Leadership in a clinical profession

The contributions of residency training programs to pharmacy's development into a clinical profession are described. Residency programs supply institutional pharmacy with mature, highly skilled clinical and managerial practitioners, and ASHP's accreditation process ensures the programs' quality. Residents develop values, philosophy, and vision that breed innovation and advancement of the profession. As pharmacy departments strive to meet the standards set by the accreditation program, the level of services rises; subsequently, higher standards are established and practice advances accordingly. Future residency training for community practice and the movement toward the Pharm.D. as the sole entry-level degree for practitioners must be evaluated in terms of effect on patient care and on pharmacy school and hospital resources. Planning for future pharmacy education and manpower needs should involve the whole profession, but the needs of community and hospital pharmacy may differ. A goal for the future is entry-level residency training for all hospital pharmacists, with the Pharm.D. degree as a prerequisite. Such a residency program would focus on clinical practice and provide experience in all pharmaceutical services and the overall management of a pharmacy department; it would be a prerequisite for advanced specialized residency programs. Managers of departments providing clinical services will need an entry-level clinical residency followed by a specialized residency in administration. In their 25-year history, residency programs have contributed greatly to the profession. Efforts to develop quality residency training sites and promote them to pharmacy graduates should continue.     

Comparison of job expectations fulfillment of BS and entry-level PharmD graduates in hospital and community practice.

Job expectations are an important link between work and subsequent employee mental and physical well-being. Schools and colleges play an important role in the development of job expectations. This role gives them the responsibility of not only technically training students but also instilling in them realistic job previews and career expectations. Failure to do so places the graduate in a state of conflict between the reality of work in his/her chosen career and his/her preconceived expectations regarding the work. This state represents a potential source of job-related stress. BS and entry level PharmD training programs represent two approaches to pharmaceutical education in a practice environment which remains essentially the same for graduates of both programs. As such, there is the potential for a mismatch of job expectations resulting from one or both of the degree types. The present study investigated the following research questions: (i) to what extent are job expectations being fulfilled for pharmacists in hospital and community pharmacy; and (ii) in community and hospital practice, does the fulfillment of job expectations of BS and entry level PharmD graduates differ? Questionnaires were mailed to randomly selected 1980 to 1986 graduates of seven schools or colleges of pharmacy to elicit responses regarding fulfillment of job expectations in their present community or hospital pharmacy positions. The response rate was 48 percent. The subsequent data revealed that pharmacists generally felt that their job expectations were being fulfilled. No differences in overall fulfillment of job expectations were found between BS and entry level PharmD graduates in either community or hospital pharmacy practice.(ABSTRACT TRUNCATED AT 250 WORDS)     

Role of Pharmacy Residency Training in Career Planning: A Student’s Perspective

Pharmacy students typically become more focused on career planning and assessment in the final year of their PharmD training. Weighing career options in the advanced pharmacy practice experience year can be both exciting and stressful. The goal of this article is to provide a primer on how pharmacy students can assess how a residency can fit into career planning. This article will describe the various career paths available to graduating students, highlight ways in which a residency can complement career choices, review the current state of the job market for pharmacists, discuss the current and future plans for residency programs, and present thoughts from some current and former residents on why they chose to complete a residency. Most career paths require some additional training, and a residency provides appropriate experience very quickly compared to on-the-job training. Alternative plans to residency training must also be considered, as there are not enough residency positions for candidates. Directors of pharmacy must consider several factors when giving career advice on pharmacy residency training to pharmacy students; they should provide the students with an honest assessment of their work skills and their abilities to successfully complete a residency. This assessment will help the students to set a plan for improvement and give them a better chance at being matched to a pharmacy residency.Students typically become more focused on career planning and assessment in the final year of their PharmD training. That year is reserved for advanced pharmacy practice experiences (APPEs), in which students rotate for a minimum of 1,500 hours at 9 often unique practice sites under the guidance of a preceptor and additional staff. Throughout this year, the students are exposed to many different aspects of pharmacy including community, ambulatory care, hospital/health system, inpatient/acute care, and elective rotations. The exposure to the different pharmacy practice settings often causes the students to reevaluate or reconsider their chosen career path. In addition, family members, preceptors, friends, and colleagues often inquire about the students’ job plans, further education, or training. This time of exploring career options can be exciting, as well as stressful, for students on the verge of graduation. Often the decisions students make during the final year of the PharmD program are binding for many years following graduation, possibly even limiting their future career goals. Some students may make decisions based on the necessity to pay off a heavy school loan debt or the desire to work in a particular geographic area due to family concerns.Students often request career advice from pharmacy directors, who are acting as either their APPE preceptor or in connection with their employment. The pharmacy profession and job market have changed drastically in the last 10 to 15 years, making a student’s viewpoint on career planning and assessment very different from that of a pharmacy director who has been in the profession for many years. Acting as a mentor, the pharmacy director can help the students explore the following questions: How much school debt do I have? What personal concerns will influence my career plan? What aspects of pharmacy do I enjoy? Where do I see myself in 20 years? How is the profession of pharmacy changing? Should I pursue a residency?To the last question, and as part of the career planning and assessment process, students need to decide whether to pursue a residency or an entry-level pharmacist position upon graduation. Postgraduate residencies are becoming an increasingly popular option as the competition in the job market increases; the additional years of training may provide better preparation for a specific position.Despite the increase in students pursuing residency training, most PharmD students have chosen to work in community practice upon graduation. These practice areas do not require the completion of postgraduate training. According to the 2014 Pharmacy Student Graduating Survey conducted by the American Association of Colleges of Pharmacy (AACP), 5,827 of 9,527 (61%) responding students indicated that they planned to work in a chain community pharmacy upon graduation.¹ For those students entering hospital pharmacy, 3,147 of 9,527 (33%) responding students planned to pursue a staff position. There were 2,461 (25%) responding students who had plans to pursue a pharmacy residency program upon graduation.¹Residency training provides knowledge and experience at a faster pace and in a more systematic manner than can be obtained in an entry-level pharmacist position. Residency training also provides the opportunity for interprofessional collaboration, instills personal and professional confidence, provides avenues in which to advocate for the profession of pharmacy, and broadens clinical decision-making abilities. With the profession of pharmacy becoming an increasingly clinically focused profession, residency training enables a pharmacist to practice at the “top of their license” and provide exceptional patient care. It can also enable a pharmacist to become a sought after candidate by employers.The goal of this article is to provide a primer on how pharmacy students can evaluate the role of a pharmacy residency in their career planning. The article will describe the various career paths available to graduating students, highlight ways in which a residency can compliment career choices, review the current state of the job market for pharmacists, discuss the current and future plans for residency programs, and present thoughts from some current and former residents on why they chose to complete a residency. The information in this article will help students in deciding whether or not to pursue postgraduate education. In addition, this article may provide a helpful student perspective for pharmacy directors as they serve as mentors for students and young pharmacists.     

Advancing patient care through innovative practice: the Clinical Partners Program.

PURPOSE: The development, implementation, and outcomes assessment of an innovative pharmacist-managed ambulatory care and community pharmacy practice clinic are described. SUMMARY: The Clinical Partners Program at The Ohio State University (OSU) provides an active learning environment for students and residents, offers a patient-focused practice model based on pharmaceutical care principles, and serves as an arena for applied research in pharmacy practice. The program offers multiple services, including anticoagulation management, diabetes self-management, cholesterol management, hepatitis C education, herbal product and dietary supplement consultations, medication management, smoking cessation, and wellness. The practice is currently staffed by two faculty members from the college of pharmacy, with a 0.8 full-time-equivalent (FTE) pharmacist and a 0.65 FTE community pharmacy resident. It has served as a training site for 17 pharmacy residents, 28 bachelor of science (B.S.) in pharmacy students, 30 post-B.S. doctor of pharmacy (Pharm.D.) students, and 132 entry-level Pharm.D. students at various levels of training. The most successful methods of reimbursement for programs have been contracted services with OSU Managed Health Care Systems, Inc., which serves OSU faculty and staff and fee-for-service billing, charged directly to non-OSU patients. Numerous studies have shown that Clinical Partners has consistently demonstrated improved therapeutic outcomes over those achieved in traditional practice. Faculty are exploring outreach services, including the development of advanced practice community sites for the college, establishing patient care services within physician offices, and providing disease management services for self-insured employers. CONCLUSION: The Clinical Partners Program has improved patient care and provided education and training opportunities for pharmacy students and residents.     

Salary and entry-level requirements for pharmacy technicians compared with other health technologist and technician occupations in Maryland

ObjectivesPharmacy technician programs are experiencing important transitions to new educational standards, an enhanced accreditation framework, and changing requirements by state boards of pharmacy. The requirements are highly variable from state to state and have practical consequences for the pharmacy workforce in terms of technician recruitment, retention, and satisfaction. Using the state of Maryland as a case report, the purpose of this analysis was to compare the requirements necessary to become either a pharmacy technician or another type of health technologist, including board licensure or registration; training, education or certification or both; and 2016 median salary as reported by the Bureau of Labor Statistics.Data sourcesThis analysis of salaries and job requirements for health technologists and technicians in the state of Maryland was conducted using the Standard Occupational Classification system and the Bureau of Labor Statistics wage data.SummaryNuclear medicine technologists have the highest median salary at $38.50 per hour. No relationship between increasing entry-level qualifications and salary was identified, but pharmacy technicians were found to have the lowest median salary at $15.10 per hour. Although 5 occupations have median salaries greater than $30, 9 have median hourly salaries less than $20, of which 5 have minimum qualifications mandated by statute and regulation.ConclusionPharmacy technicians have the lowest median salary compared with other health technologists and technicians in Maryland. With pharmacy technicians reporting low satisfaction with salary as a reason for intending to leave an employer, implementing mandatory minimum entry-level requirements without a corresponding increase in salary could lead to a reduction in applicants for positions.     

Syrian Pharmacy Students�� Intentions and Attitudes Toward Postgraduate Education

Objective. To investigate Syrian pharmacy students’ intentions and attitudes toward postgraduate study, and to determine and evaluate the factors that influence their preferences.Methods. A questionnaire was developed and used to collect data from final-year bachelor of pharmacy (BPharm) students at Damascus University.Results. Of the 265 students who responded to the survey, approximately 50% intended to work, 25% intended to pursue further study, and 25% were undecided. Personal fulfillment was the factor that most influenced students’ intentions concerning future education. Men were more concerned over their financial future, while women’s intentions were more influenced by scientific issues. The 3 most preferred pharmaceutical areas of further study were biochemistry and laboratory diagnosis, pharmaceutics and pharmaceutical industry, and clinical pharmacy. More students favored pursuing graduate school abroad rather than in Syria. The majority of those who intended to enroll in local graduate programs were interested in academic programs while less than a fifth favored residency programs.Conclusions. The graduate programs in Syria do not appear to satisfy pharmacy students'' ambitions or have the capacity to accommodate the growing demand associated with the rapid increase in the number of pharmacy graduates in the country. Consequently, a majority of students prefer to pursue postgraduate study abroad.     

Assessing factors influencing pharmacy interns career choices in Saudi Arabia

BackgroundThe number of students enrolled in the colleges of pharmacy in Saudi Arabia is high, and the number of pharmacy graduates expected to join the workforce in the coming years is expected to grow. There are limited number of studies that assess factors influencing pharmacy students’ career choices in Saudi Arabia in the literature. The aim of this study was to assess the factors that influence career goals and to investigate students’ perceptions about their career goals.MethodsThis study was a prospective cross-sectional survey targeting PharmD students in their last year (i.e. interns) in the academic year of 2018 – 2019. A questionnaire containing four parts and total questions of 32 was completed by interns. Data collected and analyzed using Qualtrics. This study was reviewed and approved by the Unit of Biomedical Ethics Research Committee at King Abdulaziz University.Results93 were reachable via email and all of them attended the interview and completed the survey (100% response rate). The most important job considerations were: work environment (67.7%), advancement opportunities (55.9%), salary (52.7%), benefits (40.9%), flexible work schedule (34%), and finally geographic region (29%). The top ranked career goal upon graduation were in industry and drug company (35.5%), clinical pharmacy (26.9%), (14%) academics/research and hospital pharmacy setting (inpatient/outpatient) (14%) each, and regulatory and community pharmacy (3.2% and 4.3%, respectively)ConclusionThis study showed that work environment, advancement opportunities, and salary were the most important job consideration for pharmacy interns. The top ranked career goals were industry and drug company followed by clinical pharmacy. Further studies across Saudi Arabia are needed to confirm our results.     

Pharmacy students attitude and perception toward working in community pharmacy in Saudi Arabia

ObjectiveThe objective of this study is to determine the level of attitude and perception of Saudi pharmacy students toward working in community pharmacies after graduation and to assess cultural, educational, and job related barriers and limitations that interfere with students and community pharmacy as a favorable workplace.MethodsA cross sectional questionnaire, was mailed to a random sample of 600 pharmacy students. It included questions on students' future careers, ideal environment and barriers that might face them in community pharmacy.ResultsFour hundreds and twelve (412) completed the survey (response rate was 69%). Mean age was 23 years and 51.2% of respondents were female. Our results revealed low responses toward how interested they are to work in community pharmacy. The study response showed that improvement in salary and money incomes (46%) and culture and society issue (45%) are the two main barrier to make the career in community pharmacy more attractive.ConclusionsSaudi pharmacy students had a negative attitudes and insufficient knowledge about community pharmacy. Pharmacy school would have an important role to fill the knowledge gap and prepare the student to work in the community pharmacy. In order to successfully “Saudization” the community pharmacy setting, efforts should be made to overcome their perceived barriers.     

An Assessment of Recent Pharmacy Graduates' Knowledge and Competency,Professional Practice Functions,and Involvement in Pharmacy Teaching Programs

Study Objectives . To determine self-evaluated professional knowledge and competency, functions, demographic information, lifelong learning, degree and training status, practice sites, involvement in pharmacy teaching programs, and salary for recent pharmacy graduates. Design . A survey of recent Bachelor of Science (B.S.) pharmacy graduates of the University of Wisconsin School of Pharmacy. Measurements and Main Results . A total of 371 B.S. pharmacy graduates (55% response rate) provided information. Graduates who had an advanced degree or training (from many programs) after completing their B.S. pharmacy degree, and those who were teaching in pharmacy programs generally had higher self-rated levels of knowledge and competencies. Hospital pharmacists spent less of their work time in dispensing activities (33.82% ± 30.39%) than community pharmacists (61.04% ± 19.97%; t =8.78, df = 288, p<0.001); community pharmacists spent twice as much of their work time counseling and educating patients (16.65% ± 10.47% vs 7.13% ± 7.39%; t = 9.06, df = 288, p<0.001). The amount of time pharmacists spent in dispensing functions had a negative association with knowledge and competencies in the sections on pharmacokinetic and disease process (r=−0.277, p<0.01), patient communications (r=−0.272, p<0.01), and administrative and economic aspects of practice (r=−0.210, p<0.01) for all respondents. Pharmacists reported that they spent 13.78 ± 14.06 hours per month outside work in professional lifelong learning. There was a negative association between the time pharmacists spent dispensing and the time they spent in professional lifelong learning (r=−0.239, p<0.001), and a positive relationship between the time spent in such learning and the time providing information to prescribers and other health care professionals (r=0.214, p<0.001), monitoring patients (r=0.216, p<0.001), and performing primary care activities (r=0.176, p<0.001). Graduates reported a mean yearly salary of $46,879 ± $8183. More hospital pharmacists were involved in teaching (48, 37%) than those practicing in a community setting (19, 12%). Conclusions . Practice site, advanced degree or training, lifelong learning, involvement in teaching programs, and time spent in various professional functions were associated with pharmacists' self-rated knowledge and competencies. (Pharmacotherapy 1994;14(6):712–723)     

An exploratory study of community pharmacy practice change

OBJECTIVES: (1) To compare the resources and practitioner activities in community pharmacies that have changed practice with those in pharmacies that have not changed; and (2) in pharmacies that have changed practice, to identify factors affecting a pharmacy's ability to support pharmacy practice change. DESIGN: Multiple-case design, in which six pharmacies were studied in depth. SETTING: Six independent community pharmacies in Iowa. PARTICIPANTS: Pharmacy owners. INTERVENTION: A mail survey and an on-site personal interview were used to collect information about the pharmacy's practice changes and influences on the practice change process. MAIN OUTCOME MEASURES: 14 criteria of pharmacy practice change and 5 types of influences on change (environmental variables, organizational variables, owner/manager characteristics, strategy-making features, attributes of change). RESULTS: Three pharmacies had made considerable change, one had made some change, and two had made little or no change. After a broad set of initial changes, subsequent changes tended to be made incrementally. A variety of factors were identified that support pharmacy practice change. Most of the factors were associated with improving resources, such as upgraded staff skills, involvement in demonstration projects, regular environmental scanning, and regular interaction with advocates for pharmacy practice change (e.g., college of pharmacy, pharmacy associations, innovative practitioners). Also, experienced owners who looked to the future and actively addressed constraints were associated with making pharmacy practice change. CONCLUSION: Practitioners and other interested parties should consider a broad array of activities when trying to facilitate pharmacy practice change. Researchers can use these findings to develop studies that will provide stronger scientific evidence that can contribute to a model of pharmacy practice change. The continued study of pharmacy practice change can assist pharmacists working to translate a philosophy of pharmaceutical care into daily practice.     

Career Choices and Preferences of Saudi Pharmacy Undergraduates: A Cross Sectional Study

BackgroundDespite the increasing number of pharmacy schools and their graduates, the healthcare workforce shortage has increased in Saudi Arabia’s pharmacy sector, especially with the opening of new retail pharmacies, industries and pharmaceutical companies, which means that more pharmacist positions have been created with expanded working hours. However, very limited data are available regarding the views and preferences of pharmacy students regarding their future job choices in Saudi Arabia, which may create concerns for licensing organizations, employers and institutions and also gaps between what students want and the vacancies for pharmacists. Therefore, this study aims to identify pharmacy students’ career choices and examine the factors that influence their choices across different pharmacy schools in Saudi via a cross-sectional survey.Materials and methodsA cross-sectional survey was carried out of undergraduates at all education levels at different colleges of pharmacy across Saudi Arabia from October 2017 to March 2018. The questionnaire gathered students’ characteristics and covered the importance of general job considerations for students, their choices and the factors influencing their future career choices and finally the students’ opinions regarding different work settings. The data were analysed using the Statistical Package for the Social Sciences (SPSS).ResultsHospital pharmacies were the preferred area of practice (n = 212: 51.6%), followed by academia and research centres (n = 102: 24.8%), while the pharmaceutical industry and community pharmacies were the least preferred, at 7% and 2%, respectively. Based on the respondents’ characteristics and preferred future career, a multivariate logistic regression revealed that the pharmD students were 4 times more likely to prefer hospital pharmacy posts (odds ratio (OR) = 4.554, p = 0.033) compared with the B-pharm students. Among the factors that influenced the students’ choices were personal interest, in addition to training experience and organizational reputation. The most important job considerations, according to the students, was moving up the job ladder (n = 346; 84.2%), and job openings in a certain field (n = 341; 83%). The Kruskal-Wallis test for nonparametric ordinal data declared detected several significant differences among different pharmacy settings for each item measuring the pharmD and B-pharm students' attitudes and opinions.ConclusionBy identifying these gaps and pharmacy students' goals and needs, we aim to draw the government’s attention to these to ensure a future balance between supply and demand and effective pharmacy workforce planning, which is mandatory.     

Accommodating Pharmacy Students With Physical Disabilities During the Experiential Learning Curricula

Accommodating pharmacy students with physical disabilities during the experiential learning portion of the Doctor of Pharmacy (PharmD) curriculum can present unique challenges for pharmacy schools. The available literature regarding accommodations for pharmacy students in the experiential learning environment is sparse, leaving programs with little guidance. This commentary from the Big Ten Academic Alliance calls on the Academy to create a community of shared resources and best practice examples and offers practical suggestions for accommodating pharmacy students with mobility, vision, and auditory disabilities during introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs).     

Home Medication Reviews in a Patient Care Experience for Undergraduate Pharmacy Students

Objectives. To evaluate the effectiveness of conducting medication management reviews (MMRs) and home medication reviews (HMRs) on improving undergraduate pharmacy students'' pharmaceutical care skills and clinical knowledge.Design. Fifth-year bachelor of science in pharmacy students were enrolled in a structured course in which MMR cases based on real patient scenarios were completed, findings were discussed in groups, and comprehensive feedback was provided by course instructors. Each student was then asked to recruit a real patient through a community pharmacy and conduct an HMR.Assessment. Students’ pre- and post-course scores on the same MMR case improved significantly, with 84.6% of students passing the post-course assessment. Students also completed a new post-course MMR case and 74.8% received a passing score. Students'' answers on a post-course self-assessment showed a significant improvement in their scores regarding knowledge and skills in conducting MMRs and HMRs.Conclusion. Medication management reviews and home medication reviews are excellent tools for educating pharmacy students and providing them with needed actual clinical practice experience.     

Does community pharmacy offer women family‐friendly working conditions and equal opportunities? The accounts of female community pharmacists over the age of 30

Objective The sex mix of the pharmacy workforce has altered significantly over the last 60 years such that in 2005 54% of the practising pharmacy workforce was female. After the age of 30 years, part‐time working is common and it is often assumed that pharmacy working attracts and suits women because it is flexible and family friendly. This paper aims to explore to what extent that is true. Setting This study was based in the North West of England. Method Face‐to‐face interviews (n=30) were conducted with women over the age of 30 years who worked as community pharmacists. The interview schedule was designed to explore: interviewees' motivation for choosing pharmacy; employment history; motivation for choosing a particular pattern of working; views of recent changes in pharmacy; and future career plans. Key findings In line with previous studies this sample of female community pharmacists adopted heterogenous work patterns, and personal and extrinsic structural factors were found to influence work patterns. Importantly, there was evidence of a lack of family‐friendly practices, with antisocial hours, difficulties accommodating annual leave, and the restrictive legislative framework that necessitates that a pharmacist is always present in a store, all affecting work patterns. Conclusion Our study, in contrast to other studies, suggests that for about half of the women interviewed, community pharmacy working was difficult to combine with family commitments. This finding has implications for employers and workforce planners because an increasing proportion of the community pharmacy workforce is female.     

Importance of direct patient care in advanced pharmacy practice experiences

The Accreditation Council for Pharmacy Education issued revised standards (Standards 2007) for professional programs leading to the Doctor of Pharmacy degree in July 2007. The new standards require colleges and schools of pharmacy to provide pharmacy practice experiences that include direct interaction with diverse patient populations. These experiences are to take place in multiple practice environments (e.g., community, ambulatory care, acute care medicine, specialized practice areas) and must include face-to-face interactions between students and patients, and students and health care providers. In 2009, the American College of Clinical Pharmacy (ACCP) identified concerns among their members that training for some students during the fourth year of pharmacy curriculums are essentially observational experiences rather than encounters where students actively participate in direct patient care activities. These ACCP members also stated that there is a need to identify effective mechanisms for preceptors to balance patient care responsibilities with students' educational needs in order to fully prepare graduates for contemporary, patient-centered practice. The 2010 ACCP Educational Affairs Committee was charged to provide recommendations to more effectively foster the integration of pharmacy students into direct patient care activities during advanced pharmacy practice experiences (APPEs). In this commentary, the benefits to key stakeholders (pharmacy students, APPE preceptors, clerkship sites, health care institutions, academic pharmacy programs) of this approach are reviewed. Recommendations for implementation of direct patient care experiences are also provided, together with discussion of the practical issues associated with delivery of effective APPE. Examples of ambulatory care and acute care APPE models that successfully integrate pharmacy students into the delivery of direct patient care are described. Enabling students to engage in high-quality patient care experiences and to assume responsibility for drug therapy outcomes is achievable in a variety of practice settings. In our opinion, such an approach is mandatory if contemporary pharmacy education is to be successful in producing a skilled workforce capable of affecting drug therapy outcomes.     

Regulatory burden and salary for pharmacy technicians in the United States

BackgroundEducation, training, and certification requirements for pharmacy technicians are determined by individual state boards of pharmacy resulting in heterogeneity in the entry-level requirements to practice in the United States (US).ObjectiveTo determine an association between state-level registration/licensure requirements and salary for pharmacy technicians.MethodsAll 50 states and the District of Columbia (DC) were categorized into two groups, high regulation (HR) or low regulation (LR). Salaries were compared using the 2016 hourly salary published by the Bureau of Labor Statistics (BLS). To adjust for cost of living, an index was created using median hourly salary and hourly wage needed to afford a two-bedroom rental for each state obtained from the National Low Income Housing Coalition (NLIHC) 2016 Out of Reach Report. Average median salary and the average salary-housing index (SHI) were compared using a student t-test.ResultsThe sample included 23 H R states and 28 L R states. Salary differences were not significant despite regulatory requirements (LR: $14.74±$1.57; HR: $15.60±$1.80; p-value: 0.065). There was also no difference in SHI scores (LR: 0.83 ± 0.15; HR: 0.88 ± 0.19; p-value: 0.21).ConclusionDespite increased regulatory burden in the HR states, income levels are not significantly higher.     

Pharmacy education in Cuba

Background In Cuba, as in other countries around the world, professional pharmacy has moved from a product orientation (dispensing medications) to a focus on the patient. Aim To provide an overview of the current status of pharmacy education in Cuba. Methods Research was conducted on the historical records of the curriculums used in pharmacy education in Cuba. Results All programs require a minimum of 5 years of postsecondary education prior to attainment of the Bachelor of Science in Pharmacy degree, which is currently the entry-level degree for the profession. The main change currently affecting practice of and education in pharmacy in Cuba is the introduction of pharmaceutical care concept. Conclusions All University Schools of Pharmacy are formally involved in the continuing professional development of practitioners as an important part of the educational life cycle for pharmacists.     

Structural features of pharmacy function--the analysis using structural equation modeling

In order to examine the structural features of community pharmacy function and to clarify areas meriting priority in efforts to expand pharmacy functions in the home care field, a questionnaire survey was conducted. Using the distribution of responses regarding the actual conditions entailed in the 16 categories of pharmacy services, factor analysis was carried out. Structural equation modeling was performed and the fitness of the path model constructed to study the interrelatedness of the individual factors extracted by factor analysis was considered. Four factors comprised pharmacy services "dispensing", "supply of goods", "offering home care", and "cooperation in community health and medical programs". The interrelatedness of four pharmacy functions by the result of structural equation modeling indicated the following insights. 1) By strengthening "cooperation in community health and medical programs", it is possible to directly improve the functions of "dispensing", and "offering home care". An improvement in "collecting and utilizing patient information", "providing appropriate instruction", "providing introductions to medical institutions and physicians", and "supplying over-the-counter drugs" can be expected as a result of direct benefits accrued by "cooperation in community health and medical programs". 2) By strengthening "offering home care", it is possible to directly improve "supply of goods". An improvement in "stocking long-term care goods and sanitary goods" can be expected as a result of direct benefits accrued by "offering home care". In conclusion, this study indicated that the areas meriting priority in the expansion and upgrading of pharmacy functions is stronger "cooperation in community health and medical programs".