Conclusion: The majority of independent community pharmacists are interested in incorporating personalized medicine services into their practices, but they require further education before this is possible. Future initiatives should focus on the development of comprehensive education programs to further train pharmacists for provision of these services.Objectives: To evaluate the perceptions of independent community pharmacists within a regional independent community pharmacy cooperative on implementing personalized medicine services at their pharmacies and to gauge the pharmacists' self-reported knowledge of pharmacogenomic principles.Design: Descriptive, exploratory, nonexperimental study.Setting: American Pharmacy Services Corporation (APSC), 2011-12.Participants: Pharmacists (n = 101) affiliated with the independent pharmacies of APSC.Intervention: Single-mode surveyMain outcome measures: Independent community pharmacists' interest in implementing personalized medicine services, perceived readiness to provide such services, and perceived barriers to implementation.Results: 101 completed surveys were returned for data analysis. The majority of pharmacists surveyed (75%) expressed interest in offering personalized medicine services. When asked to describe their knowledge of pharmacogenomics and readiness to implement such services, more than 50% said they were not knowledgeable on the subject and would not currently be comfortable making drug therapy recommendations to physicians or confident counseling patients based on results of genetic screenings without further training and education. Respondents identified cost of providing the service, reimbursement issues, current knowledge of pharmacogenomics, and time to devote to the program as the greatest barriers to implementing personalized medicine services.

Background and Objectives: Community pharmacy screening for chronic disease risk factors can promote early detection. Little is known about how pharmacy services are used post-screening. The PIAAF Pharmacy study screened elderly participants for hypertension, diabetes, and atrial fibrillation (AF) in 26 pharmacies in Ontario and Alberta. The primary objective was to determine whether patients screening at risk for AF, hypertension and diabetes had increased odds and rates of pharmacy service receipt than those at lower risk. Methods: Participants’ pharmacy data were extracted. A conceptual framework of potentially influential factors was constructed. Measurable factors were used as variables in regression analyses. Generalized estimating equations (GEE) were created to model 1) receipt of all pharmacy services, 2) receipt of medication review, and 3) receipt of influenza vaccination. Results: 165 of 535 patients received 229 pharmacy services. 64% were medication reviews and 25% were influenza vaccinations. Screening at high risk for diabetes, hypertension, and AF was not associated with increased receipt of pharmacy services, except for influenza vaccine, which was associated with screening as high risk for diabetes (OR = 1.69 [95% CI 1.09, 2.64]). Screening in October (IRR = 2.85 [95% CI 1.67, 4.84]), eligibility for annual-only medication reviews (IRR = 2.15 [95% CI 1.53, 3.01]), number of medications (IRR = 1.92 [95% CI 1.07, 3.46]), new medications (IRR = 2.00 [95% CI 1.37, 2.93]), and living in Alberta (IRR = 1.46 [95% CI 1.07, 2.01]) were associated with increased rates of receiving pharmacy services. Discussion and Conclusions: Screening results were not associated with increased receipt of pharmacy services, with the exception of influenza vaccine and high risk of diabetes. A gap exists between screening and pharmacy service receipt. Pharmacists can use screening interventions and individual screening results as an opportunity to provide pharmacy services to those with chronic disease risk factors. / Thesis / Master of Health Sciences (MSc) / Community pharmacies may be ideal locations for screening of chronic diseases such as diabetes, high blood pressure, and abnormal heart rhythms. It is not well understood how pharmacy services are used in people after screening for these risk factors. This project aims to see if people screening at higher risk levels were more likely to receive pharmacy services than those at lower risk. We used patients’ pharmacy data to see what services they had received after screening, and then created statistical models to determine which patient-, pharmacy-, community-, and screening-related factors were associated with a greater chance of receiving pharmacy services. Being at risk of diabetes, high blood pressure, and irregular heart rhythms were not associated with a greater likelihood of receiving pharmacy services, except in those at high risk for diabetes—these patients were found be associated with a higher chance of receiving flu shots.

Community pharmacy practice is changing, putting a greater emphasis on patient involvement and empowerment than on physical drug products. Developing practice philosophies, such as pharmaceutical care, are operationalised through an ever-evolving service proliferation. There is, however, a paucity of studies addressing the patients’ subjective perceptions of pharmacy services. The few studies that measure the impact of pharmacy services on humanistic outcomes show little or no effect. This might be due to the services, or the assessment instruments used. The aim of this thesis was to enhance the understanding of how patients perceive community pharmacy services, their preferences for community pharmacy services, and how these services could be evaluated from the patient perspective. This was done by: 1.exploring patients’ perceptions of an existing pharmaceutical care service using in-depth interviews; 2. exploring patient preferences for the ideal pharmacy visit using Q methodology, and characterising those patient groups that have different preferences and; 3. testing the validity of the Swedish version of the Pharmaceutical Therapy-Related Quality of Life (PTRQoL)-instrument, using think aloud methodology. Patients had vague, and sometimes erroneous, understandings about a pharmaceutical care service that they were currently receiving. They reported that the service had increased their feeling of safety, enhanced their knowledge, provided drug treatment control, and empowered them. Seven different viewpoints of the ideal pharmacy service were identified, which could be broadly divided into two groups, those emphasising the physical drug products as central to the encounter and those seeking a relationship with the pharmacist. Some differences between the group characteristics were identified, but not specific enough to guide individualised care practice. Several problems with the validity of the PTRQoL-instrument were detected. Overall, the thesis has highlighted various aspects of patient perspectives on community pharmacy services that could be used for the development andassessment of such services.

Thesis (Ph.D.)--University of Florida, 2004. / Typescript. Title from title page of source document. Document formatted into pages; contains 173 pages. Includes Vita. Includes bibliographical references.

This research aims to assess the existing relationship and characteristics between Maori health providers (MHPs) and pharmacy services in New Zealand and to provide future direction, pathways and strategies for collaboration, planning and improving health outcomes for Maori within the primary health care environment. The characteristics of the relationship were identified and discussed before exploring strategies to strengthen the relationship and to improve Māori health outcomes. The assessment and analysis of the characteristics required an exploration of MHPs current knowledge of pharmacy services, the expectations of MHPs of pharmacy services and the current knowledge of pharmacists of MHP services and Maori health. Themes identified that characterised the relationship were related to knowledge, health philosophies, interaction, service and capacity issues. Knowledge issues incorporated themes of group dynamics, historical context, participant knowledge, pharmacy participant knowledge, MHP participant knowledge, solutions/ outcome knowledge, consideration of Maori. Health philosophies related to themes of paradigms/worldviews, kaupapa Maori, capacity, culture and delivery of services, Treaty of Waitangi, knowledge of culture, communication and te reo, rongoa Maori, environmental culture, access, tino rangatiratanga. Interaction issues discussed the themes of collaboration and communication, extent of collaboration, contact with Maori, community relationships, cost, benefits and opportunities. The pharmacy environment, cost and health service delivery were identified as themes relating to service issues. Capacity issues included themes of mana, direct workforce development (education, employment, promotion), indirect workforce development (education, environment, relationship building, funding), and the Maori Pharmacists Association. This research attempted to follow kaupapa Maori qualitative research methodology, methods and the epistemology of kaupapa Maori throughout the research and design process. One to one semi-structured interviews were conducted with participants from each group. The sample size was established based on the purposeful sampling strategy of maximum variation sampling (7 MHP participants, 8 pharmacy participants. Responses were directly related to differences in world-views and the historical context of the two health provider groups with respect to their roles in health. Variations within each group were related to knowledge, location and previous experience working with their counterparts. Recommendations were associated with themes/issues of environment, knowledge, communication, cultural awareness, collaboration, services and the increased awareness of the roles and responsibilities with respect to each health provider group. This dissertation also highlighted a number of key components that formed a collaborative, empowerment model of health created between organisations with different world-views, which can be adapted to a number of environments where there are different or opposing world-views within the overall same patient population. It is anticipated that the results and outcomes from this research will help develop Maori responsive pharmacy services based on health promotion and wellness to Maori locally, regionally, nationally and have a positive impact on Maori health in collaboration with MHPs. Areas of pharmaceutical care are highlighted which may encourage projects or initiatives in collaboration with MHPs to enhance health gains for Maori, while increasing professional practice roles and scope for pharmacy.

<p>Syftet med denna studie är dels att undersöka hur stor andel av arbetstiden som sjuksköterskor, inom kommunala hälso- och sjukvården i Kalmar kommun, använder för kontakt med apoteken, dels att belysa hur sjuksköterskorna ser på kontakten med apoteken med avseende på dess omfattning och innehåll.</p><p>Kalmars kommunala sjuksköterskor förde under en vecka i februari 2009 tidsdagbok över sin apotekskontakt. I anslutning till detta utfördes även en enkätundersökning bland dessa sjuksköterskor.</p><p>Svarsfrekvensen var låg; 43 % av sjuksköterskorna deltog i enkätstudien och endast 19 % deltog i tidsstudien. Den genomsnittliga andelen arbetstid som ägnades åt apotekskontakt fastställdes till 4,6 ± 3,9 %. Enkätstudien visade på en del önskemål om förändring i såväl kontakten med apoteken som i de kommunala rutinerna. Förslag som lades fram av sjuksköterskorna för en minskning av kontakttiden med apoteken var bland annat att annan personal inom hälso- och sjukvården eller anhöriga till patienten gör apoteksärenden i stället för sjuksköterskorna, samt att apoteken ska införa en särskild kö för vårdpersonal och därmed minska kötiden.</p><p>Den låga svarsfrekvensen gör att inga statistiskt signifikanta slutsatser kan dras av studien och då i synnerhet inte av tidsstudien. Studien visar dock på stora variationer sjuksköterskorna emellan, i andel arbetstid som ägnas åt apotekskontakt. Validiteten och precisionen för denna variation är ej hög, delvis på grund av det låga deltagandet. Enkätundersökningen visade på problem som kan härröras till brist i kommunikationen mellan såväl sjuksköterskor och övrig hälso- och sjukvårdspersonal, som mellan sjuksköterskor och apotekspersonal. En förbättrad interprofessionell kommunikation skulle eventuellt kunna lösa denna problematik.</p>

<p>Antiretroviral therapy places extraordinarily high demands on adherence, since non-adherence affects both individuals and society due to the spread of resistant viral strains. The aims of the thesis were to investigate the prevalence of adherence in Swedish HIV-infected patients, changes in adherence over time, and factors associated with adherence, including patients’ readiness to adhere. Further, to investigate the collaboration between nurses, doctors and pharmacists after the introduction of a HIV-clinic satellite pharmacy. Data were collected via two cross-sectional patient surveys in 1998 and 2002, qualitative interviews with health care personnel at a major HIV clinic, and a nation-wide, cross-sectional patient survey in 2003-2004. </p><p>The level of adherence improved from 28% in 1998 to 57% in 2002, possibly due to simplified treatment and a new multi-professional treatment model at the clinic. The proportion of adherent patients was 63% in the nationwide survey. Factors associated with adherence were high age, high quality patient-provider relationships, no drug or alcohol problems and shorter time on treatment. </p><p>A hypothesized structural equational model, using readiness and adherence as separate latent concepts, was tested and found to support readiness as a distinct factor influencing adherence. </p><p>The health care personnel believed that conventional pharmacies had several disadvantages in serving the HIV infected population. They found the HIV-clinic satellite pharmacy valuable, since it contributed to increased communication and trust between the health care professions, and improved teamwork in medication management.</p><p>In conclusion, the level of adherence increased over time, and several factors associated with adherence were identified. Improved collaboration between health care professionals may enhance treatment support, and increased attention should be given to interventions that focus on the individual’s readiness for behavioural change in order to optimize treatment outcomes.</p>

Antiretroviral therapy places extraordinarily high demands on adherence, since non-adherence affects both individuals and society due to the spread of resistant viral strains. The aims of the thesis were to investigate the prevalence of adherence in Swedish HIV-infected patients, changes in adherence over time, and factors associated with adherence, including patients’ readiness to adhere. Further, to investigate the collaboration between nurses, doctors and pharmacists after the introduction of a HIV-clinic satellite pharmacy. Data were collected via two cross-sectional patient surveys in 1998 and 2002, qualitative interviews with health care personnel at a major HIV clinic, and a nation-wide, cross-sectional patient survey in 2003-2004. The level of adherence improved from 28% in 1998 to 57% in 2002, possibly due to simplified treatment and a new multi-professional treatment model at the clinic. The proportion of adherent patients was 63% in the nationwide survey. Factors associated with adherence were high age, high quality patient-provider relationships, no drug or alcohol problems and shorter time on treatment. A hypothesized structural equational model, using readiness and adherence as separate latent concepts, was tested and found to support readiness as a distinct factor influencing adherence. The health care personnel believed that conventional pharmacies had several disadvantages in serving the HIV infected population. They found the HIV-clinic satellite pharmacy valuable, since it contributed to increased communication and trust between the health care professions, and improved teamwork in medication management. In conclusion, the level of adherence increased over time, and several factors associated with adherence were identified. Improved collaboration between health care professionals may enhance treatment support, and increased attention should be given to interventions that focus on the individual’s readiness for behavioural change in order to optimize treatment outcomes.

Community pharmacists are unique amongst professionals as they practice their profession in a commercial environment. This environment, where the dichotomy between the professional and business aspects of community pharmacy practice intersect, can place the professional objectives of pharmacy at odds with the business objectives. At the same time, ownership of community pharmacies is transitioning from pharmacist-owned and -operated establishments, to corporate-owned and -operated.<p>The objective of this study was to investigate whether ownership type influences the pharmacists, or in this case the pharmacy managers, organizational behaviour, role orientation and professional autonomy. Specifically, exploring whether ownership type (independent, franchise, corporate) impacts the professional, business and environmental (organizational) aspects of community pharmacy practice.<p>This study employed both quantitative and qualitative research methods. A cross-Canada, self-administered postal survey of community pharmacy managers was conducted in the spring of 2007. Contact information was obtained from individual provincial regulatory bodies across Canada and a stratified, random sample of community pharmacy managers was compiled. Items centred on professional and employer authority, manager autonomy, level of managerial control, orientation to professional and business aspects of practice and the manager role, affinity to professional and business characteristics of community pharmacy practice, and innovation. The survey was followed by semi-structured, in-depth telephone interviews with select self identified respondents from the survey portion of the study.<p>The random, stratified sample consisted of 2,000 community pharmacy managers. Of the 2,000 questionnaires mailed out, 39 were returned as undeliverable. A total of 646 responses were received, for a response rate of 32.9 percent (646/1,961); while the response rate may not be ideal, the sample size was purposely made larger to account for the possibility of a low response rate. Seven interviews were conducted following the survey.<p>Ontario, as the largest province, had the most responses with 289 (44.7%), and the majority of respondents were male (393, 60.8%). The greater part of respondents indicated their sole degree was their Bachelor of Pharmacy practice degree (499, 77.2%). A larger majority of respondents were either the pharmacy manager (398, 61.6%) or owner (215, 33.3%). Just under half of respondents practiced in independent pharmacies (44.6%), while 35.4 percent practiced in corporate pharmacies and 18.4 percent practiced in franchise pharmacies.<p>As a whole, respondents were more likely to have access to information required for making clinical rather than business decisions. One quarter (24.4%) of respondents were never or rarely willing to go against company policies to carry out their professional duties, while one third (33.4%) were often or always willing to do so. Less than one-fifth (17.4%) of respondents had to follow policies(professional and business) developed by non-professionals, while 42.6 percent had to follow policies only with regard to business practices. The majority (89.5%) agreed that it is possible to be both a good professional and a successful businessperson.<p>Fifteen distinct constructs emerged regarding (1) professional and (2) employer authority, (3) manager autonomy, (4) decision-making, (5) managerial control, (6) professional characteristics, orientation to (7) professional and (8) business aspects of the manager role, affinity to (9) professional and (10) business characteristics of community pharmacy practice, (11) connection to the employer,(12) role conflict, (13) innovation, (14) bureaucracy and (15) manager requests. The main independent variable was ownership structure: independent, franchise, or corporate. In analyzing the independent variable by the above constructs, significant differences (p < 0.05) arose for all constructs except for three related to the professional nature of practice: professional practice standards, professional orientation and professional affinity. <p>Independent and franchise respondents were more likely to agree that the employer should influence practice standards than corporate respondents (p < 0.001). When exploring the level of autonomy respondents had in their pharmacy, significant differences arose among all three respondent types (p < 0.001); respondents in independent pharmacies felt they had the highest level of autonomy followed by franchise respondents and then corporate respondents, with more than one standard deviation difference between independent and corporate respondents.<p>Significant differences also emerged among the three respondent types with regard to the amount of control the respondent had in their pharmacy (p < 0.001); independent respondents felt they had the most control followed by franchise respondents and then corporate respondents, with almost one standard deviation difference between independent and corporate respondents. With regard to business orientation and affinity to business related aspects of practice, independent and franchise respondents were significantly (p < 0.001) more likely to place higher importance on such activities than corporate respondents. Results of the interview portion of the study were used to bring a greater understanding to the survey portion of the research. <p>There were a total of seven interviews conducted, with each interview lasting between 30 and 90 minutes in length. A total of nine themes emerged from the interviews: (1) autonomy, (2) behaviour, (3) environment, (4) future, (5) human resources, (6) image, (7) incentives, (8) professional standards and (9) role as manager.<p>Finding of this study suggest that regardless of ownership structure, respondents emerge as professionally orientated and focused. Independent respondents appear to have more autonomy, control and decision-making capabilities than corporate respondents. Despite being professionally orientated and focused, corporate respondents appear cognizant of the restrictions placed on pharmacy practice in their pharmacy. On top of ownership structure, the dependent variables of age, gender, geographic region and years with employer appear to play a role in answers provided by community pharmacy managers.<p>As ownership of community pharmacy continues to transition from pharmacist controlled to corporate-owned, managers, owners and the profession must acknowledge the professional implications that may result. While this study adds to the community pharmacy practice literature, there is recognition that additional research is necessary pertaining to the dynamic nature and culture of community pharmacy practice.

Community pharmacists are unique amongst professionals as they practice their profession in a commercial environment. This environment, where the dichotomy between the professional and business aspects of community pharmacy practice intersect, can place the professional objectives of pharmacy at odds with the business objectives. At the same time, ownership of community pharmacies is transitioning from pharmacist-owned and -operated establishments, to corporate-owned and -operated.<p>The objective of this study was to investigate whether ownership type influences the pharmacists, or in this case the pharmacy managers, organizational behaviour, role orientation and professional autonomy. Specifically, exploring whether ownership type (independent, franchise, corporate) impacts the professional, business and environmental (organizational) aspects of community pharmacy practice.<p>This study employed both quantitative and qualitative research methods. A cross-Canada, self-administered postal survey of community pharmacy managers was conducted in the spring of 2007. Contact information was obtained from individual provincial regulatory bodies across Canada and a stratified, random sample of community pharmacy managers was compiled. Items centred on professional and employer authority, manager autonomy, level of managerial control, orientation to professional and business aspects of practice and the manager role, affinity to professional and business characteristics of community pharmacy practice, and innovation. The survey was followed by semi-structured, in-depth telephone interviews with select self identified respondents from the survey portion of the study.<p>The random, stratified sample consisted of 2,000 community pharmacy managers. Of the 2,000 questionnaires mailed out, 39 were returned as undeliverable. A total of 646 responses were received, for a response rate of 32.9 percent (646/1,961); while the response rate may not be ideal, the sample size was purposely made larger to account for the possibility of a low response rate. Seven interviews were conducted following the survey.<p>Ontario, as the largest province, had the most responses with 289 (44.7%), and the majority of respondents were male (393, 60.8%). The greater part of respondents indicated their sole degree was their Bachelor of Pharmacy practice degree (499, 77.2%). A larger majority of respondents were either the pharmacy manager (398, 61.6%) or owner (215, 33.3%). Just under half of respondents practiced in independent pharmacies (44.6%), while 35.4 percent practiced in corporate pharmacies and 18.4 percent practiced in franchise pharmacies.<p>As a whole, respondents were more likely to have access to information required for making clinical rather than business decisions. One quarter (24.4%) of respondents were never or rarely willing to go against company policies to carry out their professional duties, while one third (33.4%) were often or always willing to do so. Less than one-fifth (17.4%) of respondents had to follow policies(professional and business) developed by non-professionals, while 42.6 percent had to follow policies only with regard to business practices. The majority (89.5%) agreed that it is possible to be both a good professional and a successful businessperson.<p>Fifteen distinct constructs emerged regarding (1) professional and (2) employer authority, (3) manager autonomy, (4) decision-making, (5) managerial control, (6) professional characteristics, orientation to (7) professional and (8) business aspects of the manager role, affinity to (9) professional and (10) business characteristics of community pharmacy practice, (11) connection to the employer,(12) role conflict, (13) innovation, (14) bureaucracy and (15) manager requests. The main independent variable was ownership structure: independent, franchise, or corporate. In analyzing the independent variable by the above constructs, significant differences (p < 0.05) arose for all constructs except for three related to the professional nature of practice: professional practice standards, professional orientation and professional affinity. <p>Independent and franchise respondents were more likely to agree that the employer should influence practice standards than corporate respondents (p < 0.001). When exploring the level of autonomy respondents had in their pharmacy, significant differences arose among all three respondent types (p < 0.001); respondents in independent pharmacies felt they had the highest level of autonomy followed by franchise respondents and then corporate respondents, with more than one standard deviation difference between independent and corporate respondents.<p>Significant differences also emerged among the three respondent types with regard to the amount of control the respondent had in their pharmacy (p < 0.001); independent respondents felt they had the most control followed by franchise respondents and then corporate respondents, with almost one standard deviation difference between independent and corporate respondents. With regard to business orientation and affinity to business related aspects of practice, independent and franchise respondents were significantly (p < 0.001) more likely to place higher importance on such activities than corporate respondents. Results of the interview portion of the study were used to bring a greater understanding to the survey portion of the research. <p>There were a total of seven interviews conducted, with each interview lasting between 30 and 90 minutes in length. A total of nine themes emerged from the interviews: (1) autonomy, (2) behaviour, (3) environment, (4) future, (5) human resources, (6) image, (7) incentives, (8) professional standards and (9) role as manager.<p>Finding of this study suggest that regardless of ownership structure, respondents emerge as professionally orientated and focused. Independent respondents appear to have more autonomy, control and decision-making capabilities than corporate respondents. Despite being professionally orientated and focused, corporate respondents appear cognizant of the restrictions placed on pharmacy practice in their pharmacy. On top of ownership structure, the dependent variables of age, gender, geographic region and years with employer appear to play a role in answers provided by community pharmacy managers.<p>As ownership of community pharmacy continues to transition from pharmacist controlled to corporate-owned, managers, owners and the profession must acknowledge the professional implications that may result. While this study adds to the community pharmacy practice literature, there is recognition that additional research is necessary pertaining to the dynamic nature and culture of community pharmacy practice.