Personality Traits of Hospital Pharmacists: Toward a Better Understanding of Factors Influencing Pharmacy Practice Change

Background

The profession of pharmacy has adopted a mandate to become more patient-centred; however, significant change in this direction has not been achieved.

Objective:

To characterize the personality traits of hospital pharmacists in one Canadian province, to provide insights into potential barriers to practice change.

Methods:

A cross-sectional survey of hospital pharmacists was conducted in Alberta, Canada. An invitation to participate was sent to all 766 hospital pharmacists practising in the province’s 2 health service organizations. The survey was based on the Big Five Inventory, a validated, reliable instrument that uses a 5-point Likert scale to measure the traits of extraversion, agreeableness, conscientiousness, neuroticism, and openness.

Results:

Of the 347 pharmacists who completed the survey (45% response rate), the majority (297 [86%]) were staff pharmacists working full time in an urban setting. The average age of respondents was 41 years (standard deviation [SD] 11 years), and the average period in practice was 17 years (SD 11 years). Respondents’ mean scores were 3.2 (SD 0.7) on extraversion, 3.8 (SD 0.4) on agreeableness, 4.0 (SD 0.4) on conscientiousness, 2.5 (SD 0.7) on neuroticism, and 3.5 (SD 0.6) on openness. Total frequency counts revealed that respondents tended toward stronger expression of extraversion, agreeableness, conscientiousness, and openness and low levels of neuroticism (with the latter indicating stability).

Conclusion:

The Big Five Inventory represents a novel approach to examining pharmacists’ change-related behaviours. Improving understanding of hospital pharmacists’ personality traits will provide insights for the development of training and support programs tailored specifically to this group.     

An Inservice Program on Pharmacogenetics to Individualize Drug Therapy

Objectives

To provide an understanding of the principles and applications of pharmacogenetics in drug therapy optimization.

Design

An online learning session accessed using the hospital intranet and a live case-based session were offered to hospital pharmacists, residents, students, and interns.

Assessment

Knowledge was assessed with “check your knowledge” questions, case discussions, and a follow-up questionnaire. Pharmacists evaluated the instructor and the course using an anonymous survey tool.

Conclusion

This education provided pharmacists with a basic understanding of pharmacogenetics and the ability to apply pharmacogenetics to clinical practice.     

2014 CSHP National Awards Program Winners Programme national des prix 2014 de la SCPH : lauréats et lauréates

Background:

Personal smartphones are used frequently by healthcare practitioners in hospitals to assist in the provision of care. The Vancouver Island Health Authority (VIHA) is one of the first health authorities in Canada to endorse the iPhone® smartphone as a potentially valuable tool for clinical practice. We collaborated with the University of British Columbia (UBC) Faculty of Pharmaceutical Sciences to design and conduct our research. To the best of our knowledge this is the first study of its kind in North America.

Objective:

To measure smartphones effect on pharmacists’ efficiency, to assess pharmacist acceptance of corporate smartphones, and to investigate how these devices are being utilized.

Methods:

This multi-center time-trial, survey, and observational prospective study enrolled 90 pharmacists across eight hospitals on Vancouver Island. Participants performed a time-trial of 22 situational drug information questions before and after receiving an iPhone. They also completed both demographic and satisfaction surveys. A subset of 14 of the 90 pharmacists participated in a pre and post iPhone implementation eight hour direct observation study. Lastly, communication data from the phone service provider was collected and analyzed.

Results:

Smartphone use facilitated a statistically significant faster median response time over all the situational time-trial questions combined by approximately six minutes (2895 seconds pre-iPhone vs. 2538 seconds post-iPhone) (p=0.039). Almost half of pharmacists reported that the smartphone increased their confidence and competence to resolve drug therapy problems. Smartphone use did not significantly influence time spent walking to obtain a resource, use of computers, or in the answering of clinical questions in observation.

Conclusion:

Pharmacists readily accepted smartphones into their practice. Despite the lack of impact on direct observation measures of workflow, smartphones improved pharmacists’ efficiency in the answering of hypothetical questions. This research provides sufficient evidence to continue to support the use of smartphones within VIHA’s pharmacy department.     

Patients’ Recall of Interaction with a Pharmacist During Hospital Admission

Background

CSHP 2015 objective 1.5 proposes that at least 50% of recently hospitalized patients or their caregivers will recall speaking with a pharmacist while in the hospital.

Objective:

To determine the baseline prevalence of patients’ recall of interaction with a pharmacist during their hospital admission and their level of satisfaction with these encounters, following a major reorganization of health authorities in New Brunswick.

Methods:

Former inpatients from 27 units in 9 hospitals in the Horizon Health Network were randomly selected to complete a telephone survey within 5 to 7 months after discharge from hospital. Patients’ responses were validated against pharmacists’ documentation in the patients’ health records.

Results:

From June 2010 to July 2011, a total of 1028 former inpatients were screened, of whom 399 completed the telephone survey. More than half of the respondents were women (225 [56.4%]), and the mean age was 67 years. Overall, 184 patients (46.1%) recalled speaking with a pharmacist during their recent admission. Of these, 164 (89.1%) were “satisfied” or “very satisfied” with these interactions. In addition, 332 respondents (83.2%) indicated that if the hospital offered the opportunity to talk with a pharmacist who could help answer their questions about medications, they would take advantage of this service. The electronic hospital records of 181 patients (from 15 units at 3 sites) were analyzed to seek evidence of pharmacists’ interventions or encounters (e.g., medication history, consultation). Pharmacist documentation was found in the health records of 166 (91.7%) of all patients in this sample.

Conclusions:

Almost half of former inpatients recalled speaking with a pharmacist during a recent hospital admission. The majority of patients were satisfied with these interactions and would welcome future services from hospital pharmacists.     

Comparison of Practice Patterns Between Inpatient Cardiology Pharmacists With and Without Added Qualifications in Cardiology

Background:

There is a paucity of data comparing practice patterns between board-certified specialists with added qualifications in cardiology (AQCV) and cardiovascular pharmacists without these credentials.

Purpose:

The purpose is to characterize differences in practice between inpatient pharmacists with and without AQCV.

Methods:

We conducted a multicenter, retrospective, cross-sectional, case-controlled survey. An AQCV pharmacist list was extracted from the Board of Pharmacy Specialties Web site. Hospitals with AQCV pharmacists comprised the case group. Hospitals were excluded if the AQCV pharmacists did not provide direct patient care, practiced in the outpatient setting, or were in a Veterans Affairs hospital. Each case hospital was matched to hospitals without an AQCV pharmacist in a 1:3 ratio (case:control) by region, cardiovascular discharges, and teaching hospital status. Institutions completed a survey characterizing their pharmacy services.

Results:

Fifty-six hospitals completed the survey (21 AQCV, 35 non-AQCV). More AQCV pharmacists participated on rounds (100% vs 82.9%, P = .04) and devoted more time performing administrative tasks (20.5% ± 15.3% vs 11.1% ± 8.1%, P = .001) than non-AQCV pharmacists. Conversely, AQCV pharmacists spent less time providing clinical care (52.4% ± 14.5% vs 66.2% ± 19.8%, P = .007), were less involved with drug protocol management (71.4% vs 91.4%, P = .05), and performed less order verification than non-AQCV pharmacists.

Conclusions:

Practice patterns differ between inpatient pharmacists with and without AQCV. Further research is needed to determine whether AQCV credentialing improves patient outcomes and to delineate what specific tasks performed by inpatient cardiology pharmacists may improve patient outcomes.     

Practice characteristics of bachelor of science and doctor of pharmacy degreed pharmacists based on the 2009 National Workforce Survey

Objective

To compare practice settings and activities of pharmacists with bachelor of science (BS) in pharmacy and doctor of pharmacy (PharmD) degrees.

Methods

Data from the 2009 National Pharmacist Workforce Survey instrument were analyzed. Multivariate regression was used to examine the association of the PharmD degree with time spent in dispensing and patient care.

Results

The survey response rate by pharmacists was 52%, and 562 usable responses met our inclusion criteria. Sixty-three percent of BS and 39% of PharmD pharmacists were employed in community pharmacies, compared with 21% of BS and 38% of PharmD pharmacists employed in hospital pharmacy settings. Practicing in a community setting had the strongest influence on time spent in dispensing and time spent in patient care. Among respondents with PharmD degrees, a residency was associated with less time in dispensing and more time in patient care.

Conclusion

Time spent in dispensing and patient care were influenced more by practice setting than by educational degree and residency training.     

Assessment of the pharmacogenomics educational needs of pharmacists

Objectives

To evaluate the self-perceived knowledge and confidence of inpatient and outpatient pharmacists in applying pharmacogenomics information to clinical practice.

Methods

A 19-question multiple-choice, electronic needs-assessment survey instrument was distributed to 480 inpatient and outpatient pharmacists in a large, academic, multi-campus healthcare system.

Results

The survey response rate was 64% (303). Most respondents (85%) agreed that pharmacists should be required to be knowledgeable about pharmacogenomics, and 65% agreed that pharmacists should be capable of providing information on the appropriate use of pharmacogenomics testing. Sixty-three percent felt they could not accurately apply the results of pharmacogenomics tests to drug-therapy selection, dosing, or monitoring.

Conclusion

Pharmacists believe pharmacogenomics knowledge is important to the profession, but they lack the knowledge and self-confidence to act on the results of pharmacogenomics testing and may benefit from pharmacogenomics education.     

Practice Settings, Job Responsibilities, and Job Satisfaction of Nontraditional PharmD and BS Pharmacy Graduates

Objectives

To assess differences in the practice of pharmacy and in job satisfaction between graduates of a nontraditional doctor of pharmacy (PharmD) program and a bachelor of science (BS) in pharmacy program.

Methods

Two separate survey instruments were mailed to 293 PharmD graduates and 293 BS graduates.

Results

Two hundred fourteen (73.0%) of the 293 nontraditional PharmD graduates and 189 (64.5%) of the 293 BS graduates completed the survey instruments. Nontraditional PharmD graduates expressed greater satisfaction, both in their current position and with pharmacy as a career, compared to BS graduates. Nontraditional PharmD graduates were more likely than BS graduates to practice in a hospital and have more clinical responsibilities.

Conclusions

Nontraditional PharmD graduates are more likely to have greater satisfaction with their job and with pharmacy as a career compared to BS-trained pharmacists.     

Student pharmacists' perceptions of testing and study strategies

Objectives

To solicit student pharmacists'' perceptions of testing, study strategies, and recall ability, and use of retrieval practices in metacognitive learning strategies.

Methods

A 42-item survey instrument was constructed that covered the following areas of interest: perceptions of the purpose of testing, perceptions of study strategies, perceptions of recall ability, use of retrieval practice, and demographic characteristics. The survey instrument was administered to first-, second-, and third-year doctor of pharmacy (PharmD) students (N = 425) at Purdue University.

Results

Students perceived the primary purpose of tests to be to assess the amount of material they had learned. Massed practice was a technique that they frequently used in studying for course examinations. Students did not express confidence in their ability to recall learned information once they became pharmacists. The use of retrieval practice in learning was not used by most student pharmacists, nor did students perceive retrieval practice to increase retention or learning.

Conclusion

Perceptions of testing and the manner in which student pharmacists engage in learning activities may not be optimal for the development of lifelong learners.     

Pharmacists' perceptions of their professional role: insights into hospital pharmacy culture

Background:

Numerous studies have demonstrated the positive impacts of pharmacists on patient outcomes. To capitalize on these positive impacts, hospital pharmacy organizations around the world are now calling on pharmacists to shift their focus from distribution of medications to patient outcomes. This new emphasis is consistent with the vision statement for the profession of pharmacy in Canada, as set out in the Blueprint for Pharmacy: “Optimal drug therapy outcomes for Canadians through patient-centred care”. Given the ambitious nature of this statement and these goals, it is essential to understand what pharmacists currently think of their practice.

Objective:

To conduct a qualitative and semiquantitative analysis of hospital pharmacists’ perceptions of their role in patient care.

Methods:

A researcher posing as a University of Alberta student who was studying how health professionals use language to describe what they do contacted the pharmacy departments of all hospitals in Alberta. The “top-of-mind” approach was used in asking hospital pharmacists 2 questions: (1) How many years have you been practising pharmacy? (2) In 3 or 4 words (or phrases), from your perspective could you please tell me, “What does a pharmacist do”? These techniques were used to minimize the impact of social desirability bias. Content analysis was used to categorize hospital pharmacists’ responses into 4 broad categories: patient-centred, drug-focused, drug distribution, and ambiguous.

Results:

A total of 103 phone calls were made to hospital pharmacies, and 85 pharmacists contacted in this way were willing to participate in the survey. Hospital pharmacists provided 333 individual responses to the question about their activities. Of these, 79 (23.7%) were patient-centred, 98 (29.4%) were drug-focused, and 82 (24.6%) were in the drug-distribution category. Ambiguous responses accounted for the remaining 74 (22.2%).

Conclusion:

Aspects of care categorized as other than patient-centred should not be construed as unimportant. However, the fact that they were reported in this survey more frequently than patient-centred aspects suggests that hospital pharmacists in Alberta may have not fully embraced the concept of patient-centred care as outlined in the Blueprint for Pharmacy.     

Increasing Hospital Pharmacist Clinical Competence in Intensive Pharmacotherapeutics Using a Novel Pharmacist Clinical Educational Program

Background:

Intensive pharmacotherapeutics (IP) is the application of multiple evidence-based practices applied at a patient-specific level, creating the overall best treatment plan in medically complex patients. To practice at this level, a high level of clinical knowledge and competency is paramount.

Objective:

The goal of the pharmacist clinical educational program was to develop an engaging, challenging, and interactive program, which was concise but intense, to improve pharmacists’ clinical knowledge and critical thinking skills.

Methods:

A 12-week educational series was developed and successfully implemented. The primary outcome was a comparison of the proportion of accepted clinical interventions per total number of medication orders reviewed by hospital pharmacists during and after the pharmacist clinical educational program to a 3-month baseline. The secondary outcome was to anonymously gauge participant satisfaction with the program.

Results:

The proportion of accepted clinical interventions increased from 6.4% (at baseline) to 9.1% and 8.7% in the 3 months during and 3 months immediately after the educational program, respectively (P < .01). The overall acceptance rate for clinical interventions remained >90% for all periods. Approximately 94% of respondents (n = 16) indicated that the program met their educational needs.

Conclusions:

The development of a clinical educational program to engage, challenge, and incentivize pharmacists is an essential tool to elevate the practice of IP. By maximizing existing resources, programming can be provided in an efficient and cost-effective manner. As health systems continue to merge on a national level, the methods described here demonstrate a means to provide critical education for both clinical and organizational competency.     

Care providers' satisfaction with restructured clinical pharmacy services in a tertiary care teaching hospital

Background:

At the time this study was undertaken, clinical pharmacy services at the authors’ institution, a tertiary care teaching hospital, were largely reactive in nature, with patients and units receiving inconsistent coverage.

Objective:

To develop an evidence-based model of proactive practice and to evaluate the satisfaction of pharmacists and other stakeholders after restructuring of clinical pharmacy services.

Methods:

The literature was reviewed to determine a core set of pharmacist services associated with the greatest beneficial impact on patients’ health. On the basis of established staffing levels, the work schedule was modified, and pharmacists were assigned to a limited number of patient care teams to proactively and consistently provide these core services. Other patient care teams continued to receive reactive troubleshooting-based services, as directed by staff in the pharmacy dispensary. A satisfaction survey was distributed to all pharmacists, nurses, and physicians 18 months after the restructuring.

Results:

Of the 26 pharmacists who responded to the survey, all agreed or strongly agreed that the restructuring of services had improved job satisfaction and patient safety and that other health care professionals valued their contribution to patient care. Nurses and physicians from units where pharmacists had been assigned to provide proactive services perceived pharmacist services more favourably than those from units where pharmacist services were reactive. Pharmacists, nurses, and physicians all felt that proactive pharmacist services should be more widely available. Challenges reported by pharmacists included increased expectations for documentation and guilt about “cutting back” services where they had previously been provided.

Conclusions:

Restructuring clinical pharmacy services in an evidence-based manner improved pharmacists’ satisfaction and created demand from other stakeholders to provide this level of service for all patients.     

Community pharmacists’ attitudes toward dispensing errors at community pharmacy setting in Central Saudi Arabia

Purpose

The main objective of this study was to survey pharmacists’ attitudes toward dispensing errors in community pharmacy settings in Saudi Arabia.

Methods

A cross-sectional survey of community pharmacists in Riyadh region, Saudi Arabia was conducted over a period of 6 months from March through September 2012. A stratified random sample of eight hundred registered pharmacy practitioners was collected all over Riyadh region. Statistical analysis was done using SPSS version19.0 for windows (SPSS Inc., Chicago, Illinois).

Results

The response rate was almost 82%. The majority of the respondents are young adults (90.2%). The median for years of registration of respondent pharmacists was 9 years (range 1–37 years). About 62% (407) of the respondents have a positive response while only 37.8% (n = 248) have a negative response in this respect. The major factors identified were pharmacist assistant (82.2%) and high workload (72.5%). The most appreciated factors that help reducing dispensing errors are improving doctors’ hand writing and reducing work load of the pharmacist (82.9% and 82.8% respectively), having drug names that are distinctive (76.1%) and having more than one pharmacist in duty (75.5%).

Conclusion

In conclusion, majority of community pharmacists indicated that the risk of dispensing errors was increasing and most of them were aware of dispensing errors. It is obvious from the study results that dispensing errors is a big concern for community pharmacy practice in Saudi Arabia. Therefore, there is an urgent need for the professional organizations and Pharmacy Boards in Saudi Arabia to determine standards for the profession.     

Using human patient simulation to prepare student pharmacists to manage medical emergencies in an ambulatory setting

Objective

To implement a simulation-based educational experience focused on medical emergencies in an ambulatory pharmacy setting.

Design

Second-year student pharmacists were assigned randomly to groups and played the role of pharmacists in a community pharmacy setting in which a simulated patient experienced 1 of 5 emergency scenarios: medication-related allergic reaction, acute asthma attack, hypoglycemia, myocardial infarction, and stroke. The students were expected to use patient assessment techniques to determine which emergency the simulated patient was experiencing and the appropriate intervention. Following each simulation, a debriefing session was conducted.

Assessment

Eighty-two student pharmacists completed the simulation activity. Ninety-three percent of student groups correctly identified the emergency. A post-activity survey instrument was administered, and 83% of responders indicated this activity was effective or very effective.

Conclusion

Simulation of emergencies seen in an ambulatory pharmacy setting allowed students to assert knowledge, practice communication skills, apply assessment techniques, and work as a team in a low-risk environment.     

A guided interview process to improve student pharmacists' identification of drug therapy problems

Objective

To measure agreement between advanced pharmacy practice experience students using a guided interview process and experienced clinical pharmacists using standard practices to identify drug therapy problems.

Methods

Student pharmacists enrolled in an advanced pharmacy practice experience (APPE) and clinical pharmacists conducted medication therapy management interviews to identify drug therapy problems in elderly patients recruited from the community. Student pharmacists used a guided interview tool, while clinical pharmacists'' interviews were conducted using their usual and customary practices. Student pharmacists also were surveyed to determine their perceptions of the interview tool.

Results

Fair to moderate agreement was observed on student and clinical pharmacists'' identification of 4 of 7 drug therapy problems. Of those, agreement was significantly higher than chance for 3 drug therapy problems (adverse drug reaction, dosage too high, and needs additional drug therapy) and not significant for 1 (unnecessary drug therapy). Students strongly agreed that the interview tool was useful but agreed less strongly on recommending its use in practice.

Conclusions

The guided interview process served as a useful teaching aid to assist student pharmacists to identify drug therapy problems.     

Patients’ perception,views and satisfaction with pharmacists’ role as health care provider in community pharmacy setting at Riyadh,Saudi Arabia

Objectives

This study will provide guiding information about the population perception, views and satisfaction with pharmacist’s performance as health care provider in the community pharmacy setting in Riyadh, Saudi Arabia.

Method

The study was conducted in Riyadh, Saudi Arabia, from July through December 2010. A total of 125 community pharmacies in Riyadh city were randomly selected according to their geographical distribution (north, south, east, and west). They represent about 10–15% of all community pharmacies in the city. The questionnaire composed of 8 items about patients’ views and satisfaction with the pharmacists’ role in the current community pharmacy practice. The questionnaire was coded, checked for accuracy and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0 for Windows (SPSS Inc., Chicago, Illinois).

Results

The response rate was almost 85% where 2000 patients were approached and 1699 of them responded to our questionnaire. The majority of respondents is young adults and adults (82.8%), male (67.5%) and married (66.9%). Seventy one percent of respondents assured that community pharmacist is available in the working while only 37.3% of respondents perceived the pharmacist as a mere vendor. About 38% assured sou moto counseling by the pharmacist, 35% reported pharmacist plays an active role in their compliances to treatments, 43% acknowledged the role of pharmacist in solving medication related problems, 34% considered the pharmacist as a health awareness provider and 44.6% felt that pharmacist is indispensable and an effective part of the health care system.

Conclusion

The image and professional performance of community pharmacist are improving in Saudi Arabia. The Saudi patients show better satisfaction, perception and appreciation of the pharmacists’ role in the health care team. However, extra efforts should be paid to improve the clinical skills of the community pharmacists. Community pharmacists need to be able to reach out to patient, assess their hesitations and promptly offer solution which was appreciated by the patients as the survey indicates. They should play a pro-active role in becoming an effective and indispensable part of health care. Furthermore, they should be able to advice, guide, direct and persuade the patient to comply correct usage of drugs. Finally, community pharmacists should equip themselves with appropriate knowledge and competencies in order to tender efficient and outstanding pharmaceutical health care.