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Hikaka J, Haua R, Parore N, McIntosh B, Anderson A, Pewhairangi K, Brown R. Designing for health equity: A mixed method study exploring community experiences and perceptions of pharmacists' role in minor ailment care. Res Social Adm Pharm 2023; 19:643-652. [PMID: 36639337 DOI: 10.1016/j.sapharm.2022.12.011] [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: 10/14/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Minor ailments are self-limiting, easily diagnosable and treatable conditions. Funded pharmacist minor ailments services (PMAS) have been posited to improve medicines access equity and, despite ethnic minorities across the globe experiencing reduced access to medicines and health care, PMAS internationally have not explicitly centered ethnic equity in service design or outcome measurement. OBJECTIVE To explore Māori experiences of minor ailments care and perceptions of the pharmacists' role. METHODS This mixed methods study collected data through facilitated wānanga (collaborative knowledge-sharing group discussions). Eligible participants (Māori, 18 years plus, obtained medicine from pharmacy in last 3 years) were recruited through local pharmacist networks using convenience sampling. Wānanga included qualitative data collection through discussion using a topic guide and a quantitative questionnaire. Indigenous theory was applied within a general inductive approach to thematic development to analyze qualitative data. Quantitative data was reported using simple descriptive statistics. RESULTS Thirteen wānanga (3 in-person, 10 online) were conducted from September 2021-February 2022 with 62 participants from seven New Zealand regions. The minor ailments that participants were most likely to seek treatment from pharmacy first, instead of a doctor, were eczema (87.2%), coughs and colds (85.7%), headlice (85.7%), insect bites (83.9%), and hayfever (83.9%). Four themes were generated from the qualitative data: designing the right environment for minor ailment care; clinically and culturally safe care; moving from stigmatizing to strengths-based services; the benefits of PMAS. Participant-informed ideas for PMAS service development centered on Māori aspirations included: developing clinically and culturally safe pharmacy environments, enabling medicine supply outside of the physical pharmacy setting, avoiding stigmatizing language when promoting PMAS availability, and collaborative practice with other health providers. CONCLUSION This study provides important recommendations when developing PMAS to increase the likelihood of delivering equitable care, and has international application across multiple pharmacy and health service settings.
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Affiliation(s)
- Joanna Hikaka
- Ngā Kaitiaki o Te Puna Rongoā o Aotearoa- the Māori Pharmacists' Association, PO Box 42013, Acacia Bay Post Shop, Taupō, 3330, New Zealand.
| | - Robert Haua
- Ngā Kaitiaki o Te Puna Rongoā o Aotearoa- the Māori Pharmacists' Association, PO Box 42013, Acacia Bay Post Shop, Taupō, 3330, New Zealand
| | - Nora Parore
- Ngā Kaitiaki o Te Puna Rongoā o Aotearoa- the Māori Pharmacists' Association, PO Box 42013, Acacia Bay Post Shop, Taupō, 3330, New Zealand
| | - Brendon McIntosh
- Ngā Kaitiaki o Te Puna Rongoā o Aotearoa- the Māori Pharmacists' Association, PO Box 42013, Acacia Bay Post Shop, Taupō, 3330, New Zealand
| | | | - Kevin Pewhairangi
- Ngā Kaitiaki o Te Puna Rongoā o Aotearoa- the Māori Pharmacists' Association, PO Box 42013, Acacia Bay Post Shop, Taupō, 3330, New Zealand
| | - Rachel Brown
- The National Hauora Coalition, Auckland, New Zealand
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Examining equity in a void of evidence - Pharmacist minor ailments services and the role of systematic reviews. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 7:100174. [PMID: 36072438 PMCID: PMC9441336 DOI: 10.1016/j.rcsop.2022.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 11/22/2022] Open
Abstract
Pharmacist minor ailment services (PMAS) are formalised services which remunerate pharmacists for delivering care and providing medicines used to treat minor ailments such as hayfever, musculoskeletal pain, head lice and constipation. PMAS have been postulated to improve medicines access equity yet there is little evidence to suggest that equitable health outcomes from PMAS have been achieved in those countries where these services have been initiated. Systematic reviews are regarded as the gold standard in assessing evidence of outcome effectiveness, including equity of outcomes. Our research team developed a systematic search strategy and review protocol to examine ethnic variation in PMAS outcomes. No results were returned, even with the inclusion of grey literature, and therefore the impact of PMAS on ethnic equity could not be examined. This commentary discusses the potential for PMAS to achieve medicines access equity and the role of empty reviews in identifying gaps in the literature and advocating for equity.
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Identifying Drug-Therapy Problems among Syrian Refugees in Zaatari Refugee Camp. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127199. [PMID: 35742447 PMCID: PMC9223639 DOI: 10.3390/ijerph19127199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Abstract
Background: Due to a lack of proper pharmaceutical care, Syrian refugees in the Zaatari refugee camp are more likely to have drug-related issues, such as prescription errors and adverse drug occurrences. Aim: The current study aims to identify drug-therapy problems among Syrian refugees in the Zaatari refugee camp. Method: This is a retrospective cross-sectional study. Patients’ files were collected from the Zaatari camp database. Patients who were 18 years or older and were previously diagnosed with a chronic disease were included. A classification of drug therapy problems (DTPs) was adapted. Results: The data of 1530 adult patients (896 females) were collected. The mean age of the sample was 53.7 years and the mean Body mass Index (BMI) was 27.20. The mean of all taken medications was 4.01 (±2.33) medications, with a maximum number of 13. A total of 3572 DTPs was identified, with a mean of 2.33 (±1.26) DTPs per patient. Based on the above-mentioned classification, 70.32% of the DTPs were related to indication, 26.65% were related to effectiveness, and 3.03% were related to safety. Conclusion: This study found that refugees in the Zaatari refugee camp have numerous DTPs among their medications. Greater focus should be placed on their medical care, in order to prevent any future complications due to DTPs.
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P Iqbal M, Walpola R, Harris-Roxas B, Li J, Mears S, Hall J, Harrison R. Improving primary health care quality for refugees and asylum seekers: A systematic review of interventional approaches. Health Expect 2021; 25:2065-2094. [PMID: 34651378 PMCID: PMC9615090 DOI: 10.1111/hex.13365] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 09/07/2021] [Accepted: 09/19/2021] [Indexed: 12/30/2022] Open
Abstract
Background It has been widely acknowledged that refugees are at risk of poorer health outcomes, spanning mental health and general well‐being. A common point of access to health care for the migrant population is via the primary health care network in the country of resettlement. This review aims to synthesize the evidence of primary health care interventions to improve the quality of health care provided to refugees and asylum seekers. Methods A systematic review was undertaken, and 55 articles were included in the final review. The Preferred Reporting Items for Systematic Reviews was used to guide the reporting of the review, and articles were managed using a reference‐management software (Covidence). The findings were analysed using a narrative empirical synthesis. A quality assessment was conducted for all the studies included. Results The interventions within the broad primary care setting could be organized into four categories, that is, those that focused on developing the skills of individual refugees/asylum seekers and their families; skills of primary health care workers; system and/or service integration models and structures; and lastly, interventions enhancing communication services. Promoting effective health care delivery for refugees, asylum seekers and their families is a complex challenge faced by primary care professionals, the patients themselves and the communication between them. Conclusion This review highlights the innovative interventions in primary care promoting refugee health. Primary care interventions mostly focused on upskilling doctors, with a paucity of research exploring the involvement of other health care members. Further research can explore the involvement of interprofessional team members in providing effective refugee/migrant health. Patient or Public Contribution Patient and public involvement was explored in terms of interventions designed to improve health care delivery for the humanitarian migrant population, that is, specifically refugees and asylum seekers.
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Affiliation(s)
- Maha P Iqbal
- School of Population Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ramesh Walpola
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ben Harris-Roxas
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,South Eastern Sydney Research Collaboration Hub (SEaRCH), Population and Community Health, South Eastern Sydney Local Health District, Darlinghurst, New South Wales, Australia
| | - Jiadai Li
- School of Population Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Mears
- Hunter New England Medical Library, New Lambton, New South Wales, Australia
| | - John Hall
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation; Level 6, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Carter KL, Bonanni S. Role of the pharmacist in refugee health. Am J Health Syst Pharm 2019; 76:403-406. [PMID: 31361836 DOI: 10.1093/ajhp/zxy011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Kimberly Lane Carter
- Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA.,Penn Center for Primary Care, University of Pennsylvania Health System, Philadelphia, PA
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Gebregeorgise DT, Mohammed TA, Redi ZS, Sporrong SK. Customers' perceptions of and satisfaction with medicine retail outlet services in Addis Ababa, Ethiopia: a cross-sectional study. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 26:222-231. [PMID: 28737242 DOI: 10.1111/ijpp.12384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 05/15/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The aim of this study was to assess customers' perceptions of and satisfaction with MRO services in Addis Ababa and to explore factors associated with their satisfaction and reasons for visits. METHODS A cross-sectional survey was conducted among customers selected from 28 MROs in Addis Ababa, using multi-stage sampling techniques. Simple descriptive statistics and multivariable logistic regression at 95% confidence interval were used for the analysis. KEY FINDINGS Of 396 respondents, 324 (81.8%) visited MROs to purchase prescription medicines. A majority (338/396; 85.4%) of them perceived that pharmacists and druggists (pharmacy professionals) play a major role in healthcare delivery. A third (140/396; 35.4%) of the respondents agreed with the statement that pharmacy professionals are more concerned about patient care than about their business. Regarding reasons for visiting, being married was positively associated with buying over-the-counter, higher educational status was linked with more satisfaction. Overall, 56.8% (225/396) of the respondents reported that they were satisfied with the service provided by MROs. CONCLUSION Customers of MROs had mixed perceptions of and satisfaction with the current service. Marital status and age were associated with the reason for visiting, while the educational level was associated with the level of satisfaction. The overall positive perceptions and satisfaction about MROs should be taken as an opportunity to promote and improve pharmaceutical services rendered in MROs, to ensure that the public is receiving maximum benefit.
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Affiliation(s)
- Dawit T Gebregeorgise
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tofik A Mohammed
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zebiba S Redi
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sofia Kälvemark Sporrong
- Section for Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
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Curley LE, Moody J, Gobarani R, Aspden T, Jensen M, McDonald M, Shaw J, Sheridan J. Is there potential for the future provision of triage services in community pharmacy? J Pharm Policy Pract 2016; 9:29. [PMID: 27708786 PMCID: PMC5050954 DOI: 10.1186/s40545-016-0080-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/10/2016] [Indexed: 11/22/2022] Open
Abstract
Background Worldwide the demands on emergency and primary health care services are increasing. General practitioners and accident and emergency departments are often used unnecessarily for the treatment of minor ailments. Community pharmacy is often the first port of call for patients in the provision of advice on minor ailments, advising the patient on treatment or referring the patient to an appropriate health professional when necessary. The potential for community pharmacists to act as providers of triage services has started to be recognised, and community pharmacy triage services (CPTS) are emerging in a number of countries. This review aimed to explore whether key components of triage services can be identified in the literature surrounding community pharmacy, to explore the evidence for the feasibility of implementing CPTS and to evaluate the evidence for the appropriateness of such services. Methods Systematic searches were conducted in MEDLINE, EMBASE and International Pharmaceutical Abstracts (IPA) databases from 1980 to March 2016. Results Key elements of community pharmacy triage were identified in 37 studies, which were included in the review. When a guideline or protocol was used, accuracy in identifying the presenting condition was high, with concordance rates ranging from 70 % to 97.6 % between the pharmacist and a medical expert. However, when guidelines and protocols were not used, often questioning was deemed insufficient. Where other health professionals had reviewed decisions made by pharmacists and their staff, e.g. around advice and referral, the decisions were considered to be appropriate in the majority of cases. Authors of the included studies provided recommendations for improving these services, including use of guidelines/protocols, education and staff training, documentation, improving communication between health professional groups and consideration of privacy and confidentiality. Conclusion Whilst few studies had specifically trialled triage services, results from this review indicate that a CPTS is feasible and appropriate, and has the potential to reduce the burden on other healthcare services. Questions still remain on issues such as ensuring the consistency of the service, whether all pharmacies could provide this service and who will fund the service.
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Affiliation(s)
- Louise E Curley
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Janice Moody
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Rukshar Gobarani
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Trudi Aspden
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Maree Jensen
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Maureen McDonald
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - John Shaw
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Janie Sheridan
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
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Al-Smadi AM, Halaseh HJ, Gammoh OS, Ashour AF, Gharaibeh B, Khoury LS. Do Chronic Diseases and Availability of Medications Predict Post-traumatic Stress Disorder (PTSD) among Syrian Refugees in Jordan? ACTA ACUST UNITED AC 2016. [DOI: 10.3923/pjn.2016.936.941] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Understanding quality use of medicines in refugee communities in Australian primary care: a qualitative study. Br J Gen Pract 2016; 66:e397-409. [PMID: 27162206 DOI: 10.3399/bjgp16x685249] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 01/27/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Although refugee health issues are increasingly experienced in primary health care, few studies have explored the quality use of medicines in refugee communities even though access to and quality use of medicines is a key component of care delivery. AIM To identify strategies to support the quality use of medicines in refugee communities. DESIGN AND SETTING Qualitative study with primary healthcare providers and refugee health leaders in Brisbane, Australia. METHOD Semi-structured interviews were conducted with refugee health leaders, pharmacists, practice nurses, and GPs. Data were recorded and transcribed. Thematic analysis was used to identify key barriers and facilitators for the quality use of medicines. RESULTS Five barriers, including communication and language barriers, limited health literacy and financial cost, and four facilitators, including better coordination between healthcare providers and improved healthcare provider training, were identified. This study provides a rich exploration relating to medication use and examines the engagement between pharmacists and refugees, highlighting some communication concerns. It recognises the supportive role of the practice nurse and offers practical strategies for improving community knowledge about safe medicines use. CONCLUSION This preliminary study builds on previous studies investigating refugee health access and health literacy. It offers new understandings towards enhancing quality use of medicines in refugee communities and practical insights to assist the targeting of resources for future interventions.
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Gammouh OS, Al-Smadi AM, Tawalbeh LI, Khoury LS. Chronic diseases, lack of medications, and depression among Syrian refugees in Jordan, 2013-2014. Prev Chronic Dis 2015; 12:E10. [PMID: 25633485 PMCID: PMC4310712 DOI: 10.5888/pcd12.140424] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Studying mental and physical health problems in refugees facilitates providing suitable health care, thus improving their quality of life. We studied depression tendency in Syrian refugees in Jordan in the light of chronic diseases and medication availability. Also, depression prevalence and depression comorbidity with chronic diseases were identified. METHODS In this multicenter cross-sectional survey, data from Syrian refugees attending Caritas centers in 6 Jordanian cities from November 2013 through June 2014 were analyzed. Participants' demographics, depression, previously diagnosed chronic diseases, and newly diagnosed chronic diseases and the availability of medications were studied. Logistic regression was used to examine predictors for depression. RESULTS Of 765 refugees who participated, about one-third demonstrated significant depression as measured by the Beck Depression Inventory. Descriptive analyses showed that depression was comorbid in 35% of participants with previously diagnosed chronic diseases and in 40% of participants with newly diagnosed chronic diseases. Newly diagnosed chronic diseases and lack of medications significantly contributed to depression, but the regression model as a whole explained less than 5% of the variance. CONCLUSION Because the regression model showed low effect size, we concluded that newly diagnosed chronic diseases and medication shortages could not predict depression in Syrian refugees residing in Jordan. Therefore, further studies of additional factors are recommended. Prompt measures have to be taken to prevent the spread of chronic diseases and improve mental health in this fragile population.
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Bellamy K, Ostini R, Martini N, Kairuz T. Access to medication and pharmacy services for resettled refugees: a systematic review. Aust J Prim Health 2015; 21:273-8. [DOI: 10.1071/py14121] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/21/2014] [Indexed: 11/23/2022]
Abstract
The difficulties that resettled refugees experience in accessing primary health-care services have been widely documented. In most developed countries, pharmacists are often the first health-care professional contacted by consumers; however, the ability of refugees to access community pharmacies and medication may be limited. This review systematically reviewed the literature and synthesised findings of research that explored barriers and/or facilitators of access to medication and pharmacy services for resettled refugees. This review adhered to guidelines for systematic reviews by PRISMA (preferred reporting items for systematic reviews and meta-analyses). Databases were searched during March 2014 and included Scopus, ProQuest Sociological Abstracts, PubMed, Embase and APAIS Health. The Australian and International grey literature was also explored. Nine studies met the quality and inclusion criteria. The research reported in seven of the nine studies was conducted in the US, one was conducted in Australia and the other in the UK. The majority of studies focussed on South-east Asian refugees. Themes identified across the studies included language and the use of interpreters; navigating the Western health-care system; culture and illness beliefs; medication non-adherence; use of traditional medicine; and family, peer and community support. There is a significant paucity of published research exploring barriers to medication and pharmacy services among resettled refugees. This systematic review highlights the need for appropriate interpreting and translation services, as well as pharmacy staff demonstrating effective cross-cultural communication skills.
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Ingar N, Farrell B, Pottie K. Building a welcoming community: The role of pharmacists in improving health outcomes for immigrants and refugees. Can Pharm J (Ott) 2013; 146:21-5. [PMID: 23795164 DOI: 10.1177/1715163512472321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nafisa Ingar
- C.T. Lamont Primary Health Care Research Centre (Ingar, Farrell, Pottie), University of Waterloo, Waterloo, Ontario
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Pumtong S, Boardman HF, Anderson CW. A multi-method evaluation of the Pharmacy First Minor Ailments scheme. Int J Clin Pharm 2011; 33:573-81. [DOI: 10.1007/s11096-011-9513-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Accepted: 04/11/2011] [Indexed: 11/28/2022]
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