Pharmacy from the perspectives of other health professions: An intervention to foster professional identity among freshmen pharmacy students

BackgroundProfessional identity is crucial for the development of pharmacy students’ professional confidence, learning motivation and future career choices. However, how to develop students’ professional identity in pharmacy education is an underdeveloped field of research. The critical component of professional identity has been considered formed as a result of stepwise socialization. Therefore, pharmacy professional identity might be influenced by associations with other health care professionals, such as physicians and nurses, who are involved in health care collaboration with pharmacists.ObjectivesThis work aimed to investigate the effect of a student-led interview intervention called “Pharmacy from the perspectives of other health professions” as an intervention on pharmacy freshmen’s perceptions and positivity toward the pharmacy profession.MethodsIn this prospective pre/postintervention study, the effect of the interview intervention on students’ job preferences as well as attitudes toward the pharmacy profession and pharmacists’ role in health care was evaluated among 70 first-year pharmacy undergraduates equally divided into intervention and control groups using a self-developed questionnaire.ResultsCompared with the controls, the numbers of respondents reporting no specific reasons for selecting the pharmacy profession and stating that they were unclear about their preferred post-graduation work sector were significantly reduced after the intervention. Participating in the intervention increased the number of students who agreed or strongly agreed that they would have a fulfilling and socially respectable career. Significantly more students in the intervention group agreed with the pharmacists’ role in health care as well as the current situation of pharmacy human resources than in the control group.ConclusionThis student-led interview intervention could be applied as an effective tool for improving students’ professional identity and positivity in pharmacy education.     

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.     

Supporting patients with mental illness: Deconstructing barriers to community pharmacist access

Objectives

To discuss the barriers faced by individuals with mental health conditions attempting to access their community pharmacists and to propose solutions toward deconstructing those barriers.

The impact of professional socialisation on pharmacy students' role perceptions

Objective — To evaluate pharmacy students' perceptions of the relative status of seven health professional groups: dentists, general medical practitioners (GPs), medical specialists, nurses, pharmacists, physiotherapists and social workers Method — A 56-item questionnaire was sent to 389 pharmacy undergraduate students, from the University of Queensland, Australia, and the Queen's University of Belfast, Northern Ireland Key findings — In comparison with their Australian counterparts, students from Northern Ireland rated pharmacists significantly higher, and GPs, medical specialists, physiotherapists, and social workers significantly lower, on a measure of overall professional status. Respondents also rated pharmacists significantly higher, and GPs, physiotherapists and social workers significantly lower, on a professional potency dimension to the status measure. However, both student groups ranked pharmacists first on a receptivity dimension to the status measure, indicating their perception of pharmacy as an empathetic profession. Medical specialists were uniformly rated highest of the professions on the potency dimension and lowest on receptivity Conclusion — It is posited that differences between the students' perceptions of the health professionals reflect both cultural and educational differences     

“There's very little that you can do other than refer them to the doctor if you think they've got postnatal depression”: Scoping the potential for perinatal mental health care by community pharmacists

BackgroundTwenty percent of women in the UK develop perinatal mental health (PMH) problems, which have widespread effects on maternal and child health. Community pharmacists are ideally placed to identify PMH problems and refer to other trained healthcare professionals.ObjectiveThis study explored community pharmacists’ attitudes, current counselling practices, and barriers to providing mental health advice to perinatal women.MethodsA qualitative focus group study was performed virtually with community pharmacists (n = 11), working in urban settings across London. A topic guide was used to cover current counselling practice, barriers to and confidence in counselling women, and thoughts on potential pharmacist-led perinatal mental health services. The focus groups were recorded, transcribed, and analysed using thematic analysis.ResultsThree themes were identified: Doing Mental Health Care; Willing, but Unable; and Introspection and reflection, which were related through a central organising concept of ‘Perinatal mental health care as a new frontier for community pharmacy’. It was found that while community pharmacists provide mental health advice to perinatal women and their partners, they lacked confidence, which was related to a lack of knowledge and inadequate training opportunities. Organisational barriers were identified including a lack of a formal referral pathway to existing mental health services and other trained healthcare professionals. Perceptions of opportunities and recommendations for service improvement and change were also garnered.ConclusionThis study demonstrates community pharmacists have a potential role within community mental healthcare in identification of PMH problems and providing appropriate advice and support. Upskilling community pharmacists in mental health should be considered to increase knowledge and confidence while formal referral pathways to other trained healthcare professionals and existing services should be established and made available to pharmacists.     

Community pharmacy in Australia: A health hub destination of the future

BackgroundRates of chronic illness are rising in Australia and as medications are frequently used in the management of a range of chronic conditions, community pharmacists are in an ideal position to better assist these consumers. There is currently limited information as to how pharmacy can do this from the perspective of consumer health organizations, health advocates and professional support organizations.ObjectivesTo explore new roles, opportunities and any associated barriers for community pharmacy to better assist consumers with chronic illnesses.MethodsRepresentatives of non-government consumer health organizations (n = 10) were interviewed from the key health priority areas emphasized by the Australian government. Health advocates (n = 3), innovative health care professionals (n = 4) and representatives of health care professional organizations (n = 4) from pharmacy and medicine also participated. Interviews were analyzed via thematic analysis.ResultsTwenty-one in-depth interviews were conducted. The core finding was the potential for community pharmacies to become a health hub destination, whereby pharmacy staff assist consumers with chronic conditions to: navigate the health system (e.g., provide information on support services), manage their medications, and provide health advocacy. Participants expressed their concern that consumers may not be aware of the breadth of the pharmacist's expertise and that further collaboration is needed with non-government consumer health organizations and other health providers. Emphasis was placed on the improvement of the pharmacist's current role, particularly in the area of medication advice and accessibility, with the current pharmacy remuneration model identified as a barrier to becoming a health hub destination.ConclusionThe eventual progression toward a health hub destination was seen to be important to better assist consumers with chronic conditions. This focuses on a more proactive approach to care encompassing simple advice, referrals to consumer health organizations and ultimately, health advocacy. However, further research is required into how community pharmacy can become a health hub given that this is a new concept and there are existing professional barriers.     

The changing roles of pharmacists in community pharmacies: perception of reality in India

Aim of the review To summarise the state of community pharmacy in India including: the provision of patient care, pharmacy education, the pharmaceutical market, healthcare delivery, community pharmacy services, the professional role of community pharmacists, and future developments. Method Medline, Scirus, and Google Scholar databases and the journals “Indian Journal of Pharmaceutical Sciences” and “Indian Journal of Hospital Pharmacy” were searched up to the end of December 2008. In addition to these, other available sources were used to identify relevant articles. Results India has a fast growing pharmaceutical industry sector and a need for well educated pharmacists. Domestic sale of medicines is estimated to be $5 billion during 2006 and increasing. The supply of medicines to the population is undertaken by privately owned community pharmacies and sometimes also by hospital pharmacies. Community pharmacists are involved only in dispensing medicines. Community pharmacists have an opportunity to improve healthcare of the population, particularly of the disadvantaged section of the society that does not have the resources to visit clinics (both the poor and rural population). However, important barriers to the provision of pharmaceutical care exists, including lack of proper education and training of pharmacists, weak implementation of existing laws, and lack of recognition of the pharmacy as a profession by the other healthcare professionals. Conclusion The healthcare services in community pharmacies, currently insignificant, must undergo reforms to meet the changing needs of modern medicines users. The pharmacist’s role in patient care is expected to grow as professional and educational standards develop. Although pharmacists’ contributions to health care are not yet recognized, there is every reason to be optimistic toward making patient care in community pharmacy setting a success. For this, the educational system for pharmacists has to be adapted.     

Making the Most of a Professional Meeting

The Director’s Forum series is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. During the early winter months, pharmacists will converge upon a major city and participate in the Midyear Clinical Meeting (“Midyear”) of the American Society of Health-System Pharmacists. This meeting involves almost 21,000 students, residents, and new and seasoned professionals catching up with colleagues and classmates, networking for better practice solutions, and presenting their organization’s successes. In this era of fiscal restraint, many hospitals are reducing travel expenses and limiting the participation of their staff in professional meetings. In the past, professional meetings may have been seen as a boondoggle, but they can benefit individuals at all stages of their career (student, mid-level, and late careers). Students can make vital career decisions through information received at professional meetings, mid-level career individuals will gain valuable ideas for practice model enhancement, and late career individuals can provide mentoring for younger and mid-level career professionals. If properly managed, attendance at a professional meeting can have very positive benefits on the career growth of pharmacy staff and help in the pharmacy department’s development of effective patient-centered services.The American Society of Health-System Pharmacists (ASHP) sponsors 2 professional meetings a year with the purpose of uniting past colleagues and friends, creating new knowledge through education sessions, and promoting the important role of health system pharmacy to the media and public. Historically, ASHP sponsored the annual meeting in June to conduct the business of the Society: instating officers, voting on new policies and procedures, and honoring members with awards. To recognize ASHP’s clinical achievements and their focus on patient-centered pharmacy services, ASHP also sponsors a December meeting, which is known as the Midyear Clinical Meeting or Midyear.The Midyear is the world’s largest gathering of pharmacists, with some 21,000 pharmacists, students, and others attending. This meeting has become a world stage for pharmacy, and most pharmacy directors budget for 1 or more members of their staff to attend. Depending on the location, a pharmacist attending a Midyear meeting may cost an organization upwards of $2,500 to $3,000 for their travel, registration, food, and lodging. For departments that have residency programs, that are recruiting for positions, or have staff who are presenting papers, as many as 5 to 10 department members may attend the Midyear. The cost of this attendance becomes a budget figure that some administrators may be hesitant to support, given the climate of cost-containment in health care.The participation of pharmacists is growing in other professional organizations and medical societies. For example, the Society for Critical Care Medicine (SCCM) has established a section for pharmacists and has had pharmacy participation in their meetings since the 1980s. SCCM grants fellowship status to pharmacists (FCCM) and has even elected a pharmacist as president (Dr. Judith Jacobi). Infectious diseases, nutrition, and burn medical society meetings are open to pharmacists, but many have very costly registration and lodging fees. As the specialty interests of the pharmacist staff grow, the director of pharmacy will have to determine what meeting or meetings to fund. He or she will also have to justify the cost of attendance.Professional meetings can have great benefit for pharmacy staff and the department. This article will (1) describe the importance of attending professional meetings; (2) discuss pre-planning in advance of attending a professional meeting; (3) detail how attendance at a professional meeting differs for students, new practitioners, and mid- and late-career pharmacists; and (4) describe how information gathered at a professional meeting can contribute to personal and department growth. As pharmacy budgets become tighter and as discretionary money for travel to professional meetings is reduced, pharmacy directors must continue to justify the expense of meeting attendance to hospital administrators and staff. If properly managed, attendance at professional meetings can have very positive benefits on individual career growth and can help the department to develop effective patient-centered pharmacy services.     

Pharmacists' awareness of Australia's health care reforms and their beliefs and attitudes about their current and future roles

Objective To explore pharmacists' awareness of Australia's health care reforms and their beliefs and attitudes about their current and future roles. Methods Four focus groups were conducted with 32 South Australian pharmacists: two groups included community pharmacists and pharmacy owners; one included hospital pharmacists and another, consultant pharmacists. Key findings Four themes emerged: (1) poor awareness of health care reform agenda; (2) strong adherence to the supply model; (3) lack of appreciation of alternative models; and (4) communication barriers. Conclusions Participants' low awareness of Australia's health care reforms and their expressed beliefs and attitudes to their current role in the health system suggest that they are not well prepared for the potential future roles expected of health professionals in the health care reform agenda.     

Harvey A.K. Whitney lecture. Taking charge of the profession

The relationship between pharmacists' attitudes toward the profession and their career opportunities is described. Pharmacists must be committed to the idea that pharmacy is an essential component of health care. Pharmacy education needs to instill an attitude of service and excellence and an expectation of success. Social, political, economic, and professional change has challenged fundamental assumptions and values that made life predictable in the past. Pharmacists have permitted others to establish the scope and limits of professional pharmacy practice; it is time for pharmacists themselves to determine the future of their profession by focusing on providing services to fulfill unmet health-care needs. The profession as a whole will suffer if pharmacists view certain practice roles or settings as inferior. When all pharmacists accept "drug-use control" as the primary ethic that drives pharmaceutical decisions, the public, the government, and other health-care providers will respect that role for pharmacists. Studying the pharmacy literature can enhance pharmacists' positive feelings about their contributions. Pharmacists alone are responsible for the status of the profession and for changing what needs to be changed. By changing their thinking about the profession, pharmacists can broaden their career opportunities.     

Recurrent education for pharmacists to support regional medicine

New-generation pharmacists who graduate from the 6-year pharmacy education program will come into being in Japan in 2 years' time. The new program regards technical skills and caring attitudes suitable for healthcare professionals as important, as well as expert knowledge. Pharmacists are expected to become more involved in pharmacotherapy and patient care to overcome rural physician shortage and achieve better outcomes in pharmacotherapy. Pharmacists themselves also want to contribute to improve pharmacotherapy and patient care. Pharmacists educated with the former 4-year education program, however, hardly had a chance to learn clinical pharmacy or pharmaceutical care when they were pharmacy students. They have so far studied clinical knowledge, skills, and attitudes by themselves mostly after graduation. Therefore most pharmacists have not received systematic education or training about clinical pharmacy. Pharmacy schools employ pharmacists and physicians as professors, and built practical rooms for pre-clinical training to study pharmacy practice in recent years. We should use those human resources and laboratory equipment in pharmacy schools to facilitate recurrent education for pharmacists. Internet-based real time remote lecture is also useful for pharmacists working far from pharmacy schools to attend a recurrent class. I propose an education system in which pharmacists who completed the recurrent education program teach students pharmacy practice in their worksites, and both pharmacists and students are developing their practical skills to a high degree together.     

“A little bit more looking…listening and feeling” A qualitative interview study exploring advanced clinical practice in primary care and community pharmacy

Background Growing demands on healthcare globally, combined with workforce shortages, have led to greater skill mix in healthcare settings. Pharmacists are increasingly moving into complex areas of practice, a move supported by policy and education/training changes. Aim To understand the nature of extended roles for pharmacists practising at an advanced level in primary care and community pharmacy settings, to explore how clinical and physical examination was incorporated into practice and to understand the impact of providing such examination on practice and on patient relationships. Method Telephone interviews (N?=?15) were conducted with a purposive sample of pharmacists using clinical and physical examination in their practice in Great Britain. The sample included primary care pharmacists (N?=?5), community pharmacists (N?=?4), pharmacists working across settings (N?=?5) and one working in another primary care setting. Participants were recruited through professional networks, social media and snowballing. Results Primary care pharmacists and community pharmacists were utilising clinical and physical examination skills in their practice. Some community pharmacists were operating locally-commissioned services for low acuity conditions. Incorporating such examinations into practice enabled pharmacists to look at the patient holistically and enhanced pharmacist/patient relationships. Barriers to practise included lack of timely sharing of patient data and perceived reluctance on the part of some pharmacists for advanced practice. Conclusion With growing opportunities to provide patient-focussed care, it remains to be seen whether pharmacists, both in Great Britain and elsewhere, are able to overcome some of the organisational, structural and cultural barriers to advanced practice that currently exist in community pharmacy.

     

Clinical pharmacy interventions: an optimum way to accomplish positive patient care outcome

In this age of demand for optimum quality of care and shortened length of patient stay in the hospital, the opportunities for clinical pharmacy interventions are enormous. Pharmacists, with their unique background in clinical therapeutics, can make a significant difference in patient outcome. As in our case, initially there may be some skepticism among some of the physicians about the intent of pharmacy interventions. However, pharmacists' continual striving for improvement of quality of care can persuade skeptical physicians to consider pharmacists as their allies in achieving optimum quality of care. At our institution, our consistent approach has resulted in support from our physicians. Continuous feedback from managers to staff pharmacists (our monthly performance review feedback program) also helps to continue consistency of the program. The recent focus of the Joint Commission on optimum quality of care has also created an arena of tremendous opportunities for pharmacists to work with the physicians and other health care professionals to accomplish excellence in quality of care.     

Pharmaceutical Policy and the Pharmacy Profession*

In this article, the authors look at the relationship between pharmaceutical policy and the pharmacy profession with focus on pharmacy practice and pharmacists in the health care sector. Pharmaceutical policy encompasses three major policy inputs: public health policy, health care policy and industrial policy. In order to analyse and understand pharmaceutical policy, it is important to know how policymakers view pharmacy and pharmacists. The authors look at the issues that arise when policy regulates pharmacy as a business, and what this means for the profession. The perspective of pharmacy as a health care profession, as well as what it means when we view pharmaceutical policy in the context of the health sector labour market, is discussed. The authors also discuss how factors external to the profession are affecting its purpose and realm of practice, including the current trend in managerialism, and how the division of labour with other health professionals such as physicians and pharmacy assistants is affecting the pharmacy profession’s position in the labour market. Next the authors look at ways in which the pharmacy profession has affected policy. Pharmacists have been instrumental in developing new and expanding roles for the profession, sometimes inspired by external events, but often as a result of their own prerogative. The pharmacy profession is encouraged to take a leading role in forming and contributing to policy, in this way making visible its contribution to society in general and public health in particular. If not, the profession will forever be reacting to policy and will remain at the mercy of policymakers and other strong actors in society. This article is the fifth in a series of articles on this topic that will appear in Pharmacy World & Science during 2005.     

Enhancing community pharmacy through advanced pharmacy practice experiences

The pressures driving the need for an expanded practice scope in community pharmacy have been building for the past 2 decades. Many pharmacists have chosen to embrace the pharmaceutical care model in their practice sites to meet patient and healthcare system needs. The potential for medication therapy management (MTM) services provide an additional career opportunity for pharmacy graduates. Colleges of pharmacy offer advanced pharmacy practice experiences (APPEs) in the community setting that are designed to prepare students for these opportunities. These sites provide students with the opportunity to observe the integration of pharmaceutical care activities into community practice. Although developing an APPE site is challenging, serving as a preceptor benefits the students, the site, and the patients served. Therefore, colleges of pharmacy and community pharmacists are collaborating to increase the number of APPE sites to prepare pharmacy students for practice today and tomorrow.     

European barriers to the implementation of pharmaceutical care

Objective — To establish the perceived barriers to the implementation of pharmaceutical care into community pharmacy practice in different European countries and the relative importance of these barriers. Method — Structured interviews with representatives from national pharmacists' organisations or pharmaceutical care researchers from 11 European countries known to be actively attempting to implement pharmaceutical care. Respondents were asked to consider a list of 25 potential barriers to pharmaceutical care and to score the relative importance of each for their own country. Data were analysed to produce a European overview of barriers as well as inter‐country comparisons. Key findings — Lack of time and lack of money are major barriers for the implementation of pharmaceutical care in European countries. Many other barriers were identified, but their impact on the implementation of pharmaceutical care seems to differ markedly over Europe. No correlation was found between money and time as barriers. Some clusters of countries were identified with similar barrier patterns. Conclusion — Time and money are perceived to be major both in absolute and relative rankings. The European pharmaceutical associations need to pay attention to remuneration issues before attempting to implement pharmaceutical care in their countries. The results also show that pharmaceutical organisations need to work continuously to change attitudes among pharmacists. Important barriers have also been identified in the educational domain and changes in the European curriculae for pharmacy are therefore needed. Co‐operation between some countries on these issues would appear to be useful.     

Addressing the global need for public health clinical pharmacists through student pharmacist education: a focus on developing nations

It is time for pharmacists to begin advancing their roles in public health and play a more integral part in public health initiatives. Within developed nations, the profession has demonstrated its value in advancing preventive care; however, the same cannot be said for pharmacists worldwide. Emphasis on training public health pharmacists should also be on developing nations, where the need for preventive care is highly unmet. To ensure all graduating pharmacists are prepared to engage in public health activities, education in this field must be provided during their main years of pharmacy school. In conclusion, public health education should be incorporated into pharmacy curriculae within developing nations so all pharmacy graduates are prepared to engage in public health activities.     

Pharmacist independent prescribing in secondary care: opportunities and challenges

In recent years a number of countries have extended prescribing rights to pharmacists in a variety of formats. The latter includes independent prescribing, which is a developing area of practice for pharmacists in secondary care. Potential opportunities presented by wide scale implementation of pharmacist prescribing in secondary care include improved prescribing safety, more efficient pharmacist medication reviews, increased scope of practice with greater pharmacist integration into acute patient care pathways and enhanced professional or job satisfaction. However, notable challenges remain and these need to be acknowledged and addressed if a pharmacist prescribing is to develop sufficiently within developing healthcare systems. These barriers can be broadly categorised as lack of support (financial and time resources), medical staff acceptance and the pharmacy profession itself (adoption, implementation strategy, research resources, second pharmacist clinical check). Larger multicentre studies that investigate the contribution of hospital-based pharmacist prescribers to medicines optimisation and patient-related outcomes are still needed. Furthermore, a strategic approach from the pharmacy profession and leadership is required to ensure that pharmacist prescribers are fully integrated into future healthcare service and workforce strategies.     

Provision of clinical pharmacy services during the COVID-19 pandemic: Experiences of pharmacists from 16 European countries

BackgroundThe pharmacy profession has an important role in the frontline healthcare response to COVID-19 across all settings.ObjectiveThis study sought to explore the views and experiences of clinical pharmacists in relation to the provision of clinical pharmacy services during COVID-19.MethodsSemi-structured qualitative interviews were conducted with pharmacists working in clinical roles in healthcare settings across Europe. Participants were recruited through professional organisations of clinical and hospitals pharmacists combined with a snowballing technique. The Pharmacy Emergency Preparedness and Response Framework and Disaster Preparedness Framework for pharmacy services were used to generate data which were analysed using the thematic framework method.ResultsTwenty-two participants from 16 European countries described a range of measures to protect patients, public and healthcare staff against virus transmission including developing and disseminating educational materials. Most described their involvement in aspects of evidence provision such as facilitating clinical trials, gathering and appraising evidence and disseminating clinical information. Many hospital-based pharmacists were reassigned to new roles such as intensive care. Routine clinical services were extensively interrupted and remote forms of communication were used. Most were motivated by a strong sense of professionalism to continue delivering services. A number of facilitators and barriers to prevention, preparedness and response actions were identified which related to uptake of new roles, recognition of pharmacists roles in the healthcare team, information gathering, communication with patients and healthcare professionals, and provision of routine clinical services.ConclusionsParticipants in this multinational qualitative study described a range of service adaptations and adoption of novel roles to prevent and mitigate the public health impact of the pandemic. The study findings may help to inform governments, public health agencies and healthcare systems in harnessing ongoing service provision and adapt to any future interruptions.