Driving factors of community pharmacist weight management service: A structural equation modeling.

BACKGROUND: Even though the effectiveness of community pharmacists in helping customers to reduce weight has been evident, few pharmacists provided weight management services (WMS). To drive community pharmacist WMS provision, factors affecting their intention and WMS provision were important to be investigated. OBJECTIVE: The present study aimed to explore relationships among pharmacist authority, perceived customer obstruction, WMS performance support, obstacles, and facilitators with intention to provide WMS and WMS rovision using structural equation modeling (WMS. METHOD: Self-administered questionnaires were utilized to collect data from 302 Thai community pharmacists from December 2022 to March 2023. Structural equation modeling (SEM) was used to explore the influencing factors on pharmacist WMS intention and WMS provision. RESULTS: Pharmacist authority (r = 0.35), WMS performance support (r = 0.24), and facilitators (r = 0.22) were significantly correlated with community pharmacist WMS provision. Pharmacist authority (r = 0.50), facilitators (r = 0.46), and WMS performance support (r = 0.42) were significantly correlated with community pharmacist intention to provide WMS e structural equation model (SEM), pharmacist authority (ß = 0.34) and intention (ß = 0.16) significantly influenced WMS provision (R2 = 0.20). Authority (ß = 0.49) and WMS performance support (ß = 0.28) significantly influenced pharmacist intention to WMS (R2 = 0.42). The model from empirical data indicated a good fit with the hypothetical model (p-value = 0.000, Comparatively Fit Index = 0.9, and Tucker-Lewis Index = 0.878). CONCLUSION: Pharmacist authority had direct effects with both their intention to provide WMS and WMS provision. WMS performance support had a direct effect on intention to provide WMS and an indirect effect on WMS provision. Facilitators also had significant correlations with intention to provide WMS and WMS provision.

A systematic review on pharmacists' turnover and turnover intention.

BACKGROUND: Turnover is an important issue in all healthcare professions including pharmacy practice settings. A high turnover rate of pharmacists, not only has negative financial impact, but also reduces quality of care and patient safety. The high turnover also increases workload and job stress which can increase job errors and decrease job efficiency and performance in pharmacy practices. OBJECTIVES: To systematically review the extent of pharmacists' turnover and their intention to leave their jobs or the pharmacy profession. METHODS: An electronic search was performed from database inception to December 19, 2020 using the following 6 databases; PubMed, Scopus, ScienceDirect, ProQuest, ERIC, and ERIC-EBSCO. Articles were included if they were relevant to reports of pharmacist turnover or turnover intention. Only research studies were included, but not editorials, letters, or review articles. RESULTS: Twenty-eight studies were contained within this systematic review. Using the QualSyst assessment tool to assess the included article qualities, all studies demonstrated good quality with quality assessment score of 0.75. Fifteen studies (53.6%) were conducted from the US, 3 studies (10.7%) from Taiwan, 2 studies (7.1%) from the UK, and the remaining studies from Lithuania, Australia, New Zealand, Malaysia, Saudi Arabia, and Jamaica. The turnover of the pharmacists from their jobs ranged from 8.6 to 17%, and the turnover from the pharmacy profession was in the range of 6-9%. The turnover intention of the pharmacists in their jobs was from 13% to 61.2%, and the turnover intention in the pharmacy profession was 6.5%-18.8%. Hospital pharmacists had significantly higher turnover intentions than community ones. The turnover intention rates of both hospital and community pharmacists have gradually increased over time in both European countries and Asian countries. CONCLUSION: Based on the included articles, pharmacists' turnover rate appeared to increase over time. However, based on the heterogeneity of studies, further research is warranted to confirm this and to help to identify the potential causes of turnover intention since intention was related to behavior.

Consumption of Calcium and Knowledge About Calcium Sources and Nutrition Labels Among Lower Secondary School Students in Thailand.

OBJECTIVE: A three study research program was conducted to identify high calcium products available in the market (study I), identify high calcium products that were known or consumed by lower secondary school students in the last three months (study II), and identify the amount and sources of calcium that students had consumed in the prior 24 hours, their knowledge about sources of high calcium and how to interpret calcium information on nutrition labels of food packages (study III). METHODS: In study I, a cross-sectional market survey was employed. In studies II and III, a school-based cross-sectional survey was employed. The survey population was students enrolled in grades 7-9 (11-14 years old) in a medium-sized lower secondary school in semi-urban Khon Kaen, Thailand. A total of 309 students were invited, with 168 and 209 students participating in studies II and III, respectively. Data were collected with self-administered questionnaires. RESULTS: Ninety-three high calcium products were identified. Only 49 were known or consumed by students in the last three months. The median amount of calcium consumed in the previous 24 hours was 410 mg (IQR: 160, 983). Only 31.1% of students (65/209) consumed more than the Thai recommended daily intake (TRDI) of calcium (800mg) in the previous 24 hours. Their main source of calcium was milk. Other high calcium items that were consumed were malt drink, minnow, canned fish, calcium fortified soy milk and Chinese kale. The overall average knowledge score was 6.5±2.4 out of a maximum of 17. The average knowledge scores for high calcium food sources and for interpreting the calcium information on a sample nutrition label were 4.6+1.8 (out of 12), and 1.9±1.2 (out of 5), respectively. DISCUSSION: Students should be introduced to high calcium products in their community such as hard tofu, minnow, and small freshwater shrimp. Educational programs on nutrition label interpretation are needed.

Awareness, Intention to Act and Action in the Exercising of Patients' Rights: A Case Study of Patients in Khmer Soviet Friendship Hospital, Phnom Penh, Cambodia.

BACKGROUND AND OBJECTIVES: In Cambodia, the patients' rights guideline was officially released in 2007 as a measure of the government policy to promote greater awareness and empower Cambodian people to exercise their rights as patients. The aim of this study was to identify the proportion of patients aware of the existence of patients' rights and compare the proportions of patients intending to exercise their rights and those actually exercising their rights among the aware and unaware groups. METHODS: Data were collected with a structured questionnaire, using face-to-face interview technique, from 142 randomly selected outpatients visiting the Khmer Soviet Friendship Hospital in Phnom Penh, Cambodia. Intention to exercise patients' rights was measured on a 5-point Likert scale (ranging from 1 "definitely not" to 5 "definitely yes"). RESULTS: The proportion of Cambodian patients who were aware of the existence of patients' rights was 31.0% (95% CI: 23.5, 39.3). The average intention to act scores was 4.0±0.5 for the whole group, and 4.3±0.4 and 3.9±0.5 for those aware and unaware of the existence of patients' rights, respectively. The difference in the mean scores of intentions to act between the aware and unaware groups was statistically significant (mean difference =0.40, 95% CI: 0.22, 0.58, t140=4.514, P< 0.001). Patients reported a total of 250 situations in which they believed they should take action to exercise their rights and 96 times that they took action (38.4%, 95% CI: 35.46, 41.34). CONCLUSION: The proportion of Cambodian outpatients aware of the existence of patients' rights and the proportion of outpatients that exercised their rights were both low. Nevertheless, it appeared that raising awareness of the existence of patients' rights raised patient's intention to act, which corresponds to the hierarchy-of-effects behavioral model.

Anticholinergics and benzodiazepines on cognitive impairment among elderly with Alzheimer's disease: a 1 year follow-up study.

OBJECTIVE: Age-associated decline in central cholinergic activity makes older adults susceptible to harmful effects of anticholinergics (ACs). Evidence exists of an association between effects of AC medications on cognition. This retrospective cohort study examines how ACs affect cognition among older adults with Alzheimer's disease (AD) who received acetylcholine esterase inhibitors (AChEIs) over the course of 12 months. RESULTS: A total of 133 (80% women, mean age 78.38 years, SD 7.4) were recruited. No difference in sex, age and comorbid diseases was observed between participants who took ACs, benzodiazepines (BZDs) and AChEIs. The most common prescribed ACs was quetiapine, being used for behavioral and psychological symptoms (BPSD). Multilevel analysis showed that the change of mental state examination scores were significantly predicted in the group using ACs (t (169), - 2.52, p = .020) but not with the groups using BZD (t (162), 0.84, p = .440). Evidence showed that older adults with Alzheimer's disease and exposed to ACs exhibited lower global cognitive scores than those without AC exposure. Using ACs could be a trade-off between controlling BPSD and aggravating cognitive impairment. Highlighting the awareness of the potential anticholinergic effect is important and may be the best policy.

Use of Potentially Inappropriate Medications in People With Dementia in Vietnam and Its Associated Factors.

This study examined the use of potentially inappropriate medicines that may affect cognition (PIMcog) in people with dementia and its associated factors. Medical records of all outpatients with dementia attending a tertiary hospital in Vietnam between January 1, 2015, and December 31, 2016, were examined. Medicine use was assessed against a list of PIMcog. Variables associated with having a PIMcog were assessed using a multiple logistic regression. Of the 128 patients, 41% used a PIMcog, 39.1% used cholinesterase inhibitors (CEIs) concomitantly with anticholinergics, and 18% used antipsychotics. The number of hospital visits (adjusted odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.02-1.16) and number of treating specialists (adjusted OR: 0.61; 95% CI: 0.45-0.83) were associated with PIMcog use. This study highlights a high-level use of medicines that can further impair cognition or reduce the effectiveness of CEIs in people with dementia. Efforts to improve quality use of medicines for this population are warranted.

Performance of health product risk management and surveillance conducted by health personnel at sub-district health promotion hospitals in the northeast region of Thailand.

BACKGROUND: Health personnel at sub-district health promotion hospitals (SD-HPHs) are assigned to take responsibility for 15 activities related to health product risk management and surveillance (HP-RM&S). This cross-sectional survey aimed to identify factors that determined their job performance and to record their expressed needs to support HP-RM&S operation. In this study, job performance was defined as completion of all 15 activities. METHODS: Self-administered postal questionnaires were used to collect data from 380 randomly selected health personnel who were in charge of HP-RM&S at SD-HPHs in the northeast of Thailand. RESULTS: Thirty-six point one percent (n=137) of the respondents were able to perform all 15 of the HP-RM&S activities assigned to SD-HPHs. A logistic regression model identified three factors that statistically significantly determined the completion of all 15 HP-RM&S activities. These were: receiving a high or very high level of support from the community (adjusted odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.5, 4.1), the responsible persons for HP-RM&S did not hold an administrative position (adjusted OR: 1.7; 95% CI: 1.1, 2.7), and having at least one training session related to HP-RM&S per year (adjusted OR: 1.7; 95% CI 1.1, 2.6). There were 1,536 expressed needs which can be classified into four major categories, ie, training needs (41.6%, n=639), resource support (28.3%, n=435), mechanisms that facilitate HP-RM&S operation (24.1%, n=370) and adjusting of the scope of HP-RM&S (6.0%, n=92). The topics most frequently referred to in training needs were drug law, food law, and cosmetics law. CONCLUSION: A strategy for improvement of the job performance in HP-RM&S of health personnel in SD-HPHs should target identifying schemes to encourage the community to proactively participate in HP-RM&S. The district health office as the organization directly controlling and supervising SD-HPHs should also regularly update knowledge base and skills necessary for HP-RM&S operation through training of the responsible health personnel.

Calcium consumption for osteoporosis prevention: knowledge, attitudes and behavior in the northeastern region, Thailand.

OBJECTIVE: Identified Thai adults' knowledge and attitudes towards calcium and determined factors predicting calcium consumption. MATERIAL AND METHOD: One thousand four hundred seventy five Thai adults, aged > or = 20 years old were interviewed, using a semi-structured questionnaire. Knowledge about role of calcium and good sources of calcium was measured using 17 questions. Attitudes towards calcium were measured with 10 opinion statements, using 7-point Likert scale (1 = strongly disagree to 7 = strongly agree). Calcium consumption, based on a 24-hour recall, was assessed using food frequency checklists and open-ended questions. RESULTS: The median score for knowledge was 15 (IQR: 12, 16; total possible score: 17). The overall median of attitudinal score was 5.6 (IQR: 4.9, 6.1; cronbach's alpha = 0.80). Approximately 10.9% consumed adequate amounts of calcium (800 mg/day). CONCLUSION: Factors significantly determining the likelihood an adequate intake of calcium were age < 35 years, support from peers and taking calcium-supplements.

Australian community pharmacists' practice in complementary medicines: a structural equation modeling approach.

OBJECTIVE: This survey tested a model of factors influencing pharmacists' practice in relation to complementary medicines (CMs). METHODS: Self-administered questionnaires were used to collect data from 212 community pharmacists in New South Wales. Structural equation modeling with AMOS version 6.0, was used to model two practices in relation to CMs: an evaluation of appropriateness of CM use and the decision to sell. RESULTS: Pharmacists' perceptions of their responsibilities in ensuring the safe use of CMs predicted the comprehensiveness of an evaluation for appropriateness of CM use (P=0.002). When level of comprehensiveness of evaluation increased, pharmacists were less likely to sell CMs in situations where the use of the products was not considered appropriate (P=0.021). Pharmacists' confidence in their CM knowledge, attitudes towards CMs, concern about pharmacy income and pharmacists' characteristics did not significantly affect their practice. CONCLUSION: Pharmacists' acceptance of their counseling responsibility with respect to CMs was the strongest predictor of both comprehensiveness of an evaluation and the decision to sell a CM. PRACTICE IMPLICATIONS: Pharmacists must be encouraged to recognise and accept their responsibility in ensuring the safe and effective use of CMs.

Measuring patient satisfaction with diabetes disease state management services in community pharmacy.

BACKGROUND: Disease state management (DSM) programs for chronic conditions such as type 2 diabetes delivered by community pharmacists are a developing trend in health care service delivery. Although patient satisfaction with DSM services is an important indicator of service quality from the consumers' perspective, to date there is no valid and reliable instrument to enable its measurement in the context of a community pharmacy delivered service. OBJECTIVE: To develop and validate an instrument to measure patient satisfaction with diabetes disease state management (DDSM) services delivered by community pharmacists. METHODS: The DDSM questionnaire (DDSM-Q) was developed on the basis of 14 in-depth, semi-structured interviews with consumers who had received diabetes care services in community pharmacy. Thirty-one questionnaire items were developed from the qualitative interview findings and also incorporated 16 modified items from an existing instrument, the Diabetes Measurement and Evaluation Tool. The DDSM-Q was sent to 160 participants of pharmacy diabetes care projects. Higher-order factor analysis was performed to extract factors of patient satisfaction. RESULTS: One hundred and fourteen questionnaires were returned, thus yielding a 71.3% response rate. Data from 108 out of 114 questionnaires were used to validate the DDSM-Q. Respondents had a mean age of 62 years and 61% were male. The 3 factors of patient satisfaction were interpreted as (1) satisfaction with the pharmacist's service ("Service"), (2) satisfaction with self-management ("Self-management"), and (3) satisfaction with knowledge and understanding of diabetes ("Knowledge"). The model fitted the data at moderate level (relative chi2 = 1.58, n = 108, adjusted goodness-of-fit index = 0.77, comparative fit index = 0.89, root mean-square error of approximation = 0.07). The model was shown to have construct validity chi2(167) = 235.62, Bollen-Stine bootstrap P = .27). Reliabilities of the 3 factors were 0.92, 0.88, and 0.86, respectively. CONCLUSION: The results support the validity and reliability of the DDSM-Q as an instrument to measure patient satisfaction with DDSM services in community pharmacy. Further research will be needed to validate the instrument in different populations.