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1.  Pharmaceutical care education in Kuwait: pharmacy students’ perspectives 
Pharmacy Practice  2014;12(3):411.
Background
Pharmaceutical care is defined as the responsible provision of medication therapy to achieve definite outcomes that improve patients’ quality of life. Pharmacy education should equip students with the knowledge, skills, and attitudes they need to practise pharmaceutical care competently.
Objective
To investigate pharmacy students’ attitudes towards pharmaceutical care, perceptions of their preparedness to perform pharmaceutical care competencies, opinions about the importance of the various pharmaceutical care activities, and the barriers to its implementation in Kuwait.
Methods
A descriptive, cross-sectional survey of pharmacy students (n=126) was conducted at Faculty of Pharmacy, Kuwait University. Data were collected via a pre-tested self-administered questionnaire. Descriptive statistics including percentages, medians and means Likert scale rating (SD) were calculated and compared using SPSS, version 19. Statistical significance was accepted at a p value of 0.05 or lower.
Results
The response rate was 99.2%. Pharmacy students expressed overall positive attitudes towards pharmaceutical care. They felt prepared to implement the various aspects of pharmaceutical care, with the least preparedness in the administrative/management aspects. Perceived pharmaceutical care competencies grew as students progressed through the curriculum. The students also appreciated the importance of the various pharmaceutical care competencies. They agreed/strongly agreed that the major barriers to the integration of pharmaceutical care into practice were lack of private counseling areas or inappropriate pharmacy layout (95.2%), lack of pharmacist time (83.3%), organizational obstacles (82.6%), and pharmacists’ physical separation from patient care areas (82.6%).
Conclusion
Pharmacy students’ attitudes and perceived preparedness can serve as needs assessment tools to guide curricular change and improvement. Student pharmacists at Kuwait University understand and advocate implementation of pharmaceutical care while also recognizing the barriers to its widespread adoption. The education and training provided at Kuwait University Faculty of Pharmacy is designed to develop students to be the change agents who can advance pharmacist-provided direct patient care.
PMCID: PMC4161404  PMID: 25243027
Students; Pharmacy; Education; Pharmacy; Curriculum; Attitude of Health Personnel; Professional Role; Kuwait
2.  Ideal and actual involvement of community pharmacists in health promotion and prevention: a cross-sectional study in Quebec, Canada 
BMC Public Health  2012;12:192.
Background
An increased interest is observed in broadening community pharmacists' role in public health. To date, little information has been gathered in Canada on community pharmacists' perceptions of their role in health promotion and prevention; however, such data are essential to the development of public-health programs in community pharmacy. A cross-sectional study was therefore conducted to explore the perceptions of community pharmacists in urban and semi-urban areas regarding their ideal and actual levels of involvement in providing health-promotion and prevention services and the barriers to such involvement.
Methods
Using a five-step modified Dillman's tailored design method, a questionnaire with 28 multiple-choice or open-ended questions (11 pages plus a cover letter) was mailed to a random sample of 1,250 pharmacists out of 1,887 community pharmacists practicing in Montreal (Quebec, Canada) and surrounding areas. It included questions on pharmacists' ideal level of involvement in providing health-promotion and preventive services; which services were actually offered in their pharmacy, the employees involved, the frequency, and duration of the services; the barriers to the provision of these services in community pharmacy; their opinion regarding the most appropriate health professionals to provide them; and the characteristics of pharmacists, pharmacies and their clientele.
Results
In all, 571 out of 1,234 (46.3%) eligible community pharmacists completed and returned the questionnaire. Most believed they should be very involved in health promotion and prevention, particularly in smoking cessation (84.3%); screening for hypertension (81.8%), diabetes (76.0%) and dyslipidemia (56.9%); and sexual health (61.7% to 89.1%); however, fewer respondents reported actually being very involved in providing such services (5.7% [lifestyle, including smoking cessation], 44.5%, 34.8%, 6.5% and 19.3%, respectively). The main barriers to the provision of these services in current practice were lack of: time (86.1%), coordination with other health care professionals (61.1%), staff or resources (57.2%), financial compensation (50.8%), and clinical tools (45.5%).
Conclusions
Although community pharmacists think they should play a significant role in health promotion and prevention, they recognize a wide gap between their ideal and actual levels of involvement. The efficient integration of primary-care pharmacists and pharmacies into public health cannot be envisioned without addressing important organizational barriers.
doi:10.1186/1471-2458-12-192
PMCID: PMC3342160  PMID: 22420693
Community pharmacists; Cross-sectional study; Health promotion; Prevention; Public health
3.  Patients’ perception, views and satisfaction with pharmacists’ role as health care provider in community pharmacy setting at Riyadh, Saudi Arabia 
Objectives
This study will provide guiding information about the population perception, views and satisfaction with pharmacist’s performance as health care provider in the community pharmacy setting in Riyadh, Saudi Arabia.
Method
The study was conducted in Riyadh, Saudi Arabia, from July through December 2010. A total of 125 community pharmacies in Riyadh city were randomly selected according to their geographical distribution (north, south, east, and west). They represent about 10–15% of all community pharmacies in the city. The questionnaire composed of 8 items about patients’ views and satisfaction with the pharmacists’ role in the current community pharmacy practice. The questionnaire was coded, checked for accuracy and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0 for Windows (SPSS Inc., Chicago, Illinois).
Results
The response rate was almost 85% where 2000 patients were approached and 1699 of them responded to our questionnaire. The majority of respondents is young adults and adults (82.8%), male (67.5%) and married (66.9%). Seventy one percent of respondents assured that community pharmacist is available in the working while only 37.3% of respondents perceived the pharmacist as a mere vendor. About 38% assured sou moto counseling by the pharmacist, 35% reported pharmacist plays an active role in their compliances to treatments, 43% acknowledged the role of pharmacist in solving medication related problems, 34% considered the pharmacist as a health awareness provider and 44.6% felt that pharmacist is indispensable and an effective part of the health care system.
Conclusion
The image and professional performance of community pharmacist are improving in Saudi Arabia. The Saudi patients show better satisfaction, perception and appreciation of the pharmacists’ role in the health care team. However, extra efforts should be paid to improve the clinical skills of the community pharmacists. Community pharmacists need to be able to reach out to patient, assess their hesitations and promptly offer solution which was appreciated by the patients as the survey indicates. They should play a pro-active role in becoming an effective and indispensable part of health care. Furthermore, they should be able to advice, guide, direct and persuade the patient to comply correct usage of drugs. Finally, community pharmacists should equip themselves with appropriate knowledge and competencies in order to tender efficient and outstanding pharmaceutical health care.
doi:10.1016/j.jsps.2012.05.007
PMCID: PMC3745196  PMID: 23960807
Community; Pharmacist; Satisfaction; Care; Drug; Perception
4.  Pharmacists’ opinions and self-reporting performance regarding the professional tasks and responsibilities in Isfahan, Iran 
Background:
The pharmacists’ roles and responsibilities toward the pharmaceutical care practice have developed considerably during the recent years.
Objectives:
The aim of this program is to explore the opinions and performances of community pharmacists with regard to their professional tasks and responsibilities in Isfahan city.
Materials and Methods:
A descriptive cross-sectional questionnaire survey of community pharmacists was conducted on a sample of 150 pharmacists using the Delphi process. Data were collected on the opinions and performances of the pharmacists’ task, professional responsibility and expertise, organizational and managing skills, and sociodemographic information.
Results:
The response rate was 93.3%. High expressions of agreement were found with most of the task and professional responsibilities and managerial skills and the mean rates of the self-reporting performance of most key tasks were ‘always’. The important differences were found in two opinions about the pharmacists’ responsibilities, (a) declining to dispense the prescribed drug that was not appropriate for the patient's illness and (b) keeping the patient's medical records for future needs. The pharmacists’ opinions on various forms of professional expertise were diverse, especially on recognizing that the required medications were not prescribed for the patient, being informed on the pharmacotherapy subsequence and predicting the therapeutic outcomes, interpreting the laboratory tests results, and assisting persons in need of emergency first aid.
Conclusion:
Pharmacists largely agreed with most of the professional tasks and responsibilities, however, new educational programs should be developed to promote the pharmacists’ knowledge and skills concerning pharmacotherapy. Also an extended role for pharmacists needs to be addressed in the pharmacy regulations and laws.
doi:10.4103/2277-9531.127544
PMCID: PMC3977400  PMID: 24741642
Opinion; pharmacists; pharmaceutical care
5.  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
6.  An assessment of community pharmacists’ attitudes towards professional practice in the Republic of Moldova  
Pharmacy Practice  2008;6(1):1-8.
Pharmacy in Moldova is undergoing a period of transition. The professional practice is adjusting to a market-oriented economy from the previous Soviet system. The pharmaceutical sector has been liberalised giving rise to a significant increase in the number of community pharmacies. This has led to some adverse effects on the profession of pharmacy with pharmacists having considerable difficulties fulfilling their professional aspirations and possibly losing confidence in further developing their professional role.
Objective
To assess community pharmacists’ attitudes towards their professional practice and to determine their perceived competence in various pharmaceutical activities.
Methods
A questionnaire which addressed managerial activities, dispensing activities, pharmaceutical care activities, inter-professional relationships, public health and competence was mailed to 600 community pharmacists who were asked to score the importance and perceived competence for each activity on a scale ranging from 0-5. In the case of pharmaceutical care activities, pharmacists were asked to score their degree of agreement or disagreement as to whether it is the responsibility of the pharmacist to engage in specific pharmaceutical care activities.
Results
A total of 370 valid questionnaires were returned giving a response rate of 61.7%. Managerial and dispensing activities were scored the highest both in terms of perceived importance and competence. The more innovative pharmaceutical care activities scored relatively low. Overall scores relating to the importance of pharmacists engaging in public health activities appear to be the lowest of the entire questionnaire. Younger pharmacists between the ages of 22-30 obtained significantly higher scores with regards to the perceived pharmacist’s responsibility in engaging in various pharmaceutical care activities. Respondents who practiced in an accredited pharmacy scored higher in the majority of questions.
Conclusion
Pharmacists in Moldova appear to be deeply rooted in the traditional approach to the practice of pharmacy pertaining mainly to distributive practice model and are somewhat distant from the other models of practice such as pharmaceutical care, drug information and self-care.
PMCID: PMC4147272  PMID: 25170358
Community Pharmacy Services; Professional Practice; Moldova
7.  Pharmacy practice in the Republic of Macedonia 
Southern Med Review  2011;4(2):88-91.
As part of wider reforms within the pharmaceutical sector, the pharmaceutical care concept has been introduced in the Republic of Macedonia. This article provides discussion on current opportunities and challenges which pharmacy practice face in Macedonia. The emphasis is on three prerequisites for the implementation of pharmaceutical care including: organization of pharmaceutical services, legislation, and professional training. The author argues that Macedonia possesses a favorable pharmacy workforce, solid legal basis and supportive structures of healthcare services in order to implement pharmaceutical care. Implementing pharmaceutical care has not been without its challenges, such as: lack of clinical skills, inadequate continuing education and the current remuneration structure for pharmacy services. While Good Pharmacy Practice (GPP) Guidelines have been developed, wider professional debate and practical steps have not been undertaken to promote the concept of pharmaceutical care nationally. Therefore, an integrated national approach to develop strategy, standards and tools for patient-oriented pharmaceutical practice has to be formulated. In addition, there is a need to undertake more comprehensive analysis of current pharmacy practice, to explore the awareness and willingness of the pharmacists to embrace pharmaceutical care practices, and to identify the opportunities and barriers for implementation of pharmacy practice.
doi:10.5655/smr.v4i2.1006
PMCID: PMC3471178  PMID: 23093887
Pharmaceutical care; pharmacy practice; Republic of Macedonia; organization of pharmaceutical services; legislation; professional training
8.  Pharmacy practice and its challenges in Yemen 
Background
Pharmacy practice in Yemen was established in 1875 in Aden.
Objectives
To describe pharmacy practice as it currently exists in Yemen, the challenges the profession faces, and to recommend changes that will improve pharmaceutical care services.
Methods
This study has two parts. Part 1 comprised a literature search performed between May and July 2011 to identify published studies on pharmacy practice in Yemen. Full text papers, abstracts, and reports in Arabic or English between 1970 and 2011 were reviewed. Part 2 consisted of a qualitative study with face-to-face interviews with a representative sample of pharmacists, staff from the Ministry of Public Health and Population (MoPHP), and patients.
Results
The analysis revealed several issues that plague pharmacy practice in Yemen:
Fewer than 10 per cent of pharmacists working in pharmacies and drug stores are graduates of governmentrecognised colleges.
Most Yemeni pharmacists are dissatisfied with their work conditions and opportunities.
Medicines are expensive and hard to access in Yemen, and counterfeit medicines are a serious problem.
Few regulations and standards exist for pharmacists and pharmaceutical care.
Pharmaceutical marketing plays an important role in marketing and selling products in Yemen.
A dearth of standards, regulations, and laws are hurting pharmacy practice in the country and potentially endangering peoples’ lives.
Conclusion
In order to improve pharmacy practice in Yemen, many changes are needed, including updating the pharmacy curriculum taught, implementing industry standards for pharmacy practice, implementing and reinforcing laws, and integrating pharmacists more fully in the healthcare industry. Additionally, the quality of the pharmacy workforce needs to be improved, and there needs to be increased awareness by the public, physicians, other healthcare professionals, and policy makers about the value of pharmacists.
doi:10.4066/AMJ.2014.1890
PMCID: PMC3920470  PMID: 24567762
Pharmacy practice; workforce; satisfaction; challenges; recommendations and Yemen
9.  A scenario-planning approach to human resources for health: the case of community pharmacists in Portugal 
Human Resources for Health  2014;12(1):58.
Background
Health workforce planning is especially important in a setting of political, social, and economic uncertainty. Portuguese community pharmacists are experiencing such conditions as well as increasing patient empowerment, shortage of primary care physicians, and primary health care reforms. This study aims to design three future scenarios for Portuguese community pharmacists, recognizing the changing environment as an opportunity to develop the role that community pharmacists may play in the Portuguese health system.
Methods
The community pharmacist scenario design followed a three-stage approach. The first stage comprised thinking of relevant questions to be addressed and definition of the scenarios horizon. The second stage comprised two face-to-face, scenario-building workshops, for which 10 experts from practice and academic settings were invited. Academic and professional experience was the main selection criteria. The first workshop was meant for context analysis and design of draft scenarios, while the second was aimed at scenario analysis and validation. The final scenarios were built merging workshops’ information with data collected from scientific literature followed by team consensus. The final stage involved scenario development carried by the authors alone, developing the narratives behind each scenario.
Results
Analysis allowed the identification of critical factors expected to have particular influence in 2020 for Portuguese community pharmacists, leading to two critical uncertainties: the “Legislative environment” and “Ability to innovate and develop services”. Three final scenarios were built, namely “Pharmacy-Mall”, “e-Pharmacist”, and “Reorganize or Die”. These scenarios provide possible trends for market needs, pharmacist workforce numbers, and expected qualifications to be developed by future professionals.
Conclusions
In all scenarios it is clear that the future advance of Portuguese community pharmacists will depend on pharmaceutical services provision beyond medicine dispensing. This innovative professional role will require the acquisition or development of competencies in the fields of management, leadership, marketing, information technologies, teamwork abilities, and behavioural and communication skills. To accomplish a sustainable evolution, legislative changes and adequate financial incentives will be beneficial. The scenario development proves to be valuable as a strategic planning tool, not only for understanding future community pharmacist needs in a complex and uncertain environment, but also for other health care professionals.
doi:10.1186/1478-4491-12-58
PMCID: PMC4201711  PMID: 25312408
Community pharmacists; Human resources for health; Pharmaceutical services; Scenario planning; Portugal
10.  The impact of pharmaceutical care on patients with hypertension and their pharmacists 
Pharmacy Practice  2011;9(2):110-115.
Objective
The purpose of the study was to assess the influence of pharmaceutical care on patients’ knowledge, quality of life and blood pressure and to determine whether new type of pharmaceutical services changes the pharmacists’ satisfaction and knowledge.
Methods
Community pharmacies were randomly assigned to study and control group and pharmacists from both groups included patients with hypertension, who meet inclusion and exclusion criteria. Study group provided the pharmaceutical care (education, pharmacotherapy monitoring, detecting and solving drug related problems) for their patients, while the control group provided the standard pharmaceutical services (dispensing medicines with or without counseling). At the beginning and the end of the study pharmacists and patients filled in the knowledge test. Pharmacists fulfilled also satisfaction questionnaire.
Results
Survey data were collected from 28 and 56 patients from community pharmacies in study and control group respectively. At the last meeting the normal blood pressure achieved 79% and 55% patients in study and control group, respectively (p>0,05). The pharmaceutical care improved patients’ knowledge about disease. Pharmacists from study group, who provided pharmaceutical care, had higher level of pharmacotherapy knowledge and professional satisfaction than the control group.
Conclusions
Implementation of pharmaceutical care into the pharmacy practice benefits both, patients and pharmacists.
PMCID: PMC3969835  PMID: 24688618
Hypertension; Medication Therapy Management; Community Pharmacy Services; Poland
11.  Exploring knowledge and attitudes towards counselling about vitamin supplements in Jordanian community pharmacies 
Pharmacy Practice  2011;9(4):242-251.
The use of multivitamins within a pharmaceutical setting has been the subject of considerable debate.
Objective
This research aimed to provide a platform for assessing and evaluating knowledge, attitudes and professional practices of Jordanian community pharmacists in counselling patients about the safe consumption of vitamins.
Methods
A cross-sectional study was conducted between October 2009 and May 2010. Data collection was carried out using a 44-item semi-structured self-administrated questionnaire. Setting: Community pharmacies in Amman with target sample of 400 pharmacists.
Results
A total of 388 pharmacists participated in this study. The majority (77.8%) of pharmacists believed that a balanced diet is more achievable by eating healthily than by vitamins supplements. 78.1% of participants believed that vitamins deficiency would not shorten life spans, while 80.7% agreed that vitamin supplements could be toxic or might contain unlabelled harmful ingredients. Less than half of pharmacists were aware that some antioxidant vitamins have been verified to be of unproven value, or may even cause cancer. While over 80% of pharmacists would recommend vitamins on a regular basis without prescription, the majority agreed that counselling on vitamin supplements is part of their role in pharmaceutical care (93.3%), in addition to providing relevant information to other healthcare professionals (78.4%). Moreover, responses to specific knowledge questions, such as the interactions of vitamins with drugs or the recommended dietary allowance of vitamins for infants, children, and pregnant women, were negative. Furthermore, only a minority of pharmacists would recheck the accuracy of dose regimens in prescriptions and symptoms of true vitamins deficiency or would follow up patients to record any consequences of vitamins consumption.
Conclusions
The questionnaire revealed satisfactory awareness of community pharmacists about their role in counselling; however, further programmes to update their knowledge are mandatory to emphasise the importance of vitamin supplements as part of complementary medicine, and their exclusion from being considered as merely over the counter (OTC) products.
PMCID: PMC3818741  PMID: 24198863
Vitamins; Community Pharmacy Services; Professional Practice; Jordan
12.  Medical Students' Exposure to and Attitudes about the Pharmaceutical Industry: A Systematic Review 
PLoS Medicine  2011;8(5):e1001037.
A systematic review of published studies reveals that undergraduate medical students may experience substantial exposure to pharmaceutical marketing, and that this contact may be associated with positive attitudes about marketing.
Background
The relationship between health professionals and the pharmaceutical industry has become a source of controversy. Physicians' attitudes towards the industry can form early in their careers, but little is known about this key stage of development.
Methods and Findings
We performed a systematic review reported according to PRISMA guidelines to determine the frequency and nature of medical students' exposure to the drug industry, as well as students' attitudes concerning pharmaceutical policy issues. We searched MEDLINE, EMBASE, Web of Science, and ERIC from the earliest available dates through May 2010, as well as bibliographies of selected studies. We sought original studies that reported quantitative or qualitative data about medical students' exposure to pharmaceutical marketing, their attitudes about marketing practices, relationships with industry, and related pharmaceutical policy issues. Studies were separated, where possible, into those that addressed preclinical versus clinical training, and were quality rated using a standard methodology. Thirty-two studies met inclusion criteria. We found that 40%–100% of medical students reported interacting with the pharmaceutical industry. A substantial proportion of students (13%–69%) were reported as believing that gifts from industry influence prescribing. Eight studies reported a correlation between frequency of contact and favorable attitudes toward industry interactions. Students were more approving of gifts to physicians or medical students than to government officials. Certain attitudes appeared to change during medical school, though a time trend was not performed; for example, clinical students (53%–71%) were more likely than preclinical students (29%–62%) to report that promotional information helps educate about new drugs.
Conclusions
Undergraduate medical education provides substantial contact with pharmaceutical marketing, and the extent of such contact is associated with positive attitudes about marketing and skepticism about negative implications of these interactions. These results support future research into the association between exposure and attitudes, as well as any modifiable factors that contribute to attitudinal changes during medical education.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
The complex relationship between health professionals and the pharmaceutical industry has long been a subject of discussion among physicians and policymakers. There is a growing body of evidence that suggests that physicians' interactions with pharmaceutical sales representatives may influence clinical decision making in a way that is not always in the best interests of individual patients, for example, encouraging the use of expensive treatments that have no therapeutic advantage over less costly alternatives. The pharmaceutical industry often uses physician education as a marketing tool, as in the case of Continuing Medical Education courses that are designed to drive prescribing practices.
One reason that physicians may be particularly susceptible to pharmaceutical industry marketing messages is that doctors' attitudes towards the pharmaceutical industry may form early in their careers. The socialization effect of professional schooling is strong, and plays a lasting role in shaping views and behaviors.
Why Was This Study Done?
Recently, particularly in the US, some medical schools have limited students' and faculties' contact with industry, but some have argued that these restrictions are detrimental to students' education. Given the controversy over the pharmaceutical industry's role in undergraduate medical training, consolidating current knowledge in this area may be useful for setting priorities for changes to educational practices. In this study, the researchers systematically examined studies of pharmaceutical industry interactions with medical students and whether such interactions influenced students' views on related topics.
What Did the Researchers Do and Find?
The researchers did a comprehensive literature search using appropriate search terms for all relevant quantitative and qualitative studies published before June 2010. Using strict inclusion criteria, the researchers then selected 48 articles (from 1,603 abstracts) for full review and identified 32 eligible for analysis—giving a total of approximately 9,850 medical students studying at 76 medical schools or hospitals.
Most students had some form of interaction with the pharmaceutical industry but contact increased in the clinical years, with up to 90% of all clinical students receiving some form of educational material. The highest level of exposure occurred in the US. In most studies, the majority of students in their clinical training years found it ethically permissible for medical students to accept gifts from drug manufacturers, while a smaller percentage of preclinical students reported such attitudes. Students justified their entitlement to gifts by citing financial hardship or by asserting that most other students accepted gifts. In addition, although most students believed that education from industry sources is biased, students variably reported that information obtained from industry sources was useful and a valuable part of their education.
Almost two-thirds of students reported that they were immune to bias induced by promotion, gifts, or interactions with sales representatives but also reported that fellow medical students or doctors are influenced by such encounters. Eight studies reported a relationship between exposure to the pharmaceutical industry and positive attitudes about industry interactions and marketing strategies (although not all included supportive statistical data). Finally, student opinions were split on whether physician–industry interactions should be regulated by medical schools or the government.
What Do These Findings Mean?
This analysis shows that students are frequently exposed to pharmaceutical marketing, even in the preclinical years, and that the extent of students' contact with industry is generally associated with positive attitudes about marketing and skepticism towards any negative implications of interactions with industry. Therefore, strategies to educate students about interactions with the pharmaceutical industry should directly address widely held misconceptions about the effects of marketing and other biases that can emerge from industry interactions. But education alone may be insufficient. Institutional policies, such as rules regulating industry interactions, can play an important role in shaping students' attitudes, and interventions that decrease students' contact with industry and eliminate gifts may have a positive effect on building the skills that evidence-based medical practice requires. These changes can help cultivate strong professional values and instill in students a respect for scientific principles and critical evidence review that will later inform clinical decision-making and prescribing practices.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001037.
Further information about the influence of the pharmaceutical industry on doctors and medical students can be found at the American Medical Students Association PharmFree campaign and PharmFree Scorecard, Medsin-UKs PharmAware campaign, the nonprofit organization Healthy Skepticism, and the Web site of No Free Lunch.
doi:10.1371/journal.pmed.1001037
PMCID: PMC3101205  PMID: 21629685
13.  Pharmacy students’ attitudes toward pharmaceutical care in Qatar 
Objectives
The study objectives were to investigate Qatar pharmacy students’ attitudes toward pharmaceutical care (PC), to identify the factors that influence their attitudes, and to recognize their perceived barriers for PC provision.
Methods
A cross-sectional and online survey of Qatar pharmacy students was conducted.
Results
Over 4 weeks, 46 surveys were submitted (88% response rate). All respondents agreed that the pharmacist’s primary responsibility is to prevent and resolve medication therapy problems. Most respondents believed that PC provision is professionally rewarding and that all pharmacists should provide PC (93% and 91% of respondents, respectively). Highly perceived barriers for PC provision included lack of access to patient information (76%), inadequate drug information sources (55%), and time constraints (53%). Professional year and practical experience duration were inversely significantly associated with four and five statements, respectively, out of the 13 Standard Pharmaceutical Care Attitudes Survey statements, including the statements related to the value of PC, and its benefit in improving patient health and pharmacy practitioners’ careers.
Conclusion
Qatar pharmacy students had positive attitudes toward PC. Efforts should be exerted to overcome their perceived barriers.
doi:10.2147/TCRM.S56982
PMCID: PMC3938321  PMID: 24591836
Qatar; pharmaceutical care; pharmacy; student
14.  Adherence: a review of education, research, practice, and policy in the United States 
Pharmacy Practice  2010;8(1):1-17.
Objective
To describe the education, research, practice, and policy related to pharmacist interventions to improve medication adherence in community settings in the United States.
Methods
Authors used MEDLINE and International Pharmaceutical Abstracts (since 1990) to identify community and ambulatory pharmacy intervention studies which aimed to improve medication adherence. The authors also searched the primary literature using Ovid to identify studies related to the pharmacy teaching of medication adherence. The bibliographies of relevant studies were reviewed in order to identify additional literature. We searched the tables of content of three US pharmacy education journals and reviewed the American Association of Colleges of Pharmacy website for materials on teaching adherence principles. Policies related to medication adherence were identified based on what was commonly known to the authors from professional experience, attendance at professional meetings, and pharmacy journals.
Results
Research and Practice: 29 studies were identified: 18 randomized controlled trials; 3 prospective cohort studies; 2 retrospective cohort studies; 5 case-controlled studies; and one other study. There was considerable variability in types of interventions and use of adherence measures. Many of the interventions were completed by pharmacists with advanced clinical backgrounds and not typical of pharmacists in community settings. The positive intervention effects had either decreased or not been sustained after interventions were removed. Although not formally assessed, in general, the average community pharmacy did not routinely assess and/or intervene on medication adherence.
Education
National pharmacy education groups support the need for pharmacists to learn and use adherence-related skills. Educational efforts involving adherence have focused on students’ awareness of adherence barriers and communication skills needed to engage patients in behavioral change.
Policy
Several changes in pharmacy practice and national legislation have provided pharmacists opportunities to intervene and monitor medication adherence. Some of these changes have involved the use of technologies and provision of specialized services to improve adherence.
Conclusions
Researchers and practitioners need to evaluate feasible and sustainable models for pharmacists in community settings to consistently and efficiently help patients better use their medications and improve their health outcomes.
PMCID: PMC4140572  PMID: 25152788
Medication Adherence; Pharmacists; Education; Pharmacy; United States
15.  Smoking cessation in community pharmacy practice–a clinical information needs analysis 
SpringerPlus  2013;2:449.
Background
With the emerging role of pharmacists in implementing smoking cessation services and the recent evidence about smoking cessation pharmacotherapies, a needs analysis to assess baseline knowledge about current smoking cessation practice is needed; hence, training and development in this area can target possible ‘gaps’.
Objective
This study aimed at exploring pharmacy students’ knowledge about and attitudes toward smoking cessation, as compared to practicing community pharmacists and smoking cessation educators. The overall objective was to uncover underlying ‘gaps’ in pharmacy-based smoking cessation practice, particularly clinical gaps.
Setting
Final-year pharmacy students at the University of Sydney, practicing community pharmacists and smoking cessation educators in Australia.
Method
As no previous standard pharmacist-focused smoking cessation knowledge questionnaires exist, a review of the literature informed the development of such a questionnaire. The questionnaire was administered to a cohort of fourth-year pharmacy students at the University of Sydney, practicing pharmacists and smoking cessation educators. Data analysis was performed using Predictive Analytics SoftWare (PASW® Statistics 18). Mean total scores, independent t-tests, analysis of variances and exploratory factor analysis were performed.
Main outcome measure
To determine areas of major clinical deficits about current evidence related to smoking cessation interventions at the pharmacy level.
Results
Responses from 250 students, 51 pharmacists and 20 educators were obtained. Smoking educators scored significantly higher than pharmacists and students (P < .05), while score differences in the latter two groups were not statistically significant (P > .05). All groups scored high on ‘general’ knowledge questions as compared to specialised pharmacologic and pharmacotherapeutic questions. All respondents demonstrated positive attitudes toward the implications of smoking cessation. Factor analysis of the 24-item knowledge section extracted 12 items loading on 5 factors accounting for 53% of the total variance.
Conclusions
The results provide a valid indication of ‘gaps’ in the practice of up-to-date smoking cessation services among Australian pharmacy professionals, particularly in clinical expertise areas involving assessment of nicotine dependence and indications, dosages, adverse effects, contraindications, drug interactions and combinations of available pharmacotherapies. These gaps should be addressed, and the results should inform the design, implementation and evaluation of a pharmacy-based educational training program targeting current clinical issues in smoking cessation.
doi:10.1186/2193-1801-2-449
PMCID: PMC3777019  PMID: 24058894
Attitudes; Knowledge; Pharmacy; Questionnaire; Smoking cessation
16.  Practice, awareness and opinion of pharmacists toward disposal of unwanted medications in Kuwait 
Background
The disposal of unwanted medications has been a concern in many countries, as pharmaceutical waste enters the ecosystem, ultimately having an effect on human health and environment. Earlier studies in Kuwait found that the method of disposal by the public was by disposing in the garbage or by flushing down the drain. In accordance with patient preference and environment safety, it would be appropriate to use local government pharmacies as collection points for proper disposal.
Objective
To determine the practice of pharmacists, working in government healthcare sectors, with regard to disposal of returned unwanted medications by the public. This study also aims to assess pharmacists’ awareness toward the impact of improper disposal on the environment and to investigate whether pharmacists agree to have their pharmacies as collection points for future take-back programs.
Method
A random sample of 144 pharmacists from the six main governmental hospitals and 12 specialized polyclinics in Kuwait, completed a self-administered questionnaire about their practice of disposal, awareness and opinion on using pharmacies as collection points for proper disposal of UMs. Data were analyzed using descriptive statistics.
Results
A total of 144 pharmacists completed the survey. Throwing UMs in the trash was the main method of disposal by majority of the respondents (73%). Only 23 pharmacists disposed UMs according to the guidelines of Ministry of Health, Kuwait (MOH). However, about 82% are aware that improper disposal causes damage to the environment and 97% agree that it is their responsibility to protect the environment. About 86–88% of the pharmacists agree to have government hospital pharmacies and polyclinics as collection points for future take-back programs.
Conclusion
Even though the current practice of disposal by majority of pharmacists is inappropriate, they are aware of the damage and acknowledge their responsibilities toward environment protection. Concerned authorities should monitor and implement proper disposal guidelines in all pharmacies. Majority of pharmacists support the idea of having the government pharmacies as collection points for safe disposal of UMs in Kuwait.
doi:10.1016/j.jsps.2012.04.001
PMCID: PMC3744962  PMID: 23960793
Unwanted medications; Pharmaceutical waste; Environment; Pharmacist; Kuwait
17.  Adherence: a review of education, research, practice and policy in Australia 
Pharmacy Practice  2009;7(1):1-10.
Community pharmacists are well placed to deliver adherence support services as well as other pharmaceutical services to patients. They are often the last point of contact with patients collecting medicines in the healthcare chain, and they tend to be visited by patients on a regular basis to collect prescription medicines. They have the opportunity to reinforce information already received from other health practitioners, provide further information and monitor adherence to therapy.
The past decade has seen an increase in focus on the importance of adherence to therapy, not only in the higher education sector, but also in government policy and community pharmacy practice. Adherence monitoring and promotion has not only become the foundation of courses taught in pharmacy schools, but has become an essential component of disease management and pharmaceutical services delivered by community pharmacists.
Aims
This article aims to describe the education, research, practice and policy in the area of adherence to therapy in Australia with a focus on community pharmacists.
Methods
A search of MEDLINE and International Pharmaceutical Abstracts as well as hand searches of the bibliographies of retrieved articles was conducted for the period 2000-2008. All pharmacy schools in Australia were also contacted to obtain information on the patient adherence to therapy content of their courses.
Results
Ten studies met the inclusion criteria. Only one study had a specific adherence focus, with the remainder including adherence support and monitoring as part of the overall interventions delivered by the community pharmacists. In the majority of cases the interventions resulted in an improvement in patients’ adherence to therapy. The research was supported by government and pharmacy professional organisation initiatives in the area of cognitive pharmaceutical services. All universities which responded delivered specific patient adherence courses.
Conclusions
Australian pharmacy schools are educating cohorts of students who will have the skills to monitor and support patient medication adherence in the context of contemporary pharmacy practice. This is supported by research evidence, government policy and fits well into the move to expand community pharmacy services to include chronic disease state management and primary health care.
PMCID: PMC4139750  PMID: 25147586
Medication Adherence; Pharmacists; Australia
18.  CONTINUING PHARMACEUTICAL EDUCATION FOR COMMUNITY PHARMACISTS IN THE EASTERN PROVINCE OF SAUDI ARABIA 
Background:
Community pharmacists in Saudi Arabia very often make decisions that affect patient outcome. Previous studies have indicated that they have access to limited sources of information. Therefore, structured continuing pharmaceutical education (CPE) is necessary to improve their standards and attitudes.
Aims:
Identify the most important topics for CPE as well as the most significant barriers to conducting CPE successfully.
Methods:
A questionnaire was distributed to 120 pharmacists working in 88 community pharmacies in the Eastern Province of Saudi Arabia. The survey contained five sections: general background, topics for CPE that could be of great interest to community pharmacists, possible obstacles to attending CPE, method of instruction, and the most suitable time and day of the week for conducting CPE.
Results:
One hundred and five (87.5%) pharmacists answered the survey questionnaire. The rank order of the five most selected topics for CPE were: drug interaction (81.9%), drug use during pregnancy (77.1%), use of anti-microbial agents (62.5%), pharmaceutical ethics (53.3%), geriatric and pediatric pharmacology (45.7%). For pharmacists, the most important obstacles to attending CPE were lack of time (96.2%), distance from practice (74.2%), and lack of programs or information about these programs (54.3%). Interestingly, 47.6% of the pharmacists recommended credentialing CPE and stated that knowing the lecturer was not considered an important factor.
Conclusion and recommendations:
The findings of this study demonstrated that pharmacists are willing to participate in CPE programs. However, the working conditions of pharmacists would be a major barrier to their attendance. Therefore, improvement of the working conditions of community pharmacists, development of credited CPE programs in each region, as well as improving communication between the Saudi Pharmaceutical Association and community pharmacists are highly recommended.
PMCID: PMC3439743  PMID: 23008650
Continuing pharmaceutical education; pharmaceutical care; community pharmacists; community pharmacies; Saudi Arabia
19.  Pharmacy Education in France 
In France, to practice as a pharmacist, one needs a “diplome d'état de Docteur en Pharmacie” This degree is awarded after 6 or 9 years of pharmacy studies, depending on the option chosen by the student. The degree is offered only at universities and is recognized in France as well as throughout the European Union.
Each university in France is divided into faculties called Unité de Formation et de Recherche (UFR). There are 24 faculties of pharmacy or UFRs de pharmacie. A national committee develops a pharmacy education program at the national level and each faculty adapts this program according to its specific features and means (eg, faculty, buildings). The number of students accepted in the second year is determined each year by a Government decree (numerus clausus).
Successive placements, totalling 62 weeks, progressively familiarize the student with professional practice, and enable him/her to acquire the required competencies, such as drug monitoring and educating and counselling patients. Challenges facing community pharmacies in the next 10 years are patient education, home health care, and orthopaedics; in hospital pharmacies, empowering pharmacists to supervise and validate all prescriptions; and finally, research in pharmacy practice.
PMCID: PMC2661173  PMID: 19325952
international pharmacy education; France
20.  Pharmacists’ Perceptions of Their Professional Role: Insights into Hospital Pharmacy Culture 
Background:
Numerous studies have demonstrated the positive impacts of pharmacists on patient outcomes. To capitalize on these positive impacts, hospital pharmacy organizations around the world are now calling on pharmacists to shift their focus from distribution of medications to patient outcomes. This new emphasis is consistent with the vision statement for the profession of pharmacy in Canada, as set out in the Blueprint for Pharmacy: “Optimal drug therapy outcomes for Canadians through patient-centred care”. Given the ambitious nature of this statement and these goals, it is essential to understand what pharmacists currently think of their practice.
Objective:
To conduct a qualitative and semiquantitative analysis of hospital pharmacists’ perceptions of their role in patient care.
Methods:
A researcher posing as a University of Alberta student who was studying how health professionals use language to describe what they do contacted the pharmacy departments of all hospitals in Alberta. The “top-of-mind” approach was used in asking hospital pharmacists 2 questions: (1) How many years have you been practising pharmacy? (2) In 3 or 4 words (or phrases), from your perspective could you please tell me, “What does a pharmacist do”? These techniques were used to minimize the impact of social desirability bias. Content analysis was used to categorize hospital pharmacists’ responses into 4 broad categories: patient-centred, drug-focused, drug distribution, and ambiguous.
Results:
A total of 103 phone calls were made to hospital pharmacies, and 85 pharmacists contacted in this way were willing to participate in the survey. Hospital pharmacists provided 333 individual responses to the question about their activities. Of these, 79 (23.7%) were patient-centred, 98 (29.4%) were drug-focused, and 82 (24.6%) were in the drug-distribution category. Ambiguous responses accounted for the remaining 74 (22.2%).
Conclusion:
Aspects of care categorized as other than patient-centred should not be construed as unimportant. However, the fact that they were reported in this survey more frequently than patient-centred aspects suggests that hospital pharmacists in Alberta may have not fully embraced the concept of patient-centred care as outlined in the Blueprint for Pharmacy.
PMCID: PMC3053190  PMID: 22479026
patient-centred; drug-focused; drug distribution; top-of-mind approach; hospital pharmacist; pharmacy culture; pratique axée sur le patient; pratique axée sur les médicaments; distribution des médicaments; analyse des réponses spontanées; pharmacien d’hôpital; culture de la pharmacie
21.  How can pharmacist remuneration systems in Europe contribute to generic medicine dispensing?  
Pharmacy Practice  2012;10(1):3-8.
Generic medicines can generate larger savings to health care budgets when their use is supported by incentives on both the supply-side and the demand-side. Pharmacists’'remuneration is one factor influencing the dispensing of generic medicines.
Objective
The aim of this article is to provide an overview of different pharmacist remuneration systems for generic medicines in Europe, with a view to exploring how pharmacist remuneration systems can contribute to generic medicine dispensing.
Methods
Data were obtained from a literature review, a Master thesis in Pharmaceutical Care at the Catholic University of Leuven and a mailing sent to all members of the Pharmaceutical Group of the European Union with a request for information about the local remuneration systems of community pharmacists and the possible existence of reports on discounting practices.
Results
Pharmacists remuneration in most European countries consists of the combination of a fixed fee per item and a certain percentage of the acquisition cost or the delivery price of the medicines. This percentage component can be fixed, regressive or capped for very high-cost medicines and acts as a disincentive for dispensing generic medicines. Discounting for generic medicines is common practice in several European countries but information on this practice tends to be confidential. Nevertheless, data for Belgium, France, the Netherlands and United Kingdom indicated that discounting percentages varied from 10% to 70% of the wholesale selling price.
Conclusions
Pharmacists can play an important role in the development of a generic medicines market. Pharmacists should not be financially penalized for dispensing generic medicines. Therefore, their remuneration should move towards a fee-for-performance remuneration instead of a price-dependent reimbursement which is currently used in many European countries. Such a fee-for-performance remuneration system provides a stimulus for generic medicines dispensing as pharmacists are not penalized for dispensing them but also needs to account for the loss of income to pharmacists from prohibiting discounting practices.
PMCID: PMC3798161  PMID: 24155810
Drugs, Generic; Drug Substitution; Fees, Pharmaceutical; Pharmacists; Europe
22.  Pharmaceutical Consultation in UAE Community Pharmacies 
In recent years, the focus of pharmacists as traditional drug dispensers has shifted to more active and participative role in risk assessment, risk management, and other medication related consultation activities. Pharmacy profession is evolving steadily in the United Arab Emirates (UAE). Pharmacists in UAE are so much occupied in their administrative and managerial duties that dispensing is mostly attended to by pharmacy technicians. Pharmacist-led patient counseling is limited to the dosage and frequency of medications and rarely adverse reactions and drug interactions with other medications. Therefore we decided to perform quantitative questionnaires study to explore the role of pharmacist in patient counseling in UAE, the evaluation of pharmacist's opinion on patient counseling and the potential determinants of personal consultation. Results show the frequency and nature of inquiries received by pharmacist. Five to twenty inquires per month are received from patient, most of them related to drug prescription and dose recommendation. Thirty nine percent of pharmacists received inquiries from doctors, most of them related to the dose and mode of action. Ninty two percent of the pharmacists agreed that patient counseling is their professional responsibility. About 82% of pharmacists agreed that counseling will increase their sales and enhance the reputation of their pharmacies. Seventy percent of pharmacists mentioned that they need to undergo training for effective counseling while 46% of pharmacists felt that more staff in the pharmacies would have a positive influence on patient compliance to medication therapies and patient safety. The potential determinants of personal consultation show that 52% of participants trusted pharmacist and 55% considered the pharmacist as a friend. Forty eight percent of participants visited the pharmacy for medical recommendation while 30% for drug compounding, 72% agreed that pharmacist conducts full instruction while 31% agreed about full investigation. In conclusion, reorganization of the pharmacist's activities may improve pharmaceutical consultations. Pharmacists must be exposed to recent trends in drug therapy, dosage forms, dosage, adverse effects and interaction. This will go a long way in providing rational use of drugs to the patients and improve their quality of life.
doi:10.4103/0250-474X.95621
PMCID: PMC3374556  PMID: 22707824
Attitudes and behaviors; community pharmacists; patient counseling; patient information leaflets; personal consultation
23.  Implementing ward based clinical pharmacy services in an Ethiopian University Hospital 
Pharmacy Practice  2013;11(1):51-57.
Background
Clinical pharmacy practice has developed internationally to expand the role of a pharmacist well beyond the traditional roles of compounding, dispensing and supplying drugs to roles more directly in caring for patients. Studies on the activities of the clinical pharmacist in an inpatient ward in resource constrained settings are scarce, however.
Objective
To assess ward based clinical pharmacy services in an internal medicine ward of Jimma University Specialized Hospital.
Methods
The study was carried out in the internal medicine ward from March to April, 2011 at Jimma University Specialized Hospital. The study design was a prospective observational study where pharmaceutical care services provided by clinical pharmacists for inpatients were documented over a period of two months. Interventions like optimization of rational drug use and physician acceptance of these recommendations were documented. Clinical significance of interventions was evaluated by an independent team (1 internist, 1 clinical pharmacologist) using a standardized method for categorizing drug related problems (DRPs).
Results
A total of 149 drug related interventions conducted for 48 patients were documented; among which 133(89.3%) were clinical pharmacists initiated interventions and 16(10.7%) interventions were initiated by other health care professionals. The most frequent DRPs underlying interventions were unnecessary drug therapy, 36(24.2%); needs additional drug therapy, 34(22.8%) and noncompliance, 29(19.5%). The most frequent intervention type was change of dosage/instruction for use, 23(15.4%). Acceptance rate by physicians was 68.4%. Among the interventions that were rated as clinically significant, 46(48.9%) and 25(26.6%) had major and moderate clinical importance respectively.
Conclusions
Involving trained clinical pharmacists in the healthcare team leads to clinically relevant and well accepted optimization of medicine use in a resource limited settings. This approach can likely be generalized to other health care settings in the country to improve medication outcomes.
PMCID: PMC3780502  PMID: 24155850
Medication Errors; Inpatients; Pharmaceutical Services; Professional Practice; Ethiopia
24.  Care Providers’ Satisfaction with Restructured Clinical Pharmacy Services in a Tertiary Care Teaching Hospital 
Background:
At the time this study was undertaken, clinical pharmacy services at the authors’ institution, a tertiary care teaching hospital, were largely reactive in nature, with patients and units receiving inconsistent coverage.
Objective:
To develop an evidence-based model of proactive practice and to evaluate the satisfaction of pharmacists and other stakeholders after restructuring of clinical pharmacy services.
Methods:
The literature was reviewed to determine a core set of pharmacist services associated with the greatest beneficial impact on patients’ health. On the basis of established staffing levels, the work schedule was modified, and pharmacists were assigned to a limited number of patient care teams to proactively and consistently provide these core services. Other patient care teams continued to receive reactive troubleshooting-based services, as directed by staff in the pharmacy dispensary. A satisfaction survey was distributed to all pharmacists, nurses, and physicians 18 months after the restructuring.
Results:
Of the 26 pharmacists who responded to the survey, all agreed or strongly agreed that the restructuring of services had improved job satisfaction and patient safety and that other health care professionals valued their contribution to patient care. Nurses and physicians from units where pharmacists had been assigned to provide proactive services perceived pharmacist services more favourably than those from units where pharmacist services were reactive. Pharmacists, nurses, and physicians all felt that proactive pharmacist services should be more widely available. Challenges reported by pharmacists included increased expectations for documentation and guilt about “cutting back” services where they had previously been provided.
Conclusions:
Restructuring clinical pharmacy services in an evidence-based manner improved pharmacists’ satisfaction and created demand from other stakeholders to provide this level of service for all patients.
PMCID: PMC2858499  PMID: 22478965
clinical pharmacy; restructuring; tertiary care hospital; evidence-based; practice delivery; pharmacie clinique; restructuration; hôpital de soins tertiaires; données probantes; prestation de services
25.  Health literacy in the pharmacy setting: defining pharmacotherapy literacy 
Pharmacy Practice  2011;9(4):213-220.
Objective
All currently available definitions of health literacy may be considered quite general. Given the complex nature of the patient-pharmacy encounter and the varying tasks required to properly and successfully consume or administer medication or to adhere to a pharmaceutical care regimen, these available definitions may describe inadequately a patient’s health literacy for the purpose of pharmacotherapy and pharmacist intervention. Therefore, the objective of this research was to conceptualize the Pharmacotherapy Literacy construct.
Methods
Licensed pharmacists (n=2,368) were mailed a questionnaire providing them with the Healthy People 2010 definition of health literacy and asked, “Given this definition, how would you define Pharmacotherapy Literacy?” A total of 420 usable surveys were returned of which 176 (42%) included responses to the open-ended question concerning pharmacotherapy literacy. Responses were reviewed independently and collectively by the authors. Common themes were identified, compared and discussed until consensus was reached. An initial definition was formulated and distributed to six doctoral-trained academicians and practicing pharmacists who were asked to offer their opinions of the definition as well as suggestions for its improvement. The definition was modified and subjected to further review from 15 additional doctoral-trained academicians and practicing pharmacists who provided feedback concerning its improvement.
Results
Based on the recommendations received from the academicians and pharmacists, the following, final definition was formulated by the authors: Pharmacotherapy Literacy - An individual’s capacity to obtain, evaluate, calculate, and comprehend basic information about pharmacotherapy and pharmacy related services necessary to make appropriate medication-related decisions, regardless of the mode of content delivery (e.g. written, oral, visual images and symbols).
Conclusions
As the ever-changing pharmacy environment continues to advance and become more complex in nature, a definition of health literacy specific to the pharmacy setting - thereby providing a name and a focus - may improve medication consumption, medication safety, and the patient-pharmacist relationship.
PMCID: PMC3818737  PMID: 24198859
Health Literacy; Drug Therapy; Medication Errors; Consensus

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