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1.
Soins ; 64(841): 50-51, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31864514

RESUMEN

Beyond the checking of a prescription, the pathophysiological characteristics of the patient and the other prescribed medicines, pharmacists contribute to the field of oncology in their other missions. The benefits in terms of the reduction of risks for caregivers have been favoured by the centralisation of preparations combined with the application of other methods derived from industry. Research is continuing in order to dispense safe medicines which comply with the prescription and control the risks linked to the use of these highly active medicines.


Asunto(s)
Cuidadores/psicología , Relaciones Interprofesionales , Neoplasias/tratamiento farmacológico , Farmacéuticos/psicología , Humanos
2.
BMC Public Health ; 19(1): 1560, 2019 Nov 26.
Artículo en Inglés | MEDLINE | ID: mdl-31771536

RESUMEN

BACKGROUND: As in many other low and middle income countries (LIMCs), Vietnam has experienced a major growth in the pharmaceutical industry, with large numbers of pharmacies and drug stores, and increasing drug expenditure per capita over the past decade. Despite regulatory frameworks that have been introduced to control the dispensing and use of prescription-only drugs, including antibiotics, compliance has been reported to be strikingly low particularly in rural parts of Vietnam. This qualitative study aimed to understand antibiotic access and use practices in the community from both supplier and consumer perspectives in order to support the identification and development of future interventions. METHODS: This qualitative study was part of a project on community antibiotic access and use (ABACUS) in six LMICs. The focus was Ba Vi district of Hanoi capital city, where we conducted 16 indepth interviews (IDIs) with drug suppliers, and 16 IDIs and 6 focus group discussions (FGDs) with community members. Drug suppliers were sampled based on mapping of all informal and formal antibiotic purchase or dispensing points in the study area. Community members were identified through local networks and relationships with the field collaborators. All IDIs and FGDs were audio-taped, transcribed and analysed using content analysis. RESULTS: We identified a large number of antibiotic suppliers in the locality with widespread infringements of regulatory requirements. Established reciprocal relationships between suppliers and consumers in drug transactions were noted, as was the consumers' trust in the knowledge and services provided by the suppliers. In addition, antibiotic use has become a habitual choice in most illness conditions, driven by both suppliers and consumers. CONCLUSIONS: This study presents an analysis of the practices of antibiotic access and use in a rural Vietnamese setting. It highlights the interactions between antibiotic suppliers and consumers in the community and identifies possible targets for interventions.


Asunto(s)
Antibacterianos/economía , Legislación de Medicamentos , Población Rural , Adulto , Antibacterianos/provisión & distribución , Antibacterianos/uso terapéutico , Femenino , Grupos Focales , Humanos , Masculino , Farmacéuticos/psicología , Investigación Cualitativa , Población Rural/estadística & datos numéricos , Vietnam
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
6.
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
7.
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
8.
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
9.
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
10.
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
11.
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
12.
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
13.
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
14.
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
15.
Am J Health Syst Pharm ; 76(12): 874-887, 2019 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-31361855

RESUMEN

PURPOSE: Pharmacists are accountable for medication-related services provided to patients. As payment models transition from reimbursement for volume to reimbursement for value, pharmacy departments must demonstrate improvements in patient care outcomes and quality measure performance. The transition begins with an awareness of quality measures for which pharmacists and pharmacy personnel can demonstrate accountability across the continuum of care. The objective of the Pharmacy Accountability Measures (PAM) Work Group is to identify measures for which pharmacy departments can and should assume accountability. SUMMARY: The National Quality Forum (NQF) Quality Positioning System (QPS) was queried for NQF-endorsed medication-related measures. Included measures were curated into a data set of 6 therapeutic categories: antithrombotic safety, cardiovascular control, glucose control, pain management, behavioral health, and antimicrobial stewardship. Subject matter expert (SME) panels assigned to each area analyzed each measure according to a predetermined ranking system developed by the PAM Work Group. Measures remaining after SME review were disseminated during a public comment period for review and ballot. Over 1,000 measures are captured in the NQF QPS; 656 of the measures were found to be endorsed and medication use related or impacted by medication management services. A single reviewer categorized 140 measures into therapeutic categories for SME review; the remaining measures were unrelated to those clinical domains. The SME groups identified 28 measures for inclusion. CONCLUSION: An understanding of the endorsed quality measures available for public reporting programs provides an opportunity for pharmacists to demonstrate accountability for performance, thus improving quality and safety and demonstrating value of care provided.


Asunto(s)
Administración del Tratamiento Farmacológico/organización & administración , Servicios Farmacéuticos/organización & administración , Garantía de la Calidad de Atención de Salud/normas , /economía , Humanos , Administración del Tratamiento Farmacológico/economía , Administración del Tratamiento Farmacológico/normas , Servicios Farmacéuticos/economía , Servicios Farmacéuticos/normas , Farmacéuticos/economía , Farmacéuticos/organización & administración , Farmacéuticos/psicología , /normas , Rol Profesional/psicología , Garantía de la Calidad de Atención de Salud/economía , Reembolso de Incentivo/economía , Reembolso de Incentivo/normas , Responsabilidad Social , Estados Unidos
16.
Am J Health Syst Pharm ; 76(8): 512-520, 2019 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-31361862

RESUMEN

PURPOSE: Transgender/gender nonconforming (TGNC) adults' worries and coping actions related to discrimination by healthcare professionals were evaluated. METHODS: A community-led participatory approach was used to develop, implement, and analyze the survey. Respondents were recruited using a snowball recruitment method. The questionnaire measured population demographics, health status, worry about discrimination, perceptions of health professional competency in gender-affirming care, and actions taken to cope with discrimination. Analysis used mainly descriptive methods and chi-square analysis, where appropriate. RESULTS: There were 316 usable responses from a total of 325 responses. The typical respondent was young, white, lived within the Midwest and in urban/suburban areas. About half had college degrees and 41.7% had annual household incomes of less than $25,000. High degrees of depression risk and anxiety were reported along with low self-reported health status. Most used pharmacist services with 41.6% reporting worry about discrimination associated with such services. About half (52.5%) reported pharmacists as having very little or no competency in providing gender-affirming care. Common coping actions included delayed seeking of healthcare and non-disclosure of authentic gender identity. Thirteen percent of respondents avoided healthcare because of perceived purposeful embarrassment experienced at a pharmacy. CONCLUSION: Worry about discrimination from pharmacists was common among TGNC adults and was associated with high levels of anxiety. The majority perceived pharmacists to lack competency in transgender care.


Asunto(s)
Competencia Clínica , Farmacéuticos/psicología , Relaciones Profesional-Paciente , Discriminación Social , Personas Transgénero/psicología , Adaptación Psicológica , Adolescente , Adulto , Anciano , Asistencia Sanitaria Culturalmente Competente/organización & administración , Femenino , Humanos , Masculino , Persona de Mediana Edad , Servicios Farmacéuticos/organización & administración , Farmacéuticos/organización & administración , Encuestas y Cuestionarios/estadística & datos numéricos , Adulto Joven
17.
Am J Health Syst Pharm ; 76(13): 980-990, 2019 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-31361883

RESUMEN

PURPOSE: Complementary health approaches including the use of dietary supplements (DS) such as vitamin, mineral, nutritional, and herbal supplements are popular in the United States. Beyond a statement issued by the American Society of Health-System Pharmacists (ASHP) in 2004, knowledge about the role of pharmacists related to DS use is largely unknown. The objectives of this study were to identify pharmacists' and other key stakeholders' perceptions and opinions about assuming roles that ensure the appropriate and safe use of DS. METHODS: A grounded theory approach involving in-depth, semi-structured key informant audio-recorded phone interviews with 12 practicing pharmacists and 10 key stakeholders were conducted. Key themes were identified using open coding, grouping, and categorizing. RESULTS: Participants believed the majority of their patients self-select and purchase DS from a pharmacy, often in conjunction with conventional medicines, and reported concerns about the regulatory standards, efficacy, and safety of DS. Despite acknowledging their ethical and professional responsibilities regarding DS, as identified by the ASHP statement and other sources, the majority of pharmacists are not expecting their profession to adopt these in the near future because of multiple barriers. CONCLUSIONS: There is a substantial disconnect between awareness of DS use and pharmacists adopting professional responsibilities regarding DS. The barriers identified are multifaceted, indicating the need for a joint effort from key stakeholders in developing a coordinated approach to supporting pharmacists in their practice efforts to ensure the appropriate and safe use of DS.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Suplementos Dietéticos/efectos adversos , Educación del Paciente como Asunto/organización & administración , Farmacéuticos/organización & administración , Rol Profesional , Actitud del Personal de Salud , Comportamiento del Consumidor , Estudios Transversales , Femenino , Teoría Fundamentada , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Farmacéuticos/psicología , Participación de los Interesados , 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.
PLoS One ; 14(6): e0217673, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31216322

RESUMEN

OBJECTIVES: The Code of Ethics of pharmacy practitioners in Australia recognises the obligation to provide care to patients in a culturally safe and responsive manner. The aim of this exploratory study was to examine how Australian community pharmacists understand and experience the concept of 'culture' in their everyday practice environment. METHODS: Voluntary, semi-structured interviews were conducted at community pharmacy placement sites in South-East Queensland, Australia. Pharmacists were asked to recall an incident that evoked their cultural awareness during the course of their practice. The question stated, verbatim: "We are preparing our students to be pharmacists in a highly multicultural community. Can you think of an incident where you learnt something about another person's culture or it made you more aware of your own culture? Please briefly describe the incident." Reportable responses were collected from 59 of the 92 visited pharmacists. These responses were audio-recorded and transcribed. The data were collated and analysed through iterative, reflexive, thematic analysis using constant comparison. RESULTS AND SIGNIFICANCE: The responses provided a rich selection of lived experiences within Australian multicultural pharmacy practice, describing professional dilemmas, fears and the strategies employed to overcome practice challenges. Six main response categories were identified: (i) Language/communication challenges, (ii) Cultural attitudes and behaviours, (iii) Exposure to culture due to pharmacy location, (iv) Religion, gender, and age, (v) Prejudiced/perceived racist attitudes and discrimination towards 'other' cultures, (vi) Perceived 'sameness' of different cultures. The study has provided valuable insights into community pharmacists' experiences of culture in their day-to-day professional practice, also highlighting the associated strategies used to maintain a high standard of practice. There is merit in ensuring that the pharmacy curriculum and professional development programs are designed to respond to the ethical obligation of pharmacists to practise in a culturally safe, responsive manner that acknowledges and incorporates the importance of culture, cultural differences and intercultural relations, while addressing culturally unique needs in a skilled and professional manner.


Asunto(s)
Actitud del Personal de Salud , Farmacia/estadística & datos numéricos , Adulto , Australia , Comunicación , Servicios Comunitarios de Farmacia , Diversidad Cultural , Femenino , Humanos , Masculino , Persona de Mediana Edad , Farmacéuticos/psicología , Práctica Profesional/estadística & datos numéricos , Rol Profesional , Adulto Joven
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