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1.  Role of community pharmacists in asthma – Australian research highlighting pathways for future primary care models 
The Australasian Medical Journal  2011;4(4):190-200.
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.
doi:10.4066/AMJ.2011790
PMCID: PMC3562897  PMID: 23393510
Asthma; community pharmacy; pharmacists’disease state management; self-management; health promotion; inhaler technique
2.  Issues Facing Pharmacy Leaders in 2013 
Hospital Pharmacy  2013;48(5):433-437.
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.
doi:10.1310/hpj4805-433
PMCID: PMC3839473  PMID: 24421500
3.  Enhancing Community Pharmacy Through Advanced Pharmacy Practice Experiences 
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.
PMCID: PMC1636895  PMID: 17136162
curriculum; advanced pharmacy practice experience; community pharmacy; preceptor
4.  The WHO UNESCO FIP Pharmacy Education Taskforce 
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.
doi:10.1186/1478-4491-7-45
PMCID: PMC2697153  PMID: 19500351
5.  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
6.  Issues Facing Pharmacy Leaders in 2014: Suggestions for Pharmacy Strategic Planning 
Hospital Pharmacy  2014;49(3):295-302.
In 2013, the Director’s Forum published our assessment of issues facing pharmacy leaders to assist pharmacy directors in planning for the year ahead. The issues include health care reform and the Affordable Care Act, the American Society of Health-System Pharmacists Pharmacy Practice Model Initiative, the health care workforce, patients’ perceptions of pharmacists, and the changing landscape of pharmacy education. Based on our environmental scan, the issues addressed in 2013 are pertinent to a department’s plan for 2014. The goal of this article is to provide practical approaches to each of these issues to help pharmacy directors focus their department’s goals for 2014 to support the development of patient-centered pharmacy services. This column will address (1) strategies to reduce medication costs and generate new pharmacy revenue streams, (2) innovative approaches to improving medication safety and quality, (3) steps to advance the clinical practice model, and (4) ways to create mutually beneficial student experiences.
doi:10.1310/hpj4903-295
PMCID: PMC3971116  PMID: 24715750
7.  Enhancing Pharmacy Practice Models Through Pharmacists’ Privileging 
Hospital Pharmacy  2013;48(2):160-165.
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.
doi:10.1310/hpj4802-160
PMCID: PMC3839474  PMID: 24421454
8.  The changing face of pharmacy practice and the need for a new model of pharmacy education 
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.
doi:10.1016/j.jyp.2012.09.001
PMCID: PMC3758081  PMID: 24023452
Pharmacist; Pharmaceutical care; Rational use of medicine; Pharmacy education; Rational pharmacotherapy
9.  Education of Pharmacists in Canada 
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.
PMCID: PMC2661159  PMID: 19325948
Canada; comparative education; international pharmacy education
10.  Pharmacists' Research Contributions in the Fight against HIV/AIDs 
AIDS Research and Treatment  2012;2012:869891.
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.
doi:10.1155/2012/869891
PMCID: PMC3501816  PMID: 23193465
11.  Recent Trends on the Future of Graduate Education in the Pharmaceutical Sciences and Research 
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.
doi:10.4103/0975-1483.63173
PMCID: PMC3021699  PMID: 21264127
Education; pharmacy curriculum; research
12.  University-Based Continuing Education for Pharmacists 
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.
doi:10.5688/ajpe76220
PMCID: PMC3305929  PMID: 22438592
continuing education; professional development; continuing professional development; universities
13.  The Team Education and Adherence Monitoring (TEAM) Trial: Pharmacy Interventions to Improve Hypertension Control in Blacks 
Background
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.
Conclusions
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.
doi:10.1161/CIRCOUTCOMES.109.849992
PMCID: PMC2787470  PMID: 20031847
14.  Design of a trial to evaluate the impact of clinical pharmacists and community health promoters working with African-Americans and Latinos with Diabetes 
BMC Public Health  2012;12:891.
Background
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.
Methods/Design
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.
Discussion
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.
Trial registration
ClinicalTrials.gov identifier: NCT01498159
doi:10.1186/1471-2458-12-891
PMCID: PMC3571948  PMID: 23088168
(3–10): Diabetes mellitus/drug therapy; Patient compliance; Patient education; Pharmacists; Community health workers
15.  PictureRx: Illustrated Medication Instructions for Patients with Limited Health Literacy 
Objectives
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.
Practice description
PictureRx is applicable to all pharmacy practice settings.
Practice innovation
PictureRx enables pharmacists to rapidly produce evidence-based, illustrated medication instructions that are well-understood by patients of all health literacy levels.
Results
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.
Conclusion
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.
doi:10.1331/JAPhA.2012.11132
PMCID: PMC3603360  PMID: 23023858
Medication management; health literacy; Latinos; communication; illustrated medication instructions
16.  Patient And phaRmacist Telephonic Encounters (PARTE) in an underserved rural population with asthma: methods and rationale 
Innovations in pharmacy  2011;2(3):49-.
Purpose
Methods used to deliver and test a pharmacy-based asthma care telephonic service for an underserved, rural patient population are described.
Summary
In a randomized controlled trial (RCT), the Patient And phaRmacist Telephonic Encounters (PARTE) project is assessing the feasibility, acceptability, and preliminary impact of providing pharmacy-based asthma care service telephonically. The target audience is a low income patient population across a large geographic area served by a federally qualified community health center. Ninety-eight participants have been randomized to either standard care or the intervention group who received consultation and direct feedback from pharmacists via telephone regarding their asthma self-management and medication use. Pharmacists used a counseling framework that incorporates the Indian Health Services 3 Prime Questions and the RIM Technique (Recognition, Identification, and Management) for managing medication use problems. Pharmacists encouraged patients to be active partners in the decision-making process to identify and address the underlying cause of medication use problems. Uniquely, this trial collected process and summative data using qualitative and quantitative approaches. Pharmacists’ training, the fidelity and quality of pharmacists’ service delivery, and short term patient outcomes are being evaluated. This evaluation will improve our ability to address research challenges and intervention barriers, refine staff training, explore patient perspectives, and evaluate measures’ power to provide preliminary patient outcome findings.
Conclusion
A mixed method evaluation of a structured pharmacist intervention has the potential to offer insights regarding staff training, service fidelity and short term outcomes using quantitative and qualitative data in an RCT. Results will provide evidence regarding the feasibility and quality of carrying out the study and service delivery from the multiple perspectives of participants, clinicians, and researchers.
PMCID: PMC3711922  PMID: 23864987
patient-pharmacist communication; asthma; telepharmacy
17.  Individual and neighborhood-level factors associated with non-prescription counseling in pharmacies participating in the New York State Expanded Syringe Access Program (ESAP) 
Objective
To determine the individual- and neighborhood-level predictors of frequent non-prescription in-pharmacy counseling.
Design
Cross-sectional survey
Setting
130 pharmacies registered in the Expanded Syringe Access Program (ESAP) in New York City.
Participants
477 pharmacists, non-pharmacist owner/managers, and technicians/clerks.
Main outcome measures
Frequent counseling on medical conditions, health insurance, and other products.
Results
Technicians were less likely than pharmacists to provide frequent counseling on medical conditions or health insurance. In terms of neighborhood-level characteristics, pharmacies in areas of high employment disability were less likely to provide frequent health insurance counseling and pharmacies in areas with higher deprivation were more likely to provide counseling on other products.
Conclusion
ESAP pharmacy staff is a frequent source of non-prescription counseling for their patients/customers in disadvantaged neighborhoods of NYC. These findings suggest that ESAP pharmacy staff may be amenable to providing relevant counseling services to injection drug using syringe customers and warrants further investigation.
doi:10.1331/JAPhA.2010.09202
PMCID: PMC3575749  PMID: 20833615
Expanded Syringe Access Program; in-pharmacy counseling; injection drug users; expanded services; New York City
18.  The impact of pharmaceutical care on patients with hypertension and their pharmacists 
Pharmacy Practice  2011;9(2):110-115.
Objective
The purpose of the study was to assess the influence of pharmaceutical care on patients’ knowledge, quality of life and blood pressure and to determine whether new type of pharmaceutical services changes the pharmacists’ satisfaction and knowledge.
Methods
Community pharmacies were randomly assigned to study and control group and pharmacists from both groups included patients with hypertension, who meet inclusion and exclusion criteria. Study group provided the pharmaceutical care (education, pharmacotherapy monitoring, detecting and solving drug related problems) for their patients, while the control group provided the standard pharmaceutical services (dispensing medicines with or without counseling). At the beginning and the end of the study pharmacists and patients filled in the knowledge test. Pharmacists fulfilled also satisfaction questionnaire.
Results
Survey data were collected from 28 and 56 patients from community pharmacies in study and control group respectively. At the last meeting the normal blood pressure achieved 79% and 55% patients in study and control group, respectively (p>0,05). The pharmaceutical care improved patients’ knowledge about disease. Pharmacists from study group, who provided pharmaceutical care, had higher level of pharmacotherapy knowledge and professional satisfaction than the control group.
Conclusions
Implementation of pharmaceutical care into the pharmacy practice benefits both, patients and pharmacists.
PMCID: PMC3969835
Hypertension; Medication Therapy Management; Community Pharmacy Services; Poland
19.  Care Providers’ Satisfaction with Restructured Clinical Pharmacy Services in a Tertiary Care Teaching Hospital 
Background:
At the time this study was undertaken, clinical pharmacy services at the authors’ institution, a tertiary care teaching hospital, were largely reactive in nature, with patients and units receiving inconsistent coverage.
Objective:
To develop an evidence-based model of proactive practice and to evaluate the satisfaction of pharmacists and other stakeholders after restructuring of clinical pharmacy services.
Methods:
The literature was reviewed to determine a core set of pharmacist services associated with the greatest beneficial impact on patients’ health. On the basis of established staffing levels, the work schedule was modified, and pharmacists were assigned to a limited number of patient care teams to proactively and consistently provide these core services. Other patient care teams continued to receive reactive troubleshooting-based services, as directed by staff in the pharmacy dispensary. A satisfaction survey was distributed to all pharmacists, nurses, and physicians 18 months after the restructuring.
Results:
Of the 26 pharmacists who responded to the survey, all agreed or strongly agreed that the restructuring of services had improved job satisfaction and patient safety and that other health care professionals valued their contribution to patient care. Nurses and physicians from units where pharmacists had been assigned to provide proactive services perceived pharmacist services more favourably than those from units where pharmacist services were reactive. Pharmacists, nurses, and physicians all felt that proactive pharmacist services should be more widely available. Challenges reported by pharmacists included increased expectations for documentation and guilt about “cutting back” services where they had previously been provided.
Conclusions:
Restructuring clinical pharmacy services in an evidence-based manner improved pharmacists’ satisfaction and created demand from other stakeholders to provide this level of service for all patients.
PMCID: PMC2858499  PMID: 22478965
clinical pharmacy; restructuring; tertiary care hospital; evidence-based; practice delivery; pharmacie clinique; restructuration; hôpital de soins tertiaires; données probantes; prestation de services
20.  Prostate cancer education in the Washington, DC, area. 
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.
PMCID: PMC2594186  PMID: 12442999
21.  What Patients Want: Preferences Regarding Hospital Pharmacy Services 
Background
The role of hospital pharmacists has evolved over the past couple of decades from preparation and distribution of medications to active involvement in health care teams, through identification and resolution of patients’ medication-related issues in an effort to improve patient outcomes. However, patients’ preferences about pharmacy services are not well known.
Objective:
To use content analysis of open-ended survey responses from recently discharged patients to determine desired pharmacy services.
Methods:
Former inpatients were randomly selected for participation in a telephone survey following discharge from acute care hospitals in the Horizon Health Network in New Brunswick. The survey included the question, “What service or information would you like a pharmacist to provide in the hospital that would most help you in managing your medications?” For responses to this question, 2 raters established response categories, obtained acceptable inter-rater agreement, and independently scored the responses.
Results:
Four global categories of responses were obtained, each having multiple subcategories. Of the 703 responses (from 325 respondents), 445 (63.3%) were related to the category “information about medications”, including purpose, adherence, and side effects. The second most common response category was “self-disclosure” (167 [23.8%]), including experiences with pharmacies, medications, or hospitals. Less frequently, responses pertained to “pharmacy services” (54 [7.7%]), such as medication costs and continuity of care, and to “information source for medications” (37 [5.3%]).
Conclusions:
Most respondents to this survey wanted hospital pharmacists to provide a general medication overview, including information about side effects and interactions, during their admission. The results suggest that many patients are unaware of other potential clinical services that pharmacists can provide. A future study could assess patients’ willingness to select from a guiding list of potential clinical services.
PMCID: PMC3694939  PMID: 23814285
clinical pharmacy services; expanded pharmacy services; patient expectations; services de pharmacie clinique; services de pharmacie élargis; attentes des patients
22.  Evaluation of Croatian Community Pharmacists' Patient Care Competencies Using the General Level Framework 
Objectives
To assess Croatian community pharmacists' patient care competencies using the General Level Framework (GLF).
Methods
The competencies of 100 community pharmacists working in 38 community pharmacies were evaluated using an adapted version of the GLF.
Results
Pharmacists demonstrated the best performance in the competency areas drug specific issues and provision of drug products; the poorest performance was in the competency areas evaluation of outcomes and monitoring drug therapy. Pharmacists' behavior varied the most in the following areas: ensuring that the prescription is legal, prioritization of medication management problems, and identification of drug-drug interactions.
Conclusions
Competencies were identified that need to be developed to improve pharmacist interventions in community settings. This study provides the first data on pharmacists' performance in Croatia and serves as a starting point for future studies and actions.
PMCID: PMC3073111  PMID: 21519425
competency; pharmacist; General Level Framework; Croatia; community pharmacy
23.  Dual Degree Programs at the University of Kentucky College of Pharmacy 
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.
PMCID: PMC2254237  PMID: 18322574
dual degree; joint degree; education; doctor of pharmacy degree; master of business administration; master of public administration
24.  Over the counter drugs. The interface between the community pharmacist and patients. 
BMJ : British Medical Journal  1996;312(7033):758-760.
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.
PMCID: PMC2350455  PMID: 8605465
25.  Using Human Patient Simulation to Prepare Student Pharmacists to Manage Medical Emergencies in an Ambulatory Setting 
Objective
To implement a simulation-based educational experience focused on medical emergencies in an ambulatory pharmacy setting.
Design
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.
Assessment
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.
Conclusion
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.
PMCID: PMC3049662  PMID: 21451755
patient simulation; community pharmacy; emergency care; ambulatory care

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