A narrative review of the well-being and burnout of U.S. community pharmacists.

OBJECTIVES: The purpose of this narrative review is to summarize the literature on well-being and burnout among community pharmacists in the U.S. and provide recommendations for future research. METHODS: Relevant literature was identified by searching PubMed for combinations of keywords such as "burnout" and "well-being" combined with "pharmacists." Titles and abstracts were reviewed for relevancy, and full text articles were reviewed when applicable. RESULTS: While burnout is defined by its 3 core symptoms of emotional exhaustion, depersonalization, and low personal accomplishment, well-being is more challenging to define and measure, which has led to it being less studied. Community pharmacists faced high rates of burnout, low quality of life (QOL), and extreme fatigue prior to the COVID-19 pandemic, a situation that has likely only worsened. Factors such as workload, the type of community pharmacy, the level of education or training of the pharmacist, and stress may be some of the contributors to high rates of burnout. Clinician burnout may be related to high rates of mental health disorders seen in pharmacists, may impact patient safety and satisfaction, and may affect productivity and costs to employers and the healthcare system overall. There has been no research into interventions or strategies to support well-being and reduce burnout among community pharmacists, but having a workplace that is perceived as supporting well-being may have some impact. Recommendations for future research include the following: (1) define well-being, (2) explore why various factors support well-being or contribute to burnout, (3) determine the impact of community pharmacists experiencing well-being or burnout, and (4) develop strategies to support well-being and reduce burnout that are specific to community pharmacy. CONCLUSION: There is a sparsity of evidence regarding community pharmacist well-being and burnout. Further research is needed to generate the evidence needed to support interventions that are specific to the unique work setting of community pharmacists.

Student perspectives on caring and connectedness in the PharmD classroom.

INTRODUCTION: Mental health concerns are increasing exponentially within the college student population. Successfully coping with the stress of adjusting to college can be difficult particularly for students majoring in science- and health-related disciplines like pharmacy. This study aimed to understand how well-being is integrated and could be improved upon within the learning environment from the students' perspective. METHODS: Several college of pharmacy faculty collaborated with campus wellness staff through an initiative that aimed to integrate mental health and well-being strategies into the learning environment. At the end of each semester, pharmacy students responded to open-ended questions meant to evaluate their perspectives of the professor participating in the well-being program. Grounded theory was used to code the responses. RESULTS: Four themes emerged from the student responses: (1) Instruct in a creative, consistent, and clear manner; (2) Be genuine; (3) Establish a welcoming environment; and (4) Invest in students. Pharmacy students experienced their classrooms as more than just a place to learn class material but as an environment that valued the students as people. CONCLUSIONS: The study highlights the role of faculty as educators of classroom material and of including practices that facilitate a sense of connectedness and caring within the classroom.

Using the Theory of Planned Behavior to assess community pharmacists' intention to prescribe using the Formulary and Protocol Compendia.

BACKGROUND: Oregon pharmacists can autonomously prescribe hormonal contraception, naloxone, and various medications and devices from a Formulary and Protocol Compendia (FPC). Prescribing using the FPC has seen limited uptake. OBJECTIVES: (1) Assess Oregon community pharmacists' intention to prescribe using the FPC; (2) Determine the impact that attitudes, subjective norms (SN), perceived behavioral control (PBC), perceived obligation, and past prescribing behavior have on pharmacists' intention to prescribe; (3) Examine the relationship between beliefs and pharmacists' attitudes, subjective norms, and perceived behavioral control. METHODS: This study was conducted as a cross sectional survey, which was developed based on the results of a previously conducted research project. A modified version of the Theory of Planned Behavior (TPB) was the study framework. All Oregon community pharmacists with a public email address were invited to participate. The questionnaire collected information on TPB constructs as well as demographic and practice information. TPB constructs were measured directly (intention, attitudes, SN, PBC, perceived obligation, and past prescribing behavior) and indirectly (attitudes, SN, and PBC). Descriptive statistics were used for all items. Multiple linear regression was used to assess Objectives 2 and 3. RESULTS: There were 175 useable responses included in the analysis of the estimated 1015 community pharmacists that received the survey invitation (17%). Respondents had 16.5 ± 13.3 years in practice, 60% held a PharmD degree, and 69% had prescribed in some manner before. Mean intention to prescribe using the FPC was 5.0 ± 1.5 (7-point scale with 7 indicating higher intention). Attitudes, SN, PBC, and PO were significant predictors of intention to prescribe, while past prescribing behavior was not (Adj R2 = 0.741, p < .0001). Attitudes were explained by beliefs about increasing patient access (p = .0179). PBC was explained by beliefs about having policies and procedures in place (p = .004) and feeling comfortable prescribing (p = .008). CONCLUSIONS: Oregon community pharmacists have a positive intention to prescribe using the FPC, but actual uptake remains low. Efforts to increase uptake should focus on the beliefs that contribute most strongly to pharmacist intention.

An exploration of the mental health and well-being of postgraduates in pharmacy and pharmaceutical science programs.

BACKGROUND: Postgraduate students enrolled at colleges and schools of pharmacy are at an increased risk of experiencing difficulties with mental health and well-being; however, there is minimal work exploring mental health and well-being among postgraduates in pharmacy and pharmaceutical science programs. OBJECTIVES: (1) to explore the current mental health and well-being of pharmacy postgraduates, (2) to identify factors that promote and hinder mental well-being at the individual and organizational levels, and (3) to explore perspectives regarding organizational priorities, resources, and support tools that may improve the mental health and well-being of postgraduates in pharmacy and pharmaceutical science programs. METHODS: This study conducted a cross-sectional survey of postgraduates in pharmacy and pharmaceutical science programs. Surveys were distributed electronically via the American Pharmacists Association's (APhA) broadcast e-mail system to postgraduate members and through the professional networks of APhA Academy of Pharmaceutical Research and Science (APhA-APRS) Postgraduate Advisory Committee members. The survey had 3 sections: demographics, current mental health and well-being status, and barriers and facilitators to mental health and well-being. Descriptive statistics and frequencies were generated for quantitative survey responses. Open-ended responses were categorized and presented with each question. RESULTS: Fifty-one responses were analyzed. The sample had a mean age of 29.0 ± 6.6 years, included 58.8% women or womxn, and most were in doctoral programs (58.8%) for 2.3 ± 2.7 years in various disciplines. There were 27.5% of respondents categorized as having flourishing mental health and 7.8% with languishing mental health. Factors such as practicing self-care or engaging in hobbies (94.1% for each) were most commonly rated as having a positive impact on well-being, and societal racism and discrimination (66.7%) was most commonly reported as having a negative effect on well-being. Top priorities for postgraduates included work-life balance, career prospects, meaningful relationships, and financial concerns. CONCLUSION: There are a number of organizational and institutional priorities that may improve pharmacy and pharmaceutical science graduate students' mental health and well-being.

Pharmacists' intention to prescribe under new legislation.

BACKGROUND: In 2017, Oregon passed legislation that authorized pharmacists to autonomously prescribe specified medications or devices that were included on the Formulary and Protocol Compendia (FPC). Factors that impact pharmacists' intention to prescribe from the FPC are not currently known. OBJECTIVES: Identify factors that influence pharmacists' intention to prescribe. METHODS: The Theory of Planned Behavior (TPB) served as the framework. Three focus groups were conducted with Oregon pharmacists between May and June 2019 to elicit salient beliefs about prescribing related to TPB constructs, including attitudes, subjective norms, perceived behavioral control, and perceived obligation. Two investigators conducted a qualitative content analysis and reached agreement on names of categories during consensus meetings. A codebook was created after analysis of the first focus group and used to guide the remaining analysis. Participants reported background information and awareness of prescribing rules via a questionnaire; descriptive statistics were used to report background information and the prescribing awareness summary score. RESULTS: Thirteen participants had 14.1 ± 10.8 years of pharmacist experience. Most earned a Doctor of Pharmacy degree (84.6%) and worked in a community pharmacy setting (61.5%). The mean score on the awareness assessment was 6.3 ± 0.9 (7 = highest awareness). The majority (76.9%) had previous prescribing experience. Attitudes were found to be shaped by behavioral beliefs related to the impact of pharmacist prescribing on patient-centered care and on practice transformation. Normative beliefs were primarily driven by outside groups past experiences with pharmacists and pharmacies. Control beliefs included the following categories: operational readiness; the relationships between comfort, competence, and confidence; and Board of Pharmacy requirements. CONCLUSIONS: TPB was useful for exploring pharmacists' beliefs related to their intention to prescribe using the FPC. Determining the relative importance of these factors in a broader population will enable stakeholders to develop interventions to improve uptake of prescribing via the FPC.

Longitudinal well-being measurements in doctor of pharmacy students following a college-specific intervention.

BACKGROUND AND PURPOSE: Supporting clinician mental health and well-being must start in the learning environment, especially as health profession students have been shown to have higher rates of mental illness than their peers pursuing other careers. This project aimed to support positive mental health in pharmacy students through small changes that faculty implemented both inside and outside of the classroom. EDUCATIONAL ACTIVITY AND SETTING: In partnership with the Counseling and Mental Health Center, faculty received training, resources, and (in some cases) classroom observation and feedback on how to incorporate small changes that support student well-being. Assessments were performed each semester beginning in spring 2018 and ending in spring 2020. These included the Mental Health Continuum - Short Form (measuring positive mental health and well-being), the Theories of Intelligence Scale - Self Form for Adults (measuring growth mindset), the Sense of Belonging Scale (measuring five domains of social connectedness), and the Brief Resilience Scale (measuring resilience). Participating faculty were surveyed regarding how frequently selected activities were incorporated into their practice and how comfortable they felt supporting student mental health. FINDINGS: Positive trends were seen throughout the project on the scales assessing growth mindset and sense of belonging. SUMMARY: Supporting positive mental health in pharmacy students in the learning environment is important for both students and the quality and safety of the health care system. Future efforts should expand on this work by refining the measurements used, identifying more interventions, and evaluating the impact these efforts have as students become pharmacists.

Use of patient assessment skills in advanced pharmacy practice experiences.

INTRODUCTION: Pharmacy programs are required to teach patient assessment (PA) skills. However, pharmacist workforce survey data indicates that limited opportunities exist for students to practice PA skills in real-world settings. The study objectives were to (1) assess how often PA skills are utilized by fourth-year pharmacy (P4) students on advanced pharmacy practice experiences (APPEs), (2) determine perceived competence in performing PA skills, and (3) examine relationships between grade-point average or post-graduation plans and the number of skills performed and between skill use frequency and self-reported competency. METHODS: P4 students completed a questionnaire assessing 13 PA skills. Respondents performing a skill indicated frequency of use and rated their competence using a 5-point scale. Descriptive and bivariate statistics were reported. RESULTS: The response rate was 81%. Measuring blood pressure (BP) (76%) and evaluating metered-dose inhaler (MDI) technique (74%) were most commonly performed. Peak-flow meter evaluation (6%) and lymph node examination (2%) were least commonly performed. Measuring BP and evaluating MDI technique had the highest competency ratings (4.6 + 0.7 for both). Lung (3.4 + 0.7) and heart (2.8 + 1) auscultation had the lowest competency ratings. Positive correlations were found between the frequency of skill use and self-reported competence for assessing MDI technique, peripheral pulses, and peripheral edema. No other findings were significant. CONCLUSIONS: P4 students reported high perceived competency for PA skills performed frequently during APPEs. Preceptor education, requiring skill use, and encouraging students to proactively identify situations to use skills could increase opportunities for use of PA skills.