Pharmacist roles in the medication use process: Perceptions of patients, physicians, and pharmacists.

OBJECTIVES: It is uncertain whether stakeholder perceptions of pharmacist roles in the medication use process (MUP) have evolved alongside pharmacist advanced scope of practice. This study aimed to examine patient, pharmacist, and physician perceptions of pharmacist roles in the MUP. DESIGN: This IRB-approved study used a cross-sectional design with online panels of patients, pharmacists, and physicians. SETTING AND PARTICIPANTS: A Qualtrics panel of 1,004 patients, 205 pharmacists, and 200 physicians completed the surveys between August-November 2021. OUTCOME MEASURES: Using role theory as framework, 12-item surveys were developed to examine perceptions regarding effectiveness of and best choice for improving each MUP step. Data analysis included descriptive statistics, correlations, and comparisons. RESULTS: Majority of the physician, pharmacist, and patient samples believed that physicians prescribe the best possible medications (93.5%, 83.4%, 89.0% respectively), prescriptions are filled accurately (59.0%, 61.4%, 92.6% respectively) and timely (86.0%, 68.8, 90.2% respectively). Majority of physicians (78.5%) opined prescriptions are generally error free and patients are monitored (71%); fewer pharmacists agreed (42.9%, 51%; p<0.05). Most patients (92.4%) reported taking medications as directed; only 60% professionals agreed (p<0.05). Physicians selected 'pharmacists' as top choice for reducing dispensing errors, providing counseling, and helping patients take medications as directed. Patients wanted pharmacists to help manage their medications (87.0%) and 'someone' to periodically check on their health (100%). All 3 groups agreed physician-pharmacist collaboration was important to improve patient care and outcomes (90.0%-97.1%); however, 24% of physicians were uninterested in collaboration. Both professionals reported lack of time, appropriate setup, and interprofessional communication as challenges to collaboration. CONCLUSION: Pharmacists believe their roles have evolved to align with expanded opportunities. Patients perceived pharmacists play comprehensive roles in medication management through counseling and monitoring. Physicians recognized pharmacist roles in dispensing and counseling, but not in prescribing or monitoring. Clarity in role expectations amongst these stakeholders is critical to optimizing pharmacist roles and patient outcomes.

Implementation and Evaluation of a Prior Authorization Workflow for New-Start Inpatient Medications in Preparation for Discharge.

Purpose: Medications that require prior authorization can complicate the discharge planning process. This study implemented and evaluated a process for identifying and completing prior authorizations during the inpatient setting prior to patient discharge. Methods: A patient identification tool was developed within the electronic health record to alert the patient care resource manager of inpatient orders for targeted medications that frequently require prior authorization with the potential to delay discharge. A workflow process using the identification tool and flowsheet documentation was developed to prompt the initiation of a prior authorization, if necessary. Following hospital-wide implementation, descriptive data for a 2-month period was collected. Results: The tool detected 1353 medications for 1096 patient encounters over the 2-month period. The most frequent medications identified included apixaban (28.1%), enoxaparin (14.4%), sacubitril/valsartan (6.4%), and darbepoetin (6.4%). For the medications identified, there were 93 medications documented in the flowsheet data for 91 unique patient encounters. Of the 93 medications documented, 30% did not require prior authorization, 29% had prior authorization started, 10% were for patients discharged to a facility, 3% were for home medications, 3% were medications discontinued at discharge, 1% had prior authorization denied, and 24% had missing data. The most frequent medications documented in the flowsheet included apixaban (12%), enoxaparin (10%), and rifaximin (20%). Of the 28 prior authorizations processed, 2 led to a referral to the Medication Assistance Program. Conclusion: The implementation of an identification tool and documentation process can help improve PA workflow and discharge care coordination.

Assessment of pharmacy technician learning preferences and implications for training.

PURPOSE: To assess pharmacy technician learning preferences using the VARK tool and through self-identification. METHODS: The VARK (visual, aural, read/write, kinesthetic) questionnaire was incorporated into a larger survey, which was distributed during live staff meetings and a continuing education session held by the Ohio Pharmacists Association attended by 204 pharmacy technicians across various practice settings. RESULTS: A 90% response rate was achieved. Most respondents (78.8%) self-identified a single predominant learning preference, with 60.3% indicating a preference for kinesthetic learning methods. In contrast, after assessment with the VARK questionnaire 37.9% of survey participants were categorized as having a quadmodal learning style incorporating all VARK modalities. With regard to the Pharmacy Technician Certification Exam, a large majority of participants (96.2% of those providing a response) indicated that they had taken the exam in the past, with 17 participants (9.3% of those providing a response) indicating more than 1 attempt to pass the exam. Furthermore, experiential (on-the-job) training was identified by a large majority of survey respondents (79.3%) as the preferred way to learn new information. CONCLUSION: Learning preferences of pharmacy technicians vary amongst individuals, with many found to have multiple learning preferences through VARK questionnaire assessment. Incorporating experiential training and establishing learning preferences of pharmacy technicians may aid in development of accredited training programs that cater to the needs of pharmacy technicians.

Patient perceptions of pharmacogenomic testing in the community pharmacy setting.

BACKGROUND: In order to optimize community pharmacist roles and patient outcomes, a better understanding of patient perceptions of pharmacogenomic (PGx) testing may be helpful for successful integration into community pharmacy practice. OBJECTIVE: The objective of this study was to identify patient perceptions related to PGx testing in the community pharmacy setting. METHODS: Semi-structured, face-to-face interviews were conducted with adults ≥18 years of age to gather their perceptions of PGx testing. Interview participants were taking either an antiplatelet agent or a selective serotonin reuptake inhibitor listed in Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines and were patients at one of two community pharmacies in West Michigan. Interview questions were designed to follow the Theory of Planned Behavior and to take into account existing literature on patient perceptions of PGx. Interviews were recorded, transcribed by a third party transcription service, coded by a team of three researchers to identify themes, and analyzed using nVivo qualitative analysis software. RESULTS: A total of 19 interviews were conducted over a period of 16 days in June 2016. Upon preliminary evaluation, four themes related to patient perceptions of PGx testing were consistently observed across multiple interviews: 1) trust, 2) experience, 3) risk/benefit, and 4) clarity. CONCLUSIONS: Semi-structured patient interviews revealed four themes related to PGx testing in the community pharmacy setting. These themes may influence the desire to pursue PGx testing. Future research may seek to identify how community pharmacists can communicate with patients about PGx in the context of these themes to empower patients to make positive health care decisions.

Triple strength utility of the Modified Drug Adherence Work-Up (M-DRAW) tool in a veterans affairs outpatient diabetes clinic.

OBJECTIVE: The purpose of this study was to test the psychometric properties of the M-DRAW tool and to examine its applicability and utility at a primary clinic setting in patients with diabetes. METHODS: A prospective, pre-post interview design study was conducted at the VA Loma Linda Health System (VALLHS) from 03/2017-03/2018. Eligibility criteria consisted of English-speaking patrons who were 18 years and older, diagnosed with Type 2 diabetes mellitus, residing in non-institutional setting, and having 1 + prescriptions for diabetes. A priming question about self-reported adherence was used to assign participants to control (Group A) or intervention (Group N). Pharmacist-led interventions were thus directed to those who recognized their medication nonadherence issue. The M-DRAW tool consisted of 13 statements about barriers to adherence on a 4-point frequency scale. A "3 = sometimes" or "4 = often" on each item indicated a barrier to adherence that was then addressed using the GUIDE strategy using motivational interviewing with the participant. RESULTS: Of the 200 eligible individuals, 88 participants completed both baseline and follow-up assessments (Group A, n = 63; Group N, n = 25). Participants were male (98.8%), taking 7-8 medications on average, and using insulin (79.5%). The tool yielded good internal consistency (Cronbach's alpha = 0.873). Using confirmatory factor analysis, four factors were extracted with items loading as hypothesized. At baseline, group N identified three times greater number of barriers from the M-DRAW tool compared to Group A (5.1 items vs. 1.7, p < 0.05). At 3-month follow-up, a decrease in the number of barriers was observed among Group N. Both PDC and HbA1c did not result in statistically significant reduction in pre-post change. CONCLUSIONS: The M-DRAW tool is shown to be reliable and valid. A tailored intervention reduced the number of barriers contributing to medication nonadherence and resulted in a trend of improved clinical outcomes.

Pharmacy technician involvement in community pharmacy medication therapy management.

OBJECTIVES: To assess the impact of technician involvement on the completion of medication therapy management (MTM) services in a community pharmacy setting and to describe pharmacists' and technicians' perceptions of technician involvement in MTM-related tasks and their satisfaction with the technician's role in MTM. DESIGN: Prospective observational study. SETTING AND PARTICIPANTS: In the fall of 2015, pharmacists and selected technicians from 32 grocery store-based community pharmacies were trained to use technicians within MTM services. MAIN OUTCOME MEASURES: Completed MTM claims were evaluated at all pharmacies for 3 months before training and 3 months after training. An electronic survey, developed with the use of competencies taught in the training and relevant published literature, was distributed via e-mail to trained employees 3 months after training. RESULTS: The total number of completed MTM claims at the 32 pharmacy sites was higher during the posttraining time period (2687 claims) versus the pretraining period (1735 claims). Of the 182 trained participants, 112 (61.5%) completed the survey. Overall, perceived technician involvement was lower than expected. However, identifying MTM opportunities was the most commonly reported technician MTM task, with 62.5% of technicians and 47.2% of pharmacists reporting technician involvement. Nearly one-half of technicians (42.5%) and pharmacists (44.0%) agreed or strongly agreed they were satisfied with the technician's role in MTM services, and 40.0% of technicians agreed that they were more satisfied with their work in the pharmacy after involvement in MTM. CONCLUSION: Three months after initial training of technicians in MTM, participation of technicians was lower than expected. However, the technicians involved most often reported identifying MTM opportunities for pharmacists, which may be a focus for future technician trainings. In addition, technician involvement in MTM services may increase satisfaction with many aspects of work for actively involved technicians.

Efficiency analysis of a barcode-enabled and integrated medication-tracking system.

PURPOSE: Operational efficiency improvements for pharmacy workflow processes were evaluated using a barcode-enabled and integrated medication-tracking system for medications dispensed from the pharmacy to the emergency department (ED). METHODS: The preimplementation study period (Period 1) was defined as November 17-December 16, 2015; system implementation and training, were defined as December 17, 2015-January 18, 2016; and postimplementation (Period 2) was defined as January 19-February 17, 2016. Periods 1 and 2 were compared to (1) quantify the number and type of phone calls received related to medication inquiries, (2) evaluate the percentage of redispensed doses per total dispensed doses, and (3) assess the rate of medication administration record (MAR) messages received per total dispensed doses. RESULTS: A reduction in the total number of phone calls by 77% was observed (from 125 to 29 calls). A 0.7% difference was detected for re-dispensed doses as well as MAR messages (0.009% difference in rate) between the 2 study periods. This difference was observed despite an increase in the total amount of dispensed doses that occurred for both redispensed doses (936) and MAR messages (920) during Period 2. CONCLUSION: A barcode-enabled and integrated medication-tracking system was successfully implemented into the medication distribution process in the ED. The process change increased operational pharmacy efficiencies by decreasing medication status phone calls, redispensed doses, and MAR messages.

Validating the Modified Drug Adherence Work-Up (M-DRAW) Tool to Identify and Address Barriers to Medication Adherence.

Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW) was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often). The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity) in patients taking one or more prescription medication(s) for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 "adherers" (65.4%), and into the intervention group of nine "unintentional and intentional non-adherers" (34.6%). Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74) for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p < 0.05). The current study did not investigate construct validity due to small sample size and challenges on follow-up with patients. Future testing of the tool will include construct validation.

Decision-making during initiation of medication therapy.

BACKGROUND: Individuals' frequent and consistent interaction with medications can serve as a unifying element to help coordinate individuals' health care services. Despite its potential to improve coordination of heath care, initiation of medication therapy from the perspective of individuals' experiences remains largely unexamined. OBJECTIVES: The objectives for this study were to describe the viewpoints of consumers, physicians, pharmacists, and social workers regarding initiation of medication therapy in terms of: (1) activation and engagement, (2) information processing, and (3) economic factors. METHODS: Data were collected via mailed survey methodology from random samples of 400 adults, 400 physicians, 400 pharmacists, and 400 social workers residing in Minnesota. Responses to open-ended questions were coded using content analysis and summarized with descriptive statistics. RESULTS: The findings showed that consumer views of (1) activation and engagement, (2) information processing, and (3) economic factors differed from the views of physicians, pharmacists, and social workers. Consumers typically view initiation of medication therapy within the context of their overall lives. Physicians view it as a biomedical puzzle in which diagnosis, drug product selection, and risk assessment are main concerns. Pharmacists view it as a health care systems puzzle in which insurance coverage, cost, and risk management are main concerns. Social workers view it as a social systems puzzle in which access to care, cost, and social support are main concerns. CONCLUSIONS: Initiation of medication therapy is a disjointed experience for many consumers. The best timing for providing information about prescription drugs to individuals depends largely on what kinds of thoughts and impressions they have about a new therapy at various stages of the medication use process. The findings from this study can be useful for (1) developing consumer-centered approaches for medication use and (2) coordinating health care through the integration of the medication experience using consumer viewpoints.

The social network paradigm and applications in pharmacy.

BACKGROUND: There have been calls for research to include contextual and macrolevel factors within explanatory models of human health. A network approach focuses on the influence of relationships to predict behavior. OBJECTIVES: The first objective was to describe the social network paradigm based in sociology that uses network principles and methods to visualize, quantify, and predict outcomes using the structure and function of relationships. The second objective was to discuss applications of this approach in the context of health to guide future research in pharmacy. METHODS: This was a descriptive overview of conceptual models, methods, measures, and analyses that are used in the social network paradigm. RESULTS: The social network paradigm contains conceptual models that rely on relational and structural assumptions to make predictions related to human behavior. Although there is not 1 dominate theory of social networks, several models hold across applications and are commonly used by scholars. The methodology emphasized considerations of network boundaries, sampling strategies, and the type of data collected. Specific variables used in social network analysis were defined and dichotomized into constructs of centrality and cohesion. Network analysis was described in terms of available computational programs, data management, and statistical testing. Related research in health care was applied and ideas for pharmacy were proposed using a social network-based theoretical model. CONCLUSIONS: There is growing momentum for health behaviorists to gain familiarity for studying the effect of social networks on behavior. Applications in pharmacy using social network models, methods, and analysis can be used as a stand-alone perspective or in conjunction with other theoretical perspectives in an effort to explain human health or organizational behavior in health care settings.

College of pharmacy-based medication therapy management program for a university system.

OBJECTIVE: To document and evaluate the design and operation of a medication therapy management (MTM) benefit and associated MTM clinic developed by the University of Minnesota College of Pharmacy as a covered health plan benefit for University of Minnesota, Duluth (UMD) employees, early retirees, and their dependents. SETTING: Office-based, nondispensing pharmacy at UMD. PRACTICE DESCRIPTION: College of Pharmacy, Duluth faculty developed and provided MTM services as a covered health benefit for UMD beneficiaries. PRACTICE INNOVATION: Partnership between a university campus and a college of pharmacy to design and implement an MTM benefit as part of the university health plan covering current employees, early retirees, and dependents. MAIN OUTCOME MEASURES: MTM benefit design, MTM clinic implementation, patient complexity comparisons, and drug therapy problems identified and addressed. RESULTS: Of 1,000 eligible beneficiaries, 68 (∼7%) took advantage of the MTM benefit, consistent with national participation rates but lower than the 25% goal for participation. Beneficiaries receiving MTM services were three times more complex in terms of health resource use than the "typical" UMD beneficiary and were experiencing 7.22 drug therapy problems per patient. CONCLUSION: The UMD MTM clinic was successful in providing UMD beneficiaries access to MTM services. The MTM benefit was subsequently offered throughout the entire University of Minnesota system (Crookston, Duluth, Minneapolis-St. Paul, and Morris).

Professional technical standards in colleges and schools of pharmacy.

OBJECTIVE: To determine the prevalence, characteristics, and use of professional technical standards among colleges and schools of pharmacy accredited by the Accreditation Council for Pharmacy Education (ACPE). METHODS: The Web site of every college and school of pharmacy accredited by ACPE was searched to identify information regarding the availability, content, and use of technical standards and to obtain demographic information. RESULTS: Information was obtained from all of the 114 colleges and schools of pharmacy and 67 (59%) had technical standards in place. Common themes for technical standards were: observation; communication; motor; intellectual, conceptual, integrative and quantitative abilities; and behavioral and social attributes. Of those colleges and schools with technical standards, 61 (91%) had standards that addressed all 5 of these themes and 34 (51%) specified that the technical standards were used in their admission, progression, and graduation procedures. CONCLUSION: More than half of the colleges and schools of pharmacy examined in this study have technical standards; however, 41% have yet to develop and implement them. Colleges and schools of pharmacy looking for guidance in technical standards development could use the technical standards themes identified in this study.

PDP or MA-PD? Medicare part D enrollment decisions in CMS Region 25.

BACKGROUND: The Medicare Prescription Drug Improvement and Modernization Act of 2003 provides outpatient prescription drug coverage for Medicare beneficiaries through private insurers. This coverage is available through 2 primary venues: stand-alone prescription drug plans (PDPs) and integrated managed care (or Medicare Advantage) plans that also provide prescription drug coverage (MA-PDs). OBJECTIVES: The first objective was to describe factors associated with Medicare beneficiaries choosing to enroll in any Medicare part D PDP. The second objective was to describe factors associated with the choice of an MA-PD, given enrollment in the part D program. METHODS: The study used a cross-sectional, survey design. Data were collected from a stratified random sample of 5000 community-dwelling adults, aged 65 years and older in the Center for Medicaid and Medicare Services Region 25. Data were collected by means of a mailed questionnaire. Data analyses included univariate and bivariate descriptive statistics and multivariate probit modeling. RESULTS: The overall adjusted response rate was 50.2% (2309 of 4603). Data from 1490 respondents (32.4% of those attempted) were analyzed in this study. Nearly 75% of sample members elected to enroll in one of the Medicare part D coverage options in 2007, with more than 3 times as many choosing a PDP compared with a MA-PD option (57.2% vs 17.8%). A variety of variables including rurality, plan price, perceived future need for medications, and preferences emerged as important predictors of choosing to enroll in any Medicare part D drug plan, whereas rurality, state of residence, and number of diagnosed medical conditions were associated with the decision to enroll in a MA-PD. CONCLUSIONS: Models of health insurance demand and plan choice applied in this context appear to be modestly effective. Rurality and state of residence were particularly important contributors to both of these decisions, as were a variety of individual characteristics.

A thematic analysis for how patients, prescribers, experts, and patient advocates view the prescription choice process.

BACKGROUND: Typically, patients are unaware of the cost consequences regarding prescribing decisions during their clinical encounter and rarely talk with their physicians about costs of prescription drugs. Prescription medications that are deemed by patients to be too costly when the costs become known after purchase are discontinued or used at suboptimal doses compared to prescription medications that are deemed to be worth the cost. OBJECTIVES: To learn more about the prescription choice process from several viewpoints, the purpose of this study was to uncover and describe how patients, prescribers, experts, and patient advocates view the prescription choice process. METHODS: Data were collected via 9 focus group interviews held between April 24 and July 31, 2007 (3 with patients, 3 with prescribers, 2 with experts, and 1 with patient advocates). The interviews were audiotaped and transcribed. The resulting text was analyzed in a descriptive and interpretive manner. Theme extraction was based on convergence and external divergence; that is, identified themes were internally consistent but distinct from one and another. To ensure quality and credibility of analysis, multiple analysts and multiple methods were used to provide a quality check on selective perception and blind interpretive bias that could occur through a single person doing all of the analysis or through employment of a single method. RESULTS: The findings revealed 5 overall themes related to the prescription choice process: (1) information, (2) relationship, (3) patient variation, (4) practitioner variation, and (5) role expectations. The results showed that patients, prescribers, experts, and patient advocates viewed the themes within differing contexts. CONCLUSIONS: It appears that the prescription choice process entails an interplay among information, relationship, patient variation, practitioner variation, and role expectations, with each viewed within different contexts by individuals engaged in such decision making.

Outcome and self-efficacy expectations for medication management of patients with diabetes: influence of the pharmacist-patient relationship.

OBJECTIVE: To examine how outcome and self-efficacy expectations for medication management and self-monitoring of patients with diabetes vary by different indicators of a pharmacist-patient relationship. DESIGN: Cross-sectional descriptive study. SETTING: United States during late 2004. PARTICIPANTS: 568 noninstitutionalized adults (age > or = 18 years) with type 1 or type 2 diabetes who use at least one antidiabetic medication. INTERVENTION: Self-administered mail survey. MAIN OUTCOME MEASURES: Outcome and self-efficacy expectations for medication management and self-monitoring and pharmacist-patient relationship indicators. RESULTS: The adjusted response rate was 60.6% (568 of 937). Respondents had differing mean self-efficacy expectation scores (F = 7.82, P < 0.001) across knowing the pharmacist to varying degrees, and mean self-efficacy expectation scores were slightly higher for those who consult with a pharmacist to learn about antidiabetic medications (t = -2.41, P = 0.02) compared with those who do not. Relationship quality was correlated with both self-efficacy (r = 0.17, P < 0.000) and outcome expectation (r= 0.11, P = 0.02) scales. Self-efficacy expectations were higher for those scoring in the upper third of the pharmacist-patient relationship index compared with those in the lower third (t = -2.79, P = 0.006). CONCLUSION: Descriptive results support some association between the pharmacist-patient relationship and self-efficacy expectations, although whether this association lies in pharmacists providing education, social support, or both is not clear. Further research is needed to investigate this association to better elucidate the potential contribution of a pharmacist-patient relationship to patients' diabetes self-management. The pharmacist-patient relationship index developed for this study appears to provide a more comprehensive and sensitive measure compared with other indices, suggesting potential utility in future studies.

Implementing after-hours pharmacy coverage for critical access hospitals in northeast Minnesota.

PURPOSE: A project that used health information technology (IT) to provide after-hours pharmacy coverage to critical access hospitals in northeast Minnesota is described. SUMMARY: SISU Medical Systems was established to address the health care IT needs of the Wilderness Health Care Coalition hospitals. Administrators and nursing and pharmacy leaders at several Wilderness Coalition hospitals were interested in obtaining after-hours pharmacy services to optimize patient safety. Eight of the Wilderness Coalition critical access hospitals obtained the technology necessary to allow pharmacy staff at St. Luke's Hospital (the hub hospital) in Duluth, Minnesota, to electronically enter orders into the rural hospitals' patient electronic medical records. The system placed the orders into the patients' medication profiles on automated dispensing machines located at seven of the eight rural hospitals. The pharmacy computer system allowed for medication order processing, drug interaction checking, medication dispensing via automated dispensing cabinets at the rural hospital sites, and formulary and inventory management. Medications that were not available in a rural hospital's automated dispensing cabinet were obtained from the locked pharmacy by the nurse supervisor. Round-the-clock pharmacy coverage was almost achieved. Participating rural hospitals received 24-hour coverage from the hub hospital during weekends and holidays, but no after-hours (4 a.m.-7 a.m.) coverage was provided on weekdays. The staff at the rural hospitals determined from their experiences that new orders were less likely to be written during these hours. CONCLUSION: Using Internet-based health IT, pharmacists from a metropolitan (hub) hospital with round-the-clock pharmacist coverage participated in the care of patients at a number of small, rural hospitals and helped ensure that those patients received safe and effective medication therapy. The coverage provided by pharmacists at the hub hospital improved nursing satisfaction with the overall quality of pharmacy services provided by both the hub hospital and the local onsite pharmacists.

Pharmacists' and patients' roles in the pharmacist-patient relationship: are pharmacists and patients reading from the same relationship script?

BACKGROUND: Pharmacists' professional roles have maturated to include provision of information, education, and pharmaceutical care services. These changes have resulted in a focus on collaborative pharmacist-patient professional relationships, in which pharmacists and patients both have roles and responsibilities. OBJECTIVE: The study purpose was to investigate pharmacists' and patients' views of selected pharmacist and patient roles in the pharmacist-patient professional relationship, using principles of role theory. Pharmacist and patient role dimensions studied included (1) "information sharing,"(2) "responsible behavior," and (3) "interpersonal communication." "Creating a patient-centered relationship" and "active communication related to health care" were additional pharmacist and patient role dimensions studied, respectively. METHODS: Data were collected via mailed questionnaires from national random samples of 500 patients aged 18 years and older and 500 pharmacists. Internal consistency reliability was estimated for pharmacist and patient role dimensions using Cronbach's coefficient alpha and bivariate correlation analysis. Student's t test was used to compare pharmacists' and patients' views of role dimensions (alpha level of significance=.05). Descriptive statistics were used to characterize the pharmacist and patient samples. RESULTS: The adjusted response rates for the pharmacist and patient groups were 34.9% (173/496) and 40.8% (196/480), respectively. Pharmacist and patient role dimensions exhibited adequate reliability coefficients. Results showed that pharmacists and patients have similar views regarding pharmacists' "information sharing" roles in the relationship, but for the most part, patients agree less about pharmacists' "responsible behavior," "creating a patient-centered relationship," and "interpersonal communication" roles. Regarding patient roles in the relationship, pharmacists and patients have different views about patients' "information sharing," "responsible behavior," "interpersonal communication," and "active communication related to health care" roles. Results suggest that pharmacists more strongly agree that these are patient roles in the relationship than patients do. CONCLUSIONS: If pharmacists and patients agree on relationship roles, the functionality and outcomes of this relationship will be optimized. Future research is needed to monitor trends in pharmacists' and patients' views of their relationship roles and to develop strategies as needed to ensure that pharmacists and patients are following the same relationship script.

Testing a pharmacist-patient relationship quality model among older persons with diabetes.

BACKGROUND: Considering recent changes to the Medicare program, pharmacists will have unique opportunities to be reimbursed for providing Medication Therapy Management Services to older persons with diabetes. A high-quality pharmacist-patient relationship can lay the foundation for effective provision of Medication Therapy Management Services and improved care in this cohort. OBJECTIVE: To test a pharmacist-patient relationship quality model in a group of older persons with diabetes from the patient's perspective. Antecedents to relationship quality were pharmacist participative behavior/patient-centeredness of relationship, patient participative behavior, and pharmacist-patient interpersonal communication. Pharmacist-patient relationship commitment was the outcome of relationship quality studied. METHODS: Data were collected via mailed questionnaire from a random sample of 600 community-dwelling adults in the United States who (1) were 65 years of age and older, (2) had type 1 or type 2 diabetes, (3) used at least one prescription medication to treat their diabetes, and (4) used some type of nonmail order pharmacy as their primary source of obtaining prescription medications. Model relationships were tested using path analysis. RESULTS: The adjusted response rate was 41.6% (221/531). The models explained 47% and 49% of the variance in relationship quality and relationship commitment, respectively. In the relationship quality model, pharmacist participative behavior/patient-centeredness of relationship (beta=.51, P<.001) and pharmacist-patient interpersonal communication (beta=.17, P=.008) had direct effects on relationship quality. In the relationship commitment model, relationship quality had a direct effect on relationship commitment (beta=.60, P<.001). Pharmacist participative behavior/patient-centeredness and pharmacist-patient interpersonal communication had indirect effects on relationship commitment through their effects on relationship quality, which is a mediator in the model. CONCLUSIONS: Results affirm findings from previous research showing that patients' perceptions of pharmacist participative behavior/patient-centeredness of relationship and pharmacist-patient interpersonal communication are positively related to perceptions of relationship quality. Also, relationship quality is a strong mediator between pharmacist participative behavior/patient-centeredness of relationship and relationship commitment, as well as between pharmacist-patient interpersonal communication and relationship commitment.

Relationships between Hispanic ethnicity and attitudes and beliefs toward herbal medicine use among older adults.

BACKGROUND: Little is known about the underlying intentions to use herbal medicines among Hispanic older adults. Understanding these intentions is critical to the provision of effective counseling. OBJECTIVES: The objectives were to (1) identify predictors of the intention to use herbal medicines for health problems in the next 6 months among Hispanic and non-Hispanic older adults using the Theory of Planned Behavior (TPB); and (2) compare their beliefs underlying significant predictors of intention with use herbal medicines for health problems in the next 6 months. METHODS: Using a cross-sectional research design, data were collected via self-administered questionnaires from convenience samples at a Senior Health Clinic and a Veterans Affairs Hospital outpatient pharmacy. Study subjects were community dwelling adults aged 65 years and older and able to complete the survey in English. Multiple regression analysis was used to identify the significant predictors of intention to use herbal medicines in the TPB within each ethnicity. Independent t tests were used to compare the beliefs underlying the significant predictors of intention with use herbal medicines across the 2 groups. RESULTS: For both Hispanic (N=80) and non-Hispanic (N=171) patients, attitudes toward using herbal medicines was the only significant predictor of the intention to use herbal medicines in the next 6 months (Hispanics, Adj. R(2)=0.59, beta=0.78, P<.001; non-Hispanics, Adj. R(2)=0.57, beta=0.66, P<.001). The magnitude of the beta coefficients did not differ significantly between the 2 ethnicities. Compared with non-Hispanics, Hispanics believed that herbal medicines are cheaper, have fewer side effects, work better, and are more convenient to use than other medicines. CONCLUSIONS: Understanding ethnic differences in behavioral beliefs underlying attitudes toward the use of herbal medicines can help pharmacists and other health care professionals in educating and formulating appropriate counseling strategies specific to older patients of different ethnicities.

Provision of risk management and risk assessment information: the role of the pharmacist.

BACKGROUND: There exists a need to conceptualize and understand the roles that pharmacists serve to help convince others such as patients, prescribers, and payers to value their contributions and to plan for the roles they could serve in the future within the health care system. OBJECTIVE: The purpose of this study was to (1) describe and track differences in pharmacists' and patients' views about the pharmacist's and physician's role in medication risk management and risk assessment in 1995, 1998, 2001, and 2004, and (2) describe associations between selected demographic variables and reported opinions about the pharmacist's role using data from 2004. METHODS: Brushwood's Risk Management/Risk Assessment Framework was used as a conceptual guide for developing 2 risk management and 2 risk assessment scenarios. For each scenario, study participants were asked to select the level of responsibility shared by physicians and pharmacists in addressing the drug therapy problem. Data were collected in 1995, 1998, 2001, and 2004 using random samples of pharmacists and patients as study subjects. Descriptive statistics and logistic regression analysis were used for analyzing the data. RESULTS: The results showed that pharmacists view their role as providing risk management information to patients and may view this role as adding value to patient care above and beyond a level that can be provided by a physician alone. In 2004, pharmacists started to view the risk assessment scenarios as being more their responsibility as well. Patients, on the other hand, consistently viewed their physician as having primary responsibility for their health care in all of the scenarios we studied. CONCLUSIONS: Pharmacists view their role as one that adds unique value to a patient's health through their provision of medication risk management and some types of risk assessment. However, patients do not yet view the pharmacist as the primary provider of either medication risk management or risk assessment information.