Evaluating digital competencies for pharmacists

BackgroundDigital technologies are widely used in healthcare. In the UK, Health Education England developed a framework on digital capabilities so that healthcare professionals could determine their health literacy, evaluate their competencies and identify their learning needs. For pharmacists, specific digital capabilities were developed - Digital Capabilities for the Pharmacy Workforce.AimThe aim of this study was to explore the views of pharmacists on digital competency in the workplace and evaluate the suitability of the Digital Capabilities Framework for the Pharmacy Workforce for use within clinical practice.MethodologyA focus group of experienced pharmacists working within the NHS in the UK was conducted and thematic analysis of the content was undertaken.ResultsSeven pharmacy staff took part in an online focus group. They held senior positions across various London NHS hospitals and in community settings. From the content of the focus group, four themes were identified: Theme 1 - Use of digital technology, Theme 2 - Digital competency and training of the pharmacy workforce, Theme 3 - Assessment of digital competency and Theme 4 - Evaluation of the Digital Capabilities Framework for the Pharmacy Workforce. The pharmacists in this study suggested that the Digital Capabilities Framework could be used as a helpful assessment tool to ensure that all staff should have the appropriate digital skills and capabilities to fulfil their pharmacy role.ConclusionWith widespread use of digital technologies in practice, there is a need for formal digital technology training for pharmacists. The Digital Capabilities Framework has the potential to be utilised as an assessment tool to ensure pharmacy staff have the appropriate levels of digital skills to fulfil their clinical duties and make their service more efficient.     

Community pharmacy interventions to improve antibiotic stewardship and implications for pharmacy education: A narrative overview

BackgroundAntibiotic resistance is one of the world's most pressing public health problems, resulting in over 23,000 deaths per year. One of the main contributing factors to antimicrobial resistance is antibiotic misuse and overuse. Community pharmacists can play a role in reducing antibiotic resistance, since they are one of the most accessible healthcare professionals.ObjectiveThe purpose of this paper is to describe community pharmacy interventions and strategies to reduce antibiotic misuse and overuse and to discuss the implications for pharmacy training.MethodsA narrative overview strategy was employed to identify papers on antibiotic stewardship and the role of the community pharmacist. Our review examined potential stewardship strategies and interventions within community pharmacy practice that provide opportunities for pharmacists to engage or lead in the reduction of antimicrobial resistance.ResultsWe describe five promising community pharmacist-led intervention strategies: Collaborative Practice Agreements (CPAs), point-of-care (POC) testing, patient consultations, academic detailing and serving as an advocate for patients and other healthcare providersConclusionsThis review highlights topics that may warrant increased attention in pharmacy school curricula. Pharmacy schools may want to consider modifying their curricula to address the shifts in practice of the community pharmacist – emphasizing the expanded role of the pharmacist in patient care and public health issues such as outpatient antibiotic stewardship.     

Food for thought: Can community pharmacists help patients living in food deserts?

BackgroundCommunity pharmacists can play an important role in helping patients who live in food deserts through screening, adjusting therapeutic recommendations and counseling practices, and making referrals to community resources. However, literature regarding community pharmacists’ knowledge, practices, and attitudes regarding food deserts is scant.ObjectivesThe primary objective of this study was to assess Ohio community pharmacists’ knowledge regarding food deserts. Secondary objectives included determining their attitudes, practices, and perceived barriers related to this topic.MethodsAn anonymous 26-question survey was created and distributed to a random sample of 500 licensed community pharmacists in Ohio. Participants were granted 3 weeks to complete the survey and were offered a link to free Accreditation Council for Pharmacy Education–approved continuing pharmacy education as an incentive. The survey was deemed exempt by the Institutional Review Board.ResultsThe survey was successfully delivered to 491 pharmacists; 72 participated (14.7% response rate). About 43% of respondents were familiar with the term “food desert,” and less than one-third (31.9%) reported being aware of community resources. Of those who thought that some of their patients lived in food deserts, the majority indicated that they did not consider it in patient interactions (65.1%) and “never” adjusted their counseling practices (65.1%). Barriers that prevented them from referring patients included lack of knowledge and confidence as well as workflow constraints. About 68% of respondents somewhat or strongly agreed that pharmacists could help patients living in food deserts, and 65.3% were interested in learning more information about food deserts.ConclusionDeficiencies in knowledge regarding food deserts and available resources were found among Ohio community pharmacists, but they showed interest in learning more information. Efforts should be made to educate community pharmacists about food deserts and to determine how to optimize their ability to assist patients as needed.     

“There's very little that you can do other than refer them to the doctor if you think they've got postnatal depression”: Scoping the potential for perinatal mental health care by community pharmacists

BackgroundTwenty percent of women in the UK develop perinatal mental health (PMH) problems, which have widespread effects on maternal and child health. Community pharmacists are ideally placed to identify PMH problems and refer to other trained healthcare professionals.ObjectiveThis study explored community pharmacists’ attitudes, current counselling practices, and barriers to providing mental health advice to perinatal women.MethodsA qualitative focus group study was performed virtually with community pharmacists (n = 11), working in urban settings across London. A topic guide was used to cover current counselling practice, barriers to and confidence in counselling women, and thoughts on potential pharmacist-led perinatal mental health services. The focus groups were recorded, transcribed, and analysed using thematic analysis.ResultsThree themes were identified: Doing Mental Health Care; Willing, but Unable; and Introspection and reflection, which were related through a central organising concept of ‘Perinatal mental health care as a new frontier for community pharmacy’. It was found that while community pharmacists provide mental health advice to perinatal women and their partners, they lacked confidence, which was related to a lack of knowledge and inadequate training opportunities. Organisational barriers were identified including a lack of a formal referral pathway to existing mental health services and other trained healthcare professionals. Perceptions of opportunities and recommendations for service improvement and change were also garnered.ConclusionThis study demonstrates community pharmacists have a potential role within community mental healthcare in identification of PMH problems and providing appropriate advice and support. Upskilling community pharmacists in mental health should be considered to increase knowledge and confidence while formal referral pathways to other trained healthcare professionals and existing services should be established and made available to pharmacists.     

“It is the future. Clinical pharmaceutical care simply has to be a matter of course.” - Community pharmacy clinical service providers' and service developers’ views on complex implementation factors

BackgroundWhile there is a lot of documented evidence about the clinical and cost effectiveness of pharmacists’ role extensions there is an inherent gap between service development and implementation.Objective(s): This study aims to better understand the complex factors that influence the implementation of clinical pharmacy services from both the perspective of the community pharmacy service providers and service developers.MethodsA prospective qualitative interview study using purposive sampling of twelve service developers and twelve community pharmacy service providers from across all nine Federal States of Austria. The validated and piloted interview guide contained questions and prompts on role perceptions, attitudes, experience, implementation barriers, training needs and measures identified to strengthen clinical pharmacy provision in community pharmacy. Verbatim quotes were independently mapped to the Framework for the Implementation of Services in Pharmacy (FISpH) by two researchers.Results24 Interviews were carried out. Data saturation was achieved. There is a great deal of enthusiasm to develop the remit of clinical pharmacy services. It is seen as important to ensure the future survival of the profession. Service developers are more positive and confident in the implementation success and pharmacists’ skills than providers. Clear mandates for politics, academia and individual pharmacists have been discussed to affect change.ConclusionsAustrian pharmacists are facing the same well documented challenges as many other healthcare systems only with more urgency. The development of a clinical pharmacy service framework; education accreditation standard and a well-supported continuous professional development system are considered key to bring about the necessary culture shift.     

“If I were to do this,how would I experience it?” Developing a theoretical framework for exploring pharmacists’ practice in the domain of assisted dying

BackgroundWorldwide, pharmacy practice is changing to include new roles and responsibilities. Laws enabling the implementation of assisted dying are expanding in international jurisdictions. Pharmacy practice in assisted dying is subsequently expanding. However, studies of how pharmacists experience their practice when engaged in assisted dying are absent. To progress research into the lived experiences of pharmacists practicing in assisted dying, the development of an inquiry framework to guide such research is the first step.ObjectiveThe objective was to develop a theoretical framework of inquiry for use in subsequent continuing research which may explore the actual experience of pharmacy practice in assisted dying.MethodsPerspectives were gathered from expert and senior pharmacists who were anticipating the imminent implementation of assisted dying practice. Analysis focused on understanding what aspects of practice experience were important to them. Interview-conversations centred on the question: If you had the chance to talk to experienced pharmacist practitioners who have been involved in the practice of assisted dying, what aspects regarding their experiences, would you like to know about? A conventional approach to qualitative content analysis was utilized to analyze the data.ResultsFindings summarized questions posed by pharmacists contemplating the implementation of assisted dying practice. These perspectives formed the foundation of a theoretical inquiry framework constituted by 8 inter-related dimensional range-continuums. Each range-continuum, designed to explore the lived experiences of pharmacists in practice, is defined. Examples of how the inquiry dimensions will be used to inform future exploratory research are offered within the framework.ConclusionsThe theoretical inquiry framework will be used to develop knowledge for pharmacists contemplating participation (or not) in assisted dying practice. It is timely to progress research that reveals the informed experiences of pharmacists that are actually practicing in this area. The framework may be adapted for researching pharmacists’ experience in other practice areas and contexts.     

Shedding the light on Pharmacists’ roles during COVID-19 global pandemic

Introduction(Background)The role of pharmacists revolves around providing the highest levels of care to society and ensuring the provision of medicine to all patients. However, with the spread of coronavirus disease 2019 (COVID ?19), pharmacists as a very important part of healthcare professionals’ team are responsible for fighting against the disease regardless of their setting of practice. The role of pharmacists will undergo a little change to extend and include other roles in order to ensure the safety of the community and limit the virus spread. Also, they will be required to obtain information from reliable sources, and to be up to date, so they can be reliable advisors to the community and raise their awareness.ObjectivesThe purpose of this review is to highlight community and hospital pharmacists’ roles during (COVID-19) global pandemic, and to clearly illustrate how they are contributing to maintain pharmacy services continuity, supporting other healthcare professionals, and facilitating the patient’s education.SummaryClinical pharmacists provide direct patient care through monitoring adverse drug reactions, ensuring individualized treatment, performing evidence-based practice, and evaluating drugs in clinical trials. On the other hand, community pharmacists which are the most accessible healthcare providers by the community increase their awareness regarding the preventive measures, balance medicines supply and demand, provide drive-thru and home delivery services, offer telehealth counselling, psychological support, refer suspected COVID-19 patients, and provide vaccination when available.ConclusionInnovative pharmacists’ roles have emerged to adapt to changes during COVID-19 pandemic, however, they may be needed in the post COVID-19 world as well.     

The role of pharmacists in developing countries: The current scenario in the United Arab Emirates

Pharmacy practice has passed several rounds of advancements over the past few years. It had changed the traditional positioning criteria of pharmacists as business people into patient-centered healthcare professionals. This worldwide shift is increasingly accumulating pressure on UAE pharmacists to turn up into better level of service providing accompanied with higher demand of inter-personal skills and intellectual capabilities. This can be accomplished through stressing the significance of continuing pharmacy education in basic sciences as well as social and administrative pharmacy techniques and its collaboration in elevating the quality of pharmacy practice in the UAE.     

Explanations and unresolved issues pertaining to the development of the Nuclear Pharmacy Compounding Guidelines

OBJECTIVES: To provide background information related to the development of the Nuclear Pharmacy Compounding Guidelines, to discuss regulatory complexities related to radiopharmaceutical compounding practice, and to summarize the gaps in the current compounding regulations for radiopharmaceuticals. DATA SOURCES: The Guidelines closely follow the provisions of section 503A of the Federal Food, Drug, and Cosmetic Act (FD&C Act), the monographs and chapters related to pharmacy compounding in the United States Pharmacopeia (USP), and the recommended guidelines published by the American Society of Health-System Pharmacists. SUMMARY: The Food and Drug Administration Modernization Act (FDAMA) of 1997 established parameters under which the compounding of drug products is appropriate and lawful, but these criteria expressly do not apply to radiopharmaceuticals. The Nuclear Pharmacy Compounding Practice Committee, a group of nuclear pharmacists convened by the American Pharmaceutical Association, developed the Nuclear Pharmacy Compounding Guidelines to establish a set of principles and guidelines for good radiopharmaceutical compounding practice. The intent of the new document is to provide guidance on radiopharmaceutical compounding practices that have evolved over the last 2 decades and to place them in an appropriate regulatory framework in accordance with previous enforcement policies and guidelines issued by the U.S. Food and Drug Administration (FDA) regarding the exemption of certain pharmacy practices from enforcement of adulteration, misbranding, and new drug requirements. CONCLUSION: The Nuclear Pharmacy Compounding Guidelines, recently released by APhA, is the first official document that provides realistic and practical compounding guidance for nuclear pharmacists. Even though the United States Court of Appeals for the Ninth Circuit recently ruled section 503A of the FD&C Act to be invalid in its entirety, and the Supreme Court upheld that ruling, the compliance policy guides issued by FDA in March 1992 and revised in May 2002 maintain guiding principles on pharmacy compounding similar to those stated in section 503A of the FD&C Act. The Nuclear Pharmacy Compounding Practice Committee is optimistic that the practical information contained in the Guidelines will assist state boards of pharmacy, FDA, and the United States Pharmacopeial Convention in setting appropriate standards for nuclear pharmacy compounding practice that will ensure the continued availability of high-quality compounded radiopharmaceuticals at reasonable cost.     

Shot of a lifetime: How pharmacists stay ahead of the season

ObjectivesThe profession of pharmacy has long advocated for the advancement of practice through increased clinical responsibility. Provision of immunization related services has been one service pharmacists have been able to provide to add to their existing responsibilities. A universal influenza vaccination has been under investigation and is nearing success. While other clinical services should be considered, now more than ever, development of the universal vaccine should provide a pause for the profession and consideration of not only the impact on student learning opportunities but also pharmacy revenue.SummaryThe development of the universal influenza vaccination poses a potential challenge to existing service-related revenue models for community pharmacies. There are many other opportunities pharmacists can capitalize on including, but not limited to, travel and other vaccinations, point-of-care testing, and transitions-of-care. In addition, through initiatives such as “Flip the Pharmacy” and Community Pharmacy Enhanced Service Network, pharmacists are in a great position to be innovative with clinical services while continuing to provide learners with training opportunities.ConclusionMany opportunities exist for pharmacists to expand services that lean into their clinical training and add other vaccination opportunities. These opportunities can augment revenue streams and still provide learners with training.     

An exploration of the utility of appraisals for the revalidation of pharmacy professionals in community pharmacy in Great Britain

BackgroundWith revalidation in pharmacy in the United Kingdom fast approaching, appropriate systems of revalidation in community pharmacy are required. With little known about the potential use of appraisals for evaluating fitness to practice in pharmacy professionals (pharmacists and pharmacy technicians) in this sector, research was undertaken to explore their potential utility in a revalidation process.ObjectivesTo examine existing structures and processes in community pharmacy appraisals in Great Britain (ie, England, Scotland, and Wales) and consider the views of pharmacy stakeholders on if, and how, appraisals could contribute to revalidation of pharmacy professionals.MethodsSemi-structured telephone interviews were conducted with senior staff (eg, superintendents and professional development managers) from chain community pharmacies as well as pharmacy managers/owners from independent pharmacies. Senior staff from locum agencies and pharmacy technician stakeholders were also interviewed.ResultsAppraisals were in place for pharmacists in most chain pharmacies but not in independent pharmacies. Locum pharmacists were not appraised, either by the companies they worked for or by the locum agencies. Pharmacy managers/owners working in independent pharmacies were also not appraised. Pharmacy technicians were appraised in most chain pharmacies but only in some independent pharmacies. Where appraisals were in operation, they were carried out by line managers who may or may not be a pharmacist. Appraisals did not seem to cover areas relevant to fitness to practice but instead focused more on performance related to business targets. This was particularly true for those in more senior positions within the organization such as area managers and superintendent pharmacists.ConclusionsExisting systems of appraisal, on their own, do not seem to be suitable for revalidating a pharmacy professional. Considerable changes to the existing appraisal systems in community pharmacy and employer engagement may be necessary if they are to play a role in revalidation.     

Planning for health information exchange: Perspectives of community pharmacists in the Community Pharmacy Enhanced Services Network of Indiana

BackgroundCommunity pharmacists are one of the most accessible health professionals and provide many different services. However, lack of access to complete patient information is a barrier to making meaningful patient interventions.ObjectivesTo determine (1) current and desired health information access among community pharmacists in the Community Pharmacy Enhanced Services Network (CPESN) of Indiana and (2) design considerations for a health information exchange tool for use by community pharmacists.MethodsThis voluntary study was conducted over an 8-day survey period in which 40 pharmacies within the CPESN Indiana network were contacted during regular business hours and asked to take part in a 15-minute telephone survey. Questions asked were informed by the following Consolidated Framework for Implementation Research intervention characteristics domain constructs: relative advantage, evidence strength and quality, adaptability, trialability, complexity, costs, and design quality and packaging.ResultsOf the 40 contacted pharmacies, 32 (80%) completed the survey. Most pharmacies reported access to immunization registry data; no other routine access was reported by any pharmacy. In questions assessing the relative advantage of Health Information Exchange (HIE) access compared with their current information access, at least 84.4% said that they agreed or strongly agreed with all statements. When choosing the data element most desirable to have access to via HIE in a community pharmacy, the most frequently selected choices were updated medication orders (n = 18, 56.3%), progress notes (n = 5, 15.6%), and laboratory tests (n = 4, 12.5%). Suggestions to improve ease of implementation included integration within dispensing software and clinical decision-making support features, such as alerts for pertinent lab values.ConclusionIntegrating HIE data into community pharmacies would provide community pharmacists with access to important patient data, and pharmacists believed that this would improve their practice. Future research should explore whether implementation of this type of tool leads to better patient outcomes and improved pharmacist job satisfaction.     

Examining the association between the “My Pharmacist” model and the service quality of community pharmacies

BackgroundIn Japan, patients can freely choose medical facilities. Many visit different medical facilities for different diseases, and for convenience, often utilize the pharmacies neighboring these facilities. Accordingly, a “My Pharmacy” model was recommended, in which patients select a single pharmacy using their own judgement to receive proper medication services. A “My Pharmacist” model, in which the pharmacist is constantly involved in the treatment of a patient, was also proposed. However, patients’ evaluations of pharmacist/pharmacy services under these models have not been investigated.ObjectiveTo examine how a patient's constant involvement with the same pharmacist and pharmacy is associated with their evaluation of the quality of pharmacy services.MethodsA cross-sectional survey using a self-administered questionnaire was conducted among patients who used pharmacies periodically. Patients evaluated the pharmacist/pharmacy services and were classified into 4 groups (“My Pharmacy/My Pharmacist,” “My Pharmacy/Multiple Pharmacists,” “Multiple Pharmacies/My Pharmacist,” and “Multiple Pharmacies/Multiple Pharmacists”) according to the form of their usage of pharmacies and pharmacists. An intergroup comparison was then performed and correlations within each group analyzed.ResultsData from 3,492 individuals using 147 pharmacies were analyzed. “My Pharmacy” users had significantly higher scores than did “Multiple Pharmacies” users on patient experience of proper medication services (e.g., identifying duplicate medication) (p < 0.001). “My Pharmacy/My Pharmacist” users scored higher than the other three groups on four evaluation factors, including “pharmacy/pharmacist's interpersonal services” (“sharing and utilizing patient information,” “enhanced health support function,” and “consideration towards patients”), “patient satisfaction with the pharmacy,” “placing more emphasis on quality of interaction with pharmacist than on waiting time,” and “attitude when visiting healthcare facilities” (all p < 0.001).ConclusionThe findings indicate that highly tailored, in-person services provided by “My Pharmacists” are associated with not only with the degree of patients’ overall satisfaction, but also their evaluation of “the quality of pharmacist services.”     

Shedding the light on Pharmacists’ roles during COVID-19 global pandemic

Introduction(Background)The role of pharmacists revolves around providing the highest levels of care to society and ensuring the provision of medicine to all patients. However, with the spread of coronavirus disease 2019 (COVID −19), pharmacists as a very important part of healthcare professionals’ team are responsible for fighting against the disease regardless of their setting of practice. The role of pharmacists will undergo a little change to extend and include other roles in order to ensure the safety of the community and limit the virus spread. Also, they will be required to obtain information from reliable sources, and to be up to date, so they can be reliable advisors to the community and raise their awareness.ObjectivesThe purpose of this review is to highlight community and hospital pharmacists’ roles during (COVID-19) global pandemic, and to clearly illustrate how they are contributing to maintain pharmacy services continuity, supporting other healthcare professionals, and facilitating the patient’s education.SummaryClinical pharmacists provide direct patient care through monitoring adverse drug reactions, ensuring individualized treatment, performing evidence-based practice, and evaluating drugs in clinical trials. On the other hand, community pharmacists which are the most accessible healthcare providers by the community increase their awareness regarding the preventive measures, balance medicines supply and demand, provide drive-thru and home delivery services, offer telehealth counselling, psychological support, refer suspected COVID-19 patients, and provide vaccination when available.ConclusionInnovative pharmacists’ roles have emerged to adapt to changes during COVID-19 pandemic, however, they may be needed in the post COVID-19 world as well.     

Implementation and evaluation of an interprofessional physical assessment skills workshop for Wisconsin pharmacists

BackgroundPharmacists have a critical, expanding role in health care delivery. In particular, pharmacists in community pharmacy and ambulatory care settings are important and frequent access points for health care services.ObjectiveWe describe the interprofessional development and implementation of an interactive, broadly applicable physical assessment skills–based continuing pharmacy education program to provide an avenue for the attainment of this warranted set of skills for pharmacists who desire to provide advanced patient care services in their respective practices.MethodsPharmacists, in collaboration with family medicine and emergency medicine physicians, developed workshop content, design, and flow. The structure of the workshops consisted of didactic training, hands-on practical application, simulated practice, and case-based certification examinations.ResultsOn a postworkshop survey, all respondents answered “agree” or “strongly agree” when asked if the workshops were useful, advanced their skills, and advanced their confidence. It was also found that more than 50% of the participants used their physical assessment skills monthly and 11% daily. The most common assessment performed was obtaining an accurate manual blood pressure.ConclusionThe interprofessional development and implementation of workshops dedicated to physical assessment skills education is feasible and led to the incorporation of these skills into pharmacists’ practice, particularly in the community and ambulatory care settings.