when presented with hypothetical ethical dilemmas. In contrast to this positivist approach, pharmacists reported using a social constructionist approach with peers as a reference. Pharmacists avoided ethical scenario options that required complex management. Interns reported more exposure to potential practice privacy breaches.
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Affiliation(s)
- H Laetitia Hattingh
- School of Pharmacy and Pharmacology, Griffith University, Clinical Sciences 2, G16_3.26, Gold Coast Campus, Gold Coast, QLD, 4215, Australia. .,Quality Use of Medicines Network, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4215, Australia.
| | - Michelle A King
- School of Pharmacy and Pharmacology, Griffith University, Clinical Sciences 2, G16_3.26, Gold Coast Campus, Gold Coast, QLD, 4215, Australia.,Quality Use of Medicines Network, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4215, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4215, Australia
| | - Denise L Hope
- School of Pharmacy and Pharmacology, Griffith University, Clinical Sciences 2, G16_3.26, Gold Coast Campus, Gold Coast, QLD, 4215, Australia.,Quality Use of Medicines Network, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4215, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4215, Australia
| | - Elizabeth George
- School of Pharmacy and Pharmacology, Griffith University, Clinical Sciences 2, G16_3.26, Gold Coast Campus, Gold Coast, QLD, 4215, Australia
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Al-Qudah RA, Tuza O, Tawfiek H, Chaar B, Basheti IA. Community pharmacy ethical practice in Jordan: assessing attitude, needs and barriers. Pharm Pract (Granada) 2019; 17:1386. [PMID: 31015876 PMCID: PMC6463417 DOI: 10.18549/pharmpract.2019.1.1386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 02/24/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Having a local code of ethics, based on moral obligations and virtues, known
to all practicing pharmacists is important in order to guide them in
relationships with patients, health professionals, and society. Objective: To investigate pharmacists’ attitude and barriers towards applying the
ethical principles published by the Jordanian Pharmacists Association in the
Jordanian code of ethics. Methods: The study objectives were addressed in a cross-sectional study completed by a
convenience sample of community pharmacists, in both cities; Amman and Irbid
A questionnaire was used to achieve the study objective. The questionnaire
was developed and validated, investigating pharmacists’
socio-demographic and practice characteristics, perceived attitude toward
certain practice scenarios, and perceived barriers towards applying the
locally published ethical principles while dealing with their patients. The
questionnaire was self-completed by pharmacists between January and August
2017. Collected data was analyzed using SPSS version 21. Descriptive
statistics and parametric tests were used with p<0.05 set a priori as
significant. Results: Seven hundred and four pharmacists (Amman n=486; Irbid n=218) responded to
the questionnaire, providing completely answered questionnaires with a
response rates of 69.4% in Amman and 99.6% in Irbid.
Pharmacists from both cities revealed that they use the Internet as their
main resource to obtain ethical information when they need it, to help them
deal with their patients (34.0% from Amman and 31.5% from
Irbid). More pharmacists in Amman (57.0%) had access to resources
regarding ethical information at their practice sites compared to
pharmacists in Irbid (24.0%). Significant differences in attitude was
found between pharmacists practicing in both cities, as significantly less
pharmacists from Amman (37.8%) declared that they would sell a
medication for an unreported indication according to national and
international guidelines, if recommended by the consultant, compared to
pharmacists from Irbid (77.7%, p<0.001). Conclusions: Despite having ethical guidance from the Jordanian Pharmacists Association,
the majority of pharmacists in Jordan do not use this resource; instead,
most choose to access ethical guidance on-line. Pharmacists from the
capital, Amman, reported to adhere more with the guidelines when selling a
medication for an unreported indication compared to pharmacists from the
smaller city, Irbid. Results of this study call for more actions from the
authorities in the country responsible for setting and enforcing the
pharmaceutical Code of Ethics.
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Affiliation(s)
- Rajaa A Al-Qudah
- Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Science Private University. Amman (Jordan).
| | - Omar Tuza
- Faculty of Pharmacy, Applied Science Private University. Amman (Jordan).
| | - Haneen Tawfiek
- Faculty of Pharmacy, Applied Science Private University. Amman (Jordan).
| | - Betty Chaar
- Faculty of Pharmacy, University of Sydney. Sydney (Australia).
| | - Iman A Basheti
- Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Sciences Private University. Amman (Jordan).
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29
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Exploring influences on pharmacists’ and students’ ethical reasoning in a changing practice landscape in Australia. Int J Clin Pharm 2018; 41:280-288. [DOI: 10.1007/s11096-018-0774-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 12/15/2018] [Indexed: 11/25/2022]
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Kruijtbosch M, Göttgens-Jansen W, Floor-Schreudering A, van Leeuwen E, Bouvy ML. Moral dilemmas reflect professional core values of pharmacists in community pharmacy. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 27:140-148. [PMID: 30338875 PMCID: PMC6587987 DOI: 10.1111/ijpp.12490] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/04/2018] [Indexed: 12/04/2022]
Abstract
Objectives The aim was to recognise the professional core values in the moral dilemmas of pharmacists in community pharmacy and to customise the descriptions of these values for community pharmacy practice. Methods The narratives of 128 moral dilemmas, collected from Dutch PharmD students and early career pharmacists who experienced these dilemmas in practice, were qualitatively analysed. An expert panel deductively coded relevant portions of these narratives with the core values as formulated by the Royal Dutch Pharmacists Association. Other values that emerged were inductively coded and if possible used to further customise the respective core values. Key findings The expert panel identified all four professional core values, that is, commitment to the patient's well‐being (117, 91.4%), reliable and caring (116, 90.6%), pharmaceutical expertise (72, 56.2%) and responsibility to society (30, 23.4%) in the 128 moral dilemma narratives. Thirteen other values that emerged in the analysis could all be used for the customisation of the professional core values in descriptions that better reflect community pharmacy practice. Conclusions Professional core values were identified in moral dilemma narratives of pharmacists in community pharmacy and customised for their practice. These customised core values can enable pharmacists to better recognise moral dilemmas in practice. This can add to the advancement of the profession as a pharmaceutical care practice.
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Affiliation(s)
- Martine Kruijtbosch
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Wilma Göttgens-Jansen
- Radboud University Medical Center, Radboud Institute for Health Sciences (RIHS), Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Annemieke Floor-Schreudering
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Evert van Leeuwen
- Radboud University Medical Center, Radboud Institute for Health Sciences (RIHS), Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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