Challenges to the pharmacist profession from escalating pharmaceutical demand

Optimizing the Pharmacotherapy of Vascular Surgery Patients at Hospital Admission and Discharge (PHAROS): Protocol for a Quasi-Experimental Clinical Uncontrolled Trial

BACKGROUND

Patient safety is essential in pharmacotherapy, especially in surgical contexts, due to the elevated risk of drug-related complications. Vascular surgery patients are particularly susceptible because of their complex medication needs and underlying health conditions. Improved safety monitoring and targeted pharmaceutical care in collaboration with physicians are crucial to minimize these risks and enhance patient outcomes.

OBJECTIVE

This protocol evaluates whether structured pharmaceutical care interventions-including medication reconciliation, medication review, and patient education-can reduce the prevalence of drug-related problems at hospital admission and discharge in vascular surgery patients.

METHODS

This prospective, uncontrolled study was conducted over 1 year in the Vascular Surgery Department at the National Institute of Cardiovascular Diseases in Bratislava, Slovakia. The study included adult patients with carotid artery disease or lower extremity artery disease who were on 3 or more medications, with an estimated sample size of approximately 100 patients. The primary intervention involved 3 key changes in practice: medication reconciliation at both admission and discharge, where hospital pharmacists review and verify medication lists; medication review to identify and address drug-related problems; and patient education at discharge. Pharmacist-proposed interventions were documented and communicated to the physician for treatment adjustments. The primary outcome is the change in drug-related problem prevalence from hospital admission to discharge. Secondary outcomes include the acceptance rate of pharmacist recommendations and patient understanding of pharmacotherapy. Data collection involved documenting the number, type, and frequency of drug-related problems; the anatomical therapeutic chemical classification of medications associated with drug-related problems; and patients' social, demographic, and clinical characteristics, with a focus on factors related to drug-related problems, comorbidities, and medication use. Data analysis will use the paired Wilcoxon signed-rank test to compare the prevalence of drug-related problems and medication counts between admission and discharge. Continuous variables will be presented as means (SDs), while categorical variables will be reported as counts and percentages. Patient understanding of pharmacotherapy will be evaluated using a 3-point scale, classifying understanding as good (2-3 points per medication), modest (1-2 points), or poor (0-1 point).

RESULTS

Recruitment began in September 2021 and concluded in August 2022. Data collection occurred continuously during hospital stays, capturing demographics, comorbidities, pharmacotherapy, and drug-related problems at admission and discharge. Important milestones included the initial data review, which began in August 2023 to assess recruitment and data quality, including an early evaluation of drug-related problems. The primary analysis was completed in January 2024, focusing on the reduction in drug-related problems, intervention acceptance, and patient understanding. The final report was to be prepared by June 2024, disseminating the findings on pharmacist-led intervention impacts.

CONCLUSIONS

This study should demonstrate that pharmacist-led interventions in collaboration with physicians can reduce pharmacotherapy risks and optimize medicine management for patient safety.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04930302; https://clinicaltrials.gov/study/NCT04930302.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/60728.

Pharmacists' Professional Satisfaction and Challenges: A Netnographic Analysis of Reddit and Facebook Discussions

Pharmacists, essential healthcare providers, face significant challenges in professional satisfaction and well-being. This study investigates the factors influencing pharmacists' professional satisfaction, mainly focusing on workload, organizational support, job autonomy, work-life balance, and resilience against burnout. Data were collected from relevant online forums on Facebook and Reddit using a netnographic methodology. The data were anonymized and thematically coded to identify key themes from 23 conversation threads, primarily involving or concerning Romanian pharmacists. The analysis revealed several critical issues: widespread dissatisfaction with salaries, challenges in professional recognition, and the demanding nature of university education. Additional themes included economic and financial insights, global trends and technological impacts, personal experiences and satisfaction, professional growth and education, regulatory and market environment, and workplace dynamics. Findings indicate these factors significantly impact pharmacists' job satisfaction and overall well-being. The study concludes that addressing these issues through targeted interventions, such as policy reforms, educational updates, and enhanced organizational support, can improve the professional lives of pharmacists, thereby enhancing their contributions to healthcare outcomes.

"Why Didn't They Teach Us This?" A Qualitative Investigation of Pharmacist Stakeholder Perspectives of Business Management for Community Pharmacists

Expanding the scope of practice has provided an opportunity to reflect on the business management role of the community pharmacist. This study aimed to determine stakeholder perspectives of what business management skills are required for the community pharmacist, potential barriers impeding changes to management in the pharmacy program or community pharmacy setting, and strategies to improve the business management role of the profession. Purposively selected community pharmacists across two states in Australia were invited to participate in semi-structured phone interviews. A hybrid approach of inductive and deductive coding was used to transcribe and thematically analyse interviews. Twelve stakeholders described 35 business management skills in a community pharmacy, with 13 skills consistently used by participants. Thematic analysis revealed two barriers and two strategies to improve business management skills in both the pharmacy curriculum and community pharmacy. Strategies to improve business management across the profession include pharmacy programs covering recommended managerial content, learning from experience-based education and creation of a standardised mentorship program. There is an opportunity for business management culture change within the profession, and this may require community pharmacists developing a dual thinking process to appropriately balance professionalism and business management.

Prestige and financial stability: motivating factors to pursue a doctor of pharmacy degree

OBJECTIVE

This study aims to identify factors influencing students' decision to pursue a doctorate in pharmacy (PharmD).

METHODS

Focus-group interviews and quantitative surveys were used in sequence to investigate pharmacy students' motivations. A total of 36 current PharmD students from two US colleges of pharmacy participated in five focus groups. The resulting qualitative findings, along with existing literature, informed the development of a survey questionnaire, which was then administered to two cohorts of first-year pharmacy students at one of the participating colleges.

KEY FINDINGS

Identified themes include prestige of a doctorate, patient interaction, career versatility, and pharmacy school's lower intensity vis-à-vis medical school. A total of 110 first-year pharmacy students from a 4-year program (average (SD) age 23 (5); 65% female) completed the survey (98.5% response rate). The order of factors that respondents ranked as important or somewhat important for choosing pharmacy include: financial stability (n = 107 (97%)), prestige of a doctorate degree ((n = 97 (88%)), good work-life balance ((n = 96 (87%)), the opportunity to use critical thinking skills ((n = 93 (85%)), having patient interaction and communication ((n = 91 (83%)), and being in a profession or service ((n = 91 (83%)).

CONCLUSIONS

US PharmD students are mainly drawn by job and financial stability, prestige of a doctorate, and a good work-life balance.

Pharmacists' Satisfaction with Work and Working Conditions in New Zealand-An Updated Survey and a Comparison to Canada

BACKGROUND

As roles have evolved over time, changes in workplace environments have created higher patient expectations creating stressful conditions for pharmacists.

AIM

To evaluate pharmacists' perceptions of their working conditions, work dissatisfaction, and psychological distress; determine their predictors in New Zealand (NZ); and compare results with Canadian studies and historic NZ data.

METHODS

A cross-sectional online survey was distributed to registered pharmacists in NZ. The survey included demographics, work satisfaction, psychological distress, and perceptions of their working conditions (six statements with agreement rated on a 5-point Likert scale). Comparisons were made with surveys from Canada and NZ. Chi-square, t-tests, and non-parametric statistics were used to make comparisons.

RESULTS

The response rate was 24.7% (694/2815) with 73.1% practicing in a community pharmacy (45.8% independent, 27.3% chains). Pharmacists disagreed on having adequate time for breaks and tasks, while the majority contemplated leaving the profession and/or not repeating their careers again if given the choice. Working longer hours and processing more prescriptions per day were predictive factors for poorer job satisfaction. More NZ pharmacists perceived their work environment to be conducive to safe and effective primary care (57% vs. 47%, p < 0.001) and reported that they had enough staff (45% vs. 32%, p = 0.002) as compared to Canadian pharmacists. Pharmacists' job satisfaction and psychological distress have not improved compared to the assessment 20 years prior.

CONCLUSIONS

NZ pharmacists perceive working conditions to be sub-optimal yet had higher satisfaction than their Canadian counterparts. Work dissatisfaction and psychological distress are high and have not improved over the last two decades.

Validation of the Copenhagen Burnout Inventory in Pharmacists

OBJECTIVES

This study aimed to 1) determine the validity of the Copenhagen Burnout Inventory (CBI) for use in the assessment of burnout in a sample of pharmacists using confirmatory factor analysis (CFA), and 2) use the CBI items and other measures of work-life to assess burnout in pharmacists employed in various types of practice.

METHODS

A cross-sectional survey was administered to a sample of 2,582 pharmacists in a single Midwestern US state. The survey included the three subscales of the CBI, each of which measures personal, work-related, and patient-related dimensions of burnout. Other items included demographics, practice type, workload, and work-life balance. CFA was used to measure fit, and Cronbach's alpha was used to assess reliability. Correlation was used to assess criterion validity of the CBI. Logistic regression and bivariate analyses were used to assess pharmacist burnout based on demographics.

RESULTS

Following the removal of 2 items from the measurement model, a 17-item 3-factor CBI was found to possess satisfactory psychometric properties for use in pharmacists. The CBI correlated with measures of work-life demonstrating criterion validity. A logistic regression showed that younger pharmacists and community pharmacists experience higher burnout than older pharmacists and clinical pharmacists. Community pharmacists also more often reported high workloads and poorer work-life integration. Both community and clinic pharmacists desired more time providing patient care services and less time dispensing.

CONCLUSION

The CBI is a psychometrically reliable and valid instrument for assessing burnout in pharmacists. Younger pharmacists and community pharmacists warrant attention due to their higher degree of burnout.

Do disasters predict international pharmacy legislation?

Objective The aim of this study was to explore whether a relationship exists between the number of disasters a jurisdiction has experienced and the presence of disaster-specific pharmacy legislation. Methods Pharmacy legislation specific to disasters was reviewed for five countries: Australia, Canada, UK, US and New Zealand. A binary logistic regression test using a generalised estimating equation was used to examine the association between the number of disasters experienced by a state, province, territory or country and whether they had disaster-specific pharmacy legislation. Results Three of six models were statistically significant, suggesting that the odds of a jurisdiction having disaster-specific pharmacy legislation increased as the number of disasters increased for the period 2007-17 and 2013-17. There was an association between the everyday emergency supply legislation and the presence of the extended disaster-specific emergency supply legislation . Conclusions It is evident from this review that there are inconsistencies as to the level of assistance pharmacists can provide during times of crisis depending on their jurisdiction and location of practice. It is not a question of whether pharmacists have the skills and capabilities to assist, but rather what legislative barriers are preventing them from being able to contribute further to the disaster healthcare team. What is known about the topic? The contributing factors to disaster-specific pharmacy legislation has not previously been explored in Australia. It can be postulated that the number of disasters experienced by a jurisdiction increases the likelihood of governments introducing disaster-specific pharmacy legislation based on other countries. What does this paper add? This study compared five countries and their pharmacy legislation specific to disasters. It identified that as the number of disasters increases, the odds of a jurisdiction having disaster-specific emergency supply or disaster relocation or mobile pharmacy legislation increases. However, this is likely to be only one of many factors affecting the political decisions of when and what legislation is passed in relation to pharmacists' roles in disasters. What are the implications for practitioners? Pharmacists are well situated in the community to be of assistance during disasters. However, their ability to help patients with chronic disease management or providing necessary vaccinations in disasters is limited by the legislation in their jurisdiction. Releasing pharmacists' full potential in disasters could alleviate the burden of low-acuity patients on other healthcare services. This could subsequently free up other healthcare professionals to treat high-acuity patients and emergencies.

Workload of pharmacists and the performance of pharmacy services

Objective

To evaluate the influence of pharmacists’ dispensing workload (PDW) on pharmacy services as measured by prescription suggestion rate (PSR) and dispensing error rate (DER).

Method

This was an observational study in northern and southern Taiwan’s two largest medical centers, from 2012 to 2018. We calculated monthly PDW as number of prescriptions divided by number of pharmacist working days. We used monthly PSR and DER as outcome indicators for pharmacists’ review and dispensing services, respectively. We used Poisson regression model with generalized estimation equation methods to evaluate the influence of PDW on PSR and DER.

Results

The monthly mean of 463,587 (SD 32,898) prescriptions yielded mean PDW, PSR and DER of 52 (SD 3) prescriptions per pharmacist working days, 30 (SD 7) and 8 (SD 2) per 10,000 prescriptions monthly, respectively. There was significant negative impact of PDW on PSR (adjusted rate ratio, aRR: 0.9786; 95%CI: 0.9744–0.9829) and DER (aRR: 0.9567; 95%CI: 0.9477–0.9658). Stratified analyses by time periods (2012–2015 and 2016–2018) revealed the impact of PDW on PSR to be similar in both periods; but with positive association between PDW and DER in the more recent one (aRR: 1.0086, 95%CI: 1.0003–1.0169).

Conclusions

Reduced pharmacist workload was associated with re-allocation of pharmacy time to provide prescription suggestions and, more recently, decrease dispensing errors. Continuous efforts to maintain appropriate workload for pharmacists are recommended to ensure prescription quality.

Looking Back at US Pharmacy’s Past to Help Discern Its Future

Objective: To review specific literature that aimed to predict the future of US pharmacy, beginning in the late 1980s. Data Sources: Articles were identified from searching MEDLINE, CINAHL, Google Scholar, and references of relevant articles. The following combinations of search terms were used: future, pharmacy, prediction, and forecast. Study Selection and Data Extraction: The following inclusion criteria were applied: (1) full-text commentary, review, or original research and (2) focused predominantly on the pharmacy in the United States. Data on predictions for the future of pharmacy were extracted. Data Synthesis: We selected 3 articles published between 1988 and 2006, with each aiming to project the future for the following decade. We examined each prediction in light of the current knowledge. Relevance to Patient Care and Clinical Practice: Educators, practitioners, and other stakeholders should consider reflecting on the changes in pharmacy for the past 3 decades and applying both historical and emerging trends to improve patient care and sustain practice in the third decade of the 21st century and beyond. Conclusion: Most of the predictions for the future of pharmacy from the past 3 decades materialized, with some still in progress (reimbursement for pharmacy services), whereas others manifested in unexpected ways (transition from shortage to excess of pharmacists). Current forces shaping pharmacy include, but are not limited to, growing spending and use of specialty drugs, automation of pharmacy operations, growth of pharmacy in the digital health enterprise, and growing consumer interest in the use of analytical pharmacy that tests drugs before dispensing.

Evaluation of the current status of the value-added pharmacy services and pharmacists’ attitude in Bulgaria

Value-added pharmacy services (VAPS) are additional services to the traditional pharmacy activities, which do not include dispensing of medicinal products and professional consultation. Over 51% of the community pharmacies in Bulgaria offer VAPS but mainly measuring of blood pressure (67.4%) and blood glucose (12.9%). About 60% of community pharmacists in the country are willing to perform other VAPS. About 70% of them believe that patients would rate VAPS as useful. Younger pharmacists with professional experience less than 5 years (90.9%) tend to believe that VAPS would be positively rated by their patients. The study shows that VAPS different from consultation and dispensing of medicinal products have a potential for development in the community pharmacies in Bulgaria.

Assessment of pharmacists' knowledge, attitude and practice in chain community pharmacies towards their current function and performance in Indonesia

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.

The Need to Strengthen the Role of the Pharmacist in Sri Lanka: Perspectives

The role of the pharmacist in healthcare has evolved greatly over the last half-century, from dispensing to providing direct patient-oriented activities not associated with dispensing. However, pharmacist-led healthcare services in Sri Lanka must undergo reform to fully take advantage of their expertise and training in medicine management and related outcomes in Sri Lankan patients. As befits a profession's role development and value, professional and educational standards for pharmacists need ongoing development and growth. Currently, university curricula and continuing professional education in Sri Lanka require further development and optimisation to provide the theoretical and practical knowledge and skills regarding quality use of medicines and patient-oriented care. Furthermore, pharmacists' roles in Sri Lankan hospital and community pharmacist settings need to be recognised and should include the pharmacist as an integral part of the multidisciplinary healthcare team in Sri Lanka. Studies from developed countries and some developing countries have demonstrated that expanded pharmacists' roles have had a significant positive cost-effective impact on the population's health. Therefore, the availability of qualified Sri Lankan pharmacists trained to deliver expanded professional services accompanied by greater pharmacist integration into healthcare delivery is crucially important to ensure quality use of medicines within the Sri Lankan healthcare system and optimise the medication-related needs of Sri Lankans.

Disaster Health Management: Do Pharmacists Fit in the Team?

BACKGROUND

In addition to the traditional logistics role, pharmacists are undertaking important new roles in disasters. Despite this, little is known about the level of acceptance of these activities by other providers.

PROBLEM

The aim of this study was to determine the international opinion of disaster and health professionals regarding the emerging roles of pharmacists in disasters.

METHODS

Delegates at the World Association for Disaster and Emergency Medicine's (WADEM; Madison, Wisconsin USA) 20th Congress in Toronto, Canada (April 2017) were invited to complete an anonymous survey posing eight questions regarding attitudes towards pharmacists' roles in disasters. Quantitative data were analyzed using IBM (IBM Corp.; Armonk, New York USA) SPSS statistical software version 23, and qualitative data were manually coded.

RESULTS

Of the 222 surveys handed out, 126 surveys were completed yielding a 56.8% response rate. Of the respondents, 96.8% (122/126) believed pharmacists had a role in disasters additional to logistics. Out of 11 potential roles pharmacists could perform in a disaster, provided on a 5-point Likert scale, eight roles were given a rating of "Agree" or "Strongly Agree" by 72.4% or more of the participants. Lack of understanding of a pharmacist's roles and capabilities was the highest described barrier to pharmacists' roles in disaster management.

CONCLUSIONS

This multi-disciplinary disaster health "community" agreed pharmacists have roles in disasters in addition to the established role in supply chain logistics. Participants accepted that pharmacists could possibly undertake numerous clinical roles in a disaster. Several barriers were identified that may be preventing pharmacists from being further included in disaster health management planning and response.WatsonKE, TippettV, SingletonJA, NissenLM. Disaster health management: do pharmacists fit in the team?Prehosp Disaster Med. 2019;34(1):30-37.

A unique degree program for pre-pharmacy education: An undergraduate degree in pharmaceutical sciences

BACKGROUND AND PURPOSE

Within the coming decade, the demand for well-trained pharmacists is expected to only increase, especially with the aging of the United States (US) population.

EDUCATIONAL ACTIVITY AND SETTING

To help fill this growing demand, the University of California, Irvine (UCI) aims to offer a unique pre-pharmacy degree program and has developed a Bachelor of Science (BS) degree in Pharmaceutical Sciences to help achieve this goal. In this commentary, we share our experience with our curriculum and highlight its features in an effort to encourage other institutions to enhance the learning experience of their pre-pharmacy students.

FINDINGS

The efforts of the UCI Department of Pharmaceutical Sciences has resulted in UCI being consistently ranked as one of the top feeder institutions by the Pharmacy College Application Service (PharmCAS) in recent years.

DISCUSSION AND SUMMARY

The UCI Pharmaceutical Sciences Bachelor of Science offers a unique pre-pharmacy educational experience in an effort to better prepare undergraduates for the rigors of the doctorate of pharmacy curriculum.

Medicine dispensing service in primary health care of SUS

OBJECTIVE

To characterize the medicine dispensing services in the primary health care network in Brazil and in its different regions, aiming to promote the access and rational use of medicines.

METHODS

This is a cross-sectional, quantitative study with data obtained from the Pesquisa Nacional sobre Acesso, Utilização e Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), 2015. Observation visits were carried out in 1,175 dispensing units, and interviews were held with 1,139 professionals responsible for the dispensation of medicines in the dispensing units and 495 municipal coordinators of pharmaceutical services.

RESULTS

More than half (53%) of the units presented a space smaller than 10 m2 for dispensing of medicines; 23.8% had bars or barriers between users and dispenser; 41.7% had computerized system; and 23.7% had counters for individual care. Among those responsible for dispensation, 87.4% said they always or repeatedly inform users how to use the medicines, and 18.1% reported developing some type of clinical activity. Isolated pharmacies presented a more developed physical and personal structure than those belonging to health units, but we found no significant differences regarding the information provided and the development of clinical activities.

CONCLUSIONS

There are major differences in the organization models of dispensation between cities, with regional differences regarding the physical structure and professionals involved. The centralization of medicine dispensing in pharmacies separated from the health services is associated with better structural and professional conditions, as in the dispensing units of the South, Southeast, and Midwest regions. However, the development of dispensation as health service does not prevail in any pharmacy or region of the Country yet.

Female pharmacists' career perceptions in Saudi Arabia: A survey at an academic center in Jeddah

OBJECTIVES

This study aimed to describe existing patterns of female pharmacy students' perceptions and their expectations regarding employment, job sectors, salaries, difficulties, and burdens, and to understand students' long-term prospects for employment in the pharmaceutical sector. The second objective was to assess students' perceptions of their careers in the short- and long-term.

METHODS

This prospective survey was conducted on female pharmacy students at King Abdulaziz University, Jeddah from January 12, 2013 through January 21, 2013. The survey instrument was distributed online using Survey Monkey and was designed to assess students' opinions regarding employment in pharmacy.

RESULTS

A total of 108 students responded to the surveyed. Approximately half reported that they would prefer to work in the government sector (50.9%), followed by the academic field (19.4%). Community pharmacies were underrepresented in the responses. Students' working durations, their preferred working shifts, and their 10-year prospects differed significantly from what was expected (p < 0.001). Similarly, students' preferences to work specific shifts (p < 0.001) and their long-term prospects (p < 0.001) were significantly different from what was expected. Participants perceived community and private pharmacies as the least rewarding in terms of remuneration. Approximately 61.1% of the participants perceived salaries at private hospitals to range between $1865 and $2397/month (p < 0.001).

CONCLUSION

Female graduates anticipate challenges in the pharmacy workforce, especially in the pharmaceutical sector. Lack of training, job stability, as well as religious and cultural constraints appeared to influence female graduate's decision to join a particular sector in the pharmacy field.

Evaluating the Changing Financial Burdens for Graduating Pharmacists

Objective. To compare new practitioners in 2009 and 2014 by modeling net income from available salary, expenditure, and student loan data. Methods. A Monte Carlo simulation with probabilistic sensitivity analysis was conducted to model net income for graduating pharmacists in 2009 and 2014. Mean and standard deviations were recorded for each model parameter. Student t-tests were used to compare the mean differences between 2009 and 2014 cohorts. Results. Pharmacist salary and disposable income were higher on average in 2014 compared with 2009. Consumer expenditures were higher in 2014, offsetting the higher salary resulting in a 2014 discretionary income that was less than in 2009 [95% CI: -$2,336, -$1,587]. Net income decreased from 2009 to 2014 for all pharmacy school types. Conclusion. Regardless of loan payment strategy, net incomes for pharmacists graduating from public and private institutions were less in 2014 compared with 2009.

Challenges to clinical pharmacy practice in Nigerian hospitals: a qualitative exploration of stakeholders' views

RATIONALE, AIMS AND OBJECTIVES

In Nigeria, a shift from the traditional pharmacists' role of dispensing and compounding of medications began in the 1980s with the introduction of drug information services and unit dose-dispensing systems in some hospitals. More than three decades after this, clinical pharmacy practice is still underdeveloped. This study was conducted to explore stakeholders' views on the barriers to the development of clinical pharmacy practice in Nigerian hospitals.

METHODS

Qualitative, semi-structured interviews were conducted with 44 purposefully sampled Nigerian stakeholders including pharmacists, pharmacy technicians, doctors, policymakers and patient group representatives. Transcribed interviews were entered into the QSR (Burlington, MA, USA) NVivo 10 software and analysed thematically.

RESULTS

Three major themes emerged from the study: pharmacists' professional identity, the structure of pharmacy practice and external barriers. The results revealed an ongoing struggle by Nigerian hospital pharmacists to establish their clinical identities as many non-pharmacy stakeholders viewed pharmacists' roles to be mainly supply based. Barriers to the development of clinical pharmacy practice identified included pharmacists' lack of confidence, shortage of pharmacy staff, underutilisation of pharmacy technicians, lack of specialisation and clinical career structure, medical dominance and opposition and lack of policies that support clinical pharmacy practice.

CONCLUSION

Several years after its introduction, clinical pharmacy practice is yet to be fully developed in Nigerian hospitals. The barriers identified in this study need to be addressed in order for clinical pharmacy practice to flourish.

Overcoming Barriers to Establishing an Inpatient Vaccination Program for Pneumococcus Using Standing Orders

Objectives:

To identify and classify barriers to establishing a standing orders program (SOP) for adult pneumococcal vaccination in acute care inpatient facilities and to provide recommendations for overcoming these roadblocks. Vaccination rates in hospitals with SOPs are generally higher than those in hospitals that require individual physician orders. The array of solutions drawn from our experience in different hospital settings should permit many types of facilities to anticipate and overcome barriers, allowing a smoother transition from initiation to successful implementation of an inpatient pneumococcal vaccination SOP.

Design:

Descriptive study of barriers and solutions encountered during implementation of a pneumococcal vaccination SOP in three hospitals of the University of Pittsburgh Medical Center Health System (UPMC) and in the scientific literature.

Setting:

As of 2004, two UPMC tertiary-care hospitals and one UPMC community hospital had incorporated SOPs into existing physician order-driven programs for inpatient vaccination with pneumococcal polysaccharide vaccine.

Results:

Barriers were identified at each step of implementation and categorized as patient related, provider related, or institutional. Based on a process of continual review and revision of our programs in response to encountered barriers, steps were taken to overcome these impediments.

Conclusions:

A strong commitment by key individuals in the facility's administration including a physician champion; ongoing, persistent efforts to educate and train staff; and close monitoring of the vaccination rate were essential for successful implementation of a SOP for pneumococcal vaccination of eligible inpatients. Legal statutes and evaluations of external hospital-rating associations regarding the effectiveness of the vaccination program were major motivating factors in its success.

Factors associated with pharmacists' perceptions of their working conditions and safety and effectiveness of patient care

BACKGROUND

In recent years, the role of pharmacists has changed, as have various provincial legislations, which now allow pharmacists to provide additional health services to patients. With these changes comes growing concern about how well the current pharmacy working environment is adapting and whether it may also be creating work-related stress that may contribute to potentially unsafe practices of patient care.

METHODS

To characterize the current working conditions of pharmacists in British Columbia, an online survey was developed and distributed to all College of Pharmacists of BC (CPBC) registrants by email. The survey consisted of questions on pharmacists' demographics, practice setting and perceptions of workplace conditions. Responses were collected from October 1 to November 10, 2013. All data were summarized using descriptive statistics, and regression models were constructed to assess the association between various factors and pharmacists' self-reported working conditions.

RESULTS

Twenty-three percent (1241/5300) of pharmacists registered with the CPBC responded, with 78% working in the community pharmacy setting (58% chain, 19% independent). Pharmacists mostly disagreed with the statements that they had enough time for breaks or lunches or to do their jobs, as well as enough staffing support. Pharmacists' perceptions of their workplace environment were negatively associated with workplace-imposed advanced service quotas (for medication reviews, immunizations and prescription adaptations); being employed at chain store pharmacies, compared to independent pharmacies or hospitals/long-term care settings; and higher prescription volume.

DISCUSSION

Pharmacists working in chain community pharmacies who are required to meet monthly quotas for expanded services reported a substantial negative impact on their working conditions and perceived safety of patient care. Can Pharm J (Ott) 2016;149:xx-xx.

Are community-based pharmacists underused in the care of persons living with HIV? A need for structural and policy changes

OBJECTIVE

To describe community pharmacists' perceptions on their current role in direct patient care services, an expanded role for pharmacists in providing patient care services, and changes needed to optimally use pharmacists' expertise to provide high-quality direct patient care services to people living with human immunodeficiency virus (HIV) infections.

DESIGN

Cross-sectional study.

SETTING

Four Midwestern cities in the United States in August through October 2009.

PARTICIPANTS

28 community-based pharmacists practicing in 17 pharmacies.

INTERVENTIONS

Interviews.

MAIN OUTCOME MEASURES

Opinions of participants about roles of specialty and nonspecialty pharmacists in caring for patients living with HIV infections.

RESULTS

Pharmacists noted that although challenges in our health care system characterized by inaccessible health professionals presented opportunities for a greater pharmacist role, there were missed opportunities for greater level of patient care services in many community-based nonspecialty settings. Many pharmacists in semispecialty and nonspecialty pharmacies expressed a desire for an expanded role in patient care congruent with their pharmacy education and training.

CONCLUSION

Structural-level policy changes needed to transform community-based pharmacy settings to patient-centered medical homes include recognizing pharmacists as important players in the multidisciplinary health care team, extending the health information exchange highway to include pharmacist-generated electronic therapeutic records, and realigning financial incentives. Comprehensive policy initiatives are needed to optimize the use of highly trained pharmacists in enhancing the quality of health care to an ever-growing number of Americans with chronic conditions who access care in community-based pharmacy settings.

Pharmacist work stress and learning from quality related events

BACKGROUND

Among the many stresses faced by pharmacy staff, quality related event (QRE) learning can be among the most significant. In the absence of a supportive organizational culture, the potential for blaming individuals, versus identifying key process flaws, is significant and can be very intimidating to those involved in such discussions and may increase an already stressful work environment.

OBJECTIVE

This research develops and tests a model of the relationship between the work stress faced by pharmacists and the extent of QRE learning in community pharmacies. Building upon recent research models that explore job characteristics and safety climate, the model proposes that work stress captured by the effort that the pharmacist invests into job performance, the extent to which the pharmacist is rewarded for such efforts, and the extent of pharmacist work-related commitment to their job, influence pharmacist assessment of the working conditions within their community pharmacy. It is further proposed that working conditions influence the extent of a blame culture and safety focus in the pharmacy, which, in turn, influences organizational learning from QREs.

METHODS

This research formed part of a larger study focused on QRE reporting in community pharmacies. As part of the larger study, a total of 1035 questionnaires were mailed to community pharmacists, pharmacy managers, and pharmacy owners in the Canadian province of Saskatchewan during the fall of 2013 and winter and spring of 2014. Partial least squares (PLS) using SmartPLS was selected to test and further develop the proposed model. An examination of the statistical significance of latent variable paths, convergent validity, construct reliability, discriminant validity, and variance explained was used to assess the overall quality of the model.

RESULTS

Of the 1035 questionnaire sent, a total of 432 questionnaires were returned for an initial response rate of approximately 42%. However, for this research, only questionnaires from staff pharmacists were used thereby reducing the number of usable questionnaires to 265. The final model highlights that pharmacist work stress greatly influences perceptions of the working conditions in the pharmacy (R(2) = 0.52), which, in turn, influence assessments of the safety focus (R(2) = 0.27) and blame culture (R(2) = 0.14) in the pharmacy. The model also found that the extent of a safety focus and blame culture within the pharmacy both influence the extent of organizational learning from QREs (R(2) = 0.44) within the pharmacy.

CONCLUSIONS

In an environment where financial rewards are not always possible, ensuring that pharmacy staff feel respected and encouraged in providing safe care may help enhance QRE learning. Given the importance placed on organizational reporting of, and learning from, QREs in many jurisdictions in North America, the findings from this study suggest that a number of working conditions and perceptions of blame culture and organizational safety need to be explored before such processes can become entrenched in work flow.

Public perceptions of pharmacist expanded scope of practice services in Nova Scotia

BACKGROUND

Community pharmacists have been transitioning from traditional dispensing roles toward a much broader scope of practice. The objective of this research was to explore public perceptions of expanded scope of practice (ESOP) services as they relate to pharmacy and pharmacist characteristics.

METHODS

The Survey on New Services Offered by Nova Scotia Pharmacists was developed and deployed using in-pharmacy intercept surveys and online public surveys in Nova Scotia. The survey focused on 4 key ESOP elements/services: 1) prescribing for minor ailments (ambulatory conditions), 2) injections and vaccinations, 3) prescription renewals and 4) medication reviews. Data were analyzed using comparisons between groups (multivariate analysis of variance) and principal component analysis.

RESULTS

A total of 385 surveys were obtained from the public regarding their perceptions and use of ESOP services (online n = 237, in-pharmacy intercept n = 148). A number of significant differences were found on the basis of respondent sex, age and the location of survey deployment.

DISCUSSION

Overall, public perceptions of pharmacists' knowledge and skills in providing ESOP services are positive. A pharmacist's ability to communicate, protect confidentiality and provide quality information regarding medications is important to the public.

CONCLUSION

Respondents who already have a good relationship with their pharmacist are more likely to see value in ESOP services. Future public education strategies should focus on factors positively affecting the public's perceptions of ESOP services and should encourage public use of these services through intentional patient education of the benefits of ESOP services and strengthening of the patient-provider relationship.

Assessment of Pharmacy Manpower and Services in New England

OBJECTIVES

This study assessed longitudinal trends in pharmacy staffing and services in the 6 New England states by comparing survey results from 2008 and 2013.

METHODS

A validated 32-item survey was mailed in 2008 and 2013 to a random sample of 2000 pharmacists. Each sample represented approximately 15% (2008) and 13% (2013) of the active rosters.

RESULTS

Response rates were 24% in 2008 and 23% in 2013. In all, 45% of 2013 respondents reported a pharmacist position vacancy in the past 12 months versus 62% in 2008. In all, 12% of 2013 respondents agreed or strongly agreed with a statement regarding pharmacists' shortage versus 77% in 2008. Disease management services were reported to be offered by 23% of 2013 respondents versus 28% in 2008. Reasons for not offering the services in 2013 included the lack of staffing (61%), expertise (28%), and reimbursement (29%). In 2008, these results were 74%, 33%, and 31%, respectively.

CONCLUSIONS

The pharmacist shortage within New England was alleviated during 2008 to 2013. Participation of pharmacists in disease management services did not follow staffing trends as fewer pharmacists reported providing services. Key barriers to services provision persist and consideration of how to resolve them (medication therapy management reimbursement and additional education) should be explored.

Workplace stress in community pharmacies in England: associations with individual, organizational and job characteristics

OBJECTIVES

To describe the levels of workplace stress that community pharmacists perceive and to examine associations with individual, organizational and job characteristics.

METHODS

A cross-sectional mailed survey of 2000 randomly selected community pharmacists practising in England incorporating a validated organizational stress screening tool (ASSET).

RESULTS

Response rate was 48%. Community pharmacists reported significantly higher levels of stress than other health care workers for seven out of eight work-related stressors. Regression analyses demonstrated significant associations between a number of individual, organizational and job characteristics and stress. Long working days, being a pharmacy manager and working for large multiples were associated with higher reported levels of stress across a number of work-related stressors including work overload, control and the job itself. However, self-reported measures of workload (such as dispensing volume) were not associated with higher stress levels.

CONCLUSIONS

The growth in corporate ownership of community pharmacies, which is associated with more stressful working environments, together with current economic pressures could have consequences not only for the future well-being of pharmacists but also for patient safety.

The effect of community pharmacy-based interventions on patient health outcomes: a systematic review

Many studies have demonstrated the beneficial effects that pharmacist-provided patient care services can have on patient health outcomes. However, the effectiveness of patient care services delivered by pharmacists in community pharmacy settings, where organizational barriers may affect service implementation or limit effectiveness, remains unclear. The authors systematically reviewed the literature on the effectiveness of pharmacist-delivered patient care services in community pharmacy settings in the United States. Of the 749 articles retrieved, 21 were eligible for inclusion in the review. Information concerning 134 outcomes was extracted from the included articles. Of these, 50 (37.3%) demonstrated statistically significant, beneficial intervention effects. The percentage of studies reporting favorable findings ranged from 50% for blood pressure to 0% for lipids, safety outcomes, and quality of life. Our findings suggest that evidence supporting the effectiveness of pharmacist-provided direct patient care services delivered in the community pharmacy setting is more limited than in other settings.

British pharmacists' work-life balance – is it a problem?

Objectives

Using a validated tool, the study aimed to explore pharmacists' experiences of maintaining work/life balance in a large, nationally representative sample of pharmacists in Great Britain (GB).

Methods

A two-page postal questionnaire was sent in 2008 to all GB-domiciled pharmacists who were registered with the regulatory body for pharmacy in GB (just over 44 000 pharmacists). Demographic information, work patterns and other employment data were collected and analysed using regression techniques to explore the link between these characteristics and a validated measure of work/life balance.

Key findings

The response rate to the census was 69.6% (n = 30 517). Eighty-three per cent (n = 25 243) of respondents were working as a pharmacist and were therefore eligible to complete the work/life balance statements. The results reported here relate to 12 364 individuals who had full data for the work/life balance scale and the demographic and work variables. Findings indicate that age, ethnicity, having caring responsibilities, sector of practice, hours of work and type of job are significant predictors of work/life balance problems.

Conclusions

Pharmacy employers and government should recognise the changing demographic characteristics of the profession and consider what support might be available to the workforce to help alleviate work/life balance problems being experienced by certain groups of pharmacists.

Physicians' perceptions, attitudes and expectations regarding the role of hospital-based pharmacists in the West Bank, Palestine

OBJECTIVE

To evaluate the perceptions, expectations and experiences of physicians with regard to hospital-based pharmacists in the West Bank, Palestine.

METHODS

A self-administered questionnaire was distributed to 250 physicians practising in four general hospitals in the West Bank, Palestine. The main sections of the questionnaire comprised a series of statements pertaining to physicians' perceptions, expectations and experiences with pharmacists.

KEY FINDINGS

One hundred and fifty seven questionnaires were completed and returned (response rate, 62.8%). The majority of respondents were most comfortable with pharmacists detecting and preventing prescription errors (76.4%; 95% confidence interval (CI) 69.5-81.2%) and patient education (57.9%; CI 51.2-63.4%) but they were not comfortable with pharmacists suggesting the use of prescription medications to patients (56.7%; CI 49.8-62.4%). Most physicians (62.4%; CI 56.8-69.1%) expected the pharmacist to educate their patients about the safe and appropriate use of their medication. However, approximately one-third (31.7%; CI 26.0-39.6%) did not expect pharmacists to be available for consultation during rounds. Physicians' experiences with pharmacists were less favourable; whereas 77% (CI 70.2-81.5%) of the physicians agreed that pharmacists were always a reliable source of information, only 11.5% (CI 6.2-16.4%) agreed that pharmacists appeared to be willing to take responsibility for solving any drug-related problems.

CONCLUSION

The present study showed that hospital physicians are more likely to accept traditional pharmacy services than newer clinical services for hospital-based pharmacists in the West Bank, Palestine. Pharmacists should therefore interact more positively and more frequently with physicians. This will close the gap between the physicians' commonly held perceptions of what they expect pharmacists to do and what pharmacists can actually do, and gain support for an extended role of hospital-based pharmacists in future patient therapy management.

Rural inpatient telepharmacy consultation demonstration for after-hours medication review

OBJECTIVE

Medication errors contribute to a significant number of fatal and nonfatal adverse medical events each year. Many actions, from both a policy and innovation standpoint, have been taken to reduce medication errors in the inpatient setting; yet, these actions often target larger urban hospitals. Rural hospitals face many more challenges in implementing these changes due to fewer resources and lower patient volumes. Our article discusses the implementation and results of a telepharmacy demonstration implemented between the University of California Davis Health System and six rural hospitals.

MATERIALS AND METHODS

A retrospective chart review obtained baseline medication errors for comparison with the prospective review of medication orders through telepharmacy. Medication orders from rural hospitals were transmitted via fax to the University of California Davis Pharmacy for after-hours review. If a medication required after-hours removal from the pharmacy, it was requested that video verification by a telepharmacist be used to verify that the correct medication was removed from the pharmacy.

RESULTS

Baseline findings from the retrospective chart review indicated that 30.0% of patients had one or more medication errors and that these errors occurred in 7.2% of the medication orders. None of these errors were found to have resulted in harm to the patients. During the telepharmacy demonstration, 2,378 medication orders were screened from 504 independent order review requests. In total, 58 (19.2%) patients had one or more medication errors. The errors from the telepharmacy demonstration represented potential errors that were identified through telepharmacy medication review.

CONCLUSIONS

Telepharmacy represents a potential alternative to around-the-clock on-site pharmacist medication review for rural hospitals.

Improving the working relationship between doctors and pharmacists: is inter-professional education the answer?

Despite their common history, there are many cultural, attitudinal and practical differences between the professions of medicine and pharmacy that ultimately influence patient care and health outcomes. While poor communication between doctors and pharmacists is a major cause of medical errors, it is clear that effective, deliberate doctor-pharmacist collaboration within certain clinical settings significantly improves patient care. This may be particularly true for those patients with chronic illnesses and/or requiring regular medication reviews. Moreover, in hospitals, clinical and antibiotic pharmacists are successfully influencing prescribing and infection control policy. Under the new Irish Pharmacy Act (2007), pharmacists are legally obliged to provide pharmaceutical care to their patients, thus fulfilling a more patient-centred role than their traditional 'dispensing' one. However, meeting this obligation relies on the existence of good doctor-pharmacist working relationships, such that inter-disciplinary teamwork in monitoring patients becomes the norm in all healthcare settings. As discussed here, efforts to improve these relationships must focus on the strategic introduction of agreed changes in working practices between the two professions and on educational aspects of pharmaceutical care. For example, standardized education of doctors/medical students such that they learn to prescribe in an optimal manner and ongoing inter-professional education of doctors and pharmacists in therapeutics, are likely to be of paramount importance. Here, insights into the types of factors that help or hinder the improvement of these working relationships and the importance of education and agreed working practices in defining the separate but inter-dependent professions of pharmacy and medicine are reviewed and discussed.

The conflicts between professional and non professional work of community pharmacists in Indonesia

Objective

The study aimed to determine the type of professional and non professional work of community pharmacists in Surabaya Indonesia and find the difference between time spent for performing both works in actual (current) situation and ideal (expected) situation.

Methods

A cross sectional study was conducted by combining purposive sampling for selecting the community pharmacists. Afterwards, the data was analyzed using SPSS v16 to provide the descriptive results and completed with Wilcoxon signed rank test to find the difference between time spent in actual and ideal situation. The sample size was 100 respondents of 300 pharmacists who have been practicing in Surabaya.

Results

From 100 participants just 30 participants gave response to the questionnaire, 67% was female who 20-30 years old at most (53%) with working experience as pharmacist less than 3 years (60%) and working 30 hours per week (60%) in pharmacy. Significant difference between time spent in actual and ideal situation was found.

Discussion

The time spent for performing professional and non professional work in ideal situation was significantly higher than in actual situation except for preparing medicines activity. This finding illustrated that the respondents did not have adequate time to provide ideal services in their daily practice. Therefore, they expected to improve their time and level of work in more professional manner. Surprisingly, they were also willing to provide more time and higher level of work in some non professional work.

Conclusions

The Indonesian community pharmacists spent little time on both professional work and non-professional work in their daily activities. This indicated that the pharmacists did not focus on delivering quality professional work.

Credentialing of pharmacy technicians in the USA

Objective

This review will compare the USA and UK regarding pharmacy technicians' roles, it will summarize the current roles and responsibilities of pharmacy technicians in the USA, public perception of pharmacy technicians, pharmacy organizations' perspectives on pharmacy technician credentialing, academic programmes for pharmacy technicians, accreditation of pharmacy technician programmes, pharmacy technician certification exams and differing perspectives on the push for standardized technician training. It will conclude with observations regarding the importance of standardized pharmacy technician training.

Methods

Articles were identified via searches of PubMed and IPA from inception to November 2010 related to credentialing of pharmacy technicians. Search terms included pharmacy technician, pharmacy technician certification, pharmacy registration, technician education and technician requirements. Articles describing the roles and responsibilities of a technician, public perception of technicians, demographics, certification processes and the future of technician roles were included. An Internet search was also performed to identify articles in the lay press related to this topic.

Key findings

Providing a pharmacy technician with proper training and education is necessary for operating a successful pharmacy. In the USA, mandating a national standardized training programme is the source of the debate. Current rules and regulations regarding the training and education needed for a pharmacy technician vary from state to state in the USA. Attitudes of technicians towards standardized training may be difficult to change.

Conclusion

This paper provides a review of pharmacy technicians' roles and responsibilities across different pharmacy settings. Although the literature provides some insight, more studies are needed to assess the value and impact of the knowledge and skills possessed by certified pharmacy technicians with standardized training compared with technicians with site-specific or limited training.

An examination of pharmacists' labor supply and wages

BACKGROUND

For the last decade, there has been a shortage of pharmacists for most of the United States. This shortage is in part because of demand-side phenomena (eg, increasing prescription drug use, increases in the complexity of drug regimens, and an aging population). However, there also may be supply-side causes. Although the number of pharmacy school graduates has increased, most graduates are women, many of whom may choose to work part-time. Because of the change in sex composition of the workforce, some researchers conclude that pharmacist shortages will be even more critical in the future.

OBJECTIVES

The goals of this article are to model pharmacists' decisions to work, estimate pharmacists' wages, and identify influences on the number of hours worked by pharmacists in the United States.

METHODS

Pharmacist labor supply is examined using a static, 3-step, empirical labor supply model that estimates the decision to work, hourly wages, and number of hours worked for U.S. pharmacists.

RESULTS

Pharmacists have high starting wages but flat wage trajectories. Although many pharmacists are working part-time, this is true for women and men. Income effects do not dominate substitution effects, even at the high level of compensation found here.

CONCLUSIONS

Results indicate that previous predictions brought about by the changing sex composition of the pharmacist labor force might not come to pass, and additional pharmacists may be attracted to the profession by higher wages and flexible schedules.

Opinion comparison concerning future information technology in Finnish community pharmacies

OBJECTIVE

To compare the opinions of community pharmacy owners, managers and personnel concerning the key features of the future information technology system needed in Finnish community pharmacies.

SETTING

The study was targeted to the pharmacists working in community pharmacies as managers (owners and staff pharmacists with M.Sc. degree) or personnel responsible for dispensing and patient counselling (pharmacists with B.Sc. degree).

METHOD

A national cross-sectional survey to all of Finnish community pharmacy owners (n = 580) and staff pharmacists (B.Sc. and M.Sc. degrees, n = 1709) working in community pharmacies, was conducted in order to determine differences in opinions between these occupation groups with different professional duties. The response rates were 53% for pharmacy owners (n = 308) and 22% for staff pharmacists (n = 373).

MAIN OUTCOME MEASURE

The main outcome measure was the perceived importance of 89 potential features for a new IT system ranked by using a five-point Likert scale.

RESULTS

The responding community pharmacy managers and staff pharmacists had differences in their ranking of more than half (52%) of the potential features listed in the survey questionnaire. The features related to the pharmacy's internal processes, such as financial management, sales and marketing management and stock holding, were ranked significantly higher by the managers, while the personnel prioritized the features supporting pharmaceutical service provision and personnel management. The managers and personnel shared their opinion on the importance of features supporting drug information and patient counselling, medication safety and interprofessional collaboration.

CONCLUSION

The managers and staff pharmacists have different views of the importance of IT features, reflecting their different professional duties in the community pharmacy. A high priority was given for the features familiar to the users and needed in their daily practice. This indicates the need for involving different occupation groups in planning the new IT systems for community pharmacies.

The use of queueing and simulative analyses to improve an overwhelmed pharmacy call center

Like many others, the St. Louis Veterans Administration Medical Center (VAMC) Pharmacy help desk receives far more calls than can be processed by current staffing levels. The objective of the study is to improve pharmaceutical services provided by the call center, by using queueing theory and discrete event dynamic simulation to analyze incoming telephone traffic to the help desk. Queueing and simulation models using both archival and hand-gathered data over a 1-year period were created, compared, and presented in order to determine the minimum quantities of staff needed to reach the desired service threshold. The simulation model was validated in comparison with real-world data. Results suggest that telephone traffic congestion in this setting may be alleviated by increasing the number of staff responsible for telephone services from 2 to 6 throughout the week, with an additional one serving on Monday. Both queueing and simulative models can be used to improve overwhelm pharmacy call centers, by determining the theoretical minimal staff needed to reach a service threshold.

Perceived barriers to provision of medication therapy management services (MTMS) and the likelihood of a pharmacist to work in a pharmacy that provides MTMS

BACKGROUND

Recently, medication therapy management services (MTMS) has gained significant attention as an important type of pharmaceutical care designed to improve patient outcomes with more appropriate medication usage and monitoring. Although the provision of MTMS is increasing in pharmacies across the nation, and pharmacists are well equipped to administer MTMS, many community pharmacists are not currently providing these services.

OBJECTIVE

To determine barriers to provision of MTMS perceived by pharmacists and factors associated with the likelihood of working in a pharmacy that provides MTMS.

METHODS

Surveys were mailed to 906 community pharmacists licensed in West Virginia using a stratified random sample. The instrument was constructed and finalized following a review by experts and pilot tested in a convenience sample of pharmacists. Principal components analysis was performed to determine the factors that describe perceived barriers to provision of MTMS. Discriminant analysis using factor scores and other demographic and practice variables was performed to predict respondents' likelihood to work in a pharmacy that provides MTMS.

RESULTS

A 3-factor model was extracted from the responses, which explained 53.3% of the total variance. The factors included perceived ability to respond to patient interest, pharmacy-related factors, and enabling factors. The discriminant function correctly classified 76.2% of cases and included comfort level with provision of services, perceived value of services to patients, perceived ability to respond to patient interest, and whether they currently offer MTMS. These variables were all positively correlated with pharmacists' likelihood of working in a pharmacy that provides MTMS.

CONCLUSIONS

Comfort level and ability are important factors that influence pharmacists' likelihood of working in a pharmacy that provides MTMS. These findings highlight the importance of advanced practice experiences, certificate programs, and residencies to build pharmacists' confidence, and the role of targeted recruitment to attract pharmacists to community pharmacies that provide MTMS.

Does community pharmacy offer women family-friendly working conditions and equal opportunities? The accounts of female community pharmacists over the age of 30

Objective The sex mix of the pharmacy workforce has altered significantly over the last 60 years such that in 2005 54% of the practising pharmacy workforce was female. After the age of 30 years, part-time working is common and it is often assumed that pharmacy working attracts and suits women because it is flexible and family friendly. This paper aims to explore to what extent that is true.

Setting This study was based in the North West of England.

Method Face-to-face interviews (n=30) were conducted with women over the age of 30 years who worked as community pharmacists. The interview schedule was designed to explore: interviewees' motivation for choosing pharmacy; employment history; motivation for choosing a particular pattern of working; views of recent changes in pharmacy; and future career plans.

Key findings In line with previous studies this sample of female community pharmacists adopted heterogenous work patterns, and personal and extrinsic structural factors were found to influence work patterns. Importantly, there was evidence of a lack of family-friendly practices, with antisocial hours, difficulties accommodating annual leave, and the restrictive legislative framework that necessitates that a pharmacist is always present in a store, all affecting work patterns.

Conclusion Our study, in contrast to other studies, suggests that for about half of the women interviewed, community pharmacy working was difficult to combine with family commitments. This finding has implications for employers and workforce planners because an increasing proportion of the community pharmacy workforce is female.

Workload pressure among recently qualified pharmacists: An exploratory study of intentions to leave the profession

Objectives

To explore the reasons why recently qualified pharmacists had chosen to follow non-standard career paths, or were thinking of doing so.

Methods

Participants in a nationwide longitudinal cohort study examining pharmacy careers who were either working in non-standard roles (i.e. not primarily employed in community, primary care or hospital pharmacy), or who had expressed a likelihood of leaving the profession in the near future, were invited to participate in a follow-up qualitative study. After pilot work to inform the design of a semi-structured interview schedule 12 telephone interviews were conducted with pharmacists who had qualified within the last 5 years.

Key findings

Regardless of the sector in which these early career pharmacists had gained work experience, there was a common occurrence of workload pressures influencing career decisions. Pressures in community pharmacy were often related to the need to meet certain targets in a business environment. Community pharmacists also bemoaned a lack of resources, such as support staff, which often meant that their day-to-day routines became monotonous and unfulfilling. A feeling of being undervalued and underutilised was the main concern voiced by all pharmacists and represented the views of those with experience of working in both the community and hospital sectors. This situation arose because participants felt that they had been highly trained to deliver new pharmaceutical services yet the opportunities to use their skills did not materialise, partly due to the nature of their workloads.

Conclusions

Early career pharmacists can become disillusioned because the pressure to perform routine tasks often results in a lack of time to provide new pharmaceutical services. Increased job satisfaction levels are seen when more opportunities for clinical input are afforded to pharmacists. This could be achieved through the use of clear guidelines on staffing levels and, more importantly, the provision of adequate support staff.

Delivering health care through community pharmacies: are working conditions deterring female pharmacists' participation?

OBJECTIVE

Recent UK government policy has placed community pharmacists at the frontline of health care delivery in order to improve patient access. Community pharmacy has been beset by recruitment and retention problems which potentially threaten health service delivery. This is largely a consequence of an increased demand for pharmacists. Additionally, the proportion of female pharmacists in the profession has risen. Consequently, interrupted career patterns and part-time working practices have increased, shrinking the pool of available workers. This study aimed to examine the importance of factors influencing female community pharmacists' work patterns.

METHOD

Q methodology was used in a sample of 40 female UK-based community pharmacists.

RESULTS

Nine distinct factors emerged from a factor analysis of Q sorts: fulfilled pharmacists; family first or pharmacy shelved; low stress altruist; permanent part-time employees; focused on free time and finances; pressurized modernizers; wandering wage slaves; overloaded and under resourced for the new contract; and pin money part-timers. Female community pharmacists often worked below their potential and part-time at a practitioner level in response to a combination of domestic commitments and intensifying work place pressures.

CONCLUSIONS

Family-friendly flexible work environments, adequate staffing levels and improved management support, might be more effective in increasing workforce participation than enhanced salary levels in this group of workers.

Barriers to expanding advanced pharmacy practice experience site availability in an experiential education consortium

OBJECTIVES

To compare 2006-2007 and projected 2010-2011 advanced pharmacy practice experience (APPE) availability and needs for 4 colleges and schools of pharmacy in Georgia and Alabama and to examine barriers and offer potential solutions to increase APPE site and preceptor availability.

METHODS

Data on APPE needs and availability were gathered prospectively and evaluated relative to current and projected enrollment and planned programmatic changes.

RESULTS

Combined 2006-2007 non-community APPE needs and availabilities were 3,590 and 4,427, respectively, with a surplus availability of 837. Combined projected 2010-2011 non-community APPEs were estimated at 4,309. Assuming 2006-2007 non-community availability remained unchanged, the surplus availability declined to 118.

CONCLUSIONS

The need for quality experiential education represents a significant barrier and rate-limiting step to the matriculation of the increased numbers of pharmacists. Barriers to expanding APPE availability include: introductory pharmacy practice experience (IPPE) and APPE expansion, growth of new and existing pharmacy programs, financial instability of acute care facilities, and lack of preceptor development resources. Regional experiential education consortiums can provide a constructive approach to improve access to quality sites and preceptors through standardizing processes and leveraging resources.

The global pharmacy workforce: a systematic review of the literature

The importance of health workforce provision has gained significance and is now considered one of the most pressing issues worldwide, across all health professions. Against this background, the objectives of the work presented here were to systematically explore and identify contemporary issues surrounding expansion of the global pharmacy workforce in order to assist the International Pharmaceutical Federation working group on the workforce. International peer and non-peer-reviewed literature published between January 1998 and February 2008 was analysed. Articles were collated by performing searches of appropriate databases and reference lists of relevant articles; in addition, key informants were contacted. Information that met specific quality standards and pertained to the pharmacy workforce was extracted to matrices and assigned an evidence grade. Sixty-nine papers were identified for inclusion (48 peer reviewed and 21 non-peer-reviewed). Evaluation of evidence revealed the global pharmacy workforce to be composed of increasing numbers of females who were working fewer hours; this decreased their overall full-time equivalent contribution to the workforce, compared to male pharmacists. Distribution of pharmacists was uneven with respect to location (urban/rural, less-developed/more-developed countries) and work sector (private/public). Graduates showed a preference for completing pre-registration training near where they studied as an undergraduate; this was of considerable importance to rural areas. Increases in the number of pharmacy student enrollments and pharmacy schools occurred alongside an expansion in the number and roles of pharmacy technicians. Increased international awareness and support existed for the certification, registration and regulation of pharmacy technicians and accreditation of training courses. The most common factors adding to the demand for pharmacists were increased feminization, clinical governance measures, complexity of medication therapy and increased prescriptions. To maintain and expand the future pharmacy workforce, increases in recruitment and retention will be essential, as will decreases in attrition, where possible. However, scaling up the global pharmacy workforce is a complex, multifactorial responsibility that requires coordinated action. Further research by means of prospective and comparative methods, not only surveys, is needed into feminization; decreasing demand for postgraduate training; graduate trends; job satisfaction and the impact of pharmacy technicians; and how effective existing interventions are at expanding the pharmacy workforce. More coordinated monitoring and modelling of the pharmacy workforce worldwide (particularly in developing countries) is required.

Confronting the growing burden of chronic disease: can the U.S. health care workforce do the job?

The U.S. chronic illness burden is increasing and is felt more strongly in minority and low-income populations: in 2005, 133 million Americans had at least one chronic condition. Prevention and management of chronic disease are best performed by multidisciplinary teams in primary care and public health. However, the future health care work-force is not projected to include an appropriate mix of personnel capable of staffing such teams. To prepare for the growing chronic disease burden, a larger interdisciplinary primary care workforce is needed, and payment for primary care should reward practices that incorporate multidisciplinary teams.

Forward and backward transitions in pharmacy-based immunization services

BACKGROUND

Community pharmacies can engage in immunization services by contracting with an external workforce (outsourced mechanism) or staff pharmacists (in-house mechanism) to deliver the services. Because an outsourced mechanism generally requires lower organizational commitment, pharmacies often start with an outsourced mechanism. Later, these pharmacies can have 1 of the following transitions: sit on a fence by continuing with an outsourced mechanism, move backward by abandoning any immunization services, or move forward by implementing an in-house mechanism.

OBJECTIVES

Using Rogers' Diffusion of Innovations model and Behavioral Theory of the Firm as guidance, this study identified the associations between perceived characteristics of immunization services and backward/forward transitions.

METHODS

A cross-sectional mail survey was conducted to collect data from key informants of Washington State community pharmacies during May-July 2004 (response rate=46.9%). A total of 106 pharmacies were included in the analysis. Based on pharmacy's immunization service transitions, these pharmacies were identified as Fence sitters, Backward movers, or Forward movers. Relationships between these transitions, pharmacy characteristics, and perceived characteristics of immunization services were analyzed using bivariate and multinomial logistic regression techniques.

RESULTS

Backward and Forward movers had less positive assessments of outsourced services when compared with Fence sitters. Backward and Forward movers differed in their perceptions of in-house services; Backward movers generally perceived no differences between these 2 services, whereas Forward movers generally perceived in-house services to be superior to outsourced services. Furthermore, the odds of being a Forward mover increased as perceived technical and social benefits of outsourced services decreased, perceived compatibility of in-house services increased, and perceived complexity of in-house services decreased.

CONCLUSIONS

Perceived characteristics of outsourced and in-house innovations were associated with backward and forward transitions. Findings can be used to guide the development of strategies for facilitating organizational change and preventing the abandonment of immunization services.