Asthma is one of the most common chronic conditions affecting the Australian population. Amongst primary healthcare professionals, pharmacists are the most accessible and this places pharmacists in an excellent position to play a role in the management of asthma. Globally, trials of many community pharmacy-based asthma care models have provided evidence that pharmacist delivered interventions can improve clinical, humanistic and economic outcomes for asthma patients. In Australia, a decade of coordinated research efforts, in various aspects of asthma care, has culminated in the implementation trial of the Pharmacy Asthma Management Service (PAMS), a comprehensive disease management model.
There has been research investigating asthma medication adherence through data mining, ways in which usual asthma care can be improved. Our research has focused on self-management education, inhaler technique interventions, spirometry trials, interprofessional models of care, and regional trials addressing the particular needs of rural communities. We have determined that inhaler technique education is a necessity and should be repeated if correct technique is to be maintained. We have identified this effectiveness of health promotion and health education, conducted within and outside the confines of the pharmacy, in public for a and settings such as schools, and established that this outreach role is particularly well received and increases the opportunity for people with asthma to engage in their asthma management.
Our research has identified that asthma patients have needs which pharmacists delivering specialized models of care, can address. There is a lot of evidence for the effectiveness of asthma care by pharmacists, the future must involve integration of this role into primary care.
Asthma; community pharmacy; pharmacists’disease state management; self-management; health promotion; inhaler technique
The Director’s Forum provides directors of pharmacy practical ways to develop patient-centered pharmacy services. Pharmacy directors must understand the key issues facing their departments and incorporate strategies for these issues as part of their strategic planning process. Health care reform and the Affordable Care Act require that departments operate efficiently and closely monitor their drug expense. The American Society of Health-System Pharmacists’ Pharmacy Practice Model Initiative will serve as a valuable resource during 2013 to enhance the pharmacy practice model. By using their health care workforce, particularly pharmacy technicians, in an innovative way, pharmacy directors will allow the pharmacists to increase their clinical activity. By promoting the role of the hospital pharmacist to patients, directors will help to improve patients’ understanding of their medications and increase their satisfaction with their care. Finally by changing the activities of pharmacy students in practice models, the patient care role of the pharmacist can be expanded. Through a greater understanding of the issues facing them and their effect on the operations of the pharmacy, pharmacy directors will learn effective ways to develop patient-centered pharmacy services.
Pharmacists' roles are evolving from that of compounders and dispensers of medicines to that of experts on medicines within multidisciplinary health care teams. In the developing country context, the pharmacy is often the most accessible or even the sole point of access to health care advice and services.
Because of their knowledge of medicines and clinical therapeutics, pharmacists are suitably placed for task shifting in health care and could be further trained to undertake functions such as clinical management and laboratory diagnostics. Indeed, pharmacists have been shown to be willing, competent, and cost-effective providers of what the professional literature calls "pharmaceutical care interventions"; however, internationally, there is an underuse of pharmacists for patient care and public health efforts. A coordinated and multifaceted effort to advance workforce planning, training and education is needed in order to prepare an adequate number of well-trained pharmacists for such roles.
Acknowledging that health care needs can vary across geography and culture, an international group of key stakeholders in pharmacy education and global health has reached unanimous agreement that pharmacy education must be quality-driven and directed towards societal health care needs, the services required to meet those needs, the competences necessary to provide these services and the education needed to ensure those competences. Using that framework, this commentary describes the Pharmacy Education Taskforce of the World Health Organization, United Nations Educational, Scientific and Cultural Organization and the International Pharmaceutical Federation Global Pharmacy and the Education Action Plan 2008–2010, including the foundation, domains, objectives and outcome measures, and includes several examples of current activities within this scope.
The pressures driving the need for an expanded practice scope in community pharmacy have been building for the past 2 decades. Many pharmacists have chosen to embrace the pharmaceutical care model in their practice sites to meet patient and healthcare system needs. The potential for medication therapy management (MTM) services provide an additional career opportunity for pharmacy graduates. Colleges of pharmacy offer advanced pharmacy practice experiences (APPEs) in the community setting that are designed to prepare students for these opportunities. These sites provide students with the opportunity to observe the integration of pharmaceutical care activities into community practice. Although developing an APPE site is challenging, serving as a preceptor benefits the students, the site, and the patients served. Therefore, colleges of pharmacy and community pharmacists are collaborating to increase the number of APPE sites to prepare pharmacy students for practice today and tomorrow.
curriculum; advanced pharmacy practice experience; community pharmacy; preceptor
Pharmacy profession has evolved from its conventional and traditional drug focused basis to an advanced patient focused basis over the years. In the past century the pharmacists were more involved in compounding and manufacturing of medicines, but this role has significantly reduced over time. This advancement in the role of pharmacist calls for them to be the part of the broader health care team working for providing better health care for the patients, thus contributing in achieving the global millennium development goals. To match up, the role of today's pharmacists needs to be expanded to include pharmaceutical care concepts, making the pharmacist a health care professional rather than a drug seller in a commercial enterprise. Therefore, pharmacy schools should prepare a program that has competence with the changing role of the pharmacist. The education should provide ability for critical thinking, improve problem-solving skills and decision making during pharmacotherapy. The student should be trained to create, transmit, and apply new knowledge based on cutting-edge research in the pharmaceutical, social, and clinical sciences; collaborate with other health professionals and learn to enhance the quality of life through improved health for the people of local society and as well as the global community.
Pharmacist; Pharmaceutical care; Rational use of medicine; Pharmacy education; Rational pharmacotherapy
To describe (1) the role of illustrated medication instructions in pharmacy practice, (2) the evidence for their use, and (3) our experience with their implementation.
PictureRx is applicable to all pharmacy practice settings.
PictureRx enables pharmacists to rapidly produce evidence-based, illustrated medication instructions that are well-understood by patients of all health literacy levels.
PictureRx has been studied in a number of settings. The tool was successfully deployed at a busy, outpatient pharmacy; in a medical clinic for the underserved; and pilot-tested among elderly, community dwelling Medicare recipients. In each of these settings, PictureRx was received favorably by patients, pharmacists, and other health care providers. It improved patients’ satisfaction with the pharmacy and knowledge about their medications. Ongoing research is assessing whether PictureRx enhances medication management among Latinos.
PictureRx helps pharmacists address challenges related to low health literacy and can be implemented into a broad range of practices environments. Ongoing research will delineate the extent to which PictureRx reduces health disparities.
Medication management; health literacy; Latinos; communication; illustrated medication instructions
University-based continuing education (CE) fulfills an important role to support the professional development of pharmacists, advance the practice of pharmacy, and contribute to societal needs for research and healthcare services. Opportunities for pharmacists to engage in new models of patient care are numerous worldwide, particularly as pharmacists’ scope of practice has expanded. Approaches to CE have changed to address the changing needs of pharmacists and now include a variety of approaches to support development of knowledge and skills. There is emphasis on the learning process as well as the knowledge, with the introduction of the concept of continuing professional development (CPD).
As institutions of research and education, universities are uniquely positioned to bridge the gap between academic and practice environments, providing opportunities for translation of knowledge to practice. The Faculty of Pharmacy and Pharmaceutical Sciences at the University of Alberta is a provider of CE in Alberta, Canada, where an expanded scope of pharmacy practice includes prescribing, administering injections, accessing electronic patient records, and ordering laboratory tests. In this paper, the Faculty offers views about future directions for CE, including the integration of CE with core faculty activities, expanding the audience for CE, areas of focus for learning, and partnerships. Finally, we hope to ignite dialogue with others in the profession about the role and function of university-based CE.
continuing education; professional development; continuing professional development; universities
Recent studies suggest that involving pharmacists is an effective strategy for improving patient adherence and blood pressure (BP) control. To date, few controlled studies have tested the cost-effectiveness of specific models for improving patient adherence and BP control in community pharmacies, where most Americans obtain prescriptions. We hypothesized that a team model of adherence monitoring and intervention in corporately owned community pharmacies can improve patient adherence, prescribing, and BP control among hypertensive African American patients.
Methods and Results
The Team Education and Adherence Monitoring (TEAM) Trial is a randomized controlled trial testing a multi-step intervention for improving adherence monitoring and intervention in 28 corporately owned community pharmacies. Patients in the 14 control pharmacies received “usual care” and patients in the 14 intervention pharmacies received TEAM Care by trained pharmacists and pharmacy technicians working with patients and physicians. Data collectors screened 1,250 patients and enrolled 576 hypertensive African American patients. The primary endpoints were the proportion of patients achieving BP control and reductions in systolic and diastolic BP measured after 6 and 12 months. Secondary endpoints were changes in adherence monitoring and intervention, patient adherence and barriers to adherence, prescribing, and cost-effectiveness. Researchers also will examine potential covariates and barriers to change.
Involving pharmacists is a potentially powerful means of improving BP control in African Americans. Pharmacists are in an excellent position to monitor patients between clinic visits and to provide useful information to patients and physicians.
To investigate older patient, physician and pharmacist perspectives about the pharmacists’ role in pharmacist-patient interactions.
Eight focus group discussions.
Senior centers, community pharmacies, primary care physician offices.
Forty-two patients aged 63 and older, 17 primary care physicians, and 13 community pharmacists.
Qualitative analysis of focus group discussions.
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.
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.
pharmacist-patient interactions; provider-patient communication; prescription medication; qualitative research methods
Director’s Forum is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. This article focuses on the concept of granting clinical privileges to pharmacists (acute and ambulatory care) to improve the efficiency and effectiveness of medication use. As the practice models change in hospital pharmacy practice to require the pharmacist to enter into pharmacy board-approved consult agreements, institutional privileging of pharmacists will be necessary. The pharmacy director must understand the steps of the credentialing and privileging process and should apply the process where appropriate in the department. Through hospital medical staff actively supporting pharmacists’ privileging, the national Pharmacy Practice Model Initiative (PPMI) can meet its goals of integrating pharmacists as effective members of the patient care team with tangible accountability for achieving optimal drug therapy outcomes.
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.
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.
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.
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.
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.
clinical pharmacy; restructuring; tertiary care hospital; evidence-based; practice delivery; pharmacie clinique; restructuration; hôpital de soins tertiaires; données probantes; prestation de services
Pharmacists are key members of the healthcare team, especially in minority and urban communities. This study was developed to assess pharmacists' ability and willingness to counsel the public on prostate cancer in the community pharmacy setting. A mail survey was sent to all 192 community pharmacies in Washington, DC, and Prince George's County, Maryland. A total of 90 pharmacists responded to the questionnaire, providing a 46.9% response rate. One third of the pharmacists indicated a willingness to participate in a prostate cancer training program. Perceived benefits and perceived barriers were each measured through five questionnaire items using Likert-style statements with responses ranging from "strongly agree" to "strongly disagree." The most significant predictor of perceived benefits of providing prostate cancer information was gender; male pharmacists perceived greater benefits for providing prostate cancer information than female pharmacists. Similarly, black pharmacists perceived greater benefits of providing prostate cancer information to their patients than non-black pharmacists. Also, pharmacists in stores that offered disease state management programs had a significantly lower perceived benefit of providing prostate cancer information. These findings indicate that gender and race may play a role in health promotion in health disparities. There were no significant barriers to providing prostate cancer information. Thus, many pharmacists are willing to participate in health education on prostate cancer.
Pharmacists have made many contributions to HIV/AIDs research and are still showing their significance as members of the healthcare team through innovative clinical trials. Pharmacists are showing advances in several healthcare settings including inpatient, outpatient, and community pharmacies. Because of the complex regimens of highly active antiretroviral therapy (HAART), the increased life span of patients living with HIV, and other concomitant medications taken for comorbid disease states, there is a high risk for health-related complications and the development of adverse events. These adverse events may lead to decreased adherence to HAART, which may cause the development of HIV drug resistance. Pharmacists are providing examples through growing research on how they help combat medication-related errors and also continue to contribute as healthcare providers as a part of a holistic healthcare team.
In Canada, the education of pharmacists is built upon a foundation of strong, research-intensive publicly funded universities and a universal health-care system that balances government and private financing for prescription medications. The evolution of pharmacy education and practice in Canada has laid the foundation for a variety of emerging trends related to expanded roles for pharmacists, increasing interprofessional collaboration for patient-centered care, and emergence of pharmacy technicians as a soon-to-be regulated professional group in parts of the country. Current challenges include the need to better integrate internationally educated pharmacists within the domestic workforce and tools to ensure continuous professional development and maintenance of competency of practitioners. Academic pharmacy is currently debating how best to manage the need to enhance the pharmacy curriculum to meet current and future skills needs, and whether a doctor of pharmacy (PharmD) degree ought to become the standard entry-to-practice qualification for pharmacists in Canada.
Canada; comparative education; international pharmacy education
To implement a simulation-based educational experience focused on medical emergencies in an ambulatory pharmacy setting.
Second-year student pharmacists were assigned randomly to groups and played the role of pharmacists in a community pharmacy setting in which a simulated patient experienced 1 of 5 emergency scenarios: medication-related allergic reaction, acute asthma attack, hypoglycemia, myocardial infarction, and stroke. The students were expected to use patient assessment techniques to determine which emergency the simulated patient was experiencing and the appropriate intervention. Following each simulation, a debriefing session was conducted.
Eighty-two student pharmacists completed the simulation activity. Ninety-three percent of student groups correctly identified the emergency. A post-activity survey instrument was administered, and 83% of responders indicated this activity was effective or very effective.
Simulation of emergencies seen in an ambulatory pharmacy setting allowed students to assert knowledge, practice communication skills, apply assessment techniques, and work as a team in a low-risk environment.
patient simulation; community pharmacy; emergency care; ambulatory care
The rapid growth and evolution of the pharmacy profession has created a wide array of opportunities for graduating pharmacists beyond traditional community pharmacy or hospital practice. Management and leadership positions in federal and state healthcare agencies, pharmaceutical companies, hospitals, retail pharmacies, academia and managed care organizations increasingly require the pharmaceutical knowledge obtained through a doctor of pharmacy (PharmD) degree combined with financial, organizational, and management skills. In these innovative positions, pharmacists are being called upon to assume responsibilities as executives and administrators in systems providing pharmacist care services to patients.
To endow students with knowledge and skills required to perform the duties required in these decision-making positions, the University of Kentucky College of Pharmacy has established 3 joint degree programs: the PharmD/Master of Business Administration (PharmD/MBA), PharmD/Master of Public Administration (PharmD/MPA), and PharmD/Master of Science in Economics (PharmD/MS). This paper describes these joint degree programs.
dual degree; joint degree; education; doctor of pharmacy degree; master of business administration; master of public administration
Pharmacists play an important part in primary health care, and their accessibility is a key factor. Their NHS payments relate predominantly to the dispensing of prescribed medicines; to recognise the service element of their advisory role, an NHS funded professional fee could be built into the cost structure for pharmacy medicines. The increased number of medicines available over the counter has highlighted the need for training for counter assistants; it will become compulsory in July 1996, and some family health services authorities are providing this. The shift to care in the community could mean that pharmacists will have an even greater role in the primary health care team. Encouraging the public to seek advice from the community pharmacist may lead to a greater proportion of visits to doctors resulting from referrals from the pharmacist. Joint development by pharmacists and doctors of guidelines for advice on, and recommendation of, over the counter medicines is needed.
Pharmaceutical care signifies a shift of practice in pharmacy from being drug product-oriented to the one that is patient-oriented to achieve definite outcomes that improves patients’ quality of life. In order to achieve pharmaceutical care, pharmacists have to assume the role of caregiver, communicator, decision-maker, teacher, researcher, life-long learner, leader, and manager, which will help him to provide individualized care. As the patients visit community pharmacists more often, they can play a major role in providing individual care to the patients especially in the management of chronic noncommunicable diseases (NCDs). Community pharmacists have to upgrade their expertise in drug product orientation to that of clinical orientation to provide patient oriented care. Hence pharmacists have a larger role to play in managing NCDs which are rapidly increasing in India.
Burden of disease; noncommunicable diseases; pharmaceutical care
Health-related quality of life (HRQoL) after stroke is an important healthcare measure. Pharmaceutical Care (PC) is an evolving concept to optimize drug-therapy, minimize drug-related problems, and improve HRQoL of patients. The purpose of this study was to evaluate the impact of PC on HRQoL, as determined by Short Form 36 (SF-36) among patients after TIA or ischemic stroke one-year following their initial entry in hospital.
Patients were assigned to either an intervention (IG) or a control group (CG). The individual assignment of the patient to IG or CG depended on the community pharmacy to which the patients were assigned for care. Community pharmacies either delivered standard care (CG) or provided intensified PC (IG). Pharmacists who are members of the "Quality Assurance Working Group" (QAWG) provided PC for patients in IG.
255 patients were recruited (IG: n = 90; CG: n = 165) between 06/2004 to 01/2007. During the study, the HRQoL of the patients in IG did not change significantly. In the CG, a significant decrease in the HRQoL was observed in 7/8 subscales and in both summary measures of SF-36.
This is the first follow-up study in Germany involving a major community hospital, rehabilitation hospitals, community pharmacies and general practitioners investigating the impact of PC on HRQoL of patients after ischemic stroke. Our findings indicate that an intensified education and care of patients after ischemic stroke by dedicated pharmacists based on a concept of PC may maintain the HRQoL of IG patients.
To understand how community pharmacists use electronic prescribing (e-prescribing) technology; and to describe the workflow challenges pharmacy personnel encounter as a result of using e-prescribing technology.
Cross-sectional qualitative study.
Seven community pharmacies in Wisconsin from December 2010 to March 2011
16 pharmacists and 14 pharmacy technicians (in three chain and four independent pharmacies).
Think-aloud protocol and pharmacy group interviews.
Main outcome measures
Pharmacy staff description of their use of e-prescribing technology and challenges encountered in their daily workflow related to this technology.
Two contributing factors were perceived to influence e-prescribing workflow: issues stemming from prescribing or transmitting software, and issues from within the pharmacy. Pharmacies experienced both delays in receiving, and inaccurate e-prescriptions from physician offices. Receiving an overwhelming number of e-prescriptions with inaccurate or unclear information resulted in significant time delays for patients as pharmacists contacted physicians to clarify wrong information. In addition, pharmacy personnel reported that lack of formal training and the disconnect between the way pharmacists verify accuracy and conduct drug utilization review and the presentation of e-prescription information on the computer screen significantly influenced the speed of processing an e-prescription.
E-prescriptions processing can hinder pharmacy workflow. As the number of e-prescriptions transmitted to pharmacies increases due to legislative mandates; it is essential that the technology that supports e-prescriptions (both on the prescriber and pharmacy operating systems) be redesigned to facilitate pharmacy workflow processes and to prevent unintended consequences, such as increased medication errors, user frustration, and stress.
E-prescribing; electronic prescribing; community pharmacy; workflow
Given the increasing prevalence of diabetes and the lack of patients reaching recommended therapeutic goals, novel models of team-based care are emerging. These teams typically include a combination of physicians, nurses, case managers, pharmacists, and community-based peer health promoters (HPs). Recent evidence supports the role of pharmacists in diabetes management to improve glycemic control, as they offer expertise in medication management with the ability to collaboratively intensify therapy. However, few studies of pharmacy-based models of care have focused on low income, minority populations that are most in need of intervention. Alternatively, HP interventions have focused largely upon low income minority groups, addressing their unique psychosocial and environmental challenges in diabetes self-care. This study will evaluate the impact of HPs as a complement to pharmacist management in a randomized controlled trial.
The primary aim of this randomized trial is to evaluate the effectiveness of clinical pharmacists and HPs on diabetes behaviors (including healthy eating, physical activity, and medication adherence), hemoglobin A1c, blood pressure, and LDL-cholesterol levels. A total of 300 minority patients with uncontrolled diabetes from the University of Illinois Medical Center ambulatory network in Chicago will be randomized to either pharmacist management alone, or pharmacist management plus HP support. After one year, the pharmacist-only group will be intensified by the addition of HP support and maintenance will be assessed by phasing out HP support from the pharmacist plus HP group (crossover design). Outcomes will be evaluated at baseline, 6, 12, and 24 months. In addition, program and healthcare utilization data will be incorporated into cost and cost-effectiveness evaluations of pharmacist management with and without HP support.
The study will evaluate an innovative, integrated approach to chronic disease management in minorities with poorly controlled diabetes. The approach is comprised of clinic-based pharmacists and community-based health promoters collaborating together. They will target patient-level factors (e.g., lack of adherence to lifestyle modification and medications) and provider-level factors (e.g., clinical inertia) that contribute to poor clinical outcomes in diabetes. Importantly, the study design and analytic approach will help determine the differential and combined impact of adherence to lifestyle changes, medication, and intensification on clinical outcomes.
ClinicalTrials.gov identifier: NCT01498159
(3–10): Diabetes mellitus/drug therapy; Patient compliance; Patient education; Pharmacists; Community health workers
Harmonization of pharmacy education has to be made a global agenda that will encompass the developments that have taken place in basic, medical, pharmaceutical sciences in serving the needs and expectations of the society. The professional pharmacy curriculum is designed to produce pharmacists who have the abilities and skills to provide drug information, education, and pharmaceutical care to patients; manage the pharmacy and its medication distribution and control systems; and promote public health. Required coursework for all pharmacy students includes pharmaceutical chemistry; pharmaceutics (drug dosage forms, delivery, and disposition in the human body) pharmacology; therapeutics (the clinical use of drugs and dietary supplements in patients); drug information and analysis; pharmacy administration (including pharmacy law, bioethics, health systems, pharmacoeconomics, medical informatics); clinical skills (physical assessment, patient counseling, drug therapy monitoring for appropriate selection, dose, effect, interactions, use); and clinical pharmacy practice in pharmacies, industry, health maintenance organizations, hospital wards, and ambulatory care clinics.
Education; pharmacy curriculum; research
Despite decades of public health initiatives, tobacco use remains the leading known preventable cause of death in the United States. Clinicians have a proven, positive effect on patients’ ability to quit, and pharmacists are strategically positioned to assist patients with quitting. The American Association of Colleges of Pharmacy recognizes health promotion and disease prevention as a key educational outcome; as such, tobacco cessation education should be a required component of pharmacy curricula to ensure that all pharmacy graduates possess the requisite evidence-based knowledge and skills to intervene with patients who use tobacco. Faculty members teaching tobacco cessation-related content must be knowledgeable and proficient in providing comprehensive cessation counseling, and all preceptors and practicing pharmacists providing direct patient care should screen for tobacco use and provide at least minimal counseling as a routine component of care. Pharmacy organizations should establish policies and resolutions addressing the profession’s role in tobacco cessation and control, and the profession should work together to eliminate tobacco sales in all practice settings where pharmacy services are rendered.
academic pharmacy; policy; public health; smoking; tobacco
The newly emerging practice of Pharmaceutical Care requires that pharmacists take responsibility for the outcomes of drug therapy. Improvement in Quality of Life (QoL) represents the final outcome of the care process and indicates the success of interventions.
To assess the impact of a Pharmaceutical Care specialist asthma service provided by community pharmacists to a sample of patients with asthma, the outcome indicators being changes in health status and QoL.
Sixty-two adult asthma patients (17 years and older) living in two rural regions of New Zealand, were segregated into two groups for phased introduction to the service. The patients acted as their own controls before they received the pharmacists’ service. They had been diagnosed with asthma at least six months previously, and their asthma was symptomatic and not considered optimally controlled prior to the study.
There was significant improvement in asthma-related QoL (as measured by the Asthma Quality of Life Questionnaire) following introduction of the service, and pharmacists were able to identify, prevent or resolve over 400 drug-related problems.
The results suggest that with appropriate training and support, New Zealand pharmacists can help asthma patients achieve greater quality of life. This research has implications for the introduction of Pharmaceutical Care services in other countries and for patients with other conditions who require ongoing management.
Pharmaceutical Care; Quality of Life; asthma; pharmacists
Pharmacy support-staff (pharmacy technicians, dispensers and Medicines
Counter Assistants) support the delivery of pharmaceutical and retail
functions of the pharmacy. Workflow is supervised and at times dependent
upon the pharmacist’s presence. Policy makers and pharmacy’s representative
bodies are seeking to extend the community pharmacist's role including
requiring the pharmacist to undertake private consultations away from the
dispensary and shop floor areas. However, support-staff voices are seldom
heard and little is known about the impact such policies have on them.
The objective of this study is to explore the impact and consequences of the
English Medicine Use Review (MUR) service on pharmacy support-staff.
Ten weeks of ethnographic-oriented observations in two English community
pharmacies and interviews with 5 pharmacists and 12 support-staff. A
thematic approach was used to analyse the data.
Despite viewing MURs as a worthwhile activity, interviews with support-staff
revealed that some felt frustrated when they were left to explain to
patients why the pharmacist was not available when carrying out an MUR.
Dependency on the pharmacist to complete professional and accuracy checks on
prescriptions grieved dispensing staff because dispensing workflow was
disrupted and they could not get their work done. Medicines Counter
Assistants were observed to have less dependency when selling medicines but
some still reported concerns over of customers and patients waiting for the
pharmacist. A range of tacit and ad hoc strategies were consequently found
to be deployed to handle situations when the pharmacist was absent
performing an MUR.
Consideration should be given to support-staff and pharmacists’ existing work
obligations when developing new pharmacy extended roles that require private
consultations with patients. Understanding organisational culture and
providing adequate resourcing for new services are needed to avoid
improvisations or enactments by pharmacy support-staff and to allow
successful innovation and policy implementation.
Pharmacists' Aides; Pharmacists; Workflow; Community Pharmacy Services; Drug Utilization Review; Professional Practice; United Kingdom