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1.
BMC Health Serv Res ; 19(1): 805, 2019 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-31694628

RESUMEN

BACKGROUND: Since December 2010, a nationwide real-time medication surveillance program has been implemented in Korea to prevent potential adverse drug reactions. Our goal was to evaluate physicians' and pharmacists' satisfaction and clinical needs for the medication surveillance program in Korea. METHODS: Both web- and paper-based surveys were conducted using a structured questionnaire among 1164 physicians and pharmacists from May 23, 2014 to August 11, 2014. The survey consisted of questions about the participant's satisfaction with the medication surveillance program, clinical usefulness, clinical need for the medication surveillance program, and sociodemographic characteristics. Multivariate ordinal logistic regression was performed to investigate the factors influencing satisfaction levels with the medication surveillance program. RESULTS: We analyzed data from 1120 respondents, including 503 physicians and 617 pharmacists. Overall, 63.1% of the respondents were satisfied with the medication surveillance program. Pharmacists were more satisfied with the program than were physicians (69.1% vs. 55.6%; adjusted odds ratio, 2.13; 95% confidence interval, 1.65-2.76). Among the respondents, 77.8% cited a decrease in therapeutic duplication to be a major improvement resulting from the medication surveillance program, 82.6% considered the drug-drug interaction information useful, and 48.7% suggested that the program should include information on liver or kidney disease-drug interaction. CONCLUSIONS: Overall, 63.0% of physicians and pharmacists were satisfied, and a decrease in therapeutic duplication was regarded as the most beneficial component. Further improvements by considering clinical needs of physicians and pharmacists will be needed to increase satisfaction.


Asunto(s)
Revisión de la Utilización de Medicamentos/normas , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Errores de Medicación/prevención & control , Farmacéuticos/estadística & datos numéricos , Médicos/estadística & datos numéricos , Interacciones de Drogas , Humanos , Satisfacción Personal , República de Corea
2.
BMC Health Serv Res ; 19(1): 816, 2019 Nov 08.
Artículo en Inglés | MEDLINE | ID: mdl-31703672

RESUMEN

BACKGROUND: Pharmaceutical compounding is an essential component in pharmacy practice allowing pharmacists to provide dosage forms or strengths that are commercially unavailable. Medications compounded for patient-specific needs contribute to personalized medicine. Extemporaneous compounding provided by pharmacies overcomes the market shortage of these therapeutic products. The aim of this study is to investigate and characterize the prevalence, characteristics, and determinants of extemporaneous compounding in Jordanian pharmacies. METHODS: This study was based on a cross-sectional questionnaire and included 431 randomly selected pharmacies in the twelve governorates of the country. Data were collected via face to face interviews of pharmacists who voluntarily and verbally responded to the questions. RESULTS: Results revealed that 223 (51.7%) of the surveyed pharmacies practiced extemporaneous compounding. The main reason for not providing extemporaneous compounding services was lack of prescription orders for compounded preparations (53.8%). The second reason was lack of the equipment and supplies necessary for compounding (24.4%). Extemporaneous compounding prescriptions were mainly issued by dermatologists (98.2%); dermatological indication was the most common of all extemporaneous compounded prescriptions. The main reason for requesting compounded medications was the lack of a commercially available product (87.9%). The vast majority of the compounded dosage forms were creams (99.6) and ointments (91.5), followed by solutions (23.3%). Only 5 (2.2%) of the studied compounding pharmacies prepared sterile products. The major sources for compounding protocols were the physician order (94.2%), and 'in-house' protocols (44.8%). However, the main resource for estimating compounded medications expiration date was information based on pharmacist's experience (57.8%) and the physician's order (53.4%). CONCLUSIONS: Extemporaneous compounding is a common element of pharmaceutical care. Topical preparations are the most commonly compounded products. Finding from this study suggest that there is a need for standardizing the compounded product formularies, product quality testing, and improving the consistency in estimation of an expiration date of compounded products.


Asunto(s)
Composición de Medicamentos/estadística & datos numéricos , Farmacias/estadística & datos numéricos , Adulto , Anciano , Servicios Comunitarios de Farmacia/estadística & datos numéricos , Estudios Transversales , Femenino , Humanos , Jordania , Masculino , Persona de Mediana Edad , Farmacéuticos/estadística & datos numéricos , Servicio de Farmacia en Hospital/estadística & datos numéricos , Médicos/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
3.
Int J Equity Health ; 18(1): 151, 2019 10 12.
Artículo en Inglés | MEDLINE | ID: mdl-31604434

RESUMEN

BACKGROUND: Patients belonging to marginalised (medically under-served) groups experience problems with medicines (i.e. non-adherence, side effects) and poorer health outcomes largely due to inequitable access to healthcare (arising from poor governance, cultural exclusion etc.). In order to promote service equity and outcomes for patients, the focus of this paper is to explore the implementation and impact of a new co-produced digital educational intervention on one National Health Service (NHS) funded community pharmacy medicines management service. METHODS: Semi-structured interviews with a total of 32 participants. This included a purposive sample of 22 community pharmacy professionals, (16 pharmacists and 6 pharmacy support staff) all who offered the medicine management service. In order to obtain a fuller picture of the barriers to learning, five professionals who were unable to complete the learning were also included. Ten patients (from a marginalised group) who had received the service (as a result of the digital educational intervention) were also interviewed. Drawing on an interpretative analysis, Normalisation Process Theory (NPT) was used as a theoretical framework. RESULTS: Three themes are explored. The first is how the digital learning intervention was implemented and applied. Despite being well received, pharmacists found it challenging completing and cascading the learning due to organisational constraints (e.g. lack of time, workload). Using the four NPT constructs (coherence, cognitive participation, collective action and reflexive monitoring) the second theme exposes the impact of the learning and the organisational process of 'normalisation'. Professional reflective accounts revealed instances where inequitable access to health services were evident. Those completing the intervention felt more aware, capable and better equipped to engage with the needs of patients who were from a marginalised group. Operationally there was minimal structural change in service delivery constraining translation of learning to practice. The impact on patients, explored in our final theme, revealed that they experience significant disadvantage and problems with their medicines. The medication review was welcomed and the discussion with the pharmacist was helpful in addressing their medicine-related concerns. CONCLUSIONS: The co-produced digital educational intervention increases pharmacy professionals' awareness and motivation to engage with marginalised groups. However structural barriers often hindered translation into practice. Patients reported significant health and medicine challenges that were going unnoticed. They welcomed the additional support the medication review offered. Policy makers and employers should better enable and facilitate ways for pharmacy professionals to better engage with marginalised groups. The impact of the educational intervention on patients' health and medicines management could be substantial if supported and promoted effectively.


Asunto(s)
Educación en Farmacia/organización & administración , Equidad en Salud/organización & administración , Farmacéuticos/psicología , Adulto , Inglaterra , Femenino , Humanos , Masculino , Persona de Mediana Edad , Farmacéuticos/estadística & datos numéricos , Investigación Cualitativa , Medicina Estatal
4.
Int J Pharm Compd ; 23(5): 422-427, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31513542

RESUMEN

Medicating animals poses unique challenges that are often best dealt with via compounding. Pharmacists receive compounding training while in pharmacy school, but this training is not veterinary specific. Pharmacists are expected to have enough knowledge to properly verify prescriptions that are received at their practice site while keeping with the most up-to-date guidelines related to animal and human health. Whether pharmacists have the proper training to verify and/or compound veterinary specific medications is unknown. A self-administered survey was distributed electronically to 4,550 email addresses on record with the American College of Veterinary Pharmacists, the International Academy of Compounding Pharmacists, and the Society of Veterinary Hospital Pharmacists. The survey asked questions about regulations and standards associated with the use of prescription or compounded medications. Of the 4,550 distributed surveys, 153 were received, for a 3.4% response rate. Of the responses received, only 131 were used in the final data analysis. Most respondents correctly answered the assessment question regarding the ability to compound backordered, commercially available products. A majority of respondents incorrectly answered the question regarding the proper flavoring for a medication for a ferret. Those with more training perceived themselves to have a higher level of skill (r = 0.41, P<0.001). Similarly, those with formal veterinary training had better scores on Question 4 of the assessment questions, which requires knowledge of feline toxicities (P=0.029). The most common compounded medications dispensed in practice by pharmacists are methimazole, metronidazole, and gabapentin. Pharmacists mostly recognized that compounding backordered, commercially available products is permitted. Formal training improves familiarity with current compounding rules, regulations, and best practices. Formal training in veterinary pharmacy and veterinary compounding should be promoted and encouraged. Efforts should also be made at improving pharmacists' understanding of both veterinary and compounding laws and regulations.


Asunto(s)
Servicios Farmacéuticos , Farmacias , Drogas Veterinarias , Animales , Gatos , Composición de Medicamentos/estadística & datos numéricos , Humanos , Farmacéuticos/estadística & datos numéricos
5.
J Glob Health ; 9(2): 010412, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31489183

RESUMEN

Background: Antimicrobial resistance (AMR) driven by antibiotic consumption is a growing global health threat. However, data on antimicrobial consumption patterns in low- and middle-income countries (LMICs) is sparse. Here, we investigate the patterns of antibiotic sales in humans and livestock in urban Nairobi, Kenya, and evaluate the level of awareness and common behaviours related to antibiotic use and AMR amongst human and veterinary pharmacists. Methods: A total of 40 human and 19 veterinary drug store pharmacists were interviewed in Nairobi in 2018 using a standard questionnaire. Data recorded included demographic variables, types of antibiotics sold, antibiotic customers, antibiotic prescribing practices and knowledge of antibiotic use and AMR. Results: Our study shows that at the retail level, there is a considerable overlap between antibiotic classes (10/15) sold for use in both human and veterinary medicine. Whilst in our study, clinical training significantly influenced knowledge on issues related to antibiotic use and AMR and respondents had a relatively adequate level of knowledge about AMR, several inappropriate prescribing practices were identified. For example, we found that most veterinary and human drug stores (100% and 52% respectively) sold antibiotics without a prescription and noted that customer preference was an important factor when prescribing antibiotics in half of the drug stores. Conclusion: Although more research is needed to understand the drivers of antibiotic consumption in both human and animal populations, these findings highlight the need for immediate strategies to improve prescribing practices across the pharmacists in Nairobi and by extension other low- and middle-income country settings.


Asunto(s)
Antibacterianos/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud , Farmacéuticos/psicología , Adulto , Animales , Estudios Transversales , Farmacorresistencia Microbiana , Femenino , Humanos , Prescripción Inadecuada/estadística & datos numéricos , Kenia , Masculino , Farmacéuticos/estadística & datos numéricos , Encuestas y Cuestionarios
6.
Am J Health Syst Pharm ; 76(Supplement_3): S74-S78, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31418772

RESUMEN

PURPOSE: The development and implementation of centralized mail-order pharmacy services in an academic healthcare system are described. SUMMARY: The use of mail-order pharmacy services continues to increase, as mail-order services offer patient benefits such as reduced copayments and improved clinical outcomes. Prior to undertaking an initiative to improve its mail-order pharmacy services, the University of Utah Health system's pharmacy department offered decentralized mail-order pharmacy services at all of its retail pharmacies, but there was no standardized process for processing mail-order prescriptions or providing phone support to mail-order patients. Centralized mail-order pharmacy services were developed and implemented by creating (1) a standard process for mail-order pharmacy services, (2) a centralized mail-order prescription filling center, and (3) a call center to support mail-order pharmacy services. Implementation of centralized mail-order pharmacy services resulted in an almost 50% reduction in time spent by pharmacy team members on mail-order prescription filling and packaging tasks. Use of a central call center resulted in a decreased call abandonment rate and contributed to a decreased pharmacy workload resulting from an overall reduction in call volume due to an increased rate of first-call issue resolution. CONCLUSION: Establishment of a centralized mail-order pharmacy service along with operational and infrastructure improvements resulted in improved quality and regulatory compliance and enhanced labor efficiency and patient communication.


Asunto(s)
Implementación de Plan de Salud , Farmacias/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Servicios Postales , Centrales de Llamados/organización & administración , Hospitales Universitarios/organización & administración , Hospitales Universitarios/estadística & datos numéricos , Humanos , Farmacias/estadística & datos numéricos , Farmacéuticos/organización & administración , Farmacéuticos/estadística & datos numéricos , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Carga de Trabajo/estadística & datos numéricos
7.
BMC Health Serv Res ; 19(1): 571, 2019 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-31412944

RESUMEN

BACKGROUND: The use of psychotropic substances is controlled in most parts of the world due to their potential of abuse and addiction. Diazepam is one of the psychotropic substances which can be dispensed in community pharmacies in Tanzania. As per good dispensing practices and pharmacy laws, diazepam in the community pharmacies should strictly be stored in a controlled box and dispensed only by prescription. However, to our understanding little had been reported on availability and dispensing practices of diazepam in Tanzania. METHODS: A descriptive cross-sectional study which involved 178 randomly selected registered community pharmacies in Kinondoni district was conducted from January to March 2018. Simulated client approach was used to assess the availability and dispensers practice about dispensing of diazepam. Location of pharmacies was categorized as being at the centre or periphery of the Kinondoni district. Chi-squared test was used for the analysis of categorical data using SPSS version 23. The p-value of < 0.05 was considered significant. RESULT: The total of 178 community pharmacies were visited, the majority of the dispensers (89.1%) encountered were female. Most (69.1%) of the studied pharmacies were located at the centre of Kinondoni district. Diazepam was available in 91% of community pharmacies and 70% of dispensers issued diazepam without prescription. CONCLUSION: Diazepam was available in most of the community pharmacies in Kinondoni district, and the majority of the dispensers dispensed diazepam without prescription. This calls for the regulatory authorities to be more vigilant on the availability of diazepam and enhance the provision of ethical pharmacy practice in the community pharmacies.


Asunto(s)
Servicios Comunitarios de Farmacia , Diazepam , Prescripciones de Medicamentos/estadística & datos numéricos , Hipnóticos y Sedantes , Farmacéuticos , Servicios Comunitarios de Farmacia/legislación & jurisprudencia , Servicios Comunitarios de Farmacia/estadística & datos numéricos , Estudios Transversales , Diazepam/provisión & distribución , Humanos , Hipnóticos y Sedantes/provisión & distribución , Farmacéuticos/legislación & jurisprudencia , Farmacéuticos/estadística & datos numéricos , Tanzanía
8.
BMC Complement Altern Med ; 19(1): 229, 2019 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-31438941

RESUMEN

BACKGROUND: Use of complementary and alternative medicine (CAM), including vitamins, minerals, herbals, and other dietary supplements, is widespread in the United States (ranging from 24% in Hispanics to 50% in American Indians). Pharmacists are an accessible source for healthcare information, but little is known about their use of CAM products and to whom they would recommend these products. METHODS: A cross-sectional survey was sent via email to pharmacists licensed in one state in the United States in 2015. The survey included items about their use of 10 vitamins and minerals, and 21 herbal or other dietary supplements, as well as reasons for use, conditions used to treat, if they would recommend the product to patients, family, or friends, their perception of CAM safety and effectiveness, and four demographic questions. Descriptive statistics were used to summarize the data, and a chi-square test was used to determine differences between pharmacists' use of vitamins/minerals and herbals/other dietary supplements. The a priori alpha level was 0.05. RESULTS: A total of 639 pharmacists completed the survey. Female pharmacists used vitamins/minerals (p = 0.031) and herbals/others (p = 0.039) more than male pharmacists. Older pharmacists used herbals/others more than younger pharmacists (p < 0.001). Fifty-nine percent thought the dietary supplements in the survey were safe while 32% reported they were effective. Seventy-eight percent of respondents reported use of any vitamin or mineral product versus 42% who reported use of any herbal or other dietary supplement. Commonly used products included: multivitamins (91%), vitamin C (71%), fish oil (65%), probiotics (53%), and fiber (53%). The most commonly reported reason for use was general health and wellness (17-90%). Pharmacists most commonly recommend fiber/psyllium (94%) and calcium (90%) to patients, family, and friends. CONCLUSIONS: Pharmacists in this survey selectively used vitamins, minerals, herbals and other dietary supplements, and recommended some of the more commonly used products to patients, family and friends. This is valuable information given that pharmacists are frontline healthcare professionals who may be asked to provide advice about these products.


Asunto(s)
Micronutrientes/uso terapéutico , Educación del Paciente como Asunto/estadística & datos numéricos , Farmacéuticos/estadística & datos numéricos , Preparaciones de Plantas/uso terapéutico , Adulto , Actitud del Personal de Salud , Terapias Complementarias/estadística & datos numéricos , Estudios Transversales , Suplementos Dietéticos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto/métodos , Farmacia , Estados Unidos/epidemiología , Adulto Joven
9.
Malar J ; 18(1): 260, 2019 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-31362736

RESUMEN

BACKGROUND: Despite recent strides made towards reducing the emergence of artemisinin resistance, inappropriate dispensing practices for anti-malarials in both private and public sectors affect treatment outcomes negatively. In Ghana, private retail pharmacies are the most accessible health facilities for managing diseases of common occurrence. However, there is growing concern about the number of patients harmed by dispensing errors in the management of malaria in retail pharmacies. Although considerable work has been done in this area, several questions regarding dispensing practices remain unanswered. This study, therefore, sought to investigate the predictors of appropriate dispensing practices for anti-malarials in community pharmacies in the La Nkwantanang-Madina municipality of Greater Accra, Ghana. METHODS: A cross-sectional analytic study was conducted in sixty-one randomly selected community pharmacies in the La Nkwantanang-Madina. Data from 230 clients and 106 dispensers were analysed. It was checked for internal consistency and completeness then entered and analysed using STATA I/C version 14.0. Frequencies, Chi square tests, and logistic regression analyses were conducted, accounting for clustering. RESULTS AND DISCUSSION: Of the 106 dispensers interviewed, 71.4% were medicine counter assistants. The mean age of dispensers was 30.4 years (SD 8.8). Over 88.0% of clients were advised to complete the full course of their anti-malarials. However, the 8-h loading dose principle for artemether-lumefantrine was not explained to 88.3% of the clients. More than half of the clients (52.2%) were given appropriate dispensing information on anti-malarial use. Most clients (66.1%), were dispensed anti-malarials without malaria tests. Dispensers with more than a 10-years experience were less likely to dispense artemisinin-based combinations appropriately relative to dispensers with less than 2 years experience (AOR = 0.04, 95% CI 0.002-0.802 p-value = 0.036) while pharmacy interns were about 19 times more likely (AOR = 18.5, 95% CI 1.40-245.6 p-value = 0.03) to dispense artemisinin-based combinations appropriately compared to pharmacists. CONCLUSION: Dispensing practices for anti-malarials is unsatisfactory. There is a need to enforce existing legislation with educational programmes directed towards dispensers especially those with more than 10 years experience. Specific adherence to the World Health Organization Test, Treat and Track initiative should be encouraged to ensure effective use of anti-malarials.


Asunto(s)
Antimaláricos/efectos adversos , Competencia Clínica/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Farmacias/estadística & datos numéricos , Farmacéuticos/psicología , Adulto , Anciano , Estudios Transversales , Femenino , Ghana , Humanos , Masculino , Persona de Mediana Edad , Farmacéuticos/estadística & datos numéricos , Adulto Joven
10.
J Manag Care Spec Pharm ; 25(9): 989-994, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31456496

RESUMEN

BACKGROUND: Pharmacies have a unique opportunity to address suboptimal adult vaccination rates, but few solutions have proven effective. Such strategies are challenged by the lack of access that many pharmacies have to a patient's complete immunization history; consequently, they are unable to identify which of their patients actually require vaccination. A pharmacy-based strategy that leverages such information could enhance efforts to increase rates of guideline-based vaccination. OBJECTIVE: To determine the effect on vaccination rates of an automated telephonic intervention for adults in need of either pneumococcal vaccination or herpes zoster vaccination, or both. METHODS: Over a 1-year period, patients with identified vaccine gaps at 246 pharmacies of 3 pharmacy chains were randomly assigned to receive either usual care or an automated telephonic prompt for pneumococcal and/or herpes zoster vaccines based on patient records contained in state immunization registries and pharmacy data. The primary outcome was the proportion with administration of at least one of the vaccines offered between March 2016 and January 2017 based on intention-to-treat principles. Subgroup analyses included vaccination rates by age and sex. An as-treated analysis was also performed. RESULTS: 21,971 patients were included in the study, 57% of whom were female, with a mean age of 63 years. Vaccine administration proportions were 0.0214 (236/11,009) in the intervention group, and 0.0205 (225/10,962) in the control group (OR = 1.05, 95% CI = 0.87-1.26). Results did not differ in subgroup analyses based on patient age, sex, or individual pharmacy chain. Among intervention patients, 3,666 (0.333) completed the call by listening to the entire prompt. In an as-treated analysis comparing individuals who completed calls versus control, the intervention increased the odds of vaccination by 26% (OR = 1.26, 95% CI = 1.00-1.61). CONCLUSIONS: The automated prompt did not significantly increase vaccination rates. Potential barriers included intervention technical flaws, low rates of connecting with patients, insufficient follow-up by the pharmacy, and patients placing a relatively low priority on being vaccinated. DISCLOSURES: This project was funded by Pfizer and Merck through a grant from the Pharmacy Quality Alliance. Stolpe was an employee of the Pharmacy Quality Alliance at the onset of this project and an employee of Scientific Technologies Corporation during the data collection phase of the project. Stolpe has also served on the advisory board for Merck. Choudhry has no conflicts of interest to declare.


Asunto(s)
Servicios Comunitarios de Farmacia/estadística & datos numéricos , Inmunización/estadística & datos numéricos , Teléfono/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Femenino , Vacuna contra el Herpes Zóster/inmunología , Humanos , Vacunas contra la Influenza/inmunología , Masculino , Persona de Mediana Edad , Farmacéuticos/estadística & datos numéricos , Vacunas Neumococicas/inmunología , Sistema de Registros , Encuestas y Cuestionarios
11.
Am J Health Syst Pharm ; 76(7): 470-477, 2019 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-31415682

RESUMEN

PURPOSE: The development and implementation of a team-based pharmacy practice model is described. METHODS: In January 2016 a transition from a staff-specialist to a team-based pharmacy practice model was implemented. The overall goal of the model change was to enhance the pharmacist's clinical roles and further integrate pharmacists into the healthcare team. Before implementation of the new staffing model, a formalized metric evaluation process was created. The aim of this metric evaluation was to gauge model success, determine areas of model revision, and objectively communicate pharmacist impact. Objective metrics were evaluated before implementation and 1 year after implementation. In addition, surveys were distributed to pharmacists, physicians, nursing and hospital administration before and after model implementation. RESULTS: At 1-year postimplementation, the pharmacist:patient bed ratio decreased from 1:87 to 1:47, the number of rounds/huddles with pharmacist attendance increased by 63% to 80 per week, and the number of clinical interventions and new clinical consultations increased from 57 to 62 and from 12 to 16 per day, respectively. Nonformulary medication use also decreased from 1.77 to 0.623 per 1000 patient days, and compliance with therapeutic initiatives increased from 77%to 91%. Overall, 72% of pharmacist survey responses indicated satisfaction with the model change. CONCLUSION: A team-based pharmacy practice model was designed and successfully implemented over a 3-year period. Data analysis revealed improvements in clinical and operational endpoints and enhanced pharmacist, physician, and nursing satisfaction.


Asunto(s)
Modelos Organizacionales , Grupo de Atención al Paciente/organización & administración , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Rol Profesional , Centros Médicos Académicos/organización & administración , Actitud del Personal de Salud , Implementación de Plan de Salud , Humanos , Satisfacción en el Trabajo , Enfermeras y Enfermeros/psicología , Farmacéuticos/psicología , Farmacéuticos/estadística & datos numéricos , Médicos/psicología , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Rondas de Enseñanza/estadística & datos numéricos , Carga de Trabajo/estadística & datos numéricos
12.
Am J Health Syst Pharm ; 76(11): 836-845, 2019 05 17.
Artículo en Inglés | MEDLINE | ID: mdl-31415690

RESUMEN

PURPOSE: To evaluate final-year pharmacy students' perceptions toward pharmacogenomics education, their attitudes on its clinical relevance, and their readiness to use such knowledge in practice. METHODS: A 19-question survey was developed and modified from prior studies and was pretested on a small group of pharmacogenomics faculty and pharmacy students. The final survey was administered to 978 final-year pharmacy students in 8 school/colleges of pharmacy in New York and New Jersey between January and May 2017. The survey targeted 3 main themes: perceptions toward pharmacogenomics education, attitudes toward the clinical relevance of this education, and the students' readiness to use knowledge of pharmacogenomics in practice. RESULTS: With a 35% response rate, the majority (81%) of the 339 student participants believed that pharmacogenomics was a useful clinical tool for pharmacists, yet only 40% felt that it had been a relevant part of their training. Almost half (46%) received only 1-3 lectures on pharmacogenomics and the majority were not ready to use it in practice. Survey results pointed toward practice-based trainings such as pharmacogenomics rotations as the most helpful in preparing students for practice. CONCLUSIONS: Final-year student pharmacists reported varying exposure to pharmacogenomics content in their pharmacy training and had positive attitudes toward the clinical relevance of the discipline, yet they expressed low confidence in their readiness to use this information in practice.


Asunto(s)
Actitud del Personal de Salud , Educación en Farmacia/métodos , Farmacéuticos/psicología , Farmacogenética/educación , Estudiantes de Farmacia/psicología , Adulto , Curriculum , Docentes/psicología , Docentes/estadística & datos numéricos , Femenino , Humanos , Masculino , Farmacéuticos/estadística & datos numéricos , Estudiantes de Farmacia/estadística & datos numéricos , Encuestas y Cuestionarios/estadística & datos numéricos , Estados Unidos , Adulto Joven
13.
Am J Health Syst Pharm ; 76(16): 1238-1247, 2019 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-31369113

RESUMEN

PURPOSE: The purpose of this study was to identify and describe strategies that have successfully achieved collaboration among physicians and pharmacists providing comprehensive medication management (CMM) to support development of CMM services. METHODS: A 2-phase, mixed-methods approach was employed to identify successful strategies for building pharmacist-physician relationships in primary care clinic settings. Phase I used a qualitative approach to identify strategies deemed successful in building relationships with physicians. An advisory group of pharmacists with experience building CMM practices assisted in the development of minimum criteria characterizing pharmacists as having strong collaborative relationships. Semi-structured interviews were conducted with 10 interviewees meeting established criteria. Researchers coded interview transcripts and identified the resulting strategies. Phase II employed a survey instrument to determine how frequently identified strategies are used and evaluate the relative level of perceived impact of each strategy, which was distributed to a national audience of pharmacists practicing in ambulatory care settings. Responses from pharmacists meeting prespecified criteria were included in the analysis. RESULTS: Thirty-three strategies were identified and grouped into 8 themes. In phase II, 104 survey respondents met defined criteria and were eligible to endorse use of identified strategies and rate their relative influence. CONCLUSIONS: Thirty-three strategies were identified and grouped into 8 themes to aid pharmacists practicing CMM in developing stronger collaborative relationships with physician colleagues. A national sampling found many of these strategies were employed by a majority of pharmacists, who had found them to be influential in creating collaborative relationships.


Asunto(s)
Atención Ambulatoria/organización & administración , Relaciones Interprofesionales , Farmacéuticos/organización & administración , Médicos/organización & administración , Atención Primaria de Salud/organización & administración , Atención Ambulatoria/estadística & datos numéricos , Actitud del Personal de Salud , Conducta Cooperativa , Humanos , Farmacéuticos/psicología , Farmacéuticos/estadística & datos numéricos , Médicos/psicología , Atención Primaria de Salud/estadística & datos numéricos , Investigación Cualitativa , Encuestas y Cuestionarios , Estados Unidos
14.
BMC Health Serv Res ; 19(1): 476, 2019 Jul 11.
Artículo en Inglés | MEDLINE | ID: mdl-31296200

RESUMEN

BACKGROUND: The use of medication abortion is increasing rapidly in India, the majority of which is purchased through pharmacies. More information is needed about the quality of services provided by pharmacist about medication abortion, especially barriers to providing high quality information. The goal of this study was to explore the quality of pharmacist medication abortion provision using mixed methods to inform the developed of an intervention for this population. METHODS: Data was collected via convenience sampling using three methods: a quantitative survey of pharmacists (N = 283), mystery clients (N = 111), and in-depth qualitative interviews with pharmacist (N = 11). Quality indictors from the quantitative data from surveys and mystery clients were compared. Qualitative interviews were used to elucidate reasons behind findings from the quantitative survey. RESULTS: Quality of information provided to client purchasing medication abortion was low, especially related to timing and dosing of misoprostol (18% of pharmacists knew correct timing) and side effects (31% not telling any information on side effects). Mystery clients reported lower quality (less correct information) than pharmacists reported about their own behaviors. Qualitative interviews suggested that many barriers exist for pharmacists, including perceptions about what information clients can understand and desire, and also lack of comfort giving certain information to certain types of clients (young women). CONCLUSIONS: It is essential to improve the quality of information given to client purchasing medication abortion from pharmacists. Our findings highlight specific gaps in knowledge and reasons for poor quality information. Differences in guidelines available at that time from the Indian Government, World Health Organization, and the medication abortion boxes may lead to confusion amongst pharmacists and potentially clients. Interventions need to improve both knowledge about medication abortion and also biases in the provision of care.


Asunto(s)
Aborto Inducido/métodos , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Difusión de la Información , Farmacéuticos/psicología , Calidad de la Atención de Salud , Adulto , Femenino , Humanos , India , Masculino , Misoprostol/administración & dosificación , Farmacéuticos/estadística & datos numéricos , Embarazo , Investigación Cualitativa , Encuestas y Cuestionarios
15.
BMC Complement Altern Med ; 19(1): 179, 2019 Jul 19.
Artículo en Inglés | MEDLINE | ID: mdl-31324241

RESUMEN

BACKGROUND: Community-dwelling persons with dementia commonly use dietary supplements (DS), often without receiving help with the administration. Patient safety is a concern, as DS-drug interactions and adverse events are potential complications. Since many persons with dementia buy their DS in pharmacies, we investigated Norwegian pharmacy employees' attitudes and professional practice behaviors related to DS. METHODS: We conducted a survey in eight Norwegian municipalities of pharmacy employees involved in the sale of DS. The questionnaire covered demographics and investigated attitudes toward DS, professional practice behaviors related to the sale of DS, experiences with customers with dementia, and perceived and attributed responsibilities with regard to patient safety. RESULTS: One hundred and five employees responded (response rate: 52%). Most employees regarded general practitioners (GPs) as primarily responsible for safeguarding the use of DS by persons with dementia and rated themselves less responsible. Thirty-seven percent of the employees reported personal use of DS (past or current use). Nine percent considered some of the DS to have symptomatic or prophylactic effects against dementia. Forty-eight percent confirmed that they informed customers about potential adverse events; 42% indicated that they did this sometimes. Sixteen percent checked regularly for DS-drug interactions, and two-thirds checked depending on the customers' health, the type of drug or the type of DS. One-quarter regularly asked about the co-use of prescription drugs (PD) when selling DS, while only 2% asked about the co-use of DS when dispensing PD. Only 25% reported access to independent scientific information on all or most DS sold in their pharmacy. Eight percent had experienced unsafe use of DS by persons with dementia. Six percent had been taught about counselling persons with dementia. Education level influenced professional practice behavior to some extent. CONCLUSION: Pharmacy employees do not see themselves as primarily responsible for the safe use of DS by persons with dementia. Moreover, they have limited experience with the unsafe use of DS by these persons. There is potential for improvement regarding tools and educational interventions for pharmacy employees to provide sufficient help to persons with dementia who use DS.


Asunto(s)
Demencia/tratamiento farmacológico , Suplementos Dietéticos/análisis , Farmacéuticos/psicología , Adulto , Anciano , Demencia/psicología , Interacciones de Drogas , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Noruega , Farmacéuticos/estadística & datos numéricos , Farmacia , Encuestas y Cuestionarios
16.
Am J Health Syst Pharm ; 76(6): 360-365, 2019 Feb 21.
Artículo en Inglés | MEDLINE | ID: mdl-31361840

RESUMEN

PURPOSE: This study evaluated employee perceptions of safety culture in 9 health-system-owned community pharmacies using a safety culture survey before and after implementation of a Pharmacy Services Call Center (PSCC) designed to reduce distractions through reduction of phone volume related to refills and prescription readiness. METHODS: The Agency for Healthcare Research and Quality (AHRQ) Community Pharmacy Survey on Patient Safety Culture (CPSPSC) was used to collect employee safety culture perceptions pre-post PSCC implementation. A percent positive score (PPS) was calculated for each of 11 CPSPSC composite questions and for 1 overall rating of patient safety question based on AHRQ-suggested analytic procedures. Pre-post PSCC implementation, PPSs were compared using a chi-square test. RESULTS: Overall, the lowest composite PPS (Staffing, Work Pressure, and Pace) and the highest composite PPS (Patient Counseling) ranked the same in both survey periods. Of the nine PSCC pharmacies, statistically significant (p < 0.05) PPS improvements occurred in 4 composites including Teamwork (11.9%), Communication About Mistakes (18%), Staff Training and Skills (20.6%), and Staffing, Work Pressure, and Pace (11.8%). PSCC pharmacies also reported a 9.3% (NS) improvement in overall rating of pharmacy patient safety post PSCC implementation. Separate analysis of pharmacist responses was consistent with pharmacy level results, but technician results differed slightly in overall rating of safety perceptions. CONCLUSION: Presence of the PSCC appeared to increase pharmacy employees' perceptions of safety culture in the community pharmacies, an integral part of overall patient safety.


Asunto(s)
Actitud del Personal de Salud , Centrales de Llamados/organización & administración , Servicios Comunitarios de Farmacia/organización & administración , Seguridad del Paciente , Administración de la Seguridad , Centros Médicos Académicos/organización & administración , Centros Médicos Académicos/estadística & datos numéricos , Servicios Comunitarios de Farmacia/estadística & datos numéricos , Consejo/organización & administración , Implementación de Plan de Salud , Humanos , Errores de Medicación/prevención & control , Farmacéuticos/psicología , Farmacéuticos/estadística & datos numéricos , Técnicos de Farmacia/psicología , Técnicos de Farmacia/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Encuestas y Cuestionarios/estadística & datos numéricos , Estados Unidos , United States Agency for Healthcare Research and Quality , Carga de Trabajo/psicología , Carga de Trabajo/estadística & datos numéricos
17.
Am J Health Syst Pharm ; 76(6): 353-359, 2019 Feb 21.
Artículo en Inglés | MEDLINE | ID: mdl-31361842

RESUMEN

PURPOSE: The process and methods used in an impact assessment of a centralized pharmacy call center on community pharmacy employee patient safety climate perceptions, telephone distractions/interruptions, and prescription filling efficiency are described. SUMMARY: A broad-based team designed a multi-faceted, pre-post call center implementation analysis that included multiple change assessment measures. First, yearly administration of the Agency for Healthcare Research and Quality Community Pharmacy Survey on Patient Safety Culture was used to assess patient safety climate based on employee perceptions of a safe working environment and potential for errors due to interruptions and distractions. Evaluative measures of staff workload that assessed telephone interference with prescription filling activities pre and 3 months post implementation included (1) the NASA Task Load Index, (2) multi-tasking observations through shadowing of pharmacists and technicians to count number of interruptions/distractions per prescription "touched," and (3) self-reported work sampling to assess proportional time estimates of clinical, professional, and technical activities. Finally, pharmacy efficiency and prescription filling capacity were assessed using operational measures (prescriptions filled, patients served, phone call volume changes, prescription rework counting). Data analysis included summary statistics, Student's t-test, and chi-square analysis, as appropriate, in addition to assessing convergence and agreement among measures. Every evaluative method showed a positive outcome from call center implementation, although individual pharmacies may have accrued greater benefit from call reduction than others. CONCLUSION: Multiple analysis methods can be used to evaluate the impact of workflow changes.


Asunto(s)
Centrales de Llamados/organización & administración , Servicios Comunitarios de Farmacia/organización & administración , Errores de Medicación/prevención & control , Seguridad del Paciente , Centros Médicos Académicos/organización & administración , Centros Médicos Académicos/estadística & datos numéricos , Servicios Comunitarios de Farmacia/estadística & datos numéricos , Prescripciones de Medicamentos/estadística & datos numéricos , Eficiencia Organizacional/estadística & datos numéricos , Implementación de Plan de Salud , Humanos , Auditoría Administrativa/estadística & datos numéricos , Comportamiento Multifuncional , Farmacéuticos/organización & administración , Farmacéuticos/psicología , Farmacéuticos/estadística & datos numéricos , Técnicos de Farmacia/organización & administración , Técnicos de Farmacia/psicología , Técnicos de Farmacia/estadística & datos numéricos , Rol Profesional/psicología , Evaluación de Programas y Proyectos de Salud , Administración de la Seguridad/organización & administración , Encuestas y Cuestionarios/estadística & datos numéricos , Teléfono , Estados Unidos , United States Agency for Healthcare Research and Quality , Carga de Trabajo/psicología , Carga de Trabajo/estadística & datos numéricos
18.
Am J Health Syst Pharm ; 76(15): 1127-1141, 2019 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-31361871

RESUMEN

PURPOSE: Results of the 2018 ASHP national survey of pharmacy practice in hospital settings pertaining to the pharmacy workforce are presented. METHODS: Pharmacy directors at 4,897 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method of contact by mail and email. Survey completion was online. IMS Health supplied data on hospital characteristics; the survey sample was drawn from the IMS hospital database. RESULTS: The survey response rate was 16.6%. The results indicate that inpatient staffing has increased for both pharmacists and pharmacy technicians. More than half of the respondents reported shortages of pharmacy managers, experienced technicians, and experienced pharmacy technicians with sterile compounding experience. More than half of the respondents reported an excess of entry-level frontline pharmacists. The perceived shortage of pharmacists is in decline, while the perceived shortage of pharmacy technicians, especially those with years of experience, is increasing. Pharmacists commonly chair multidisciplinary committees within health systems, and pharmacy leaders often report directly to the chief executive officer or chief operating officer; they are often responsible for reporting quality information associated with medication use to the health system's board. The use of a pharmacist credentialing and privileging process beyond licensure has increased over the past 4 years. Attention is being devoted to stress in the work place and addressing burnout among healthcare professionals, including pharmacists. CONCLUSION: The profession is fostering a workforce that is appropriate in composition, sufficient in number, and has the competence to improve the value and safety of medication use.


Asunto(s)
Servicio de Farmacia en Hospital/organización & administración , Mejoramiento de la Calidad/organización & administración , Recursos Humanos/estadística & datos numéricos , Sistemas de Medicación en Hospital/organización & administración , Sistemas de Medicación en Hospital/estadística & datos numéricos , Farmacéuticos/estadística & datos numéricos , Servicio de Farmacia en Hospital/estadística & datos numéricos , Técnicos de Farmacia/estadística & datos numéricos , Mejoramiento de la Calidad/estadística & datos numéricos , Sociedades Farmacéuticas , Encuestas y Cuestionarios/estadística & datos numéricos , Estados Unidos
19.
Immun Inflamm Dis ; 7(3): 214-228, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31290265

RESUMEN

BACKGROUND: Clinicians draw on instructional approaches when training patients with anaphylaxis to use adrenaline autoinjectors, but patient use is poor. Psychological barriers to these behaviours exist but are not considered routinely when training patients to use autoinjectors. Health Psychology principles suggest exploring these factors with patients could improve their autoinjector use. OBJECTIVE: To evaluate the impact of a 90-minute workshop training clinicians in strategies and techniques for exploring and responding to psychological barriers to autoinjector use with patients. Attendees' knowledge, confidence and likelihood of using the strategies were expected to improve. METHODS: Impact was evaluated using a longitudinal mixed-method design. Twenty-nine clinicians (general and specialist nurses, general practitioners, and pharmacists) supporting patients with anaphylaxis in UK hospitals and general practice attended. Self-rated knowledge, confidence, and likelihood of using the strategies taught were evaluated online 1 week before, 1 to 3, and 6 to 8 weeks after the workshop. Clinicians were invited for telephone interview after attending to explore qualitatively the workshop impact. RESULTS: χ2 analyses were significant in most cases (P < .05), with sustained (6-8 weeks) improvements in knowledge, confidence, and likelihood of using the strategies taught. Thematic analysis of interview data showed the workshop enhanced attendees' knowledge of the care pathway, understanding of patient's experience of anaphylaxis as psychological not purely physical, and altered their communication with this and other patient groups. However, interviewees perceived lack of time and organisational factors as barriers to using the strategies and techniques taught in clinical contexts. CONCLUSION: Training clinicians in psychologically informed strategies produce sustained improvements in their confidence and knowledge around patient autoinjector education, and their likelihood of using strategies in clinical practice. CLINICAL RELEVANCE: Exploring psychological barriers should be part of training patients with anaphylaxis in autoinjector use.


Asunto(s)
Anafilaxia/prevención & control , Educación Médica/métodos , Epinefrina/administración & dosificación , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Autoadministración/métodos , Encuestas y Cuestionarios , Adulto , Anafilaxia/tratamiento farmacológico , Educación Médica/estadística & datos numéricos , Femenino , Médicos Generales/psicología , Médicos Generales/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Enfermeras Clínicas/psicología , Enfermeras Clínicas/estadística & datos numéricos , Farmacéuticos/psicología , Farmacéuticos/estadística & datos numéricos , Médicos/psicología , Médicos/estadística & datos numéricos , Autoadministración/estadística & datos numéricos , Vasoconstrictores/administración & dosificación
20.
Expert Opin Drug Saf ; 18(8): 745-752, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31232612

RESUMEN

Objectives: Adverse drug reactions (ADRs) are a pervasive global problem, and its management is integral to patient safety and healthcare quality. Pharmacists play a pivotal role in monitoring and reporting ADRs, which has a direct impact on patient care. The aim of this study was to identify potential factors that facilitate pharmacists in community and hospital settings to report ADRs. Methods: A cross-sectional, online survey using a validated questionnaire was administered to pharmacists working in community and hospital pharmacies in Saudi Arabia. Results: 1,717 community and 153 hospital pharmacists participated in this study. Only 10.2% and 26.8% of community and hospital pharmacists, respectively, admitted ever reporting an ADR. The most reported factors that may facilitate ADRs reporting have included ongoing improvements in therapeutic knowledge about ADRs, attending educational programs with continuous medical education credits, the seriousness of the experienced ADRs and accessibility to patients' medical profile. The impact of peers by seeing colleagues reporting ADRs and ADRs due to herbal or traditional medicine were the least important factors reported by pharmacists. Conclusion: The study identified factors that can effectively address the under-reporting of ADRs by pharmacists. A multi-stakeholder, multi-pronged approach of ADR reporting is needed to develop greater awareness of this issue among pharmacists.


Asunto(s)
Sistemas de Registro de Reacción Adversa a Medicamentos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Farmacéuticos/estadística & datos numéricos , Adulto , Servicios Comunitarios de Farmacia/organización & administración , Estudios Transversales , Femenino , Humanos , Masculino , Farmacovigilancia , Servicio de Farmacia en Hospital/organización & administración , Rol Profesional , Arabia Saudita , Encuestas y Cuestionarios
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