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Ellie Rosenfeld Sharon Kinney Carlye Weiner Fiona Newall Allison Williams Noel Cranswick Ian Wong Narelle Borrott Elizabeth Manias 《Research in social & administrative pharmacy》2018,14(3):269-278
Objective
Children are particularly vulnerable to experiencing medication incidents in hospitals. Making sound medication decisions is therefore of paramount importance. Prior research has principally described pharmacists' role in reducing medication errors. There is a dearth of information about pharmacists' interactions with pediatric hospital staff across disciplines in resolving medication issues. The aim of this study was to examine interdisciplinary medication decision making by pharmacists in pediatric hospital settings.Design
An ethnographic design was undertaken comprising observations, semi-structured interviews and focus groups. Audio-recorded data were analyzed thematically.Setting
The study was conducted in three wards of an Australian pediatric tertiary teaching hospital, comprising general surgical, gastroenterology, endocrinology, neurology, adolescent and rehabilitation settings.Participants
Pharmacists, registered nurses and doctors were recruited from diverse clinical wards following information sessions.Results
Pharmacists were central to complex pediatric medication decision making, intervening about dosage, administration, drug interactions and authorities. Pharmacists proactively contacted doctors and nurses about prescribing issues; conversely, staff routinely approached pharmacists for medication advice. Pharmacists were perceived as medication experts, their extensive knowledge valued in resolving complex issues: when off-label medications were prescribed, when protocols were absent or ambiguous, where tension existed between protocol adherence and patient safety, and where patients on multiple medications were at risk of medication error. Pharmacists had strong relationships with doctors and nurses, which had a bearing on pharmacists' input in interventions. Furthermore, pharmacists identified prescribing errors through strategies, such as case note review and medication reconciliation, although the lack of emergency department pharmacists and limited after-hours staffing posed challenges to both strategies.Conclusions
Pharmacists made a substantial and highly valued contribution to pediatric inter-professional medication decision making. These results provide new knowledge that informs theoretical developments of pharmacists' role in decision making. 相似文献2.
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Objectives
The study objectives were to a) assess knowledge and experience; b) describe perceptions and attitudes; and c) identify training needs of community-based pharmacists regarding HIV pre-exposure prophylaxis (PrEP).Design
This was a cross-sectional survey study.Setting and participants
The survey was administered online to pharmacists practicing in a community setting in the state of Minnesota.Outcome measures
Measures included knowledge of and experience with HIV PrEP, perceptions and attitudes towards pharmacists' involvement, and HIV PrEP-specific training needs for pharmacists.Results
With a survey response rate of approximately 13% (n = 347), most respondents (76.4%) agreed that HIV PrEP can be beneficial in high-risk populations. Forty-six percent of respondents were not aware of U.S. Food and Drug Administration approval of emtricitabine and tenofovir disoproxil fumarate for PrEP. Most respondents (71.1%) were "not at all familiar" with Centers for Disease Control and Prevention guidelines for PrEP. Twenty-one percent of respondents had sufficient knowledge to counsel patients on PrEP. Experience with counseling on PrEP (21.8%), having dispensed PrEP in the last 2 years (33.1%), fewer years in practice (≤10 years), location of practice site (urban or suburban), and having received HIV continuing education in the last 2 years (33.0%) were associated with more knowledge of HIV PrEP. Top concerns with counseling were knowledge about the medication and behavior modification. The most frequently indicated primary concerns with implementing PrEP initiatives were identifying appropriate candidates and patient adherence.Conclusion
As pharmacists' roles continue to expand, relevant content in pharmacy education and requisite training (including continuing education) are critical to addressing knowledge gaps and competencies that will enable pharmacists engage more effectively in public health efforts such as HIV prevention. 相似文献10.
Objectives
To determine a) the impact of pharmacy setting (chain vs. independent) and b) pharmacists' communication styles on patients' pharmacist selection preferences and their perceptions of pharmacists.Design
A 2 (pharmacy setting) × 4 (communication style of pharmacist) mixed-design experiment using online vignettes, where pharmacy setting (chain vs. independent) was the between-subjects factor and the communication style of the pharmacists (paternalistic, informative, interpretive, or deliberative) was the within-subjects factor.Setting and participants
A total of 502 adult U.S. participants completed an online survey.Main outcome measures
Participants completed measures of perceived expertise, quality of medical care, and patient satisfaction after exposure to each vignette. They also selected which of the 4 pharmacists they would want to visit, along with answering an open-ended prompt explaining their decision.Results
Mixed analysis of variance results revealed that pharmacy setting had no impact on the dependent variables, although pharmacists adopting more patient-centered communication (i.e., deliberative or interpretive) were perceived to have greater expertise (P < 0.001). These pharmacists were also predicted to provide a higher quality of care (P < 0.001) and greater patient satisfaction (P < 0.001). Although the majority of participants would choose to visit a patient-centered pharmacist, about 1 in 6 stated that he or she would prefer a pharmacist adopting a paternalistic communication style. Participants' rationale for their selections focused primarily on how the pharmacists would communicate or recommend treatments.Conclusion
Although patient-centered care is seen as a criterion standard in pharmacy practice, there is a large subset of patients who prefer pharmacists who communicate from a more biomedical perspective. Future research and interprofessional educational opportunities with colleagues in communication disciplines may be fruitful in helping pharmacists to better assess patient cues that might signal their willingness to be more or less active participants in their care. Pharmacies may also find it useful to improve how they market pharmacists so that patients can more effectively choose pharmacists who fit the style of care they would like to receive. 相似文献11.
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Nick Schulte Janelle F. Ruisinger Emily S. Prohaska Katelyn M. Steele Brittany L. Melton 《Journal of the American Pharmacists Association》2017,57(3):407-411
Objectives
Assess patients' and caregivers' perceptions of comprehensive medication review (CMR) offers and when a CMR is needed, follow-up actions performed after the CMR, and recall of pharmacists' recommendations made during CMRs.Methods
A 22-item cross-sectional survey with multiple response, 5-point Likert scale (1 = strongly disagree; 5 = strongly agree), yes/no, and free response prompts was administered to patients and caregivers who completed a CMR between October 1, 2014, and September 30, 2015. Surveys were administered to study participants by telephone or by mail if they were not reachable by telephone.Results
Eighty of 141 surveys were completed (57%). Respondents were mostly white, female, and age 65 years or older, with an annual income less than $25,000. Respondents indicated that they were likely to accept CMR offers from pharmacists or pharmacy technicians they know (100% and 94%, respectively) and by telephone call (90%). Respondents strongly agreed that CMRs should be completed annually and when initiating medication for a new diagnosis (median = 5; interquartile range, 3-5). Most respondents received at least 1 recommendation (90%), recalled receiving their CMR summary (66%), and discussed their CMR with their prescribers (67%). Respondents who reported receiving a pharmacist recommendation during their CMR were more likely to strongly agree they should have an annual CMR (P = 0.009). Accurate recall of recommendations made during CMRs was 54%. General health and medication recommendations were significantly associated with respondents' recall of recommendations (P = 0.011 and P = 0.045, respectively).Conclusion
Patients and caregivers who received a CMR stated that they are likely to accept future CMR offers from a pharmacist or technician with whom they are familiar, and more patients and caregivers would accept offers by telephone than by other methods. In addition, a newly diagnosed condition presents an opportunity for strategic CMR appointment offers. Although pharmacists regularly made therapy interventions during CMRs, it is important to ensure that CMR recipients have clear instructions for follow-up with their prescribers. 相似文献14.
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Matthew Lengel Catherine H. Kuhn Marcia Worley Allison M. Wehr James W. McAuley 《Journal of the American Pharmacists Association》2018,58(2):179-185.e2
Objectives
To assess the impact of technician involvement on the completion of medication therapy management (MTM) services in a community pharmacy setting and to describe pharmacists' and technicians' perceptions of technician involvement in MTM-related tasks and their satisfaction with the technician's role in MTM.Design
Prospective observational study.Setting and participants
In the fall of 2015, pharmacists and selected technicians from 32 grocery store–based community pharmacies were trained to use technicians within MTM services.Main outcome measures
Completed MTM claims were evaluated at all pharmacies for 3 months before training and 3 months after training. An electronic survey, developed with the use of competencies taught in the training and relevant published literature, was distributed via e-mail to trained employees 3 months after training.Results
The total number of completed MTM claims at the 32 pharmacy sites was higher during the posttraining time period (2687 claims) versus the pretraining period (1735 claims). Of the 182 trained participants, 112 (61.5%) completed the survey. Overall, perceived technician involvement was lower than expected. However, identifying MTM opportunities was the most commonly reported technician MTM task, with 62.5% of technicians and 47.2% of pharmacists reporting technician involvement. Nearly one-half of technicians (42.5%) and pharmacists (44.0%) agreed or strongly agreed they were satisfied with the technician's role in MTM services, and 40.0% of technicians agreed that they were more satisfied with their work in the pharmacy after involvement in MTM.Conclusion
Three months after initial training of technicians in MTM, participation of technicians was lower than expected. However, the technicians involved most often reported identifying MTM opportunities for pharmacists, which may be a focus for future technician trainings. In addition, technician involvement in MTM services may increase satisfaction with many aspects of work for actively involved technicians. 相似文献16.
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Olayinka O. Shiyanbola Elizabeth Unni Yen-Ming Huang Cameron Lanier 《Research in social & administrative pharmacy》2018,14(9):824-830
Background
Beliefs in medications and illness perceptions is associated with medication adherence among individuals with diabetes and several adherence interventions focus on patients' beliefs in medicines and illnesses. Though health literacy is important in medication adherence, the relationship between health literacy and medication adherence remains inconclusive; thus raising the question as to whether health literacy has an amplifying or reducing effect on the relationship between beliefs and adherence.Objective
The study examined (1) the association between health literacy, beliefs in medicines, illness perceptions, and medication adherence in individuals with type 2 diabetes and (2) the moderating effects of health literacy (including numeracy and document literacy) on the relationship between illness perceptions, beliefs in medicines, and medication adherence.Methods
Adults ≥20 years taking oral diabetes medicines at two family medicine clinics, completed a cross-sectional survey. Participants were assessed on beliefs in medicines, illness perceptions, health literacy, self-efficacy, and medication adherence. Multiple linear regressions examined the effect of health literacy, beliefs and self-efficacy, and the moderator effect of health literacy in the relationship between beliefs and adherence.Results
Of the 174 participants, more than half were women (57.5%) and white (67.8%). There was a significant positive association between self-efficacy and adherence (β?=?0.486, p?<?.001), and a negative association between threatening illness perceptions and adherence (β?=??0.292, p?<?.001). Health literacy had a significant moderator effect on the relationship between adherence and concerns beliefs (β?=??0.156, p?=?.014) and threatening illness perceptions (β?=?0.196, p?=?.002). The concern beliefs - adherence association was only significant at marginal and adequate literacy levels. When health literacy was separated into numeracy and document literacy, only numeracy moderated the illness perceptions - adherence relationship (β?=?0.149, p?=?.038).Conclusions
Health literacy, especially numeracy, needs to be initially addressed before diabetes adherence interventions that address individual concerns about medicines and threatening illness perceptions can work. 相似文献18.
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