医院药师和患者关系的分析

医院药患关系产生主要包括药师因素和患者因素两个方面，药师服务态度差，工作责任心不强，专业知识掌握不扎实，不能与患者进行合适的沟通等容易引起药患纠纷；患者由于疾病困扰，精神和经济的双重压力以及法律意识不断增强，均易引起患者情绪不满，最终引起纠纷。因此，药师应从服务水平、专业技术水平以及沟通等多方面进行提高，在临床工作中，学会正确处理药患关系，真正站在患者的立场想问题、处理问题，减少药患纠纷的产生，不仅可以提升医院形象，也能提高患者对医院的满意度，对于构建和谐的药患关系具有重要意义。     

Workload and its impact on community pharmacists' job satisfaction and stress: a review of the literature

Objective The objective was to identify, review and evaluate published literature on workloads of pharmacists in community pharmacy. It included identification of research involving the measurement of pharmacist workload and its impact on stress levels and job satisfaction. The review focused on literature relating to practice in the UK. Methods Electronic databases were searched from 1995 to May 2011. In addition, manual searches were completed for documents not available electronically. The findings were analysed with specific focus on research methodology, workload and its impact on pharmacist job satisfaction and stress levels. Key findings Thirteen relevant studies relating to workload in community pharmacy alone or in conjunction with job satisfaction and stress were identified. One utilised both qualitative and quantitative methods to identify differences in pharmacist workload in retail pharmacy businesses before and after the implementation of the 2005 English and Welsh community pharmacy contractual framework. This indicated that pharmacists spend most of their working day dispensing. The majority of studies suggested community pharmacists generally perceived that workload levels were increasing. Several also stated that increased workload contributed to increasing job‐related stress and decreasing job satisfaction. No studies reporting dispensing rates for community pharmacies in the UK were identified and there was limited evidence concerning time devoted to non‐dispensing services. One study investigated the differences between self‐estimated and actual workload. Conclusions Whilst there is a clear perception that the type and amount of work output expected from individual community pharmacists has been changing and increasing over the last few decades, pharmacists are viewed as continuing to remain based in the dispensary. The impact of such changes to the practice of community pharmacy in the UK is poorly defined, although links have been made to increasing levels of pharmacist job dissatisfaction and stress.     

Supplementary pharmacist prescribers' views about communication skills teaching and learning,and applying these new skills in practice

Objective To explore supplementary pharmacist prescribers' (SPPs') views of communication skills teaching and learning, and its impact on their practice. Method Semi‐structured in‐depth telephone interviews. Key findings A total of 66/143 (46%) pharmacists consented to take part. Of these 66, nine SPPs were purposively selected to represent three different sectors of pharmacy: primary care, hospital and community. Questions for a semi‐structured interview schedule were derived from themes identified from SPP self‐reflective essays submitted earlier in the course. Framework analysis was used to interpret the data. SPPs' views of communication skills teaching and learning were positive. Topics raised as particularly useful were how to structure the consultation, eliciting a patient‐centred history, including the patient's perspective on their situation and/or illness, and working in partnership with the patient. However, interviewees highlighted some practical difficulties with putting these new skills into practice. Conclusions The results indicate that SPPs view communication skills training as changing aspects of their consultation practice. The communication skills identified for further development tended to be those not usually required in traditional pharmacy consultations. The results emphasise the importance of providing communication skills training for extended roles.     

Pharmacists' communication with Spanish-speaking patients: A review of the literature to establish an agenda for future research

BackgroundSpanish-speaking people represent more than 12% of the total population in the United States and are poised to become the largest minority group in the United States by 2015. Although researchers have studied pharmacist-patient communication for approximately 30 years, little emphasis has been placed on the interactions between pharmacists and Spanish-speaking patients.ObjectivesThe objectives of this review are (1) to describe empirical studies on Spanish-speaking patient/pharmacist communication examined relative to patient factors, pharmacist factors, and environmental factors that may influence Spanish-speaking patient/pharmacist communication and (2) to integrate medical and nursing literature to generate a research agenda for future study in this area.MethodsWe compiled articles from a systematic review of (1) CINAHL, International Pharmacy Abstracts, PubMed, and Web of Knowledge databases using “Hispanic limited English proficiency,” “Latino limited English proficiency,” “language-assistance services,” “Spanish-speaking patients,” “Latino patients,” “Spanish-speaking health literacy,” “pharmacy health literacy,” “patient-provider communication,” “pharmacy language barriers,” and (2) bibliographies of selected articles.ResultsThis search generated 1174 articles, 7 of which met the inclusion criteria. We categorized the results into 4 topic areas: “Spanish-speaking patient literacy,” “pharmacists knowledge of/proficiency in the Spanish language,” “pharmacy resources to overcome language barriers,” and “pharmacists' attitudes toward communicating with Spanish-speaking patients.”ConclusionsThese studies provide a macroscopic look at the linguistic services offered in pharmacies, gaps in services, and their subsequent impact on pharmacists and patients. Future research should investigate Spanish-speaking patients' literacy issues, pharmacy staff language skills, factors that influence pharmacists' counseling, and language-assistance programs for pharmacists and patients. Furthermore, these studies need to be conducted in large Hispanic/Latino populated areas where positive service models are likely to be present. Addressing these issues will provide pharmacists and pharmacies with information to overcome language barriers and provide Spanish-speaking patients with quality care.     

Factors influencing patient participation in medication counseling at the community pharmacy: A systematic review

BackgroundFindings document that patient participation in pharmacy encounters is associated with favorable outcomes. However, there is a need to understand factors that may enhance or hinder patient engagement and pharmacist counseling behaviors during their medication discussions. This review aims to: (1) identify barriers and facilitators for patient engagement in pharmacy consultations, (2) explore the relationship between patient factors (such as demographics and communication behavior) and subsequent pharmacist counseling behavior.MethodsA systematic review of literature using PRISMA guidelines examined studies published in English addressing influences on patient participation and the relationship between patient factors and pharmacist counseling behavior. Four databases were used - PubMed, CINAHL, PsycINFO, and Scopus. Findings were framed thematically within the constructs of Street's Linguistic Model of Patient Participation in Care (LM).FindingsFifty studies from 1983 to 2019, including 37 using self-reported data, were identified. Patient involvement in patient-pharmacist communication was influenced by enabling factors such as patient knowledge, communication skills, and pharmacy environment. Predisposing factors for participation ranged from patients' beliefs and past experiences to demographic characteristics such as gender and age. Pharmacists' participative behavior with patients was positively associated with patients’ engagement and perceived patient cues in the conversation.ConclusionThis systematic review identified predictors of patients' engagement in pharmacy encounters drawing on LM framework. Various predisposing factors, enabling factors, and pharmacist’ responses impacted patients' willingness to actively participate in medication counseling at community pharmacies. Equally important, studies documented considerable impact by patients on pharmacists' counseling behavior. Pharmacy encounters should no longer be viewed as controlled simply by pharmacists’ expertise and agendas. Patient characteristics and factors such as patient question-asking and expectations also appear to be associated with and influence patient-pharmacist interpersonal communication. Additional research needs to address the identified facilitators and barriers to enhance patient participation and pharmacist counseling behavior.     

Pharmaceutical consultations in community pharmacies: utility of the Roter Interaction Analysis System to study pharmacist–patient communication

Communication is a key issue in the delivery of healthcare services. In the pharmacy context, pharmacist–patient communication may vary from brief counselling episodes to extensive pharmaceutical care consultations. Many community pharmacies have developed practices to facilitate the effective delivery of pharmacy care, in particular to chronic patients, although the nature and extent of the services differ widely from country to country. Diabetes‐focused pharmaceutical care is an example highlighting both the opportunities and challenges associated with an expansion of pharmacy services from product dispensing to pharmaceutical consultations. An area of particular challenge of such an expansion of pharmaceutical services is the development of expertise in the delivery of patient‐centred pharmaceutical consultations. Although well known to medicine and nursing, patient‐centredness has not been routinely incorporated into the training of pharmacists, evaluation of pharmacy practice or conduct of pharmacy‐related research. There are few studies of the communication process based on analysis of an objective record such as an audio or video recording and the common perspective is largely a one‐way information flow from pharmacist to patient. This has hampered the field's ability to link pharmacy communication to outcomes, including patient adherence and satisfaction with services. An extensive body of communication research on physician–patient interaction, employing the Roter Interaction Analysis System (RIAS), exists and the system presents a potentially useful tool in the pharmacy context. The purpose of this essay is to explore the utility of the RIAS for analysis of pharmacist–patient interaction and its implication for improving patient care and optimizing pharmacy‐specific outcomes.     

Identifying caring behaviors of pharmacists through observations and interviews.

OBJECTIVE: To identify caring behaviors of community pharmacists demonstrated in the pharmacist-patient interaction. DESIGN: Qualitative research. SETTING: Five community pharmacies in the Greater Chicago area. PARTICIPANTS: 8 pharmacists identified as "caring pharmacists" by corporate managers and 13 pharmacy technicians. INTERVENTIONS: Observations of pharmacy personnel interacting with patients and interviews of 2 pharmacists. MAIN OUTCOME MEASURES: Caring behaviors. RESULTS: Four categories of caring behaviors emerged from the observation field notes: physical behaviors (leaning toward patient, smiling, looking patient in eye), relationship behaviors (greeting patients, knowing name, making small talk), task behaviors-nonpharmacy (explaining receipt and money transaction), and task behaviors-pharmacy (providing information, calling physician, asking about allergies and explaining interactions). In interviews, pharmacists said that a caring pharmacist was about "being for the patient," and both noted that caring pharmacists greet the patient, inquire about the patient's health and family, and are sincerely interested in the patient. Mentors and family members are important in developing caring pharmacists, the pharmacists said. CONCLUSION: Specific caring behaviors identifiable among pharmacists and pharmacy technicians. These behaviors can be modeled by pharmacy managers and should be taught in pharmacy schools.     

Why do Australian registered pharmacists leave the profession? a qualitative study

Background Understanding why people choose to leave their professions is important to inform workforce planning to meet community needs. Poor job satisfaction has been linked to health practitioners expressing intentions to leave in other professions such as nursing, occupational therapy and medicine, but little is known about the reasons why pharmacists leave their profession. Objective To explore reasons why Australian pharmacists leave the profession. Setting As part of a survey of the Australian pharmacist workforce, a questionnaire was mailed to all registered pharmacists (n = 7,764) on the registers of the Pharmacy Boards of Victoria and South Australia; 1,627 (21 %) responded. Participants, who were registered but no longer working as a pharmacist, were asked to provide contact details if they were willing to be interviewed for this study; 89 (5.5 %) pharmacists accepted an invitation. A proportionate sample of 20 was selected for the interview. Method A semi-structured interview schedule was developed with probe options which encouraged participants to further explore their responses to questions. De-identified audio records of interviews were transcribed verbatim and thematically analysed. Main outcome measure Reasons why pharmacists leave the pharmacy profession. Results Five themes emerged: (1) Dissatisfaction with the professional environment; (2) lack of career paths and opportunities; (3) under-utilisation of pharmacists’ knowledge and skills; (4) wanting a change; and (5) staying connected with pharmacy. Conclusion These findings provide insights to the pharmacy sector, previously unexplored in Australia, and informs future pharmacist workforce planning. To retain experienced, mid-career pharmacists in the profession, strategies to increase opportunities for career progression, better use of pharmacists’ knowledge and skills and involvement in patient care are required to increase job satisfaction and improve retention rates.     

Pharmacists' perceptions of their role in asthma management and barriers to the provision of asthma services

Objectives Few studies have explored pharmacists' perceptions of their potential role in asthma management. This study aimed to investigate community pharmacists' perceptions of their role in the provision of asthma care, to compare the perceptions of metropolitan and regional pharmacists with regards to their role, to identify barriers to the provision of asthma management services and to explore their level of inter‐professional contact. Methods A 29‐item questionnaire was mailed to a convenience sample of community pharmacists. Items included pharmacists' perceptions of their role in asthma management, barriers to pharmacy asthma services and inter‐professional contact. The setting was community pharmacies in metropolitan and rural New South Wales, Australia. Key findings Seventy‐five pharmacists (63% male, 69% in metropolitan pharmacies) returned completed questionnaires (response rate 89%). Pharmacists perceived their role in asthma management along three major dimensions: ‘patient self‐management’, ‘medication use’ and ‘asthma control’. Regional pharmacists described a broader role than metropolitan pharmacists. Most participants perceived time and patient‐related factors to be the main barriers to optimal asthma care with pharmacist's lack of confidence and skills in various aspects of asthma care less important barriers. Almost 70% indicated that they would like more inter‐professional contact regarding the care of patients with asthma. Conclusions Community pharmacists perceived a three‐dimensional role in asthma care with regional pharmacists more likely to embrace a broader role in asthma management compared to metropolitan pharmacists. Pharmacists identified time and patient‐related factors as the major barriers to the provision of asthma services. Future research should explore barriers and facilitators to expansion of the pharmacist's role in asthma management in a holistic way.     

The relationships among work stress,strain and self-reported errors in UK community pharmacy

BackgroundChanges in the UK community pharmacy profession including new contractual frameworks, expansion of services, and increasing levels of workload have prompted concerns about rising levels of workplace stress and overload. This has implications for pharmacist health and well-being and the occurrence of errors that pose a risk to patient safety. Despite these concerns being voiced in the profession, few studies have explored work stress in the community pharmacy context.ObjectivesTo investigate work-related stress among UK community pharmacists and to explore its relationships with pharmacists' psychological and physical well-being, and the occurrence of self-reported dispensing errors and detection of prescribing errors.MethodA cross-sectional postal survey of a random sample of practicing community pharmacists (n = 903) used ASSET (A Shortened Stress Evaluation Tool) and questions relating to self-reported involvement in errors. Stress data were compared to general working population norms, and regressed on well-being and self-reported errors.ResultsAnalysis of the data revealed that pharmacists reported significantly higher levels of workplace stressors than the general working population, with concerns about work-life balance, the nature of the job, and work relationships being the most influential on health and well-being. Despite this, pharmacists were not found to report worse health than the general working population. Self-reported error involvement was linked to both high dispensing volume and being troubled by perceived overload (dispensing errors), and resources and communication (detection of prescribing errors).ConclusionsThis study contributes to the literature by benchmarking community pharmacists' health and well-being, and investigating sources of stress using a quantitative approach. A further important contribution to the literature is the identification of a quantitative link between high workload and self-reported dispensing errors.     

Exploring the gap: community pharmacists' perceptions of their current role compared with their aspirations

Objective — To investigate community pharmacy managers' perceptions of their role in providing health care to patients and to compare these with their aspirations for the future. Method — Fourteen pharmacist managers from one regional area of a UK national multiple pharmacy chain participated in two focus groups. Key findings — Participants voiced a shared vision of wanting to play a more integral part in the health care of patients. Strategies put forward to embrace a more participative role included delegation of health screening and minor illness clinics from the prescriber to the pharmacist, having more formalised and open channels of communication with prescribers and moving away from performing technical duties, such as the physical assembly of medicines. Participants in both groups showed awareness that apathy and inaction would result in potential opportunities for pharmacy to be lost or passed over to another profession within the primary health care team (PHCT). Two key external obstacles that currently prevented attainment of desired roles were identified: first, a lack of awareness among other health care professionals and the general public about the pharmacist's skills and attributes and, secondly, current UK legislation that limits the potential for community pharmacists to expand their role away from the pharmacy premises. Conclusions — Participants believed that they could provide a more comprehensive pharmaceutical service if given the chance. However, they believed that implementation of change would be difficult considering the obstacles that needed to be surmounted for change to occur.     

Serving multi-ethnic populations: measuring the cultural sensitivity of pharmacy interns in New York City

The cultural sensitivity of pharmacy interns in New York City towards issues associated with serving multi-ethnic populations was examined and measured. Cultural sensitivity included areas such as ability to speak/understand the local language, an understanding of the health needs and problems of different cultural groups and the desire to help patients of different ethnic backgrounds. In general, the 108 pharmacy interns who answered the survey instrument appeared to recognise the importance for practising pharmacists to be sensitive to the needs of ethnic populations. The interns felt that medication compliance, pharmacist-patient relationship, patient satisfaction, patient trust and ability to understand over-the-counter directions would be greater if the pharmacist could speak the language and understand the culture of the customer population. Pharmacy interns of ethnic background and those with multilingual capabilities were found to exhibit greater cultural sensitivity. The results should be useful to educators in preparing future pharmacists for the profession.     

The pharmacy supervisor and the employee pharmacist's job satisfaction

It seems obvious that satisfaction with one's immediate supervisor would have a significant impact on one's general job satisfaction. However, this relationship has received little attention in the pharmacy literature. This study was designed to determine 1) whether there are differences in job-related satisfaction between pharmacists whose immediate supervisors are pharmacists and those whose supervisors are not pharmacists, and 2) whether the occurrence of conflict between a pharmacist and his or her immediate supervisor is related to the employee pharmacist's job and career satisfaction. The most pronounced finding was the importance of supervisors being pharmacists: satisfaction on five of six satisfaction subscales was related to whether one's supervisor was a pharmacist. Moreover, pharmacists who had the fewest conflicts and disagreements with their supervisors were more satisfied with their choice of pharmacy as a career, their employers, their supervisors, and their jobs.     

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.