Conceptualising production, productivity and technology in pharmacy practice: a novel framework for policy, education and research.

CONTEXT AND BACKGROUND: People and health systems worldwide face serious challenges due to shifting disease demographics, rising population demands and weaknesses in healthcare provision, including capacity shortages and lack of impact of healthcare services. These multiple challenges, linked with the global push to achieve universal health coverage, have made apparent the importance of investing in workforce development to improve population health and economic well-being. In relation to medicines, health systems face challenges in terms of access to needed medicines, optimising medicines use and reducing risk. In 2017, the International Pharmaceutical Federation (FIP) published global policy on workforce development ('the Nanjing Statements') that describe an envisioned future for professional education and training. The documents make clear that expanding the pharmacy workforce benefits patients, and continually improving education and training produces better clinical outcomes. AIMS AND PURPOSE: The opportunities for harnessing new technologies in pharmacy practice have been relatively ignored. This paper presents a conceptual framework for analysing production methods, productivity and technology in pharmacy practice that differentiates between dispensing and pharmaceutical care services. We outline a framework that may be employed to study the relationship between pharmacy practice and productivity, shaped by educational and technological inputs. METHOD AND RESULTS: The analysis is performed from the point of view of health systems economics. In relation to pharmaceutical care (patient-oriented practice), pharmacists are service providers; however, their primary purpose is not to deliver consultations, but to maximise the quantum of health gain they secure. Our analysis demonstrates that 'technology shock' is clearly beneficial compared with orthodox notions of productivity or incremental gain implementations. Additionally, the whole process of providing professional services using 'pharmaceutical care technologies' is governed by local institutional frames, suggesting that activities may be structured differently in different places and countries. DISCUSSION AND CONCLUSION: Addressing problems with medication use with the development of a pharmaceutical workforce that is sufficient in quantity and competence is a long-term issue. As a result of this analysis, there emerges a challenge about the profession's relationship with existing and emerging technical innovations. Our novel framework is designed to facilitate policy, education and research by providing an analytical approach to service delivery. By using this approach, the profession could develop examples of good practice in both developed and developing countries worldwide.

Activities of Latvian pharmacists in the Latvian Red Cross organization in exile in Germany (1945-1976).

The Latvian Red Cross has performed its assistance mission outside the territory of Latvia for several decades. In the 40-s of the 20th century, the state of Latvia and its people went through one of the most tragic pages of their history. Due to the re-occupation made by the Soviet Union in 1944, many people of Latvia fled to exile and under exile conditions the Latvian societies, parishes and public organizations came into being, including the Latvian Red Cross. It started its activities in the second part of the 40-s of the 20th century in Germany and then representative offices emerged in the U.S.A., Sweden, France, Italy, Denmark, Belgium, Australia, New Zealand. Special attention should be paid to the fact that the activity under exile conditions was of a large scale, well-organized and long-lasting. Substantial work at that time has been done by a number of pharmacists. Among them, the pharmacist and doctor Hugo Skudins (1903-1976) should be emphasized, who organized the purveyance of medication and sending them to Latvians in the occupied Latvia and to the penal camps in Siberia.

Nicole J. Brandt: Always Another Mountain to Climb.

Incoming 2015-2016 ASCP President Nicole "Nicki" Brandt juggles a demanding schedule: She teaches at the University of Maryland School of Pharmacy, participates in research at the Peter Lamy Center on Drug Therapy and Aging, consults at the Baltimore Veterans Affairs Medical Center's geriatric assessment and Alzheimer's disease and dementia clinic, and works as a consultant pharmacist at the Pickersgill Retirement Community Center in Baltimore. In recent years, she has also become active in a new sphere: health policy.

Pharmaceutical care- urgency: Proposing a practical clinical framework for pharmacy students.

BACKGROUND AND PURPOSE: Prioritizing a drug therapy problem (DTP) during an experiential placement is challenging for some pharmacy students, suggesting a gap in pre-placement preparedness and the need to modify existing resources. A modified DTP prioritizing framework is proposed to enhance clinical reasoning and increase students' confidence in performing this important step in the pharmaceutical care process. EDUCATIONAL ACTIVITY AND SETTING: Students' baseline DTP prioritizing capability was assessed in an informal focus group consisting of pharmacy students and experienced hospital pharmacy preceptors. Participants ranked the urgency for addressing 47 common medical conditions and selected a time frame to resolve the DTP. Participants also provided feedback on a proposed DTP prioritizing framework. A modified, student-focused DTP prioritizing framework, incorporating elements of curricular knowledge, principal elements of urgency, and time frame for taking action to resolve the identified DTP is described. FINDINGS: Students' DTP urgency rankings were heterogeneous and showed greater deviation from the anticipated ranking (R = 0.61) compared to the pharmacist cohort (R = 0.807), reinforcing our view of the need for a modified DTP prioritizing framework for students. In qualitative terms, students felt the framework's focus on curricular knowledge would contribute to the development of expertise. Preceptors felt the framework reflected their usual practice and would help guide discussions with students. SUMMARY: The modified DTP prioritizing framework, described in this article, may be utilized both to enhance student success and preceptor development in the experiential setting.

[The Medical-Pharmaceutical Department of the Junta for aid to Spanish Republicans, Mexico delegation]. / El Servicio Médico-Farmacéutico de la Junta de Auxilio a los republicanos españoles, delegación de Mexico.

Between 1940 and 1942, the Mexican delegation of the Junta for Aid to Spanish republicans founded and supported its own Medical-Pharmaceutical Department in Mexico City, formed by recently exiled Spanish professionals. It initially dealt with home medical care, charging for each medical service performed by specialists and each drug prescription. It later included a polyclinic with a staff of specialists and its own pharmacy. Finally, a small hospital and a laboratory for medical tests were planned, but circumstances prevented the project from getting under way. The study addresses the reasons for the birth of the Medical Pharmaceutical Service, its funding, organization and functioning, the professionals on whom it depended, its lines of action and its immediate projects. It also covers the main problems faced during its development and the reasons for its forced dissolution.

[Dean Paul Gillot (Magneux 1887-Nancy 1935). A multiform but unfortunately interrupted career. A comparison of past and current practices]. / Le Doyen Paul Gillot (Magneux 1887-Nancy 1935), une carrière multiforme malheureusement inachevée.... Comparaison de quelques pratiques d'hier et d'aujourd'hui.

Paul Gillot came in Nancy to study pharmacy. Having obtained his diploma in 1913, one year before First World War, he was enlisted as a soldier then an officer, for five years. During these years, he was wounded and severely ill and he never recovered. In 1919, coming back at the school of pharmacy in Nancy, he began his thesis and his universitary career and became simultaneously hospital pharmacist and inspector of community pharmacies. In 1929 he had the luck of beeing nominated as the professor of materia medica, and in 1935 he was choosed as the dean of the faculty. Unfortunately he died some weeks after his election. The paper describes successively the activities of professor Paul Gillot during all his short life, and closes by some reflections about universitary practices of this period.

Kevin Fearon 2020-2021 ASCP PRESIDENT.

With more than 3 decades of experience in the institutional pharmacy field, Kevin Fearon steps into the role of the ASCP President with a keen desire to help pharmacy and business leaders collaborate toward a common goal of helping care for older people.

Cultural Sensitivity and Global Pharmacy Engagement in the United States.

Objective. To provide a resource for schools and colleges of pharmacy in different regions of the world that are considering sending their students and faculty members to the United States for training. Methods. A literature review (2000-2018) was conducted that involved database and Internet searches using specific keywords and terms. Information was also solicited from authors in different regions of the United States who have hosted international students and faculty members. Recommendations for pharmacists and other health care practitioners on culturally sensitive engagement were formulated. Results. Global engagement between schools and colleges of pharmacy from different regions of the world and the United States is increasing. In addition to various cultural aspects, general information about the US health care system, pharmacy education programs, and pharmacy practice were found to be available to individuals who are charged with organizing and facilitating these exchanges. Common stereotypes and misconceptions about the United States were also identified. Conclusion. For international learners to have an enriching and fruitful engagement while in the United States, an understanding of American culture in general as well as the unique cultural aspects of different regions of the country as provided in this paper is critical.

Evolution of the TRICARE Pharmacy Benefit: A Decade of Change.

TRICARE is the military's health plan that provides coverage to 9.4 million active duty and retired uniformed services personnel and their family members. The TRICARE pharmacy benefit has undergone many changes in the last decade. These changes include assigning newly approved drugs to nonformulary status after regulatory approval, the addition of weight loss medications to the benefit, channel management point-of-service requirements for some medications, and copay increases. Several initiatives have resulted in significant cost avoidance to the Department of Defense (DoD). The purpose of this article is to discuss the changes to the TRICARE pharmacy benefit, describe the continual challenges, and estimate cost savings associated with implementation of these changes. DoD implemented its 3-tier Uniform Formulary in 2005. Since then, many changes have been enacted, including more extensive use of prior authorization, step therapy, and quantity limits; coverage of over-the-counter medications; the retail refund program; coverage of vaccines and smoking cessation agents; mandatory mail/military treatment facility requirements; rapid review and initial nonformulary status for newly approved innovator drugs; revisions to the compounded drug benefit; initial deployment of a new medical record system; coverage of weight loss medications; and the ability to exclude medications from the Uniform Formulary. Although the TRICARE pharmacy benefit has evolved significantly, the focus remains on the beneficiaries, with an overall goal of providing integrated, affordable, and high quality health services for the Military Health System. Challenges for the future include maximizing clinical effectiveness in the face of rising pharmaceutical costs and cost avoidance, while supporting the needs of TRICARE beneficiaries. DISCLOSURES: No outside funding supported this study. The authors declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. The information discussed here represents the views of the authors and does not necessarily reflect the views of the Defense Health Agency (DHA), the Department of Defense (DoD), or the Departments of the Army, Navy, and Air Force. The authors have nothing to disclose that presents a potential conflict of interest.

Percepção de farmacêuticos na implantação do Cuidado Farmacêutico na Atenção Básica / Pharmacists' perceptions on the implementation of Pharmaceutical Care in Primary Care

Resumo O artigo descreve a percepção de 10 farmacêuticos da Atenção Básica (AB) de uma região do município de São Paulo que participaram do processo de implantação do Cuidado Farmacêutico. A partir de uma pesquisa qualitativa com grupos focais e abordagem descritiva, os conteúdos foram analisados utilizando-se a Análise de Conteúdo. Das 52 unidades de registro organizadas em 10 categorias, resultaram três sínteses sobre o processo de implantação do CF. Nesse contexto, foi possível descrever o papel do farmacêutico na AB após a implantação dos serviços clínicos, de modo a identificar suas percepções, dificuldades e avanços. Os resultados demonstraram aspectos positivos, além da necessidade de uma mudança gradual no perfil e nas competências dos farmacêuticos para o desenvolvimento de serviços clínicos, ultrapassando os limites da categoria e dependendo do trabalho em equipe realizado na AB. Logo, os resultados promovem os diferentes papéis dos atores envolvidos nesta prática (usuários, equipe de saúde, gestores e farmacêuticos) e valorizam novas formas de cuidado no SUS.

Abstract The article describes the perception of 10 pharmacists from the Primary Health Care (PHC) of a region in the municipality of São Paulo that participated in the process of implementing the Pharmaceutical Care (PC). Based on qualitative research with focus groups and descriptive approach, contents were reviewed using the Content Analysis. The 52 registration units organized in 10 categories resulted in three summaries about the PC implementation process. In this context, we could describe the role of pharmacists in PHC after the implementation of clinical services, in order to identify their perceptions, difficulties and advances. Results unveiled positive aspects, besides the need for gradual change in the profile and competences of pharmacists to develop clinical services, extrapolating the category boundaries, and depending on the teamwork performed at PHC. Therefore, results promote the different roles of the players involved in this practice (users, health team, managers, and pharmacists), and value new forms of care in the Brazilian Health System (SUS).

Assessment of pharmacy manpower and services in West Virginia.

BACKGROUND: The shortage of pharmacists across the nation has been much publicized and has been identified as one of the reasons for new schools of pharmacy to open or for existing colleges and schools of pharmacy to increase their class sizes. This article represents the assessment of a new school of pharmacy's evaluation of staffing and practice in its geographic area. OBJECTIVE: This survey represents the first data point within the School of Pharmacy assessment plan and will be repeated at several intervals after the program opens to longitudinally evaluate its impact on pharmacy staffing and services within West Virginia. METHODS: Using a modified Dillman survey methodology a random sample of 548 pharmacists in West Virginia, approximately one-third the active roster, were surveyed regarding staffing and services in West Virginia. RESULTS: A response rate of 32.78% was achieved and findings indicated that there is a staffing shortage of pharmacists within West Virginia, that staffing impacts the services pharmacists provide, and that more pharmacists would be willing to offer disease management services if staffing levels were at appropriate levels. CONCLUSIONS: A shortage of pharmacists does exist in West Virginia and it has implications on patient care. Longitudinal evaluation of the impact of a new pharmacy program will be conducted and the staffing and services within West Virginia should be continued to be studied.