Stakeholders' perspectives and use of web-based knowledge support for environmental information on pharmaceuticals.

Background: Pharmaceuticals treat and prevent diseases but can pose a risk to organisms, predominantly in aquatic environments. The use of pharmaceuticals is predicted to increase due to, among other factors, a growing and aging population and climate change. Therefore, it is important to develop mitigation strategies to prevent pharmaceutical residues from entering the environment. In Sweden, two public pharmaceutical web-based knowledge supports provide information on the environmental impact of pharmaceuticals. Objective: To explore stakeholder perspectives, use and future opportunities related to two webbased knowledge supports publicizing environmental information on pharmaceuticals. Methods: Stakeholders identified for their experience with the knowledge supports, pharmaceutical policy, and stakeholder collaboration were recruited using purposive and snowball sampling for semi-structured interviews. Interviews were conducted in person or via video calls. Respondents included twenty-one representatives from the pharmaceutical industry, regional and national authorities, academia, and an independent research institute. Interview transcripts were analyzed using content analysis. Results: Respondents valued having environmental information on pharmaceuticals publicly accessible on two well-known pharmaceutical knowledge supports. The knowledge supports have been used in Sweden and internationally. Perceived differences were recognized between the impact and perspectives of the two knowledge supports with a general preference for the Janusinfo knowledge support. The preference was especially identified regarding transparency and the use of the information in clinical practice. Barriers to impact were a lack of resources and decision-making criteria. Respondents believed that the impact and value of the knowledge supports could be improved with more authority involvement. Conclusion: Public knowledge support providing environmental information on pharmaceuticals has been valuable across sectors, especially, among Drug and Therapeutics Committees. We believe the results from this study could be useful for other countries interested in implementing a similar system.

'The way you talk, do I have a choice?' Patient narratives of medication decision-making during hospitalization.

OBJECTIVE: Based on the principle of the autonomy of the patient, shared decision-making (SDM) is the ideal approach in clinical encounters. In SDM, patients and healthcare professionals (HCPs) share knowledge and power when faced with the task of making decisions. However, patients are often not involved in the decision-making process. In this study, we explore medication decision-making during hospitalization and how power in the specific patient-HCP relationship is articulated, as analysed by Foucauldian theory. METHODS: A qualitative case study, comprising observations of patient-HCP encounters at an internal medicines ward at a university hospital in Norway, followed by semi-structured interviews. The narratives (n = 4 patients) were selected from a larger study (n = 15 patients). The rationale behind the choice of these patients was to include diverse and rich accounts. The four patients in their 40s-70s were included close to the day of presumed discharge. RESULTS: The narratives provide an insight into the patients as persons, their perspectives, including what mattered to them during their hospitalization, especially in relation to medications. Overall, SDM was not observed in this study. Even though all the participants actively tried to keep their autonomous capacity and to resist the HCPs' use of power, they were not able to change the established dynamics. Moreover, they were not allowed an equal voice to those of HCPs and thus not to escape the system's objectification and subjectification of them. CONCLUSION: There is a need for HCPs to get more familiarized with SDM. The healthcare system and the individual HCP need to make more room for dialogue with the patients about their preferences. A part of this is also how health care systems are structured and scheduled, thus, it is important to empower patients and HCPs alike.

Pharmacists in general practice: what do they do? A qualitative case study.

BACKGROUND: Pharmacists working in general practice are a relatively new phenomenon in many European countries. Providing insight into what pharmacists do in general practice may support further implementation of general practice-based pharmacist roles and enhance their contribution to health care. AIM: To explore the tasks performed by pharmacists in general practice in Sweden. METHOD: A case study was conducted in 7 general practices in Uppsala County, Sweden, where pharmacists were employed. Activities performed by pharmacists were self-reported during March 2021. Participant observations and semi-structured interviews with pharmacists were conducted between October and November 2021. Self-reported activities were categorised and analysed using descriptive statistics. Qualitative data were analysed using conventional content analysis. RESULTS: In total, 174 activities were self-reported by 8 pharmacists. Two pharmacists were observed for 2 days each, and 6 pharmacists were interviewed. Their main task was conducting medication reviews in older patients with polypharmacy. In addition, they handled a broad variety of drug-related questions and treatment follow-up. Pharmacists described working in a more efficient and needs-based manner over time. They stressed that working at the practice increased their accessibility to and their collaborative work with other healthcare professionals, and enabled them to meet patients face-to-face. Future challenges include defining tasks more clearly, assuming greater responsibility for patient care, and meeting the growing demand for pharmacists in general practice. CONCLUSION: Pharmacists in general practice in Sweden perform a broad variety of tasks related to identifying, resolving and preventing drug-related problems, mainly in older patients with polypharmacy.

Knowledge support for environmental information on pharmaceuticals: experiences among Swedish Drug and Therapeutics Committees.

BACKGROUND: Two publicly available Swedish knowledge support systems, "Pharmaceuticals and Environment" on Janusinfo.se and Fass.se, provide environmental information on pharmaceuticals. Janusinfo is provided by the public healthcare system in Stockholm and Fass is provided by the pharmaceutical industry. The objectives of this study were to investigate the experiences among Swedish Drug and Therapeutics Committees (DTCs) with using the databases, retrieve development proposals for these, and investigate the DTCs' challenges with working with pharmaceuticals in the environment. METHODS: A cross-sectional survey with 21 questions, both closed and open-ended, was distributed electronically in March 2022 to Sweden's 21 DTCs. Descriptive statistics and inductive categorization were used for the analysis. RESULTS: A total of 132 respondents from 18 regions filled out the survey. The average regional response rate was 42%. The DTCs used the knowledge supports to consider environmental aspects of pharmaceuticals in their formularies and in education. Respondents were more familiar with Janusinfo compared to Fass but appreciated the availability of both. The DTCs especially valued the concrete proposals for certain active pharmaceutical ingredients on Janusinfo. Respondents requested that all medicinal products have environmental information on Fass. Challenges included lack of data, lack of transparency from the pharmaceutical industry and difficulties considering the environmental aspect of pharmaceuticals in their healthcare practice. Respondents wanted more knowledge, clear messages, and legislation to support their work to reduce the negative environmental impact of pharmaceuticals. CONCLUSIONS: This study demonstrates that knowledge supports for environmental information on pharmaceuticals are valuable for the DTCs in Sweden, but the respondents experienced challenges in their work in this field. The study can provide insights to those in other countries interested in considering environmental aspects in their formulary decision-making.

Magistral Compounding with 3D Printing: A Promising Way to Achieve Personalized Medicine.

BACKGROUND: Magistral compounding has always been an integral part of pharmacy practice. The increasing demand worldwide for personalized drug treatments might be accommodated by an increase in magistral compounding. The new, flexible technology of 3D medicine printing could advance this process even further. However, the issue of how 3D medicine printing can be implemented within the existing magistral compounding infrastructure has not been explored. AIMS: To investigate how 3D printing can be integrated into the existing compounding system by taking regulatory, economic, and profession-oriented aspects into account. METHODS: Semi-structured interviews were conducted with relevant Dutch stakeholders representing various health institutions, such as health ministries and boards, professional bodies, and different types of pharmacies. Participants were identified through purposeful sampling. Content analysis was applied to identify the main themes. RESULTS: A total of 15 Dutch stakeholders were interviewed. It was found that the prevalence of compounding in community pharmacies in the Netherlands has decreased as a result of the practice shifting to specialized compounding pharmacies due to higher costs, lack of space, and the need to fulfill quality requirements. All interviewees considered 3D printing to be a promising compounding technique for community pharmacies, as it offers an automated approach with high digital flexibility and enables adapted formulations, including 'polypills.' Regulatory and quality assurance challenges were considered comparable to those of normal magistral products; however, there remain pending regulatory issues regarding quality control, particularly for Active Pharmaceutical Ingredients containing intermediate feedstock materials (e.g., prefilled cartridges) in 3D printing. 3D printing was believed to become cost effective over time. CONCLUSION: In the Netherlands, specialized compounding pharmacies have largely taken over compounding activities. 3D printing could be introduced within this system; however, challenges regarding how to regulate prefilled cartridges have yet to be addressed. Compounding using 3D printing in regular community pharmacies could enhance patients' individualized treatment; however, this activity would require incentives to stimulate the return of compounding to normal pharmacy practice.

Ethnography and its potential for studying the social in social pharmacy: An example of autonomy and pharmaceuticals in eldercare.

Studying the social aspects of pharmaceuticals is an inherent part of the field of social pharmacy. Ethnography as a methodology provides a lens to guide researchers on this endeavor by offering richer insights into "real world practices" of professionals, patients and relatives compared to other methods. With a focus on meaning making, ethnography goes beyond descriptions and promotes theory-informed interpretations. Therefore, this methodology can lead to new understandings of medicine use in practice and in policy making. This article provides a brief introduction to ethnography, especially in relation to doing participant observation and fieldwork. An example from an ethnographic fieldwork on Danish home care for frail elderly is used to illustrate how ethnography can be applied, while focusing on three key features of ethnographic analysis: Thick descriptions, analytical generalizability and reflexivity.

Data-Enriched Edible Pharmaceuticals (DEEP) with Bespoke Design, Dose and Drug Release.

Data-enriched edible pharmaceuticals (DEEP) is an approach to obtain personalized medicine, in terms of flexible and precise drug doses, while at the same time containing data, embedded in quick response (QR) codes at a single dosage unit level. The aim of this study was to fabricate DEEP with a patient-tailored dose, modify drug release and design to meet patients' preferences. It also aimed to investigate physical stability in terms of the readability of QR code patterns of DEEP during storage. Cannabinoids, namely, cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC), were used as the model active pharmaceutical ingredients (APIs). Three different substrates and two colorants for the ink were tested for their suitability to fabricate DEEP by desktop inkjet printing. Flexible doses and customizable designs of DEEP were obtained by manipulating the digital design of the QR code, particularly, by exploring different pattern types, embedded images and the physical size of the QR code pattern. Modification of the release of both APIs from DEEP was achieved by applying a hydroxypropyl cellulose (HPC) polymer coating. The appearance and readability of uncoated and polymer-coated DEEP did not change on storage in cold and dry conditions; however, the HPC polymer layer was insufficient in preserving the readability of the QR code pattern in the extreme storage condition (40 °C and 75% relative humidity). To sum up, the DEEP concept provides opportunities for the personalization of medicines, considering also patients' preferences.

The observer effect in a hospital setting - Experiences from the observed and the observers.

BACKGROUND: Observation studies are used in health care research, e.g. to explore behaviors of patients or health care professionals in hospitals. A methodological challenge in observation studies is the observer effect, as it can jeopardize the quality of a study. OBJECTIVES: To capture different dimensions of the observer effect through health care professionals' and patients' experiences, and their reactions to being observed in a hospital setting, and in addition, observers' experiences from performing an observation study. METHOD: Four focus group interviews (health care professionals and observers) and 10 individual interviews (patients) were conducted with participants from a Norwegian observation study focusing on medication communication at a hospital ward. In all 26 persons were interviewed, whereof 3 were observers (pharmacist, pharmacy students). Data were collected between September 2019 and January 2020 and analyzed by an inductive, thematic analysis approach. RESULTS: Five main themes were identified; Experiencing being observed; Temporarily adapting medication communication behavior; Consequences for the patients; To interact or not - reflections on the relations and Observing the observers. Respondents reported some observer effects, but also that these diminished with time. Even though minimal interaction was used as a strategy, observers and the observed still built rapport. CONCLUSIONS: The observer effect in relation to medication communication seemed to be small and temporary in this specific hospital setting, among other things as staff and patients were used to extra persons (e.g. students) being around. Medication communication in hospital settings is a complex behavior, and appears to not be strongly impacted by the presence of observers, especially with a long observation time. It is important for researchers to monitor and record the observer effect in the specific setting of the study. This can be done by interviews with the observed and the observers by someone not connected to the observation study.

A Presentation of Central Communication Aspects in the Patient-Provider Relationship-Potential Learnings for Community Pharmacists.

Several studies have shown that communication between patients and HCPs is still not optimal in integrating patients' perspectives on how best to manage their diseases and their medication. One such area where encounters between patients and professionals still needs to develop to better incorporate the patient's perspective is pharmacy practice. The aim of this study was therefore to explore and present new typologies and communication aspects of HCP-patient relationships since a comprehensive literature search in 1997 conducted by Sondell and Söderfeldt, and relate the findings to pharmacy practice. In total, 11 articles were identified by applying the techniques of a purposeful literature search. The articles covered aspects of: shifting and adapting roles during the encounter, techniques to ensure individualizing in the encounter, avoiding inappropriate routines, coping with internet-informed patients, achieving mutual goals, dealing with uncertainty including avoiding rigid preconceptions, using social conversation, incorporating patients' prior experiences, aligning language, adapting greetings and exploring the cultures and communication patterns of patients from other ethnic backgrounds. The variety of these communication aspects points to the immense complexity of communication as a practice discipline. This article has presented some of the literature that pharmacists can consult, in the endeavor of improving their communication practices.

Rationales and arguments behind the adoption of self-selection of nonprescription medicines in Denmark.

BACKGROUND: Pharmacies in Europe have undergone considerable changes in their regulation over the last decades, also regarding nonprescription medicines (NPMs). In 2001, selected NPMs were released for sale outside pharmacies in Denmark. To ensure consumer safety, it was decided that NPMs must be stored behind the counter. In 2018, an amending act came into force, which allowed self-selection of NPMs. The purpose of this study was to examine the rationales and related arguments, including their validity and relevance, behind the policy on self-selection of NPMs in Denmark. METHODS: A qualitative study design, combining document analysis and individual interviews with key stakeholders, was used. Legislative documents were retrieved from the Parliaments' homepage. Interviewees were recruited through purposeful sampling. Interviews were analyzed using directed content analysis. Rationales and supporting arguments were identified, thematized and analyzed as to their validity and relevance. RESULTS: In total, 24 stakeholders (including political parties) were represented in the documents, whereof 7 were interviewed. Ten supported the new policy and 13 were against; 1 was on both sides. Six rationales and 9 supportive arguments were found. The advocates' main rationale was increased accessibility and arguments related to freedom of choice and discretion. The opponents' main rationale for not adopting the policy was consumer safety and arguments related to perception of NPMs and counseling. The validity and relevance were questionable in both advocates' and opponents' arguments, yet slightly better in the case of the opponents'. Although not mentioned in the documents, economic interests were probably behind some stakeholders' position. CONCLUSION: The formal rationale behind the adoption of self-selection of NPMs was increased accessibility. However, bearing in mind the rationales and their supporting arguments, economic interests and previous changes within the sector, it could be argued that an underlying rationale behind adopting the policy was to liberalize the Danish pharmacy sector even further.

The antibiotic knowledge, attitudes and behaviors of patients, doctors and pharmacists in the WHO Eastern European region - a qualitative, comparative analysis of the culture of antibiotic use in Armenia, Georgia, Kazakhstan, Moldova, Russia and Tajikistan.

BACKGROUND: To reduce antimicrobial resistance (AMR), initiatives such as surveillance activities and activities to increase knowledge about how and why antibiotics (ABs) are (mis)used are needed. More surveillance systems are in place in the WHO Western European region than in the Eastern region, and only sparse knowledge exists about the current culture of AB use in the Eastern European countries. OBJECTIVE: To investigate AB knowledge, attitudes and behaviors in countries in the WHO Eastern European region in order to identify overall similarities and differences across the region and how AB knowledge, attitudes and behavior patterns may be influenced by the national health care system. METHODS: Semi-structured interviews were conducted in Armenia, Georgia, Kazakhstan, Moldova, Russia and Tajikistan with patients, doctors and pharmacists. In total, 80 interviews were carried out. A directed content analysis was applied, followed by a comparative analysis, identifying the similarities and differences in AB attitudes, knowledge and behaviors between the countries and discussing how the national health care systems might influence these patterns. RESULTS: Cross-national patterns were identified regarding patients seeking ABs over-the-counter (OTC), patient variations in their requests for ABs when consulting doctors, and, finally, doctors and pharmacists appearing knowledgeable about ABs and their uses, with doctors displaying careful attitudes towards AMR. Indications of national differences between the countries included the ability of patients to afford ABs, prescribing practices of doctors and pharmacist attitudes towards selling ABs without prescriptions. Multiple aspects involved in patient and pharmacist AB decision making were detected, such as various rationales involved in buying/selling ABs OTC, implying that these processes are more complex than previously reported in the literature. CONCLUSIONS: Similarities across the Eastern European region could be seen in patient needs and uses of antibiotics obtained OTC at community pharmacies, whereas doctors appeared more influenced by specific structures of the national healthcare system.

Patients', Pharmacy Staff Members', and Pharmacy Researchers' Perceptions of Central Elements in Prescription Encounters at the Pharmacy Counter.

Background: Studies suggest that the way pharmacy counselling takes place does not fully support patients in obtaining optimal medicine use. To understand the basis of current challenges in pharmacy counselling, we investigated which selected related cues, i.e., objects, sounds, or circumstances in prescription encounters, patients, and pharmacy staff notice, and how they interpret these cues. Pharmacy practice researchers' cue orientation was also investigated to explore possible differences to those of staff and patients. Methods: Twelve focus group interviews representing 5 community pharmacies (staff and patients) and 2 universities (researchers) were conducted during 2017-2018 in Denmark. A total of 20 patients, 22 pharmacy staff, and 6 pharmacy researchers participated. A theoretical analysis based on cue orientation and social appraisal was conducted. Results: Pharmacy staff, patients and researchers noticed different selected related cues in prescription encounters. Staff particularly noticed 'types of patients'. Patients were more divided and grouped into three overall categories: 'types of staff', medical content, and the situation around the encounter. Pharmacy researchers noticed multiple cues. Different emotions were integrated in the construction of the cues. Conclusion: Differences in the cue orientation between all three groups were identified. The identified types of cues and emotions can explain an underlying dissatisfaction with the encounters. Patients lack, in particular, more personal contact. Staff need to consider these aspects to provide relevant counselling.

Competence, competition and collaboration: Perceived challenges among Swedish community pharmacists engaging in pharmaceutical services provision and research.

BACKGROUND: Creating evidence of effectiveness is an important part of service development. In an ongoing research project Swedish community pharmacists participate in services research by recruiting patients initiated on statins to an adherence-promoting cognitive pharmaceutical service, jointly run by nurses and pharmacists. AIMS: To explore the pharmacists' experiences of providing part of the service and their views regarding future participation in practice research aiming at developing cognitive pharmaceutical services. METHODS: Focus group interviews were conducted with community pharmacists from pharmacies participating in the project. A semi-structured interview guide was developed, based on the aim and earlier research. RESULTS: The domains identified were the service itself, operative conditions, the pharmacists' role/profession and stakeholders. The research project was thought to promote the local pharmacy to customers, increase job satisfaction and contribute to service development. However, a perceived lack of competence among pharmacists affected both patient communication and project involvement. Additional resources and strengthened collaboration with other local healthcare were requested. Competition among pharmacy chains was identified as a barrier to patient-centred service provision and research. CONCLUSION: The current operative conditions in Swedish community pharmacies were perceived by pharmacists as hampering cognitive pharmaceutical services provision and research. Additional resources, improved communication skills and research competence, and increased collaboration with other healthcare and across pharmacy chains are necessary changes. A stronger patient-centred perspective among all stakeholders is required.

Danish Physicians' Views on the Appropriateness of the Involvement of Patients with Type 2 Diabetes in Regulatory Decision Making: A Qualitative Study.

BACKGROUND: Regulators, the pharmaceutical industry, and patient organizations expect an increased inclusion of patients' risk preferences in medical regulatory decisions, for example, with regard to market approval. Merging of input from patients with, for example, multiple sclerosis, with expertise from health professionals in regulatory decisions has already occurred. The complex task of involving larger and more heterogeneous patient populations (e.g. with diabetes mellitus, asthma), however, remains. OBJECTIVE: This study aimed to understand physicians' experiences with factors influencing patients with diabetes mellitus perceived risks of their medicines and to explore how physicians, based on these experiences, perceive patients with diabetes to be suited for involvement in regulatory decisions. This study will provide knowledge that can improve the inclusion of heterogeneous patient groups in regulatory decisions. METHODS: We conducted five semi-structured interviews with physicians with different types of experiences with patients' risk perceptions (for example, being in contact with individual patients vs. being involved in developing guidelines at the population level) and one focus group interview with eight general practitioners in Sjælland, Denmark. We applied a thematic analysis to explore physicians' experiences of the risk perceptions of patients with type 2 diabetes and their perceptions of patients' fitness for involvement in regulatory decisions. RESULTS: The risk perceptions and preferences of patients with diabetes were perceived to be rather diverse. Four drivers behind this diversity were described: past experiences, personality, prognosis ability, and knowledge. The legitimacy of patient preferences was not questioned, but the diversity of risk perceptions made the respondents question the existence of a uniform 'patient voice' useful for regulatory decision making. CONCLUSION: The respondents acknowledged the relevance and legitimacy of the patient perspective, but it was a concern that patient risk perceptions, at present, are too diverse to be included in regulatory decisions. Whether patients make regulatory decisions as perceived by physicians needs to be confirmed by future studies.

Swedish patients' trust in the bioequivalence of interchangeable generics. What factors are important for low trust?

Background: Generic substitution (GS), is a cost-containment strategy meant to contain pharmaceutical expenditure without compromising health objectives. In order to shape GS into a policy that is both efficient and safe it is crucial to understand which factors are most important for patients' trust in GS. Objective: To assess Swedish patients' level of trust in the bioequivalence of cheap and expensive generic medicines, and the association between trust and various factors. Methods: A cross-sectional study was conducted. Questionnaires were handed out at 12 community pharmacies in Sweden, selected through stratified sampling, between March and April 2015. The questionnaire included seven socio-demographic questions in addition to 18 items divided into three sections: the 'views on generic medicine'-scale, information on and prior experiences of GS, financial aspects and change of color/name. Odds Ratios (ORs) were estimated applying adjusted logistic regression analyses with trust in the bioequivalence of generic medicines used as outcome variable and various factors as predictors. Results: A total of 719 patients participated (response rate 85.7%). The results show that 70.7% of the respondents' trust that cheap and expensive interchangeable generic medicines are equal. Of the respondents 36.0% considered the change in appearance and 40.8% the change in names to complicate adherence. Lower trust in the bioequivalence of generic medicines were associated with being female (aOR=1.82, 95%CI 1.20:2.75, p<0.01), patients perceiving that changes in product name and appearance make adherence more complicated (aOR=2.18, 95%CI 1.48:3.19, p<0.001), disagreeing in that GS saves money for me (the customer) (aOR=2.68, 95%CI 1.58:4.55, p<0.001) or that GS saves money for society (aOR=3.21, 95%CI 1.46:7.08, p<0.01). Conclusions: Seven out of ten respondents had trust in the bioequivalence of generic medicines, and one in three considered GS to complicate adherence. Four factors were associated with lower trust in GS, i.e. female gender, agreeing that changes in product name and appearance complicates adherence, disagreeing in that GS saves money for me or disagreeing in that GS saves money for the society. Low trust in GS needs to be addressed, not least in the communication between health professionals and patients

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Nordic Pharmacy Students' Opinions of their Patient Communication Skills Training.

Objective. To describe Nordic pharmacy students' opinions of their patient communication skills training (PCST), and the association between course leaders' reports of PCST qualities and students' perceptions of their training. Secondary objective was to determine what factors influence these associations. Methods. A cross-sectional questionnaire-based study was performed. The various curricula were categorized into three types (basic, intermediate and innovative training) and students were divided into three groups according to the type of training they had received. Multivariable logistic regression models were fitted with different opinions as outcomes and three types of training as exposure, using generalized estimation equations. Results. There were 370 students who responded (response rate: 77%). Students within the innovative group were significantly more likely to agree that they had received sufficient training, and to agree with the assertion that the pharmacy school had contributed to their level of skills compared to students in the basic group. Conclusion. There appears to be an association between larger and varied programs of training in patient communication skills and positive attitudes toward this training on the part of the students, with students reporting that they received sufficient training, which likely enhanced their skills.

Unintended consequences for patients of future personalized pharmacoprinting.

Manufacturing pharmaceuticals by the use of 3D printing is a promising way to achieve more personalized drug treatment. To effectively use this technology, patients need to continuously measure their health, and new decisions have to be taken, for example, regarding the number of daily drugs including how many active pharmaceutical substances these should contain along with decisions around size, shape and color. Positive as well as negative effects of pharmacoprinted medicine on patients are likely to occur. Negative consequences with influence on patient autonomy and role might include: patients not being capable or interested in conducting self-monitoring, loosing overview of the medical treatment, reducing the ability to perform self-regulation, loosing trust in the pharmacoprinted medicine, and not being interested in taking on a new role in medical decision making. These issues are discussed in the paper in order to prevent upcoming challenges in the area of pharmacoprinting.

Swedish patients' trust in the bioequivalence of interchangeable generics. What factors are important for low trust?

BACKGROUND: Generic substitution (GS), is a cost-containment strategy meant to contain pharmaceutical expenditure without compromising health objectives. In order to shape GS into a policy that is both efficient and safe it is crucial to understand which factors are most important for patients' trust in GS. OBJECTIVE: To assess Swedish patients' level of trust in the bioequivalence of cheap and expensive generic medicines, and the association between trust and various factors. METHODS: A cross-sectional study was conducted. Questionnaires were handed out at 12 community pharmacies in Sweden, selected through stratified sampling, between March and April 2015. The questionnaire included seven socio-demographic questions in addition to 18 items divided into three sections: the 'views on generic medicine'-scale, information on and prior experiences of GS, financial aspects and change of color/name. Odds Ratios (ORs) were estimated applying adjusted logistic regression analyses with trust in the bioequivalence of generic medicines used as outcome variable and various factors as predictors. RESULTS: A total of 719 patients participated (response rate 85.7%). The results show that 70.7% of the respondents' trust that cheap and expensive interchangeable generic medicines are equal. Of the respondents 36.0% considered the change in appearance and 40.8% the change in names to complicate adherence. Lower trust in the bioequivalence of generic medicines were associated with being female (aOR=1.82, 95%CI 1.20:2.75, p<0.01), patients perceiving that changes in product name and appearance make adherence more complicated (aOR=2.18, 95%CI 1.48:3.19, p<0.001), disagreeing in that GS saves money for me (the customer) (aOR=2.68, 95%CI 1.58:4.55, p<0.001) or that GS saves money for society (aOR=3.21, 95%CI 1.46:7.08, p<0.01). CONCLUSIONS: Seven out of ten respondents had trust in the bioequivalence of generic medicines, and one in three considered GS to complicate adherence. Four factors were associated with lower trust in GS, i.e. female gender, agreeing that changes in product name and appearance complicates adherence, disagreeing in that GS saves money for me or disagreeing in that GS saves money for the society. Low trust in GS needs to be addressed, not least in the communication between health professionals and patients.

Customers' perceptions of and satisfaction with medicine retail outlet services in Addis Ababa, Ethiopia: a cross-sectional study.

OBJECTIVES: The aim of this study was to assess customers' perceptions of and satisfaction with MRO services in Addis Ababa and to explore factors associated with their satisfaction and reasons for visits. METHODS: A cross-sectional survey was conducted among customers selected from 28 MROs in Addis Ababa, using multi-stage sampling techniques. Simple descriptive statistics and multivariable logistic regression at 95% confidence interval were used for the analysis. KEY FINDINGS: Of 396 respondents, 324 (81.8%) visited MROs to purchase prescription medicines. A majority (338/396; 85.4%) of them perceived that pharmacists and druggists (pharmacy professionals) play a major role in healthcare delivery. A third (140/396; 35.4%) of the respondents agreed with the statement that pharmacy professionals are more concerned about patient care than about their business. Regarding reasons for visiting, being married was positively associated with buying over-the-counter, higher educational status was linked with more satisfaction. Overall, 56.8% (225/396) of the respondents reported that they were satisfied with the service provided by MROs. CONCLUSION: Customers of MROs had mixed perceptions of and satisfaction with the current service. Marital status and age were associated with the reason for visiting, while the educational level was associated with the level of satisfaction. The overall positive perceptions and satisfaction about MROs should be taken as an opportunity to promote and improve pharmaceutical services rendered in MROs, to ensure that the public is receiving maximum benefit.

Factors associated with pharmacy students' attitudes towards learning communication skills - A study among Nordic pharmacy students.

INTRODUCTION: Good communication skills are essential for pharmacy students to help patients with their medicines. Students' attitudes towards communication skills learning will influence their willingness to engage in communication training, and their skills when dealing with patients later on in their professional life. OBJECTIVE: The aim of this study was to explore Nordic pharmacy students' attitudes to communication skills learning, and the associations between those attitudes and various student characteristics. METHOD AND MATERIALS: A cross-sectional questionnaire-based study was conducted in 11 Nordic pharmacy schools between April 2015 and January 2016. The overall response rate for the final study population was 77% (367 out of 479 students). Pharmacy students who had fulfilled all mandatory communication training and most of their pharmacy practical experience periods were included. The communication skills attitudes scale was the main outcome. Linear regression models were fitted with the outcome variable and various student characteristics as the predictors, using generalized estimating equations to account for clustering within pharmacy schools. RESULTS: Nordic pharmacy students in general have moderately positive attitudes towards learning communication skills. Positive attitudes towards learning communication skills among pharmacy students were associated with being female (ßadjusted 0.42, 95% CI 0.20 to 0.63, p < 0.001), following a newer pharmacy training program (ßadjusted 0.81, 95% CI 0.63 to 0.98, p < 0.001), having higher self-rated need for communication skills improvement (ßadjusted 0.50, 95% CI 0.30 to 0.71, p<0.001) and believing one's communication skills are not the result of personality (ßadjusted -0.24, 95% CI -0.44 to -0.04, p=0.017). CONCLUSION: The study provides important information for faculty members responsible for curriculum improvements and teachers to refine their teaching of communication skills. From this, the teaching can be better tailored to suit different students. The students' chances of being able to effectively help patients in the future will be increased by that.