no / This research aims to develop a better understanding of how cardiology patients experience the care provided by community pharmacy after discharge from hospital. • Contact with community pharmacists is infrequent and can be via a proxy. Patients’ experiences of community pharmacy care are limited and many patients have unmet medicines use support needs. • Community pharmacy misses opportunities to support patients in their medicines use after hospital discharge / Conference abstract.

No description available.

No description available.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

The aim of this study is to evaluate the supply of markers for the identification of syringes distributed by pharmacy needle exchanges and to determine if this product and service delivery offers a feasible method of marking syringes to promote the reduction of accidental sharing of syringes and needles amongst injecting drug users (IDU) and thereby reduce the risk of transmission of blood borne viruses (BBVs) and other related infections. This study involves the assessment, implementation and evaluation of syringe markers as a pilot study within three community pharmacy sites in Glasgow. The secondary aims of the study were to identify whether the supply of syringe markers from community pharmacy needle exchanges was acceptable to IDU and if it enabled them to mark their syringes. The literature review demonstrates that providing a means of identification of personal injecting equipment has been proposed as a viable option that should be promoted to prevent the inadvertent accidental sharing of syringes within a group setting. Needle exchanges (NEX) are important component parts of the harm reduction responses designed to reduce the physical health harms caused to individuals through injecting drug use. The literature is reviewed on BBV transmission and the historical, legal and policy context associated with the development of NEXs. Community pharmacies act as a source of health advice and can help to facilitate access to treatment services for those attending the NEX. However the specific aim of this study is not to investigate the totality of the benefits of a NEX but to examine the supply of a potential means of reducing accidental and unintentional sharing of all injecting equipment and thereby contribute to minimising some of the health harms linked to injecting drug use. Three established community pharmacies were identified as suitable sites to pilot the supply of syringe markers. A number of criteria were used to select the sites. These included an assessment of the geographic locations, staffing arrangements, NEX attendances and transactional activity and the availability of private consultation facilities. The health board central database which holds records on a range of factors including, the characteristics of those who attend NEX and detailed information on all transactions, was used to identify the most suitable sites to pilot the new intervention. This indicated that the characteristics of those who attended the three chosen sites were broadly similar to the wider NEX attending population. The evaluation was conducted in two separate periods. The first 4 week period was the supply phase where markers were distributed over this period to all patients receiving NEX packs from the 3 pharmacies. The second data collection phase was undertaken in the following 4 week period. Data was collected by means of a structured questionnaire. In order to reduce the potential interviewer bias it was decided to incorporate the use of peer researchers in the administration of the questionnaire. The Scottish Drugs Forum (SDF) was approached and agreement was reached to use members of the Service User Involvement Group (SUIG) to assist with the design and administration of the questionnaire. A submission was made to the health board Research Ethics Committee (REC) and approval was given to enable the study and the research evaluation to proceed. Before the start of the study, joint briefing and training sessions were held for pharmacy staff from the 3 sites and the 6 participating SUIG members. A total of 177 questionnaires were completed during the second data collection phase of the evaluation. Information was collected on personal details and injecting behaviours (including deliberate and accidental sharing), any current means of syringe identification, use of the markers and on the usefulness of the instruction card. Most individuals (75%, n=132) had been supplied with the markers to trial during the first supply phase of the study with 63% of the 132 (n=83) of those individuals reporting use of the markers. The results of the evaluation and subsequent analysis of the findings indicated that the syringe marker supply could be successfully implemented using pharmacy NEXs. The product and the supply method were acceptable to both staff and service users. Initial bivariate analysis was conducted using a number of dependent and independent variables identified within the questionnaire. These findings highlighted a number of areas worthy of further exploration, including emerging differences between male and female respondents, and indicated specific target groups for future developments in syringe identification. The contribution of the peer researchers was found to be a significant factor in successfully completing the evaluation. However it is not possible to make any definitive statements on how effective the intervention is in terms of reducing the transmission of BBVs and other related infections. The findings of the evaluation indicated a number of potential areas of work that could be usefully explored to investigate the effectiveness of the markers in reducing the transmission of infections. The limitations of the evaluation became apparent during the course of the study and the implications of these limitations are discussed.

No / OBJECTIVES: The aims of this study were to conduct the proof of concept study and to develop and evaluate an educational intervention that promotes the evidence-based supply of non-prescription medicines (NPMs). METHOD: An educational intervention was delivered to pharmacy assistants and pharmacists in three pharmacies in England. The intervention included the provision of summaries of evidence for the treatment of four minor ailments and resulted in the preparation of evidence-based portfolios for the treatment of the following ailments: athlete's foot, cough, nasal congestion and period pain. The effect of the intervention was evaluated using a combination of direct overt observation, vignettes, self-reported behaviour and interviews. KEY FINDINGS: Evaluation data were collected from the three pharmacies. Data were derived from 3 pharmacists and 13 assistants, of whom 10 (3 pharmacists; 7 assistants) attended the training event. Comparing pre- and post-intervention practice, 8/11 (pre-) versus 5/6 (post-) observed, 46/80 versus 62/80 vignette and 25/30 versus 39/40 self-reported recommendations were evidence based. Prior to the intervention, 3/16 participants understood the role of evidence regarding the supply of NPMs compared with 16/16 post-intervention. Participants reported relying upon experiential knowledge to inform their decision making prior to the educational intervention. Thereafter, the participants reported using evidence to a greater extent. Barriers and facilitators for evidence-based practice were also identified. CONCLUSION: A one-off educational intervention increased participants' self-reported awareness and potential application of evidence to inform their supply of NPMs. Further research is needed to assess the effectiveness, long-term impact, generalisability and cost-effectiveness of this intervention for a wider range of common conditions.

This research utilised mixed methodology to gain insight into community pharmacists’ adoption of medicines and services related to two key innovative policy interventions aimed at enhanced minor ailment management; namely the ongoing legal status reclassification of medicines; and the introduction of the Scottish Minor Ailment Service. Prompted by the lack of qualitative and large scale quantitative evaluation from the pharmacists’ perspective, the aim was to investigate pharmacists’ adoption of these innovations. Data were generated to evaluate the process related aspects of innovation adoption from community pharmacists’ perspectives; and to identify and quantify key factors associated with the adoption of these innovations, thereby considering the wider relevance to new community pharmacy services. A range of methods was used including: formal systematic review of peer reviewed published literature on factors associated with innovation adoption following methods recommended by the Centre for Reviews and Dissemination at the University of York; extensive review of policy documents of all the devolved UK Governments; qualitative focus groups and interviews with 20 community pharmacists from four Scottish Health Boards; and lastly a cross sectional survey of the pharmacists responsible for nonprescription medicines from all Scottish community pharmacies (N=1138). The theoretical framework of diffusion of innovations was adopted to design the quantitative research instrument and interpret the data. Rigour was enhanced by consideration of aspects of validity and reliability at all stages. The highest standards of research governance and ethics were applied throughout the study. Qualitative interviews provided insight into the process related aspects of innovation adoption. Where current changes were embraced reluctantly by many who deemed the pace as fast and furious, others were keen to contribute to developments taking place within pharmacy and were eager to play a more proactive role in leading and introducing change to the public. Regardless of practice setting and ownership model, the merits of each innovation appeared to be considered at the individual practitioner level. Hence an organisational level decision to implement an innovation did not necessarily translate to adoption at the individual practitioner level. Using descriptive, bivariate and multivariate quantitative models informed by the results of the qualitative interviews and systematic review of the literature, the quantitative study showed pharmacists’ perceived attributes of innovations (such as benefits to their professional role development and patients); and patient demand and use of services had the highest association with whether or how far innovations were adopted. Issues such as differences in availability of resources were less able to explain differing level of innovation adoption by the pharmacist respondents. These findings suggest that as innovations around minor ailment management have not yet required reorientation of existing services, the issue of how pharmacists’ perceive the characteristics of the innovations such as: potential for financial benefits to pharmacy, professional role development and patients; is key to predicting whether future innovations of a similar nature will be successfully adopted by pharmacists.

Background: Recently, health plans have initiated pay-for-performance (P4P) programs to incentivize pharmacies to focus on medication-related quality measures. Little research exists as to what attributes help a pharmacy to perform well in a P4P program. Objectives: This study aimed to: (1) propose a conceptual framework evolved from theories pertaining to economic, psychology, and organizational behavior disciplines that may contribute to a pharmacy's performance in a financial incentive program; (2) develop theoretically-derived questionnaires designed to elicit from pharmacists and pharmacy management pharmacy characteristics and pharmacy personnel factors thought to be associated with achieving quality measures specified for a pharmacy P4P program; (3) psychometrically assess these two newly developed questionnaires designed to collect information from community pharmacies eligible to participate in a pharmacy P4P program; (4) assess the magnitude of the relationship between pharmacy-related and construct redundancy of latent variables identified in objective 3; and (5) examine pharmacy factors' association with community pharmacies achieving quality measures in a pharmacy P4P program. Methods: Two survey instruments were created from a theoretically-derived conceptual framework to measure pertinent pharmacy characteristics and pharmacy personnel factors using a multi-step, mixed-methods process. Questionnaire development entailed semi-structured interviews, item generation, expert content validation, and cognitive debriefings. Developed questionnaires were evaluated in a non-experimental, cross-sectional survey of pharmacists and pharmacy management. Pharmacy personnel surveyed for this study were affiliated with pharmacies in Inland Empire Health Plan's (IEHP's) community pharmacy network. Using items measured in each questionnaire, specified groups of items were hypothesized to have a certain underlying latent variable. Latent variables hypothesized for items measured in the pharmacist questionnaire included: (1)"adherence management -services," (2)"adherence management-counseling," (3) "asthma management," (4) "pharmacist-prescriber relationship," (5) "chronic disease management," (6) "non-dispensing ability," and (7) "workload impact". For items measured in the pharmacy management questionnaire, eight latent variables were hypothesized: (1) "program understanding," (2) "program financial salience," (3) "program involvement," (4) "organization's adaptability," (5) "organization's innovativeness," (6) "organization's proactiveness," (7) "organization's risk-taking." and (8) "organization's focal emphasis." For hypothesized latent variables with four or more items, the value thresholds of three assessment indexes were employed as criteria to evaluate each measurement model's goodness-of-fit. Indexes included: (1) 2 test statistic (i.e.,>0.05), (2) root mean square error of approximation (RMSEA) (i.e., 0.05), and (3) comparative fit index (CFI) (i.e.,>0.95). The statistical significance of item factor loadings was assessed for latent variables with (1) four or more items deemed to have adequate model fit per index criteria and (2) only three items, for which goodness-of-fit may not be assessed. Structural modeling was used to explore associations between (1) pairs of latent variables with adequate model fit and/or statistically significant factor loadings; and (2) latent variables with medication-related quality measures. The strength of associations among latent variable pairs was measured with correlation coefficients. Latent variable pairs with significant correlations greater than 0.50 were evaluated for construct redundancy, for which a change in CFI was used as the comparison criteria to determine whether the latent variables are better represented as one (i.e., (CFI<-0.01) or two constructs (i.e., (CFI ≥ -0.01). Mediation-related quality measures specified as dependent variables in structural models included: diabetes medication adherence, hypertension medication adherence, hypercholesterolemia medication adherence, absence of controller therapy in patients with asthma, use of high-risk medications in elderly, and generic dispensing rate. Results: The empirically derived conceptual framework outlined four major domains proposed for consideration when evaluating pharmacy P4P programs: (1) incentive; (2) pharmacy; (3) other influencing factors; and (4) P4P program measures. From this framework, two questionnaires were developed with the aim of measuring pharmacists' and pharmacy management's pharmacy attitudes and perspectives of a community pharmacy P4P program. The pharmacist survey instrument consisted of five sections: (i) community pharmacy P4P program; (ii) pharmacy services; (iii) pharmacist workload; (iv) pharmacy practice site; and (v) pharmacist's background. The pharmacy management questionnaire consisted of four sections: (i) pharmacy P4P program; (ii) pharmacy organization's characteristics; (iii) pharmacy practice site; and (iv) respondent's background information. Among the 604 pharmacies invited to participate, pharmacists from 114 unique pharmacies (19%) and pharmacy management from 100 unique pharmacies (17%) participated in the survey. This study identified psychometrically validated measurement models for latent constructs with items measured in the pharmacist ("adherence management-counseling," "asthma management," "workload impact" ) and pharmacy management ("program involvement," "organization's innovativeness," "organization's proactiveness," "organization's risk-taking" ) questionnaires). With the exception of "program involvement," the latent constructs measured in the pharmacy management questionnaire were identified to be significantly correlated (𝛹>0.50, p<0.001) and more parsimoniously represented as one factor rather than two (∆CFI<-0.01). No significant associations were identified in exploratory analyses of validated measurement models from the pharmacist questionnaire with targeted medication-related quality measures in IEHP's community pharmacy P4P program. Conclusion: This study collected data for two questionnaires evaluating (1) pharmaceutical care services conceptualized to be associated with targeting medication-related quality measures and (2) pharmacy management's attitudes toward a pharmacy P4P program. Furthermore, psychometric assessment of each questionnaire supplied initial validity evidence for three constructs for the pharmacist questionnaire ("adherence management-counseling," "asthma management," and "workload impact" ) and four constructs for the pharmacy management questionnaire ("program involvement," "organization's innovativeness," "organization's proactiveness," and "organization's risk-taking" ). Subsequent validation of these latent constructs in larger sample sizes is required. Continued study of pharmacy factors and their association with medication-related quality measures is needed to improve our understanding of pharmacies' performance in financial incentive programs. As pharmacy organizations are increasingly integrated into more financial incentive programs aimed at targeting process- and outcomes-related quality measures, it is essential to be able to measure pharmacy and management factors in order to determine which factor(s) impact pharmacy performance.

Background: Concern has been raised that the workload of community pharmacists (CPs) is linked to the occurrence of dispensing errors (DEs). One aspect of workload that has not yet been measured in this setting, but has been linked to errors in other industries, is mental workload (MWL). Aims: (1) Measure the relationship between MWL and DEs during a routine pharmacy task, the final accuracy check, which research suggests is critical to DE prevention. (2) Quantify the role that expertise plays in this relationship. (3) Explore CPs and pharmacy students’ experiences of MWL and DEs. Methods: A mixed methods approach was taken and three studies were conducted. In study one, CPs (n=104) and students (n=93) checked dispensed items for DEs. Participants took part in one of four conditions (distraction, no distraction, dual-task or single-task) and their DE detection and MWL was measured. Study two was a diary study of CPs’ (n=40) MWL during a day in their “real-life” practice. Study three presented an interpretative phenomenological analysis of CPs’ (n=14) and students’ (n=15) experiences of MWL and DEs. Main findings: Study one found that high MWL was related to reduced DE detection, but only for students, confirming the important role of expertise. Distractions did not affect DE detection but was linked to increased MWL. Study 2 highlighted specific times of the day when CPs’ MWL was exceptionally high. Study 3 found several factors which increased MWL, including the lack of control CP’s had over their workload, difficulties communicating with prescribers and targets. Conclusions: MWL has been found to be a useful tool for measuring the impact of workload on pharmacy safety. The findings are linked to current work design and human factors theory and suggestions are made for how CPs’ work could be redesigned to reduce their MWL and improve safety.

Purpose: Practice-based research networks (PBRN) seek to shorten the gap between research and application in primary patient care settings. Inclusion of community pharmacies in primary care PBRNs is relatively unexplored. Such a PBRN model could improve care coordination and community-based research, especially in rural and underserved areas. The objectives of this study were to: 1) evaluate rural Appalachian community pharmacy key informants’ perceptions of PBRNs and practice-based research; 2) explore key informants’ perceptions of perceived applicability of practice-based research domains; and 3) explore pharmacy key informant interest in PBRN participation. Methods: The sample consisted of community pharmacies within city limits of all Appalachian Research Network (AppNET) PBRN communities in South Central Appalachia. A descriptive, cross-sectional, questionnaire-based study was conducted from November 2013 to February 2014. Bivariate and multivariate analyses were conducted to examine associations between key informant and practice characteristics, and PBRN interest and perceptions. Findings: A 47.8% response rate was obtained. Most key informants (88%) were very or somewhat interested in participating in AppNET. Enrichment of patient care (82.8%), improved relationships with providers in the community (75.9%), and professional development opportunities (69.0%) were perceived by more than two-thirds of respondents to be very beneficial outcomes of PBRN participation. Respondents ranked time constraints (63%) and workflow disruptions (20%) as the biggest barriers to PBRN participation. Conclusion: Key informants in rural Appalachian community pharmacies indicated interest in PBRN participation. Integration of community pharmacies into existing rural PBRNs could advance community level care coordination and promote improved health outcomes in rural and underserved areas. Type: Original Research