National Pharmacist Workforce Study (NPWS): Description of 2019 Survey Methods and Assessment of Nonresponse Bias

Effect of Artificial Intelligence Helpfulness and Uncertainty on Cognitive Interactions with Pharmacists: Randomized Controlled Trial

BACKGROUND

Clinical decision support systems leveraging artificial intelligence (AI) are increasingly integrated into health care practices, including pharmacy medication verification. Communicating uncertainty in an AI prediction is viewed as an important mechanism for boosting human collaboration and trust. Yet, little is known about the effects on human cognition as a result of interacting with such types of AI advice.

OBJECTIVE

This study aimed to evaluate the cognitive interaction patterns of pharmacists during medication product verification when using an AI prototype. Moreover, we examine the impact of AI's assistance, both helpful and unhelpful, and the communication of uncertainty of AI-generated results on pharmacists' cognitive interaction with the prototype.

METHODS

In a randomized controlled trial, 30 pharmacists from professional networks each performed 200 medication verification tasks while their eye movements were recorded using an online eye tracker. Participants completed 100 verifications without AI assistance and 100 with AI assistance (either with black box help without uncertainty information or uncertainty-aware help, which displays AI uncertainty). Fixation patterns (first and last areas fixated, number of fixations, fixation duration, and dwell times) were analyzed in relation to AI help type and helpfulness.

RESULTS

Pharmacists shifted 19%-26% of their total fixations to AI-generated regions when these were available, suggesting the integration of AI advice in decision-making. AI assistance did not reduce the number of fixations on fill images, which remained the primary focus area. Unhelpful AI advice led to longer dwell times on reference and fill images, indicating increased cognitive processing. Displaying AI uncertainty led to longer cognitive processing times as measured by dwell times in original images.

CONCLUSIONS

Unhelpful AI increases cognitive processing time in the original images. Transparency in AI is needed in "black box" systems, but showing more information can add a cognitive burden. Therefore, the communication of uncertainty should be optimized and integrated into clinical workflows using user-centered design to avoid increasing cognitive load or impeding clinicians' original workflow.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06795477; https://clinicaltrials.gov/study/NCT06795477.

Impact of the COVID-19 pandemic on pharmacists practicing in community pharmacies in the state of Nebraska

BACKGROUND

The rapid increase in COVID-19 combined with uncertainty surrounding transmission and treatment protocols resulted in unprecedented burnout amongst health care workers. As other health care workers scrambled to support patients, community pharmacists quickly responded to the pandemic by extending their services. This constantly changing environment amongst other factors created a high degree of psychological burden associated with COVID-19 for pharmacists. Although studies have examined the psychological impact of the pandemic on frontline health care workers, pharmacists are rarely included in these studies.

OBJECTIVE

To examine the impact of COVID-19 on work and personal well-being from the perspective of pharmacists practicing in community pharmacies in Nebraska.

METHODS

A cross-sectional online survey collected data from pharmacists with an active Nebraska Pharmacist license (N=2763) from November 2022 to January 2023. The survey was a hybrid of researcher-developed items and the validated abbreviated Maslach Burnout Inventory (aMBI). The aMBI is a 9-item Likert-scale scored instrument, which captures three domains of burnout: Personal Accomplishment; Emotional Exhaustion; and Depersonalization. Data was analyzed using IBM SPSS Statistics version 27.

RESULTS

The response rate to the survey was 12.3% (n=339). Mean age of the respondents was 44.8 years with an average of 18.7 years in practice. Most respondents (n = 113, 50.7%) practiced in a community pharmacy followed by hospital (n = 72, 32.3%). 55.8% of community pharmacists reported that they considered leaving their current employer. Chi-square analysis confirmed that community pharmacists are more burned out than noncommunity pharmacists.

CONCLUSIONS

Pharmacists realized they had not been recognized for their contributions as frontline health care workers, which motivated them to consider leaving their employer and even the profession of pharmacy. This study found community pharmacists are burned out more than non-community pharmacists. Within community pharmacies, it was found that pharmacists practicing at corporate-owned community pharmacies had increased burnout compared to those practicing in independent community pharmacies.

Navigating power dynamics between pharmacy preceptors and learners

Pharmacy preceptors are crucial in pharmacy experiential education. They help develop learners during didactic learning, experiential learning, and post-graduate training. Preceptors hold a position of authority over learners as they are responsible for providing feedback and ultimately completing evaluations that determine whether the student passes or does not pass the rotation. Preceptor status, behavior, and communication style may cause students to feel intimidated. Preceptors should be aware of this power differential and keep generational, gender, cultural, and other factors in mind when providing feedback. Preceptors should also receive training and be open to constructive feedback from learners to ensure the experience meets the needs of the learner and allow for adjustments on the experiential rotation. Students should be empowered to provide open and honest feedback to preceptors in a psychologically safe environment without fear of repercussions.

Identifying Services Provided in Community Pharmacy Practice Settings

Background: To better address their patients' needs, community pharmacists are expanding from their traditional role of dispensing to managing medications and providing other care. Objective: This study characterized services reported by pharmacists practicing in community pharmacy settings in the 2019 National Pharmacist Workforce Study (NPWS). Methods: The 2019 NPWS was conducted via an online survey. E-mails containing survey links were sent to a systematic random sample of 96,110 U.S. pharmacists. The survey allowed tailoring of questions related to specific practice settings and for respondents in community pharmacies included reporting on delivery of twelve services. Other descriptive characteristic questions included community pharmacy type, staffing, monitoring activities, self-reported workload, and respondent demographics. An index was created by summing the number of yes responses for the service questions. This index served as the dependent variable in an ordinary least squares regression examining the association of work setting characteristics with the index. Results: Usable responses were received from 2,150 community pharmacists. The top four services were: administer vaccines (91.1%), patient medication assistance program (83.7%), naloxone dispensing (72.8%) and medication synchronization (67.2%). The regression model was significant, with supermarket pharmacies having a higher service index than large chains. Elevated service index scores were associated with more technicians on duty, CPESN participation, direct communication with primary care providers, practicing under a CPA and monitoring activities. Conclusions: Pharmacy operational characteristics were important influences on the delivery of services in community pharmacies. These findings can help inform the continuing transformation of community pharmacy practice.

Exploring the pharmacy students' perspectives on off-campus online learning experiences amid COVID-19 crises: A cross-sectional survey

Background

The pandemic of COVID-19 has placed many challenges for pharmacy students' learning experiences via the online e- system. There is paucity of studies that addresses this in colleges of pharmacies in United Arab Emirates (UAE).

Objective

We have explored the preparedness, attitudes, experiences, and barriers/facilitators, and delineated factors that may affect the pharmacy students' e-learning process amid the COVID-19 crises.

Methods

The current study was cross-sectional, and survey-based (anonymously self-administered) that utilized theoretical domains framework. The survey (multiple statements) was comprised of four domains (based on theoretical domain framework) that has elaborated on the preparedness, attitudes, experiences and barriers for the pharmacy students' e-learning (all years and interns). The validated (Cronbach Alfa 0.821) and piloted survey posted to the Google form and a link distributed to the pharmacy students. The survey was comprised of four domains (34 statements), distributed as five in preparedness, eleven in attitude, eleven in the experiences, and seven in the barriers/facilitators (theoretical domains framework).

Outcome measure

The primary outcome was the total sum of scores of individual statements and each individual four domain of the questionnaire (preparedness, attitude, experiences, and barriers/facilitators).

Results

Two hundred thirty respondents participated in the survey (230/400, response rate 57.5%), of which 193 were females (83.9%) versus 37 males (16.1%). The mean age (years) was 19.9 ± 1.9 (males 19.8 ± 1.6 and females 20.0 ± 1.9). The mean total score for preparedness Q1 to Q5 (domain maximum score 25); and for the attitude Q6 to Q16 (domain maximum score of 60) were 14.9 ± 3.8 (95% CI 14.4 - 15.4; P < 0.05), 29.5 ± 7.4 (95% CI 28.6 - 30.5; P < 0.05) respectively. While for the experiences Q17 to Q27 (domain maximum score 55); and for the barriers/facilitators Q28 to Q34 (domain maximum score 30) 40.1 ± 8.0 (95% CI 39.1 - 41.1; P < 0.0001), and 20.9 ± 4.9 (95% CI 20.3-21.5;P < 0.05) respectively.

Conclusion

Our pharmacy students support the use of e-learning in pharmacy education, and seems prepared for the future technology moves in education. The colleges of pharmacies need to conduct further research on versatile innovative models such as virtual learning/artificial intelligence that fits with their students' perspectives.

Qualitative Analysis of Pharmacy Students' Self-identified Preconceptions Regarding the Term Clinical Pharmacy

Objective. To evaluate third-year pharmacy students' self-identified preconceptions regarding the term clinical pharmacy as defined by the American College of Clinical Pharmacy (ACCP).Methods. Third-year pharmacy students were led in a multipart activity focused on evaluating their preconceptions about the term clinical pharmacy after exposure to the unabridged definition published by ACCP. Students were asked to identify two preconceptions they had before the activity that were dispelled after reading the article. Thematic coding was used to identify semantic themes and generate summaries of student perceptions.Results. Three hundred twenty-two third-year pharmacy students' assignment data was coded to reveal six major themes about their preconceptions related to the term clinical pharmacy: setting, required training, job responsibilities, scope within the health care system, job environment (physical, emotional, financial), and limited knowledge about clinical pharmacy. Consistencies in thought were found within two of these themes, namely setting and required training. Significant variance was seen in the remaining four themes, specifically regarding types of activities performed, job environment, the scope of practice, and impact in the health care system.Conclusion. Third-year pharmacy students' preconceptions about clinical pharmacy were related to the exclusivity of where it can be practiced and the need for additional training as a requirement. However, high variability was seen in the majority of the remaining themes, illustrating an inconsistent view of what clinical pharmacy is and the need for intentional focus on professional identity formation within the pharmacy curriculum.

What drives job satisfaction among community pharmacists? An application of relative importance analysis

Background

Pharmacy employers want to improve pharmacists' job satisfaction, but ratings of job satisfaction are highly subjective, as evaluating job satisfaction involves weighing simultaneously the importance of multiple correlated determinants that are often perceived unequally.

Objectives

To 1) describe the application of relative importance analysis in estimating the predictive ability of correlated determinants of job satisfaction, and to rank the determinants in order of relative importance, and 2) explore how the perceived relative importance of job satisfaction predictors may vary across community pharmacists' age, gender, and work setting categories.

Methods

Data were obtained from the 2019 National Pharmacy Workforce Survey administered to 96,110 licensed U.S. pharmacists. Multiple regression analysis (MR) and relative weight analysis (RWA) were used to assess the predictive ability of determinants to explain pharmacists' job satisfaction. Subgroup analyses were performed to explore variations in the perceived relative importance of predictors across pharmacists' age, gender and work setting categories.

Results

Over the entire sample of community pharmacists, no personal experience of workplace discrimination [RW = 0.0613, rank = 1] and less reported engagement in advanced dispensing activities [RW = 0.0235, rank = 2] were most associated with greater job satisfaction, as both predictors jointly accounted for 67.5% of the predicted criterion variance (R ²). Pharmacists' compensation was observed to have the lowest perceived relative importance for predicting job satisfaction [RW = 0.0005, rank = 6], accounting for 0.5% of R ². Between-group comparisons showed that, no personal experience of workplace discrimination had the highest perceived relative importance for job satisfaction across pharmacists' age groups, among women, and across most work settings except small chain pharmacies. Within-group comparisons showed that pharmacists' compensation was significantly more important than professional interactions (Δ_RW(PC-PPI) 0.2900 [0.0637, 0.5360]) for job satisfaction among pharmacists in large chain pharmacies, while patient-care services was significantly more important than compensation for job satisfaction in independent (Δ_RW(PPS-PC) 0.1761 [0.0017, 0.5980]) and health system retail pharmacists (Δ_RW(PPS-PC) 0.4190 [0.0444, 0.8303]).

Conclusions

Relative importance analysis corroborated multiple regression and provided a more interpretable presentation of variable influence on community pharmacists job satisfaction as the importance of personal and workplace characteristics in how pharmacists evaluate their job satisfaction varied across age, gender and work setting categories.

Improving Communication in Intensive Care Unit to Ward Transitions: Protocol for Multisite National Implementation of the ICU-PAUSE Handoff Tool

BACKGROUND

The intensive care unit (ICU)-ward transfer poses a particularly high-risk period for patients. The period after transfer has been associated with adverse events and additional work for care teams related to miscommunication or omission of information. Standardized handoff processes have been found to reduce communication errors and adverse patient events in other clinical environments but are understudied at the ICU-ward interface. We previously developed an electronic ICU-ward transfer tool, ICU-PAUSE, which embeds the key elements and diagnostic reasoning to facilitate a safe transfer of care at ICU discharge.

OBJECTIVE

The aim of this study is to evaluate the implementation process of the ICU-PAUSE handoff tool across 10 academic medical centers, including the rate of adoption and acceptability, as perceived by clinical care teams.

METHODS

ICU-PAUSE will be implemented in the medical ICU across 10 academic hospitals, with each site customizing the tool to their institution's needs. Our mixed methods study will include a combination of a chart review, quantitative surveys, and qualitative interviews. After a 90-day implementation period, we will conduct a retrospective chart review to evaluate the rate of uptake of ICU-PAUSE. We will also conduct postimplementation surveys of providers to assess perceptions of the tool and its impact on the frequency of communication errors and adverse events during ICU-ward transfers. Lastly, we will conduct semistructured interviews of faculty stakeholders with subsequent thematic analysis with the goal of identifying benefits and barriers in implementing and using ICU-PAUSE.

RESULTS

ICU-PAUSE was piloted in the medical ICU at Barnes-Jewish Hospital, the teaching hospital of Washington University School of Medicine in St. Louis, in 2019. As of July 2022, implementation of ICU-PAUSE is ongoing at 6 of 10 participating sites. Our results will be published in 2023.

CONCLUSIONS

Our process of ICU-PAUSE implementation embeds each step of template design, uptake, and customization in the needs of users and key stakeholders. Here, we introduce our approach to evaluate its acceptability, usability, and impact on communication errors according to the tenets of sociotechnical theory. We anticipate that ICU-PAUSE will offer an effective handoff tool for the ICU-ward transition that can be generalized to other institutions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/40918.

Leadership aspiration: An intersectional analysis of racial and gender equity in pharmacy

BACKGROUND

The glass ceiling is a metaphor used to describe an invisible barrier that prevents an underrepresented group from rising beyond a certain level. Among pharmacists, underrepresented groups face various barriers and limitations to their successes.

OBJECTIVES

The purpose of this study was to apply the intersectionality framework to data collected from the 2019 National Pharmacist Workforce Study (NPWS) to understand the association of gender and race with leadership aspiration among pharmacists, including differences in perceived barriers and attractors for pursuing leadership.

METHODS

The 2019 NPWS was conducted using an electronic Qualtrics survey. Three e-mails containing the survey link were sent to a systematic random sample of 94,803 pharmacists through the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS had an overall response rate of 6% (5705/94,803). A total of 8466 pharmacists clicked on the survey link, resulting in a usable response rate of 67.3% (5705/8466). Data were analyzed in SPSS software using descriptive and Pearson's r and chi-square test statistics.

RESULTS

Black, Indigenous, and People of Color (BIPOC) pharmacists reported holding 10.7% of all leadership positions. Leadership positions included manager, assistant manager, executive, dean, director, chief pharmacy officer, owner or partner, and other leadership position types. White men and women reported the lowest interest in leadership (38.8% and 37.7%), whereas Black men (65.1%), Latinas (59.2%), Black women (58.5%), and Latinos (57.1%) had the highest interest in leadership. "The ability to make an impact" was the most frequently selected attractor for wanting to pursue leadership, selected by 92.5% and 79.6% of Black men and women, respectively, 77.8% of Other women, and 76.9% of Latinos. At graduation from pharmacy school, the student debt loan average of all graduation years ranged from $63,886 (± $73,701) for Other men to $112,384 (± $105,417) for Black women. Higher student loan debt was positively correlated with wanting to pursue a leadership position (r = 0.22, P < 0.001). Black women graduating 2011-2019 had the highest student loan debt at graduation ($194,456 ± $88,898).

CONCLUSION

Interest in leadership positions by BIPOC pharmacists compared with reported leadership roles were inversely correlated. Understanding the discrepancy in interest in leadership and reported leadership positions held, particularly with relation to race and gender, is essential to understanding equity in pharmacy leadership. Further research is warranted to understand the factors that impede the ascension of women and underrepresented pharmacists into leadership positions.

Tatted not tattered

Tattoos are common practice in underrepresented groups. However, institutional policies often prohibit visible tattoos of health professionals. This affects marginalized groups where tattoos may be the cultural norm. There are conflicting findings on perceptions of tattoos on medical professionals from the perspectives of peers, patients, and learners. Tattoo restriction can be discriminatory against already marginalized persons and sends a message of exclusion. Policies surrounding tattoo restriction should be re-evaluated to create an inclusive environment for all.

Total Worker Health® Employer Preparedness: A Proposed Model and Survey of Human Resource Managers' Perceptions

OBJECTIVE

Recent disasters have demonstrated gaps in employers' preparedness to protect employees and promote their well-being in the face of disruptive events. Our objective was to develop a useful strategy for advancing comprehensive employer preparedness and to assess employer preparedness in a sample of employers.

METHODS

A Total Worker Health Employer Preparedness Model was developed to include seven domains: planning, human resources policies, hazard reduction, training, staffing, communications, and resources for resilience. A Survey and scoring Index based upon the Model were administered to human resources professionals in the northeast United States.

RESULTS

Seventy-six responded, representing diverse employment sectors. The mean Index score was 8.8 (out of 23), which is a moderate level of preparedness. Nine scored over 15, indicating greater preparedness. Thirteen scored 0. Employers were most prepared for severe weather events and least prepared for acts of violence. There were no significant differences by sector, size, or reach, although the health-care sector reported higher scores.

CONCLUSIONS

This unique attempt to assess TWH Employer Preparedness can serve as the basis of important further study that strengthens the empirical basis of the construct. Additionally, the Model, Survey, and Index can assist employers in advancing their preparedness for all hazards.

Use of the Professional Fulfillment Index in Pharmacists: A Confirmatory Factor Analysis

Most research on pharmacist professional wellbeing has focused on measuring burnout. However, using valid and reliable instruments to assess professional fulfillment in pharmacists can expand understanding of pharmacists' professional wellbeing. This study aimed to (1) establish the validity of the Professional Fulfillment Index (PFI) for a sample of pharmacists licensed in the United States (US) using confirmatory factor analysis (CFA), and (2) compare the professional wellbeing of pharmacists across demographics and work settings. Data for this study were obtained from the 2019 National Pharmacy Workforce Survey (NPWS). The survey assessed pharmacist professional wellbeing using the PFI. The model fit of the PFI was assessed using CFA. Multiple linear regression was used to compare pharmacist wellbeing across demographics and work settings. The CFA affirmed that the PFI possesses a satisfactory model fit for use in pharmacists. Regression analysis showed higher burnout (work exhaustion and interpersonal disengagement) was associated with decreasing age, being female, working more hours, and working in a community pharmacy. Higher professional fulfillment was associated with men, and working in non-community pharmacy work settings. The PFI is a psychometrically reliable and valid instrument for assessing the professional wellbeing of pharmacists.

An intersectional review of discrimination and harassment experiences in pharmacy: Findings from the 2019 National Pharmacist Workforce Survey

BACKGROUND

Most pharmacists in the United States are women, and the profession is becoming more racially diverse. The recent increase in political and social movements in the United States has heightened our awareness of the importance of better understanding the experiences of underrepresented individuals and groups. Little is known about discrimination and harassment in the profession of pharmacy in the United States.

OBJECTIVES

The purpose of this study was to provide evidence that discrimination and harassment exist in the pharmacy profession and explore differences in discrimination and harassment using the intersectionality of race and sex.

METHODS

The 2019 National Pharmacist Workforce Survey (NPWS) utilized an electronic survey that was distributed using a 3-contact Dillman approach by email to a randomized sample of 96,110 licensed pharmacists from all 50 U.S. states using the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS included a new battery of questions to assess the prevalence of discrimination and harassment in pharmacy.

RESULTS

The most common bases of discrimination experienced were based on age (31.2%), sex (29%), and race or ethnicity (16.6%). The most common type of harassment experienced was "hearing demeaning comments related to race or ethnicity" at 15.6%. The intersectionality analysis revealed different experiences among sex or race combinations. Black and Asian male pharmacists had the highest rate of "hearing demeaning comments about race or ethnicity." Nonwhite pharmacists were more likely to experience harassment from customers or patients compared with their white colleagues. Black female pharmacists had the highest rate of being "very unsatisfied" with the results of reporting discrimination and harassment to their employer.

CONCLUSION

Discrimination, including harassment and sexual harassment, is illegal, immoral, and unjust. As the profession of pharmacy continues to become more diverse, there must be a conscious, systemic, and sustained effort to create and maintain workplaces that are safe, equitable, and free of discrimination.