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1.  Patient self-management and pharmacist-led patient self-management in Hong Kong: A focus group study from different healthcare professionals' perspectives 
Background
Patient self-management is a key approach to manage non-communicable diseases. A pharmacist-led approach in patient self-management means collaborative care between pharmacists and patients. However, the development of both patient self-management and role of pharmacists is limited in Hong Kong. The objectives of this study are to understand the perspectives of physicians, pharmacists, traditional Chinese medicine (TCM) practitioners, and dispensers on self-management of patients with chronic conditions, in addition to exploring the possibilities of developing pharmacist-led patient self-management in Hong Kong.
Methods
Participants were invited through the University as well as professional networks. Fifty-one participants comprised of physicians, pharmacists, TCM practitioners and dispensers participated in homogenous focus group discussions. Perspectives in patient self-management and pharmacist-led patient self-management were discussed. The discussions were audio recorded, transcribed and analysed accordingly.
Results
The majority of the participants were in support of patients with stable chronic diseases engaging in self-management. Medication compliance, monitoring of disease parameters and complications, lifestyle modification and identifying situations to seek help from health professionals were generally agreed to be covered in patient self-management. All pharmacists believed that they had extended roles in addition to drug management but the other three professionals believed that pharmacists were drug experts only and could only play an assisting role. Physicians, TCM practitioners, and dispensers were concerned that pharmacist-led patient self-management could be hindered, due to unfamiliarity with the pharmacy profession, the perception of insufficient training in disease management, and lack of trust of patients.
Conclusions
An effective chronic disease management model should involve patients in stable condition to participate in self-management in order to prevent health deterioration and to save healthcare costs. The role of pharmacists should not be limited to drugs and should be extended in the primary healthcare system. Pharmacist-led patient self-management could be developed gradually with the support of government by enhancing pharmacists' responsibilities in health services and developing public-private partnership with community pharmacists. Developing facilitating measures to enhance the implementation of the pharmacist-led approach should also be considered, such as allowing pharmacists to access electronic health records, as well as deregulation of more prescription-only medicines to pharmacy-only medicines.
doi:10.1186/1472-6963-11-121
PMCID: PMC3127980  PMID: 21609422
patient self-management; pharmacist-led patient self-management; chronic disease; health policy; Hong Kong
2.  Use of chinese and western over-the-counter medications in Hong Kong 
Chinese Medicine  2010;5:41.
Benefits of engaging community pharmacists in providing wider primary care are internationally acknowledged; in Hong Kong, however, strategies for harnessing their potential contributions are yet to be launched. Here, community pharmacist and Chinese medicine retailers are responsible for providing western and Chinese over-the-counter (OTC) medications. Patterns of OTC uses reflect the characteristics of populations who rely on community pharmacists and Chinese medicine retailers as their main point of contact with the healthcare system. Analyzing the data from a Hong Kong survey (n = 33,263) on self medication and medical consultation patterns, we propose, in this article, an extended role for community pharmacists and Chinese medicine retailers, which entails aspects as follows: (1) referring patients to other medical services where appropriate; (2) providing health education and preventative services; (3) safeguarding the use of Chinese herbal medicines.
doi:10.1186/1749-8546-5-41
PMCID: PMC3004905  PMID: 21143942
3.  Patient perceptions of pharmacist roles in guiding self-medication of over-the-counter therapy in Qatar 
Background:
Self-care, including self-medication with over-the-counter (OTC) drugs, facilitates the public’s increased willingness to assume greater responsibility for their own health. Direct consultation with pharmacists provides efficient professional guidance for safe and appropriate OTC use.
Objective:
The purpose of this study was to characterize patient perceptions of pharmacists and use of nonprescription therapy in an ambulatory care population in Qatar.
Methods:
Patients having prescriptions filled at one organization’s private medical clinics during two distinct two-week periods were invited to participate in a short verbal questionnaire. Awareness of pharmacist roles in guiding OTC drug selection was assessed, as were patient preferences for OTC indications. Attitudes towards pharmacist and nurse drug knowledge and comfort with direct dispensing were also evaluated.
Results:
Five hundred seventy patients participated representing 29 countries. Most respondents were men (92.1%) with mean age of 38.3 years. Almost 1 in 7 did not know medical complaints could be assessed by a pharmacist (15.3%) and 1 in 5 (21.9%) were unaware pharmacists could directly supply OTC therapy. The majority (85.3%) would be interested in this service. In general, respondents were more comfortable with medication and related advice supplied by pharmacists as opposed to nursing professionals.
Conclusion:
Patients were familiar with the roles of pharmacists as they pertain to self-medication with OTC therapy and described the desire to use such a service within this Qatar ambulatory health care setting.
PMCID: PMC2875718  PMID: 20517469
patient; self-medication; over-the-counter; pharmacist; Qatar
4.  Physician perceptions of pharmacist roles in a primary care setting in Qatar 
Purpose
Pharmacists are uniquely trained to provide guidance to patients in the selection of appropriate non-prescription therapy. Physicians in Qatar may not always recognize how pharmacists function in assuring safe medication use. Both these health professional groups come from heterogeneous training and experiences before migrating to the country and these backgrounds could influence collaborative patient care. Qatar Petroleum (QP), the largest private employer in the country, has developed a pharmacist-guided medication consulting service at their primary care clinics, but physician comfort with pharmacists recommending drug therapy is currently unknown. The objective of this study is to characterize physician perceptions of pharmacists and their roles in a primary care patient setting in Qatar.
Methods
This cross-sectional survey was developed following a comprehensive literature review and administered in English and Arabic. Consenting QP physicians were asked questions to assess experiences, comfort and expectations of pharmacist roles and abilities to provide medication-related advice and recommend and monitor therapies.
Results
The median age of the 62 (77.5%) physicians who responded was between 40 and 50 years old and almost two-third were men (64.5%). Fourteen different nationalities were represented. Physicians were more comfortable with pharmacist activities closely linked to drug products than responsibilities associated with monitoring and optimization of patient outcomes. Medication education (96.6%) and drug knowledge (90%) were practically unanimously recognized as abilities expected of pharmacists, but consultative roles, such as assisting in drug regimen design were less acknowledged. They proposed pharmacist spend more time with physicians attending joint meetings or education events to help advance acceptance of pharmacists in patient-centered care at this site.
Conclusions
Physicians had low comfort and expectations of patient-oriented pharmacist roles but were not threatened to learn more about these capabilities or explore enhanced collaboration in patient care.
doi:10.1186/1744-8603-8-12
PMCID: PMC3475112  PMID: 22650614
Physician; Perceptions; Pharmacists; Qatar
5.  Do community pharmacists have the attitudes and knowledge to support evidence based self-management of low back pain? 
Background
In many countries, community pharmacists can be consulted without appointment in a large number of convenient locations. They are in an ideal position to give advice to patients at the onset of low back pain and also reinforce advice given by other healthcare professionals. There is little specific information about the quality of care provided in the pharmacy for people with back pain. The main objectives of this survey were to determine the attitudes, knowledge and reported practice of English pharmacists advising people who present with acute or chronic low back pain.
Methods
A questionnaire was designed for anonymous self-completion by pharmacists attending continuing education sessions. Demographic questions were designed to allow comparison with a national pharmacy workforce survey. Attitudes were measured with the Back Beliefs Questionnaire (BBQ) and questions based on the Working Backs Scotland campaign. Questions about the treatment of back pain in the community pharmacy were written (or adapted) to reflect and characterise the nature of practice. In response to two clinical vignettes, respondents were asked to select proposals that they would recommend in practice.
Results
335 responses from community pharmacists were analysed. Middle aged pharmacists, women, pharmacy managers and locums were over-represented compared to registration and workforce data. The mean (SD) BBQ score for the pharmacists was 31.37 (5.75), which was slightly more positive than in similar surveys of other groups. Those who had suffered from back pain seem to demonstrate more confidence (fewer negative feelings, more advice opportunities and better advice provision) in their perception of advice given in the pharmacy. Awareness of written information that could help to support practice was low. Reponses to the clinical vignettes were generally in line with the evidence base. Pharmacists expressed some caution about recommending activity. Most respondents said they would benefit from more education about back pain.
Conclusion
Those sampled generally expressed positive attitudes about back pain and were able to offer evidence based advice. Pharmacists may benefit from training to increase their ability and confidence to offer support for self-care in back pain. Further research would be useful to clarify the representativeness of the sample.
doi:10.1186/1471-2474-8-10
PMCID: PMC1796877  PMID: 17266748
6.  Diabetes patient management by pharmacists during Ramadan 
Background
Many Muslim diabetes patients choose to participate in Ramadan despite medical advice to the contrary. This study aims to describe Qatar pharmacists’ practice, knowledge, and attitudes towards guiding diabetes medication management during Ramadan.
Methods
A cross-sectional descriptive study was performed among a convenience sample of 580 Qatar pharmacists. A web-based questionnaire was systematically developed following comprehensive literature review and structured according to 4 main domains: subject demographics; diabetes patient care experiences; knowledge of appropriate patient care during Ramadan fasting; and attitudes towards potential pharmacist responsibilities in this regard.
Results
In the 3 months prior to Ramadan (July 2012), 178 (31%) pharmacists responded to the survey. Ambulatory (103, 58%) and inpatient practices (72, 41%) were similarly represented. One-third of pharmacists reported at least weekly interaction with diabetes patients during Ramadan. The most popular resources for management advice were the internet (94, 53%) and practice guidelines (80, 45%); however only 20% were aware of and had read the American Diabetes Association Ramadan consensus document. Pharmacist knowledge scores of appropriate care was overall fair (99, 57%). Pharmacists identified several barriers to participating in diabetes management including workload and lack of private counseling areas, but expressed attitudes consistent with a desire to assume greater roles in advising fasting diabetes patients.
Conclusion
Qatar pharmacists face several practical barriers to guiding diabetes patient self-management during Ramadan, but are motivated to assume a greater role in such care. Educational programs are necessary to improve pharmacist knowledge in the provision of accurate patient advice.
doi:10.1186/1472-6963-14-117
PMCID: PMC3975299  PMID: 24606885
Diabetes; Patient care; Fasting; Ramadan; Pharmacist
7.  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
8.  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
9.  Piloting the role of a pharmacist in a community palliative care multidisciplinary team: an Australian experience 
BMC Palliative Care  2011;10:16.
Background
While the home is the most common setting for the provision of palliative care in Australia, a common problem encountered here is the inability of patient/carers to manage medications, which can lead to misadventure and hospitalisation. This can be averted through detection and resolution of drug related problems (DRPs) by a pharmacist; however, they are rarely included as members of the palliative care team. The aim of this study was to pilot a model of care that supports the role of a pharmacist in a community palliative care team. A component of the study was to develop a cost-effective model for continuing the inclusion of a pharmacist within a community palliative care service.
Methods
The study was undertaken (February March 2009-June 2010) in three phases. Development (Phase 1) involved a literature review; scoping the pharmacist's role; creating tools for recording DRPs and interventions, a communication and education strategy, a care pathway and evidence based patient information. These were then implemented in Phase 2. Evaluation (Phase 3) of the impact of the pharmacist's role from the perspectives of team members was undertaken using an online survey and focus group. Impact on clinical outcomes was determined by the number of patients screened to assess their risk of medication misadventure, as well as the number of medication reviews and interventions performed to resolve DRPs.
Results
The pharmacist screened most patients (88.4%, 373/422) referred to the palliative care service to assess their risk of medication misadventure, and undertook 52 home visits. Medication reviews were commonly conducted at the majority of home visits (88%, 46/52), and a variety of DRPs (113) were detected at this point, the most common being "patient requests drug information" (25%, 28/113) and "condition not adequately treated" (22%, 25/113). The pharmacist made 120 recommendations in relation to her interventions.
Fifty percent of online survey respondents (10/20) had interacted 10 or more times with the pharmacist for advice. All felt that the pharmacist's role was helpful, improving their knowledge of the different medications used in palliative care. The six team members who participated in the focus group indicated that there were several benefits of the pharmacist's contributions towards medication screening and review.
Conclusions
The inclusion of a pharmacist in a community palliative care team lead to an increase in the medication-related knowledge and skills of its members, improved patients' medication management, and minimised related errors. The model of care created can potentially be duplicated by other palliative care services, although its cost-effectiveness was unable to be accurately tested within the study.
doi:10.1186/1472-684X-10-16
PMCID: PMC3215169  PMID: 22035160
10.  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
11.  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
12.  Patient attitudes regarding the role of the pharmacist and interest in expanded pharmacist services 
Canadian Pharmacists Journal : CPJ  2014;147(4):239-247.
Background:
Pharmacists are consistently ranked among the most trusted professionals, and research shows high levels of satisfaction with pharmacist services. Studies have also shown that the public is generally unaware of the full range of roles and responsibilities of a pharmacist. The purpose of this study was to explore the public’s knowledge and attitudes regarding the role of the community pharmacist and to determine their likelihood of using expanded pharmacist services.
Methods:
Adults across Newfoundland and Labrador were surveyed by telephone. Survey questions addressed how frequently participants visited the pharmacy, understanding of duties undertaken by pharmacists, perceptions and attitudes regarding pharmacists as health care professionals, likelihood of using expanded pharmacist services and participant demographics. Comparisons were made between responses from urban and rural participants and frequent versus nonfrequent pharmacy users, to determine if there were any differences.
Results:
The majority of participants were generally aware of what pharmacists do when filling prescriptions; those who visited the pharmacy more frequently appeared to be more informed. Participants indicated they would take advantage of the expanded services suggested, with greatest interest in receiving advice for minor ailment management and prescription refills from pharmacists. Results support the prevailing view that pharmacists are trusted health professionals who should have access to patients’ health information to provide best care.
Conclusion:
The public is aware of aspects of the pharmacist’s role, but opportunities exist to better educate the public on the knowledge, skills and unique professional abilities of pharmacists to support uptake of expanded pharmacist services.
doi:10.1177/1715163514535731
PMCID: PMC4212442  PMID: 25360150
13.  Knowledge, attitudes and beliefs about chronic noncancer pain in primary care: A Canadian survey of physicians and pharmacists 
Inaccurate knowledge, beliefs and attitudes held by health care professionals responsible for the treatment of chronic noncancer pain is a considerable barrier to the optimal treatment of these patients. In this study, the authors surveyed physicians and pharmacists caring for a cohort of chronic pain patients participating in the ACCORD program (Application Concertée des Connaissances et Ressources en Douleur) to evaluate their knowledge, attitudes and beliefs about chronic pain.
BACKGROUND:
Primary care providers’ knowledge, attitudes and beliefs (KAB) regarding chronic noncancer pain (CNCP) are a barrier to optimal management.
OBJECTIVES:
To evaluate and identify the determinants of the KAB of primary care physicians and pharmacists, and to document clinician preferences regarding the content and format of a continuing education program (CEP).
METHOD:
Physicians and pharmacists of 486 CNCP patients participated. Physicians completed the original version of the KnowPain-50 questionnaire. Pharmacists completed a modified version. A multivariate linear regression model was developed to identify the determinants of their KAB.
RESULTS:
A total of 137 of 387 (35.4%) physicians and 110 of 278 (39.5%) pharmacists completed the survey. Compared with the physicians, the pharmacists surveyed included more women (64% versus 38%) and had less clinical experience (15 years versus 26 years). The mean KnowPain-50 score was 69.3% (95% CI 68.0% to 70.5%) for physicians and 63.8% (95% CI 62.5% to 65.1%) for pharmacists. Low scores were observed on all aspects of pain management: initial assessment (physicians, 68.3%; pharmacists, 65.4%); definition of treatment goals and expectations (76.1%; 61.6%); development of a treatment plan (66.4%; 59.0%); and reassessment and management of longitudinal care (64.3%; 53.1%). Ten hours of reported CEP sessions increased the KAB score by 0.3 points. All clinicians considered a CEP for CNCP to be essential. Physicians preferred an interactive format, while pharmacists had no clear preferences.
CONCLUSION:
A CEP to improve primary care providers’ knowledge and competency in managing CNCP, and to reduce false beliefs and inappropriate attitudes regarding CNCP is relevant and perceived as necessary by clinicians.
PMCID: PMC4197751  PMID: 25299473
Beliefs; Chronic noncancer pain; Knowledge; Physicians and pharmacists; Primary care
14.  Pharmacy ethics: evaluation pharmacists’ ethical attitude 
Alterations in pharmacy practice from prescription dispensing to more patient-centered relationship intensifies the necessity of clinical decision-making. Pharmacists’ knowledge as well as ethical reasoning affects their clinical decision-making. Unfortunately in Iran pharmacy ethics did not develop along with medical ethics and special considerations are of major importance. The study was designed to evaluate pharmacists’ attitude toward some principles of bioethics.
A cross-sectional survey was performed on a sample of Iranian pharmacists attended in continuous education programs in 2010. Based on the pharmacists’ attitude toward common ethical problems, 9 Likert-type scale scenarios were designed. A thousand pharmacists were surveyed and 505 questionnaires were filled. For the whole questionnaire the strongly disagree answer was the most ethical answer. On a scale from 1–5 on which 5=strongly disagree, the total score of pharmacists ethical attitude was 17.69 ± 3.57. For easier analysis we considered the score of 1 for agree and strongly agree answers, score of 2 for neutral answers and score of 3 for disagree and strongly disagree answers. The total score in confidentiality for all participants was 4.15 ± 1.45 out of 9, in autonomy 6.25 ± 1.85 out of 9, in non-maleficence 5.14 ± 1.17 out of 6 and in justice was 2.27 ± 0.89 out of 3, however there was no significant difference between men and women in the total score and the score of each theme. The older participants (> 40 years) significantly had lower total score (P< 0.05) as well as the score of each theme (P< 0.05), except for non-maleficence. The work experience showed impact on the pharmacists’ attitude toward autonomy and the participants with more than 5 years work experience significantly obtained lower score in this theme.
Compiling ethical guidelines and improving pharmacy ethics curriculum is highly critical to provide the best pharmaceutical care and to make clinical decisions in critical situations. Therefore further quantitative and qualitative investigations into finding pitfalls and challenges in this issue are highly recommended.
PMCID: PMC3714006  PMID: 23908747
Pharmacy ethics; Ethical attitude; Confidentiality; Autonomy
15.  Enhancing Collaborative Pharmaceutical Care for Patients with Chronic Kidney Disease: Survey of Community Pharmacists 
Background
The Kidney Care Clinic at Sunnybrook Health Sciences Centre provides multidisciplinary care for patients with stage 4 or 5 chronic kidney disease. These patients are at high risk of drug therapy problems. Clinic pharmacists review medications and provide recommendations at each visit, but potential gaps in care exist between clinic visits. Community pharmacists are ideally situated to identify and resolve drug therapy problems between visits.
Objectives:
To determine community pharmacists’ confidence in managing care for patients with chronic kidney disease; to identify opportunities for improving collaboration between clinic and community pharmacists; and to determine the key clinical information that community pharmacists would use when caring for these patients.
Methods:
An anonymous survey was sent by mail and electronically to community pharmacies that were providing prescription medications for clinic patients. A total of 318 surveys were sent to 96 pharmacies. Data analysis was based on descriptive statistics, including frequencies, ranges, and measures of central tendency.
Results:
Fifty-one completed surveys were returned (response rate 16%). Thirty-five (69%) of the responding pharmacists were not aware or were unsure that a patient from the Kidney Care Clinic was a client of their pharmacy. Forty-six (90%) were confident in providing counselling about medications used to manage chronic kidney disease, and 32 (63%) indicated confidence in recommending drug dosing changes based on kidney function. Forty-five (88%) of the pharmacists indicated a willingness to play a greater role in reviewing medications for patients with chronic kidney disease, and all agreed that they would benefit from education about the complications of this disease and their management. Clinical information ranked most useful included an updated medication list with indications and details regarding recent medication changes.
Conclusions:
Community pharmacists indicated willingness to have greater involvement in the care of patients with chronic kidney disease. The survey results revealed a need to increase awareness of clinic patients among community providers. Participants were receptive to continuing education, and initial efforts should focus on dosing adjustments of renal drugs and the complications of chronic kidney disease. Tools for transferring clinical information must be developed.
PMCID: PMC4152965  PMID: 25214657
seamless care; pharmaceutical care; chronic kidney disease; collaborative; clinic; community pharmacist; soins continus; soins pharmaceutiques; insuffisance rénale chronique; collaboration; clinique; pharmacien communautaire
16.  A cross sectional pilot study on assessing the knowledge, attitude and behavior of community pharmacists to adverse drug reaction related aspects in the Sultanate of Oman 
Background and objectives
Adverse drug reaction (ADR) monitoring and reporting requires a multidisciplinary approach and pharmacists have a major role to play in it. The present pilot study was conducted to assess the knowledge, attitude and behavior of community pharmacists to ADR related aspects in the Sultanate of Oman.
Methods
A self-administered questionnaire comprising of 21 questions were distributed to a random sample of pharmacists in two Governorates in the Sultanate of Oman. It assessed the knowledge of pharmacists on some of the selected basic aspects of drug safety. Further, the knowledge and attitude of community pharmacists toward ADR reporting and their behavior on ADR related aspects were assessed. A scoring scheme was used to estimate the median total score of participants for various parameters. Obtained scores were correlated with the demographics of the respondents.
Results
A total of 107 community pharmacists participated in the survey giving a response rate of 72.3%. The responses of the pharmacists to the questions on the drug safety of individual drugs were incorrect for some important and practical questions. Consequently, total median score corresponding to these questions was 5 (Inter Quartile Range, IQR 2) out of a possible maximum score of 9, which was below the acceptable score. Total median score based on knowledge, attitude and behavior was 38 (IQR 8) out of a possible maximum of 50 which shows a moderate score. Lack of awareness on how to report an ADR and concern that the report may be wrong were the most common factors discouraging pharmacists from reporting ADRs. Qualification as well as years of experience were the only demographic parameters which had an influence on the score obtained by the pharmacists.
Conclusions
Even though the pharmacists had an acceptable knowledge, attitude and behavior on ADR reporting and related aspects, a good number of them had below than acceptable knowledge on drug safety related aspects of specific drugs. Educational programs have to be continued to generate awareness on how to report ADR and stimulate pharmacists’ more active participation in the pharmacovigilance program. There is a genuine need to have training programs to improve the knowledge of pharmacists on ADR related aspects which are of benefit on a daily basis which could greatly have an impact on patient safety.
doi:10.1016/j.jsps.2013.07.006
PMCID: PMC3950505  PMID: 24648829
Knowledge; Attitude; Behavior; Community pharmacists; Adverse drug reactions; Oman
17.  Assessment of professionalism in Iranian pharmacists 
In the recent years, the role of a pharmacist has been significantly changed. Traditionally, in the late 20th century, a pharmacist’s role was considered as merely dispensing medication to patients. This view however, has been significantly altered, and, today, a pharmacist is supposed to provide patients with information regarding the medication they are to take, as well as on different aspects of their disease. Therefore, one can suggest that some other factors have recently come into play in the daily tasks of a pharmacist such as accountability and authority.
The current cross-sectional survey is conducted on a cohort of community pharmacists attending a continuing education program. A questionnaire comprised of 26 Likert-type scale questions was designed to assess pharmacists’ attitude towards professionalism and its subscales which are defined later in detail. A total number of 1000 pharmacists were surveyed and 560 of them filled and returned the questionnaires. On a scale from 1-5 on which 1 was corresponded with strongly agree and 5 with strongly disagree, the total score of pharmacists professionalism was 92.9 ± 10.4 out of 130. As regards the subscales, in the subscale of accountability 46.8% of participants, in the subscale of altruism 90.1% of participants, in the theme of duty 85.7% of participants, and in the subscale of working relationship with physicians 84% of pharmacist achieved more than two third of the total score. Only in term of conflict of interest 67.9% of participants scored less than two third (17–25) of the total score. Women obtained significantly higher scores in altruism (P<0.05). Furthermore, there was a correlation between age and the score of accountability and working relationship with physicians; and, the same was observed in regards with work experience with the score of working relationship with physicians. The employment position affected neither our participants’ response to the whole questionnaire nor any of subscales.
Although the total score for professionalism was not dramatically decreased, the significantly low results are alarming and they should be considered more seriously. In order to enhance the level of pharmacists’ professionalism, especially in some special aspects, it seems necessary to conduct similar surveys on pharmacy students and registered pharmacists with a more comprehensive questionnaire. Overall, it can be concluded that designing a proper teaching course in professionalism for pharmacy students is of paramount importance if we are to promote professionalism in future pharmacists.
PMCID: PMC3713883  PMID: 23908748
Pharmacy professionalism; Altruism; Accountability; Pharmacy ethics
18.  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
19.  The Role of the Pediatric Pharmacist in Personalized Medicine and Clinical Pharmacogenomics for Children 
With the initiatives by the National Institutes of Health and the Food and Drug Administration, pharmacogenomics has now moved from the laboratory to the patient bedside. Over 100 drug-products now contain pharmacogenomic information as part of their labeling. Many of these are commonly used in the pediatric population. Direct-to-consumer genetic test kits also require intervention and guidance from healthcare professionals. This increased trend towards personalized medicine mandates that healthcare professionals develop a working knowledge about pharmacogenomics and its application towards patient care. Because pharmacogenomic testing can provide patient-specific predictors for response to and safety of medications, pharmacists are positioned to play an active role in pharmacogenomic testing, clinical interpretation of results, and recommendations for individualization of drug therapy. Opportunities for pharmacists exist in both inpatient and outpatient settings, such as pharmacist-managed clinical pharmacogenomics consultation services and educating patients and families about pharmacogenomic testing. In addition to clinical roles, pharmacists may also be involved in genetically-influenced drug discovery and development. Given the potential for genetic and age-dependent factors to influence drug selection and dosing, pediatric pharmacists should be involved in the development of dosing recommendations and interprofessional practice guidelines regarding pharmacogenomic testing in pediatric patients. Opportunities to become knowledgeable and competent in pharmacogenomics span from coursework as part of the pharmacy curriculum to postgraduate education (e.g., residencies, fellowships, continuing education). However, there exists a need for additional postgraduate learning opportunities for practicing pharmacists. As a result, the Pediatric Pharmacy Advocacy Group (PPAG) acknowledges a need for increased education of both student and practicing pharmacists, with consideration of special patient populations, such as infants and children. PPAG endorses and advocates for the involvement of pediatric pharmacists in pharmacogenomic testing and in using those results to provide safe and effective medication use in pediatric patients of all ages. Additionally, PPAG strongly encourages pediatric pharmacists to take responsibility for educating patients and their families about the importance of pharmacogenomic testing and its role in the safe and effective use of medications.
doi:10.5863/1551-6776-16.2.118
PMCID: PMC3208440  PMID: 22477836
pediatrics; personalized medicine; pharmacist; pharmacogenomics; testing
20.  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
21.  Diagnostic Reasoning by Hospital Pharmacists: Assessment of Attitudes, Knowledge, and Skills 
Background:
Hospital pharmacists participate in activities that may be considered diagnostic. Two reasoning approaches to diagnosis have been described: non-analytic and analytic. Of the 6 analytic traditions, the probabilistic tradition has been shown to improve diagnostic accuracy and reduce unnecessary testing. To the authors’ knowledge, pharmacists’ attitudes toward having a diagnostic role and their diagnostic knowledge and skills have never been studied.
Objectives:
To describe pharmacists’ attitudes toward the role of diagnosis in pharmacotherapeutic problem-solving and to characterize the extent of pharmacists’ knowledge and skills related to diagnostic literacy.
Methods:
Pharmacists working within Lower Mainland Pharmacy Services (British Columbia) who spent at least 33% of their time in direct patient care were invited to participate in a prospective observational survey. The survey sought information about demographic characteristics and attitudes toward diagnosis. Diagnostic knowledge and skills were tested by means of 3 case scenarios. The analysis included simple descriptive statistics and inferential statistics to evaluate relationships between responses and experience and training.
Results:
Of 266 pharmacists invited to participate, 94 responded. The attitudes section of the survey was completed by 90 pharmacists; of these, 80 (89%) agreed with the definition of “diagnosis” proposed in the survey, and 83 (92%) agreed that it is important for pharmacists to have diagnosis-related skills. Respondents preferred an analytic to a non-analytic approach to diagnostic decision-making. The probabilistic tradition was not the preferred method in any of the 3 cases. In evaluating 5 clinical scenarios that might require diagnostic skills, on average 84% of respondents agreed that they should be involved in assessing such problems. Respondents’ knowledge of and ability to apply probabilistic diagnostic tools were highest for test sensitivity (average of 61% of respondents with the correct answers) and lower for test specificity (average of 48% with correct answers) and likelihood ratios (average of 39% with correct answers).
Conclusions:
Respondents to this survey strongly believed that diagnostic skills were important for solving drug-related problems, but they demonstrated low levels of knowledge and ability to apply concepts of probabilistic diagnostic reasoning. Opportunities to expand pharmacists’ knowledge of diagnostic reasoning exist, and the findings reported here indicate that pharmacists would consider such professional development valuable.
PMCID: PMC3420847  PMID: 22919102
diagnostic literacy; diagnostic traditions; pharmacists’ diagnosing; probabilistic diagnostic tools; connaissances diagnostiques; traditions diagnostiques; diagnostic établi par les pharmaciens; outils de diagnostic probabiliste
22.  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
23.  Collaboration between family physicians and community pharmacists to enhance adherence to chronic medications 
Canadian Family Physician  2009;55(12):e69-e75.
ABSTRACT
OBJECTIVE
To ascertain the opinions of family physicians about medication adherence in patients with chronic diseases and the role of community pharmacists in improving adherence to chronic medications, as well as their opinions on increased collaboration with pharmacists to enhance medication adherence.
DESIGN
A self-administered postal survey of 19 questions, with opinions collected by ordinal (5-point Likert scale) and open responses.
SETTING
Saskatchewan.
PARTICIPANTS
Two hundred and eighty-six family physicians working in Saskatchewan in January 2008.
MAIN OUTCOME MEASURES
Descriptive statistics of physicians’ opinions on the following: medication adherence in patients with chronic diseases; their current interaction with community pharmacists; and potential collaborative strategies to promote medication adherence.
RESULTS
The response rate was 39.4%. Approximately 75% of the physicians acknowledged that nonadherence to chronic medications was a problem among their patients. Medication costs and side effects were identified as the 2 most common reasons for medication nonadherence. Only one-quarter of physicians communicated regularly with community pharmacists about adherence issues; most of these physicians were rural physicians. Most physicians agreed that increased collaboration with pharmacists would improve adherence, although support for potential interactions with pharmacists varied. Concerns were expressed about time required by physicians and financial reimbursement. Physicians in practice for less than 10 years and those practising in rural areas were more willing to share clinical information and communicate with pharmacists to promote medication adherence.
CONCLUSION
Saskatchewan family physicians appreciate the importance of medication nonadherence but currently seldom interact with community pharmacists on this issue. They believe that pharmacists have a role in supporting patients with medication adherence and indicate a willingness to work more collaboratively with them to promote adherence. For this type of collaboration to be effective, it appears that increased adherence-related communication between the 2 health care providers and additional health care funding are required.
PMCID: PMC2793205  PMID: 20008581
24.  Survey of pharmacist-managed primary care clinics using healthcare failure mode and effect analysis 
Pharmacy Practice  2013;11(4):196-202.
Objective
The primary objective was to expand upon results of a previously piloted patient perception survey with Healthcare Failure Mode and Effect Analysis (HFMEA), to identify areas within pharmacist-managed clinics needing improvement.
Methods
The survey was adapted for use in pharmacist-managed clinics. Patients completed the survey following regularly scheduled pharmacist appointments. Data were analyzed with a method adapted from HFMEA. Product scores could range from five to 25. A product of five indicates that pharmacists are doing a good job on the items that patients place the most value on, while a product score of 25 indicates that pharmacists are doing a poor job. A score greater than or equal to ten was used to identify areas for improvement.
Results
Seventy-one patients completed surveys. Thirteen components were assessed and no item achieved a mean product greater than or equal to ten. The survey item with the highest mean product pertained to discussion of potential medication side effects (mean: 7.06; interquartile range: 5-10). Analysis of each survey item found that all survey items had multiple individual responses that provided a product score of greater than or equal to ten. The survey items most frequently listed in the overall population as being most valued were “Told you the name of each of your medicines and what they are used for”, “Answered your questions fully,” and “Explained what your medicines do”.
Conclusions
Educational components provided during pharmacist-managed clinic appointments are aligned with patients’ needs and are successfully incorporating the components that patients value highly in a patient-healthcare provider interaction. The HFMEA model can be an important teaching tool to identify specific processes in need of improvement and to help enhance pharmacists’ self-efficacy, which may further improve patient care.
PMCID: PMC3869635  PMID: 24367459
Pharmaceutical Services; Delivery of Health Care; Systems Analysis; Total Quality Management; United States
25.  Learning to prescribe – pharmacists' experiences of supplementary prescribing training in England 
Background
The introduction of non-medical prescribing for professions such as pharmacy and nursing in recent years offers additional responsibilities and opportunities but attendant training issues. In the UK and in contrast to some international models, becoming a non-medical prescriber involves the completion of an accredited training course offered by many higher education institutions, where the skills and knowledge necessary for prescribing are learnt. Aims: to explore pharmacists' perceptions and experiences of learning to prescribe on supplementary prescribing (SP) courses, particularly in relation to inter-professional learning, course content and subsequent use of prescribing in practice.
Methods
A postal questionnaire survey was sent to all 808 SP registered pharmacists in England in April 2007, exploring demographic, training, prescribing, safety culture and general perceptions of SP.
Results
After one follow-up, 411 (51%) of pharmacists responded. 82% agreed SP training was useful, 58% agreed courses provided appropriate knowledge and 62% agreed that the necessary prescribing skills were gained. Clinical examination, consultation skills training and practical experience with doctors were valued highly; pharmacology training and some aspects of course delivery were criticised. Mixed views on inter-professional learning were reported – insights into other professions being valued but knowledge and skills differences considered problematic. 67% believed SP and recent independent prescribing (IP) should be taught together, with more diagnostic training wanted; few pharmacists trained in IP, but many were training or intending to train. There was no association between pharmacists' attitudes towards prescribing training and when they undertook training between 2004 and 2007 but earlier cohorts were more likely to be using supplementary prescribing in practice.
Conclusion
Pharmacists appeared to value their SP training and suggested improvements that could inform future courses. The benefits of inter-professional learning, however, may conflict with providing profession-specific training. SP training may be perceived to be an instrumental 'stepping stone' in pharmacists' professional project of gaining full IP status.
doi:10.1186/1472-6920-8-57
PMCID: PMC2615422  PMID: 19061487

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