Ethical Issues in Consenting Older Adults: Academic Researchers and Community Perspectives.

OBJECTIVES: Obtaining informed consents from older adults is surrounded by many ethical and practical challenges. The objective of this study was to evaluate ethical issues and strategies in consenting older adults in Jordan as perceived by academic researchers and older adults. METHODS: An anonymous questionnaire was distributed to academic researchers in the Jordanian health sciences colleges, and a sample of older adults. The study survey included items eliciting demographics, professional characteristics, and perceptions regarding the consenting process in older adults, consent-related skills in elderly, and strategies to improve the consenting process in older adults. The survey was then modified to assess the consent-related ethical issues and challenges as viewed by a sample of older adults after explaining the concept of the consenting process to them. KEY FINDINGS: A total of 250 academic researchers and 233 older adults participated in the study. Both researchers and older adults reported that having to sign the written forms and the impact of age-related physical impairments were the most challenging obstacles when consenting older adults. Lack of consistency and repeating questions were the most frequently encountered obstacles by researchers in consenting older adults. Ensuring privacy (anonymity/confidentiality), dedicating more time for the consenting process, treating older adults as autonomous individuals and respecting their cultural beliefs were the most helpful strategies recommended by both academic researchers and older adults. CONCLUSIONS: Obtaining informed consents from older adults is a challenging process. Researchers should be aware of the special needs and strategies to achieve realistic and ethical informed consents from older adults.

Review of National and International Accreditation of Pharmacy Programs in the Gulf Cooperation Council Countries.

Objective. To compare the different philosophies, emphases and processes of national and international accreditation paths available to pharmacy programs in Gulf Cooperation Council (GCC) countries. To identify engagement of GCC pharmacy programs with International Pharmacy Accreditation or Certification (IPAC) and the outcome advantages of IPAC compared to other national accreditation standards. Findings. National quality standards across the GCC countries are similarly structured but in different stages of development. Pharmacy specific standards are absent. Of the 44 institutions identified offering pharmacy degrees, only three out of 28 of those in the Kingdom of Saudi Arabia (KSA) and all but two out of 15 elsewhere in the GCC, have national program-level accreditation. Nine of the institutions have IPAC via either the Accreditation Council for Pharmacy Education-International Services Program (ACPE-ISP), the Canadian Council for Accreditation of Pharmacy Programs (CCAPP) or the German Accreditation Agency in Health and Social Sciences (AHPGS). None of the institutions have sought accreditation from the Australian Pharmacy Council (APC). IPAC may serve as a tool to provide specific recognition of the quality of pharmacy programs and to enhance the quality of pharmacy education in the region. Summary. In the absence of national bodies to accredit pharmacy initial training degrees, IPAC has become increasingly popular in the GCC countries. There are distinct regional differences in uptake and choice of IPAC. IPAC may serve as a tool to provide specific recognition of the quality of pharmacy programs and to enhance the quality of pharmacy education in the region in the absence of an unmet for pharmacy-specific national accreditation.

Assessment of Texan pharmacists' attitudes, behaviors, and preferences related to continuing pharmacy education.

BACKGROUND: Whether the available Continuing Education (CE) programs meet pharmacists' continuously increasing needs and preferences is open to question. OBJECTIVES: to investigate pharmacists' perceptions and attitudes concerning available CE programs, evaluate the pharmacists' choices with regard to selecting among different CE programs, and investigate the factors that are associated with preference to utilize online CE programs. METHOD: A 17-question survey was developed and mailed to a random sample of 600 Texan pharmacists. In addition to collecting basic demographic information, the survey investigated pharmacists' choices with regard to delivery and content of CE programs, motivations to participation in CE programs, and pharmacists' preferences for future CE programs. RESULTS: A total of 161 pharmacists completed the survey and mailed back their responses. Excluding the 75 undeliverable surveys, the response rate was 31%. Approximately 83% of respondents found that currently available CE programs met their educational needs. The most important factors influencing pharmacists' choices with regard to CE programs were the scope programs, the location where programs are held, and the cost associated with enrolling in such programs. Online CE was the most preferred mode of CE among participants. The factors that were associated with pharmacists' preferences to complete 50% or more of required CE through online programs were previous use of online CE programs, preference to limit the duration of CE programs to 1 or 2 hour-long, and perceived ability to find adequate CE programs among currently available CE programs. CONCLUSION: The findings suggest modalities for CE programs providers on how to improve CE programs in the future in order to meet the preferences of local pharmacists.

Reliability assessment of a peer evaluation instrument in a team-based learning course.

OBJECTIVE: To evaluate the reliability of a peer evaluation instrument in a longitudinal team-based learning setting. METHODS: Student pharmacists were instructed to evaluate the contributions of their peers. Evaluations were analyzed for the variance of the scores by identifying low, medium, and high scores. Agreement between performance ratings within each group of students was assessed via intra-class correlation coefficient (ICC). RESULTS: We found little variation in the standard deviation (SD) based on the score means among the high, medium, and low scores within each group. The lack of variation in SD of results between groups suggests that the peer evaluation instrument produces precise results. The ICC showed strong concordance among raters. CONCLUSIONS: Findings suggest that our student peer evaluation instrument provides a reliable method for peer assessment in team-based learning settings.

Reliability assessment of a peer evaluation instrument in a team-based learning course

Objective: To evaluate the reliability of a peer evaluation instrument in a longitudinal team-based learning setting. Methods: Student pharmacists were instructed to evaluate the contributions of their peers. Evaluations were analyzed for the variance of the scores by identifying low, medium, and high scores. Agreement between performance ratings within each group of students was assessed via intra-class correlation coefficient (ICC). Results: We found little variation in the standard deviation (SD) based on the score means among the high, medium, and low scores within each group. The lack of variation in SD of results between groups suggests that the peer evaluation instrument produces precise results. The ICC showed strong concordance among raters. Conclusions: Findings suggest that our student peer evaluation instrument provides a reliable method for peer assessment in team-based learning settings (AU)

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Parental attitudes affecting compliance with the recommendation for two doses of 2009 pandemic influenza A (H1N1) vaccine in children less than 10 years of age in West Virginia.

OBJECTIVE: It is unclear why parents would decline the second dose of an influenza vaccine for their children during a declared global pandemic. Therefore our objective was to examine parental attitudes behind parents foregoing the second dose of 2009 pandemic influenza A (H1N1) vaccine for their children in Kanawha County, WV. METHOD: A survey tool addressing barriers to receiving second dose was developed and validated with a randomly generated parent focus group. The West Virginia's Statewide Immunization Information System (WVSIIS) database listed 1,925 parents who have one child or more who received the first but not the second dose of vaccine within the recommended time period. The surveys and letters were sent to all the 1,925 parents. Participants were offered the choice of completing a paper version of the survey sent through the mail or an online version at a password-protected website. RESULTS: A total of 381 surveys were received (345 hardcopy surveys and 36 online surveys) and were included in the analyses (response rate 22.0%). Of these 381 respondents 249 did not meet the inclusion criteria. Thus our effective response rate was 132/1525, or 8.66%. The major reasons for respondents being unable to have their child(ren) receive the second dose were related to access limitations. A perception of low urgency and safety of vaccine were other concerns. However, the majority of respondents (80%) did not cite safety concern as a reason for not accepting the second dose. CONCLUSION: Our findings suggest that rather than safety concerns, parents often faced access challenges in having their children fully vaccinated which were perhaps not widely recognized.

Patient attitudes toward community pharmacist attire.

The white coat has symbolized professionalism, while representing provider-patient fiduciary relationship. Although well described in the literature for physicians, few studies examine the impact of pharmacist attire on patients' opinions regarding professionalism and trust. Therefore, understanding patient perceptions regarding pharmacist's attire and its influence on comfort, confidence, trust, and professionalism may provide guidance on ways to enhance the quality of the provider-patient relationship. A 43-item Likert-type questionnaire was administered to 347 adults in a community pharmacy setting to determine preferences about the pharmacist's attire, accessories, and body art incorporating 8 photographs depicting a male pharmacist in various degrees of dress formality (ie, casual to professional). Descriptive and inferential statistics were used to summarize and analyze the data. Survey respondents reported it was desirable/strongly desirable that pharmacists be dressed in a shirt and tie, dress shoes, white coat, and name tag (mean 4.21-4.72), whereas they should not be dressed in jeans, casual shoes, or have visible body art (mean 2.17-2.78). Over 86% of the respondents felt that a pharmacist with a white coat instilled feelings of comfort, confidence, trust, and professionalism. In a community pharmacy setting, a pharmacist wearing a white coat appears to be the mainstay in displaying professionalism and inspiring trust in adult patients.

Availability and perceived value of masters of business administration degree programs in pharmaceutical marketing and management.

OBJECTIVES: To examine pharmacist-targeted master of business administration (MBA) degree programs and investigate pharmacists' perceptions regarding them. METHODS: Specialized MBA programs in pharmaceutical marketing and management offered at US colleges and schools of pharmacy were identified in the literature and compared. Pharmacists' perceptions of MBA programs were evaluated through a survey of clinical preceptors affiliated with a school of pharmacy. RESULTS: Seven US universities that offer an MBA program in pharmaceutical marketing and management were identified. Thirty-three percent of the 57 pharmacist preceptors who responded to the survey reported plans to pursue an MBA degree program. Respondents preferred MBA programs related to healthcare or pharmacy (66%) over general MBA programs (33%). CONCLUSION: An MBA in pharmaceutical marketing and management could provide pharmacists with advanced knowledge of the operational and strategic business aspects of pharmacy practice and give pharmacy graduates an advantage in an increasingly competitive job market.

Pharmacy faculty retirement at colleges and schools of pharmacy in the United States and Canada.

OBJECTIVES: To examine the work-related activities of full-time faculty members 55 years of age and older; to describe the retirement plans and perceptions of these faculty members; and to examine the factors, perceptions, or conditions that might influence the retirement decision. METHODS: Pharmacy faculty members aged 55 years and older in the United States and Canada were invited to participate in an online survey regarding their perceptions on issues related to their retirement planning behavior. RESULTS: Four hundred eighty-eight faculty members completed the survey instrument. The typical respondent worked 50 hours per week on work-related activities, was active in teaching and service, and had published an average of 5 refereed papers during the previous 36 months. The number of articles published was positively related to the respondent's target retirement age. The average anticipated retirement age was 66.6 years, and most respondents participated in a defined benefit plan. The majority would revise their target retirement age downwards if conditions were favorable. CONCLUSION: The primary factors that influence the pharmacy faculty retirement decision include financial status, academic productivity, and higher order needs such as the opportunity to participate in meaningful activities. These findings can be used by administrators in strategic planning related to attracting and retaining quality faculty members.

Concurrent use of an audience response system at a multi-campus college of pharmacy.

OBJECTIVE: To assess the impact of an audience response system (ARS) on student engagement at a multi-campus college of pharmacy. METHODS: An online questionnaire was designed and administered to measure the impact of an ARS on student engagement, distance education, projected use, and satisfaction among pharmacy students for a course delivered across 3 sites via synchronous video transmission. RESULTS: Students reported that use of the ARS made it easier to participate (85.3%) and helped them to focus (75.7%) in classes when the lecturer was physically at a different site. They also valued that the ARS allowed them to respond anonymously (93.2%). A minority of students indicated that use of the ARS was distracting (11.8%). CONCLUSIONS: Implementation of an ARS was associated with positive student perceptions of engagement and may improve feelings of connectedness among students at schools with multiple sites. Use of ARSs could also represent a cognitive intercession strategy to help reduce communication apprehension.

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.

Community pharmacists' use of language-access services in the United States.

OBJECTIVE: To examine community pharmacists' use of language-access services (LASs) in the United States. DESIGN: Cross-sectional study. SETTING: United States from January to February 2009. PARTICIPANTS: 1,000 pharmacists (500 community chain and 500 community independent pharmacists). INTERVENTION: Mailed survey. MAIN OUTCOMES MEASURE: Use, availability, and characterization of written translation and verbal interpretation LASs, along with perceived barriers for LASs. RESULTS: 296 surveys were completed, yielding an adjusted response rate of 30.0%. Computer software was used more often for translation LASs (57.4%) compared with pharmacists using on-site personnel (38.4%). Almost one-half of all pharmacies (49.8%) that possessed LAS capacity failed to notify patients of their availability. Many respondents indicated that they never used translation (40.9%) or interpretation (39.8%) in their pharmacies. The most commonly cited barrier for use of LASs by community pharmacists was potential inaccuracies in translation/interpretation (52.1%). Lack of time (25.1%) was frequently cited for failing to use LASs. CONCLUSION: Community pharmacists are not consistently or optimally using LASs in daily practice. Failure to use LASs can result in poorer outcomes for patients with limited English proficiency. Developing means to navigate work station-related barriers to LASs may yield improved patient care. Incorporation of professional continuing educational programs, automated LAS kiosks, natural language processing, and social media solutions merit exploration in addressing these challenges.

Pharmacist use of social media.

INTRODUCTION: The rapid emergence and exploding usage of social media (also called Web 2.0) present pharmacists with new professional, ethical and time management challenges. OBJECTIVES: To describe social media use among pharmacists in West Virginia, USA. METHODS: A survey was administered during the West Virginia Pharmacist Association 102nd Annual Convention held in October 2009. The meeting participants were pharmacists practising in the different regions of West Virginia. All conference attendees were eligible to participate. RESULTS: The survey was completed by all 50 pharmacists in attendance, yielding a response rate of 100%. Social media use was found to be common among West Virginia pharmacists, with the most frequently used applications including: YouTube (74%), Wikipedia (72%), Facebook (50%), and blogs (26%). However, there were some tools that pharmacists barely used such as Bebo, Hi5, Flickr and Friendster. Given the widespread use of Facebook by respondent pharmacists, it is noteworthy that they indicated the main purposes for using it were for chatting, uploading pictures and keeping touch with friends rather than for professional and educational purposes. DISCUSSION: Presently, pharmacists utilize social media primarily for personal purposes. As social media becomes more sophisticated and widely adopted in the healthcare arena, it is probable that pharmacists will also increasingly utilize it for professional and educational purposes.

E-prescribing: attitudes and perceptions of community pharmacists in Puerto Rico.

E-prescribing may help reduce medical errors. Study objectives were to determine use, perceptions, and a model of adoption regarding e-prescribing. A questionnaire was developed and sent to pharmacists in Puerto Rico. Multiple regression analyses were used to test a model of influences on adoption. 438 pharmacists responded. The overall adoption model was significant. Perceived advantages had a positive influence on adoption. Pharmacist groups demonstrating higher adoption included: male > female, chain > independent, younger > older (all p < 0.05). Barriers had a negative influence (p = 0.01). The model employed here can help explain pharmacist adoption and integration of e-prescribing.

Global education implications of the foreign pharmacy graduate equivalency examination.

Although the Foreign Pharmacy Graduate Equivalency Examination (FPGEE) is not intended to measure educational outcomes or institutional effectiveness, it may be a reliable and valid criterion to assess the quality or success of international pharmacy programs. This comprehensive review describes the evolution and historical milestones of the FPGEE, along with trends in structure, administration, and passing rates, and the impact of country of origin on participant performance. Similarities between the FPGEE and the Pharmacy Curriculum Outcomes Assessment (PCOA) are also explored. This paper aims to provide a global prospective and insight for foreign academic institutions into parameters for evaluating their students' educational capabilities.

Physician attitudes toward collaborative agreements with pharmacists and their expectations of community pharmacists' responsibilities in West Virginia.

OBJECTIVES: To (1) investigate physicians' expectations about community pharmacist's roles and physician attitudes toward collaborative agreements with community pharmacists in West Virginia and (2) determine physicians' perceptions of pharmacists providing medication therapy management (MTM) services. METHODS: A mail survey was conducted for a random sample of 500 physicians practicing in West Virginia. Survey items measured the physicians' perceptions about the roles of pharmacists, their level of comfort with pharmacists providing certain MTM services, and their attitudes toward a collaborative agreement with pharmacists. RESULTS: 102 responses were received, yielding a response rate of 22.1%; 60% of the physicians had a favorable attitude toward supporting collaborative agreement with pharmacists. Physicians were more comfortable with certain areas of MTM services, such as general drug education and the Medicare Part D prescription drug benefit, and they expected pharmacists to identify medication errors and educate the patients about the safe and appropriate use of medications. CONCLUSION: Of the physician respondents, 60% reported a favorable attitude toward collaborative practice agreements, but their attitude toward pharmacists' role in collaborative drug therapy management and pharmacists providing MTM services were not that favorable. Participating physicians may not have consistent expectations regarding pharmacists providing patient care.

Physician attitudes toward pharmacist provision of medication therapy management services.

OBJECTIVE: The implementation of Medicare Part D in 2006 has the potential to advance the profession of pharmacy through the provision and remuneration of pharmacist-provided medication therapy management (MTM) services. Limited research has evaluated physician attitudes toward pharmacist-provided MTM services, and little is known about factors that may affect these attitudes. The aim of this study was to test a model of physicians' attitudes toward pharmacist-provided MTM services as a part of Medicare Part D. SETTING AND METHOD: A mail survey was sent to a random sample of 500 physicians practicing in West Virginia. Multiple linear regression was used to test the model. MAIN OUTCOME MEASURE: The independent variables included prescription volume, specialty type, years of practice, gender, academic affiliation, practice size, physicians' attitudes toward collaborative agreement, and physician-pharmacist communication frequency. Additionally, physician age was included as a control variable. RESULTS: A total of 102 responses were received yielding a response rate of 22.1%. The mean for physicians' attitude to support provision of MTM by pharmacists was 2.84 out of 5. The overall physicians' attitudes model for provision of MTM by pharmacists was found to be significant. Physicians' attitudes toward collaborative agreement, specialty, years of practice, physician-pharmacist communication frequency regarding patients communication, and gender had significant influences on physician attitudes toward provision of MTM by pharmacists. CONCLUSION: The proposed model can provide insight into physicians' attitudes toward provision of MTM by pharmacists and may be helpful in developing future approaches and policies to further improve this collaborative relationship.

Characteristics of physicians targeted by the pharmaceutical industry to participate in e-detailing.

Electronic detailing (e-detailing) has been introduced in the last few years by the pharmaceutical industry as a new communication channel through which to promote pharmaceutical products to physicians. E-detailing involves using digital technology, such as Internet, video conferencing, and interactive voice response, by which drug companies target their marketing efforts toward specific physicians with pinpoint accuracy. A mail survey of 671 Iowa physicians was used to gather information about the physician characteristics and practice setting characteristics of those who are usually targeted by pharmaceutical companies to participate in e-detailing. A model is developed and tested to explain firms' targeting strategy for targeting physicians for e-detailing.