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.

Health care professionals’ and students’ attitude toward collaboration between pharmacists and physicians in Croatia

Background As traditional roles of pharmacists and physicians seem nowadays insufficient to ensure patient safety and therapy effectiveness, interprofessional collaboration has been suggested to improve health outcomes. Objective To assess and compare the attitudes of physicians and pharmacists, as well as medical and pharmacy students in Croatia, toward interprofessional collaboration in primary health care. Methods The study included 513 pharmacists and physicians, and 365 students of pharmacy and medicine from Croatia. The validated questionnaire, Scale of Attitudes Toward Physician–Pharmacist Collaboration, was translated in Croatian and completed, anonymously and voluntarily, by all participants. Results Pharmacists showed a more positive attitude toward collaboration than physicians (53.8 ± 4.8 vs. 50.7 ± 5.0). Pharmacy students expressed the most positive attitude (56.2 ± 4.9), while medical students showed the remarkably lowest attitude toward collaboration (44.6 ± 6.2). Conclusion Pharmacists and physicians in Croatia expressed a relatively positive attitude toward their collaboration, comparable with their colleges in the USA. On the other hand, medical students expressed a 21 % less positive attitude than pharmacy students which could have an effect on interprofessional collaboration in the future when those students start working as health care professionals. Future studies, focusing on the promotion of this collaboration, on both under-graduated and post-graduated level, are warranted.     

Community Pharmacists as Patient Advocates: Physician Attitudes

ObjectivesTo assess physician attitudes toward community pharmacists acting as patient advocates with respect to drug-related matters, and to correlate physician attitudes with physician characteristics and physician–pharmacist interactions.SettingState of Utah.ParticipantsPhysicians in family practice, internal medicine, pediatrics, and psychiatry.InterventionsMail survey.Main Outcome MeasuresPhysician attitudes toward community pharmacists performing 15 patient advocacy activities, as well as physician–pharmacist interaction and respondent demographics.ResultsFavorable attitudes were identified for pharmacists monitoring drug use, counseling patients, advising physicians, contacting physicians to discuss patients’ pharmacotherapy, and recording over-the-counter product use in patient profiles. Attitudes were less favorable toward pharmacists helping patients manage adverse drug reactions, suggesting drug regimen alterations, providing health screening services, selecting drugs by a protocol, discussing therapeutic equivalents with patients, and changing dosage forms to better suit patient needs. Physician age was negatively correlated with attitude toward a pharmacist aiding a physician in selecting a drug to be prescribed. The helpfulness of physician–pharmacist interactions was positively correlated with physician attitudes.ConclusionFrom the physician’s perspective, the most appropriate areas for expansion of the community pharmacist’s role into patient advocacy are in monitoring pharmacotherapy, assisting physicians in coordinating pharmacotherapy, and providing patients with medication information. Physician resistance is more likely in areas where community pharmacists assume a more autonomous role in patient care.     

Comparison of community and hospital pharmacists' attitudes and behaviors on medication error disclosure to the patient: A pilot study

Objectives

To determine pharmacists' attitudes and behaviors on medication errors and their disclosure and to compare community and hospital pharmacists on such views.

Independent prescribing by pharmacists: a study of the awareness, views and attitudes of Scottish community pharmacists

Aims

To investigate community pharmacists’ awareness, views and attitudes relating to independent prescribing by community pharmacists and their perceptions of competence and training needs for the management of some common conditions.

Setting

Community pharmacies in Scotland.

Method

A pre-piloted postal questionnaire was mailed to 500 randomly selected community pharmacies in Scotland for completion by the ‘main pharmacist’.

Main outcome measures

Scottish community pharmacists’ awareness, views and attitudes towards independent prescribing by community pharmacists; perceived competence and training needs in relation to diagnosis and treatment of conditions in four therapeutic areas; perceptions about patient accessibility to medicines and safety of independent prescribing by community pharmacists; and attitudes towards becoming an independent prescriber. The items regarding perceptions and attitudes were subjected to Principal Components Analysis (PCA) to identify the domains. Univariate analysis was performed on individual items in the questionnaire against total scores on the identified domains; significant variables in univariate analysis were further analysed in linear regression models.

Results

A response rate of 43.4% (217/500) was achieved. Despite expressing confidence in their abilities to become independent prescribers and feeling competent in diagnosing and treating those conditions listed in the questionnaire, clinical training prior to implementation of independent prescribing was regarded important by 211 (97.7%) respondents, while 191 (88.4%) regarded clinical training in drugs used for treating the conditions to be important. Gaining improved patient consultation skills and ability to communicate prescribing actions to GP practices were regarded to be important by 125 (57.9%) and 172 (80.0%), respectively. In PCA, three domains—confidence in independent prescribing, satisfaction with the?current methods of supply, and requirements for the process of independent prescribing were identified. Practising more hours per week as a pharmacist (p = 0.01), supplementary prescribing training (p = 0.02), and involvement in Scottish Executive pharmaceutical care model schemes (p = 0.02), were found to be associated with greater ‘confidence in independent prescribing’.

Conclusion

High awareness of independent prescribing and perceived competence in diagnosing and selecting appropriate drugs for treating many common conditions were identified. Prescribing training with emphasis on evidence-based medicine, generic issues of prescribing and diagnostic and consultation skills is warranted before independent prescribing is undertaken by community pharmacists.     

Development and validation of a measure and a model of general practitioner attitudes toward collaboration with pharmacists

BackgroundCollaboration between general practitioners (GPs) and community pharmacists has been shown to be effective in improving patient outcomes. However, little is known about GP attitudes toward collaborating with their pharmacist counterparts and variables that influence this interprofessional collaboration.ObjectivesTo develop and validate, in the context of primary care in Australia 1) an instrument to measure GP attitudes toward collaborating with pharmacists and 2) a model that illustrates how GP attitudes (and other variables) influence GP-pharmacist collaborative behavior.MethodsThe “Attitudes Toward Collaboration Instrument for GPs” (ATCI-GP) was developed to measure GP attitudes toward GP-pharmacist collaboration based on existing literature and qualitative interviews with GPs and community pharmacists. The ATCI-GP and a previously validated behavioral measure “Frequency of Interprofessional Collaboration Instrument for GPs” (FICI-GP) were included in a survey and administered to a sample of 1145 GPs in 12 divisions of general practice across Australia. Principal component analysis (PCA) was used to assess the structure of the ATCI-GP. Structural equation modeling was used to determine how attitudes (measured by the ATCI-GP) and other variables, influence collaborative behavior (measured by the FICI-GP).ResultsThree hundred and seventy-six surveys were completed and returned for a response rate of 33%. PCA of the ATCI-GP suggested a two factor (“interactional and practitioner determinants” and “role for pharmacist in medication management”) solution accounting for 66.2% of the variance. The model for GP-pharmacist collaboration demonstrated adequate fit (χ²/df = 2.27, CFI = .99, RMSEA = .060, 90% CI [.052–.069]). Factors found to predict collaboration included: 1) Interactional and practitioner determinants 2) environmental determinants and 3) GP perception of the pharmacists' role in medication management.ConclusionsThe study provides evidence for the validity of the ATCI-GP for measuring GP-pharmacist collaboration from the GPs perspective and supports a model for collaboration in which collaborative behavior is influenced by a number of variables.     

Influence of attitudes on pharmacists' intention to report serious adverse drug events to the Food and Drug Administration

AIM

To investigate the influence of pharmacists'' attitudes on intention to report serious adverse drug events (ADEs) to the Food and Drug Administration (FDA).

METHODS

This cross-sectional study used a mail survey to collect data from hospital and community pharmacists practicing in Texas, United States. Three and 16 items were used to measure intention and attitudes, respectively, using a seven-point bipolar scale. Pharmacists'' demographic and practice characteristics, and past reporting were also measured.

RESULTS

The response rate was 26.4% (n = 377/1500 pharmacists). Most pharmacists intended (n = 297, 78.8%) to report serious ADEs that they will encounter to the FDA through MedWatch. Overall, pharmacists held favourable attitudes towards reporting serious ADEs (mean = 24.5, SD = 6.7, possible range 1–49, neutral = 16). Pharmacists intending to report serious ADEs had more favourable attitudes than those who did not (P < 0.001). About 90% of the pharmacists believed that reporting serious ADEs would improve patient safety. However, 72.6% indicated that reporting serious ADEs was time consuming and over half (55.5%) of the respondents believed that reporting serious ADEs disrupted the normal workflow. Non-intenders held stronger beliefs that ADE reporting would disrupt the normal workflow and was time consuming compared with intenders. Years of experience, number of hours worked and practice setting were associated with pharmacists'' attitudes towards reporting (P < 0.05).

CONCLUSIONS

Most pharmacists held moderately favourable attitudes and high intentions toward reporting serious ADEs to the FDA. This study''s findings contribute to an increased understanding of individual factors that influence pharmacists'' attitude and intention towards reporting serious ADEs to the FDA.     

Training and retaining community pharmacy leaders: Career pathways after completing a PGY1 community pharmacy residency affiliated with a large supermarket chain

Objective

To determine pharmacist career paths and resident perceptions after completion of a PGY1 community pharmacy residency with a national supermarket pharmacy chain.

Pharmacist’s knowledge,practice and attitudes toward pharmacovigilance and adverse drug reactions reporting process

Background

Adverse drug reactions (ADRs) are a major cause of drug related morbidity and mortality. Pharmacovigilance is the science that plays an essential role in the reduction of ADRs, thus the evolution and growth of this science are critical for effective and safe clinical practice.

Objectives

This study is considered the first study in the region to evaluate pharmacist’s knowledge, practice and attitudes toward ADRs reporting after establishing the national ADRs reporting center in Jordan.

Method

A cross sectional study was used to evaluate pharmacist knowledge and attitude toward ADRs reporting. A structured validated questionnaire was developed for this purpose and a total of 208 pharmacists were recruited to participate in this study.

Results

The majority of pharmacists have insufficient awareness and lack of knowledge about pharmacovigilance and ADRs reporting. Also the rate of reporting of ADRs was extremely poor. Several factors were found to discourage pharmacists from reporting ADRs, which include inadequate information available from the patient, unavailability of pharmacist ADRs form when needed, unawareness of the existence of the national ADRs reporting system. Also pharmacists think that ADRs are unimportant or they did not know how to report them.

Conclusion

The results of this study suggest that pharmacists have insufficient knowledge about the concept of pharmacovigilance and spontaneous ADRs reporting. On the other hand, pharmacists had positive attitudes toward pharmacovigilance, despite their little experience with ADRs reporting. Educational programs are needed to increase pharmacist’s role in the reporting process, and thus to have a positive impact on the overall patient caring process.     

Hospital pharmacists seen through the eyes of physicians: qualitative semi-structured interviews

Background Pharmacist–physician collaboration can lead to many positive outcomes. However, collaboration between healthcare providers is complex and rarely performed optimally. Objectives To study physician–pharmacist collaboration in hospital settings, from the physician’s point of view. Setting Eight regional non-teaching hospital facilities, within a local area of northwest Switzerland, supplied by an independent central pharmacy. Method Physicians were sampled using a maximal variation purposive method. Qualitative semi-structured interviews were conducted and their content was recorded. Mind maps were made with the collected data. An inductive approach was used for the analysis. Main outcome measure Physicians’ main perceptions of hospital pharmacists. Results Twelve physicians and one medical student were interviewed (average interview length 37 min). Key opinions (n ≥ 7) include the following: physicians lack knowledge about hospital pharmacists’ roles, competences and activities. Physicians report a lack of presence and involvement of hospital pharmacists. Although physicians value hospital pharmacists’ complementary competences, they also point out a knowledge gap between them and that hospital pharmacists lack clinical competences. Some pharmaceutical activities (e.g. drug formulary management or participation in ward rounds) lead to significant drawbacks for physicians. Other pharmaceutical activities (e.g. teaching and supervision) are valued and sought for by physicians. Physicians report they take drug treatment decisions as they bear the legal responsibility. Conclusion The presence, visibility and implication of hospital pharmacists need to be improved, and physicians should be more aware of what they can offer them. Physicians’ expectations and needs should be taken further into consideration and new models of interaction should be developed.