Mandatory medication content in the curricula of six health care personnel types with patient contact in Denmark.

Medication use is a complex process involving different types of health care personnel. This study investigated and compared mandatory medication content in the curricula of six types of health care personnel with patient contact. Using content analysis, three independent raters analysed the mandatory medication content for physicians, pharmacists, pharmaconomists, nurses, health care assistants and support workers in the Capital Region of Denmark. Three dimensions were analysed as follows: communication with patients about medication, medication use or pharmacology and medication formulation and production. ECTS credits were totalled for courses analysed to have high or medium content, and inter-rater reliability was tested with Fleiss' kappa. The total mandatory medication content for pharmacists was 197.0 ECTS, physicians 136.0 ECTS, pharmaconomists 123.3 ECTS, nurses 52.0 ECTS, health care assistants 17.8 ECTS and support workers 0.0 ECTS. Communication with patients about medication was included to the greatest extent in the educations of pharmaconomists (112.0 ECTS), pharmacists (37.5 ECTS) and physicians (25.0 ECTS). Knowledge about medication use and pharmacology was taught primarily to pharmacists (146.5 ECTS), physicians (123.6 ECTS) and pharmaconomists (89.8 ECTS) and to a lesser extent nurses (52.0 ECTS), health care assistants (17.8 ECTS) and support workers (0.0 ECTS). Medication formulation and production were taught only to pharmacists (93.0 ECTS) and pharmaconomists (25.1 ECTS). Mapping the basic competencies about medication taught to each of the six health care personnel types can lead to a better understanding of how they can complement each other in patient care. The study points to weaknesses in medication curriculum content for health care personnel with the most patient contact.

Drawing on healthcare professionals' ethnicity: lessons learned from a Danish community pharmacy intervention for ethnic minorities.

AIMS: To present and discuss implementation experiences regarding the involvement of community pharmacists with ethnic minority backgrounds in a medication review intervention for ethnic minority poly-pharmacy patients in Denmark. METHODS: Data sources include 1) reflection notes from an introductory seminar with pharmacists and the cross-disciplinary research team and 2) five individual interviews and one focus group interview with pharmacists. Data were thematically coded and synthesised to identify underlying rationales and challenges encountered when involving professionals with ethnic minority backgrounds in interventions for ethnic minorities. RESULTS: Informants perceived the need for interventions targeted at ethnic minority poly-pharmacy patients, and highlighted the potential of involving professionals with diverse ethnic backgrounds in such interventions. However, implementation created challenges, because the professional identity of the pharmacists reduced their options for serving as peers with the same ethnic background. Furthermore, issues related to organisational difficulties and overcoming language barriers in the intervention impacted on the potential of involving professionals with ethnic minority backgrounds. CONCLUSIONS: Involving healthcare professionals with ethnic minority backgrounds in encounters with ethnic minorities holds potential for the adaptation of services to ethnically diverse populations, thus improving access to and quality of care. However, it is important to ensure sufficient personal and organisational support and to acknowledge the delicate balance between simultaneously serving as a peer and as a professional.

Are we ready to accept the challenge? Addressing the shortcomings of contemporary qualitative health research.

BACKGROUND: Qualitative approaches represent an important contributor to health care research. However, several researchers argue that contemporary qualitative research does not live up to its full potential. By presenting a snapshot of contemporary qualitative research in the field of social and administrative pharmacy, this study challenges contributors to the field by asking: Are we ready to accept the challenge and take qualitative research one step further? PURPOSE: The purpose of this study was to initiate a constructive dialogue on the need for increased transparency in qualitative data analysis, including explicitly reflecting upon theoretical perspectives affecting the research process. METHODS: Content analysis was used to evaluate levels of theoretical visibility and analysis transparency in selected qualitative research articles published in Research in Social and Administrative Pharmacy between January 2014 and January 2015. MAIN FINDINGS: In 14 out of 21 assessed papers, the use of theory was found to be Seemingly Absent (lowest level of theory use), and the data analyses did not include any interpretive endeavors. Only two papers consistently applied theory throughout the entire study and clearly took the data analyses from a descriptive to an interpretive level. It was found that the aim of the majority of assessed papers was to change or modify a given practice, which however, resulted in a lack of both theoretical underpinnings and analysis transparency. CONCLUSION: This study takes the standpoint that theory and high-quality analysis go hand-in-hand. Based on the content analysis, articles that were deemed to be high in quality were explicit about the theoretical framework of their study and transparent in how they analyzed their data. It was found that theory contributed to the transparency of how the data were analyzed and interpreted. Two ways of improving contemporary qualitative research in the field of social and administrative pharmacy are discussed: engaging with social theory and establishing close collaboration with social scientists.

Developing and sustaining human resources in the health supply chain in Ethiopia: barriers and enablers.

INTRODUCTION: The health supply chain is often the weakest link in achieving the health-related Millennium Development Goals and universal health coverage, requiring trained professionals who are often unavailable. In Ethiopia there have been recent developments in the area of health supply chain management. The aim of this study was to explore the current status of the development of human resources in health supply chain management in Ethiopia and to identify important factors affecting this development. METHODS: A series of face-to-face interviews with key stakeholders was carried out in 2014. The interviews were conducted using a semi-structured interview guide. The interview guide comprised 51 questions. A qualitative analysis of transcripts was made. RESULTS: A total of 25 interviews were conducted. Three themes were identified: General changes: recognition, commitment and resources, Education and training, and Barriers and enablers. Results confirm the development of human resources in health supply chain management in many areas. However, several problems were identified including lack of coordination, partly due to the large number of stakeholders; reported high staff mobility; and a lack of overall strategy regarding the job/career structures necessary for maintaining human resources. Rural areas have a particular set of problems, including in transportation of goods and personnel, attracting and keeping personnel, and in communication and access to information. CONCLUSIONS: Ethiopia is on the way to developing a nationwide viable system for health supply chain management. However, there are still challenges. Short-term challenges include the importance of highlighting strategies and programs for human resources in health supply chain management. In the long term, commitments to financial support must be obtained. A strategy is needed for the further development and sustainability of human resources in the health supply chain in Ethiopia.

Pursuing Pleasures of Productivity: University Students' Use of Prescription Stimulants for Enhancement and the Moral Uncertainty of Making Work Fun.

This article presents ethnographic data on the use of prescription stimulants for enhancement purposes by university students in New York City. The study shows that students find stimulants a helpful tool in preventing procrastination, particularly in relation to feeling disinterested, overloaded, or insecure. Using stimulants, students seek pleasure in the study situation, for example, to get rid of unpleasant states of mind or intensify an already existing excitement. The article illustrates the notion that enhancement strategies do not only concern productivity in the quantitative sense of bettering results, performances, and opportunities. Students also measure their own success in terms of the qualitative experience of working hard. The article further argues that taking an ethnographic approach facilitates the study of norms in the making, as students experience moral uncertainty-not because they improve study skills and results-but because they enhance the study experience, making work fun. The article thereby seeks to nuance simplistic neoliberal ideas of personhood.

Opportunities and challenges in social pharmacy and pharmacy practice research.

Pharmacy practice and social pharmacy are two important research areas within pharmaceutical and health sciences. As the disciplines have undergone and are still undergoing changes, it is useful to reflect on the current state of their research as the basis for discussing further development. The two areas are currently beset by a lack of consensus and charged all too often with evaluating narrowly focused pharmacy services. With the added challenge of diminished funding for research and the pressures to publish results, these fields have to accommodate a much broader research framework than ever before. In this article, the challenges and opportunities in current research are reviewed, and suggestions provided on how to further research in these areas. A systematic content analysis is important to benchmark trends in the types of studies conducted, and to map the collaboration and funding within these areas.

Customer interest in and experience with various types of pharmacy counselling - a qualitative study.

BACKGROUND: Despite pharmacists' extensive knowledge in the optimization of patients' medical treatments, community pharmacies are still fighting to earn patients' trust with respect to medicinal counselling at the counter. OBJECTIVE: The aim was to investigate how patients perceive pharmacy counselling at the present time, in order to develop the patient-pharmacy relationship for the benefit of both patients and pharmacies. DESIGN: Short semi-structured interviews were carried out with pharmacy customers by pharmacy internship students. SETTING AND PARTICIPANTS: One hundred and eight customers in 35 independent pharmacies across Denmark were interviewed during the spring of 2011. MAIN VARIABLES STUDIED: Customers were interviewed about their expectations of pharmacies in general and their experiences with medical counselling in particular. RESULTS: Customers perceive community pharmacies very differently in terms of both expectations of and positive experiences with counselling. They appear to be in favour of pharmacy counselling with respect to over-the-counter medicine and first-time prescription medicine in contrast to refills. Customers find it difficult to express the health-care role of pharmacies even when experiencing and appreciating it. DISCUSSION: Lack of appreciation of pharmacy counselling for refill prescription medicine and the difficulty in defining the role of pharmacies might stem from the difficulties that customers have in understanding medicine and thus the role of counselling services with respect to medicine. The pharmacy staff does not seem to realize these barriers. CONCLUSIONS: For pharmacies to encourage customer interest in pharmacy counselling, the staff should start taking the identified barriers into account when planning communication strategies.

Encounters with immigrant customers: perspectives of Danish community pharmacy staff on challenges and solutions.

OBJECTIVES: To explore the challenges that Danish community pharmacy staff encounter when serving non-Western immigrant customers. Special attention was paid to similarities and differences between the perceptions of pharmacists and pharmacy assistants. METHODS: A questionnaire was distributed to one pharmacist and one pharmacy assistant employed at each of the 55 community pharmacies located in the five local councils in Denmark with the highest number of immigrant inhabitants. KEY FINDINGS: The total response rate was 76% (84/110). Most respondents found that the needs of immigrant customers were not sufficiently assessed at the counter (n = 55, 65%), and that their latest encounter with an immigrant customer was less satisfactory than a similar encounter with an ethnic Danish customer (n = 48, 57%) (significantly more pharmacists than assistants: odds ratio, OR, 3.19; 95% confidence interval, CI, 1.27-8.04). Forty-two per cent (n = 35) perceived that immigrant customers put pressure on pharmacy staff resources, while 27% (n = 23) found that the immigrant customer group make work more interesting. More pharmacists than assistants agreed on the latter (OR, 3.43; 95% CI, 1.04-11.33). Within the past 14 days, 86% (n = 72) experienced that their advice and counselling were not understood by immigrant customers, whereas 49% (n = 41) experienced lack of understanding by ethnic Danes; and 30% (n = 25) had consciously refrained from counselling an immigrant, whereas 19% (n = 16) had done so with an ethnic Dane. Use of under-aged children as interpreters during the past month was reported by 79% of respondents. Regarding suggestions on how to improve encounters with immigrant customers, most respondents listed interventions aimed at patients, general practitioners and pharmaceutical companies. CONCLUSIONS: Community pharmacy staff report poorer quality in their encounters with immigrant customers, including sub-optimal counselling and frequent use of under-aged children as interpreters. Our study also reveals certain differences across personnel groups, which may be explained by differences in level of education.

Involuntary autonomy: patients' perceptions of physicians, conventional medicines and risks in the management of atopic dermatitis.

Consumerism is a major force in western health care. It defines the process in which patients should or do play a more active and central role in making informed choices about health and illness. The talk of patients as consumers is closely linked, and is especially pertinent for patients managing a chronic illness. This article presents findings from a Danish qualitative study that set out to broaden the sociological debate on patients as consumers by including patients' perceptions of conventional medicines. In-depth interviews were carried out with 24 people who medically managed their own or their child's atopic dermatitis. The informants were recruited via the Division of Dermatology in a Danish Hospital which was planning an Information Day on atopic dermatitis (AD). The findings reveal how many of the informants who on the surface appear to match the profile of the so called 'consumer', by being active, critical, informed etc., in fact prefer to consult a patient-centred medical expert (a dermatologist) with good communication skills, who is able to inform, advise and support on issues of managing atopic dermatitis. These people are not seeking more independence but rather a partnership where responsibility for treatment (medicines) is shared. This preference appears to be closely linked with a sense of insecurity about what an outbreak of atopic dermatitis may lead to and insecurity about the medicines. Ultimately, the findings stress that health care politicians and professionals need to reflect upon patient's wants and needs when designing future health care. Turning health care into self-care may not be an appropriate strategy.

Multimethod research into policy changes in the pharmacy sector--the Nordic case.

This article aims to explain the nature of multimethod studies and to illustrate their role in pharmaceutical policy research. In the field of pharmaceutical policy research, methodological and theoretically sound evaluation is the main goal. Reflexive learning is required in order to address and resolve one of the important paradoxes of late modern societies, which is that while the increasing complexity of social systems progressively undermines notions of certainty in social knowledge, it simultaneously raises the stakes in relation to rational guidance of those systems. By reflecting over our own research processes, we identified the strengths and weaknesses of multimethod research. We present our research methods and the experiences of pharmaceutical policy changes from two separate evaluation studies, one from Iceland and the other from Denmark. In addition, examples from a third study in progress are included: a multimethod international comparison of recent changes in pharmaceutical policy in Iceland, Denmark and Norway. Based on our experiences and reflections, we identified four of the most important issues we encountered in carrying them out: The importance of doing research in context; Challenges of comparison and questions of compatibility of data--both qualitative and quantitative; The importance of doing these studies with a multidisciplinary team; Research in pharmaceutical policy is a fluid, ongoing process.

'I'm Happy if I Can Help'. Public views on future medicines and gene-based therapy in Iceland.

OBJECTIVE: To explore lay perceptions about medicine and drug therapy (including gene-based therapy) in the present and in the future. BACKGROUND: Following almost a year of national debate, the Icelandic parliament passed the Health Sector Database (HSD) Act in 1998. No single issue has been as much debated in Iceland as this database. Despite the explosion of popular and scientific literature in the field of bioethics, there is still a paucity of research concerning 'lay' contributions to the debates. METHODS: The study was designed as a qualitative study. Focus groups (FGs) were conducted followed by one-on-one interviews with the FG moderator. PARTICIPANTS were asked to comment on a future scenario consisting of predictions concerning the consequence of the Human Genome Project over the next 40 years. PARTICIPANTS: Forty-two persons participated in eight FGs in Iceland. The Icelandic moderator was interviewed in English after each group. CONCLUSIONS: The lay public was relatively optimistic with regard to the future of drugs and gene-based therapy. Reasons for this optimism can be found in a basic trust and belief in the welfare state and the health system. These results are not consistent with studies carried out in other countries where the public appears to be focused on the negative effects of genetic research and the threats to privacy. Most participants expressed concern about potential problems with regard to social and equity issues, whereas the HSD controversy, a discourse based on the rhetoric of bioethics, was at variance with the issues focused on by the lay public.

Studying and evaluating pharmaceutical policy--becoming a part of the policy and consultative process.

In this last article in the series the authors focus on the issue of researching and evaluating pharmaceutical policy. The past five articles made an argument for why pharmaceutical policy is important and why it is different from health policy. The evidence base needed for pharmaceutical policymaking is also somewhat specialized in relation to health policy. Taking these differences into consideration the authors provide their definition of pharmaceutical policy. The knowledge base for good pharmaceutical policymaking needs to be broad and include approaches and methodologies ranging from the highly quantitative and experimental to the purely qualitative. Other policy questions such as those concerned with rational use of medicines and economics illustrate that pharmaceutical policy needs more varied approaches than randomized clinical trials alone can provide. The importance of gaining a thorough overview and understanding of the available design and methodological options for policy analysis is emphasized. Research into pharmaceutical policy has many commonalities with evaluation and policy analysis. Some of the main pitfalls that policymakers, researchers and analysts can fall into when formulating and evaluating pharmaceutical policy are discussed and include: using too narrow evaluation questions; choosing inappropriate methods/designs; and the problem of bias and self-censorship. The authors conclude this series by advocating a strong focus on research and an international evaluation culture around pharmaceutical policy. They emphasize the importance of pharmaceutical specialists' (i.e., pharmacists') involvement in pharmaceutical policy analysis and the policy consultative process.

Advocacy coalitions and pharmacy policy in Denmark--solid cores with fuzzy edges.

This paper presents the results from a qualitative study in which the Advocacy Coalition Framework (ACF) was used to analyze deregulation of the distribution of medicine in Denmark in October 2001. The study is based on qualitative methods, and it examines the policy process between 1996 and 2001. Data sources were documents and qualitative interviews. The results show that minor modifications of the ACF are needed to make it fully applicable to the case of pharmacy policy, especially when the policy process proceeds in a predominantly corporatist state. We found that the policy process was framed by two coalitions advocating different belief systems. One coalition wanted the pharmacy sector to be controlled by the state, the other wanted a full-scale liberalization. Throughout the process there was a general shift in policy core beliefs among the actors involved--moving from positively disposed towards a market-oriented reform to being more negatively disposed towards such a reform. We argue that two factors contributed to this. First, as the discussions about a reform became more specific, technical matters began to influence the actors. Second, the legitimacy of a solution which did not alter the regulation of the pharmacy sector radically, was reinforced by institutionalized norms that made politicians take onboard pharmacy professionals' concerns.

Pharmaceutical policy and the pharmacy profession.

In this article, the authors look at the relationship between pharmaceutical policy and the pharmacy profession with focus on pharmacy practice and pharmacists in the health care sector. Pharmaceutical policy encompasses three major policy inputs: public health policy, health care policy and industrial policy. In order to analyse and understand pharmaceutical policy, it is important to know how policymakers view pharmacy and pharmacists. The authors look at the issues that arise when policy regulates pharmacy as a business, and what this means for the profession. The perspective of pharmacy as a health care profession, as well as what it means when we view pharmaceutical policy in the context of the health sector labour market, is discussed. The authors also discuss how factors external to the profession are affecting its purpose and realm of practice, including the current trend in managerialism, and how the division of labour with other health professionals such as physicians and pharmacy assistants is affecting the pharmacy profession's position in the labour market. Next the authors look at ways in which the pharmacy profession has affected policy. Pharmacists have been instrumental in developing new and expanding roles for the profession, sometimes inspired by external events, but often as a result of their own prerogative. The pharmacy profession is encouraged to take a leading role in forming and contributing to policy, in this way making visible its contribution to society in general and public health in particular. If not, the profession will forever be reacting to policy and will remain at the mercy of policymakers and other strong actors in society.

Pharmaceutical policy and the lay public.

Almost every national and supranational health policy document accords high importance to the need to listen to and 'empower' patients. The relationship between pharmaceutical policy and the lay public is not direct but mediated by several actors, including health care workers, patient organisations, industry and, most recently, the media. Although the overall aim of health and pharmaceutical policy is to address the needs of all citizens, there are only a few, well organised groups who are actually consulted and involved in the policymaking process, often with the support of the industry. The reasons for this lack of citizen involvement in health and pharmaceutical policymaking are many, for example: there is no consensus about what public involvement means; there is a predominance of special interest groups with narrow, specific agendas; not all decision makers welcome lay participation; patients and professionals have different rationalities with regard to their views on medicine. Because the lay public and medicine users are not one entity, one of the many challenges facing policy makers today is to identify, incorporate and prioritise the many diverse needs. The authors recommend research which includes studies that look at: lay attitudes towards pharmaceutical policy; lay experiences of drug therapy and how it affects their daily lives; the problem of identifying lay representatives; the relationship between industry and the consumers; the effect of the media on medicine users and on pharmaceutical policy itself. The authors acknowledge that although lay involvement in policy is still in its infancy, some patient organisations have been successful and there are developments towards increased lay involvement in pharmaceutical policymaking.

Cost-containment as part of pharmaceutical policy.

In this article the authors provide insight into the basis for price setting of medicines, the increasing pharmaceutical budgets in the past decades, and the measures governments and insures have taken to curb rising pharmaceutical costs. Four reasons are out lined for the fact that medicines are by some considered expensivey: 1) there are fundamental differences between medicines and other consumer products; 2) medicines are technology requiring an inordinate amount of research and development; 3) medicines are developed, manufactured, and distributed according to strict regulatory requirements; 4) medicines are most often selected by a physician for a specific patient and reimbursed in whole or in party by a third-party insurer or the state. Pharmaceuticals mean share of GDP has been 1.2% in OECD countries in recent decades. Pharmaceuticals accounted for 15.4% of total health expenditure, with public spending about half of this amount. Since 1970, the average share of GDP for pharmaceuticals in most countries has increased 1.5% more per year than GDP growth. Four types of strategies to curb rising Pharmaceuticals costs are described and a taxonomy of strategies provided These are:1)price and profit controls; 2) reimbursement system charges; 3) other fiscal measures; 4) quality measures. Pharmaceuticals policy has suffered from the pervasive misunderstanding that drugs are like any other commodity; resulting in policy makers viewing pharmaceuticals expenditures without thinking about drugs in their proper content of health care. The authors conclude by advocating a balanced approach to policymaking in a environment of rising pharmaceuticals costs.

Rational use of medicines--an important issue in pharmaceutical policy.

In this article the authors deal with issues of drug utilisation from a clinical and policy perspective. They address the difficulties of managing drug therapy on a population level, which is known among professionals, as the problem of rational use of medicines. Various definitions and interpretations are presented and compared. This is followed by a presentation of the concerns associated with pharmaceutical marketing from a policy perspective, including the fear that the dominance of information produced by industry may lead to irrational drug use. Next, the authors review the tools for policy making including educational, managerial, and regulatory interventions. The (often overlapping) concepts of medicines management, clinical pharmacy and pharmaceutical care are then discussed to show how professionals, sometimes in collaboration with policymakers, have tackled the problem of nonrational use of medicines. The authors address the question as to whether the rational use of medicines a universal concept, whether it can be and whether it should be? They argue that, as with most concepts, the rational use of medicines must always be viewed in context. They conclude that pharmacy needs to adapt its way of thinking to include the issue of context. They point out that clinical pharmacists today already adapt their decisons to each patient and patient group. Policy-makers are encouraged to adopt a similar approach because populations as well as particular market situations vary and therefore policy solutions cannot be considered universal.

The medicine user--lost in translation? Analysis of the official political debate prior to the deregulation of the Danish medicine distribution system.

This paper presents results from a qualitative analysis of official documents dealing with the deregulation of the Danish medicine distribution system, 2001. In an attempt to clarify how consumerism within health care is manifested in policy, this study explores how central actors in the political process explicitly referred to the needs, interests and problems of the users of medicine. The results show that explicit references to the users of medicine by central actors in the political process were limited. Based on this we argue that in this case, although the debate centred on liberal ideas it seems as if chief values of classic liberalism were lost in the process of translating a political idea into political practice.

The new consumer of medicine--the pharmacy technicians' perspective.

OBJECTIVE: Market research, and more recently health services research, has adopted the concept of the 'new consumer' to describe customers/patients who are becoming more demanding. This study aims to determine the relevancee of the concept 'new consumer' for pharmacy practice, in light of the theory of 'risk society'. METHOD: Qualitative in-depth interviews were carried out with seven pharmacy technicians from six different pharmacies in the Copenhagen area, Denmark. They were asked to describe developments, over time, in consumer behaviour. They were asked to focus on three themes: information, the authority of the pharmacy staff, and their predictions of the future pharmacy customer. RESULTS: Young customers, particularly parents of pre-school children, as well as the chronically ill appeared to share the characteristics associated with the 'new consumer'. They were: information strong (well-informed) and information seeking (inquisitive); asked critical questions; showed a desire to longer initiate dialogue; sought counselling and in general no longer blindly accepted the authority of the pharmacy staff. CONCLUSION: According to pharmacy technicians a 'new consumer' does exist and is visible in community pharmacies in Copenhagen. Seen in light of the theory of risk society, we further conclude that the behaviour of the 'new consumer' is indicative of an attempt to minimize risk of drug therapy.

Pharmaceutical care in Denmark: perceived importance of medicine-related problems and participation in postgraduate training.

OBJECTIVE: To investigate the readiness of Danish community pharmacists to provide pharmaceutical care. Special focus was on information provided to patients on medicine-related problems and participation in postgraduate training. METHOD: National cross-sectional survey distributed to all Danish community pharmacies (N = 288). Response rate 75.7%; non-responders were interviewed by telephone to establish their reasons for not participating. MAIN OUTCOME MEASURES: Prioritization of information to patients regarding medicine-related problems. Postgraduate courses selected by pharmacists during the past three years. RESULTS: In accordance with the profile of Danish community pharmacists, respondents were primarily female and half were below 45 years of age. The main reason given for not responding was lack of time. The prioritization of information to patients regarding medicine-related problems resulted in three clusters of answers. The overall topics of the clusters were: information related to the technical-practical use of medicines; information related to pharmacotherapeutic aspects of medicine use; and information related to the function of the medicine. The clusters accounted for 61.9% of the total variance. The most frequently attended postgraduate courses were on quality assurance and specific diseases. CONCLUSION: The patient information prioritized by Danish community pharmacists is primarily of a technical-practical nature. The postgraduate training pursued is primarily technical without much focus on the philosophy of pharmaceutical care. These factors contribute to the lack of proper readiness of pharmacists to practice pharmaceutical care.