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1.  The contribution of Ghanaian pharmacists to mental healthcare: current practice and barriers 
Background
There is scant knowledge of the involvement of developing country pharmacists in mental healthcare. The objectives of this study were: to examine the existing role of Ghanaian community and hospital pharmacists in the management of mental illness, and to determine the barriers that hinder pharmacists' involvement in mental healthcare in Ghana.
Method
A respondent self-completion questionnaire was randomly distributed to 120 superintendent community pharmacists out of an estimated 240 pharmacists in Kumasi, Ashanti Region of Ghana. A purposive sampling method was utilized in selecting two public psychiatric hospital pharmacists in Accra, the capital city of Ghana for a face-to-face interview. A semi-structured interview guide was employed.
Results
A 91.7% response rate was obtained for the community pharmacists' questionnaire survey. Approximately 65% of community pharmacists were not involved in mental health provision. Of the 35% who were, 57% counseled psychiatric patients and 44% of these dispensed medicines for mental illness. Perceived barriers that hindered community pharmacists' involvement in the management of mental health included inadequate education in mental health (cited by 81% of respondents) and a low level of encounter with patients (72%). The psychiatric hospital pharmacists were mostly involved in the dispensing of medicines from the hospital pharmacy.
Conclusion
Both community and hospital pharmacists in Ghana were marginally involved in the provision of mental healthcare. The greatest barrier cited was inadequate knowledge in mental health.
doi:10.1186/1752-4458-4-14
PMCID: PMC2893087  PMID: 20550668
2.  The use of opioids at the end of life: knowledge level of pharmacists and cooperation with physicians 
Purpose
What is the level of knowledge of pharmacists concerning pain management and the use of opioids at the end of life, and how do they cooperate with physicians?
Methods
A written questionnaire was sent to a sample of community and hospital pharmacists in the Netherlands. The questionnaire was completed by 182 pharmacists (response rate 45%).
Results
Pharmacists were aware of the most basic knowledge about opioids. Among the respondents, 29% erroneously thought that life-threatening respiratory depression was a danger with pain control, and 38% erroneously believed that opioids were the preferred drug for palliative sedation. One in three responding pharmacists did not think his/her theoretical knowledge was sufficient to provide advice on pain control. Most pharmacists had working agreements with physicians on euthanasia (81%), but fewer had working agreements on palliative sedation (46%) or opioid therapy (25%). Based on the experience of most of responding pharmacists (93%), physicians were open to unsolicited advice on opioid prescriptions. The majority of community pharmacists (94%) checked opioid prescriptions most often only after dispensing, while it was not a common practice among the majority of hospital pharmacists (68%) to check prescriptions at all.
Conclusions
Although the basic knowledge of most pharmacists was adequate, based on the responses to the questionnaire, there seems to be a lack of knowledge in several areas, which may hamper pharmacists in improving the quality of care when giving advice to physicians and preventing or correcting mistakes if necessary. If education is improved, a more active role of the pharmacist may improve the quality of end-of-life pharmacotherapy.
doi:10.1007/s00228-010-0901-7
PMCID: PMC3016212  PMID: 20853103
Opioids; Pain management; Pharmacists; Knowledge; Education; Multidisciplinary cooperation
3.  Experiences of community pharmacists involved in the delivery of a specialist asthma service in Australia 
Background
The role of community pharmacists in disease state management has been mooted for some years. Despite a number of trials of disease state management services, there is scant literature into the engagement of, and with, pharmacists in such trials. This paper reports pharmacists’ feedback as providers of a Pharmacy Asthma Management Service (PAMS), a trial coordinated across four academic research centres in Australia in 2009. We also propose recommendations for optimal involvement of pharmacists in academic research.
Methods
Feedback about the pharmacists’ experiences was sought via their participation in either a focus group or telephone interview (for those unable to attend their scheduled focus group) at one of three time points. A semi-structured interview guide focused discussion on the pharmacists’ training to provide the asthma service, their interactions with health professionals and patients as per the service protocol, and the future for this type of service. Focus groups were facilitated by two researchers, and the individual interviews were shared between three researchers, with data transcribed verbatim and analysed manually.
Results
Of 93 pharmacists who provided the PAMS, 25 were involved in a focus group and seven via telephone interview. All pharmacists approached agreed to provide feedback. In general, the pharmacists engaged with both the service and research components, and embraced their roles as innovators in the trial of a new service. Some experienced challenges in the recruitment of patients into the service and the amount of research-related documentation, and collaborative patient-centred relationships with GPs require further attention. Specific service components, such as the spirometry, were well received by the pharmacists and their patients. Professional rewards included satisfaction from their enhanced practice, and pharmacists largely envisaged a future for the service.
Conclusions
The PAMS provided pharmacists an opportunity to become involved in an innovative service delivery model, supported by the researchers, yet trained and empowered to implement the clinical service throughout the trial period and beyond. The balance between support and independence appeared crucial in the pharmacists’ engagement with the trial. Their feedback was overwhelmingly positive, while useful suggestions were identified for future academic trials.
doi:10.1186/1472-6963-12-164
PMCID: PMC3439711  PMID: 22709371
Pharmacy; Asthma; Disease management service; Experiences; Feedback
4.  Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial 
BMJ : British Medical Journal  2007;334(7603):1098.
Objective To test whether a drug review and symptom self management and lifestyle advice intervention by community pharmacists could reduce hospital admissions or mortality in heart failure patients.
Design Randomised controlled trial.
Setting Home based intervention in heart failure patients.
Participants 293 patients diagnosed with heart failure were included (149 intervention, 144 control) after an emergency admission.
Intervention Two home visits by one of 17 community pharmacists within two and eight weeks of discharge. Pharmacists reviewed drugs and gave symptom self management and lifestyle advice. Controls received usual care.
Main outcome measures The primary outcome was total hospital readmissions at six months. Secondary outcomes included mortality and quality of life (Minnesota living with heart failure questionnaire and EQ-5D).
Results Primary outcome data were available for 291 participants (99%). 136 (91%) intervention patients received one or two visits. 134 admissions occurred in the intervention group compared with 112 in the control group (rate ratio=1.15, 95% confidence interval 0.89 to 1.48; P=0.28, Poisson model). 30 intervention patients died compared with 24 controls (hazard ratio=1.18, 0.69 to 2.03; P=0.54). Although EQ-5D scores favoured the intervention group, Minnesota living with heart failure questionnaire scores favoured controls; neither difference was statistically significant.
Conclusion This community pharmacist intervention did not lead to reductions in hospital admissions in contrast to those found in trials of specialist nurse led interventions in heart failure. Given that heart failure accounts for 5% of hospital admissions, these results present a problem for policy makers who are faced with a shortage of specialist provision and have hoped that skilled community pharmacists could produce the same benefits.
Trial registration number ISRCTN59427925.
doi:10.1136/bmj.39164.568183.AE
PMCID: PMC1877883  PMID: 17452390
5.  Societal perspectives on community pharmacy services in West Bank - Palestine 
Pharmacy Practice  2012;10(1):17-24.
Background
Understanding the public's view of professional competency is extremely important; however little has been reported on the public's perception of community pharmacists in Palestine
Objective
To determine the perception of Palestinian consumers of the community pharmacist and the services they offer.
Methods
This project used the survey methodology administered by structured interviews to consumers who attended the 39 randomly selected pharmacies, in six main cities in Palestine. The questionnaire had range of structured questions covering: Consumers' patronage patterns, consumers’ interaction with community pharmacists, consumers’ views on how the pharmacist dealt with personal health issues, procedure with regard to handling private consultations.
Results
Of 1,017 consumers approached, 790 consumers completed the questionnaire (77.7 %). Proximity to home and presence of knowledgeable pharmacist were the main reasons for patients to visit the same pharmacy. Physicians were identified as the preferred source of advice by 57.2% and pharmacists by 23.8%. Only 17% of respondents considered pharmacists as health professionals who know a lot about drugs and are concerned about and committed to caring for the public. In addition, 49% indicated that pharmacists spoke more quietly cross the counter during counseling and almost one third reported that the pharmacist used a private area within the pharmacy. The majority of respondents would be happy to receive different extended services in the community pharmacy like blood pressure monitoring.
Conclusions
Palestinian consumers have a positive overall perception of community pharmacists and the services they offer. Awareness should be created amongst the public about the role of pharmacist and the added value they can provide as health care professional. There is a need to consider privacy when giving patient counseling to increase user satisfaction.
PMCID: PMC3798164  PMID: 24155812
Patient Satisfaction; Pharmacists; Professional Role; Middle East
6.  Using scenarios to test the appropriateness of pharmacist prescribing in asthma management 
Pharmacy Practice  2014;12(1):390.
Objective
To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists’ confidence, and appropriateness, in the context of asthma management.
Methods
Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers.
Results
In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios.
Conclusions
Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way.
PMCID: PMC3955869  PMID: 24644524
Asthma; Drug Prescriptions; Community Pharmacy Services; Professional Practice; Professional Role; Patient Simulation; Australia
7.  Management of acute diarrhea in children by community pharmacists in Lagos, Nigeria 
Pharmacy Practice  2014;12(1):376.
Background
Acute diarrhea in children leads to dehydration and death if not appropriately managed. World Health Organization (WHO) recommends treating diarrhea with oral rehydration therapy (ORT), fluids and foods. Proper management is hinged on accurate assessment of patients to identify the acute watery diarrhea.
Objective
To compare the knowledge and attitude of community pharmacists in the management of acute diarrhea in children with their observed practice.
Methods
This study was carried out using two instruments: structured self-administered questionnaire to assess knowledge and attitude of community pharmacists in the management of acute diarrhea in children and simulated patient visits to evaluate assessment of patients, recommendation of products and instructions on feeding and fluid intake. The simulated patient visits were done in 186 pharmacies in the city of Lagos, Nigeria.
Results
The study reveals that the knowledge and attitude of community pharmacists in the management of acute diarrhea in children was different from their observed practice. The difference was statistically significant (p<0.05). During the simulations, 23% carried out appropriate assessment before recommending any products, and 15% recommended ORT alone. Although information to the pharmacists indicated non-dysentery, non-cholera, acute watery diarrhea, antibiotics and antidiarrheals were irrationally recommended and these were the mainstay of symptoms’ management in practice. Questionnaire data revealed that 24% of pharmacists knew the correct instructions to give on food and fluid intake during diarrhea, whereas 8% followed WHO guideline on food and fluid intake during the visits.
Conclusions
Assessment of patients to determine acute diarrhea was inadequate. Observed practice in managing acute diarrhea in children was inappropriate and significantly different from their claims in the questionnaire. The recommendation of ORT was scanty and advice on food and fluid intake was inadequate and sometimes inappropriate. This study shows that only 15% of community pharmacists managed acute diarrhea in children according to the WHO guidelines.
PMCID: PMC3955866  PMID: 24644521
Diarrhea; Community Pharmacy Services; Professional Practice; Guideline Adherence; Patient Simulation; Nigeria
8.  A Guided Interview Process to Improve Student Pharmacists' Identification of Drug Therapy Problems 
Objective
To measure agreement between advanced pharmacy practice experience students using a guided interview process and experienced clinical pharmacists using standard practices to identify drug therapy problems.
Methods
Student pharmacists enrolled in an advanced pharmacy practice experience (APPE) and clinical pharmacists conducted medication therapy management interviews to identify drug therapy problems in elderly patients recruited from the community. Student pharmacists used a guided interview tool, while clinical pharmacists' interviews were conducted using their usual and customary practices. Student pharmacists also were surveyed to determine their perceptions of the interview tool.
Results
Fair to moderate agreement was observed on student and clinical pharmacists' identification of 4 of 7 drug therapy problems. Of those, agreement was significantly higher than chance for 3 drug therapy problems (adverse drug reaction, dosage too high, and needs additional drug therapy) and not significant for 1 (unnecessary drug therapy). Students strongly agreed that the interview tool was useful but agreed less strongly on recommending its use in practice.
Conclusions
The guided interview process served as a useful teaching aid to assist student pharmacists to identify drug therapy problems.
PMCID: PMC3049657  PMID: 21451770
guided interview; drug therapy; advanced pharmacy practice experience; interview; medication therapy management
9.  Self-medication in Poland: the pharmacist’s advisory role in Warsaw 
Background
Easy access favours the informative role that pharmacists play in Poland with regard to the proper use of medicinal products as well as preventing illness and promoting health.
Objective
The aim of the present study was to define situations in which patients ask a pharmacist for advice and to identify the most important factors that affect the patients’ decisions in seeking advice from a pharmacist.
Method
n all, 101 patients (69 women, 32 men) aged 19–67 years participated in the study. The study was conducted using a structured interview research method. Patients were asked to answer a set of closed-ended questions related to their habits regarding the purchase of medicines and the factors that affected their decision to seek the advice of a pharmacist.
Main outcome measure
Factors determining the choice to contact a pharmacy.
Results
Patients seldom asked pharmacists for advice: 77 of the patients “rarely” or “never” went to a pharmacy to consult the pharmacist. When patients did ask the pharmacist for advice, it was mainly concerning the choice of over-the-counter medicines. The most important reason for patients visiting a pharmacy for advice was the large number of pharmacies in Poland and their ease of access; the long queues of people in busy pharmacies and the lack of confidentiality in the pharmacy were considered negative factors.
Conclusion
The current advisory role of pharmacists in Poland seems of minimal importance to the public.
doi:10.1007/s11096-012-9734-z
PMCID: PMC3615165  PMID: 23225095
Counselling; Health behaviour; Over-the-counter medicines; Self-medication
10.  Role of community pharmacies in prevention of AIDS among injecting drug misusers: findings of a survey in England and Wales. 
BMJ : British Medical Journal  1989;299(6707):1076-1079.
OBJECTIVE--To determine the current and potential roles of community pharmacists in the prevention of AIDS among misusers of injected drugs. DESIGN--Cross sectional postal survey of a one in four random sample of registered pharmacies in England and Wales. SETTING--Project conducted in the addiction research unit of the Institute of Psychiatry, London. SUBJECTS--2469 Community pharmacies in the 15 regional health authorities in England and Wales. MAIN OUTCOME MEASURES--Willingness of pharmacists to sell injecting equipment to known or suspected misusers of drugs; pharmacists' attitudes to syringe exchange schemes, keeping a "sharps" box for use by misusers of drugs, and offering face to face advice and leaflets; and opinions of community pharmacists on their role in AIDS prevention and drug misuse. RESULTS--1946 Questionnaires were returned, representing a response rate of 79%. This fell short of the target of one in four pharmacies in each family practitioner committee area in England and Wales, and total numbers of respondents were therefore weighted in inverse proportion to the response rate in each area. The findings disclosed a substantial demand for injecting equipment by drug misusers. After weighting of numbers of respondents an estimated 676 of 2434 pharmacies were currently selling injecting equipment and 65 of 2415 (3%) were participating in local syringe exchange schemes; only 94 of 2410 pharmacies (4%) had a sharps box for used equipment. There was a high degree of concern among pharmacists about particular consequences of drug misusers visiting their premises, along with a widespread acceptance that the community pharmacist had an important part to play. CONCLUSIONS--Promoting the participation of community pharmacists in the prevention of AIDS among misusers of injected drugs is a viable policy, but several problems would need to be overcome before it was implemented.
PMCID: PMC1837978  PMID: 2511969
11.  Use of drugs by the elderly1 
This paper outlines the use of both prescribed and non-prescribed medication by the elderly in the community. The study examined a number of factors related to medication including compliance, the types of drugs taken, the manner in which drugs were stored and disposed of, and the advice that patients received. The findings revealed a lack of coordination of responsibility in the management of patients' medicines leading to inappropriate drug use, posing a potential risk to the patient. It is against this background that we propose that the role of the general practice pharmacist should be extended within a structured health care programme; pharmacists should be encouraged to keep total medication records on patients of 65 and over.
PMCID: PMC1438278  PMID: 7205857
12.  Risk Factors and Case Management of Acute Diarrhoea in North Gondar Zone, Ethiopia 
In Ethiopia, evidence is lacking about maternal care-taking and environmental risk factors that contribute to acute diarrhoea and the case management of diarrhoea. The aim of this study was to identify the risk factors and to understand the management of acute diarrhoea. A pretested structured questionnaire was used for interviewing mothers of 440 children in a prospective, matched, case-control study at the University of Gondar Referral and Teaching Hospital in Gondar, Ethiopia. Results of multivariate analysis demonstrated that children who were breastfed and not completely weaned and mothers who were farmers were protective factors; risk factors for diarrhoea included sharing drinking-water and introducing supplemental foods. Children presented with acute diarrhoea for 3.9 days with 4.3 stools per day. Mothers usually did not increase breastmilk and other fluids during diarrhoea episodes and generally did not take children with diarrhoea to traditional healers. Incorporating messages about the prevention and treatment of acute diarrhoea into child-health interventions will help reduce morbidity and mortality associated with this disease.
PMCID: PMC2980890  PMID: 20635636
Case-control studies; Case management; Diarrhoea, Acute; Oral rehydration solution; Prospective studies; Risk factors; Ethiopia
13.  Do community pharmacists have the attitudes and knowledge to support evidence based self-management of low back pain? 
Background
In many countries, community pharmacists can be consulted without appointment in a large number of convenient locations. They are in an ideal position to give advice to patients at the onset of low back pain and also reinforce advice given by other healthcare professionals. There is little specific information about the quality of care provided in the pharmacy for people with back pain. The main objectives of this survey were to determine the attitudes, knowledge and reported practice of English pharmacists advising people who present with acute or chronic low back pain.
Methods
A questionnaire was designed for anonymous self-completion by pharmacists attending continuing education sessions. Demographic questions were designed to allow comparison with a national pharmacy workforce survey. Attitudes were measured with the Back Beliefs Questionnaire (BBQ) and questions based on the Working Backs Scotland campaign. Questions about the treatment of back pain in the community pharmacy were written (or adapted) to reflect and characterise the nature of practice. In response to two clinical vignettes, respondents were asked to select proposals that they would recommend in practice.
Results
335 responses from community pharmacists were analysed. Middle aged pharmacists, women, pharmacy managers and locums were over-represented compared to registration and workforce data. The mean (SD) BBQ score for the pharmacists was 31.37 (5.75), which was slightly more positive than in similar surveys of other groups. Those who had suffered from back pain seem to demonstrate more confidence (fewer negative feelings, more advice opportunities and better advice provision) in their perception of advice given in the pharmacy. Awareness of written information that could help to support practice was low. Reponses to the clinical vignettes were generally in line with the evidence base. Pharmacists expressed some caution about recommending activity. Most respondents said they would benefit from more education about back pain.
Conclusion
Those sampled generally expressed positive attitudes about back pain and were able to offer evidence based advice. Pharmacists may benefit from training to increase their ability and confidence to offer support for self-care in back pain. Further research would be useful to clarify the representativeness of the sample.
doi:10.1186/1471-2474-8-10
PMCID: PMC1796877  PMID: 17266748
14.  Diabetes patient management by pharmacists during Ramadan 
Background
Many Muslim diabetes patients choose to participate in Ramadan despite medical advice to the contrary. This study aims to describe Qatar pharmacists’ practice, knowledge, and attitudes towards guiding diabetes medication management during Ramadan.
Methods
A cross-sectional descriptive study was performed among a convenience sample of 580 Qatar pharmacists. A web-based questionnaire was systematically developed following comprehensive literature review and structured according to 4 main domains: subject demographics; diabetes patient care experiences; knowledge of appropriate patient care during Ramadan fasting; and attitudes towards potential pharmacist responsibilities in this regard.
Results
In the 3 months prior to Ramadan (July 2012), 178 (31%) pharmacists responded to the survey. Ambulatory (103, 58%) and inpatient practices (72, 41%) were similarly represented. One-third of pharmacists reported at least weekly interaction with diabetes patients during Ramadan. The most popular resources for management advice were the internet (94, 53%) and practice guidelines (80, 45%); however only 20% were aware of and had read the American Diabetes Association Ramadan consensus document. Pharmacist knowledge scores of appropriate care was overall fair (99, 57%). Pharmacists identified several barriers to participating in diabetes management including workload and lack of private counseling areas, but expressed attitudes consistent with a desire to assume greater roles in advising fasting diabetes patients.
Conclusion
Qatar pharmacists face several practical barriers to guiding diabetes patient self-management during Ramadan, but are motivated to assume a greater role in such care. Educational programs are necessary to improve pharmacist knowledge in the provision of accurate patient advice.
doi:10.1186/1472-6963-14-117
PMCID: PMC3975299  PMID: 24606885
Diabetes; Patient care; Fasting; Ramadan; Pharmacist
15.  An evaluation of child health clinic services in Newcastle upon Tyne during 1972-1974. 
The community child health clinics continued to provide an important and popular service for mothers with young children in Newcastle during 1972-1974, supplementing the primary care services of general practitioners as only a minority of them had undertaken the preventive aspects of child care. Most of the work of the community clinics was done by health visitors and it consisted of advice, support, and reassurance about the everyday problems of children. Although an appreciable amount of the work of the community doctors was developmental screening (birthday checks) most mothers consulted them about relatively minor medical complaints--such as feeding difficulties, specific developmental problems, and immunisation. There was no attempt to do a birthday check on all the children in the city and those that were done revealed few significant undetected abnormalities because most of the children had already attended clinics. In a poor area of the city, family and social problems were often found but very little consultation took place between health and social services, indicating the need for better liaison between these services. The community child health clinics will need to be maintained if general practitioners cannot provide these services and are unable to include preventive as well as curative child care within their practice.
PMCID: PMC478983  PMID: 856367
16.  Can a self-management programme delivered by a community pharmacist improve asthma control? A randomised trial 
Thorax  2003;58(10):851-854.
Background: No randomised studies have addressed whether self-management for asthma can be successfully delivered by community pharmacists. Most randomised trials of asthma self-management have recruited participants from secondary care; there is uncertainty regarding its effectiveness in primary care. A randomised controlled study was undertaken to determine whether a community pharmacist could improve asthma control using self-management advice for individuals recruited during attendance at a community pharmacy.
Methods: Twenty four adults attending a community pharmacy in Tower Hamlets, east London for routine asthma medication were randomised into two groups: the intervention group received self-management advice from the pharmacist with weekly telephone follow up for 3 months and the control group received no input from the pharmacist. Participants self-completed the North of England asthma symptom scale at baseline and 3 months later.
Results: The groups were well matched at baseline for demographic characteristics and mean (SD) symptom scores (26.3 (4.8) and 27.8 (3.7) in the intervention and control groups, respectively). Symptom scores improved in the intervention group and marginally worsened in the control group to 20.3 (4.2) and 28.1 (3.5), respectively (p<0.001; difference adjusted for baseline scores = 7.0 (95% CI 4.4 to 9.5).
Conclusions: A self-management programme delivered by a community pharmacist can improve asthma control in individuals recruited at a community pharmacy. Further studies should attempt to confirm these findings using larger samples and a wider range of outcome measures.
doi:10.1136/thorax.58.10.851
PMCID: PMC1746491  PMID: 14514935
17.  Understanding public trust in services provided by community pharmacists relative to those provided by general practitioners: a qualitative study 
BMJ Open  2012;2(3):e000939.
Objectives
To apply sociological theories to understand public trust in extended services provided by community pharmacists relative to those provided by general practitioners (GPs).
Design
Qualitative study involving focus groups with members of the public.
Setting
The West of Scotland.
Participants
26 purposively sampled members of the public were involved in one of five focus groups. The groups were composed to represent known groups of users and non-users of community pharmacy, namely mothers with young children, seniors and men.
Results
Trust was seen as being crucial in healthcare settings. Focus group discussions revealed that participants were inclined to draw unfavourable comparisons between pharmacists and GPs. Importantly, participants' trust in GPs was greater than that in pharmacists. Participants considered pharmacists to be primarily involved in medicine supply, and awareness of the pharmacist's extended role was low. Participants were often reluctant to trust pharmacists to deliver unfamiliar services, particularly those perceived to be ‘high risk’. Numerous system-based factors were identified, which reinforce patient trust and confidence in GPs, including GP registration and appointment systems, GPs' expert/gatekeeper role and practice environments. Our data indicate that the nature and context of public interactions with GPs fostered familiarity with a specific GP or practice, which allowed interpersonal trust to develop. By contrast, participants' exposure to community pharmacists was limited. Additionally, a good understanding of the GPs' level of training and role promoted confidence.
Conclusion
Current UK initiatives, which aim to implement a range of pharmacist-led services, are undermined by lack of public trust. It seems improbable that the public will trust pharmacists to deliver unfamiliar services, which are perceived to be ‘high risk’, unless health systems change in a way that promotes trust in pharmacists. This may be achieved by increasing the quality and quantity of patient interactions with pharmacists and gaining GP support for extended pharmacy services.
Article summary
Article focus
Why do the public access GPs for services, which are also available in community pharmacies?
What sort of services do the public trust community pharmacists to deliver?
What factors underpin greater public trust in GP services relative to community pharmacy services?
Key messages
Public trust in GPs was greater than that in pharmacists; many were reluctant to trust pharmacists to deliver unfamiliar ‘high-risk’ services.
Numerous system-based factors reinforce public trust and confidence in GPs, including GP registration and appointment systems, GPs' expert/gatekeeper role and practice environments.
This study suggests that increasing the quality and quantity of patient interactions with pharmacists and gaining GP support for extended pharmacy services could build public trust.
Strengths and limitations of this study
This is the first study to apply sociological perspectives of trust to understand public perspectives of community pharmacy.
The qualitative approach has allowed us to gather in-depth information in an under-researched area.
The study methodology limits generalisation, although theme saturation was achieved and the context of the study is explicitly defined.
doi:10.1136/bmjopen-2012-000939
PMCID: PMC3358628  PMID: 22586286
18.  Barriers and Facilitators to Evidence-based Blood Pressure Control in Community Practice 
Journal of the American Board of Family Medicine : JABFM  2013;26(5):10.3122/jabfm.2013.05.130060.
Introduction
The Electronic Communications and Home Blood Pressure Monitoring trial (e-BP) demonstrated that team care incorporating a pharmacist to manage hypertension using secure E-mail with patients resulted in almost twice the rate of blood pressure (BP) control compared with usual care. To translate e-BP into community practices, we sought to identify contextual barriers and facilitators to implementation.
Methods
Interviews were conducted with medical providers, staff, pharmacists, and patients associated with community-based primary care clinics whose physician leaders had expressed interest in implementing e-BP. Transcripts were analyzed using qualitative template analysis, incorporating codes derived from the Consolidated Framework for Implementation Research (CFIR).
Results
Barriers included incorporating an unfamiliar pharmacist into the health care team, lack of information technology resources, and provider resistance to using a single BP management protocol. Facilitators included the intervention’s perceived potential to improve quality of care, empower patients, and save staff time. Sustainability of the intervention emerged as an overarching theme.
Conclusion
A qualitative approach to planning for translation is recommended to gain an understanding of contexts and to collaborate to adapt interventions through iterative, bidirectional information gathering. Interviewees affirmed that web pharmacist care offers small primary care practices a means to expand their workforce and provide patient-centered care. Reproducing e-BP in these practices will be challenging, but our interviewees expressed eagerness to try and were optimistic that a tailored intervention could succeed.
doi:10.3122/jabfm.2013.05.130060
PMCID: PMC3882900  PMID: 24004706
Evidence-based Medicine; Community Medicine; Home Blood Pressure Monitoring; Primary Health Care; Qualitative Research
19.  The willingness of community pharmacists to participate in a practice-based research network 
Background:
Practice-based research networks (PBRNs) are groups of practitioners and researchers with an interest in designing, evaluating and disseminating solutions to the real-world problems of clinical practices.
Objective:
To evaluate the level of interest of community pharmacists in participating in a PBRN and to document the services such a network should offer.
Method:
In a survey of community pharmacists in Montreal, Quebec, and surrounding areas, a questionnaire was mailed to a random sample of 1250 pharmacists. Two of the 28 questions were related to PBRNs: one assessed the pharmacists’ interest in participating in a PBRN; the other sought their views on which services and activities this network should offer.
Results:
In total, 571 (45.7%) pharmacists completed the questionnaire, but 6 did not answer the questions about the PBRN. Of the respondents, 58.9% indicated they were “very interested” or “interested” in joining a PBRN, while 41.1% reported little or no interest. The most popular potential services identified were access to clinical tools developed in research projects (77.0%), access to continuing education training programs developed in research projects (75.9%), information about conferences on pharmacy practice research (64.1%) and participation in the development of new pharmaceutical practices (56.1%).
Conclusion:
This study suggests that the level of interest that community pharmacists have in PBRNs is sufficient to further evaluate how such networks may optimize and facilitate pharmacy practice research. Can Pharm J 2013;146:47-54.
doi:10.1177/1715163512473240
PMCID: PMC3676248  PMID: 23795169
20.  Why Hospital Pharmacists Have Failed to Manage Antimalarial Drugs Stock-Outs in Pakistan? A Qualitative Insight 
Malaria Research and Treatment  2013;2013:342843.
Purpose. This study aimed to explore the perceptions of hospital pharmacists towards drug management and reasons underlying stock-outs of antimalarial drugs in Pakistan. Methods. A qualitative study was designed to explore the perceptions of hospital pharmacists regarding drug management and irrational use of antimalarial drugs in two major cities of Pakistan, namely, Islamabad (national capital) and Rawalpindi (twin city). Semistructured interviews were conducted with 16 hospital pharmacists using indepth interview guides at a place and time convenient for the respondents. Interviews, which were audiotaped and transcribed verbatim, were evaluated by thematic content analysis and by other authors' analysis. Results. Most of the respondents were of the view that financial constraints, inappropriate drug management, and inadequate funding were the factors contributing toward the problem of antimalarial drug stock-outs in healthcare facilities of Pakistan. The pharmacists anticipated that prescribing by nonproprietary names, training of health professionals, accepted role of hospital pharmacist in drug management, implementation of essential drug list and standard treatment guidelines for malaria in the healthcare system can minimize the problem of drug stock outs in healthcare system of Pakistan. Conclusion. The current study showed that all the respondents in the two cities agreed that hospital pharmacist has failed to play an effective role in efficient management of anti-malarial drugs stock-outs.
doi:10.1155/2013/342843
PMCID: PMC3816060  PMID: 24223321
21.  Repeat prescribing: a role for community pharmacists in controlling and monitoring repeat prescriptions. 
BACKGROUND: Traditional systems of managing repeat prescribing have been criticised for their lack of clinical and administrative controls. AIM: To compare a community pharmacist-managed repeat prescribing system with established methods of managing repeat prescribing. METHOD: A randomised controlled intervention study (19 general medical practices, 3074 patients, 62 community pharmacists). Patients on repeat medication were given sufficient three-monthly scripts, endorsed for monthly dispensing, to last until their next clinical review consultation with their general practitioner (GP). The scripts were stored by a pharmacist of the patient's choice. Each monthly dispensing was authorised by the pharmacist, using a standard protocol. The cost of the drugs prescribed and dispensed was calculated. Data on patient outcomes were obtained from pharmacist-generated patient records and GP notes. RESULTS: A total of 12.4% of patients had compliance problems, side-effects, adverse drug reactions, or drug interactions identified by the pharmacist. There were significantly more problems identified in total in the intervention group. The total number of consultations, deaths, and non-elective hospital admissions was the same in both groups. Sixty-six per cent of the study patients did not require their full quota of prescribed drugs, representing 18% of the total prescribed costs (estimated annual drug cost avoidance of 43 Pounds per patient). CONCLUSION: This system of managing repeat prescribing has been demonstrated to be logistically feasible, to identify clinical problems, and to make savings in the drugs bill.
PMCID: PMC1313673  PMID: 10897509
22.  Electronic transfer of prescription-related information: comparing views of patients, general practitioners, and pharmacists. 
BACKGROUND: The National Health Service (NHS) intends to introduce a system of electronic transfer of prescription-related information between general practitioners (GPs) and community pharmacies. The NHS Plan describes how this will be achieved. AIM: To gather opinions of patients, GPs, and community pharmacists on the development of a system of electronic transfer of prescription-related information between GPs and community pharmacies. DESIGN OF STUDY: Survey combining interviews, focus groups, and postal questionnaires. SETTING: General practitioners, opinion leaders, computing experts, pharmacists, and patients. Eight hundred members of the public, 200 GPs, and 200 community pharmacists, all living in Scotland. METHOD: Content-setting interviews and focus groups were conducted with purposive samples of relevant groups. Postal questionnaires were developed and sent to random samples of members of the public selected from the electoral roll, GPs, and community pharmacists. RESULTS: The corrected postal response rates were: 69% (patients); 74% (GPs); and 74% (community pharmacists). All three groups were generally supportive of electronic transfer of prescription-related information. Different aspects appealed to each group: patients anticipated improved convenience; GPs, better repeat prescribing; and pharmacists, an enhanced professional role. Security of patient-identifiable information was the main concern. All groups acknowledged potential benefits of a full primary care information system, but GPs and patients had reservations about allowing community pharmacists to access parts of the medical record that did not concern medication. CONCLUSION: Electronic transfer of prescription-related information is likely to be acceptable to all users, but concerns about patient confidentiality and an extended role for pharmacists in prescription management need to be addressed.
PMCID: PMC1314545  PMID: 14694696
23.  Assessment of professionalism in Iranian pharmacists 
In the recent years, the role of a pharmacist has been significantly changed. Traditionally, in the late 20th century, a pharmacist’s role was considered as merely dispensing medication to patients. This view however, has been significantly altered, and, today, a pharmacist is supposed to provide patients with information regarding the medication they are to take, as well as on different aspects of their disease. Therefore, one can suggest that some other factors have recently come into play in the daily tasks of a pharmacist such as accountability and authority.
The current cross-sectional survey is conducted on a cohort of community pharmacists attending a continuing education program. A questionnaire comprised of 26 Likert-type scale questions was designed to assess pharmacists’ attitude towards professionalism and its subscales which are defined later in detail. A total number of 1000 pharmacists were surveyed and 560 of them filled and returned the questionnaires. On a scale from 1-5 on which 1 was corresponded with strongly agree and 5 with strongly disagree, the total score of pharmacists professionalism was 92.9 ± 10.4 out of 130. As regards the subscales, in the subscale of accountability 46.8% of participants, in the subscale of altruism 90.1% of participants, in the theme of duty 85.7% of participants, and in the subscale of working relationship with physicians 84% of pharmacist achieved more than two third of the total score. Only in term of conflict of interest 67.9% of participants scored less than two third (17–25) of the total score. Women obtained significantly higher scores in altruism (P<0.05). Furthermore, there was a correlation between age and the score of accountability and working relationship with physicians; and, the same was observed in regards with work experience with the score of working relationship with physicians. The employment position affected neither our participants’ response to the whole questionnaire nor any of subscales.
Although the total score for professionalism was not dramatically decreased, the significantly low results are alarming and they should be considered more seriously. In order to enhance the level of pharmacists’ professionalism, especially in some special aspects, it seems necessary to conduct similar surveys on pharmacy students and registered pharmacists with a more comprehensive questionnaire. Overall, it can be concluded that designing a proper teaching course in professionalism for pharmacy students is of paramount importance if we are to promote professionalism in future pharmacists.
PMCID: PMC3713883  PMID: 23908748
Pharmacy professionalism; Altruism; Accountability; Pharmacy ethics
24.  Stakeholder experiences with general practice pharmacist services: a qualitative study 
BMJ Open  2013;3(9):e003214.
Objectives
To explore general practice staff, pharmacist and patient experiences with pharmacist services in Australian general practice clinics within the Pharmacists in Practice Study.
Design
Qualitative study.
Setting
Two general practice clinics in Melbourne, Australia, in which pharmacists provided medication reviews, patient and staff education, medicines information and quality assurance services over a 6-month period.
Participants
Patients, practice staff and pharmacists.
Method
Semi-structured telephone interviews with patients, focus groups with practice staff and semi-structured interviews and periodic narrative reports with practice pharmacists. Data were analysed thematically and theoretical frameworks used to explain the findings.
Results
34 participants were recruited: 18 patients, 14 practice staff (9 general practitioners, 4 practice nurses, 1 practice manager) and 2 practice pharmacists. Five main themes emerged: environment; professional relationships and integration; pharmacist attributes; staff and patient benefits and logistical challenges. Participants reported that colocation and the interdisciplinary environment of general practice enabled better communication and collaboration compared to traditional community and consultant pharmacy services. Participants felt that pharmacists needed to possess certain attributes to ensure successful integration, including being personable and proactive. Attitudinal, professional and logistical barriers were identified but were able to be overcome. The findings were explained using D'Amour's structuration model of collaboration and Roger's diffusion of innovation theory.
Conclusions
This is the first qualitative study to explore the experiences of general practice staff, pharmacists and patients on their interactions within the Australian general practice environment. Participants were receptive of colocated pharmacist services, and various barriers and facilitators to integration were identified. Future research should investigate the feasibility and sustainability of general practice pharmacist roles.
doi:10.1136/bmjopen-2013-003214
PMCID: PMC3773653  PMID: 24030867
Primary Care; Qualitative Research; Health Services Administration & Management
25.  Challenges facing providers of imported malaria-related healthcare services for Africans visiting friends and relatives (VFRs) 
Malaria Journal  2014;13:17.
Background
In many non-malarious countries, imported malaria disproportionately affects Africans visiting friends and relatives (VFRs). Most previous research has focused on understanding the knowledge, attitudes and practices of these travellers, but has not examined the quality of prevention, diagnosis and treatment services provided. The aim of this study was to understand the perspective of providers of malaria-related healthcare services to VFRs about factors impacting on the quality of these and to make recommendations about improvements.
Methods
Thirty semi-structured interviews were conducted with practice nurses providing pre-travel health advice (n = 10), general practitioners (GPs) (n = 10), hospital consultants (n = 3), and community pharmacists (n = 7) working in areas of London with large African communities and a relatively high burden of imported malaria. A thematic analysis of the results was undertaken.
Results
Time constraints in GPs’ surgeries and competing priorities, lack of confidence in issuing advice on mosquito avoidance, the cost of chemoprophylaxis and travel at short notice prevented the provision of adequate malaria prevention advice. Long GP waiting times, misdiagnoses, lack of disclosure by VFRs about recent travel, and the issue of where malaria treatment should be provided were raised as potential barriers to diagnosis and treatment.
Conclusions
Some issues raised by respondents are relevant to all travellers, irrespective of their reason for travel. The challenge for healthcare providers to reduce the burden of imported malaria in VFRs is to provide services of sufficient quality to persuade them to adopt these in preference to those with which they may be familiar in their country of birth. Although no single intervention will significantly lower the burden of imported malaria, addressing the issues raised in this research could make a significant impact.
doi:10.1186/1475-2875-13-17
PMCID: PMC3896699  PMID: 24405512
African VFRs; Imported malaria; Healthcare services; Migrant health

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