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1.  Availability and Perceived Value of Masters of Business Administration Degree Programs in Pharmaceutical Marketing and Management 
Objectives. To examine pharmacist-targeted master of business administration (MBA) degree programs and investigate pharmacists’ perceptions regarding them.
Methods. Specialized MBA programs in pharmaceutical marketing and management offered at US colleges and schools of pharmacy were identified in the literature and compared. Pharmacists’ perceptions of MBA programs were evaluated through a survey of clinical preceptors affiliated with a school of pharmacy.
Results. Seven US universities that offer an MBA program in pharmaceutical marketing and management were identified. Thirty-three percent of the 57 pharmacist preceptors who responded to the survey reported plans to pursue an MBA degree program. Respondents preferred MBA programs related to healthcare or pharmacy (66%) over general MBA programs (33%).
Conclusion. An MBA in pharmaceutical marketing and management could provide pharmacists with advanced knowledge of the operational and strategic business aspects of pharmacy practice and give pharmacy graduates an advantage in an increasingly competitive job market.
doi:10.5688/ajpe76464
PMCID: PMC3355284  PMID: 22611273
master of business administration (MBA); marketing; management; business; pharmaceutical industry; dual PharmD/MBA degree program
2.  A comprehensive system of pharmaceutical care for drug misusers 
This article outlines the evolution of a community pharmacy-based supervised consumption of methadone program in Grater Glasgow. The formalization of this program in 1994 promoted full patient compliance with the methadone regimen and reduced seepage of the drug to the illicit market. 184 of the area's 215 community pharmacies now dispense methadone for the treatment of opiate dependence. Of these, 173 have a supplementary contract with the local health board to supervise the consumption of methadone on their premises. In addition 15 of "methadone" pharmacists are involved in the provision of a pharmacy based needle exchange scheme. This has been shown to be the most efficient and cost effective method of delivering clean injecting equipment to injecting drug users in the Greater Glasgow area. Glasgow's pharmacists' have now been involved in the methadone and needle exchange programs for more than ten years. The support needed by pharmacists and the steps that have been put in place to provide this level of commitment are described. The development of the Glasgow pharmacy based services to drug users has had a major impact on practice elsewhere in the United Kingdom.
doi:10.1186/1477-7517-1-6
PMCID: PMC428584  PMID: 15169565
3.  Nonprescription Drug Therapy: Issues and Opportunities 
Nonprescription drug therapy is tightly woven into the fabric of American health care. Market forces are expected to contribute to significant expansion of nonprescription drug use. Consumers place high value on nonprescription drug therapy; however, self-medicating patients frequently need assistance from a learned intermediary to assure optimal integration of nonprescription drug therapy into the total care regimen. Pharmacist-assisted self-care holds vast potential to serve the public interest, but this expanded practice role will require higher levels of professional practice commitment by American pharmacy. That commitment must be supported by practice-relevant, competency-based, patient-centered college and school of pharmacy curricula and continuing education that assures perpetual intellectual proficiency in nonprescription drug pharmacotherapy. That knowledge and competency must be integrated holistically into the total mix of patient comorbidity and polypharmacy. The pharmacist-assisted self-care business and professional practice model must be further facilitated by state and national pharmacy organizations, chain and independent community pharmacy, pharmacy wholesalers, and others. Consumers await expanded and differentiated pharmacy-based, pharmacist-provided medication therapy management services focused on the safe, appropriate, and effective selection, use, and monitoring of nonprescription drugs therapy.
PMCID: PMC1803691  PMID: 17332863
self-care; nonprescription medication; curriculum
4.  Prescription practices and availability of artemisinin monotherapy in India: where do we stand? 
Malaria Journal  2011;10:360.
Background
The World Health Organization has urged all member states to deploy artemisinin-based combination therapy and progressively withdraw oral artemisinin monotherapies from the market due to their high recrudescence rates and to reduce the risk of drug resistance. Prescription practices by physicians and the availability of oral artemisinin monotherapies with pharmacists directly affect the pattern of their use. Thus, treatment practices for malaria, with special reference to artemisinin monotherapy prescription, in selected states of India were evaluated.
Methods
Structured, tested questionnaires were used to conduct convenience surveys of physicians and pharmacists in eleven purposively selected districts across six states in 2008. In addition, exit interviews of patients with a diagnosis of uncomplicated malaria or a prescription for an anti-malarial drug were also performed. Logistic regression was used to determine patient clinical care, and institutional factors associated with artemisinin monotherapy prescription.
Results
Five hundred and eleven physicians from 196 health facilities, 530 pharmacists, and 1, 832 patients were interviewed. Artemisinin monotherapy was available in 72.6% of pharmacies and was prescribed by physicians for uncomplicated malaria in all study states. Exit interviews among patients confirmed the high rate of use of artemisinin monotherapy with 14.8% receiving such a prescription. Case management, i.e. method of diagnosis and overall treatment, varied by state and public or private sector. Treatment in the private sector (OR 8.0, 95%CI: 3.8, 17) was the strongest predictor of artemisinin monotherapy prescription when accounting for other factors. Use of the combination therapy recommended by the national drug policy, artesunate + sulphadoxine-pyrimethamine, was minimal (4.9%), with the exception of one state.
Conclusions
Artemisinin monotherapy use was widespread across India in 2008. The accessible sale of oral artemisinin monotherapy in retail market and an inadequate supply of recommended drugs in the public sector health facilities promoted its prescription. This study resulted in notifications to all state drug controllers in India to withdraw the oral artemisinin formulations from the market. In 2010, artesunate + sulphadoxine-pyrimethamine became the universal first-line treatment for confirmed Plasmodium falciparum malaria and was deployed at full scale.
doi:10.1186/1475-2875-10-360
PMCID: PMC3283503  PMID: 22166073
5.  Development of Clinical Pharmacy services at King Khalid University Hospital and its impact on the quality of healthcare provided 
Clinical Pharmacy is a unique service provided by the leading pharmacy departments in the United States. The concept of Clinical Pharmacy evolved after the significant increase in number of pharmaceuticals in the market and the increasing potential of drug interactions. However, the Clinical Pharmacist is not merely an individual who advises on drug interactions. There are a number of functions which include but are not limited to; the design of appropriate drug therapy, such as Pharmacokinetic assessment and evaluation to optimize drug therapy, drug information dissemination to the physicians and other healthcare providers and participation as a toxicology consultant in Poison management.
At the King Khalid University Hospital (KKUH) the first Clinical Pharmacy services program began in 1983. The aim of this study is to evaluate the impact of our Clinical Pharmacy program on the patients’ care as well as its perception by the Medical staff that came from different parts of the world.
Our Clinical Pharmacists were asked to record any suggestions or interventions in the form. The forms were all collected at the end of each day and entered into a database for analysis. Each intervention was analyzed in order to assess the merit of the action in terms of the therapeutic, financial and direct cost impact.
The study showed a positive impact on the patients’ care as well as on the economy of the drugs prescribed. Meanwhile, the service was very much appreciated by the Medical staff as well as other healthcare providers.
doi:10.1016/j.jsps.2012.05.001
PMCID: PMC3745041  PMID: 23960800
Clinical Pharmacy; Economic impacts
6.  DETERIORATION OF CRYSTALLINE STROPHANTHIN IN AQUEOUS SOLUTION  
1. Many of the glass containers commonly used in the laboratory, and most of the glass ampules employed in marketing sterile solutions for hypodermic or intravenous medication, yield sufficient alkali on autoclaving, to change the reaction of distilled water from pH 6.0 to pH 9.0. 2. This increase in alkalinity is sufficient to render biologically inert and partially to decompose aqueous solutions of crystalline strophanthin in the concentration ordinarily employed in the clinic. 3. It is suggested that for clinical use crystalline strophanthin be dissolved in 0.02 M standard phosphate solution at pH 7.0, and marketed in hard glass ampules, thereby insuring stability of reaction with preservation of biologic activity. 4. It should be borne in mind, both by laboratory worker and pharmacist, that the alkali yielded, on heating, by soft glass containers may be responsible for a considerable alteration in the hydrogen ion concentration of their contents.
PMCID: PMC2128236  PMID: 19868401
7.  Clinical relevance of the gap between pre-marketing trials and medical practice: the case of the cardiovascular drugs 
Netherlands Heart Journal  2002;10(11):441-448.
Objectives/background
The external validity of trial results of new cardiovascular drugs is limited, because the short-term studies are performed with relatively small, highly selected populations. Using qualitative methods, we examined the clinical relevance of under-representation of subgroups of patients, and the underlying arguments.
Methods
Interviews with 47 physicians and pharmacists involved in the pre- or post-marketing evaluation of cardiovascular drugs, addressing the issue in general and for two new drugs, losartan and atorvastatin, in particular.
Results
The respondents were generally familiar with the under-representation of elderly patients, female patients, and patients with comorbidity in pre-marketing trials, but less familiar with details of representation in the cases of losartan and atorvastatin. In particular under-representation of patients with comorbidity was considered relevant. Arguments to confirm or refute the relevance referred to trial methodology, applicability of trial results or aspects of patient treatment. Conditional arguments referred to the aim of the trial, population size, therapeutic drug class or the timing of trials prior to or after drug registration.
Conclusions
To optimise the connection between pre-marketing clinical research and practice, trials should focus more on patient groups relevant to medical practice. If such research is not feasible prior to registration, it should be conducted afterwards. Drug information should allow practitioners to determine variations in the relative effects between subpopulations.
PMCID: PMC2499801
drug approval; drug policy; cardiovascular drugs; drug regulation; qualitative evaluation; professional practice
8.  Is there a need for a formulary of clinically interchangeable medicines to guide generic substitution in Saudi Arabia? 
The escalating healthcare expenditure is a major challenge to sustainability of the healthcare systems. To confront the escalating health expenditure in general and medicines expenditure in particular, many countries promoted the use of generic medicines. To promote generic medicines, many countries have adopted a generic substitution (GS) policy and generic prescribing. To effectively implement the GS policy, it is evident in the literature that it is essential to have an evidence-based guide on therapeutic equivalence and formulary of interchangeable medicines to guide responsible GS. In Saudi Arabia, GS is permissive and pharmacists are given the right to perform GS. While the prescriber's approval is not a requirement, patient consent is required when performing GS. Although there are some general drug references, such as the Saudi National Formulary (SNF) and list of registered medicines in the Saudi market, but there is currently no information available to healthcare professionals that documents the therapeutic and bioequivalence between medicines. Thus, it is essential to have a formulary of interchangeable medicines to guide appropriate GS or at least to include such vital information regarding therapeutic equivalence and brand interchangeability as part of the SNF. That, in turn, will not only make healthcare professionals more confident when providing GS, but will also enable the avoidance of situations where GS is inappropriate.
doi:10.1016/j.jyp.2013.06.006
PMCID: PMC3758099  PMID: 24023460
Generic substitution; Generic medicines; Formulary
9.  Teaching Self-care as a Junior Faculty Member: Perspectives and Lessons Learned 
Self-care is an important component of the doctor of pharmacy curriculum due to the expanding nonprescription medication market and the high percentage of pharmacists practicing in community pharmacy. It can be incorporated as a freestanding course or integrated throughout the curriculum. This article presents the experiences of 2 junior faculty members at 2 different pharmacy schools who were charged with coordinating self-care instruction at their institutions. It discusses the “lessons learned” regarding teaching self-care effectively in an integrated curriculum and in a freestanding course.
PMCID: PMC1803703  PMID: 17332868
self-care; nonprescription medications; teaching
10.  Constructing a Self-care Curriculum 
The purpose of this paper is to describe the unique challenges presented by a dynamic marketplace when designing a self-care curriculum. As manufacturers seek to satisfy consumer demand and increase market product shares, rapid changes occur with brand name extensions and prescription to nonprescription switches. The US Food and Drug Administration's continuous process of approving ingredients (monographs) add to this changing environment. Thus, developing learning outcomes beyond drug knowledge becomes critical. Learning outcomes must also address the multifaceted nature of self-care, including the development of skills in patient assessment (triage) and education. Determining which content areas to be covered can be difficult when consumer demand and marketplace changes are considered. For example, consumer use of dietary and herbal supplements forces pharmacists to have some basic knowledge of safety and efficacy regarding these products. Ultimately, given the dynamic, multifaceted nature of self-care, developing life-long learning skills/attitudes in students may be the most important outcome necessary for a self-care curriculum.
PMCID: PMC1803694  PMID: 17332866
self-care; prescription drugs; nonprescriptions drugs; line extensions; curriculum design
11.  Online Databases for Health Professionals 
Canadian Family Physician  1987;33:887-893.
Recent trends in the marketing of electronic information technology have increased interest among health professionals in obtaining direct access to online biomedical databases such as Medline. During 1985, the Canadian Medical Association (CMA) and Telecom Canada conducted an eight-month trial of the use made of online information retrieval systems by 23 practising physicians and one pharmacist. The results of this project demonstrated both the value and the limitations of these systems in patient-care settings. The study was able to identify the particular problems experienced by novice and infrequent users. A larger follow-up survey of 124 health-professional users of online services in Canada provided a group profile of early adopters of this innovation.
PMCID: PMC2218460
12.  Dextromethorphan. Extrapolation of findings from reproductive studies in animals to humans. 
Canadian Family Physician  1999;45:2309-2310.
QUESTION: One of my patients, who is now 8 weeks pregnant, just read in the newspaper that dextromethorphan (DM), an antitussive found in a variety of cough medicines, caused birth defects in chicken embryos. The author of the study stated that even one dose could be dangerous and that he would never allow his wife to use this drug if she were pregnant. My patient was understandably very concerned because last week she was suffering from a nasty cough and had been advised by her pharmacist to use a cough mixture containing DM, which she subsequently took for several days. ANSWER: You may reassure your patient that she did not put her baby at risk by using this substance. Dextromethorphan has been on the market for many years and has never been implicated as a human teratogen. Furthermore, chick embryos are not a good model for predicting teratogenic potential in humans and, consequently, were abandoned as such more than 30 years ago.
PMCID: PMC2328646  PMID: 10540688
13.  Development of a computerized adverse drug event monitor. 
Adverse events during drug therapy are receiving renewed attention. Some adverse drug events (ADEs) are identified only after the widespread clinical use of a drug. The Food and Drug Administration advocates post-marketing surveillance systems to provide early warnings of previously undetected ADEs. The identification of ADEs by U.S. hospitals is now required by the Joint Commission on Accreditation of Healthcare Organizations. We developed a series of computer programs and data files on the HELP System to help identify ADEs. The HELP System monitors laboratory test results, drug orders, and data entered through a computerized ADE reporting program. A nurse or pharmacist verifies computer alerts of possible ADEs. The computerized system identified 401 ADEs during the first year of use compared to 9 by voluntary reporting methods during the previous year (p less than 0.001). This paper describes the development and early use of the computerized ADE surveillance system.
PMCID: PMC2247488  PMID: 1807594
14.  Potential for Tramadol Abuse by Patients Visiting Pharmacies in Northern Iran 
Background:
It has been almost three decades since tramadol was introduced to the market as a centrally acting analgesic. It is claimed to have weak opioid properties and a low dependence potential in opioid-addicted patients. This study was designed to investigate the suspicion of potential tramadol abuse among patients visiting pharmacies in Babol, one of the major cities in northern Iran.
Methods:
Under supervision by pharmacists, a questionnaire designed to monitor drug abuse was filled out for every patient who requested tramadol from Babol’s pharmacies during 6 months (Aug. 2007 till Feb. 2008). The data obtained were used to derive descriptive statistics and to make a comparison with results from other countries.
Results:
Of 162 patients (or someone on their behalf) who had sought tramadol from a pharmacy, 92 (56%) patients did not have a prescription. At least 103 (64%) patients reported criteria for addiction (ie, for feeling of psychological well being, unable to cease taking the drug, more than two weeks of tramadol use). In total, 145 (89%) patients were aged younger than 30 years, and 90 (55%) patients were aged younger than 18 years. More than 63% of patients reported a history of addiction or drug abuse. Most of the patients with no prescription (88%) had abuse/addiction criteria.
Conclusion:
Patients who request tramadol from pharmacies in Babol seem to have a high potential for drug abuse, in particular those who do not have prescriptions. The high prevalence of people under 18 years of age seeking tramadol could be a worldwide trend. We recommend further governmental support for pharmacies to deal with tramadol abusers in northern Iran.
doi:10.4137/SART.S6174
PMCID: PMC3411529  PMID: 22879746
tramadol; drug abuse; addiction; pharmacy; Iran
15.  GenMed 010: a one day workshop on generic medicines 
The Australasian Medical Journal  2011;4(3):133-135.
This report outlines the content of a one-day workshop on Generic Medicines that was held at KIST Medical College, Lalitpur, Nepal on 13th December 2010, which was attended by 32 delegates from different institutions in Nepal, including pharmacists, pharmacologists and medical doctors. Right medicine, right patient, right dose, right frequency and duration, right information and right monitoring are conditions to be fulfilled for the rational use of medicine (RUM). The World Health Organization (WHO) defines generic medicine as ‘a pharmaceutical product, usually intended to be interchangeable with the innovator product, marketed after the expiry of patent or other exclusivity rights’. Economic factors, supportive legislation and regulation, public and professional acceptance and quality assurance are key enabling factors promoting use of generics. Increased patent protection for medicines and removing process patents is a key feature of new trade agreements and newer medicines for diseases like HIV/AIDS, tuberculosis and infectious diseases are likely to be more expensive. The Medicine and Therapeutics Committee (MTC) can play a key role in promoting generic medicine use in institutions.
Nepal being among the Least Developed Countries (LDCs) need not provide patent protection for medicines until 31st December 2015. Only a few ‘true’ generics are available in Nepal and there is huge cost variation in the price of different branded generics. Clinicians have concerns about the quality of medicines in general, substitution of poor quality brands by pharmacists and about therapeutic substitution. Generics have to meet the same regulatory requirements and be bioequivalent to reference preparations assuring their quality.
doi:10.4066/AMJ.2011.587
PMCID: PMC3562960  PMID: 23390461
Generic medicines; Nepal; Patents; Rational use of medicines
16.  Insufficient stocking of cyanide antidotes in US hospitals that provide emergency care 
Objective:
To identify the influence of catchment area, trauma center designation, hospital size, subspecialist employment, funding source, and other hospital characteristics on cyanide antidote stocking choice in US hospitals that provides emergency care.
Materials and Methods:
A web-based survey was sent out to pharmacy managers through two listservs; the American Society of Health-Systems Pharmacists and the American College of Clinical Pharmacy. A medical marketing company also broadcasted the survey to 2,659 individuals. We collected data on hospital characteristics (size, state, serving population, etc.,) to determine what influenced the hospital's stocking choice.
Results:
The survey response rate was approximately 10% (n = 286). Thirty-eight hospitals (16%) stocked at least 4 antidote kits. Safety profile, recommendations from a poison control center, and ease of use had the strongest influence on stocking decisions.
Conclusions:
Survey of 286 US hospital pharmacy managers, 38/234 (16%) hospitals had sufficient stocking of cyanide antidotes. Antidote preference was based on safety, ease of use, and recommendations by the local poison center, over cost.
doi:10.4103/0976-500X.110875
PMCID: PMC3669589  PMID: 23761707
Antidotes; cyanide; pharmacies; poisoning; stocking
17.  Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study 
Background
Computerized Provider Order Entry (CPOE) can improve patient safety, quality and efficiency, but hospitals face a host of barriers to adopting CPOE, ranging from resistance among physicians to the cost of the systems. In response to the incentives for meaningful use of health information technology and other market forces, hospitals in the United States are increasingly moving toward the adoption of CPOE. The purpose of this study was to characterize the experiences of hospitals that have successfully implemented CPOE.
Methods
We used a qualitative approach to observe clinical activities and capture the experiences of physicians, nurses, pharmacists and administrators at five community hospitals in Massachusetts (USA) that adopted CPOE in the past few years. We conducted formal, structured observations of care processes in diverse inpatient settings within each of the hospitals and completed in-depth, semi-structured interviews with clinicians and staff by telephone. After transcribing the audiorecorded interviews, we analyzed the content of the transcripts iteratively, guided by principles of the Immersion and Crystallization analytic approach. Our objective was to identify attitudes, behaviors and experiences that would constitute useful lessons for other hospitals embarking on CPOE implementation.
Results
Analysis of observations and interviews resulted in findings about the CPOE implementation process in five domains: governance, preparation, support, perceptions and consequences. Successful institutions implemented clear organizational decision-making mechanisms that involved clinicians (governance). They anticipated the need for education and training of a wide range of users (preparation). These hospitals deployed ample human resources for live, in-person training and support during implementation. Successful implementation hinged on the ability of clinical leaders to address and manage perceptions and the fear of change. Implementation proceeded smoothly when institutions identified and anticipated the consequences of the change.
Conclusions
The lessons learned in the five domains identified in this study may be useful for other community hospitals embarking on CPOE adoption.
doi:10.1186/1472-6947-13-67
PMCID: PMC3695777  PMID: 23800211
Quality of care; Clinical decision support; Meaningful use; Transformation
18.  Interactions between Non-Physician Clinicians and Industry: A Systematic Review 
PLoS Medicine  2013;10(11):e1001561.
In a systematic review of studies of interactions between non-physician clinicians and industry, Quinn Grundy and colleagues found that many of the issues identified for physicians' industry interactions exist for non-physician clinicians.
Please see later in the article for the Editors' Summary
Background
With increasing restrictions placed on physician–industry interactions, industry marketing may target other health professionals. Recent health policy developments confer even greater importance on the decision making of non-physician clinicians. The purpose of this systematic review is to examine the types and implications of non-physician clinician–industry interactions in clinical practice.
Methods and Findings
We searched MEDLINE and Web of Science from January 1, 1946, through June 24, 2013, according to PRISMA guidelines. Non-physician clinicians eligible for inclusion were: Registered Nurses, nurse prescribers, Physician Assistants, pharmacists, dieticians, and physical or occupational therapists; trainee samples were excluded. Fifteen studies met inclusion criteria. Data were synthesized qualitatively into eight outcome domains: nature and frequency of industry interactions; attitudes toward industry; perceived ethical acceptability of interactions; perceived marketing influence; perceived reliability of industry information; preparation for industry interactions; reactions to industry relations policy; and management of industry interactions. Non-physician clinicians reported interacting with the pharmaceutical and infant formula industries. Clinicians across disciplines met with pharmaceutical representatives regularly and relied on them for practice information. Clinicians frequently received industry “information,” attended sponsored “education,” and acted as distributors for similar materials targeted at patients. Clinicians generally regarded this as an ethical use of industry resources, and felt they could detect “promotion” while benefiting from industry “information.” Free samples were among the most approved and common ways that clinicians interacted with industry. Included studies were observational and of varying methodological rigor; thus, these findings may not be generalizable. This review is, however, the first to our knowledge to provide a descriptive analysis of this literature.
Conclusions
Non-physician clinicians' generally positive attitudes toward industry interactions, despite their recognition of issues related to bias, suggest that industry interactions are normalized in clinical practice across non-physician disciplines. Industry relations policy should address all disciplines and be implemented consistently in order to mitigate conflicts of interest and address such interactions' potential to affect patient care.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Making and selling health care goods (including drugs and devices) and services is big business. To maximize the profits they make for their shareholders, companies involved in health care build relationships with physicians by providing information on new drugs, organizing educational meetings, providing samples of their products, giving gifts, and holding sponsored events. These relationships help to keep physicians informed about new developments in health care but also create the potential for causing harm to patients and health care systems. These relationships may, for example, result in increased prescription rates of new, heavily marketed medications, which are often more expensive than their generic counterparts (similar unbranded drugs) and that are more likely to be recalled for safety reasons than long-established drugs. They may also affect the provision of health care services. Industry is providing an increasingly large proportion of routine health care services in many countries, so relationships built up with physicians have the potential to influence the commissioning of the services that are central to the treatment and well-being of patients.
Why Was This Study Done?
As a result of concerns about the tension between industry's need to make profits and the ethics underlying professional practice, restrictions are increasingly being placed on physician–industry interactions. In the US, for example, the Physician Payments Sunshine Act now requires US manufacturers of drugs, devices, and medical supplies that participate in federal health care programs to disclose all payments and gifts made to physicians and teaching hospitals. However, other health professionals, including those with authority to prescribe drugs such as pharmacists, Physician Assistants, and nurse practitioners are not covered by this legislation or by similar legislation in other settings, even though the restructuring of health care to prioritize primary care and multidisciplinary care models means that “non-physician clinicians” are becoming more numerous and more involved in decision-making and medication management. In this systematic review (a study that uses predefined criteria to identify all the research on a given topic), the researchers examine the nature and implications of the interactions between non-physician clinicians and industry.
What Did the Researchers Do and Find?
The researchers identified 15 published studies that examined interactions between non-physician clinicians (Registered Nurses, nurse prescribers, midwives, pharmacists, Physician Assistants, and dieticians) and industry (corporations that produce health care goods and services). They extracted the data from 16 publications (representing 15 different studies) and synthesized them qualitatively (combined the data and reached word-based, rather than numerical, conclusions) into eight outcome domains, including the nature and frequency of interactions, non-physician clinicians' attitudes toward industry, and the perceived ethical acceptability of interactions. In the research the authors identified, non-physician clinicians reported frequent interactions with the pharmaceutical and infant formula industries. Most non-physician clinicians met industry representatives regularly, received gifts and samples, and attended educational events or received educational materials (some of which they distributed to patients). In these studies, non-physician clinicians generally regarded these interactions positively and felt they were an ethical and appropriate use of industry resources. Only a minority of non-physician clinicians felt that marketing influenced their own practice, although a larger percentage felt that their colleagues would be influenced. A sizeable proportion of non-physician clinicians questioned the reliability of industry information, but most were confident that they could detect biased information and therefore rated this information as reliable, valuable, or useful.
What Do These Findings Mean?
These and other findings suggest that non-physician clinicians generally have positive attitudes toward industry interactions but recognize issues related to bias and conflict of interest. Because these findings are based on a small number of studies, most of which were undertaken in the US, they may not be generalizable to other countries. Moreover, they provide no quantitative assessment of the interaction between non-physician clinicians and industry and no information about whether industry interactions affect patient care outcomes. Nevertheless, these findings suggest that industry interactions are normalized (seen as standard) in clinical practice across non-physician disciplines. This normalization creates the potential for serious risks to patients and health care systems. The researchers suggest that it may be unrealistic to expect that non-physician clinicians can be taught individually how to interact with industry ethically or how to detect and avert bias, particularly given the ubiquitous nature of marketing and promotional materials. Instead, they suggest, the environment in which non-physician clinicians practice should be structured to mitigate the potentially harmful effects of interactions with industry.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001561.
This study is further discussed in a PLOS Medicine Perspective by James S. Yeh and Aaron S. Kesselheim
The American Medical Association provides guidance for physicians on interactions with pharmaceutical industry representatives, information about the Physician Payments Sunshine Act, and a toolkit for preparing Physician Payments Sunshine Act reports
The International Council of Nurses provides some guidance on industry interactions in its position statement on nurse-industry relations
The UK General Medical Council provides guidance on financial and commercial arrangements and conflicts of interest as part of its good medical practice website, which describes what is required of all registered doctors in the UK
Understanding and Responding to Pharmaceutical Promotion: A Practical Guide is a manual prepared by Health Action International and the World Health Organization that schools of medicine and pharmacy can use to train students how to recognize and respond to pharmaceutical promotion.
The Institute of Medicine's Report on Conflict of Interest in Medical Research, Education, and Practice recommends steps to identify, limit, and manage conflicts of interest
The University of California, San Francisco, Office of Continuing Medical Education offers a course called Marketing of Medicines
doi:10.1371/journal.pmed.1001561
PMCID: PMC3841103  PMID: 24302892
19.  Simulated Drug Discovery Process to Conduct a Synoptic Assessment of Pharmacy Students 
Objective. To implement and assess a task-based learning exercise that prompts pharmacy students to integrate their understanding of different disciplines.
Design. Master of pharmacy (MPharm degree) students were provided with simulated information from several preclinical science and from clinical trials and asked to synthesize this into a marketing authorization application for a new drug. Students made a link to pharmacy practice by creating an advice leaflet for pharmacists.
Assessment. Students’ ability to integrate information from different disciplines was evaluated by oral examination. In 2 successive academic years, 96% and 82% of students demonstrated an integrated understanding of their proposed new drug. Students indicated in a survey that their understanding of the links between different subjects improved.
Conclusion. Simulated drug discovery provides a learning environment that emphasizes the connectivity of the preclinical sciences with each other and the practice of pharmacy.
doi:10.5688/ajpe78241
PMCID: PMC3965149  PMID: 24672074
synoptic assessment; drug discovery; integrated learning; simulation
20.  Impact of Interprofessional Activities on Health Professions Students’ Knowledge of Community Pharmacists’ Role and Services 
Objectives. To determine the impact of health professions students’ participation in interprofessional activities on their knowledge of the roles of community pharmacists and community pharmacist-provided services.
Methods. Students at the Medical University of South Carolina were surveyed via a self-administered online survey tool to determine their participation in interprofessional activities as well as their knowledge of the role of community pharmacists and community pharmacist-provided services.
Results. Over 600 students completed the survey instrument. Nonpharmacy students who attended the university-sponsored Interprofessional Day were more knowledgeable of pharmacist-provided services. Previous interaction with a pharmacist increased nonpharmacy students’ awareness of the services that pharmacists provide.
Conclusion. Participation in interprofessional activities increased health professions students’ awareness of the role of pharmacists. Continued education among healthcare professions about the role of and services provided by pharmacists is needed to ensure that pharmacists have the greatest possible impact on patient care.
doi:10.5688/ajpe758152
PMCID: PMC3220333  PMID: 22102742
community pharmacy; health professions; interprofessional education
21.  China’s regional inequity in pharmacist’s drug safety practice 
Background
The promotion of patient safety and drug safety through promotion of pharmacist’s drug safety practice was among the most important aims of China’s health delivery system reform, but regional inequity in pharmacist’s drug safety practice was still serious in China.
Methods
The 2011 national patient safety and medication error baseline survey was carried out for the first time in China, and through analyzing dataset from the survey, this study was set up to test both China’s regional inequity in pharmacist’s drug safety practice and major influencing factors for pharmacist’s drug safety practice among different districts of China.
Results
Pharmacist’s drug safety practice in regions with higher per capita GDP and more abundant medical resources was still better than that in regions with lower per capita GDP and less abundant medical resources. In all districts of China, pharmacist’s drug safety knowledge, drug safety attitude, self-perceived pressure and fatigue, hospital management quality, and hospital regulation were major influencing factors for pharmacist’s drug safety practice, while only in regions with higher per capita GDP and more abundant medical resources, hospital drug safety culture, supervisor’s work team management, cooperation atmosphere of work team, and drug safety culture of work team were major influencing factors for pharmacist’s drug safety practice.
Conclusion
Regional inequity in pharmacist’s drug safety practice still existed in China. In all districts of China, promoting pharmacist’s drug safety knowledge, drug safety attitude, self-perceived pressure and fatigue, hospital management quality, and hospital regulation could help promote pharmacist’s drug safety practice, while only in regions with higher per capita GDP and more abundant medical resources, promoting hospital drug safety culture, supervisor’s work team management, cooperation atmosphere of work team, and drug safety culture of work team could help promote pharmacist’s drug safety practice. And in regions with lower per capita GDP and less abundant medical resources, the link between pharmacist’s drug safety practice and hospital drug safety culture/supervisor’s work team management/cooperation atmosphere of work team/drug safety culture of work team should also be gradually established.
doi:10.1186/1475-9276-11-38
PMCID: PMC3485099  PMID: 22867000
22.  An expanded prescribing role for pharmacists - an Australian perspective 
The Australasian Medical Journal  2011;4(4):236-242.
Expanded pharmacist prescribing is a new professional practice area for pharmacists. Currently, Australian pharmacists’ prescribing role is limited to over-the-counter medications. This review aims to identify Australian studies involving the area of expanded pharmacist prescribing. Australian studies exploring the issues of pharmacist prescribing were identified and considered in the context of its implementation internationally. Australian studies have mainly focused on the attitudes of community and hospital pharmacists towards such an expansion. Studies evaluating the views of Australian consumers and pharmacy clients were also considered. The available Australian literature indicated support from pharmacists and pharmacy clients for an expanded pharmacist prescribing role, with preference for doctors retaining a primary role in diagnosis. Australian pharmacists and pharmacy client’s views were also in agreement in terms of other key issues surrounding expanded pharmacist prescribing. These included the nature of an expanded prescribing model, the need for additional training for pharmacists and the potential for pharmacy clients gaining improved medication access, which could be achieved within an expanded role that pharmacists could provide. Current evidence from studies conducted in Australia provides valuable insight to relevant policymakers on the issue of pharmacist prescribing in order to move the agenda of pharmacist prescribing forwards.
doi:10.4066/AMJ.2011.694
PMCID: PMC3562903  PMID: 23393515
Pharmacist prescribing; Australia; pharmacy clients; Australian pharmacy; non-medical prescribing
23.  The Community Pharmacist As A Resource for the Family Physician 
Canadian Family Physician  1985;31:1977-1980.
The family physician's relationship with the community pharmacist has tended to be biased. The physician sees the pharmacist simply as a dispenser of drugs. Physicians and pharmacists are usually physically separated, lessening their chances of a collaborative working relationship. Family physicians' traditional sources of drug information include journals, colleagues and drug company literature. However, when they have some form of regular interaction with a pharmacist, physicians tend to see the pharmacist as a main source of drug information. The proper use of medication involves three critical relationships: doctor/patient, doctor/pharmacist, and pharmacist/patient. The doctor/pharmacist relationship has several components: individual consultations, regular team meetings, and establishment of a limited formulary for physicians and residents. There is evidence that compliance is improved when the pharmacist is involved in patient education.
PMCID: PMC2327876  PMID: 21274211
Pharmacist; family physician; primary care
24.  Pharmacists’ Recommendations to Improve Care Transitions 
The Annals of pharmacotherapy  2012;46(9):1152-1159.
Background
Increasingly, hospitals are implementing multi-faceted programs to improve medication reconciliation and transitions of care, often involving pharmacists.
Objective
To help delineate the optimal role of pharmacists in this context, this qualitative study assessed pharmacists’ views on their roles in hospital-based medication reconciliation and discharge counseling. We also provide pharmacists’ recommendations for improving care transitions.
Methods
Eleven study pharmacists at two hospitals who participated in the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study completed semi-structured one-on-one interviews, which were coded systematically in NVivo. Pharmacists provided their perspectives on admission and discharge medication reconciliation, in-hospital patient counseling, provision of simple medication adherence aids (e.g., pill box, illustrated daily medication schedule), and telephone follow-up.
Results
Pharmacists considered medication reconciliation, though time-consuming, to be their most important role in improving care transitions, particularly through detection of errors in the admission medication history that required correction. They also identified patients with poor understanding of their medications, who required additional counseling. Providing adherence aids was felt to be highly valuable for patients with low health literacy, though less useful for patients with adequate health literacy. Pharmacists noted that having trained administrative staff conduct the initial post-discharge follow-up call to screen for issues and triage which patients needed pharmacist follow-up was helpful and an efficient use of resources. Pharmacists’ recommendations for improving care transitions included clear communication among team members, protected time for discharge counseling, patient and family engagement in discharge counseling, and provision of patient education materials.
Conclusion
Pharmacists are well-positioned to participate in hospital-based medication reconciliation, identify patients with poor medication understanding or adherence, and provide tailored patient counseling to improve transitions of care. Additional studies are needed to confirm these findings in other settings, and to determine the efficacy and cost-effectiveness of different models of pharmacist involvement.
doi:10.1345/aph.1Q641
PMCID: PMC3575733  PMID: 22872752
pharmacist; health literacy; care transitions; medication reconciliation; qualitative research
25.  Older Patient, Physician and Pharmacist Perspectives about Community Pharmacists’ Roles 
Objectives
To investigate older patient, physician and pharmacist perspectives about the pharmacists’ role in pharmacist-patient interactions.
Methods
Design
Eight focus group discussions.
Settings
Senior centers, community pharmacies, primary care physician offices.
Participants
Forty-two patients aged 63 and older, 17 primary care physicians, and 13 community pharmacists.
Measurements
Qualitative analysis of focus group discussions.
Results
Participants in all focus groups indicated that pharmacists are a good resource for basic information about medications. Physicians appreciated pharmacists’ ability to identify drug interactions, yet did not comment on other specific aspects related to patient education and care. Physicians noted that pharmacists often were hindered by time constraints that impede patient counseling. Both patient and pharmacist participants indicated that patients often asked pharmacists to expand upon, reinforce, and explain physician-patient conversations about medications, as well as to evaluate medication appropriateness and physician treatment plans. These groups also noted that patients confided in pharmacists about medication-related problems before contacting physicians. Pharmacists identified several barriers to patient counseling, including lack of knowledge about medication indications and physician treatment plans.
Conclusions
Community-based pharmacists may often be presented with opportunities to address questions that can affect patient medication use. Older patients, physicians and pharmacists all value greater pharmacist participation in patient care. Suboptimal information flow between physicians and pharmacists may hinder pharmacist interactions with patients and detract from patient medication management. Interventions to integrate pharmacists into the patient healthcare team could improve patient medication management.
doi:10.1111/j.2042-7174.2012.00202.x
PMCID: PMC3442941  PMID: 22953767
pharmacist-patient interactions; provider-patient communication; prescription medication; qualitative research methods

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