Identification of the relationship between barriers and facilitators of pharmacist prescribing and self-reported prescribing activity using the theoretical domains framework

Background

The scope of pharmacist practice has expanded in many jurisdictions, including Nova Scotia, Canada, to include prescribing of medications.

Patient perspectives of pharmacists prescribing HIV pre-exposure prophylaxis: A survey of patients receiving antiretroviral therapy

BackgroundGroundbreaking new laws granting community pharmacists the authority to prescribe human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) medications have the potential to substantially expand PrEP access in high-risk communities. However, whether patients will be accepting of pharmacists as PrEP providers is underexplored within the literature.ObjectivesTo assess patient perspectives of pharmacist PrEP prescribing and identify potential barriers to acceptance of pharmacist-prescribed PrEP.MethodsAdult patients currently receiving antiretroviral therapy for HIV prophylaxis or treatment at a specialty pharmacy were surveyed telephonically from January 2020-April 2020. A 4-point Likert scale was used to measure perceptions in addition to open-ended questions.ResultsThe participation rate was 87.5%. Of the 49 included patients, 100% agreed/strongly agreed that pharmacists were knowledgeable about medications, but they were less likely to strongly agree that pharmacists were knowledgeable about HIV drugs (14.3% vs. 75.5% for other drugs, P < 0.001). Most (93.9%) of the patients agreed/strongly agreed that they would feel comfortable seeking a pharmacist for PrEP information or HIV testing. With respect to PrEP prescribing, 16.3% disagreed that they would feel comfortable having a pharmacist prescribe their first fill of PrEP, preferring to speak to their physician or expressing concerns that pharmacists have inadequate training. All patients expressed a desire for additional HIV/PrEP training requirements for pharmacists before allowing them to prescribe PrEP. A portion of the respondents (18.4%) expressed concerns that the increased availability of PrEP would lead to persons becoming lax about barrier protection. However, 100% of the patients agreed/strongly agreed that having pharmacist-prescribed PrEP would benefit their community.ConclusionPatients receiving antiretroviral therapy reported overall favorable perceptions of pharmacist PrEP prescribing; however, some concerns relating to pharmacists’ level of training in HIV exist. This may be ameliorated through increased pharmacist education, including how to counsel patients seeking PrEP on behavioral risk reduction.     

Medication adherence program: Adherence challenges and interventions in type 2 diabetes

ObjectivesTo describe medication adherence problems for adults with type 2 diabetes and to assess the nature and frequency of pharmacist activities in addressing them and proximate outcomes.DesignPre–post analysis.SettingFour community chain pharmacies located in Seattle, WA, from April 2008 to October 2009.Patients120 patients (mean age >60 years) with type 2 diabetes taking oral diabetes medications and who were 6 or more days late for refills.InterventionPharmacist telephone-initiated adherence support.Main outcomes measuresNature and frequency of adherence-related problems and intervention activities and impact on reduction in refill gaps.ResultsThe primary adherence challenge was difficulty taking medications (27.1%). Failure to remember doses and forgetting refills were reported by 24.6% and 26.3% of patients at baseline, respectively. Pharmacists provided support through some form of patient education (35.6% of encounters) or other adherence support (40.7%). Pharmacist time averaged slightly greater than 5 minutes per intervention and 12.6 ±  minutes (mean ± SD) over 12 months, with 3.4 ±  interventions per patient. Patient-specific education and adherence support by pharmacists and total intervention time were positively correlated, with a modest but significant reduction in refill gaps during 12 months of follow-up.ConclusionNot remembering to refill medications was the most commonly reported problem. Patient encounters averaged 4 to 6 minutes for the first visit and 12 to 13 minutes over 12 months. Phone calls by pharmacists to adults who were late for oral diabetes medication refills were effective in identifying adherence-related problems and developing support strategies to promote medication self-management in busy urban community chain pharmacy settings.     

Graduating student pharmacists’ perspectives on e-professionalism and social media: Qualitative findings

ObjectiveTo characterize students’ views and opinions of professionalism on popular social media sites and compare responses about social media behavior among students in different groups.DesignCross-sectional survey.SettingFour colleges of pharmacy in midwestern United States.Participants516 graduating student pharmacists.InterventionsOnline survey with open-ended questions.Main outcome measuresQualitative analysis of responses and themes.ResultsA total of 212 student pharmacists completed surveys (41% response rate). Mean (± SD) age was 25.2 ±  years, and 72% of respondents were women. Major overarching themes identified in the qualitative analysis were separation of personal and professional lives, how accountability for actions should vary by severity, and the extent of representation of the students’ character on social media.ConclusionIdentified themes provided important insights into the ways in which student pharmacists view social media and use this widely accessible means of personal communication.     

Hospital pharmacists’ ethical exposure and decision-making

BackgroundStudies have explored community pharmacy ethical dilemmas; however, limited research exists on hospital pharmacy ethical issues and pharmacists’ ethical decision-making processes. Research exploring this is timely, considering developments in hospital pharmacy practices, new hospital pharmacist roles, and evolving responsibilities.Aim/objectivesTo explore hospital pharmacists’ ethical decision-making and processes for managing ethical challenges in the context of evolving Australian hospital pharmacy practices.MethodsFace-to-face semi-structured interviews with 20 purposively-selected hospital pharmacists from four Queensland Health hospitals. An interview guide with 11 open-ended questions and prompts was developed, validated, and trialed. Pharmacists who consented received the guide prior to interviews. Interviews were audio recorded, transcribed verbatim, and compared with field notes. Transcribed data were imported into NVivo 12 to facilitate coding and thematic analysis.ResultsParticipants were interviewed January to April 2019; median interview duration was 17.45 min. Data saturation was reached. Participants' experiences ranged from junior level pharmacists to senior management positions, in clinical and non-clinical roles. Emerging themes were: 1) influences on the development of ethical decision-making skills, 2) ethical decision-making is an integral part of the hospital pharmacist's role, and 3) institutional requirements and settings impact on ethical exposure. A wide range of contemporary ethical issues unique to hospital pharmacy practice, mostly involving complex medication management safety, supply, and cost scenarios, were identified. Junior pharmacists indicated they would benefit from additional training, mentorship, and availability of hospital-specific targeted ethics resources.ConclusionThe findings highlighted that hospital pharmacists are regularly faced with ethical issues unique to the hospital pharmacy practice context. Application of sound and structured ethical reasoning and decision-making is, therefore, required in this setting. Participants identified many interrelated factors that impacted their ethical reasoning and behaviour. This study identified gaps that, once addressed, will better support ethical reasoning in hospital pharmacy settings.     

The voices of community pharmacists during the COVID-19 pandemic in Puerto Rico

BackgroundCommunity pharmacists have provided health care services uninterruptedly throughout the coronavirus disease 2019 (COVID-19) pandemic. However, their public health role is often overlooked.ObjectivesThe purpose of this article is to discuss the roles and the coping mechanisms of community pharmacists working during the COVID-19 pandemic in Puerto Rico.MethodsA cross-sectional study, using an electronic survey, was conducted to assess the community pharmacists’ response during the COVID-19 pandemic in Puerto Rico. Two open-ended questions explored community pharmacists’ opinions about the pharmacist’s role and coping mechanisms during the pandemic. The responses were analyzed following an inductive thematic analysis. Two major themes emerged from their responses: professional and personal experiences.ResultsOf the 302 participants who completed the survey, 77% of them answered 1 or both open-ended questions. The answers were diverse, and the respondents went beyond the specific topics asked. In professional experiences, important roles as educators and providing continuity of care and emotional support to their patients were highlighted. They also expressed concerns and frustrations on the profession’s shortcomings, feeling overworked yet with a lack of recognition. In personal experiences, most of the respondents were concerned about the impact of having to juggle work and home life. They also reported mental health concerns, expressing feeling stressed, overworked, and worried about the constant risk of exposure and fear of exposing their loved ones.ConclusionCommunity pharmacists in Puerto Rico ensured the continuation of care, provided education, and managed anxious and stressed patients. Most relied on family members to cope with the extra burden that the COVID-19 pandemic. The lack of recognition created resentfulness among participants. It is essential to listen to our community pharmacists’ voices to support and respond to their needs and learn from their experiences as frontline health care workers.     

A novel educational approach for improving medication-related problems in community pharmacies

BackgroundCommunity pharmacists have the responsibilities of identifying and resolving medication-related problems (MRPs), thereby improving patient safety.ObjectivesTo deliver a series of clinical case scenarios using WhatsApp and assess the impact of this method on the ability of pharmacists to identify MRPs.MethodsThis study was conducted in 104 community pharmacies in the United Arab Emirates (UAE) over a period of six months. Recruited pharmacies were randomly allocated to either intervention or control groups using a 1:1 allocation ratio. Senior experts in clinical pharmacy created a series of clinical case scenarios based on their clinical practice and based on previous published studies related to MRPs. WhatsApp®, a well-known messenger application, which has been proven to be an efficient platform to improve communication between learners and educators, was used to deliver clinical scenarios-based educational interventions to pharmacists. Then, pharmacists from both groups filled a standardized data reporting form. The clinical importance of pharmacist recommendations was assessed by a multidisciplinary expert panel.ResultsThe total number of patients with MRPs across the intervention and control groups was 492 versus 194 (p = 0.01). While the number of MRPs identified, the mean time needed to resolve MRPs for patients with major polypharmacy, and physicians' acceptance of pharmacist recommendations across the intervention and control groups were 492 versus 194, 1589 versus 255, 6.82 (±3.86) versus 10.78 (±6.38), and 1065/1284 (82.94%) versus 125/201 (62.18%), respectively, all with p < 0.05. Efficacy-related problems (27.56%) and safety-related problems (28.44%) were the most commonly identified MRPs by pharmacists in the intervention group. Clinically significance of pharmacist recommendations was a significant predictive factor for physicians’ acceptance of pharmacist recommendations.ConclusionClinical case scenarios delivered by WhatsApp may be useful for improving the ability of pharmacists to identify MRPs and for shortening the mean time needed to resolve MRPs.     

Operationalizing occupational fatigue in pharmacists: An exploratory factor analysis

BackgroundThe Quadruple Aim recognizes that caring for the healthcare employee is necessary to optimize patient outcomes and health system performance. Although previous research has assessed pharmacists' workload, this study is the first to describe pharmacist occupational fatigue—a characteristic of excessive workload that inhibits workers’ abilities to function at normal capacity.Objective(s): The purpose of this study was to describe occupational fatigue in pharmacists using exploratory factor analysis (EFA)—assessing whether dimensional structures used to describe occupational fatigue in other health professions fit pharmacist perceptions.MethodsA model was created to conceptualize two “fatigue” domains found in the literature—physical fatigue (ex. Physical discomfort) and mental fatigue (ex. trouble thinking clearly). These domains were operationalized and used to create a survey that was distributed to licensed pharmacists at a conference. An EFA was conducted to identify the key domains underlying pharmacist perceptions of fatigue.ResultsA total of 283 surveys were distributed, and 115 were returned and useable. Respondents were primarily white, female, and worked 9.5 h-per-day on average. The EFA suggested a statistically significant two-factor model (Χ² 9.73, p = 0.28), which included physical fatigue (α = 0.87) and mental fatigue (α = 0.82) dimensions.ConclusionsThe EFA yielded a structure similar to what was anticipated from the literature. While working, pharmacists may not be aware of fatigue related short-cuts or lapses that pose risks to patient safety. This study is just the first step in promoting systematic interventions to prevent or cope with fatigue and prevent the patient, pharmacist, and institutional outcomes.