Community pharmacists in Australia: barriers to information provision on complementary and alternative medicines

Objective To determine, by surveying Australian community pharmacists, the perceived barriers to the provision of information about complementary and alternative medicines (CAMs) and suggestions for overcoming them. Method Anonymous, self-administered survey sent to a random sample of 701 pharmacists registered in three states of Australia in 2004. Main outcome measure Pharmacists’ perceived barriers to the provision of information about CAMs. Results A total of 344 questionnaires were returned by pharmacists (49% response) of which 211 (30%) were currently practising in community pharmacy. Ninety-five percent of surveyed community pharmacists indicated that they personally received enquires about CAMs, with fewer than 15% reporting they were “very confident” in answering queries about safety, interactions or benefits of CAMs. Frequently used CAM information sources were those from manufacturers and distributors, professional newsletters and journals and textbooks. Pharmacists’ perceived barriers to the provision of CAM information included a lack of suitable training (most training was informal), deficiencies in available information sources, a lack of managerial support, the need for regulatory changes, consumer beliefs about CAM safety and time constraints due to competing demands in daily practice. Pharmacists proposed improvements to overcome these barriers including improvements to training. Conclusion There is scope for pharmacy professional organisations and educational institutions to further support pharmacists in their practice through providing information on the best information sources available and training that meets the needs of undergraduate students, pharmacists and other pharmacy staff. There is a need to examine regulatory requirements concerning the provision of product information with CAMs in Australia and to implement mechanisms for increasing consumer awareness of regulatory procedures for these medicines.     

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.     

Development and implementation of a smoking cessation clinic in community pharmacy practice

OBJECTIVE: To describe a pharmacist-operated program to help people stop smoking. SETTING: Community chain (mass-merchandise) pharmacy practice sites in Virginia. PARTICIPANTS: Faculty at the Virginia Commonwealth University School of Pharmacy (VCU) and 15 practicing pharmacists. PRACTICE DESCRIPTION: Smoking cessation clinics within the pharmacy departments of seven Target stores. PRACTICE INNOVATION: With input from the practicing pharmacists and using the most current strategies reported in the literature, faculty at VCU developed a training manual for smoking cessation counseling. This manual was used to facilitate a 4-hour training session and also served as a resource for pharmacists in the smoking cessation clinics. Pharmacists were taught about behavioral modifications, the Transtheoretical Model of Change as applied to smoking cessation, documentation, the Fagerstr?m Test for Nicotine Dependence, smoking cessation therapies, patient counseling techniques, physical assessment skills, and how to develop an individualized action plan for smoking cessation. As pharmacists established smoking cessation clinics, issues such as workflow, continuous quality improvement, and marketing were addressed by the faculty members and practitioners. RESULTS: Using the process and tools described in this article, pharmacists successfully established and operated smoking cessation clinics. CONCLUSION: The process and materials developed for this demonstration project can serve as templates for other pharmacy faculty members and community pharmacists who wish to offer smoking cessation clinics.     

Patient assessment and documentation integrated in community practice: Chat,check, and chart

ObjectiveTo explore how pharmacists integrated the Chat,Check andChart (CCC) tools in community practice and to identify barriers and facilitators to use.DesignConcurrent nested mixed-method study. Open-ended, semi-structured qualitative interviews on tools use and a quantitative survey were completed via telephone.SettingCommunity-based pharmacy practice.Participants39 community pharmacists consented to interviews2 months after the CCC training workshop; 22 completed an interview.InterventionWorkshop training on CCC tools and workplace implementation strategies.Main outcome measuresBarriers, facilitators and implementation strategies for CCC tools.ResultsMore pharmacists were implementing or had made patient assessment part of their practice (54%) than documentation of patient care (36%). Integration was facilitated by patient success, collaborative worksite, personal beliefs, and provincial regulations. Lack of routines, patient expectations, reimbursement, and time were familiar barriers. Strategies to overcome these barriers included practicing new habits, using technology, starting small, using physical reminders, and recognizing benefits.ConclusionPatient care tools for assessment and documentation had both positive and negativeeffects on patients, pharmacists, and community pharmacies because of demands on time, lack of resources, and limited personal, external, and patient expectations of pharmacists’ care. Findings resulted in Alberta College of Pharmacists academic detailing of the CCC tools duringonsite pharmacy assessments to help pharmacists meet or exceed provincial practice standards.     

Impact of a blended learning program on community pharmacists’ barriers,knowledge, and counseling practice with regard to preconception,pregnancy and lactation

BackgroundCommunity pharmacists acknowledge to have an important role in providing pharmaceutical care during preconception, pregnancy and lactation. However, pharmacists’ knowledge and counseling regarding this topic is still insufficient. Hence, educational initiatives are urgently needed.ObjectivesTo assess the impact of a blended learning program (‘intervention’) on community pharmacists' barriers, knowledge, and counseling practice with regard to preconception, pregnancy and lactation.MethodsA pre-post study was performed in collaboration with 40 randomly selected pharmacies belonging to a large pharmacy chain in Belgium. All pharmacists employed in these pharmacies were eligible to participate in a blended learning program consisting of an e-learning and an on-site training day. Data were collected using online surveys, mystery shopping visits and pharmacy records. Pharmacy conversations were assessed on information gathering, dispensed product, and case-specific information. A retention knowledge test was completed 3–6 months after the intervention.ResultsIn total, 60 pharmacists completed the post-intervention surveys (response rate: 95%). The total number of barriers decreased after the intervention, while organizational barriers such as lack of privacy (73%) and lack of time (67%) became more prevalent. Pharmacists’ short and long-term knowledge improved after the intervention (p ≤ 0.001), although knowledge declined again over time (p ≤ 0.001). During counseling, pharmacists more often spontaneously provided information about folic acid when dispensing a pregnancy test, and more often suggested the correct dose/dosage for the dispensed OTC-product against pregnancy-related nausea. However, poor information gathering, dosing errors and incomplete information were still observed.ConclusionThe blended learning decreased pharmacists' barriers and improved their short- and long-term knowledge, while counseling practice only partially improved. Hence, the blended learning was insufficient to enhance pharmacists’ information gathering competences and to fully implement pharmaceutical care services with regard to preconception, pregnancy and lactation.     

Barriers to the use of patient safety information sources by community pharmacies

BackgroundWhen patient safety information is communicated across a regulatory jurisdiction or country, the potential to enhance the safety of community pharmacy practice is significant. While there currently exists a number of sources for patient safety information (e.g., websites, safety bulletins, online tools), knowledge of the barriers that may inhibit the use of such information sources within community pharmacies is limited.ObjectiveThis research explores community pharmacy manager use of Canadian patient safety information sources and the barriers that may limit the use of such sources.MethodsA qualitative research study design using semi-structured interviews was conducted with 15 community pharmacy managers in the Halifax Regional Municipality of Nova Scotia, Canada. The study explored how pharmacists access and engage a variety of information sources, including corporate intranets, websites, and tools provided by third party data base repositories. Interview data were analyzed using thematic analysis.ResultsFive general barriers were identified: lack of time to access information sources and its contents; too many sources of available information; too much information not relevant to community pharmacy practice; complexity navigating online information sources; and lack of community pharmacy involvement in source design.ConclusionWhile pharmacies do use safety information sources to enhance practice safety, their ability to incorporate this information is inhibited by their general lack of time available to access and read safety information, lack of knowledge about where to get this information, and lack of tailored information for the community pharmacy context. Future initiatives should address increasing information awareness of available sources, consolidating and reducing information overload of such sources, and packaging information to better fit with pharmacists’ needs.     

“A little bit more looking…listening and feeling” A qualitative interview study exploring advanced clinical practice in primary care and community pharmacy

Background Growing demands on healthcare globally, combined with workforce shortages, have led to greater skill mix in healthcare settings. Pharmacists are increasingly moving into complex areas of practice, a move supported by policy and education/training changes. Aim To understand the nature of extended roles for pharmacists practising at an advanced level in primary care and community pharmacy settings, to explore how clinical and physical examination was incorporated into practice and to understand the impact of providing such examination on practice and on patient relationships. Method Telephone interviews (N?=?15) were conducted with a purposive sample of pharmacists using clinical and physical examination in their practice in Great Britain. The sample included primary care pharmacists (N?=?5), community pharmacists (N?=?4), pharmacists working across settings (N?=?5) and one working in another primary care setting. Participants were recruited through professional networks, social media and snowballing. Results Primary care pharmacists and community pharmacists were utilising clinical and physical examination skills in their practice. Some community pharmacists were operating locally-commissioned services for low acuity conditions. Incorporating such examinations into practice enabled pharmacists to look at the patient holistically and enhanced pharmacist/patient relationships. Barriers to practise included lack of timely sharing of patient data and perceived reluctance on the part of some pharmacists for advanced practice. Conclusion With growing opportunities to provide patient-focussed care, it remains to be seen whether pharmacists, both in Great Britain and elsewhere, are able to overcome some of the organisational, structural and cultural barriers to advanced practice that currently exist in community pharmacy.

     

Lebanese community-based pharmacists’ interest,practice, knowledge,and barriers towards pharmacy practice research: A cross-sectional study

ObjectiveTo assess the interest, knowledge, practice and barriers of Lebanese community-based pharmacists towards research, and to examine factors associated with interest.MethodsA cross-sectional survey, conducted between January and May 2017, enrolled community pharmacists using a proportionate random sample of community pharmacies in the five districts of Lebanon, using the list of pharmacies provided by the Lebanese Order of Pharmacists. In the absence of validated questionnaires to answer our objectives, we created a questionnaire based on previous research. The questionnaire was modified based on the experiences and issues raised during focus groups with research active pharmacists and research oriented community pharmacists.ResultsA total of 399 pharmacists was enrolled. The results showed that 231 (72%) were conscious about the important role of research in the community pharmacy setting whereas only 5.6% considered it not important. Over two-thirds (68.5%) of the pharmacists declared being interested in participating in research. There was a statistical difference in the percentage of correct answers between auto-declared and corrected responses for all terms, with all p < 0.001.The most reported barrier was lack of time during hours of work (90.9%), followed by the lack of pharmacy staff (73.7%), lack of financial resources (68.9%), patient’s lack of education and resistance to participation (64.8%), and lack of support (63.8%). Age (aOR = 0.92), years of experience (aOR = 1.06), and having been involved in research (aOR = 3.17) were associated with higher interest in research. Having studied in Lebanon (aOR = 3.63), having received previous research courses (aOR = 11.12) and being interested in research (aOR = 2.74) were associated with having participated in research projects during their professional experience.ConclusionLebanese pharmacists have the good will to conduct and participate in research, but are lacking knowledge; this issue needs to be addressed vividly. Addressing the identified barriers could improve the research output of Lebanese community pharmacists.     

Supporting patients with mental illness: Deconstructing barriers to community pharmacist access

Objectives

To discuss the barriers faced by individuals with mental health conditions attempting to access their community pharmacists and to propose solutions toward deconstructing those barriers.

Pharmaceutical care for people with depression: Belgian pharmacists' attitudes and perceived barriers

Background In the past three decades, the role of pharmacists has evolved toward working with other health professionals and the public in a patient-centered model of practice, which is called pharmaceutical care. This model has been implemented for most physical illnesses but in relation to mental health, pharmacists?? role is still evolving. Objective The objective of this study was to evaluate pharmacists?? attitudes, current practice, perceived barriers and training needs concerning pharmaceutical care for people with depression. Setting All pharmacists attending obligatory regional meetings of the Surplus Network (a Flemish community pharmacy chain) during April and May 2009. Method Written survey consisting of questions on (1) pharmacists?? attitude and current practice in depression care and pharmaceutical care for people with other illnesses; (2) potential barriers in providing pharmaceutical care for people with depression; and (3) training needs. Paired samples T tests and Wilcoxon-tests were used to analyze the data. Main outcome measure Attitude and current practice in depression care versus care for other illnesses. Results Although the results show no difference in the attitude of pharmacists toward providing care for people with depression versus other illnesses (p?=?0.315), pharmacists report to provide significantly less care to people with depression compared to people with other illnesses (p?<?0.05). Perceived barriers toward providing depression care were the lack of information about the person and their treatment, the fact that depression is a difficult condition, the lack of education in mental health and the lack of time and privacy in the pharmacy. These, and the reported training needs, may limit the self-efficacy of pharmacists and hence influence current practice. Conclusion In spite of pharmacists?? positive attitude toward depression care, current practice displays actionable flaws. Barriers and training needs should be addressed in order to improve pharmaceutical care for people with depression.     

Assessment of knowledge,attitude and practice among community pharmacists towards dental care: A national cross sectional survey

BackgroundCommunity pharmacists’ contribution in health maintenance and promotion is significant but more studies are still needed to evaluate their role as healthcare providers.ObjectivesOur primary objective was to assess knowledge, attitude, and practice among community pharmacists in Lebanon towards dental care. Secondary objectives included assessing the barriers to a good dental care practice and assess their educational needs for oral health counseling.MethodsA national cross-sectional study was carried out using an online questionnaire and targeting community pharmacists in Lebanon. Five, three and six questions were used to assess pharmacists’ perceived knowledge, attitude and practice respectively. Stepwise linear regressions were conducted taking each time a different scale score as the dependent variable.Results497 (78.88%) pharmacists completed the survey (62% females). More than half (53.3%) exhibited good perceived knowledge, 39% a positive attitude and 47.3% a good practice regarding oral health. Pharmacists reported a good perceived knowledge regarding common oral conditions (good, very good and excellent knowledge: 73.2%). Most of the pharmacists (86.52%) perceived oral health promotion as an important part of their services. Moreover, 28.77% (n = 143) of pharmacists declared having difficulties in obtaining oral health information. The main barriers to a good practice included limited interaction between dentists and pharmacists and lack of training regarding oral health. The multivariable analyses showed a significant positive intercorrelation between perceived knowledge, attitude and practice. Working in the pharmacy for more than 40 h a week was associated with higher perceived knowledge (Beta = 2.846). Having a PhD degree was associated with lower practice scores (Beta = 3.676), whereas female gender was associated with lower practice scores (Beta = 2.334).ConclusionsPharmacists have the overall required knowledge and attitude to play an important role in the patients’ counseling towards dental care.     

The training needs,attitudes and experience of pharmacy support staff in Northern Scotland

Objective The purpose of this survey was to explore: attitudes towards training; experience of training; and training needs of support staff in hospital and community pharmacies in Northern Scotland. Method A postal questionnaire was sent to hospital and community pharmacies in the five regions of Northern Scotland. The intended respondents were community pharmacists, community pharmacy support staff, hospital pharmacists, and hospital pharmacy support staff. Key findings Data were collected from 105 (62.9%) community pharmacists, 463 (57.0%) community pharmacy support staff, 19 (90.5%) hospital pharmacists, and 88 (83.8%) hospital pharmacy support staff. Pharmacists and support staff in both settings: agreed that support staff currently receive insufficient training; were in favour of support staff receiving training; and agreed that training enhances both the confidence that support staff have in themselves and the confidence that pharmacists have in their staff. Barriers to training for support staff included: lack of availability of local relevant courses; lack of time in the working day; distance to training events; insufficient staff levels to enable staff to participate in training; and the financial cost of training. There was considerable variation in respondents' preferences for format and frequency of training. Conclusions Pharmacists and support staff in hospital and community sectors have positive attitudes towards training for support staff. Future training initiatives need to address barriers to training and accommodate different preferences for training format and frequency where possible.     

Preceptors' perspectives on benefits of precepting student pharmacists to students, preceptors, and the profession.

OBJECTIVES: To educate pharmacists on the shortage of quality preceptors and the benefits received from precepting; present insights from successful preceptors and offer guidance to current and prospective preceptors; and encourage pharmacists to become preceptors and mentor aspiring pharmacy professionals. SETTING: Advanced experiential settings for Nova Southeastern, Ohio Northern, and Creighton Universities. PRACTICE DESCRIPTIONS: Hospital, community, and outpatient clinic settings. PRACTICE INNOVATION: Successful incorporation of student pharmacists and the experiential process into pharmacy practice. MAIN OUTCOME MEASURE: Not applicable. RESULTS: A variety of factors has produced an increased demand for qualified pharmacist preceptors, including workload issues, an increasing number of pharmacy schools, and an increased experiential load in the pharmacy school curricula. Characteristics of quality preceptors include demonstrating enthusiasm in their teaching, being open to questions, and providing constructive feedback. Sites and preceptors can benefit from teaching student pharmacists by receiving assistance in developing and maintaining clinical services, sensing the satisfaction of giving back to the profession, and material rewards provided by schools of pharmacy. In this article, three successful preceptors share their perspectives and insights about precepting, and a professional organization perspective is included to highlight the support for precepting student pharmacists. CONCLUSION: Additional introductory and advanced quality pharmacy experiential practice sites are needed, and pharmacists are encouraged to contact nearby pharmacy schools to become preceptors.