Characterizing specialized compounding in community pharmacies

BackgroundCompounding is a traditional role of pharmacists that declined with the availability of manufactured medicines. Compounding is now increasingly offered by community pharmacies as a specialized service, and there are calls for regulatory and practice standard changes. However, the characteristics of specialized compounding are not well understood.ObjectivesThe objective of this study was to conduct an in-depth exploration of the motivations, experiences, and practices of pharmacists who deliver “specialized compounding services” in Australian pharmacies.MethodsIn-depth interviews of 18 pharmacists responsible for compounding in pharmacies offering specialized compounding were conducted using a semistructured interview guide based on an organizational framework. Participants were selected using purposive sampling. Characteristics of specialized compounding practice compared with routine compounding and routine dispensing were explored. Interviews were audiotaped and transcribed verbatim, then analyzed using the method of “constant comparison” to identify emergent themes.ResultsPharmacists providing specialized compounding reported that compared with their prior routine practice, they used a greater variety of ingredients and dosage forms for more clinical conditions, used different equipment and processes, and had upgraded facilities for handling compounded products. Patient and physician interactions were more involved and in the case of physicians, more collaborative compared with routine dispensing. Participants reported feeling more empowered in their roles, with improved professional satisfaction.ConclusionsPharmacists in specialized compounding pharmacies report greater collaboration and interaction with prescribers and patients compared with their routine compounding and dispensing. This contributed to perceptions of empowerment and increased professional satisfaction. Specialized compounding may also be an avenue for reprofessionalization. The organization of compounding as a specialized service should be considered in proposed changes to compounding regulations and practice standards.     

Support and perceived barriers to implementing pre-exposure prophylaxis screening and dispensing in pharmacies: Examining concordance between pharmacy technicians and pharmacists

ObjectivesRecent legislation to expand pre-exposure prophylaxis (PrEP) screening and dispensing in pharmacies may significantly improve PrEP access for people at a high risk of human immunodeficiency virus (HIV) transmission. Studies have shown that pharmacists show wide support for PrEP expansion in pharmacies. However, pharmacy technicians are often the first point of contact for patients in pharmacies and are required to implement many of the tasks to ensure patients of a pharmacy receive adequate services. The purpose of this study was to assess pharmacists’ and pharmacy technicians’ perspectives regarding the implementation of PrEP screening and dispensing.MethodsWe qualitatively examined whether pharmacy technicians’ (n = 6) support and perceived barriers to screening and dispensing PrEP in pharmacies were concordant with those of pharmacists (n = 7). Pharmacy staff were recruited from high-risk HIV neighborhoods in Atlanta, GA using AIDSVu (Atlanta, GA). Two independent coders used MAXQDA (Berlin, Germany) and performed thematic data analysis and unitization to determine agreement.ResultsPharmacists and pharmacy technicians expressed strong willingness and support for screening and dispensing PrEP in pharmacies. Both groups expressed concerns about the time and the resources needed to perform PrEP screening and dispensing. Technicians, however, also reported concerns about privacy for patients, the need for community support and awareness of pharmacy-based PrEP screening, and recommended scheduling of PrEP screening activities during a limited part of the day to facilitate screening. Pharmacists reported fewer barriers but reported a need for more training of pharmacy staff to assist with PrEP screening and dispensing implementation.ConclusionPharmacy technicians discussed more barriers compared with pharmacists who were largely centered around practical considerations (i.e., logistics and workflow) that may affect the success of PrEP screening and dispensing. Given technicians’ pivotal role in the pharmacy, implementation of pharmacy-based PrEP services should address technicians’ perceived barriers in addition to those of pharmacists.     

Specialized compounding in community pharmacies: Organizational perspective

ObjectiveTo compare Australian pharmacies that did and did not provide a specialized or enhanced compounding service using a framework based on organization theory.DesignCross-sectional study.SettingAustralia, from August 2006 to January 2007.Participants465 pharmacist proprietors and compounding pharmacists.InterventionMailed questionnaire.Main outcome measuresOrganizational differences between pharmacies providing and not providing compounding as a specialized service.ResultsQuestionnaires were returned from 271 of a possible 465 (58%) pharmacies. Specialized compounding pharmacies were more likely to interact with a greater variety of prescribers of compounds and be located in a medical center/central business district setting. The majority of differences were found in the pharmacies’ organizational configuration. Specialized compounding staff were more likely to have undertaken further training in compounding and to prepare batches of product using specialized equipment and processes. A greater professional service orientation was apparent in specialized compounding pharmacies.ConclusionOrganization theory provides a useful framework for understanding specialized compounding in community pharmacies. The organizational characteristics of pharmacies providing a specialized compounding service are different from pharmacies that do not provide a specialized service. Proposed changes to regulation and practice standards are likely to affect the organization of pharmacies. More research is needed to characterize this growing specialty practice, in order to enable effective development and implementation of revised standards being considered internationally.     

Economic analysis of strategic behavior in dispensing pharmacies in the separation of dispensing and prescribing functions

In recent years, the system for the separation of dispensing and prescribing functions (SDP) has progressed in Japan. However, because of the failure of the healthcare system, it is difficult to estimate how the system of SDP contributes to the improvement of patient utility and welfare. In this paper, I try to evaluate the SDP by analyzing the strategic behavior of dispensing pharmacies, employing some economic models under imperfect information. In these models, quality is characterized as a strategic variable in monopolistic or duopolistic competition. As a result, I show that competition among dispensing pharmacies in the SDP raises the quality of pharmaceutical services, but there is some possibility of "excess entry" with free entry.     

Survey of sterile product compounding practices in Canadian hospital pharmacies

Improper preparation of sterile products by hospital or community pharmacies may have serious consequences. Recent reports of deaths or injury to patients as a result of receiving products that were contaminated during their preparation in a pharmacy have highlighted the importance of maintaining good sterile compounding practices. Efforts are now underway to develop revised guidelines for the compounding of sterile products in order to minimize the potential for future recurrence of similar incidents. This survey study was undertaken to provide background data on current sterile products compounding practices and procedures in Canadian hospital pharmacies. It was also anticipated that these data would be helpful in identifying issues that needed to be addressed in the new guidelines. Surveys were distributed to 700 Canadian hospitals with 50 or more beds. Responses from returned surveys were entered into and analyzed using the database program RBase. A total of 306 hospital pharmacies responded, with 200 indicating that sterile products were compounded within their department. The information provided by respondents provides insight into the types of sterile products being prepared in Canadian hospitals, the training background of staff involved in sterile product preparation, the type of facilities and equipment used for compounding these preparations, and the quality control/quality assurance procedures that are in place in hospital pharmacies. The information arising from this survey underscores the need for comprehensive guidelines or standards with respect to sterile product compounding, and the need for improved training of personnel involved in sterile product compounding. The results should be of interest to hospital pharmacy administrators, pharmacy regulatory bodies, and government agencies responsible for assuring the safety of pharmaceutical products used in patient care.