Exploring the Important Determinants Shaping Treatment Preferences: Qualitative Insights into Breast Cancer Patient Experiences and Perspectives in New Zealand.

Purpose: Despite the importance of acknowledging patient preferences in treatment decision-making, little is known about the treatment preferences and the factors underlying those preferences of breast cancer patients. This study aims explore patient experience and perspective regarding treatment preferences and identify the important determinants that shape these preferences in the context of New Zealand. Patients and Methods: Semi-structured online interviews comprised of six focus group discussions and five individual interviews were performed with 26 breast cancer patients. The interviews were recorded, transcribed, and analyzed using the reflexive thematic analysis approach. Results: Four main themes were derived: (1) positive treatment outcomes; (2) the negative impact of treatment-related side effects on quality of life; (3) treatment accessibility, availability, and timeliness; (4) cost of treatment. Patients revealed a strong preference towards treatments that yield longer survival, achieve remission, and prevent cancer recurrence. Additionally, patients favored treatments with minimal side effects that had minimal impact on their quality of life. There was a notable preference for treatments that were easily accessible and available in a timely manner. However, patients faced challenging decisions in balancing the costs of treatments with their benefits, leading to a consistent preference for treatments supported by government funding or medical insurance to alleviate financial burdens. Conclusion: Our study reveals that breast cancer patients in New Zealand have different perceptions and preferences regarding cancer treatment. Patients frequently find themselves making trade-offs among various attributes of a treatment, aligning these decisions with their personal values and beliefs. By considering these preferences and trade-offs in future studies that measure patient preferences, healthcare professionals can enhance their support for patients in making informed choices that align with their values and priorities. Additionally, healthcare policymakers can develop patient-centered policies that cater to the unique needs and preferences of breast cancer patients.

Describing the consumer profile of different types of community pharmacy in Aotearoa New Zealand.

Introduction Aotearoa New Zealand has a range of community pharmacies; independent, corporate, hybrid, and mail-order, each with differing service delivery models. Corporate and hybrid pharmacies do not charge the NZ$5.00 co-payment on standard prescriptions; however, prescription co-payments were universally removed from 1July 2023. Aim This research aims to describe the consumer profiles of Aotearoa New Zealand's different types of community pharmacies prior to the removal of the prescription co-payment. Methods A nationwide retrospective observational study linked 1-year of dispensing data (1 March 2022-28 February 2023) from the Pharmaceutical Collection to patient enrolment data using a National Health Index (NHI) number to identify the demographic details of people who use the different pharmacy types. People were assigned to a particular type of pharmacy if they collected at least 70% of their prescriptions from there; if they did not meet this threshold, they were defined as mixed users. Results Independent pharmacies had an older customer base and fewer Asian users compared to other pharmacy types. Hybrid pharmacies served a greater proportion of Pacific peoples and those from areas of high deprivation. Maori made up relatively equal proportions of users across all pharmacy types. Areas without major cities had fewer corporate pharmacies and only four hybrid pharmacies were identified outside of Auckland. Discussion There appears to be differences in the consumer profiles of the different pharmacy types. These results will serve as a comparison to how removing prescription co-payments shifts patients' behaviour.

Cost-Effectiveness of Pharmacist Prescribing for Managing Hypertension in the United States.

Importance: Pharmacist-led interventions can significantly improve blood pressure (BP) control. The long-term cost-effectiveness of pharmacist-prescribing interventions implemented on a large scale in the US remains unclear. Objective: To estimate the cost-effectiveness of implementing a pharmacist-prescribing intervention to improve BP control in the US. Design, Setting, and Participants: This economic evaluation included a 5-state Markov model based on the pharmacist-prescribing intervention used in The Alberta Clinical Trial in Optimizing Hypertension (or RxACTION) (2009 to 2013). In the trial, control group patients received an active intervention, including a BP wallet card, education, and usual care. Data were analyzed from January to June 2023. Main Outcomes and Measures: Cardiovascular (CV) events, end-stage kidney disease events, life years, quality-adjusted life years (QALYs), lifetime costs, and lifetime incremental cost-effectiveness ratio (ICER). CV risk was calculated using Framingham risk equations. Costs were based on the reimbursement rate for level 1 encounters, medication costs from published literature, and event costs from national surveys and pricing data sets. Quality of life was determined using a published catalog of EQ-5D utility values. One-way sensitivity analyses were used to assess alternative reimbursement values, a reduced time horizon of 5 years, alternative assumptions for BP reduction, and the assumption of no benefit to the intervention after 10 years. The model was expanded to the US population to estimate population-level cost and health impacts. Results: Assumed demographics were mean (SD) age, 64 (12.5) years, 121 (49%) male, and a mean (SD) baseline BP of 150/84 (13.9/11.5) mm Hg. Over a 30-year time horizon, the pharmacist-prescribing intervention yielded 2100 fewer cases of CV disease and 8 fewer cases of kidney disease per 10 000 patients. The intervention was also associated with 0.34 (2.5th-97.5th percentiles, 0.23-0.45) additional life years and 0.62 (2.5th-97.5th percentiles, 0.53-0.73) additional QALYs. The cost savings were $10 162 (2.5th-97.5th percentiles, $6636-$13 581) per person due to fewer CV events with the pharmacist-prescribing intervention, even after the cost of the visits and medication adjustments. The intervention continued to produce benefits in more conservative analyses despite increased costs as the ICER ranged from $2093 to $24 076. At the population level, a 50% intervention uptake was associated with a $1.137 trillion in cost savings and would save an estimated 30.2 million life years over 30 years. Conclusion and Relevance: These findings suggest that a pharmacist-prescribing intervention to improve BP control may provide high economic value. The necessary tools and resources are readily available to implement pharmacist-prescribing interventions across the US; however, reimbursement limitations remain a barrier.

Understanding Patient Preferences Regarding the Important Determinants of Breast Cancer Treatment: A Narrative Scoping Review.

Objective: Conventionally, optimal treatment strategies for breast cancer have been largely determined by physicians, with a scant understanding of patients' treatment values and preferences. Incorporating patient preferences in the decision-making process for breast cancer treatment is gaining recognition and can potentially improve treatment outcomes and compliance. This scoping review aims to synthesize evidence on the key determinants that are most valued by breast cancer patients when deciding on their treatment options. Methods: We searched three electronic databases (PubMed/MEDLINE, SCOPUS, and CINAHL Plus) utilizing a systematic scoping review method. Two reviewers independently screened, applied inclusion criteria, reviewed, and synthesized findings. A mixed-method narrative approach combining the inductive thematic analysis and content analysis methodologies was used to synthesize and summarize the findings. Results: The review included 22 studies, leading to the conceptualization of 5 overarching themes and 17 sub-themes. Among these, the most frequently cited theme was treatment benefits, followed by treatment-related process, treatment-related risk, quality of life, and cost of treatment. Women with breast cancer highly value treatments that offer good effectiveness, prolong survival, prevent recurrence, and maintain quality of life. Patient concerns include treatment-related side effects, safety, the risk of secondary cancer, and direct or indirect out-of-pocket costs. Additionally, patients also consider treatment duration, mode of administration, physician recommendation, and treatment availability and accessibility when deciding on their preferred treatment. Conclusion: The evidence synthesized in this review offers insights into refining breast cancer treatment strategies to align more closely with patient values. Recognizing and integrating patient perspectives in breast cancer care could potentially lead to improved treatment outcomes, enhanced patient compliance, and more personalized care. Healthcare professionals are encouraged to incorporate these key determinants in their treatment decision-making processes, aiming to deliver a patient-centered care that aligns with the unique preferences and values of each patient.

A systematic review of economic evaluations of pharmacist services.

BACKGROUND: Challenges to the provision of health care are occurring internationally and are expected to increase in the future, further increasing health spending. As pharmacist roles are evolving and expanding internationally to provide individualised pharmaceutical care it is important to assess the cost-effectiveness of these services. OBJECTIVES: To systematically synthesise the international literature regarding published economic evaluations of pharmacy services to assess their cost-effectiveness and clinical outcomes. METHODS: A systematic review of economic evaluations of pharmacy services was conducted in MEDLINE, EMBASE, PubMed, Scopus, Web of Science, CINAHL, IPA and online journals with search functions likely to publish economic evaluations of pharmacy services. Data were extracted regarding the interventions, the time horizon, the outcomes and the incremental cost-effectiveness ratio. Studies' quality of reporting was assessed using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) statement. RESULTS: Seventy-five studies were included in the systematic review, including 67 cost-effectiveness analyses, 6 cost-benefit analyses and 2 cost-consequence analyses. Of these, 57 were either dominant or cost-effective using a willingness-to-pay threshold of NZ$46 645 per QALY. A further 11 studies' cost-effectiveness were unable to be evaluated. Interventions considered to be most cost-effective included pharmacist medication reviews, pharmacist adherence strategies and pharmacist management of type 2 diabetes mellitus, hypertension and warfarin/INR monitoring. The quality of reporting of studies differed with no studies reporting all 28 items of the CHEERS statement. CONCLUSIONS: There is strong economic evidence to support investment in extended pharmacist services, particularly those focussed on long-term chronic health conditions.

What do pharmacy users think of free pharmacy services? Investigating pharmacy users' perceptions, attitudes and willingness to pay for free healthcare from pharmacies.

Background: Evidence exists of pharmacists providing free or partially subsidised clinical services in order to meet patient healthcare needs. Little is known about how patients perceive the quality and importance of such unfunded services to their healthcare. Objectives: To explore pharmacy user perspectives about unfunded services such as their valuation, why they chose to access these services from the pharmacy as well as their willingness to pay should pharmacies need to start charging for the provision of such services owing to budgetary constraints. Methods: This study was nested in a larger nationwide study where 51 pharmacies were recruited across fourteen locations across New Zealand . Semi-structured interviews were conducted with patients who had accessed unfunded services in community pharmacies. Patients were followed up to identify their percieved health outcomes resulting from accessing the unfunded service. Results: A total of 253 patient interviews were conducted on-site across 51 pharmacies in New Zealand. Two main themes were identified pertaining to (1) patient-provider relationship and (2) Willingness to pay. A total of fifteen different considerations were found to influence pharmacy users' decisions to access health services from the pharmacy. It was found that 62.8% of patients were willing to pay for unfunded services and the majority paying NZD$10. Conclusion: Patients positively rate these services and largely deem them important for their healthcare. Willingness to pay for services were also variable between patients and were dependant on the type of service accessed.

Pharmacists' Satisfaction with Work and Working Conditions in New Zealand-An Updated Survey and a Comparison to Canada.

BACKGROUND: As roles have evolved over time, changes in workplace environments have created higher patient expectations creating stressful conditions for pharmacists. AIM: To evaluate pharmacists' perceptions of their working conditions, work dissatisfaction, and psychological distress; determine their predictors in New Zealand (NZ); and compare results with Canadian studies and historic NZ data. METHODS: A cross-sectional online survey was distributed to registered pharmacists in NZ. The survey included demographics, work satisfaction, psychological distress, and perceptions of their working conditions (six statements with agreement rated on a 5-point Likert scale). Comparisons were made with surveys from Canada and NZ. Chi-square, t-tests, and non-parametric statistics were used to make comparisons. RESULTS: The response rate was 24.7% (694/2815) with 73.1% practicing in a community pharmacy (45.8% independent, 27.3% chains). Pharmacists disagreed on having adequate time for breaks and tasks, while the majority contemplated leaving the profession and/or not repeating their careers again if given the choice. Working longer hours and processing more prescriptions per day were predictive factors for poorer job satisfaction. More NZ pharmacists perceived their work environment to be conducive to safe and effective primary care (57% vs. 47%, p < 0.001) and reported that they had enough staff (45% vs. 32%, p = 0.002) as compared to Canadian pharmacists. Pharmacists' job satisfaction and psychological distress have not improved compared to the assessment 20 years prior. CONCLUSIONS: NZ pharmacists perceive working conditions to be sub-optimal yet had higher satisfaction than their Canadian counterparts. Work dissatisfaction and psychological distress are high and have not improved over the last two decades.

Do entry year pharmacy students have similar personal characteristics? Comparing personalities, professional goals, and role perceptions.

BACKGROUND: Schools and faculties of pharmacy are responsible for selecting students to admit into the profession. Despite many similarities, admission processes, pharmacists' training, and scope of practice are different across jurisdictions. Students that are selected for admission may then differ in a number of ways, including by personality traits and other individual difference measures. OBJECTIVE: To compare the trait characteristics between students entering a New Zealand (NZ-University of Otago) and Canadian ((University of Waterloo) pharmacy programme and to compare their professional goals and role perceptions. METHODS: Incoming first year students at each university were invited to take an online questionnaire that included personality characteristics and potential predictors of involvement in pharmacists' roles: (1) the Big Five Inventory (openness, conscientiousness, extraversion, agreeableness, neuroticism); (2) the Achievement Goals Questionnaire-Revised; (3) the Rational Experiential Inventory; and (4) Counsellor Role Orientation. Statistical tests were conducted to determine if there were differences between entry level pharmacy students from NZ and Canada. RESULTS: 184 students (97/150 Otago, 87/118 Waterloo) completed the survey. On average, Waterloo students scored higher on agreeableness (M = 80 vs. 76, p = 0.06), conscientiousness (M = 70 vs. 68, p = 0.30), mastery-approach (M = 93 vs.90, p = 0.06), and faith-in-intuition (M = 67 vs. 61, p = 0.03) compared to Otago pharmacy students who were higher for openness M = 70 vs. 66, p = 0.09). An item measuring reliance on physicians for medicine advice was endorsed more by Otago pharmacy students (M = 35 vs. M = 15, p < 0.001). Items on time pressure (e.g., "It takes too much time to for a pharmacist to talk with a patient about the medication they receive") were higher for Otago students (M = 41 vs. M = 38, p = 0.26). Higher scores for pharmacist restriction ("There should be legal restrictions on what pharmacists can tell patients") were also seen among Otago students (M = 26 vs. M = 12, p < 0.001). There were important differences between entry level pharmacy students and practicing pharmacists in both jurisdictions. DISCUSSION: While entry-level pharmacy students had similar personality profiles, differences were observed in role expectations and in experiential learning orientation. This highlights differing societal views on the role of pharmacists in each respective country. Pharmacy schools should study their student bodies when designing their curricula and electives, helping ensure graduates feel like they have the training to do what they need to do. Future work will determine if these personality and learning goals influence students' preparation for practice.

Investigating the provision, nature and associated costs of unfunded pharmacy services: A nationwide study.

BACKGROUND: There is increasing evidence of pharmacists providing free or partially subsidised patient-focused services in order to meet healthcare needs. Limited information exists about the types of unfunded services and their value. OBJECTIVES: (1) Identify the types of unfunded services provided nationally in New Zealand (NZ) and (2) Determine the costs associated with service provision. METHODS: A continuous observation time-motion study was conducted across New Zealand to characterise the provision of unfunded pharmacy services and the labour costs associated with their provision. The time-motion study spanned one business day (between seven to eight hours) in each participating pharmacy. The primary investigator (YA) spent one business day in each participating pharmacy (n = 51) and recorded details about the patient-focused services that were provided. Details included the type of service provided, approximate duration of the service and out-of-pocket costs borne by the patient. RESULTS: A total of 660 observations of unfunded services were recorded across the 51 pharmacies where 360 observation hours were carried out. Twenty-three types of unfunded services were identified, where minor ailments accounted for over half of the total observations. Labour costs associated with service provision were variable. CONCLUSION: Pharmacies across New Zealand are providing patient-focused services for which no funding is being provided.

A Systematic Review of Independent and Chain Pharmacies Effects on Medication Adherence.

As the last step in the care pathway, pharmacies can significantly impact a patient's medication adherence and the success of treatment. The potential impact of patient's pharmacy choice on their medication adherence has yet to be established. This study aims to review the impact a pharmacies ownership model, either independent or chain, has on its users' medication adherence. As a generalisation, independent pharmacies offer a more personal service and chain pharmacies offer medications at lower prices. A keyword search of EMBASE and MEDLINE databases in March 2022 identified 410 studies, of which 5 were deemed to meet our inclusion criteria. The studies mostly took place in North America, measured medication adherence using pharmacy records over a 12-month period. This review was unable to substantiate a difference in the rate of medication adherence between the users of independent and chain pharmacies. However, those with a lower income, greater medication burden, and increased age appeared to use an independent pharmacy more than a chain pharmacy and to have greater medication adherence when doing so. Establishing the differences in service provision between types of pharmacies and why people choose a pharmacy to frequent should be a focus of future research.

Pharmacy postgraduate education transformation: pharmacist preferences for microcredentials.

OBJECTIVES: To explore micro-credentialing for postgraduate study in pharmacy practice. METHODS: An online survey of practicing or intern pharmacists in New Zealand was designed to identify learner preferences for education, determine interest and demand for microcredentials and elicit preferred 'willingness-to-pay' thresholds. KEY FINDINGS: A total of 430 responses were obtained. A stacked microcredential programme was preferred by 88% over traditional courses. Interest, skill development and career development were the top-ranked aspects. Participants favoured the lowest cost option ($300 NZD per microcredential). CONCLUSIONS: Pharmacists in New Zealand are supportive of microcredentials for postgraduate study as an alternative to traditional programmes.

Prevalence of joint-specific osteoarthritis and joint pain in British Columbia, Canada.

The objective is to determine the prevalence of self-reported physician-diagnosed osteoarthritis (OA) and musculoskeletal symptoms (pain, stiffness or discomfort) in specific joints among adults in British Columbia (BC), Canada. We carried out a cross-sectional mixed-mode survey in a random population sample of persons 18 years of age and older. Estimates were weighted to reflect the age and sex distribution of the population of BC. We obtained responses from 2,233 individuals. Overall, 18.4% (95% CI 16.8-20.1) of the adult population reported OA. Of those, more than 40% had OA in multiple sites. Prevalence ranged from 8.8% (95% CI 7.6-10.1) in the knee to 2.7% (2.1-3.5) in the foot. One-year prevalence of symptoms ranged from 49.1% (47.0-51.2) in the lower back to 23.3% (21.5-25.1) in the hip. Females reported more symptoms and OA than males in all joints. The most common site of self-reported physician-diagnosed OA in BC is the knee, but OA in the hands, hips, and feet is also common. Having OA in one joint is a strong predictor of OA in other joints.

Identifying New Zealand Public Preferences for Pharmacist Prescribers in Primary Care: A Discrete Choice Experiment.

BACKGROUND AND OBJECTIVE: Given increasing patient populations, general practitioner workforce constraints and the growing demand for health services in New Zealand (NZ), the development and provision of pharmacist prescribing services could be used to improve people's access to medicines. A discrete choice experiment (DCE) was utilised to determine NZ public preferences for pharmacist prescribing services in primary care in NZ. METHODS: A D-efficient DCE design generated 20 choice questions in four blocks of five questions with three labelled alternatives per choice question. The online DCE used a NZ general public online research panel administered by an external organisation (SurveyEngine). The DCE included six attributes with two attributes each with two levels (location of consultation and consultation type), three levels (type of service and operating hours) and four levels (waiting time and cost). RESULTS: Nine hundred and twenty-four respondents completed the survey with 4620 observations available for analyses. Respondents preferred pharmacist prescribing services with the following characteristics: optimisation of medicines and changes to only current medicine service types (relative to repeat prescribing); lower consultation costs, shorter waiting times, longer operating hours and consultation by appointment (relative to walk-in and wait clinic). CONCLUSIONS: Prescribing policy could incorporate these public preferences to help develop accessible and effective primary care prescribing services utilising the skills of pharmacist prescribers to improve and reduce inequities in access to medicines in NZ. These results suggest the NZ public see pharmacists as part of the primary care prescribing team and are willing to utilise them if these services are implemented.

Are professional pharmacy services being offered for free in pharmacies? A feasibility study exploring the use of a time motion study in New Zealand.

BACKGROUND: Pharmacists report to be providing patient-focused clinical services for which they receive no remuneration. Limited literature exists about unfunded services leading to difficulties in ascertaining an appropriate study design for such research. OBJECTIVE: This study aims to assess the appropriateness of a proposed study design before launching a nationwide study to investigate the provision of unfunded patient care services. METHODS: A multi-methods approach was utilised consisting of (1) continuous time motion study in community pharmacies (2) semi structured patient interviews (3) patient follow up (4) semi structured interviews with pharmacy owners/managers. All observations of unfunded patient care services were recorded, numerically coded and descriptively analysed. Semi structured interviews were audio recorded and transcribed verbatim. A semantic thematic analysis was carried out. Appropriateness of study design was dictated by the ability to characterise services and obtain patient perceptions. RESULTS: Ten pharmacies took part in the feasibility study, across the city of Dunedin, New Zealand, representing a range of different practice settings and demographics. Ten patients were interviewed and six responded to follow up. Both pharmacy and patient recruitment proved challenging due to concerns around disruption to workflow and patient privacy. A continuous observation time motion study was found to be appropriate as it minimises disruption to workflow with no additional work required from the pharmacy teams. CONCLUSIONS: A continuous observation time motion study proved to be an appropriate method to investigate the provision of unfunded services on a national scale. The findings of the study suggest design changes such as length of observation time, increasing patient recruitment and additional patient questions to enhance the nationwide study.

Examining non-medical prescribing trends in New Zealand: 2016-2020.

BACKGROUND: Population growth and general practitioner workforce constraints are creating increasing demand for health services in New Zealand (NZ) and internationally. Non-medical prescribing (NMP) is one strategy that has been introduced to help manage this. Little is known about the NMP practice trends in NZ. The aim of this study was to provide a current overview of the scale, scope, and trends of NMP practice in NZ. METHODS: All claims for community dispensed medicines prescribed by a non-medical prescriber were extracted from the NZ Pharmaceutical Collection for the period 2016-2020. Patient demographics were retrieved from the Primary Health Organisation enrolment collection. These national databases contain prescription information for all subsidised community pharmacy medicines dispensed and healthcare enrolment data for 96% of New Zealanders. RESULTS: The proportion of prescriptions written by all NMP providers and patients receiving NMP prescriptions increased each year from 1.8% (2016) to 3.6% (2019) and 8.4% (2016) to 14.4% (2019) respectively. From 2016 to 2019, the proportion of NMP patients who had at least one NMP prescription increased from 26% to 39% for nurse prescribers, from 1% to 9% for pharmacist prescribers, from 2% to 3% for dietitian prescribers, and decreased from 47% to 22% for dentists, and from 20% to 12% for midwives. The most commonly prescribed medicines were antibiotics (amoxicillin, amoxicillin with clavulanic acid, and metronidazole), and analgesics (paracetamol, and codeine phosphate). While some NMP providers were prescribing for patients with greater health needs, all NMP providers could be better utilised to reach more of these patients. CONCLUSIONS: This study highlights that although the NMP service has been implemented in NZ, it has yet to become mainstream healthcare practice. This work provides a baseline to evaluate the NMP service moving forward and enable policy development. Improved implementation and integration of primary care NMP services can ensure continued access to prescribing services and medicines for our communities.

Identifying Community Pharmacist Preferences For Prescribing Services in Primary Care in New Zealand: A Discrete Choice Experiment.

OBJECTIVE: Given increasing patient populations, general practitioner (GP) workforce constraints and increasing demand for health services in New Zealand (NZ), the development and provision of pharmacist prescribing services may need to increase to improve people's access to medicines. A discrete choice experiment (DCE) was utilised to determine community pharmacist preferences for prescribing services in primary care in NZ, and to understand how these factors could improve the provision of pharmacist prescribing services. METHODS: A D-efficient design generated 30 labelled choice questions in three blocks of ten, and three alternatives per choice question. The online DCE was emailed to practising community pharmacists in NZ. The DCE included two attributes with five levels (prescribing model, educational requirements) and three attributes with three levels (location, professional fee, change in income). A mixed multinomial logit model was used to estimate preferences. RESULTS: A total of 264 respondents completed the survey with 2640 observations for analyses. This DCE found pharmacists preferred pharmacy services with the following characteristics: ability to prescribe using minor ailments and independent prescribing models relative to the pharmacist-only medicines prescribing model; prescribing education by accredited learning modules relative to PGDipClinPharm + PGCertPharmPres; remuneration via a professional fee; and pharmacist prescribing services located in community pharmacies rather than in GP practices. CONCLUSIONS: Prescribing policy could incorporate these pharmacist preferences to help develop accessible and effective pharmacist prescribing services that not only improve access to medicines, but also address inequity of access to medicines in NZ. These DCE results are encouraging as they signal that the community pharmacists also see themselves and their pharmacies as part of the prescribing team in primary care in NZ.

Pharmacists of the future: What determines graduates' desire to engage in patient-centred services?

BACKGROUND: Pharmacists increasingly need to provide patient centred activities like medicine management (e.g., medicine use review/home medicine review), screening for chronic illness (e.g., point of care testing for cardiovascular diseases including hypertension and hypercholesterolemia), treatment for chronic conditions (e.g., warfarin for thrombotic prophylaxis), and primary care treatment (trimethoprim, emergency contraceptive pill, and sildenafil). However, the adoption of patient-centred services into practice is still low, and it not known which pharmacist characteristics are associated with the adoption of these services. OBJECTIVE: The primary objective of this study was to investigate whether personality and other characteristics of pharmacy graduates are associated with their intention to provide patient-centred services in the future. METHODS: The study design was a cross-sectional survey of pharmacy graduates from the University of Otago at the end of 2017. The web-based survey involved several potential determinants: (1) the Achievement Goals Questionnaire (Revised), (2) five-factor ('Big Five') model of personality, (3) decision-making style using the Rational Experiential inventory, (4) general self-efficacy, (5) sense of belonging to the pharmacy profession. Additionally, interest in provision of services was assessed. RESULTS: A total of 83 graduates completed the survey (response rate 63%, female 64%, age 22.5 years, SD: 1.7). Intention to provide patient-centred services was associated with higher: conscientiousness, agreeableness, and extraversion; mastery-approach; self-efficacy; and sense of belonging to the profession. Relative to the New Zealand population norms, these students were higher in conscientiousness and lower in neuroticism. Graduates were more interested in providing new patient-centred roles than more traditional services. CONCLUSION: Overall, pharmacy graduates were very positive regarding their future involvement in patient-centred services. Pharmacy graduates' sense of self-efficacy and a sense of belonging in the profession were associated with interest in patient-centred roles. Increasing their self-efficacy and sense of belonging to the profession and building on their enthusiasm as new graduates are key to greater provision of patient-centred activities.

What free services do pharmacists offer? Investigating the provision of unfunded pharmacy services in community pharmacies.

BACKGROUND: Globally, pharmacists report to be providing free or partially subsidised patient-focused services in order to meet healthcare needs of their communities. Budget cuts to pharmacy contracts are reported to challenge the provision of such services. Limited information exists identifying the types of unfunded services provided in community pharmacies. OBJECTIVES: To identify the types of services which pharmacists report to provide that are not reimbursed by the government, insurance companies or paid for by the patient. METHODS: Semi-structured focus group discussions with pharmacists were conducted stimulating narratives from community pharmacists across New Zealand about the types of unfunded pharmacy services they provide. Discussions were audio recorded and transcribed verbatim. Inductive coding of the data was carried out using QSR International Nvivo 11 for Windows. A semantic thematic analysis was carried out. RESULTS: Twenty-four pharmacists took part in the focus groups across five regions in both the North and South Islands of New Zealand. Key themes identified from focus groups were: 'Standalone unfunded services', 'Services funded elsewhere' and 'Leakages from the current funding model'. Pharmacists reported that unfunded patient-focused services accounted for 15%-50% of their daily activities. Pharmacists stated that they believed these services often led to reduction of disease progression, hospitalisations and improved quality of life. Pharmacists also stated that given budget cuts, these services are not sustainable. CONCLUSIONS: Pharmacists report to offer many professional services without remuneration. In some cases, these services make up a substantial part of the pharmacist's time. Further budgetary constraints and increased competition may put these services at risk of being lost. Findings from this study can be applied to unfunded pharmacy services elsewhere, as worldwide pharmacy faces many similar challenges, particularly where there are budget cuts and decreasing revenue in other jurisdictions.

What Are the Preferences of Patients With Rheumatoid Arthritis for Treatment Modification? A Scoping Review.

OBJECTIVES: Optimal care of rheumatoid arthritis (RA) patients entails regular assessment of disease activity and appropriate adjustment of disease-modifying antirheumatic drugs (DMARDs) until a predefined treatment goal is achieved. This raises questions about the approach to treatment decision making among RA patients and their preference for associated treatment changes. We aimed to systematically identify and synthesize the available evidence of RA patients' preferences regarding DMARD modification with an emphasis on escalating, tapering, stopping, or switching of DMARDs. METHODS: A scoping review was undertaken to gauge the breadth of evidence from the range of studies relating to RA patients' preferences for DMARD modification. Pertinent databases were searched for relevant studies published between 1988 and 2019. Conventional content analysis was applied to generate themes about how patients perceive changes to their RA treatment. RESULTS: Of the 1730 distinct articles identified, 32 were included for review. Eight studies investigated RA patients' perceptions of switching to other DMARDs, 18 studies reported RA patients' preferences for escalating treatment, and six studies explored the possibility of tapering or stopping of biologic DMARDs. Four overarching themes relating to RA patients' preferences for treatment modification were identified: (i) patient satisfaction, (ii) patients' beliefs, (iii) information needs, and (iv) patient-clinician relationships. CONCLUSION: Uptake of treatment changes in clinical practice can be improved by understanding how RA patients approach the decision to modify their treatment and how this relates to their satisfaction, beliefs, information needs, and relationships with clinicians. Future work is needed to systematically determine the significance of these factors in RA patients' decision-making processes.

Evaluating New Zealanders' Values for Drug Coverage Decision Making: Trade-Offs between Treatments for Rare and Common Conditions.

BACKGROUND: New Zealand's near static healthcare budget limits access to expensive medications including those for rare conditions. As such, it is necessary to know the public's priority for values in the drug funding decision-making process. OBJECTIVES: The objectives of this study were to measure the relative societal importance of values of New Zealanders in informing drug funding decisions and to determine how New Zealanders trade off funding in various scenarios between common and rare diseases. METHODS: An online survey was conducted between 17 April and 17 May, 2019 on a sample of 500 New Zealanders aged ≥ 18 years. Participants ranked 13 values using an analytical hierarchy process. Participants were then presented with different trade-off scenarios to measure their attitudes towards funding drugs for common and rare diseases. RESULTS: The values ranked in the top five by most were potential effect on quality of life (71.8%), ability of the drug to work (57.6%), severity (57.6%), safety (57%), and potential to extend life (56%). Adherence and rarity held the lowest and second lowest ranking. Most believe that resources should be allocated towards drugs that have been proven to work and have the greatest health benefits. In trade-offs between access to an expensive drug therapy for a rare disease with uncertain benefits or receive a fixed cash payment, the overwhelming consensus was to receive the cash payment. CONCLUSIONS: New Zealanders ultimately value drug-related factors (e.g. quality of life and efficacy) and disease-related factors (e.g. severity of disease and equity) the most but did not value disease rarity.