共查询到20条相似文献，搜索用时 15 毫秒
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Richard J. Holden Preethi Srinivas Noll L. Campbell Daniel O. Clark Kunal S. Bodke Youngbok Hong Malaz A. Boustani Denisha Ferguson Christopher M. Callahan 《Research in social & administrative pharmacy》2019,15(1):53-60
Background
Older adults purchase and use over-the-counter (OTC) medications with potentially significant adverse effects. Some OTC medications, such as those with anticholinergic effects, are relatively contraindicated for use by older adults due to evidence of impaired cognition and other adverse effects.Objective
To inform the design of future OTC medication safety interventions for older adults, this study investigated consumers' decision making and behavior related to OTC medication purchasing and use, with a focus on OTC anticholinergic medications.Methods
The study had a cross-sectional design with multiple methods. A total of 84 adults participated in qualitative research interviews (n?=?24), in-store shopper observations (n?=?39), and laboratory-based simulated OTC shopping tasks (n?=?21). Simulated shopping participants also rank-ordered eight factors on their importance for OTC decision making.Results
Findings revealed that many participants had concerns about medication adverse effects, generally, but were not aware of age-related risk associated with the use of anticholinergic medications. Analyses produced a map of the workflow of OTC-related behavior and decision making as well as related barriers such as difficulty locating medications or comparing them to an alternative. Participants reported effectiveness, adverse effects or health risks, and price as most important to their OTC medication purchase and use decisions. A persona analysis identified two types of consumers: the habit follower, who frequently purchased OTC medications and considered them safe; and the deliberator, who was more likely to weigh their options and consider alternatives to OTC medications.Conclusion
A conceptual model of OTC medication purchase and use is presented. Drawing on study findings and behavioral theories, the model depicts dual processes for OTC medication decision making – habit-based and deliberation-based – as well as the antecedents and consequences of decision making. This model suggests several design directions for consumer-oriented interventions to promote OTC medication safety. 相似文献5.
Christian Díaz de León-Castañeda Jéssica Gutiérrez-Godínez Juventino III Colado-Velázquez Cairo Toledano-Jaimes 《Research in social & administrative pharmacy》2019,15(3):321-329
Background
In Mexico, the Modelo Nacional de Farmacia Hospitalaria (MNFH, or National Hospital Pharmacy Model), published in 2009, mainly aims to promote the provision of clinical pharmacy services in private and public hospitals. However, there is little scientific documentation about the quality of these services.Objectives
To explore healthcare professionals' perceptions related to the quality of clinical pharmacy services provision.Methods
A case-study based on a qualitative approach was performed at the pharmaceutical services unit at a public hospital located in Mexico City, which operates under the administrative control of the Ministry of Health. Donabedian's conceptual model was adapted to explore health care professionals' perceptions of the quality of clinical pharmacy services provision. Semi-structured interviews were carried out with pharmacists, physicians and nurses and then transcribed and analyzed via discourse analysis and codification techniques, using the software package Atlas. ti.Results
Limitations in pharmaceutical human resources were identified as the main factor affecting coverage and quality in clinical pharmacy services provision. However, the development in pharmacy staff of technical competences and skills for clinical pharmacy service provision were recognized. Significant improvements in the rational use of medicines were associated with clinical pharmacy services provision.Conclusions
The perception analysis performed in this study suggested that it is necessary to increase pharmacy staff in order to improve interprofessional relationships and the quality of clinical pharmacy services provision. 相似文献6.
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Michael J. Twigg David Wright Garry Barton Charlotte L. Kirkdale Tracey Thornley 《Research in social & administrative pharmacy》2019,15(1):84-92
Background
The UK Community Pharmacy Future group developed the Pharmacy Care Plan (PCP) service with a focus on patient activation, goal setting and therapy management.Objective
To estimate the effectiveness and cost-effectiveness of the PCP service from a health services perspective.Methods
Patients over 50 years of age prescribed one or more medicines including at least one for cardiovascular disease or diabetes were eligible. Medication review and person-centred consultation resulted in agreed health goals and actions towards achieving them. Clinical, process and cost-effectiveness data were collected at baseline and 12-months between February 2015 and June 2016. Mean differences are reported for clinical and process measures. Costs (NHS) and quality-adjusted life year scores were estimated and compared for 12 months pre- and post-baseline.Results
Seven hundred patients attended the initial consultation and 54% had a complete set of data obtained. There was a significant improvement in patient activation score (mean difference 5.39; 95% CI 3.9–6.9; p?<?0.001), systolic (mean difference ?2.90?mmHg; 95% CI -4.7 to ?1; p?=?0.002) and diastolic blood pressure (mean difference ?1.81?mmHg; 95% CI -2.8 to ?0.8; p?<?0.001), adherence (mean difference 0.26; 95% CI 0.1–0.4; p?<?0.001) and quality of life (mean difference 0.029; 95% CI 0.015–0.044; p?<?0.001). HDL cholesterol reduced significantly and QRisk2 scores increased significantly over the course of the 12 months.The mean incremental cost associated with the intervention was estimated to be £202.91 (95% CI 58.26 to £346.41) and the incremental QALY gain was 0.024 (95% CI 0.014 to 0.034), giving an incremental cost per QALY of £8495.Conclusions
Enrolment in the PCP service was generally associated with an improvement over 12 months in key clinical and process metrics. Results also suggest that the service would be cost-effective to the health system even when using worst case assumptions. 相似文献9.
Kenneth C. Hohmeier Sharon L.K. McDonough Leanne Justis Rein Andrea L. Brookhart Mara L. Gibson Mary F. Powers 《Journal of the American Pharmacists Association》2019,59(2):187-194
Objectives
To explore the current roles of the pharmacy technician in the provision of medication therapy management (MTM) and their relation to organizational behavior at “high-performing” community pharmacies within a nationwide supermarket chain.Design
Qualitative research study using methodologic triangulation with the use of semistructured interviews of key informants, direct observation at “high-performing” pharmacy sites, and respondent journals.Setting and participants
High-performing pharmacy sites within a large supermarket pharmacy chain in Tennessee. A high-performing site was defined as a pharmacy that has successfully implemented MTM into its pharmacy workflow.Main outcome measures
Themes related to pharmacy technician roles in the delivery of direct patient care services.Results
A total of 28 key informants were interviewed from May 2015 to May 2016. Key informants included 10 certified technicians, 5 noncertified technicians, and 13 pharmacists across 8 pharmacies in central and eastern Tennessee. Three themes were identified. At high-performing sites, pharmacy technicians were engaged in both clinical support activities as well as nonclinical support activities with the goal of improving clinical service implementation. Several barriers and facilitators were revealed.Conclusion
Within high-performing teams, expanded technician roles to support patient care service delivery were associated with successful clinical service implementation. Future studies should further explore these expanded technician duties, as well as the role of organizational culture, climate, and team dynamics, in the delivery of patient care and clinical services across a heterogeneous pharmacy setting. 相似文献10.
Kyle R. Frazier Kimberly C. McKeirnan Sorosh Kherghehpoush Lisa J. Woodard 《Journal of the American Pharmacists Association》2019,59(2):210-216
Objective
To understand rural patient opinions regarding their willingness to participate in pharmacist-provided chronic condition management.Design
Qualitative semi-structured key informant interview using The Concept of Access as a theoretical framework.Setting
Three community pharmacies serving patients in rural Washington State from November 2016 to November 2017.Participants
Current patients from 3 rural independent community pharmacies.Main Outcome Measures
Qualitative analysis of patient attitudes, acceptance, perceptions, and preferences regarding pharmacist-provided chronic condition management services in a community pharmacy.Results
Eighteen key informant interviews were conducted between November 2016 and November 2017. Five themes were identified: trust between the pharmacist, patient, and physician is key; patients already value pharmacists’ knowledge about chronic condition medications; participants identified the pharmacist as the first point of contact with regard to understanding appropriate use of medications to treat medical conditions; implementing clinical services in the community pharmacy setting may reduce the need for doctors’ visits and improve timely patient care; and creating designated clinical space, appointment options, and efficient service may increase patient accommodation.Conclusion
Management of chronic conditions continues to be one of the largest health care expenditures in the United States. One promising method of addressing this public health concern is through sustainable clinical pharmacy services. The themes identified in this study provide insight into factors that community pharmacists might consider as medical provider status continues to gain momentum and the use of clinical pharmacy services becomes more prominent. 相似文献11.
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Background
The framing of competence as a binary “either-or” process may be shaped by the measurement tools and assessment methods used to define it. Blunt measures such as passing or failing a licensure examination, or revoking/suspending a license after a single dispensing error fosters anxiety amongst professionals and potentially leads to behaviours where learning needs are actually hidden from educators, employers or regulators. Such framing may not accurately capture the lived experience of those labelled “incompetent” and in fact may be counterproductive to remediation and skills enhancement.Objectives
To examine the construct of competence as a lived experience amongst pharmacists who had been identified and labelled as incompetent by their regulatory body.Methods
A multiple single-case research design (described by Kratochwill and Levin) involving 14 practicing pharmacists identified as not meeting competence standards by their regulatory body in Ontario, Canada was used for this research. Constant-comparative qualitative analysis of semi-structured interview data was coded, categorized and used to identify and describe major research themes.Results
Two major themes were identified, related to the personal and professional consequences of being labelled “incompetent” by one's regulatory body, and the importance of psychological engagement in one's own profession in facilitating maintenance of competence.Conclusions
This study highlighted the importance of disengagement as both a cause and consequence of competence drift and pointed to the impact of regulatory policies, practices, and assessment systems that may actually inadvertently contribute to this disengagement. 相似文献13.
Maria Sjölander Lars Lindholm Bettina Pfister Jeanette Jonsson Jörn Schneede Hugo Lövheim Maria Gustafsson 《Research in social & administrative pharmacy》2019,15(3):287-291
Background
Clinical pharmacists play an increasing role in the pharmacological treatment of hospital-admitted older patients with dementia or cognitive impairment. In an earlier randomised controlled trial, clinical pharmacist involvement in the ward team could significantly reduce drug-related readmissions in patient subgroups. However, the economic impact of the intervention has not been addressed so far.Objectives
To evaluate the economic impact of clinical pharmacist engagement in hospital ward teams for medication therapy management in older patients with dementia or cognitive impairments.Methods
Economic evaluation of a randomised controlled trial conducted in two hospitals in Northern Sweden between January 2012 and December 2014. Participants included 460 hospital-admitted older patients with dementia or cognitive impairments. Patients were randomly assigned to usual care, or usual care with pharmacist intervention; the intervention consisted of medication reconciliation, medication review, and participation in ward rounds. The outcomes were measured as drug-related readmissions to hospital as assessed by a group of external experts, 180 and 30 days after discharge. Costs included pharmacists' direct labour costs for the interventions, average costs for drug-related readmissions, and from this the total cost per person was calculated.Results
The effect of the intervention on drug-related readmissions within 180 days was significant in patients without heart failure (subgroup analysis), and the intervention resulted in cost savings of €950 per person in this subgroup. Drug-related readmissions within 30 days were reduced in the total sample (post-hoc analysis), and the cost-savings in this intervention group were €460 per person.Conclusions
Post-hoc and subgroup analyses indicate that engagement of pharmacists in hospital ward teams reduced the number of drug-related readmissions, and that the cost per person was lower in the intervention group compared to the control group. Including clinical pharmacists created savings in the subgroups of older patients with dementia or cognitive impairments. 相似文献14.
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Kebede Beyene Trudi Aspden Janie Sheridan 《Research in social & administrative pharmacy》2019,15(2):130-144
Introduction
Non-recreational sharing of prescribed medicines can have positive outcomes under some circumstances, but can also result in negative health outcomes. This paper describes a theoretically underpinned and systematic approach to exploring potential interventions to reduce harm.Methods
Individual, semi-structured, face-to-face interviews were conducted with purposively sampled pharmacists (n?=?8), doctors (n?=?4), nurses (n?=?6) and patients (n?=?17) from Auckland, New Zealand. Thematic analysis of suggested interventions was undertaken, and these were linked to relevant intervention functions of the Behaviour Change Wheel (BCW). Analysis of previously defined factors influencing sharing were mapped onto the “Capability, Opportunity, Motivation – Behaviour” (COM-B) model of the BCW.Results
COM-B analysis of the factors influencing sharing behaviour revealed: (i) ‘Capability’-related factors, such as patient misconceptions about the safety of certain medicines, forgetting to refill or to carry around own medicines, and lack of knowledge about safe disposal of leftover/unused medicines; (ii) ‘Opportunity’-related factors included lack of access to health facilities, lack of time to see a doctor, linguistic and cultural barriers, lack of information from healthcare providers about risks of sharing, and having leftover/unused medicines, and (iii) ‘Motivation’-related factors included altruism, illness denial, embarrassment about seeing a doctor, not carrying around own medicines, habit, and fear of negative health consequences from missing a few doses of medicines. Five intervention functions of the BCW appear to be the most likely candidates for targeting the factors which relate to medicine sharing. These are education, persuasion, enablement, environmental restructuring and restriction.Conclusions
A variety of personal and external factors which influence sharing behaviours were identified, and the BCW provided a means by which theoretically underpinned interventions to reduce potential harms from this behaviour could be proposed. The findings can help with the design of approaches to reduce harm associated with non-recreational medicine sharing. 相似文献16.
Andrew W. Roberts Delesha M. Carpenter Austin Smith Kevin A. Look 《Research in social & administrative pharmacy》2019,15(2):222-225
Background
Expanding access to naloxone is crucial for mitigating the public health epidemic of opioid overdose deaths in America. Pharmacists now have greater independent authority to dispense naloxone to the public due to a wave of enhanced pharmacy naloxone access laws. It is unknown to what extent pharmacists are required to receive specialized training to serve in this capacity.Objectives
The goal of this study was to review naloxone training mandates from states with enhanced pharmacy naloxone access laws.Methods
Structured internet searches were completed using publicly available legislative, regulatory, and administrative records to identify the type of enhanced pharmacy naloxone access law and the presence and characteristics of a pharmacist naloxone training mandate in each state.Results
As of November 22, 2017, all 50 states have implemented an enhanced pharmacy naloxone access law. Only 19 states mandated targeted naloxone education before pharmacists engaged in independent naloxone dispensing/prescribing activities.Conclusions
A lack of standardized naloxone training requirements for naloxone-dispensing pharmacists may affect the rate of adoption of enhanced pharmacy naloxone dispensing practices at community pharmacies and suboptimal education of patients at risk of opioid overdose. Ensuring pharmacists' preparedness to serve as naloxone providers is necessary to meaningfully prevent opioid overdose deaths in their communities. 相似文献17.
Background
Self-care advice and management of minor ailments have long been provided in community pharmacies across England. However, formal pharmacy minor ailment service provision is geographically variable and has yet to gain recognition and political support as a valued sustainable service for nationwide adoption and commissioning.Objective
To investigate the sustainability potential of pharmacy minor ailment services from the perspective of community pharmacy stakeholders within the North East of England.Methods
A mixed methods approach was adopted to survey and interview stakeholders from the North East of England who commission; provide; and/or represent groups influencing the design, delivery and investment in community pharmacy clinical and public health services. The 40-item Programme Sustainability Assessment Tool, a validated instrument to assess a public health programme's capacity for sustainability across eight domains, was administered to fifty-three stakeholders, identified from a pharmacy minor ailments showcase event. The same stakeholders were invited for a semi-structured interview to explore issues further. Interviews were audio-recorded, transcribed verbatim, and underwent framework analysis.Results
Forty-two (79.2% response rate) stakeholders representing commissioning, provider and influencing (e.g. Local Professional Network) organisations completed the assessment tool. Pharmacy minor ailment services were rated as unsustainable across the majority of the domains. Elements within the domain ‘Partnerships’ demonstrated potential for sustainability. Stakeholder interviews provided detailed explanation for the low scoring sustainability domains, highlighting the multifaceted challenges threatening these services.Conclusion
The Programme Sustainability Assessment Tool allowed stakeholders to evaluate the potential of pharmacy minor ailment services in England. Follow-up interviews highlighted that initial design and implementation of services was poorly conceived and lacked evidence, thereby impeding the services' sustainability. There are many challenges facing a widespread provision of pharmacy ailment services, but it is clear the profession needs to be clear on the service objectives to secure future interest and investment. 相似文献18.
Sandra Zeater Shalom I. Benrimoj Fernando Fernandez-Llimos Victoria Garcia-Cardenas 《Journal of the American Pharmacists Association》2019,59(1):108-116.e1