Impact of an interactive workshop on community pharmacists' beliefs toward patient care

Background Patient assessment and documentation are less than optimal in pharmacy practice as preparing and dispensing medications is still a major part of community pharmacy practice. Pharmacists?? attitudes, specifically self-efficacy and role beliefs, toward practice have been shown to predict practice change. Objective This study will determine the impact of an interactive workshop on pharmacists?? attitudes toward assessment and documentation in routine pharmacy practice. Specific objectives included how (1) pharmacists?? role beliefs and self-efficacy toward assessment and documentation change after training and rehearsal and (2) frequently do pharmacists assess patient therapy and document patient care? Setting: ??Chat, Check and Chart: patient assessment and documentation demystified?? workshop Alberta College of Pharmacists Annual General Meeting in Calgary, Canada. Methods This study is pre?Cpost evaluation. Quantitative data on self-efficacy and role beliefs toward assessment and documentation was gathered from a validated written survey. Surveys were completed before and after the intervention. The intervention, an interactive workshop, focused on the use of three tools practice and was designed to support pharmacists in achieving the assessment and documentation required by the Alberta College of Pharmacists Standards for Practice. Main outcome measure: Pharmacists?? role beliefs and self-efficacy toward assessment and documentation in patient care. Results Of the 61 eligible pharmacists, the response rate was 61?% (37 pharmacists) with complete data. In the past 2 weeks, 54?% of pharmacists were assessing patients and 32.6?% of pharmacists were documenting greater than half the time. Prior to the workshop, pharmacists ??agreed?? (5.42?±?1.41) with their role in patient assessment and they were ??quite sure?? (4.75?±?1.10) they could assess patients. Pharmacists ??agreed?? (5.13?±?0.890) with their overall role in documentation of patient interactions and reported lower self-efficacy (3.88?±?1.32) for their ability to document patient interactions. After the interactive workshop, there were statistically significant increases in pharmacists?? self-efficacy and role beliefs in regards to both patient assessment and documentation (p?<?0.05). Conclusion This brief interactive workshop increased both self-efficacy and role beliefs towards assessment and documentation, indicating these pharmacists are likely to change future practice. Future research will assess practice uptake and implementation.     

Effects of empowerment on pharmacists' organizational behaviors.

OBJECTIVE: To investigate the effects of power factors, need for achievement, and empowerment on commitment, loyalty, identification, and job turnover intention among pharmacists. DESIGN: Cross-sectional study. SETTING: United States. PARTICIPANTS: 447 licensed pharmacists nationwide. INTERVENTION: Self-administered questionnaire. MAIN OUTCOME MEASURES: Structural equation modeling was used to assess the fit of the theoretical model and examine the effects of empowerment on pharmacists' behaviors within their organizations using pharmacists' self-reports. RESULTS: An overall response rate of 42.2% was obtained. The test of the hypothesized model using structural equation modeling resulted in a satisfactory fit. The effects of power factors and need for achievement on psychological empowerment (gamma11 = .75, gamma12 = .27) and structural empowerment (gamma21 = .81, gamma22 = .20) were examined. Also, the effects of psychological empowerment and structural empowerment on loyalty (beta31 = .05, beta32 = .69), commitment (beta41 = - .09, beta42 = .92), and identification (beta51 = .05, beta52 = .78) were analyzed. Finally, the effects of loyalty (beta63 = -.24), commitment (beta64 = -.74), and identification (beta65 = .35) on job turnover intention were assessed. CONCLUSION: Kanter's theory, which maintains that structures within organizations have an impact on organizational behaviors, was supported by our findings. Pharmacists' organizational behaviors such as commitment, loyalty, identification, and job turnover intention are influenced by structural empowerment. Given the pharmacist supply-and-demand imbalances of the past few years, organizations should make every effort to retain the pharmacists currently in their employ.     

Oklahoma pharmacists' explanations of professional satisfaction and dissatisfaction.

This study examined whether the theoretical constructs of role conflict and incomplete professionalization serve as valid explanations of pharmacists' professional satisfaction or dissatisfaction. A sample of registered pharmacists in Oklahoma responded to a mail-out questionnaire containing indicies designed to measure job satisfaction and professional satisfaction. The questionnaire also included a satisfaction inventory of 17 facets considered to characterize pharmacy as a profession. From the questionnaire respondents, samples of pharmacists demonstrating extreme professional satisfaction and extreme dissatisfaction were randomly selected for telephone interviews. This study found pharmacists' professional satisfaction to be significantly less than satisfaction with their job. The study results would indicate that incomplete professionalization and internalized career goals rather than role conflicts are significantly related to pharmacist professional satisfaction.     

The effects of work setting on pharmacists' empowerment and organizational behaviors

BackgroundIn traditional organizations, power determinants—access to information, resources, opportunity, and support—tend to be accessible only to top management. In today's health market, however, organizations must compete in a dynamic environment that affects the relationship between the individuals and their organization.ObjectivesThe purpose of the study was to examine the effects of work setting on antecedents of empowerment, empowerment, and its consequences: loyalty, commitment, identification, and job-turnover intention.MethodsThe study used a cross-sectional design. A model developed by Kanter is used and extrapolated for the study. A random national sample of 1,200 pharmacists was selected to participate in this research. Self-administered questionnaires were mailed to the subjects' home addresses. For data analyses, structural equation modeling analyses were conducted to test the study model.ResultsA total of 421 usable responses (40.0%) was obtained. Most of the respondents were white, males, and the average age was 47 years. Goodness-of-fit for the overall model was acceptable (SRMR = 0.06, RMSEA = 0.07, CFI = 0.91, and NNFI = 0.88.)ConclusionsConsistent with theoretical considerations, the hypothesized model was significant. Work setting affected empowerment and its consequences. Pharmacists who work in independent community pharmacies were more structurally empowered than their counterparts in hospitals or chain pharmacies. In each setting, organizational commitment and loyalty were significant predictors of job turnover intention. Increasing access to knowledge, opportunity, and support may reduce the likelihood of job turnover among chain and hospital pharmacists.     

Impact of antiemetic selection on postoperative nausea and vomiting and patient satisfaction

STUDY OBJECTIVE: To determine the impact of antiemetic selection on postoperative nausea and vomiting (PONV) and patient satisfaction after ambulatory surgery. DESIGN: Prospective, observational study. SETTING: Ambulatory surgery center in an academic medical center. PATIENTS: Five hundred fifty-four consecutive patients undergoing ambulatory surgical procedures of any kind. INTERVENTION: Data on antiemetic utilization, occurrence of PONV, and patient satisfaction were collected perioperatively. Multiple regression analyses for antiemetic choice were performed. MEASUREMENTS AND MAIN RESULTS: Prophylactic antiemetic therapy was administered to 292 (52.7%) patients, most often with droperidol (200 patients), metoclopramide (134), or dexamethasone (55). Forty-one (7.4%) patients had an episode of emesis in the postanesthesia care unit. Choice of antiemetic was not a significant predictor of PONV. Patient satisfaction for all patients was 9.5 on a 10-point scale, with no agent more or less successful than any other. CONCLUSION: As choice of antiemetic drug given for prophylaxis had little impact on clinical outcome or patient satisfaction, traditional agents should form the core of antiemetics used for PONV prophylaxis in ambulatory surgery patients.     

Impact on patient satisfaction with a structured counselling approach on natural health products.

PURPOSE: Natural health products (NHP) are commonly used by cancer patients. The provision of better information on NHP may improve the patient satisfaction and quality of life. We report the impact on patient satisfaction by routine counselling on NHP. METHODS: Patients visiting the pharmacy of a comprehensive cancer centre for the first time were recruited before (control) and after (intervention) the introduction of routine structured counselling on NHP by pharmacists. The primary endpoint was patient satisfaction. Overall cost and cost per improvement in satisfaction were estimated. RESULTS: 265 patients completed the questionnaires. The average age was about 60 years old, with roughly equal number of men and women. Breast and genitor-urinary cancers made up about 80% of the patients. Nearly 45% of patients had some college or university education. The scores for overall satisfaction and each subscale were all increased in the intervention group. This was statistically significant regarding information on NHP. Counselling was associated with an increase of about 9 minutes of counselling time and a mean additional cost of CDN$7.49 per patient. CONCLUSION: We found increased patient satisfaction with routine counselling on NHP. There was only minimal increase in workload and cost for each counselling section.     

优质护理服务对某二级综合医院住院患者满意度影响研究

目的 调查优质护理服务对某二级综合医院住院患者满意度的影响,为提高护理服务质量提供依据.方法 以分层随机抽样的方式,采用患者满意度调查表对2010年5月至2012年8月968名住院患者进行调查.结果 2010年至2012年患者总体满意度在90％以上,不同年度患者对总体满意度、技术服务水平和管理水平满意度得分差异具有统计学意义（P＜0.05）,且呈逐年升高趋势;2010年患者满意度前三位是入院介绍（87.82％）、服务态度（86.86％）、护士技术操作技术（87.82％）,满意度得分较低的是责任护士介绍（52.88％）、病房管理（59.94％）、病情观察（64.74％,主动巡视）,2012年患者满意度调查各项指标均在85％以上,与2010年比较差异均有统计学意义（P＜0.05）.结论 以病人为中心,开展“优质护理服务示范工程”活动,落实基础护理,改善就医环境,加强护患沟通,强化护理人员的优质服务理念,是医院提高患者满意度的有效途径.     

An instrument to evaluate pharmacists' patient counseling on herbal and dietary supplements

Objective

To develop a measure of pharmacists’ patient counseling on herbal and dietary supplements.

Methods

A systematic process was used for item generation, testing, and validation of a measure of pharmacists counseling on herbal and dietary supplements. Because a pharmacist-patient encounter may or may not identify an indication for taking an herb or dietary supplement, the instrument was bifurcated into 2 distinct components: (1) patient counseling in general; and (2) patient counseling related to herbal and dietary supplements.

Results

The instrument demonstrated high reliability and desirable construct validity. After adjusting for item difficulty, we found that pharmacists tended to provide more general patient counseling than counseling related to herbal and dietary supplements.

Conclusion

This instrument can be applied to assess the quality of counseling provided by pharmacists and pharmacy students, and the outcomes of pharmacist and pharmacy student education on herbal and dietary supplements.     

临床药师用药指导对肾病综合征患儿用药依从性及临床指标的影响

目的： 探讨用药指导对肾病综合征患儿依从性和临床指标的影响。方法： 对2016年12月至2018年12月南京医科大学附属儿童医院80名肾病综合征患儿进行个体化用药指导并进行调查和数据统计分析。结果： 用药指导前（服药1个月）后（服药12个月）患儿的依从性有显著性差异（P<0.05）。看护人文化程度、居住地、是否独生子女分别为影响依从性的独立因素（P<0.05）。患儿的临床指标在指导后得到改善（P<0.05）,且疾病未进展（P<0.05）。结论： 用药指导对肾病综合征患儿依从性和临床指标均有较为显著的影响,药师应通过更加积极的药学干预,提高患儿用药依从性并建立慢病的药学管理。     

Impact on medication use and adherence of Australian pharmacists' diabetes care services.

OBJECTIVE: To assess the effect of a specialized service implemented in community pharmacies for patients with type 2 diabetes on medication use and medication-related problems. DESIGN: Parallel group, multisite, control versus intervention, repeated measures design, with three different regions in New South Wales, Australia, used as intervention regions, then matched with control regions as much as possible. INTERVENTION: After initial training, pharmacists followed a clinical protocol for more than 9 months, with patient contact approximately monthly. Each patient received an adherence assessment at the beginning and end of the study, adherence support, and a medication review as part of the intervention. MAIN OUTCOME MEASURES: Risk of nonadherence using Brief Medication Questionnaire (BMQ) scores and changes to medication regimen. RESULTS: Compared with 82 control patients, 106 intervention patients with similar demographic and clinical characteristics had significantly improved self-reported nonadherence as reflected in total BMQ scores after 9 months. The mean (+/-SD) number of medications prescribed at follow-up in intervention participants decreased significantly, from 8.2+/-3.0 to 7.7+/-2.7. No reduction was observed among the control patients (7.6+/-2.4 and 7.3+/-2.4). The overall prevalence of changes to the regimen was also significantly higher in the intervention group (51%) compared with controls (40%). CONCLUSION: Community pharmacists trained in medication review and using protocols in collaboration with providers improved adherence in patients with type 2 diabetes, reduced problems patients had in accessing their medications, and recommended medication regimen changes that improved outcomes.     

Computer-based patient simulations: hospital pharmacists' performance and opinions.

The performance of pharmacists in using an interactive computer-based patient simulation program and their attitudes toward the simulations are reported. The Institutional Patient Medication Simulation program is designed to enhance and evaluate the medication problem-solving skills of pharmacists. Each simulation consists of patient data-gathering, case question, and therapy decision modules with initial assessment and monitoring nodes. Five simulations were tested: gout, urinary-tract infection, congestive heart failure, antimicrobial prophylaxis in surgery, and hypertension. Pharmacists from nine hospitals were recruited for the study. Participants were asked to perform the simulations within a specified period and to complete attitudinal questionnaires. Of the 91 pharmacists who volunteered, 72 (79%) completed the simulations and the questionnaires. The practitioners indicated that the simulations adequately tested their knowledge and that they would recommend them to colleagues. Performance scores for data gathering were less than 70%, with no significant differences among the simulations. Case question scores exceeded 80% and again were consistent among simulations, whereas therapy decision scores were more variable, with the lowest scores being recorded for antimicrobial-related simulations. Pharmacists with more hospital experience tended to perform better. Pharmacists completing a patient simulation program found the simulations to be worthwhile. Performance scores indicated some difficulty in gathering patient data and showed that correct therapeutic decisions may not always occur even if adequate information is obtained.     

Effects of pharmacists' interventions on patient outcomes in an HIV primary care clinic.

PURPOSE: The effects of pharmacists' interventions on patient outcomes in an HIV primary care clinic were studied. METHODS: All study participants were referred to a pharmacist-managed drug optimization clinic (DOC) in a county-based HIV primary care clinic between November 1, 2003, and September 30, 2004. Patients were eligible for study participation if they were 18 years of age or older and gave informed consent to participate. Pharmacists' interventions were categorized as follows: patient education, addition of a medication, dosage adjustment, discontinuation of a medication, and interpretation of viral-resistance tests. Changes in baseline CD4+ T-lymphocyte counts and viral load were also measured over the study period. Toxicities related to highly active antiretroviral therapy were recorded and graded from 0 to 4, with 0 indicating no toxicity and 4 indicating severe toxicity. Study participants used a standardized survey to measure their own health-related quality of life. Changes in CD4+ lymphocyte counts and viral load were analyzed using Student's t test and analysis of variance. Toxicity grades were analyzed using the Wilcoxon signed-rank test. RESULTS: A total of 34 patients completed the study. Pharmacists made a total of 253 interventions, most of which were categorized as patient education. The mean CD4+ lymphocyte count increased from baseline levels by 54 +/- 78 cells/mm3 over the study period (p < 0.0002). The mean +/- S.D. reduction in circulating viral load over the study period was 1.02 log10 copies/mL ( p < 0.004). CONCLUSION: HIV-infected patients who were managed by pharmacists in a DOC demonstrated significant improvement from baseline in their CD4+ lymphocyte counts, viral loads, and drug-related toxicities.     

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

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