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1.  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
2.  Physicians’ perceptions, expectations, and experience with pharmacists at Hamad Medical Corporation in Qatar 
Objectives:
The purpose of this study was to investigate the physicians’ perceptions, and expectations of their experiences with the pharmacists at Hamad Medical Corporation (HMC) in Qatar.
Method:
A cross-sectional study was conducted at HMC between January and March 2006 using a validated questionnaire. The self-administered questionnaire was distributed to 500 physicians who were working at HMC comprising Hamad General Hospital, Women’s Hospital, Rumaila Hospital, Al-Amal Hospital, Al Khor Hospital, and primary health centers. The questionnaire was composed of four parts, investigating the physicians’ expectations, experiences, and perceptions of the pharmacists.
Results:
A total of 205 questionnaires were completed (response rate 41%). A total of 183 physicians (89%) expected the pharmacist to educate patients about safe and appropriate use of drugs, whereas 118 (57%) expected the pharmacist to be available for health-care team consultation during bedside rounds. The indices of physicians showing how comfortable they were with pharmacists, and their expectations of pharmacists, were 61% and 65%, respectively, whereas the index on experience of physicians with pharmacists was lower (15%).
Conclusions:
Physicians were comfortable with pharmacists and had high expectations of pharmacists in performing their duties. However, physicians reported a poor experience with pharmacists, who infrequently informed them about the effectiveness of alternative drugs, patients experiencing problems with prescribed medications, and who took personal responsibility to resolve any drug-related problem.
doi:10.2147/JMDH.S14326
PMCID: PMC3084310  PMID: 21544250
hospital pharmacists; perceptions; expectations; experience; physicians; Qatar
3.  Pharmacy students’ attitudes toward pharmaceutical care in Qatar 
Objectives
The study objectives were to investigate Qatar pharmacy students’ attitudes toward pharmaceutical care (PC), to identify the factors that influence their attitudes, and to recognize their perceived barriers for PC provision.
Methods
A cross-sectional and online survey of Qatar pharmacy students was conducted.
Results
Over 4 weeks, 46 surveys were submitted (88% response rate). All respondents agreed that the pharmacist’s primary responsibility is to prevent and resolve medication therapy problems. Most respondents believed that PC provision is professionally rewarding and that all pharmacists should provide PC (93% and 91% of respondents, respectively). Highly perceived barriers for PC provision included lack of access to patient information (76%), inadequate drug information sources (55%), and time constraints (53%). Professional year and practical experience duration were inversely significantly associated with four and five statements, respectively, out of the 13 Standard Pharmaceutical Care Attitudes Survey statements, including the statements related to the value of PC, and its benefit in improving patient health and pharmacy practitioners’ careers.
Conclusion
Qatar pharmacy students had positive attitudes toward PC. Efforts should be exerted to overcome their perceived barriers.
doi:10.2147/TCRM.S56982
PMCID: PMC3938321  PMID: 24591836
Qatar; pharmaceutical care; pharmacy; student
4.  Public’s attitudes towards community pharmacy in Qatar: a pilot study 
Objectives
To assess the public’s attitudes towards the community pharmacist’s role in Qatar, to investigate the public’s use of community pharmacy, and to determine the public’s views of and satisfaction with community pharmacy services currently provided in Qatar.
Materials and methods
Three community pharmacies in Qatar were randomly selected as study sites. Patients 16 years of age and over who were able to communicate in English or Arabic were randomly approached and anonymously interviewed using a multipart pretested survey.
Results
Over 5 weeks, 58 patients were interviewed (60% response rate). A total of 45% of respondents perceived community pharmacists as having a good balance between health and business matters. The physician was considered the first person to contact to answer drug- related questions by 50% of respondents. Most patients agreed that the community pharmacist should provide them with the medication directions of use (93%) and advise them about the treatment of minor ailments (79%); however, more than 70% didn’t expect the community pharmacist to monitor their health progress or to perform any health screening. Half of the participants (52%) reported visiting the pharmacy at least monthly. The top factor that affected a patient’s choice of any pharmacy was pharmacy location (90%). When asked about their views about community pharmacy services in Qatar, only 37% agreed that the pharmacist gave them sufficient time to discuss their problem and was knowledgeable enough to answer their questions.
Conclusion
This pilot study suggested that the public has a poor understanding of the community pharmacist’s role in monitoring drug therapy, performing health screening, and providing drug information. Several issues of concern were raised including insufficient pharmacist– patient contact time and unsatisfactory pharmacist knowledge. To advance pharmacy practice in Qatar, efforts may be warranted to address identified issues and to promote the community pharmacist’s role in drug therapy monitoring, drug information provision, and health screening.
doi:10.2147/PPA.S22117
PMCID: PMC3176180  PMID: 21949604
pharmacist; public; attitudes; Qatar
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.  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.  Design of a medication management program for Medicare beneficiaries: Qualitative findings from patients and physicians 
Background
The quality of pharmacologic care provided to older adults is less than optimal. Medication therapy management (MTM) programs delivered to older adults in the ambulatory care setting may improve the quality of medication use for these individuals.
Objectives
We conducted focus groups with older adults and primary care physicians to explore: (1) older adults' experiences working with a clinical pharmacist in managing medications, (2) physician perspectives on the role of clinical pharmacists in facilitating medication management, and (3) key attributes of an effective MTM program and potential barriers from both patient and provider perspectives.
Methods
Five focus groups (4 with older adults, 1 with primary care physicians) were conducted by a trained moderator using a semi-structured interview guide. Each participant completed a demographic questionnaire. Sessions were recorded, transcribed verbatim, and analyzed using qualitative analysis software for theme identification.
Results
Twenty-eight older adults and 8 physicians participated. Older adults valued the professional, trusting nature of their interactions with the pharmacist. They found the clinical pharmacist to be a useful resource, thorough, personable, and a valuable team member. Physicians believe the clinical pharmacist fills a unique role as a specialized practitioner, contributing meaningfully to patient care. Physicians emphasized the importance of effective communication, pharmacist's access to the medical record, and a mutually-trusting relationship as key attributes of a program. Potential barriers to an effective program include poor communication and lack of familiarity with the patient's history. The lack of a sustainable reimbursement model was cited as a barrier to widespread implementation of MTM.
Conclusions
This study provides information to assist pharmacists in designing MTM programs in the ambulatory setting. Key attributes of an effective program include one that is comprehensive, addressing all medication-related needs over time. The clinical pharmacist's ability to build trusting relationships with both patients and providers is essential.
doi:10.1016/j.amjopharm.2012.01.002
PMCID: PMC3322273  PMID: 22284582
older adults; medication management; focus groups; collaborative practice; pharmacists
8.  Pharmacist-documented interventions during the dispensing process in a primary health care facility in Qatar 
Objectives:
To characterize prescribing error interventions documented by pharmacists in four pharmacies in a primary health care service in Qatar.
Methods:
The study was conducted in a primary health care service in the State of Qatar in the period from January to March 2008. Pharmacists in four clinics within the service used online, integrated health care software to document all clinical interventions made. Documented information included: patient’s age and gender, drug therapy details, the intervention’s details, its category, and its outcome. Interventions were categorized according to the Pharmaceutical Care Network Europe Classification of drug-related problems (DRP).
Results:
The number of patients who had their prescriptions intercepted were 589 (0.71% of the total 82,800 prescriptions received). The intercepted prescriptions generated 890 DRP-related interventions (an average of 1.9% DRPs identified across the four clinics). Fifty-four percent of all interventions were classified as drug choice problems, and 42% had safety problems (dose too high, potential significant interaction). The prescriber accepted the intervention in 53% of all interventions, and the treatment was changed accordingly. Interventions as a result of transcription errors, legality and formulary issues were eliminated from this study through the use of computerized physician order entry (CPOE).
Conclusions:
Documenting and analyzing interventions should be a routine activity in pharmacy practice setting in primary health care services. Educational outreach visits and other strategies can improve prescribing practices and enhance patient safety.
PMCID: PMC3108682  PMID: 21701611
pharmacists; interventions; prescribing errors
9.  Which Providers Should Communicate Which Critical Information About a New Medication? Patient, Pharmacist, and Physician Perspectives 
OBJECTIVES
To investigate older patient, pharmacist, and physician perspectives about what information is essential to impart to patients receiving new medication prescriptions and who should provide the information.
DESIGN
Qualitative focus group discussions.
SETTINGS
Senior centers, retail pharmacies, and primary care physician offices.
PARTICIPANTS
Forty-two patients aged 65 and older, 13 pharmacists, and 17 physicians participated in eight focus groups.
MEASUREMENT
Qualitative analysis of transcribed focus group interviews and consensus through iterative review by multidisciplinary auditors.
RESULTS
Patient, pharmacist, and physician groups all affirmed the importance of discussing medication directions and side effects and said that physicians should educate about side effects and that pharmacists could adequately counsel about certain important issues. However, there was substantial disagreement between groups about which provider could communicate which critical elements of medication-related information. Some pharmacists felt that they were best equipped to discuss medication-related issues but acknowledged that many patients want physicians to do this. Physicians tended to believe that they should provide most new-medication education for patients. Patients had mixed preferences. Patients aged 80 and older listed fewer critical topics of discussion than younger patients.
CONCLUSION
Patients, pharmacists, and physicians have incongruent beliefs about who should provide essential medication-related information. Differing expectations could lead to overlapping, inefficient efforts that result in communication deficiencies when patients receive a new medication. Collaborative efforts to ensure that patients receive complete information about new medications could be explored.
doi:10.1111/j.1532-5415.2008.02133.x
PMCID: PMC2731774  PMID: 19175439
provider–patient communication; physician–patient communication; prescription medication; older patients; qualitative focus group interviews
10.  Pharmacist and physician views on collaborative practice 
Canadian Pharmacists Journal : CPJ  2013;146(4):218-226.
Background:
Strong working relationships between pharmacists and physicians are needed to optimize patient care. Understanding attitudes and barriers to collaboration between pharmacists and physicians may help with delivery of primary health care services. The objective of this study was to capture the opinions of family physicians and community pharmacists in Newfoundland and Labrador (NL) regarding collaborative practice.
Methods:
Two parallel surveys were offered to all community pharmacists and family physicians in NL. Surveys assessed the following: attitudes and experience with collaborative practice, preferred communication methods, perceived role of pharmacists, areas for more collaboration and barriers to collaborative practice. Results for both groups were analyzed separately, with comparisons between groups to compare responses with similar questions.
Results:
Survey response rates were 78.6% and 7.1% for pharmacists and physicians, respectively. Both groups overwhelmingly agreed that collaborative practice could result in improved patient outcomes and agreed that major barriers were lack of time and compensation and the need to deal with multiple pharmacists/physicians. Physicians indicated they would like more collaboration for insurance approvals and patient counselling, while pharmacists want to assist with identifying and managing patients’ drug-related problems. Both groups want more collaboration to improve patient adherence.
Conclusion:
Both groups agree that collaborative practice can positively affect patient outcomes and would like more collaboration opportunities. However, physicians and pharmacists disagree about the areas where they would like to collaborate to deliver care. Changes to reimbursement models and infrastructure are needed to facilitate enhanced collaboration between pharmacists and physicians in the community setting.
doi:10.1177/1715163513492642
PMCID: PMC3734911  PMID: 23940479
11.  A cluster randomized controlled Trial to Evaluate an Ambulatory primary care Management program for patients with dyslipidemia: the TEAM study 
Background
Few studies have reported the efficacy of collaborative care involving family physicians and community pharmacists for patients with dyslipidemia.
Methods
We randomly assigned clusters consisting of at least two physicians and at least four pharmacists to provide collaborative care or usual care. Under the collaborative care model, pharmacists counselled patients about their medications, requested laboratory tests, monitored the effectiveness and safety of medications and patients’ adherence to therapy, and adjusted medication dosages. After 12 months of follow-up, we assessed changes in low-density lipoprotein (LDL) cholesterol (the primary outcome), the proportion of patients reaching their target lipid levels and changes in other risk factors.
Results
Fifteen clusters representing a total of 77 physicians and 108 pharmacists were initially recruited, and a total of 51 physicians and 49 pharmacists were included in the final analyses. The collaborative care teams followed a total of 108 patients, and the usual care teams followed a total of 117 patients. At baseline, mean LDL cholesterol level was higher in the collaborative care group (3.5 v. 3.2 mmol/L, p = 0.05). During the study, patients in the collaborative care group were less likely to receive high-potency statins (11% v. 40%), had more visits with health care professionals and more laboratory tests, were more likely to have their lipid-lowering treatment changed and were more likely to report lifestyle changes. At 12 months, the crude incremental mean reduction in LDL cholesterol in the collaborative care group was −0.2 mmol/L (95% confidence interval [CI] −0.3 to −0.1), and the adjusted reduction was −0.05 (95% CI −0.3 to 0.2). The crude relative risk of achieving lipid targets for patients in the collaborative care group was 1.10 (95% CI 0.95 to 1.26), and the adjusted relative risk was 1.16 (95% CI 1.01 to 1.34).
Interpretation
Collaborative care involving physicians and pharmacists had no significant clinical impact on lipid control in patients with dyslipidemia. International Standard Randomized Controlled Trial register no. ISRCTN66345533.
doi:10.1503/cmaj.090533
PMCID: PMC2842856  PMID: 20212029
12.  Pharmacist and physician collaborative prescribing 
Canadian Family Physician  2009;55(12):e86-e91.
ABSTRACT
OBJECTIVE
To determine if there is improvement in medication management when pharmacists and family physicians collaborate to prescribe medication renewals requested by fax.
DESIGN
Prospective, non-randomized controlled trial.
SETTING
W est Winds Primary Health Centre, an interdisciplinary health centre that includes an academic family medicine practice, located in Saskatoon, Sask.
PARTICIPANTS
All patients whose pharmacies faxed the health centre requesting prescription renewals between October 2007 and February 2008 were selected to participate in the study.
INTERVENTIONS
Medication renewal requests were forwarded to the pharmacist (who works in the clinic part-time) on days when he was working (intervention group). The pharmacist assessed drug-therapy issues that might preclude safe and effective prescribing of the medication. The pharmacist and physician then made a collaborative decision to authorize the requested medication or to request additional interventions first (eg, perform laboratory tests). When the pharmacist was not working, the physicians managed the renewal requests independently (control group).
MAIN OUTCOME MEASURES
Medication renewals authorized with no recommendations, medication-related problems identified, new monitoring tests ordered, and new appointments scheduled with health providers.
RESULTS
A total of 181 renewal requests were included (94 in the control group and 87 in the intervention group). The control group had significantly more requests authorized with no recommendations (75.5% vs 52.9%, P = .001). Those in the intervention group had significantly more medication-related problems identified (26 vs 10, P = .031); medication changes made (24 vs 10, P = .044); and new appointments scheduled with their family physicians (31 vs 21, P = .049).
CONCLUSION
There is an improvement in medication management when a pharmacist collaborates with family physicians to prescribe medication renewals. The collaborative model created significantly more activity with each renewal request (ie, identification of medication-related problems, medication changes, and new appointments), which reflects an improvement in the process of care.
PMCID: PMC2793207  PMID: 20008583
13.  Pharmacists' Role in Improving Diabetes Medication Management 
Today there are significant gaps between reaching the goal of “optimal medication therapy” and the current state of medication use in the United States. Pharmacists are highly accessible and well-trained—yet often underutilized—key health care professionals who can move us closer toward achieving better medication therapy outcomes for patients. Diabetes medication management programs led by pharmacists are described. This is consistent with the “medical home” concept of care that promotes primary care providers working collaboratively to coordinate patient-centered care. Pharmacists utilize their clinical expertise in monitoring and managing diabetes medication plans to positively impact health outcomes and empower patients to actively manage their health. In addition, pharmacists can serve as a resource to other health care providers and payers to assure safe, appropriate, cost-effective diabetes medication use.
PMCID: PMC2769842  PMID: 20046662
collaborative drug-therapy management; diabetes management; medication therapy management; pharmacists; role of pharmacists
14.  A randomized controlled trial of a pharmacist consultation program for family physicians and their elderly patients 
Background
Pharmacists can improve patient outcomes in institutional and pharmacy settings, but little is known about their effectiveness as consultants to primary care physicians. We examined whether an intervention by a specially trained pharmacist could reduce the number of daily medication units taken by elderly patients, as well as costs and health care use.
Methods
We conducted a randomized controlled trial in family practices in 24 sites in Ontario. We randomly allocated 48 randomly selected family physicians (69.6% participation rate) to the intervention or the control arm, along with 889 (69.5% participation rate) of their randomly selected community-dwelling, elderly patients who were taking 5 or more medications daily. In the intervention group, pharmacists conducted face-to-face medication reviews with the patients and then gave written recommendations to the physicians to resolve any drug-related problems. Process outcomes included the number of drug-related problems identified among the senior citizens in the intervention arm and the proportion of recommendations implemented by the physicians.
Results
After 5 months, seniors in the intervention and control groups were taking a mean of 12.4 and 12.2 medication units per day respectively (p = 0.50). There were no statistically significant differences in health care use or costs between groups. A mean of 2.5 drug-related problems per senior was identified in the intervention arm. Physicians implemented or attempted to implement 72.3% (790/1093) of the recommendations.
Interpretation
The intervention did not have a significant effect on patient outcomes. However, physicians were receptive to the recommendations to resolve drug-related problems, suggesting that collaboration between physicians and pharmacists is feasible.
PMCID: PMC164937  PMID: 12847034
15.  Exploring successful community pharmacist-physician collaborative working relationships using mixed methods 
Background
Collaborative working relationships (CWRs) between community pharmacists and physicians may foster the provision of medication therapy management services, disease state management, and other patient care activities; however, pharmacists have expressed difficulty in developing such relationships. Additional work is needed to understand the specific pharmacist-physician exchanges that effectively contribute to the development of CWR. Data from successful pairs of community pharmacists and physicians may provide further insights into these exchange variables and expand research on models of professional collaboration.
Objective
To describe the professional exchanges that occurred between community pharmacists and physicians engaged in successful CWRs, using a published conceptual model and tool for quantifying the extent of collaboration.
Methods
A national pool of experts in community pharmacy practice identified community pharmacists engaged in CWRs with physicians. Five pairs of community pharmacists and physician colleagues participated in individual semistructured interviews, and 4 of these pairs completed the Pharmacist-Physician Collaborative Index (PPCI). Main outcome measures include quantitative (ie, scores on the PPCI) and qualitative information about professional exchanges within 3 domains found previously to influence relationship development: relationship initiation, trustworthiness, and role specification.
Results
On the PPCI, participants scored similarly on trustworthiness; however, physicians scored higher on relationship initiation and role specification. The qualitative interviews revealed that when initiating relationships, it was important for many pharmacists to establish open communication through face-to-face visits with physicians. Furthermore, physicians were able to recognize in these pharmacists a commitment for improved patient care. Trustworthiness was established by pharmacists making consistent contributions to care that improved patient outcomes over time. Open discussions regarding professional roles and an acknowledgment of professional norms (ie, physicians as decision makers) were essential.
Conclusions
The findings support and extend the literature on pharmacist-physician CWRs by examining the exchange domains of relationship initiation, trustworthiness, and role specification qualitatively and quantitatively among pairs of practitioners. Relationships appeared to develop in a manner consistent with a published model for CWRs, including the pharmacist as relationship initiator, the importance of communication during early stages of the relationship, and an emphasis on high-quality pharmacist contributions.
doi:10.1016/j.sapharm.2009.11.008
PMCID: PMC3004536  PMID: 21111388
Pharmacists; Physicians; Collaborative working relationships; Pharmacist-physician collaborative index; Community
16.  Can Computer-Generated Evidence-Based Care Suggestions Enhance Evidence-Based Management of Asthma and Chronic Obstructive Pulmonary Disease? A Randomized, Controlled Trial 
Health Services Research  2005;40(2):477-498.
Objective
Translation of evidence-based guidelines into clinical practice has been inconsistent. We performed a randomized, controlled trial of guideline-based care suggestions delivered to physicians when writing orders on computer workstations.
Study Setting
Inner-city academic general internal medicine practice.
Study Design
Randomized, controlled trial of 246 physicians (25 percent faculty general internists, 75 percent internal medicine residents) and 20 outpatient pharmacists. We enrolled 706 of their primary care patients with asthma or chronic obstructive pulmonary disease. Care suggestions concerning drugs and monitoring were delivered to a random half of the physicians and pharmacists when writing orders or filling prescriptions using computer workstations. A 2 × 2 factorial randomization of practice sessions and pharmacists resulted in four groups of patients: physician intervention, pharmacist intervention, both interventions, and controls.
Data Extraction/Collection Methods
Adherence to the guidelines and clinical activity was assessed using patients' electronic medical records. Health-related quality of life, medication adherence, and satisfaction with care were assessed using telephone questionnaires.
Principal Findings
During their year in the study, patients made an average of five scheduled primary care visits. There were no differences between groups in adherence to the care suggestions, generic or condition-specific quality of life, satisfaction with physicians or pharmacists, medication compliance, emergency department visits, or hospitalizations. Physicians receiving the intervention had significantly higher total health care costs. Physician attitudes toward guidelines were mixed.
Conclusions
Care suggestions shown to physicians and pharmacists on computer workstations had no effect on the delivery or outcomes of care for patients with reactive airways disease.
doi:10.1111/j.1475-6773.2005.00368.x
PMCID: PMC1361152  PMID: 15762903
medical decision making; guidelines; quality improvement
17.  An exploration of the role of pharmacists within general practice clinics: the protocol for the pharmacists in practice study (PIPS) 
Background
Medication-related problems are a serious concern in Australian primary care. Pharmacist interventions have been shown to be effective in identifying and resolving these problems. Collaborative general practitioner-pharmacist services currently available in Australia are limited and underused. Limitations include geographical isolation of pharmacists and lack of communication and access to patient information. Co-location of pharmacists within the general practice clinics is a possible solution. There have been no studies in the Australian setting exploring the role of pharmacists within general practice clinics.
The aim of this study is to develop and test a multifaceted practice pharmacist role in primary care practices to improve the quality use of medicines by patients and clinic staff.
Methods/design
This is a multi-centre, prospective intervention study with a pre-post design and a qualitative component. A practice pharmacist will be located in each of two clinics and provide short and long patient consultations, drug information services and quality assurance activities. Patients receiving long consultation with a pharmacist will be followed up at 3 and 6 months. Based on sample size calculations, at least 50 patients will be recruited for long patient consultations across both sites. Outcome measures include the number, type and severity of medication-related problems identified and resolved; medication adherence; and patient satisfaction. Brief structured interviews will be conducted with patients participating in the study to evaluate their experiences with the service. Staff collaboration and satisfaction with the service will be assessed.
Discussion
This intervention has the potential to optimise medication use in primary care clinics leading to better health outcomes. This study will provide data about the effectiveness of the proposed model for pharmacist involvement in Australian general practice clinics, that will be useful to guide further research and development in this area.
Trial registration
Australian New Zealand Clinical Trials Registry: ACTRN12612000742875
doi:10.1186/1472-6963-12-246
PMCID: PMC3470952  PMID: 22876813
Pharmacists; Primary healthcare; General practice; Multidisciplinary; Family practice
18.  Collaboration between family physicians and community pharmacists 
Canadian Family Physician  2013;59(9):e413-e420.
Abstract
Objective
To ascertain the opinions of graduating family physicians about collaboration between family physicians and community pharmacists.
Design
Anonymous online survey.
Setting
Two French-Canadian university family medicine residency programs.
Participants
The 2010 and 2011 graduating family physicians (N = 343) from the University of Montreal and Laval University in Quebec.
Main outcome measures
Content of written prescriptions; frequency of and reasons for consultations with community pharmacists; and graduates’ perceptions of sharing professional responsibilities with community pharmacists.
Results
The response rate was 54.2%. Overall, graduates were open to collaborating actively with community pharmacists. For example, at least 60% of graduates reported that it was important to write on prescriptions about any changes to patients’ medication and creatinine clearance. Most graduates responded positively to sharing responsibility for the adjustment of treatment of patients with certain chronic conditions (88.3% for anticoagulation, 64.7% for hypercholesterolemia, 61.2% for hypertension, and 60.6% for diabetes) and for the initiation of treatment of minor conditions according to a collective prescription (80.6% for traveler’s diarrhea, 74.1% for juvenile acne, and 73.6% for allergic rhinitis). However, such interprofessional collaboration requires that each professional group continues to adapt to its roles and responsibilities.
Conclusion
Family medicine graduates are open to actively collaborating with community pharmacists, but they have some reservations regarding sharing certain responsibilities. As collaborative practices are changing, graduates’ opinions should be documented once they are actually practising.
PMCID: PMC3771741  PMID: 24029528
19.  Asthma Friendly Pharmacies: A Model to Improve Communication and Collaboration among Pharmacists, Patients, and Healthcare Providers 
Pharmacists, with expertise in optimizing drug therapy outcomes, are valuable components of the healthcare team and are becoming increasingly involved in public health efforts. Pharmacists and pharmacy technicians in diverse community pharmacy settings can implement a variety of asthma interventions when they are brief, supported by appropriate tools, and integrated into the workflow. The Asthma Friendly Pharmacy (AFP) model addresses the challenges of providing patient-focused care in a community pharmacy setting by offering education to pharmacists and pharmacy technicians on asthma-related pharmaceutical care services, such as identifying or resolving medication-related problems; educating patients about asthma and medication-related concepts; improving communication and strengthening relationships between pharmacists, patients, and other healthcare providers; and establishing higher expectations for the pharmacist’s role in patient care and public health efforts. This article describes the feasibility of the model in an urban community pharmacy setting and documents the interventions and communication activities promoted through the AFP model.
doi:10.1007/s11524-010-9514-9
PMCID: PMC3042067  PMID: 21337057
Asthma; Community pharmacy; Pharmacists; Pharmaceutical care; Collaboration; Communication
20.  Pharmacists’ Perceptions of Their Professional Role: Insights into Hospital Pharmacy Culture 
Background:
Numerous studies have demonstrated the positive impacts of pharmacists on patient outcomes. To capitalize on these positive impacts, hospital pharmacy organizations around the world are now calling on pharmacists to shift their focus from distribution of medications to patient outcomes. This new emphasis is consistent with the vision statement for the profession of pharmacy in Canada, as set out in the Blueprint for Pharmacy: “Optimal drug therapy outcomes for Canadians through patient-centred care”. Given the ambitious nature of this statement and these goals, it is essential to understand what pharmacists currently think of their practice.
Objective:
To conduct a qualitative and semiquantitative analysis of hospital pharmacists’ perceptions of their role in patient care.
Methods:
A researcher posing as a University of Alberta student who was studying how health professionals use language to describe what they do contacted the pharmacy departments of all hospitals in Alberta. The “top-of-mind” approach was used in asking hospital pharmacists 2 questions: (1) How many years have you been practising pharmacy? (2) In 3 or 4 words (or phrases), from your perspective could you please tell me, “What does a pharmacist do”? These techniques were used to minimize the impact of social desirability bias. Content analysis was used to categorize hospital pharmacists’ responses into 4 broad categories: patient-centred, drug-focused, drug distribution, and ambiguous.
Results:
A total of 103 phone calls were made to hospital pharmacies, and 85 pharmacists contacted in this way were willing to participate in the survey. Hospital pharmacists provided 333 individual responses to the question about their activities. Of these, 79 (23.7%) were patient-centred, 98 (29.4%) were drug-focused, and 82 (24.6%) were in the drug-distribution category. Ambiguous responses accounted for the remaining 74 (22.2%).
Conclusion:
Aspects of care categorized as other than patient-centred should not be construed as unimportant. However, the fact that they were reported in this survey more frequently than patient-centred aspects suggests that hospital pharmacists in Alberta may have not fully embraced the concept of patient-centred care as outlined in the Blueprint for Pharmacy.
PMCID: PMC3053190  PMID: 22479026
patient-centred; drug-focused; drug distribution; top-of-mind approach; hospital pharmacist; pharmacy culture; pratique axée sur le patient; pratique axée sur les médicaments; distribution des médicaments; analyse des réponses spontanées; pharmacien d’hôpital; culture de la pharmacie
21.  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
22.  Effectiveness of a pharmacist-based gout care management programme in a large integrated health plan: results from a pilot study 
BMJ Open  2014;4(1):e003627.
Objectives
The study objective was to determine the feasibility of using a pharmacist-staffed, protocol-based structured approach to improving the management of chronic, recurrent gout.
Setting
The study was carried out in the outpatient clinic of a single Kaiser Permanente medical centre. This is a community-based clinic.
Participants
We report on 100 consecutive patients between the ages of 21 and 94 (75% men) with chronic or recurrent gout, referred by their primary physicians for the purpose of management of urate-lowering therapy. Patients with stage 5 chronic kidney disease or end-stage kidney disease were excluded.
Interventions
The programme consisted of a trained clinical pharmacist and a rheumatologist. The pharmacist contacted each patient by phone, provided educational and dietary materials, and used a protocol that employs standard gout medications to achieve and maintain a serum uric acid (sUA) level of 6 mg/dL or less. Incident gout flares or adverse reactions to medications were managed in consultation with the rheumatologist.
Primary outcome measure
The primary outcome measure was the achievement and maintenance of an sUA of 6 or less for a period of at least 3 months.
Results
In 95 evaluable patients enrolled in our pilot programme, an sUA of 6 mg/dL or less was achieved and maintained in 78 patients with 4 still in the programme to date. Five patients declined to participate after referral, and another 13 patients did not complete the programme. (The majority of these were due to non-adherence.)
Conclusions
A structured pharmacist-staffed programme can effectively and safely lower and maintain uric acid levels in a high percentage of patients with recurrent gout in a primary care setting. This care model is simple to implement, efficient and warrants further validation in a clinical trial.
doi:10.1136/bmjopen-2013-003627
PMCID: PMC3902202  PMID: 24413343
23.  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
24.  A collaborative cardiologist-pharmacist care model to improve hypertension management in patients with or at high risk for cardiovascular disease 
Pharmacy Practice  2012;10(1):25-32.
Physician led collaborative drug therapy management utilizing clinical pharmacists to aid in the medication management of patients with hypertension has been shown to improve blood pressure control. With recommendations for lower blood pressures in patients with coronary artery disease, a cardiologist-pharmacist collaborative care model may be a novel way to achieve these more rigorous goals of therapy.
Objective
The purpose of this project was to evaluate this type of care model in a high cardiac risk patient population.
Methods
A retrospective cohort study determined the ability of a cardiologist-pharmacist care model (n=59) to lower blood pressure and achieve blood pressure goals (< 130/80 mmHg) in patients with or at high risk for coronary artery disease compared to usual cardiologist care (n=58) in the same clinical setting.
Results
The cardiologist-pharmacist care model showed a higher percentage of patients obtaining their goal blood pressure compared to cardiologist care alone, 49.2% versus 31.0% respectively, p=0.0456. Greater reductions in systolic blood pressure (-22 mmHg versus -12 mmHg, p=0.0077) and pulse pressure (-15 mmHg versus -7 mmHg, p=0.0153) were noted in the cardiologist-pharmacist care model. No differences in diastolic blood pressure were found. There was a shorter duration of clinic follow-up (7.0 versus 13.2 months, p=0.0013) but a higher frequency of clinic visits (10.7 versus 3.45, p<0.0001) in the cardiologist-pharmacist care model compared to usual care. The number of antihypertensive agents used did not change over the time period evaluated.
Conclusions
This study suggests a team-based approach to hypertensive care using a collaborative cardiologist-pharmacist care model improves blood pressure from baseline in a high cardiac risk patient population and was more likely to obtain more stringent blood pressure goals than usual care.
PMCID: PMC3798165  PMID: 24155813
Hypertension; Blood Pressure; Cooperative Behavior; Patient Care Team; Pharmacists; Physicians; United States
25.  Survey of Ontario primary care physicians’ experiences with opioid prescribing 
Canadian Family Physician  2011;57(3):324-332.
Abstract
Objective
To measure physicians’ experiences with opioid-related adverse events and their perceived level of confidence in their opioid prescribing skills and practices.
Design
Mailed survey.
Setting
The province of Ontario.
Participants
A total of 1000 primary care physicians randomly selected from the College of Physicians and Surgeons of Ontario registration database.
Main outcome measures
Opioid-related adverse events and concerns (eg, number of patients, type of opioid, cause of the event or concern); physicians’ confidence, comfort, and satisfaction with opioid prescribing; physicians’ opinions on strategies to optimize their prescribing; and physicians’ perspectives of their interactions with pharmacists and nurses.
Results
The response rate was close to 66%, for a total of 658 participants. Almost all respondents reported prescribing opioids for chronic pain in the past 3 months. Eighty-six percent of respondents reported being confident in their prescribing of opioids, but 42% of respondents indicated that at least 1 patient had experienced an adverse event related to opioids in the past year, usually involving oxycodone, and 16.3% of respondents did not know if their patients had experienced any opioid-related adverse events. The most commonly cited factors leading to adverse events were that the patient took more than prescribed, the prescribed dose was too high, or the patient took alcohol or sedating drugs with the opioids. Most physicians had concerns about the opioid use of 1 or more of their patients; concerns included running out of opioids early, minimal access to pain and addiction treatment, and addiction and overdose. The reported number of physicians’ patients taking opioids was positively associated with their confidence and comfort levels in opioid prescribing and negatively associated with their belief that many patients become addicted to opioids.
Conclusion
Most physicians have encountered opioid-related adverse events. Comprehensive strategies are required to promote safe prescribing of opioids, including guidelines and comprehensive office-system materials.
PMCID: PMC3056687  PMID: 21402971

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