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1.  Effectiveness of computerized clinical decision support systems for asthma and chronic obstructive pulmonary disease in primary care: a systematic review 
BMC Pulmonary Medicine  2014;14(1):189.
The use of computerized clinical decision support systems may improve the diagnosis and ongoing management of chronic diseases, which requires recurrent visits to multiple health professionals, disease and medication monitoring and modification of patient behavior. The aim of this review was to systematically review randomized controlled trials evaluating the effectiveness of computerized clinical decision systems (CCDSS) in the care of people with asthma and COPD.
Randomized controlled trials published between 2003 and 2013 were searched using multiple electronic databases Medline, EMBASE, CINAHL, IPA, Informit, PsychINFO, Compendex, and Cochrane Clinical Controlled Trials Register databases. To be included, RCTs had to evaluate the role of the CCDSSs for asthma and/or COPD in primary care.
Nineteen studies representing 16 RCTs met our inclusion criteria. The majority of the trials were conducted in patients with asthma. Study quality was generally high. Meta-analysis was not conducted because of methodological and clinical heterogeneity. The use of CCDSS improved asthma and COPD care in 14 of the 19 studies reviewed (74%). Nine of the nineteen studies showed statistically significant (p < 0.05) improvement in the primary outcomes measured. The majority of the studies evaluated health care process measures as their primary outcomes (10/19).
Evidence supports the effectiveness of CCDSS in the care of people with asthma. However there is very little information of its use in COPD care. Although there is considerable improvement in the health care process measures and clinical outcomes through the use of CCDSSs, its effects on user workload and efficiency, safety, costs of care, provider and patient satisfaction remain understudied.
Electronic supplementary material
The online version of this article (doi:10.1186/1471-2466-14-189) contains supplementary material, which is available to authorized users.
PMCID: PMC4265443  PMID: 25439006
CCDSS; Computerized clinical decision support systems; Asthma; COPD; Computerized clinical decision making; Systematic review
2.  A Comparison of Screening Methods for Sleep Disorders in Australian Community Pharmacies: A Randomized Controlled Trial 
PLoS ONE  2014;9(6):e101003.
Community pharmacies may potentially assist in screening for chronic conditions such as sleep disorders, which remain both under-diagnosed and untreated. We aimed to compare a subjective risk-assessment-only questionnaire (RAO) for common sleep disorder screening against the same risk-assessment questionnaire plus a nasal flow monitor as an objective marker of possible underlying obstructive sleep apnea (OSA) (RA+) in a community pharmacy setting. The primary outcome was the number of participants identified in RAO or RA+ group who were likely to have and consequently be diagnosed with OSA. Further outcomes included the number of participants identified as being at risk for, referred for, taking-up referral for, and then diagnosed with OSA, insomnia, and/or restless legs syndrome (RLS) in either group.
In a cluster-randomized trial, participants were recruited through 23 community pharmacies. Using validated instruments, 325 (RAO = 152, RA+ = 173) participants were screened for OSA, insomnia, and RLS.
218 (67%) participants were at risk of OSA, insomnia or RLS and these participants were referred to their primary physician. The proportion of screened participants identified as being at risk of OSA was significantly higher in the RA+ group (36% in RAO vs. 66% in RA+, OR 3.4, 95% CI (1.8–6.5), p<0.001). A 12-month follow-up was completed in 125 RAO and 155 RA+ participants. Actual referral uptake was 34% RAO, 26% RA+, OR 4.4, 95% CI (1.4–19.2), p = 0.31. The OSA diagnosis rate was higher in the RA+ arm (p = 0.01). To yield a single additional confirmed OSA diagnosis, 16 people would need to be screened using the RA+ protocol.
These results demonstrate that utilising either screening method is feasible in identifying individuals in the community pharmacy setting who are likely to have OSA, insomnia and/or RLS. Secondly, adding an objective marker of OSA to a questionnaire-based prediction tool resulted in more confirmed OSA diagnoses.
Trial Registration
: ACTRN12608000628347
PMCID: PMC4076224  PMID: 24978952
3.  Course experiences, satisfaction and career intent of final year pre-registration Australian pharmacy students 
Pharmacy Practice  2014;12(2):392.
In Australia, the profession of pharmacy has undergone many changes to adapt to the needs of the community. In recent years, concerns have been raised with evidence emerging of workforce saturation in traditional pharmacy practice sectors. It is not known how current final year pharmacy students’ perceive the different pharmacy career paths in this changing environment. Hence investigating students’ current experiences with their pharmacy course, interaction with the profession and developing an understanding of their career intentions would be an important step, as these students would make up a large proportion of future pharmacy workforce.
The objective of this study was thus to investigate final year students’ career perspectives and the reasons for choosing pharmacy, satisfaction with this choice of pharmacy as a tertiary course and a possible future career, factors affecting satisfaction and intention of future career paths.
A quantitative cross sectional survey of final year students from 3 Australian universities followed by a qualitative semi-structured interview of a convenience sample of final year students from the University of Sydney.
‘Interest in health and medicine’ was the most important reason for choosing pharmacy (n=238). The majority of students were ‘somewhat satisfied’ with the choice of pharmacy (35.7%) as a course and possible future career. Positive associations were found between satisfaction and reasons for joining pharmacy such as ‘felt pharmacy is a good profession’ (p=0.003) while negative associations included ‘joined pharmacy as a gateway to medicine or dentistry’ (p=0.001). Quantitate and qualitative results showed the most frequent perception of community pharmacy was ‘changing’ while hospital and pharmaceutical industry was described as ‘competitive’ and ‘research’ respectively. The highest career intention was community followed by hospital pharmacy.
Complex factors including university experiences are involved in shaping students’ satisfaction and perception of career. This may relate to challenges in the community pharmacy sector, job opportunities in hospital and limited understanding of the pharmaceutical industry. The results offer insight for the profession in terms of entry into various roles and also to pharmacy educators for their roles in shaping curricula and placement experiences that attract future graduates to defined career pathways in pharmacy.
PMCID: PMC4100949  PMID: 25035715
Students; Pharmacy; Career Choice; Personal Satisfaction; Pharmacists; Pharmaceutical Services; Australia
4.  A Workshop on Smoking Cessation for Pharmacy Students 
Objective. To develop, implement, and evaluate a targeted educational intervention focusing on smoking cessation with final-year undergraduate pharmacy students.
Design. A smoking-cessation educational workshop entitled Smoking Cessation in Pharmacy (SCIP) was designed on the principles of adult learning and implemented with a full cohort of final-year undergraduate pharmacy students at the University of Sydney. A previously validated questionnaire testing the knowledge and attitudes of respondents was administered both before and after implementation of the designed workshop to evaluate changes resulting from the intervention. Informal feedback was obtained from students.
Assessment. Pre-course mean total knowledge and attitude scores calculated were 65.8±9.1 and 86.4±12.1, respectively. The post-course mean total knowledge score was 74.9±8.1, and the attitude score was 88.8±9.1 Improvement in knowledge and attitudes was significant (p<0.05).
Conclusion. Educational interventions for pharmacy students designed with careful attention to pedagogic principles can improve knowledge about evidence-based smoking-cessation strategies and enhance positive attitudes to pharmacist roles in smoking cessation.
PMCID: PMC3831409  PMID: 24249860
pharmacy students; smoking cessation; workshop
5.  The role of community pharmacists in screening and subsequent management of chronic respiratory diseases: a systematic review 
Pharmacy Practice  2013;11(4):228-245.
The purpose of this review was to evaluate the role of community pharmacists in provision of screening with/without subsequent management of undiagnosed chronic obstructive pulmonary disease (COPD) and uncontrolled asthma.
An extensive literature search using four databases (ie. Medline, PubMed, International Pharmaceutical Abstracts (IPA) and Scopus) with search terms pharmacy, screening, asthma or COPD was conducted. Searches were limited to the years 2003-2013, those in English and those reporting research with humans. Data retrieval, analysis and result presentation employed a scoping review method.
Seventeen articles met the inclusion/exclusion criteria, of which fifteen studies were based on people with asthma and two were based on people with COPD. Only seven asthma studies and one COPD study involved screening followed by subsequent management. More than half of the people screened were found to be poorly controlled and up to 62% of people were identified at high risk for COPD by community pharmacists. The studies varied in the method and type of asthma control assessment/screening, the type of intervention provided and the outcomes measured. The limitations of the reviewed studies included varying definitions of asthma control, different study methodologies, and the lack of long-term follow-up. While many different methods were used for risk assessment and management services by the pharmacists, all the studies demonstrated that community pharmacists were capable of identifying people with poorly controlled asthma and undiagnosed COPD and providing them with suitable interventions.
The literature review identified that community pharmacists can play an effective role in screening of people with poorly controlled asthma and undiagnosed COPD along with delivering management interventions. However, there is very little literature available on screening for these chronic respiratory conditions. Future research should focus on development of patient care delivery model incorporating a screening protocol followed by targeted management interventions delivered by the community pharmacist.
PMCID: PMC3869639  PMID: 24367463
Mass Screening; Lung Diseases, Obstructive; Outcome Assessment (Health Care); Community Pharmacy Services; Professional Practice; Professional Role
6.  Smoking cessation in community pharmacy practice–a clinical information needs analysis 
SpringerPlus  2013;2:449.
With the emerging role of pharmacists in implementing smoking cessation services and the recent evidence about smoking cessation pharmacotherapies, a needs analysis to assess baseline knowledge about current smoking cessation practice is needed; hence, training and development in this area can target possible ‘gaps’.
This study aimed at exploring pharmacy students’ knowledge about and attitudes toward smoking cessation, as compared to practicing community pharmacists and smoking cessation educators. The overall objective was to uncover underlying ‘gaps’ in pharmacy-based smoking cessation practice, particularly clinical gaps.
Final-year pharmacy students at the University of Sydney, practicing community pharmacists and smoking cessation educators in Australia.
As no previous standard pharmacist-focused smoking cessation knowledge questionnaires exist, a review of the literature informed the development of such a questionnaire. The questionnaire was administered to a cohort of fourth-year pharmacy students at the University of Sydney, practicing pharmacists and smoking cessation educators. Data analysis was performed using Predictive Analytics SoftWare (PASW® Statistics 18). Mean total scores, independent t-tests, analysis of variances and exploratory factor analysis were performed.
Main outcome measure
To determine areas of major clinical deficits about current evidence related to smoking cessation interventions at the pharmacy level.
Responses from 250 students, 51 pharmacists and 20 educators were obtained. Smoking educators scored significantly higher than pharmacists and students (P < .05), while score differences in the latter two groups were not statistically significant (P > .05). All groups scored high on ‘general’ knowledge questions as compared to specialised pharmacologic and pharmacotherapeutic questions. All respondents demonstrated positive attitudes toward the implications of smoking cessation. Factor analysis of the 24-item knowledge section extracted 12 items loading on 5 factors accounting for 53% of the total variance.
The results provide a valid indication of ‘gaps’ in the practice of up-to-date smoking cessation services among Australian pharmacy professionals, particularly in clinical expertise areas involving assessment of nicotine dependence and indications, dosages, adverse effects, contraindications, drug interactions and combinations of available pharmacotherapies. These gaps should be addressed, and the results should inform the design, implementation and evaluation of a pharmacy-based educational training program targeting current clinical issues in smoking cessation.
PMCID: PMC3777019  PMID: 24058894
Attitudes; Knowledge; Pharmacy; Questionnaire; Smoking cessation
7.  Experiences of community pharmacists involved in the delivery of a specialist asthma service in Australia 
The role of community pharmacists in disease state management has been mooted for some years. Despite a number of trials of disease state management services, there is scant literature into the engagement of, and with, pharmacists in such trials. This paper reports pharmacists’ feedback as providers of a Pharmacy Asthma Management Service (PAMS), a trial coordinated across four academic research centres in Australia in 2009. We also propose recommendations for optimal involvement of pharmacists in academic research.
Feedback about the pharmacists’ experiences was sought via their participation in either a focus group or telephone interview (for those unable to attend their scheduled focus group) at one of three time points. A semi-structured interview guide focused discussion on the pharmacists’ training to provide the asthma service, their interactions with health professionals and patients as per the service protocol, and the future for this type of service. Focus groups were facilitated by two researchers, and the individual interviews were shared between three researchers, with data transcribed verbatim and analysed manually.
Of 93 pharmacists who provided the PAMS, 25 were involved in a focus group and seven via telephone interview. All pharmacists approached agreed to provide feedback. In general, the pharmacists engaged with both the service and research components, and embraced their roles as innovators in the trial of a new service. Some experienced challenges in the recruitment of patients into the service and the amount of research-related documentation, and collaborative patient-centred relationships with GPs require further attention. Specific service components, such as the spirometry, were well received by the pharmacists and their patients. Professional rewards included satisfaction from their enhanced practice, and pharmacists largely envisaged a future for the service.
The PAMS provided pharmacists an opportunity to become involved in an innovative service delivery model, supported by the researchers, yet trained and empowered to implement the clinical service throughout the trial period and beyond. The balance between support and independence appeared crucial in the pharmacists’ engagement with the trial. Their feedback was overwhelmingly positive, while useful suggestions were identified for future academic trials.
PMCID: PMC3439711  PMID: 22709371
Pharmacy; Asthma; Disease management service; Experiences; Feedback
8.  Intergroup Peer Assessment in Problem-Based Learning Tutorials for Undergraduate Pharmacy Students 
To develop, implement, and evaluate a process of intergroup peer assessment and feedback using problem-based learning (PBL) tutorials.
A peer-assessment process was used in a PBL tutorial setting for an integrated pharmacy practice course in which small groups of students graded each others’ PBL case presentations and provided feedback in conjunction with facilitator assessment.
Students' quantitative and qualitative perceptions of the peer assessment process were triangulated with facilitator feedback. Students became more engaged, confident, and motivated, and developed a range of self-directed, life-long learning skills. Students had mixed views regarding the fairness of the process and grade descriptors. Facilitators strongly supported the peer assessment process.
Peer assessment is an appropriate method to assess PBL skills and is endorsed by students as appropriate and useful.
PMCID: PMC3138352  PMID: 21769149
pharmacy students; peer assessment; problem-based learning
9.  An Interprofessional Learning Module on Asthma Health Promotion 
To develop, implement, and evaluate a new interprofessional learning module that focused on asthma health promotion called Taking Action Together for Asthma.
Faculty members in medicine, nursing, and pharmacy courses recruited 10 students each to participate in a 3-day interprofessional learning module. Students received extensive materials including a workbook to document their expectations and experience; completed a 1-day interprofessional workshop; received training in the Triple A (Adolescent Asthma Action) program; and went into high schools and taught the Triple A program to students in interprofessional teams.
Before and after participating in the module, students completed a questionnaire consisting of 3 previously validated instruments: the Asthma Knowledge for Health Professionals Scale, Attitudes Toward Health Care Teams Scale, and Readiness for Interprofessional Learning Scale (RIPLS). Seventeen students completed both the pre- and post-module scales and significant changes were seen only in means scores for the Attitude Toward Healthcare Teams (81.0 ± 4.7 to 85.2 ± 5.9) and the Teamwork and Collaboration subscale of the RIPLS (41.4 ± 2.7 to 43.2 ± 2.7).
Health promotion activities offer a viable mechanism for fostering interprofessional learning among health professions students.
PMCID: PMC3073104  PMID: 21519420
interprofessional learning; health professionals; teamwork; asthma
10.  Pharmacy Asthma Care Program (PACP) improves outcomes for patients in the community 
Thorax  2007;62(6):496-592.
Despite national disease management plans, optimal asthma management remains a challenge in Australia. Community pharmacists are ideally placed to implement new strategies that aim to ensure asthma care meets current standards of best practice. The impact of the Pharmacy Asthma Care Program (PACP) on asthma control was assessed using a multi‐site randomised intervention versus control repeated measures study design.
Fifty Australian pharmacies were randomised into two groups: intervention pharmacies implemented the PACP (an ongoing cycle of assessment, goal setting, monitoring and review) to 191 patients over 6 months, while control pharmacies gave their usual care to 205 control patients. Both groups administered questionnaires and conducted spirometric testing at baseline and 6 months later. The main outcome measure was asthma severity/control status.
186 of 205 control patients (91%) and 165 of 191 intervention patients (86%) completed the study. The intervention resulted in improved asthma control: patients receiving the intervention were 2.7 times more likely to improve from “severe” to “not severe” than control patients (OR 2.68, 95% CI 1.64 to 4.37; p<0.001). The intervention also resulted in improved adherence to preventer medication (OR 1.89, 95% CI 1.08 to 3.30; p = 0.03), decreased mean daily dose of reliever medication (difference −149.11 μg, 95% CI −283.87 to −14.36; p = 0.03), a shift in medication profile from reliever only to a combination of preventer, reliever with or without long‐acting β agonist (OR 3.80, 95% CI 1.40 to 10.32; p = 0.01) and improved scores on risk of non‐adherence (difference −0.44, 95% CI −0.69 to −0.18; p = 0.04), quality of life (difference −0.23, 95% CI −0.46 to 0.00; p = 0.05), asthma knowledge (difference 1.18, 95% CI 0.73 to 1.63; p<0.01) and perceived control of asthma questionnaires (difference −1.39, 95% CI −2.44 to −0.35; p<0.01). No significant change in spirometric measures occurred in either group.
A pharmacist‐delivered asthma care programme based on national guidelines improves asthma control. The sustainability and implementation of the programme within the healthcare system remains to be investigated.
PMCID: PMC2117224  PMID: 17251316
11.  Pharmacy Students' Approaches to Learning in an Australian University 
To investigate how pharmacy students' approaches to learning change over the duration of a bachelor of pharmacy degree program.
Data were obtained from a cross-sectional, repeated measures design, using a validated self-report survey instrument. Areas examined included processing and regulation strategies, motivational preferences for learning, and the relationship between approaches to learning and academic performance.
Pharmacy students were strongly vocationally oriented in their studies across all year groups. This approach had a significant relationship to academic performance. Overall, students indicated a preference for external regulation strategies. There was little evidence of maturation in approaches to learning as students progressed through the curriculum.
Students' preference for vocationally related strategies can be harnessed to increase both adoption of self-regulation behaviors and motivation for mastery of material. Comparison of our results with other studies indicates that approaches to learning may be influenced more by the learning environment than the discipline of study.
PMCID: PMC2690923  PMID: 19503704
learning, bachelor of pharmacy degree; Vermunt's Inventory of Learning Styles
12.  An Educational Intervention to Train Community Pharmacists in Providing Specialized Asthma Care 
The development, implementation, and evaluation of an educational intervention to facilitate specialized asthma care provision by community pharmacists.
Formative evaluation and a parallel group repeated measures design were used to test the effect of an educational intervention on pharmacist satisfaction and practice behavior as well as patient outcomes. The educational intervention was based on practitioner needs and principles of adult learning using flexible delivery formats.
In the intervention area, 15 pharmacists were trained with the educational intervention, and they provided specialized asthma care to 52 patients over 6 months, while in the control area, 12 pharmacists provided “usual care” to 50 patients. The intervention pharmacists were highly satisfied with the education received and rated most aspects highly. Improvements in patient clinical, humanistic, and economic outcomes in the intervention area were obtained.
The positive results of the educational intervention demonstrate the effectiveness of an educational approach grounded in the theory that inducing behavioral changes in pharmacy practitioners results in improved patient outcomes.
PMCID: PMC1637026  PMID: 17149447
community pharmacists; continuing education; asthma care; patient outcomes

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