Bachelor of pharmacy graduates' perceptions of the pharmacy administration curriculum in Trinidad and Tobago.

INTRODUCTION: As the profession of pharmacy has evolved, pharmacy education has developed to include competencies and skills related to pharmacy administration services. Competencies taught in pharmacy administration courses are expected to provide graduates with skills to effectively undertake administrative functions. Our study aimed to assess perceptions about knowledge and skills gained by the pharmacists during the Pharmacy Administration course at the School of Pharmacy, the University of the West Indies (UWI), Trinidad and Tobago. METHODS: A cross-sectional survey was carried out among pharmacists working in hospitals and community pharmacies in Trinidad using non-probability convenience sampling. A structured questionnaire was distributed to 262 pharmacists who completed the Pharmacy Administration course. Two-hundred eighteen (83%) usable responses were included for analysis. RESULTS: Many (45.4%) respondents agreed that the course provided them with the knowledge of running a business, 78% said they were able to apply the skills in their practice, and 80% mentioned that the course should be mandatory. Pharmacists found that the course on business management enhanced their knowledge in the fields of managing human resources, conflict management, marketing, project management, corporate turnaround, inventory, and financial management. CONCLUSIONS: The Pharmacy Administration course in the bachelor of science degree in pharmacy programme at the School of Pharmacy, UWI remains relevant in the areas of marketing, human resource management, and inventory management. The programme can be extended to a full time masters course to interested pharmacy graduates.

Managing oneself: an essential skill for managing others.

OBJECTIVE: To discuss the importance of self-management for student pharmacists, pharmacists, and pharmacy managers and present a series of steps that students and new pharmacists can use in managing themselves. DATA SOURCES: An English language-only literature search was conducted of the PubMed and International Pharmaceutical Abstracts databases from 1980 to 2007 using the keywords managing and career, managing oneself, and career management. Information from the search was supplemented with selected articles and books from the management and self-improvement literature. STUDY SELECTION: Cited sources were chosen based on their relevance to the article's objectives. DATA EXTRACTION: By the author. DATA SYNTHESIS: Common steps associated with managing oneself and one's career consist of taking responsibility for your life, knowing yourself, deciding what you want to do and be, establishing goals to achieve the life you want to live, and taking action. A major goal of any self-management plan for managers is to develop soft interpersonal skills that help individuals manage themselves and influence the world around them. CONCLUSION: Effective self-management is necessary for success in managing others. The steps are relatively simple but take a lifetime to master.

Improving performance of a pharmacy in a Romanian hospital through implementation of an internal management control system.

According to general principles of good practice, adopted at the international level, quality control is a key function in management and not just a simple means of verification. In a clinic or hospital pharmacy, the chief pharmacist has the training and authority to take the control measures necessary to develop and implement an Internal Managerial Control System (IMCS). The present article analyzes and describes the case of the County Hospital of Oradea, Romania, and presents how the IMCS was adopted and integrated. Quality assessment in the health services takes place via an accreditation process and quality certification, as well as through an internal audit of the hospital pharmacy. The authors report a retrospective and descriptive study carried out from 2012 to 2017, analyzing how current legislative standards are applied. The IMCS in the hospital pharmacy is a dynamic process of continuous transformation, permanently adapted to hospital requirements, achieved under the direction of the chief pharmacist and involving all pharmacy employees, as well as through good coordination practices applied by hospital management. In this specific case, the IMCS features 11 annually updated compliance standards, classed under the headings of work procedures, risk register, job descriptions and staff training. The pharmacy's good practice model for IMCS development, was adopted by all of the hospital's sectors, services and departments.

Pharmacy management strategies for improving drug adherence.

BACKGROUND: Significant gaps in quality pervade U.S. health care, leading to suboptimal care and rising costs. One key factor driving the apparent quality gaps and rising costs in the current health care system is the issue of nonadherence to prescription medications. OBJECTIVE: To describe quality gaps in managed care that are driven by nonadherence to prescription medications and characterize the components of successful pharmacy management strategies for overcoming nonadherence. SUMMARY: Collaborative networks and medication therapy management (MTM) programs are 2 pharmacy management initiatives that are useful in reducing medication nonadherence among plan members. The Pharmacy Quality Alliance has laid the foundation for developing useful pharmacy quality metrics, aggregating data, and reporting to both consumers and pharmacies. At the same time, the National Committee for Quality Assurance has developed MTM measures to monitor pharmacy quality. Both organizations have used Medicare Part D as an impetus for these initiatives in an effort to assess the value of the high-cost investment in prescription drugs resulting from the government mandate. CONCLUSION: Managed care stakeholders should strive toward a valuebased health care system by investing more on appropriate medication use, including initiatives to reduce nonadherence and avoid the high costs of treating severe disease in the future.

Processes and Metrics to Evaluate Faculty Practice Activities at US Schools of Pharmacy.

Objective. To determine what processes and metrics are employed to measure and evaluate pharmacy practice faculty members at colleges and schools of pharmacy in the United States. Methods. A 23-item web-based questionnaire was distributed to pharmacy practice department chairs at schools of pharmacy fully accredited by the Accreditation Council for Pharmacy Education (ACPE) (n=114). Results. Ninety-three pharmacy practice chairs or designees from 92 institutions responded. Seventy-six percent reported that more than 60% of the department's faculty members were engaged in practice-related activities at least eight hours per week. Fewer than half (47%) had written policies and procedures for conducting practice evaluations. Institutions commonly collected data regarding committee service at practice sites, community service events, educational programs, and number of hours engaged in practice-related activities; however, only 24% used a tool to longitudinally collect practice-related data. Publicly funded institutions were more likely than private schools to have written procedures. Conclusion. Data collection tools and best practice recommendations for conducting faculty practice evaluations are needed.

Leadership versus management: translating pharmacists' abilities into quality performance.

OBJECTIVE: To describe the quality gap in health care as it was referred to in the Institute of Medicine's reports, to try to harness pharmacy's potential to improve the quality of drug therapy, and to provide insight into the elusive leadership, management, and dynamics of change. SUMMARY: Current health care is nowhere near ideal. Successful quality initiatives have included establishing a "culture of quality" (promoting a learning organization), having good leadership, and developing strong management. Ideally, all of these concepts must be applied concurrently for the best results because using only one will not spirit medicine across the gap. To close the gap, pharmacists need to understand various types of change and select a change mechanism that will continuously improve care. CONCLUSION: Optimizing drug therapy is both a great challenge and a great opportunity for pharmacy. AMCP's Framework for Quality Drug Therapy is a continuous quality improvement model that gives us the tools to plan, implement, and evaluate strategies to improve the quality of patient care and cross the "quality chasm."

To Set Up Norms for Drug Safety and Inspection: To Guarantee Administrative Sufficiency and Avoid Regulators from Being Wrongly Punished.

Currently, as there is no systematic norm or standard for drug safety and inspection, it cannot be judged whether the regulatory authority or regulators have fulfilled their administrative responsibilities entirely or not, when a drug safety-related incident occurs. And there is a probability that some may even be wrongly punished. In this study, we have analyzed the risk of not having appropriate norms in place and also put forward recommendations for the government or the regulatory authorities to set up norms to be fulfilled for drug safety and inspection issues. This, on one hand, could provide a basic guideline for the regulatory authorities and regulators to improve their professional levels and administrative acumen and on the other hand, it could also provide a baseline for society to judge whether the regulatory authorities and regulators have fulfilled their responsibilities correctly and thereby also help prevent regulators from being mistakenly punished. This study proposes that a systematic and functional norm for drug safety and inspection could be set up relating to the determination of the responsibilities of regulatory authorities and scope of various inspections, number and frequency of inspections, number and qualifications of regulators, handling of inspection results, inspection records, and disciplinary codes for inspectors. This study also puts forward suggestions on who should be responsible for drafting the norms and what are the factors that need to be considered while formulating the norms.

Formulary control of antimicrobial usage. What price freedom?

Formulary controls are the most common and probably the most effective method for controlling abuse of antimicrobial agents in hospitalized patients. Such programs may include restriction of both the number of agents available and the way these agents may be used. These programs have been demonstrated to control pharmacy expenditures. Other potential advantages include reductions in the incidence of adverse drug reactions and the antimicrobial resistance among the hospital flora, and improvements in the overall quality of prescribing of antimicrobials. There are few data to document such benefits, however. Potential disadvantages are also poorly documented but include inconvenience for prescribing physicians, increased administrative costs, prescribing errors, and increased antimicrobial resistance. Antimicrobial control programs will likely remain common, but the availability of new information technologies should enable a transition to systems based on concurrent assessment of antimicrobial appropriateness with immediate feedback to the prescribing physician.

Improving blood pressure control in a pharmacist-managed hypertension clinic.

OBJECTIVE: To determine whether pharmaceutical care provided by a pharmacist-managed hypertension clinic results in better treatment outcomes when compared with traditional health care from a primary care physician. DESIGN: Prospective, controlled study SETTING: Veterans Affairs Medical Center, Philadelphia, Pennsylvania. PATIENTS: Fifty six patients with essential hypertension; 27 were randomly assigned to the intervention group and 29 to the control group. INTERVENTION: Patients in the intervention group were scheduled monthly to meet with a clinical pharmacist who made appropriate changes in prescribed drugs, adjusted dosages, and provided drug counseling in accordance with the hypertension guidelines in the sixth report of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Patients in the control group received standard care from their physicians. The study period was 6 months. MEASUREMENTS AND MAIN RESULTS: Treatment outcomes were measured by changes in compliance, blood pressure, and patient satisfaction. The Short Form-36 health survey and a patient satisfaction survey were used to measure changes in patient satisfaction, and a compliance evaluation survey measured compliance. Twenty-one (81%) patients in the intervention group attained their blood pressure goal of below 140/90 mm Hg at the completion of the study versus only eight (30%) in the control group (p < 0.0001). Of 11 patients with diabetes in the intervention group, 10 (91%) attained their blood pressure goal (< 130/80 mm Hg) versus only two (12 %) of 16 patients with diabetes in the control group (p < 0.0001). No significant differences in patient satisfaction or compliance were reported between the intervention and control groups. CONCLUSIONS: Pharmaceutical care improves blood pressure control and results in more patients with hypertension reaching their blood pressure goal.

Pharmacy management company-negotiated contract for drug information services.

University-based drug information services provided on a contractual basis to the pharmacies of a pharmacy management company are described. Allied Pharmacy Management, Inc. (APM), the manager of 34 institutional pharmacies, 3 community pharmacies, and 6 long-term-care and infusion therapy pharmacies, determined a need to contract for the services of a drug information center. Centers meeting basic criteria were invited to submit proposals. After careful research and negotiations, APM chose the University of Tennessee Drug Information Center for a one-year contract beginning in November 1992. Services provided under the contract include drug information consultations, formulary drug class reviews, new drug monographs, drug-use evaluation (DUE) criteria, literature reviews, and newsletters. Seven months after the contract went into effect, APM-affiliated pharmacy directors stated that they were either satisfied or very satisfied with the quality of the answers to drug information requests, the newsletters, and the drug monographs and agreed overwhelmingly that the contract should be renewed. The contract has been renewed for second and third years. During the first year, the drug information center answered 155 questions and took 121 hours to do so. In the second year there were 244 questions, requiring 161 hours. In year 1 there were 21 formulary class reviews, 6 newsletters, 5 new drug monographs, and 1 set of DUE criteria. There have been 20-25 literature searches during each contract year. The drug information services provided by a university-based drug information center under contract with a pharmacy management company satisfied the directors of the affiliated pharmacies.

Role of the director of pharmacy: the first six months.

PURPOSE: Interviewing for a director of pharmacy position is discussed, and recommended activities for a pharmacy director's first six months on the job are described. SUMMARY: A prospective pharmacy director should first target the specific positions available that best fit his or her skills. The individual should tour the hospital and the pharmacy for each position of interest. Interviews should include the pharmacy staff, the nursing staff, the direct-report manager, and the medical staff. The hospital's financial condition should be assessed and a postinterview analysis conducted. Once hired, the new director should devote the first three months to an assessment of pharmacy services, staff, and customers; a regulatory and accreditation review; and assessments of organizational leadership, information systems, and clinical services. In addition, key documents, such as hospital policies and procedures, should be reviewed. At the end of the first three months, two documents, a summary of the new director's initial assessments and a chart showing current workflow, should be completed. Tasks for the first six months on the job include devising a work plan to address issues, developing reporting systems and metrics, setting priorities, creating staffing and clinical plans, promoting staff development creating and revising procedures, and evaluating outsourcing needs. The director should take a moment from time to time to celebrate successes with the staff. CONCLUSION: The director of pharmacy has one of the most complex jobs in the hospital. Planning, communicating, networking, writing, listening, leading, and motivating are skills necessary for success.

Making sense of outpatient pharmacy management. How to control pharmacy costs while delivering quality care.

Pharmacy brings together some of the major themes ushering US healthcare into the 21st century: concern about iatrogenesis, patient consumerism, resurgence of healthcare costs, and wide disparity in access to flourishing technology.

Practical hospital pharmacy management: management strategies and methods.

This review deals with the practical management of hospital pharmacies based on experience in Indian Christian hospitals with capacities ranging from about 30 to 500 beds. However the standards of pharmacy management should not depend on size; they should be kept under review and improved as staff and financial considerations allow.

Experience of health-system pharmacy administration residents in a longitudinal human resource management program.

PURPOSE: The experience of health-system pharmacy administration (HSPA) residents in a longitudinal human resource (HR) management program is described. The subsequent benefits to the residents, department, and profession are also discussed. SUMMARY: Postgraduate year 2 HSPA residents at an academic medical center desired more responsibility for managing an operational area. To this end, a program was created in which these residents directly manage a small group of pharmacy technicians and report to a clinical manager or assistant director with oversight responsibility. These "resident managers" are responsible, under the direction of the area's clinical manager, for the personnel, schedule, time and attendance, and HR activities of the area. Resident managers have led and sustained operational improvement projects in their areas. In addition to providing learning experiences to residents, the HSPA residency program has also improved the operations of the areas in which these residents work. Benefits to the residents include conducting annual performance evaluations for employees with whom they have a relationship as it is a task every administrator completes. Resident managers at UNC have consistently stated that this longitudinal HR experience is one of the most rewarding and most challenging experiences offered in the two-year HSPA residency. The involvement of HSPA residents in longitudinal management responsibilities furthers residents' leadership success by providing trained managers who are ready to immerse themselves into practice postresidency, having employee engagement and HR skills as well as experiences with leading operational improvements. CONCLUSION: A longitudinal HR management experience was successfully incorporated into an HSPA residency combined Master of Science degree program.

Underestimating the toxicological challenges associated with the use of herbal medicinal products in developing countries.

Various reports suggest a high contemporaneous prevalence of herb-drug use in both developed and developing countries. The World Health Organisation indicates that 80% of the Asian and African populations rely on traditional medicine as the primary method for their health care needs. Since time immemorial and despite the beneficial and traditional roles of herbs in different communities, the toxicity and herb-drug interactions that emanate from this practice have led to severe adverse effects and fatalities. As a result of the perception that herbal medicinal products have low risk, consumers usually disregard any association between their use and any adverse reactions hence leading to underreporting of adverse reactions. This is particularly common in developing countries and has led to a paucity of scientific data regarding the toxicity and interactions of locally used traditional herbal medicine. Other factors like general lack of compositional and toxicological information of herbs and poor quality of adverse reaction case reports present hurdles which are highly underestimated by the population in the developing world. This review paper addresses these toxicological challenges and calls for natural health product regulations as well as for protocols and guidance documents on safety and toxicity testing of herbal medicinal products.

Pharmacy benefit managers: evaluating clinical utility in the real world.

Over the years, pharmacy benefit managers (PBMs) have conducted and published peer-reviewed research covering a broad spectrum of activities ranging from studying the impact of alternative-benefit designs on outcomes to identifying the epidemiology of treated disease to understanding the impact of medication use on overall health-care costs. It is the unique "wired" interactive role in the health-care system that enables PBMs to play an emerging role in evaluating the clinical utility of biomarkers.