Evaluation of community pharmacy service mix: evidence from the 2004 National Pharmacist Workforce Study.

OBJECTIVES: To describe the mix of pharmacy services being offered in different types of community pharmacy practices and to identify factors associated with a community pharmacy offering pharmacy services. DESIGN: Cross-sectional study. SETTING: Community pharmacies (independent, chain, mass merchandiser, and supermarket pharmacies). PARTICIPANTS: Pharmacists practicing full-time or part-time who worked in community pharmacies and responded to the 2004 National Pharmacist Workforce Survey. INTERVENTION: Mailed survey from the 2004 National Pharmacist Workforce Survey, which included core content questions for all sampled pharmacists and supplemental surveys that included workplace questions for a selected subsample of pharmacists. MAIN OUTCOME MEASURES: Type and frequency of pharmacy services being offered in a community pharmacy, including dispensing and product-related services (e.g., specialty compounding), and pharmacist care services (e.g., immunizations, smoking cessation, health screening, medication therapy management, wellness screening, nutritional support, and disease management services). RESULTS: Four pharmacist care services were reported as being offered at more than 10% of community pharmacy practices: immunizations, smoking cessation, health screening, and diabetes management. The number of pharmacist care services offered at a community pharmacy was positively associated with having at least three pharmacists on duty, innovativeness of the pharmacy, status as an independent pharmacy, and status as a supermarket pharmacy. More than one half of the community pharmacy practices did not offer any of the eight pharmacist care services included in a pharmacy service index. CONCLUSION: Pharmacy services were reported at relatively few community pharmacies, and were associated with pharmacy innovativeness, pharmacist staffing levels, and pharmacy setting. Some community pharmacies are offering pharmacy services as part of their business strategy, while others are dedicated to dispensing services. Continued study of pharmacy service availability in community pharmacies is needed to improve our understanding of our capacity to deliver such services, including medication therapy management services.     

Consumer attitudes towards community pharmacy services in Saudi Arabia

Objective The purpose of this study was to determine consumer attitudes towards community pharmacy and their preferences for the introduction of new services. Methods A self‐completion questionnaire was developed and 1,144 consumers in 55 community pharmacies were invited to complete it. The questionnaire covered consumers' choice of pharmacy; their perceptions of, and actual interactions with, community pharmacists; advice from pharmacists about general health and prescribed medicines; and privacy in the pharmacy. Respondents were asked for their views about five possible new services. Setting The study was based in community pharmacies in Riyadh City, Saudi Arabia. Key findings The response rate was 79.6%. Fifty‐nine per cent of respondents often or sometimes visited a particular pharmacy. One‐quarter of respondents perceived community pharmacists as having a good balance between health and business matters, while 56.1% thought pharmacists were more concerned with the business. The majority of respondents (69.7%) said they felt comfortable asking the pharmacist for advice. Just under half (44.8%) felt that pharmacists allowed them enough time to discuss their problem fully and listened well. In addition, 58.5% of respondents indicated that their pharmacists showed sensitivity to privacy by speaking more quietly across the counter. In 14.4% of situations pharmacists were reported to use a private area within the pharmacy when discussing personal or private matters. Most respondents (65.2%) indicated that their pharmacist was willing to discuss their health problems and tried to understand their feelings. Consumers' priorities for new services were: monitoring blood pressure; measuring weight, height and temperature; monitoring blood sugar; and monitoring cholesterol. Conclusion This study showed that most pharmacy customers feel comfortable seeking advice from their pharmacist. Although many pharmacists were reported to show sensitivity to a possible lack of privacy in the pharmacy, few respondents reported that their pharmacy had a private area for discussion. Customers' views on possible new services were generally positive, with the exception of patient medication records.     

Pharmaceutical services in family practice medical residency training programs

The extent and nature of pharmacists' involvement in family practice medical residency training programs was assessed using a national survey. Department chairmen of all 386 approved family practice residency training programs in the United States were contacted and asked to provide the names and addresses of pharmacists in charge of pharmaceutical services in the centers. A 46-item, six-page questionnaire was mailed to each pharmacist with a follow-up mailing, then a telephone call, to nonresponders. Department chairmen of 68 (18%) of the programs reported having at least one pharmacist in the center. Responses to the questionnaire were obtained from 53 (78%) of the pharmacists, four of whom were no longer involved with family practice centers. Most of the remaining 49 pharmacists were men (76%) between 30 and 40 years old (59%) with an academic appointment (67%) and a doctor of pharmacy degree or some type of postgraduate training. Drug-distribution services were provided in 37% of the centers. All pharmacies offered clinical services. Almost all pharmacies (92%) offered educational services to both medical and nursing staffs, and pharmacists in 74% of the centers were involved in research. Few family practice medical residency training centers have pharmaceutical services conducted by a pharmacist; centers with pharmacists have a wide variety of distributive and clinical services.     

Pharmacists’ experience of a diabetes risk-assessment service and analytical quality control in community pharmacies – A focus-group study

BackgroundHealthcare services such as diabetes risk-assessment are increasingly common in community pharmacies. Knowledge of community pharmacists’ experiences of such services could ease the implementation of a larger-scale service.ObjectivesTo explore Norwegian pharmacists’ experience of a diabetes risk-assessment service, including analytical quality control, in a community-pharmacy setting.MethodsThree focus-group interviews were conducted in Norway between August and September 2017. Systematic text condensation was used, an analytic approach well suited for thematic content analysis across interview data. Fourteen pharmacists took part, recruited from a project offering a diabetes risk-assessment service, including measurements of Glycated hemoglobin A1c (HbA1c), in Norwegian community pharmacies.ResultsThe pharmacists emphasized the importance of using their knowledge and skills to promote good health. They considered offering this service as being compatible with their role as pharmacists. As communication is an essential part of their work, the pharmacists evaluated their communication skills as being good. Nevertheless, how to communicate the offering of this service was seen as a challenge, for instance recruiting participants and communicating in an understandable and professional way. Inclusion of the whole pharmacy staff as a team was experienced as an important success factor for implementation of a risk-assessment service. Analytical quality control was perceived as being a natural part of their job and a manageable task.ConclusionsOffering a diabetes risk-assessment service is in line with the way a selected group of Norwegian community pharmacists perceived their professional role. However, they were uncomfortable recruiting participants, and expressed the wish for more support from the pharmacy chain. Our results add performance of analytical quality control as part of the ongoing development involving expansion of pharmacists' professional role. Future implementation studies may also benefit from giving both the pharmacy staff and customers sufficient time to familiarize themselves with the new service before measuring effects.     

Pharmacists' attitudes towards the reporting of suspected adverse drug reactions in Norway

BACKGROUND: In Scandinavian countries, pharmacists have not reported adverse drug reactions (ADRs), either due to legislative restrictions or because of lack of tradition. From 1 January 2005, Norwegian pharmacists have been encouraged by the Norwegian Medicines Agency to take a larger role in the reporting of ADRs. OBJECTIVE: To explore pharmacists' attitudes towards pharmacovigilance and their experiences with ADR reporting, to evaluate the effect of an educational programme and to compare these findings to the attitudes in a control group. METHODS: From September 2004, pharmacies in two of Norway's five health regions were invited to attend a 3-month ADR reporting study, and 39 pharmacies were recruited. One pharmacist from each pharmacy participated in a 1 day pre-study educational programme and a 1 day post-study evaluation meeting. Pharmacists involved in the study answered a questionnaire (A) regarding their attitudes to ADR reporting (active group). A control group answered the same questionnaire. One reminder was sent. The active group evaluated the study by answering questionnaire A once more and an evaluation questionnaire (B). Qualitative aspects of ADR reporting were discussed with the active group post-study. RESULTS: The response rate for questionnaire A was 97% (n = 158) in the active group, 74% (n = 184) in the control group and the response rate for questionnaire A and B post-study was 68% (n = 105) in the active group. Pharmacists in the active group had more positive attitudes to ADR reporting after taking part in the study than the control group (p < 0.001). Lack of time, confidence and knowledge of reporting rules could potentially prevent them from reporting ADRs. CONCLUSIONS: The pharmacists had positive attitudes towards pharmacovigilance, but very little experience with reporting. The educational programme clarified their role and increased their knowledge about the reporting requirements.     

Pharmacy customers’ views and experiences of using pharmacies which provide needle exchange services in Aberdeen and Glasgow, Scotland

Community pharmacists contribution to the management of drug problems is considerable. As the use of illicit drugs has increased, pharmacists have come under increasing pressure to offer services to problem drug users. However, there is concern among some pharmacists that offering such services may deter other customers. There is particular concern among some pharmacists about needle exchange services. Only 9.5% of Scottish pharmacies offer needle exchange services compared to 69% which are dispensing methadone (57% of which supervise methadone consumption). Qualitative interviews were used in a purposive sample of 10 pharmacies in Scotland. Eight customers were interviewed in each pharmacy to ascertain pharmacy customers’ views on these services. The majority of customers were supportive of these services. Customers were often unaware that the pharmacy they were interviewed in was offering services for people with drug problems. Pharmacy customers were more knowledgeable about, and more supportive, of needle exchange services than they were of methadone. This was because they believed needle exchange services helped to reduce the amount of discarded needles in public places. Pharmacy customers also recognised that needle exchange helped reduce the spread of disease. These findings should be used to encourage more pharmacists to offer needle exchange services.     

Attitudes of Ohio hospital pharmacists toward pharmacy technicians

A survey was conducted to determine the attitudes of Ohio pharmacists toward pharmacy technicians. A questionnaire was developed with questions about the current and future scope of technician responsibilities; training, certification and licensure; and possible displacement of pharmacist positions. The questionnaire was mailed in January 1990 to a random sample of 357 hospital pharmacists registered with the Ohio State Board of Pharmacy. There were 182 usable questionnaires returned, for a response rate of 51%. Nearly all the respondents (98.4%) employed pharmacy technicians. Of 32 functions listed in the questionnaire, 16 were performed by technicians at more than half of the responding hospitals. The functions performed by technicians varied depending on the size and location of the hospital; and the education, experience, and current position of respondents influenced their opinions on the appropriateness of having technicians perform several functions now and in the future. Most respondents agreed that all technicians should receive standardized training and education, and more than a third believed that technicians should be certified. The respondents did not believe that increased use of technicians would eliminate present pharmacist positions in their department but were neutral toward a statement that technicians would eliminate pharmacist positions in general. Ohio pharmacists' attitudes toward the expanding role of pharmacy technicians seemed in concert with the recommendations that have emerged in the profession.     

Future of emergency contraception lies in pharmacists' hands.

OBJECTIVE: To increase community pharmacists' awareness about issues related to the provision of emergency contraception (EC) to women by describing pharmacist outreach and training programs and discussing pharmacy access and stocking issues, California's EC Pharmacy Program, methods for raising pharmacists' awareness, and professional development opportunities. SUMMARY: EC is both safe and effective in reducing the risk of unintended pregnancy after unprotected intercourse, yet awareness of and demand for the medication has not been high, and it often is not stocked in pharmacies. Various advocacy organizations have engaged in educating the public and physicians about EC, but relatively little attention and few resources have been targeted to ensure that the pharmacy community is aware of and educated about EC. Increased visibility and access to EC in the several states that allow pharmacists to provide EC directly to women have resulted from the active participation and leadership of pharmacists. In these states, women are showing interest in and receptivity to reproductive health services provided by pharmacists. In California, some 3000 pharmacists statewide have completed training, and in 2004 they provided EC directly to approximately 175,000 women. Pharmacists who provide EC overwhelmingly (91%) report that they do so because they see it as an important community service, and many (57%) recognize the opportunity for professional development. CONCLUSION: Pharmacists are uniquely positioned to improve access to EC, and leadership within the pharmacy community can facilitate efforts to improve access. Increased education and training of pharmacists about EC--such as continuing education programs available online at www.pharmacyaccess. learnsomething.com--are critical to ensure not only that EC is available in pharmacies but also that pharmacists are engaged in meeting the reproductive health needs of women. Increased access to EC can expand pharmacists' role in health care provision. State-specific information about EC pharmacy access initiatives is available on the Web at www.GO2EC.org.     

Ambulatory Pharmacy Services Affiliated With Acute Care Hospitals

The extent to which hospital-based pharmacists provide ambulatory clinical pharmacy services in the United States is unknown. We evaluated pharmacists' activities in hospital-affiliated ambulatory clinics and home health services. A questionnaire was mailed to directors of pharmacy in one-half of the United States acute care general medical-surgical hospitals with 50 or more licensed beds. The survey response rate was 56% (n=1174). In 19% of hospitals, pharmacists provided patient care (nondispensing activities) in ambulatory clinics. The most common clinics with pharmacist involvement were diabetes (10% of hospitals), oncology (9%), cardiology (6%), and geriatrics, infectious disease, and pain (4% each). Nondispensing roles varied by clinic type; prescribing by protocol was performed in 57% of anticoagulation clinics and 7% of diabetes clinics. Home health care services, with pharmacists' activity extending beyond providing drugs, were offered by 28% of the hospitals. Thirty-six percent of the hospitals operated one or more outpatient pharmacies. A statistically significant association was observed between hospitals' inpatient clinical pharmacy services (as assessed by the pharmaceutical care index) and the involvement of pharmacists in both ambulatory clinics and home health care services.     

Survey of Canadian oncology pharmacy services--the emergence of a specialty

The provision of pharmacy services to oncology is a substantial component of hospital pharmacy practice at several Canadian hospitals. To determine the scope of such pharmacy services a survey was developed and distributed to 103 hospital pharmacies and 11 ambulatory oncology pharmacies in 1988. There were 72 responses (65%), although only 96 centres were known to offer oncology services (adjusted response = 72 of 96 = 75%). Surveys were distributed and returned in reasonable proportion across the country. Inpatient and outpatient services were reported separately, for size of service offered, and categories of work in which staff were employed. Twenty-four of fifty-seven centres report large inpatient pharmacist services, and 21 of 57 had large inpatient technician services. The ratio of pharmacists to technicians appeared to be about equal, but technicians were less likely than pharmacists to be permanently assigned (one-third vs. one-half permanently assigned). About one-half of both large and small services indicate a desire for increased time for both pharmacists and technicians. Outpatient services were reported by fewer respondents, and the job assignments in this setting were mostly permanent. Manpower usage in both settings is primarily dedicated to drug preparation and distribution, although two-thirds of centres report small clinical services (most centres desired increased clinical services). Future planning topics ranked improved clinical services and standardization of practice highest. A 91% majority agree that there should be standards for pharmacy practice in oncology pharmacists in Canada. Many factors, including insufficient clinical services, impede specialty development and recognition, but are priority areas for future development.     

Patients' perceived benefit from and satisfaction with asthma-related pharmacy services.

OBJECTIVE: To determine whether patients targeted to receive intervention from an asthma management program reported receiving more services and had greater perceived benefit and satisfaction with those services compared with asthma patients not targeted by the program. DESIGN: Mailed survey. SETTING: Community pharmacy. PATIENTS: 471 community-based patients receiving asthma medications from 44 intervention pharmacies and 1,164 patients from 46 usual care (control) pharmacies. MAIN OUTCOME MEASURES: Five-point agreement scale measuring asthma services received, perceived value of the services, and satisfaction. RESULTS: Usable surveys were received from 39.0% of intervention patients and 42.4% of controls. There were no statistically significant differences between groups in the frequency of provision of listed services. Approximately 60% of respondents from both groups received written materials on asthma medications and 54% received inhaler counseling; both were rated high for perceived benefit. Fewer than 20% reported being counseled about asthma triggers. Fewer than 5% reported pharmacists talking to physicians on their behalf. General satisfaction with pharmacy services was high (78.2% agree or strongly agree), but not statistically different between groups. More than 65% believed that pharmacists spend enough time counseling patients. Several comments indicated that patients did not expect or ask for information because they were unaware that services were available and/or they had already been counseled by their physician. Responses to the statement "my asthma is better controlled because of help given to me by the pharmacist" were equivocal and not different between groups. CONCLUSION: Overall, there were few differences between groups. General satisfaction with pharmacy services is high, but patients' perceived benefit and satisfaction with cognitive services is lower. Increased public awareness of pharmacists' capabilities and a more proactive approach to providing cognitive services is needed.     

Family health services authorities and community pharmacists at the purchaser-provider interface

The views of both purchasers (family health services authorities [FHSAs]) and providers (community pharmacists) were sought on the development of community pharmaceutical services in the light of the 1992 pharmaceutical care report. Questionnaires were posted to the 480 pharmacists in charge of all community pharmacies in Wessex and to the 98 general managers of FHSAs in England and Wales. The questionnaires focused on reactions to those recommendations of the pharmaceutical care report which, if implemented, would have significant implications for the community pharmacist's workload. Both the FHSAs and community pharmacists indicated that, in their view, the skills of the community pharmacist are currently underutilised. Both groups expressed enthusiasm for the pharmaceutical care report recommendations that the following services should be provided: domiciliary services, disposal of unwanted medicines, supply of aids for disabled people, supply of compliance aids and adverse drug reaction reporting. Neither group was enthusiastic about pharmacists providing a therapeutic drug monitoring service from community pharmacies. On other areas, pharmacists were more enthusiastic about the provision of health advice, diagnostic/screening services and treatment protocols, while FHSAs favoured distribution of welfare foods, needle exchange, instalment dispensing and referral forms. Overall, both the FHSAs and community pharmacists were receptive to the principle of the development of the role of the community pharmacist within the primary health care team but expressed concerns regarding the training and workload implications.     

Patients’ perception,views and satisfaction with pharmacists’ role as health care provider in community pharmacy setting at Riyadh,Saudi Arabia

Objectives

This study will provide guiding information about the population perception, views and satisfaction with pharmacist’s performance as health care provider in the community pharmacy setting in Riyadh, Saudi Arabia.

Method

The study was conducted in Riyadh, Saudi Arabia, from July through December 2010. A total of 125 community pharmacies in Riyadh city were randomly selected according to their geographical distribution (north, south, east, and west). They represent about 10–15% of all community pharmacies in the city. The questionnaire composed of 8 items about patients’ views and satisfaction with the pharmacists’ role in the current community pharmacy practice. The questionnaire was coded, checked for accuracy and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0 for Windows (SPSS Inc., Chicago, Illinois).

Results

The response rate was almost 85% where 2000 patients were approached and 1699 of them responded to our questionnaire. The majority of respondents is young adults and adults (82.8%), male (67.5%) and married (66.9%). Seventy one percent of respondents assured that community pharmacist is available in the working while only 37.3% of respondents perceived the pharmacist as a mere vendor. About 38% assured sou moto counseling by the pharmacist, 35% reported pharmacist plays an active role in their compliances to treatments, 43% acknowledged the role of pharmacist in solving medication related problems, 34% considered the pharmacist as a health awareness provider and 44.6% felt that pharmacist is indispensable and an effective part of the health care system.

Conclusion

The image and professional performance of community pharmacist are improving in Saudi Arabia. The Saudi patients show better satisfaction, perception and appreciation of the pharmacists’ role in the health care team. However, extra efforts should be paid to improve the clinical skills of the community pharmacists. Community pharmacists need to be able to reach out to patient, assess their hesitations and promptly offer solution which was appreciated by the patients as the survey indicates. They should play a pro-active role in becoming an effective and indispensable part of health care. Furthermore, they should be able to advice, guide, direct and persuade the patient to comply correct usage of drugs. Finally, community pharmacists should equip themselves with appropriate knowledge and competencies in order to tender efficient and outstanding pharmaceutical health care.     

The impact of increasing workloads and role expansion on female community pharmacists in the United Kingdom

BACKGROUND: Evidence from United Kingdom and the United States indicates that community pharmacists' workloads have increased in recent years for 2 reasons. First, because of social and demographic changes there has been a greater demand for pharmaceutical services. Second, the community pharmacists' role has expanded. This article explores the effect of increased workloads on female community pharmacists. METHODS: Face-to-face interviews (n=30) were conducted with women over the age of 30 years in the North West of England who worked as community pharmacists. The interview schedule was designed to explore factors underpinning female working patterns in community pharmacy. Specifically, interviewees were asked about perceptions of working conditions, positive and negative aspects of community pharmacy working, views of recent changes in pharmacy, and future career plans. RESULTS: Findings suggest that although community pharmacists enjoy aspects of their new roles, their work environment has become increasingly pressurized, resulting in decreased job satisfaction. Additionally, this study found some evidence that increasing workloads resulted in decreased health and well-being. CONCLUSIONS: The role of the community pharmacist has significantly altered in recent years, and this has occurred following a decade of increasing workloads. Consideration of the factors shaping community pharmacy points to high-pressure working environments becoming common place. This is likely to have a negative impact on pharmacists and conceivably the services they provide.