Disputats, Göteborg 2006. / Härtill 5 uppsatser. Med sammanfattning på svenska.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2006. / Härtill 5 uppsatser.

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 pharmacy practice is moving towards patient care and away from the mere dispensing of medicines. In this movement, which is guided by the philosophy of Pharmaceutical care (PC), new counselling services emerge. The purpose of the thesis was to add knowledge about the real-world provision of PC services by studying a defined PC service in Swedish pharmacies. Specific aims of this thesis were to investigate the experiences of professionals working with or close to the service and to describe the content of consultations, counselling behaviour and patterns of follow-up. Further aims were to characterise patients receiving the service and describe their perceived outcomes, in relation to standard service. Data were collected via focus groups, telephone interviews, observations, a patient medication record database and a cross-sectional survey. The practitioners reported greater use of their pharmaceutical knowledge and provision of more thorough patient support. Perceived barriers in delivering the service included difficulties in documenting and getting commitment from colleagues, managers and prescribers. Doctors working close to PC pharmacies held varying opinions about the service. Consultations dealt with issues potentially improving the outcomes of medical treatment, but the level of patient centredness varied and was limited by the practitioners’ focus on the computer screen. The rate of follow-up evaluations was modest, but was higher at pharmacies with a high volume of patients receiving the service. PC patients were mostly elderly and female, using about 10 prescription drugs. In comparison to patients receiving standard service, they were more worried, vulnerable and information-seeking. At the same time, their feelings of safety following the pharmacy visit were more pronounced than those of patients receiving standard service. They also felt better prepared for doctor visits. In order for community pharmacy to better meet patients’ needs and optimise PC services, increased attention should be given to implementation strategies, interprofessional collaboration and educational efforts focusing on patient centredness.

Thesis--University of Oklahoma. / Bibliography: leaves 62-64.