Effects of supervisory style and experientially based frames of reference on organizational alcoholism programs

Theoretical works concerning the influence of personal characteristics of work supervisors on their referral of subordinates to organizational alcoholism programs are reviewed. These works hypothesize two barriers to such referrals: supervisory style and experientially based frames of reference. The effects of these behavioral and attitudinal characteristics on supervisors' perceptions of subordinates' work readjustment are analyzed with a sample of 84 supervisors who had utilized the Federal Employee Alcoholism Policy (FEAP). Zero-order hypothesis tests illustrated that supervisory style, operationalized by the Least Preferred Co-worker Measure, was inversely related to perceived readjustment. Hence interpersonally oriented and more cognitively complex supervisors were less likely to perceive improvement. Experientially based frames of reference were operationalized by the Attitude toward the Recovering Alcoholic Scale and the Attitudes toward FEAP Scale. Only the latter was a significant influence, with high policy evaluation being positively associated with perceived readjustment. Multivariate analysis illustrated a significant main effect only for attitudes toward the alcoholism policy. These findings are discussed in terms of a need to reappraise the influence of supervisory style on referral to organizational alcoholism programs and the potential positive effects of organizational engineering on the success of such programs.     

Situational theory of leadership

The situational theory of leadership and the LEAD instruments for determining leadership style are explained, and the application of the situational leadership theory to the process of planning for and implementing organizational change is described. Early studies of leadership style identified two basic leadership styles: the task-oriented autocratic style and the relationship-oriented democratic style. Subsequent research found that most leaders exhibited one of four combinations of task and relationship behaviors. The situational leadership theory holds that the difference between the effectiveness and ineffectiveness of the four leadership styles is the appropriateness of the leader's behavior to the particular situation in which it is used. The task maturity of the individual or group being led must also be accounted for; follower readiness is defined in terms of the capacity to set high but attainable goals, willingness or ability to accept responsibility, and possession of the necessary education or experience for a specific task. A person's leadership style, range, and adaptability can be determined from the LEADSelf and LEADOther questionnaires. By applying the principles of the situational leadership theory and adapting their managerial styles to specific tasks and levels of follower maturity, the authors were successful in implementing 24-hour pharmacokinetic dosing services provided by staff pharmacists with little previous experience in clinical services. The situational leadership model enables a leader to identify a task, set goals, determine the task maturity of the individual or group, select an appropriate leadership style, and modify the style as change occurs. Pharmacy managers can use this model when implementing clinical pharmacy services.     

Barriers to counseling patients with obesity: a study of Texas community pharmacists.

OBJECTIVE: To assess barriers to the counseling of obese patients and identify pharmacists' characteristics associated with these barriers. DESIGN: Cross-sectional mail survey. SETTING: Texas. PARTICIPANTS: 139 community pharmacists. INTERVENTION: Self-administered questionnaire. MAIN OUTCOME MEASURES: Respondents' perceived barriers to pharmacists' counseling of obese patients. RESULTS: The top three barriers to counseling included lack of time (76.8%), lack of patient demand or expectations (55.8%), and lack of reimbursement/compensation (49.3%). Pharmacists indicated that they rarely to sometimes counseled obese patients and were somewhat comfortable with counseling about obesity management. They perceived obesity management strategies to be somewhat effective in weight loss, but were neutral regarding their confidence in achieving positive outcomes with counseling. Pharmacists who were more experienced were more likely to indicate that obesity is controllable without medications. Those who considered obesity controllable without medications were significantly more likely to view the various obesity management strategies as less effective, compared with those who did not share this belief. Pharmacists who viewed lack of privacy as a barrier were significantly less confident in achieving positive outcomes as a result of counseling. Creating awareness among patients about pharmacists' ability to counsel was perceived as most important in overcoming barriers. CONCLUSION: Pharmacists identified several barriers to counseling of obese patients. Pharmacists' demographics and beliefs about obesity were significantly associated with their perceived barriers.     

The pharmacy supervisor and the employee pharmacist's job satisfaction

It seems obvious that satisfaction with one's immediate supervisor would have a significant impact on one's general job satisfaction. However, this relationship has received little attention in the pharmacy literature. This study was designed to determine 1) whether there are differences in job-related satisfaction between pharmacists whose immediate supervisors are pharmacists and those whose supervisors are not pharmacists, and 2) whether the occurrence of conflict between a pharmacist and his or her immediate supervisor is related to the employee pharmacist's job and career satisfaction. The most pronounced finding was the importance of supervisors being pharmacists: satisfaction on five of six satisfaction subscales was related to whether one's supervisor was a pharmacist. Moreover, pharmacists who had the fewest conflicts and disagreements with their supervisors were more satisfied with their choice of pharmacy as a career, their employers, their supervisors, and their jobs.     

Pharmacists' perceptions of their role in asthma management and barriers to the provision of asthma services

Objectives Few studies have explored pharmacists' perceptions of their potential role in asthma management. This study aimed to investigate community pharmacists' perceptions of their role in the provision of asthma care, to compare the perceptions of metropolitan and regional pharmacists with regards to their role, to identify barriers to the provision of asthma management services and to explore their level of inter‐professional contact. Methods A 29‐item questionnaire was mailed to a convenience sample of community pharmacists. Items included pharmacists' perceptions of their role in asthma management, barriers to pharmacy asthma services and inter‐professional contact. The setting was community pharmacies in metropolitan and rural New South Wales, Australia. Key findings Seventy‐five pharmacists (63% male, 69% in metropolitan pharmacies) returned completed questionnaires (response rate 89%). Pharmacists perceived their role in asthma management along three major dimensions: ‘patient self‐management’, ‘medication use’ and ‘asthma control’. Regional pharmacists described a broader role than metropolitan pharmacists. Most participants perceived time and patient‐related factors to be the main barriers to optimal asthma care with pharmacist's lack of confidence and skills in various aspects of asthma care less important barriers. Almost 70% indicated that they would like more inter‐professional contact regarding the care of patients with asthma. Conclusions Community pharmacists perceived a three‐dimensional role in asthma care with regional pharmacists more likely to embrace a broader role in asthma management compared to metropolitan pharmacists. Pharmacists identified time and patient‐related factors as the major barriers to the provision of asthma services. Future research should explore barriers and facilitators to expansion of the pharmacist's role in asthma management in a holistic way.     

Evaluation of a mobile health intervention to support asthma self-management and adherence in the pharmacy

Background Several effective mobile health (mHealth) interventions have been developed to support patients with their medication use, however hardly any is implemented in clinical practice. Process evaluations and user experiences are therefore important for further implementation. Objective To explore experiences, barriers, and facilitators of pharmacists and patients towards the use of the interactive ADolescent Adherence Patient Tool (ADAPT). In addition, the perceptions of pharmacists towards mHealth interventions in general were explored. Setting Dutch community pharmacies. Methods Pharmacists (N?=?24) and adolescent asthma patients (N?=?87; age 12–18) completed a questionnaire about the ADAPT intervention. Pharmacists who did not have access to the ADAPT intervention (N?=?26) completed a questionnaire on their perceptions towards mHealth. Main outcome measure Experiences, barriers, and facilitators of pharmacists and patients. Results Most patients (78%) would recommend the ADAPT intervention to others, and thought that the pharmacy was the right place for mHealth aiming to support adherence (63%). The possibility to monitor asthma symptoms was highly appreciated by patients and pharmacists. Pharmacists were satisfied with ADAPT intervention (96%), and using the intervention was not time consuming (91%). The ADAPT intervention promoted contact with patients (74%) and facilitated the healthcare providing role of pharmacists (83%). Pharmacists who did not have access to the ADAPT intervention mentioned time constraints and funding as main barriers for using mHealth. Conclusion Pharmacists and patients perceived many beneficial effects and were positive about the the use of the interactive ADolescent Adherence Patient Tool (ADAPT) intervention. This study emphasizes opportunities for mHealth in improving the quality of care, which supports the need for further implementation in clinical practice.

     

Pharmacists' job satisfaction and perceived utilization of skills.

The relationship between job satisfaction and perceived utilization of skills among pharmacists practicing in institutional and ambulatory care settings in Arizona was studied, and factors thought to influence pharmacists' perceived utilization of skills were evaluated. Questionnaires on job satisfaction and perceived utilization of skills were mailed to a random sample of 600 pharmacists. Information on workplace factors such as hours worked, practice setting, and job title was collected. A 4-item measure of general job satisfaction and a 10-item measure of perceived utilization of skills were used. Responses were measured on a five-point Likert scale ranging from "strongly disagree" to "strongly agree." The response rate was 35%. There was a significant positive relationship between job satisfaction and perceived utilization of skills and between job satisfaction and adequate staffing, where "staffing" referred to factors such as competence of coworkers and workload. Pharmacists with training beyond a B.S. degree in pharmacy were more satisfied with their job than those whose highest degree was a B.S. in pharmacy. Pharmacists practicing in institutional settings, pharmacists with management titles, and older pharmacists perceived that they were utilizing their skills to a greater extent than did pharmacists practicing in ambulatory care settings, pharmacists with a general staff title, and younger pharmacists. Among a sample of Arizona pharmacists in institutional and ambulatory care settings, job satisfaction was influenced by perceived utilization of skills, staffing, and education; practice setting, job title, and age were significantly related to perceived utilization of skills.     

Optimizing the immunization activities of community chain pharmacists: Insights from a national survey

ObjectivesTo assess (1) the practices, attitudes, and perceptions of immunizing chain community pharmacists regarding implementation of immunization services per the National Vaccine Advisory Committee (NVAC) Standards of Adult Immunization Practice and (2) how community pharmacists view the effectiveness of corporate initiatives toward improving immunization volumes.DesignFollowing extensive formative research and pilot-testing, a cross-sectional survey was administered electronically to chain community pharmacists over a 4-week period.Setting and participantsRespondents were chain community pharmacists engaged in year-round immunization in the United States, randomly sampled from a list of 9717 maintained by the American Pharmacists Association.Outcome measuresPharmacists’ reports of immunization volumes, patterns of time use, perceptions of time spent on the immunization process, immunization attitudes, and confidence in completing NVAC standard components. Pharmacists also evaluated the utility of corporate goals, feedback, and incentives received.ResultsThe survey yielded 590 responses, with 489 meeting the eligibility criteria (5% response rate) and distributed from across the country. In total, 84% of respondents reported giving 26 or more vaccinations/week during the influenza season, whereas only 6% reported as many outside of the influenza season. Pharmacists spent, on average, 29% of their day addressing the immunization process during the influenza season and 12% outside of the influenza season. Only 29% of respondents were confident that their patients’ complete immunization needs were assessed at each patient encounter and only 46% were confident that their patients received strong recommendations regarding their specific immunization needs. Most pharmacists viewed corporate goals and the messages and strategies to achieve them as limited in scope and largely inadequate.ConclusionIn the context of their current role expectations, most community pharmacists who responded were not confident that key NVAC Standards were being implemented to improve patient immunization rates and did not view corporate initiatives as effective toward that effort.     

Factors associated with how often community pharmacists offer and dispense naloxone

BackgroundA recent Surgeon General's report encourages people to ask pharmacists about naloxone, but whether pharmacists are well-prepared to respond to these requests is unclear.ObjectivesDetermine factors that are associated with how often pharmacists offer and dispense naloxone.MethodsA convenience sample of 457 community pharmacists in North Carolina completed a 5-min online survey. Linear regressions were conducted to identify factors that are associated with how often pharmacists offer and dispense naloxone. Pharmacists' self-reported barriers to teaching naloxone administration were identified.ResultsMost pharmacists (81.2%) worked in pharmacies that stocked naloxone, but many never offered (36.6%) or dispensed (19.4%) naloxone. Pharmacists offered (β = 0.15, p < 0.01) and dispensed (β = 0.15, p < 0.01) naloxone more often when their pharmacy stocked more naloxone formulations. Pharmacists who were more comfortable discussing naloxone offered it more often (β = 0.26, p = 0.001). Pharmacists who worked in regional/local/grocery chain pharmacies dispensed and offered naloxone less often than other pharmacy types. Barriers to teaching naloxone administration included: time constraints, inadequate training, and perceived lack of patient comprehension.ConclusionsMany community pharmacists do not offer or dispense naloxone. Pharmacists who are uncomfortable discussing naloxone or work at smaller chain pharmacies may benefit from targeted naloxone training.     

Job characteristics and satisfaction of pharmacy technicians

Perceptions of job characteristics and job satisfaction of central-area technicians and drug-administration technicians at The Ohio State University Hospitals were analyzed. A questionnaire was administered to 79 pharmacy drug-administration technicians; 44 central-area technicians; 10 pharmacy residents, who served as objective raters (5 in the central area and 5 in the decentral area); 13 central-area pharmacists; and 17 decentral-area pharmacists. Perceived job characteristics were measured with the Job Characteristics Inventory; job satisfaction was measured by the Minnesota Job Satisfaction Questionnaire. The two groups of technicians differed significantly in their perceptions of task identity, task significance, and dealing with others. Significantly greater autonomy in technicians' jobs was perceived to exist by pharmacists and raters in both areas than by technicians. Significantly greater task identity was perceived by the central-area technicians than by their raters, and significantly greater task importance was perceived by both groups of technicians than by their pharmacists and raters. Friendship opportunities were perceived to exist to a significantly greater degree by decentral pharmacists and raters than by the drug-administration technicians. In the institution studied, both central-area and drug-administration technicians tended to be dissatisfied with their jobs. Central-area technicians' satisfaction was influenced most by the technicians' relationships with their supervisors and the feelings of accomplishment they gained. Drug-administration technicians were most satisfied if they believed they had opportunities to use their abilities. Efforts to increase job satisfaction among pharmacy technicians should focus on increasing feedback and task identity.     

Pharmacy workers’ perceptions and acceptance of bar-coded medication technology in a pediatric hospital

BackgroundThe safety benefits of bar-coded medication-dispensing and administration (BCMA) technology depend on its intended users favorably perceiving, accepting, and ultimately using the technology.Objectives(1) To describe pharmacy workers’ perceptions and acceptance of a recently implemented BCMA system and (2) to model the relationship between perceptions and acceptance of BCMA.MethodsPharmacists and pharmacy technicians at a Midwest U.S. pediatric hospital were surveyed following the hospital’s implementation of a BCMA system. Twenty-nine pharmacists' and 10 technicians’ self-reported perceptions and acceptance of the BCMA system were analyzed, supplemented by qualitative observational and free-response survey data. Perception-acceptance associations were analyzed using structural models.ResultsThe BCMA system’s perceived ease of use was rated low by pharmacists and moderate by pharmacy technicians. Both pharmacists and technicians perceived that the BCMA system was not useful for improving either personal job performance or patient care. Pharmacy workers perceived that individuals important to them encouraged BMCA use. Pharmacy workers generally intended to use BCMA but reported low satisfaction with the system. Perceptions explained 72% of the variance in intention to use BCMA and 79% of variance in satisfaction with BCMA.ConclusionsTo promote their acceptance and use, BCMA and other technologies must be better designed and integrated into the clinical work system. Key steps to achieving better design and integration include measuring clinicians’ acceptance and elucidating perceptions and other factors that shape acceptance.     

Pharmacists' perceptions of the effectiveness of antimicrobial control programs.

PURPOSE: The perceptions of the effectiveness of antimicrobial control programs (ACPs) among infectious diseases (ID) pharmacists were studied. METHODS: A survey asking pharmacists to characterize the ACP in their hospitals and rate the program's effectiveness was distributed electronically in 1999 and by regular mail in 2000 to all 365 members of the Society of Infectious Diseases Pharmacists residing in North America. RESULTS: Of the 365 surveys distributed, 323 (88.5%) were completed, 233 of which were eligible for analysis. Most respondents (99%) indicated the use of one or more ACP components (mean +/- S.D., 4.3 +/- 1.9) in their hospitals. The ACP components used most frequently included prescriber education, review of patient medical records, formularies, prior authorization, infectious diseases consultation, and clinical practice guidelines. A similar percentage of respondents indicated that ID pharmacists and ID physicians directly participated in implementing and monitoring the effectiveness of ACPs (57% and 58%, respectively). Of the 231 respondents whose hospitals had an ACP, 73% perceived that their ACP effectively addressed antimicrobial resistance, patient outcomes, or costs, with cost reduction viewed as being accomplished more often than the improvement of patient outcomes or containment of antimicrobial resistance (62%, 35%, and 38%, respectively; p < 0.001). Many indicated uncertainty regarding the effectiveness of their ACP, with a substantial percentage of respondents believing that the level of support for these programs was inadequate. CONCLUSION: ID pharmacists in 231 North American hospitals perceived that their ACP was not sufficiently effective at improving patient outcomes, containing antimicrobial resistance, and decreasing medication costs, possibly due to inadequate institutional support for the program.     

“My pharmacist”: Creating and maintaining relationship between physicians and pharmacists in primary care settings

BackgroundPharmacists and physicians are being increasingly encouraged to adopt a collaborative approach to patient care, and delivery of health services. Strong collaboration between pharmacists and physicians is known to improve patient safety, however pharmacists have expressed difficulty in developing interprofessional working relationships. There is not a significant body of knowledge around how relationships influence how and when pharmacists and physicians communicate about patient care.ObjectivesThis paper examines how pharmacists and primary care physicians communicate with each other, specifically when they have or do not have an established relationship.MethodsThematic analysis of data from semi-structured interviews with nine primary care physicians and 25 pharmacists, we examined how pharmacists and physicians talk about their roles and responsibilities in primary care and how they build relationships with each other.ResultsWe found that both groups of professionals communicated with each other in relation to the perceived scope of their practice and roles. Three emerging themes emerged in the data focusing on (1) the different ways physicians communicate with pharmacists; (2) insights into barriers discussed by pharmacists; and (3) how relationships shape collaboration and interactions. Pharmacists were also responsible for initiating the relationship as they relied on it more than the physicians. The presence or absence of a personal connection dramatically impacts how comfortable healthcare professionals are with collaboration around care.ConclusionThe findings support and extend the existing literature on pharmacist-physician collaboration, as it relates to trust, relationship, and role. The importance of strong communication is noted, as is the necessity of improving ways to build relationships to ensure strong interprofessional collaboration.     

Key factors for sustainable integration of pharmacists in team-based primary care physician practices

ObjectivesTo (1) identify strategies for financial justification of pharmacists integrated into team-based primary care, (2) describe the payment models currently used for integration of pharmacists into team-based primary care, and (3) elicit key factors facilitating sustainable pharmacist-provided patient care services in the primary care setting.DesignQualitative analysis using semistructured interviews.SettingNonacademic outpatient primary care physician practices throughout the United States from January to April 2014.ParticipantsPharmacists responsible for leadership of clinical pharmacists in primary care practices whose positions are supported through nondispensing patient care services.Main outcome measuresCurrent payment model, infrastructure, documentation strategies, and methods of quality assessment.ResultsTwelve interviews were conducted. Practices included a combination of single- and mixed-payer models in integrated and nonintegrated health systems. Various billing strategies were used, particularly in nonintegrated models, to sustain pharmacists in primary care practices utilizing both fee-for-service (FFS) and value-based incentives payments. Five main themes were elicited: (1) Pharmacists are integrated and valuable members of health care teams; (2) pharmacists are documenting in an accessible electronic health record; (3) data tracking is a facilitator for justifying and adapting practice; (4) systematized processes for pharmacist integration exist in each practice; and (5) pharmacists’ responsibilities on the team have grown and evolved over time.ConclusionPharmacists’ contributions to improving patients’ medication-related care are the same regardless of payment model. Financially sustainable integration of pharmacists on the team involves using a combination of FFS and value-based incentive payments, consistent documentation, meaningful collection of pharmacists’ contributions to improve the quality of care, and a firm understanding of the practice’s needs and financial structure. These themes can be used as a guide for pharmacists as they establish themselves in an FFS environment and adapt to a future in value-based care.     

Mandatory continuing professional education in pharmacy: the Singapore experience

Background Mandatory Continuing Professional Education (CPE) for the renewal of pharmacists’ practising certificate was implemented in Singapore in 2008 Objective To study pharmacists’ perceptions and attitudes about the impact of mandatory CPE in Singapore. Setting Singapore. Method Internet-based questionnaire survey, conducted between May and June 2011. Main outcome measure Pharmacists’ perceptions and attitudes toward mandatory CPE and the perceived difficulty in fulfilling the CPE requirements. Results The overall survey response rate was 52 % (840/1,609). Of the respondents, 32 % were non-practising, 49 % were practising in patient care areas, and 19 % were practising in non-patient care areas. More than half the pharmacists agreed that mandatory CPE (1) enhanced or increased their knowledge base and skills (70 %; 95 % CI 67–73 %), (2) motivated them to continually learn (64 %; 95 % CI, 60–67 %), and (3) motivated them to reflect on their professional practice or work (58 %; 95 % CI, 54–61 %). Mandatory CPE was not perceived to enhance or increase employability. Non-practising pharmacists appeared to have the greatest difficulty meeting the CPE requirements. Conclusions In general, pharmacists value mandatory CPE more for positive professional reasons than for employability reasons. The survey results may serve as useful baseline data for future studies of pharmacists’ perceptions and attitudes toward CPE in Singapore.     

Person-environment fit as a predictor of hospital pharmacist job performance

The relationship between person-environment fit and job performance of hospital pharmacists was examined. Person-environment fit is the extent to which personal needs are supplied in the work environment. Pharmacists (n = 86) from 10 hospitals completed a survey that assessed their need for certain attributes in the work environment and their perception of the extent to which those attributes were supplied. Statements from the Jackson Personality Research Form A were used to assess need for achievement, autonomy, cognitive structure, endurance, order, and social recognition. Statements from the same form were used to assess the degree to which respondents perceived that the hospital pharmacy environment supplied the six attributes. Person-environment fit was calculated by subtracting the environmental supply score from the personal need score. Job performance was rated by supervisors. The respondents' highest need was for achievement and lowest need was for autonomy. The supply of five of the attributes was rated similarly; the supply of autonomy was perceived to be significantly lower. Scores for person-environment fit showed that the need for endurance was most closely matched by the work environment and the need for autonomy was most poorly matched. Overall job performance was not predicted by the person-environment fit score for any of the attributes. The supply of autonomy predicted 17% of the variance in performance scores. Job performance was significantly associated with the environmental supply of autonomy but not with person-environment fit.