The overall aim of this thesis was to explore aspects of the subjective views and experiences of doctors as prescribers, focusing on responsibility for and factors of importance in achieving appropriate prescribing. To provide insights into the prescriber’s perspective the study designs were qualitative. In the first studies secondary care doctors’ perceptions of appropriate prescribing and influences in prescribing were investigated in interviews. The doctors perceived that appropriate prescribing needed continuous revision. From the perspective of the prescribers the definition of prescribing could be rephrased as: “the outcome of the recurring processes of decision making that maximises net individual health gains within society’s available resources”. Among the influences in prescribing were guidelines, colleagues and therapeutic traditions. In the subsequent studies the experiences of exchanging information regarding a patient’s drugs in an electronic patient medical record (e-PMR) shared between primary and secondary care and views of responsibility was explored, using focus groups with both primary and secondary care doctors. Considering the gap between health care levels, doctors’ views of responsibility in prescribing and exchange of information are of concern. The doctors expressed how they assume information to be in the e-PMR and active information transfer has decreased. On the other hand, they experienced an information overload in the e-PMR system. There is a need for improved and structured communication between health-care givers. Taking responsibility to review all the patient’s medications was perceived as important, but described as still not done. Lack of responsibility taken was often due to acts of omission, i.e. that doctors did not make needed changes to the list of medications due to different barriers. The barriers rested both with individual doctors and the system, but to ensure solutions that are realisable in practise, perspectives of the doctors need to be taken into consideration when overcoming those barriers.

Este trabalho tem por objetivo geral apresentar uma ferramenta computacional auxiliar na gestão dos serviços farmacêuticos bem como alguns resultados alcançados com a sua aplicação na sistematização do atendimento aos usuários do Centro de Atenção Psicossocial álcool e drogas (CAPS ad) do município de Vitória-ES, conhecido como Centro de Prevenção e Tratamento de Toxicômanos (CPTT). O Programa de Gestão em Farmácia Pública (PGFP) Módulo Saúde Mental possui um formato de banco de dados relacional, desenvolvido sob a plataforma Access e possui interface com o gerador de planilhas e gráficos do tipo Excel , aplicáveis a outras farmácias de unidades do tipo CAPS ad. Desde 2004 vem sendo utilizado e aperfeiçoado com uma proposta de informatizar a administração da farmácia, possibilitando a instrumentalização do farmacêutico via emissão de relatórios para a gestão técnica, operacional e estratégica, além de propiciar a avaliação do serviço baseando-se em indicadores sócio demográficos, de morbidade e específicos da Assistência Farmacêutica voltados para o campo da toxicodependência. Para ilustrar o uso do PGFP são apresentados dados pertencentes a 489 prontuários de usuários cadastrados na farmácia no período de janeiro de 2007 a dezembro de 2008, além de 50 prescrições médicas sistematicamente selecionadas para cada ano, coletadas a partir do sistema. Com isso, foi possível elaborar o perfil demográfico, sóciosanitário dos usuários além de aspectos relacionados a Assistência Farmacêutica local. Foi utilizado o programa computacional SPSS 11.5 for Windows para a análise estatística exploratória descritiva (distribuição de freqüências) e inferencial (teste qui-quadrado) dos dados contidos nos prontuários. Dentre algumas dessas análises, observou-se a prevalência do Crack (44%) como substância psicoativa. Revelou que a maioria dos usuários cadastrados são homens (82,4%), com faixa etária prevalente entre 25 e 34 anos (31,7%) e com grau de escolaridade equivalente ao 1 Grau Incompleto (41,3%). Com relação aos aspectos relacionados a Assistência Farmacêutica pode-se observar um No. médio de medicamentos prescritos por receita entre 1,6 1,7 itens/receita; um percentual mínimo de 96% das receitas atendidas na farmácia; e o Clonazepam como o medicamento mais prescrito no período. São citadas algumas limitações do PGFP e dos dados apresentados. Conclui-se o presente estudo fazendo-se alusão a relevância do Programa de Gestão em Farmácia Pública (PGFP), em relação não somente ao seu potencial de uso na gestão estratégica e operacional da Assistência Farmacêutica em Saúde Mental (álcool e drogas), mas fundamentalmente, como importante ferramenta de informação que propicia a elucidação do perfil da drogadição, despertando a percepção para os aspectos ligados à saúde pública e as implicações sócio-econômicas sobre a população em estudo. / The purpose of this study is presenting and proposing the usage of a computer tool as well as some of its practical results after implantation, in order to support the management of the pharmaceutical services and the systematization of the approach methods used in the pharmacy for the patients inscribed for treatment in a Mental Health Unit Alcohol and Drugs department known as CAPS ad. Specifically in the city of Vitória, this Health Unit is known and registered in the Ministry of Health as Centro de Prevenção e Tratamento de Toxicômanos (C.P.T.T.) or Treatment and Prevention Center for Drug addicts. The Community Pharmacy Data Bank for Management (CPDBM) Mental Health Module, has a relational data bank format, developed under an Access platform, with an interface with a spreadsheet and graphic generator Excel type, applicable to the routine of any other Mental Health Units pharmacy. Since 2004 the Data Bank has been used and improved within the purpose of computerization of the pharmacy management, capacitating and sourcing the pharmacist with technical, operational and strategic reports. Furthermore it allows the professional to evaluate the service through social demographic, morbidity and specific Pharmaceutical Assistance indicators. In order to highlight the usage of the CPDBM, it is presented some data extracted from 489 patients files, registered in the pharmacy, from the period of January 2007 till December 2008. Besides, it was systematically selected out of the Data Bank, information originated from 50 dispensed medicals prescriptions referred respectively to 2007 and 2008. With these informations, it became possible to elaborate both social-sanitary and demographic profiles and to describe some aspects related to the local Pharmaceutical Assistance. Either the descriptive exploratory analysis (Frequencys distribuition) or the inferential analysis [ (c2 )Test] of the statistical Data from the patients file, used the SPSS 11.5 for Windows Software. Some of these findings, pointed the prevalence of Crack (44%) as the most treated psycho active substance. It has also revealed that the majority of drug users registered in the service were men (82,4%), with prevalence for the age between 25-34 years old and a formal educational school level equivalent to less than 8 years (41,3%). In relation to the local Pharmaceutical Assistance, it was observed a medium number of medicines per prescription between 1,6-1,7; a minimum rate of 96% for the coverage of dispensed prescriptions in the pharmacy; and Clonazepam as the most prescribed medicine during the analysed period. There will be cited some limitations either from the study or the Data bank itself. Coming to an end of this study, it makes reference to the relevance of the CPDBM, not only in relation to its potential usage for the strategic and operational management of the Pharmaceutical Assistance practice in the public pharmacy inserted in the context of Mental Health (Drug abuse), but also essentially as an important instrument of information which opens the possibility to elucidate the drug addictions profile, awaking the perception for various aspects connected to public health matters and its social economical implications on the focused population.

No description available.

Este trabalho tem por objetivo geral apresentar uma ferramenta computacional auxiliar na gestão dos serviços farmacêuticos bem como alguns resultados alcançados com a sua aplicação na sistematização do atendimento aos usuários do Centro de Atenção Psicossocial álcool e drogas (CAPS ad) do município de Vitória-ES, conhecido como Centro de Prevenção e Tratamento de Toxicômanos (CPTT). O Programa de Gestão em Farmácia Pública (PGFP) Módulo Saúde Mental possui um formato de banco de dados relacional, desenvolvido sob a plataforma Access e possui interface com o gerador de planilhas e gráficos do tipo Excel , aplicáveis a outras farmácias de unidades do tipo CAPS ad. Desde 2004 vem sendo utilizado e aperfeiçoado com uma proposta de informatizar a administração da farmácia, possibilitando a instrumentalização do farmacêutico via emissão de relatórios para a gestão técnica, operacional e estratégica, além de propiciar a avaliação do serviço baseando-se em indicadores sócio demográficos, de morbidade e específicos da Assistência Farmacêutica voltados para o campo da toxicodependência. Para ilustrar o uso do PGFP são apresentados dados pertencentes a 489 prontuários de usuários cadastrados na farmácia no período de janeiro de 2007 a dezembro de 2008, além de 50 prescrições médicas sistematicamente selecionadas para cada ano, coletadas a partir do sistema. Com isso, foi possível elaborar o perfil demográfico, sóciosanitário dos usuários além de aspectos relacionados a Assistência Farmacêutica local. Foi utilizado o programa computacional SPSS 11.5 for Windows para a análise estatística exploratória descritiva (distribuição de freqüências) e inferencial (teste qui-quadrado) dos dados contidos nos prontuários. Dentre algumas dessas análises, observou-se a prevalência do Crack (44%) como substância psicoativa. Revelou que a maioria dos usuários cadastrados são homens (82,4%), com faixa etária prevalente entre 25 e 34 anos (31,7%) e com grau de escolaridade equivalente ao 1 Grau Incompleto (41,3%). Com relação aos aspectos relacionados a Assistência Farmacêutica pode-se observar um No. médio de medicamentos prescritos por receita entre 1,6 1,7 itens/receita; um percentual mínimo de 96% das receitas atendidas na farmácia; e o Clonazepam como o medicamento mais prescrito no período. São citadas algumas limitações do PGFP e dos dados apresentados. Conclui-se o presente estudo fazendo-se alusão a relevância do Programa de Gestão em Farmácia Pública (PGFP), em relação não somente ao seu potencial de uso na gestão estratégica e operacional da Assistência Farmacêutica em Saúde Mental (álcool e drogas), mas fundamentalmente, como importante ferramenta de informação que propicia a elucidação do perfil da drogadição, despertando a percepção para os aspectos ligados à saúde pública e as implicações sócio-econômicas sobre a população em estudo. / The purpose of this study is presenting and proposing the usage of a computer tool as well as some of its practical results after implantation, in order to support the management of the pharmaceutical services and the systematization of the approach methods used in the pharmacy for the patients inscribed for treatment in a Mental Health Unit Alcohol and Drugs department known as CAPS ad. Specifically in the city of Vitória, this Health Unit is known and registered in the Ministry of Health as Centro de Prevenção e Tratamento de Toxicômanos (C.P.T.T.) or Treatment and Prevention Center for Drug addicts. The Community Pharmacy Data Bank for Management (CPDBM) Mental Health Module, has a relational data bank format, developed under an Access platform, with an interface with a spreadsheet and graphic generator Excel type, applicable to the routine of any other Mental Health Units pharmacy. Since 2004 the Data Bank has been used and improved within the purpose of computerization of the pharmacy management, capacitating and sourcing the pharmacist with technical, operational and strategic reports. Furthermore it allows the professional to evaluate the service through social demographic, morbidity and specific Pharmaceutical Assistance indicators. In order to highlight the usage of the CPDBM, it is presented some data extracted from 489 patients files, registered in the pharmacy, from the period of January 2007 till December 2008. Besides, it was systematically selected out of the Data Bank, information originated from 50 dispensed medicals prescriptions referred respectively to 2007 and 2008. With these informations, it became possible to elaborate both social-sanitary and demographic profiles and to describe some aspects related to the local Pharmaceutical Assistance. Either the descriptive exploratory analysis (Frequencys distribuition) or the inferential analysis [ (c2 )Test] of the statistical Data from the patients file, used the SPSS 11.5 for Windows Software. Some of these findings, pointed the prevalence of Crack (44%) as the most treated psycho active substance. It has also revealed that the majority of drug users registered in the service were men (82,4%), with prevalence for the age between 25-34 years old and a formal educational school level equivalent to less than 8 years (41,3%). In relation to the local Pharmaceutical Assistance, it was observed a medium number of medicines per prescription between 1,6-1,7; a minimum rate of 96% for the coverage of dispensed prescriptions in the pharmacy; and Clonazepam as the most prescribed medicine during the analysed period. There will be cited some limitations either from the study or the Data bank itself. Coming to an end of this study, it makes reference to the relevance of the CPDBM, not only in relation to its potential usage for the strategic and operational management of the Pharmaceutical Assistance practice in the public pharmacy inserted in the context of Mental Health (Drug abuse), but also essentially as an important instrument of information which opens the possibility to elucidate the drug addictions profile, awaking the perception for various aspects connected to public health matters and its social economical implications on the focused population.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / In community pharmacies, at the time the pharmacist incorporates clinical practice into their routine, several barriers and facilitators influencing the implementation of patient care services. Objectives: To learn and understand the perception of a group of pharmacists on the process of implementation of Clinical Pharmacy Services in community pharmacies; Understand through a Scoping Review of literature, pharmacist perception about Clinical Pharmacy Services in community pharmacy. Methods: The study was structured in two stages. The first step corresponded to Scoping Review held in the Lilacs, PubMed, Scopus, Scielo and Web of Knowledge database. Studies should be of the pharmacist perception, and the pharmaceutical services should be patient-focused. The second stage corresponded to a qualitative study in which three focus groups were conducted with a group of 11 pharmacists. Data analysis was done using the technique of content analysis. Results: Step 1 - The literature search resulted in 29 articles that met the inclusion criteria. The studies were performed in eight different countries, had qualitative methods (focus groups, interviews, diaries and questionnaires) and quantitative (questionnaires) and 12 different classifications of pharmaceutical services were found. In most studies, pharmacists believed that their role in community pharmacies was positive for patients, barriers and facilitators for service were reported. Step 2 - The audio recording of the focus groups were fully transcribed and analyzed. The perception of pharmacists brought issues such as access to medication, barriers and facilitators to service, expectations, changes generated during the implementation of services, results achieved and consolidation of services. Conclusion: The Scoping Review made recommendations for implementation of Clinical Services Pharmacists in community pharmacies, making it easier to service delivery and enhancing practices in community pharmacies. The dissemination of positive experiences in implementations of services through perception studies have shown that it is possible to develop a model of clinical services in community pharmacies. / Em farmácias comunitárias, no momento em que o farmacêutico incorpora a prática clínica em sua rotina, várias barreiras e facilitadores influenciam a implantação de serviços de cuidado aos pacientes. Objetivos: Conhecer e compreender a percepção de um grupo de farmacêuticos sobre o processo de implementação dos Serviços Clínicos Farmacêuticos em farmácias comunitárias; Conhecer e compreender por meio de uma Revisão de Escopo da literatura, a percepção farmacêutico na provisão de Serviços Clínicos Farmacêuticos em farmácia comunitária. Metodologia: O estudo foi estruturado em duas etapas. A primeira etapa correspondeu a Revisão de Escopo realizada nas bases de dados Lilacs, PubMed, Scopus, Scielo e Web of Knowledge. Os estudos deveriam ser e se declarar de percepção de farmacêutico e os Serviços Farmacêuticos deveriam ser centrados no paciente. A segunda etapa correspondeu a um estudo qualitativo, no qual foram realizados três Grupos Focais com um grupo de 11 farmacêuticos. A análise dos dados foi feita por meio da técnica de análise de conteúdo. Resultados: Etapa 1 - A pesquisa bibliográfica resultou em 29 artigos que cumpriram os critérios de inclusão. Os estudos foram realizados em oito países diferentes, possuíam metodologias qualitativas (grupos focais, entrevistas, diários e questionários) e quantitativas (questionários), e foram encontradas 12 diferentes classificações de serviços farmacêuticos. Na maioria dos estudos, os farmacêuticos acreditavam que seu papel em farmácias comunitárias era positivo para os pacientes, barreiras e facilitadores para os serviços foram relatados. Etapa 2 - A gravação dos áudios dos grupos focais foi integralmente transcrita e analisada. A percepção dos farmacêuticos trouxe temas como acesso ao medicamento, barreiras e facilitadores para o serviço, expectativas, mudanças geradas ao longo da implementação dos serviços, resultados atingidos e a consolidação dos serviços. Conclusão: A Revisão de escopo apresentou recomendações para a implementação de serviços clínicos farmacêuticos em farmácias comunitárias, tornando mais fácil a provisão de serviços e valorizando as práticas em farmácias comunitárias. A divulgação de experiências positivas em implementações de serviços por meio de estudos de percepção têm mostrado que é possível desenvolver um modelo de serviços clínicos em farmácias comunitárias.

No description available.

Background: Community pharmacists are a key intervention point in efforts to prevent and mitigate the impact of prescription drug abuse and misuse (PDA/M); yet pharmacists' perceptions regarding PDA/M have been explored only briefly in the literature. Objectives: 1) To explore Tennessee community pharmacists' perceptions regarding opioid pain reliever (OPR) prescribing, dispensing and abuse; 2) to explore community pharmacists' self-efficacy beliefs regarding PDA/M-specific communication; and 3) to evaluate perceived barriers to engaging patients in PDA/M-specific communication. Methods: A 55-item survey instrument was developed using the Theory of Planned Behavior (TpB) as a theoretical framework. Questionnaires were mailed to a stratified sample of 2000 licensed Tennessee pharmacists using the Tailored Design Method of survey administration during October and November, 2012. Results: A response rate of 40% was obtained. A majority of pharmacists (87.5%) perceived OPR abuse to be a problem in their practice settings. On average, a little more than half (53%) of prescriptions issued for OPRs were estimated to be for patients with one or more legitimate medical reasons justifying the medication(s). A small fraction of pharmacists (13%) reported having addiction treatment facility information in their practice settings, and only a small percent reported strong self-efficacy beliefs regarding PDA/M patient communication. Job-related time constraints were perceived as the primary barrier to engaging in PDA/M communication. Conclusions: Community pharmacists in Tennessee are aware of PDA/M by patients receiving opioid prescriptions and value their role in communicating with these patients but indicate their ability to do so effectively is hindered by a lack of confidence, training, and time. Further research to identify and test methods for facilitating PDA/M communication by pharmacists is indicated.

L’atteinte d’une maîtrise optimale de l’asthme peut s’avérer difficile pour les patients, malgré l’accès à des traitements efficaces et la disponibilité de lignes directrices destinées aux professionnels de la santé pour les guider dans le choix de la pharmacothérapie et de la prise en charge de la maladie. Les pharmaciens communautaires peuvent jouer un rôle significatif dans la prise en charge de patients dont l’asthme est non-maîtrisé, en raison de leur expertise au niveau des médicaments, de leur rôle dans la délivrance et la surveillance des médicaments, de l’accès au dossier pharmaceutique des patients et de leur interaction fréquente avec les patients due aux renouvellements d’ordonnances. Il serait donc pertinent de développer une intervention adaptée aux besoins des pharmaciens communautaires et des patients asthmatiques afin de guider la prise en charge de l’asthme non-maîtrisé en pharmacie communautaire et de favoriser une implantation réussie de l’intervention. Pour ce faire, ce projet qui comprend deux volets a été mené selon un devis mixte. Dans le cadre du volet I, deux groupes de discussion et cinq entrevues individuelles avec des pharmaciens communautaires ainsi que trois entrevues individuelles avec des patients asthmatiques ont été réalisés afin de les questionner sur le développement de l’intervention. Les résultats de cette étude qualitative nous ont permis de développer une intervention composée de cinq étapes : 1) identification des patients dont l’asthme est modéré à sévère et possiblement non-maîtrisé, 2) évaluation de la maîtrise de l’asthme, 3) identification des causes de la non-maîtrise de l’asthme, s’il y a lieu, 4) prise en charge des patients en fonction des causes de la non-maîtrise de l’asthme, s’il y a lieu, et 5) suivi des patients. Dans le cadre du volet II, un devis de cohorte prospective a été utilisé afin d’évaluer la faisabilité d’implanter l’intervention à l’aide d’indicateurs d’implantation collectés par les pharmaciens participants lors des rendez-vous avec les patients et de questionnaires de satisfaction complétés par les pharmaciens et les patients à la fin de l’étude. L’intervention a été implantée par 12 des 35 (34,3%) pharmaciens recrutés pour l’étude. Parmi les 65 patients invités à participer à l’étude, 22 (33,9%) ont été inclus dans l’étude, et 20 d’entre eux (90,9%) ont eu un premier rendez-vous avec leur pharmacien. Les indicateurs d’implantation indiquent que les causes les plus fréquentes de la non-maîtrise de l’asthme étaient la faible adhésion aux médicaments d’entretien et la comorbidité. Les résultats des analyses ont démontré une amélioration significative de la maîtrise de l’asthme au deuxième rendez-vous et à six mois post-intervention comparativement au premier rendez-vous. En conclusion, l’intervention adaptée à la pratique et aux besoins des pharmaciens a été implantée avec succès dans certaines pharmacies et s’est avérée efficace pour améliorer la maîtrise de l’asthme, mais la pandémie de la COVID-19 a rendu plus difficile l’implantation de l’intervention dans les pharmacies communautaires. / Achieving optimal asthma control can be difficult for patients, despite the availability of effective medications and treatment guidelines for healthcare providers. Community pharmacists can play a significant role in the management of patients with uncontrolled asthma because of their pharmaceutical expertise, their role in dispensing and monitoring medications, their access to patients’ pharmacy file and their frequent contacts with patients due to prescription refills. It is therefore relevant to develop an intervention adapted to the needs of community pharmacists and asthma patients to guide the management of uncontrolled asthma in community pharmacies and test its implementation. This project, consisting in two parts, used a mixed methods research design. In part I, two focus groups and five individual interviews with community pharmacists as well as three individual interviews with asthma patients were conducted to develop the intervention. The results obtained from part I enabled us to develop an intervention including five steps: 1) screening of patients with potentially uncontrolled moderate to severe asthma, 2) assessment of asthma control, 3) identification of the cause(s) of uncontrolled asthma, 4) patients management according to the cause(s) of uncontrolled asthma, and 5) patients’ follow-up. During part II, we evaluated the feasibility of implementing the intervention with a prospective cohort design, using implementation indicators collected by participating pharmacists during the intervention and surveys completed by pharmacists and patients at the end of the study to assess their satisfaction with the intervention. The intervention was implemented by 12 pharmacists out of the 35 (34,3%) recruited for the study. Of the 65 patients invited to participate in the study by participating pharmacists, 22 (33,9%) were included in the study, and 20 (90,9%) had a first appointment with their pharmacist. Implementation indicators showed that the most common causes of uncontrolled asthma were poor adherence to controller medications and comorbidity. The results of part II also showed a significant improvement in asthma control at the second appointment and six months post-intervention when compared to the first appointment. In conclusion, the intervention adapted to pharmacists’ practice and needs has been successfully implemented in some pharmacies and was found efficacious to improve asthma control, but the COVID-19 pandemic made its implementation challenging.

全球遠端醫療產業蓬勃發展，各國家的法規也越來越明朗化，未來醫療需求將隨人口老化而大幅上升，如何利用新型態的醫療方式來解決醫療問題，便成為國際上討論的趨勢。本文以遠端藥事做為研究目標，透過「iHealth政昇處方宅配藥局」服務全台的經營模式，以及「春森藥局」服務社區式的經營模式，比較兩家藥局的施行歷程，如何以不同的形態達成遠端藥事。 本研究以Osterwalder提出之經營模式圖(Business Model Canvas)做為基礎，論文以商業畫布、市場機會的發掘與辨識、興業的商業概念、興業的執行、興業的成果呈現，探討機構的獲利方式、民眾的營收方式、藥事服務的形式、慢性病照護，以及政策性的醫療網絡建構等…議題，皆可做為政府規劃醫療政策之參考，本研究有別於其他遠端醫療研究多半選擇科技之論述，以藥局經營做為研究對象，探討產業商機所在。 研究結果顯示，台灣遠端藥事可以符合在現有的法規之上，藥局經由的通訊科技聯繫到病患，提供連續處方箋獲利，不需要依靠業外收入，達成藥事服務營利。比較特別的事，不同藥局要施行遠端藥事的動機不同，分別有企業藥局的經營導向，協助機構評鑑、提供民眾的宅配，此模式下的遠端藥事僅為企業願景的一部分，最終以平台建製作為目標；另一種模式為個人藥局的經營導向，藥師透過政策接觸到社區病患，提供居家服務、甚至安寧服務，實現全人照護之目標。 本研究認為，台灣的遠端藥事尚有發展之潛能。企業經營的方向，需要以機構做為穩定現金流的基礎；個人經營的方向，依然以自身的使命感為主，然而配合「遠端醫療法案」鬆綁、「居家照護政策」的補助，建製完善的社區醫療網絡，將有助於提升社區藥局參與遠端藥事服務之意願，形成新型的產業模式。 / As the telemedicine industry flourishing, the regulations became clear among the countries, the medical needs will also increase in the future. As the goal of the research, this dissertation focused on telepharmacy, the research compared two pharmacies with two different models: serves-the-entire-Taiwan bussiness model from 「iHealth政昇處方宅配藥局」, and serves-the-community bussiness model from 「春森藥局」, hoping to be able to present the telepharmacy with different forms and conditions. This research used the Business Model Canvas which was presented by Osterwalder as the foundation, Unlike other telemedicine researches, this research explored the industry opportunities, and focused on the pharmacy management perspective, instead of the science perspective. The result shows that the telepharmacy in Taiwan can be consistent with the existing regulations. What is more special is that, different pharmacies have different motivations for telepharmacy, and the telepharmacy under this model is only part of the enterprise vision, and creates Platform as the final goal; another model is the business directoin of personal pharmacy, pharmacist contacts patients in the communities through policies, provide home services, and hospice home care to achieve the goal of holistic care. This study considers that telepharmacy still has the potential for development. The direction of enterprise management needs to be based on institutions as the basis of stable cash flow; the direction of personal management sill based on their sense of mission. However, with the help of telepharmacy laws and home care policies, through building the well rounded community medical network, can help increasing the wills of the community pharmacies to participate in telepharmacy.

Community-pharmacy is in a state of flux with a series of significant recent changes including the Community-pharmacy Contract, the reconstitution of the RPSGB and the General Pharmaceutical Council. There are also socio-cultural changes such as greater numbers of women in the profession, and an increase in pharmacists reducing their hours of work. The latter comes at a time when workload/roles are expanding and diversifying, leading to potential scenarios in which there are shortfalls between the hours worked and workload demands. This will have an impact on community pharmacists, but its magnitude may be dependent on how they are professionally and organisationally committed. Whilst there has been some promising commitment research in the USA, little research has been published in GB. However, multidimensional models of commitment have been researched extensively in other professions.A programme of research was developed and conducted to characterise and understand the role of professional and organisational commitment in community-pharmacy in GB using the Three-Component Model of commitment (TCM). Various methods were used to answer the research questions including focus-groups to assess qualitatively the contextual appropriateness of the constructs (stage 1.1), and cognitive-interviews to assess construct validity (stage 1.2). Stage 2 consisted of a large survey study, which examined the psychometric validity of the measurement scales as well as salient a-priori theoretical relationships found in both community pharmacy in GB and other professional contexts. A total of 32 participants were recruited for stage one and 713 community-pharmacists participated in stage two. Ethical approval was attained from the University of Manchester Ethics Committee for both stages one and two.The research found that beyond the affective facets of professional and organisational commitment both normative and continuance facets made significant, unique and yet varied contributions to the influence of both withdrawal-behaviours and work-performance behaviours in the community pharmacy population in GB. However, the levels and strengths of the different facets of professional and organisational commitment also appeared to differ amongst the different subgroups in community pharmacists in GB. For example, independent/small-chain pharmacists exhibited significantly higher levels of affective and normative organisational commitment and significantly lower levels of organisational withdrawal behaviours compared to large-multiple pharmacists. The implications of these and other differences were highlighted and recommendations made salient to the profession and community pharmacy organisations about how the levels of the different facets of commitment may be managed to foster greater work-performance behaviours and mitigate the different withdrawal behaviours.