Decision-making by hospital pharmacy directors when deciding which clinical pharmacy services to implement and/or continue to provide was assessed. Also examined was how these decision-making activities, hospital characteristics, pharmacy characteristics, and pharmacy director demographics might be associated with the number and quality of clinical pharmacy services provided, as well as the number of clinical services implemented under the current pharmacy director. Hospital pharmacy directors reported considering a relatively large number of perceived goals for a clinical service and also indicated they use a rather broad range of decision-making methodologies in evaluating those goals when determining clinical services. Numerous variables were found to be significantly associated with the number of clinical services provided by the pharmacy department and the number of clinical services implemented under the current pharmacy director. However, relatively few variables were found to be significantly related to the quality of clinical pharmacy services being provided.

Genital chlamydia is the most commonly diagnosed sexually transmitted infection. In August 2008, the Scottish government directed its health boards to involve community pharmacies in providing chlamydia testing and treatment for young people. Lothian Health Board envisaged a pharmacy-based chlamydia testing and treatment (CT&T) service to be able to reach deprived population. This research project set out to evaluate the implementation of the CT&T in Lothian, Scotland. However, the Lothian CT&T service suffered from setbacks such as; implementation delays, minimal advertising of the service, low uptake, withdrawal by central government of specific funding to support the service costs, and subsequent termination of the service in Lothian by March 2011. As it turned out, the CT&T service ran in Lothian for only 10 months. As events unfolded, the aims of the PhD research were successively revised so as to undertake an integrated set of studies that provide important insights and generalizable knowledge about the rationale for such a service, the process of implementation, including barriers and facilitators, and the potential to utilise routine data to assess the impact of a new service. An additional component was added, in that I undertook an analysis of an anonymous routine data on chlamydia testing obtained from the microbiology reference laboratory of Lothian to describe the epidemiology of chlamydia in Lothian (2006-2010) and to report an impact of recent policy changes (2008-2009) on chlamydia surveillance activity. Methods The Centre for Disease Control (CDC) framework for programme evaluation was used to guide design the evaluation of the CT&T service, and a subset of ‘strategic’ stakeholders for the service was involved throughout. Four studies were undertaken towards the evaluation, and these employed diverse methods, as follows: (i) A training need survey of pharmacists and their support staff was undertaken in 166 community pharmacies in Lothian, to inform the training session held prior to the CT&T service launch. (ii) A survey of 33 strategic stakeholders in Lothian was undertaken to provide input to the evaluation objectives and to identify their perceptions and concerns in relation to the CT&T initiative and its evaluation. (iii) A survey of potential service users, young people aged 15-24 years, was carried out at the Genito-Urinary Medicine (GUM) clinic and two other sexual health drop-in clinics in Lothian. The survey ascertain their preferences regarding specific aspects of the CT&T service, and their views on issues identified in previous literature as facilitators or barriers with regard to utilising of such a service. (iv) In order to understand the service provider’s perspective on setting up and delivering of the CT&T service, in-depth interviews were undertaken with participating and nonparticipating pharmacists. Eleven pharmacists were purposively sampled from 66 pharmacies invited by NHS Lothian to pilot the service roll-out. Finally, after the Lothian CT&T service had been terminated, 3 strategic stakeholders for Lothian, and a Scottish Government representative were contacted by email, to elicit their views on factors contributing to policy decisions regarding pharmacybased CT&T services. Results The analysis of disaggregated (individual) routine laboratory data showed that age, gender, year of testing and deprivation were associated with the chlamydia testing outcome measures. The before-and-after analysis, with respect to recent major policy/guidance changes (that is, publication of the sexual health service standards for Scotland in 2008, and of SIGN guidelines for chlamydia in 2009), showed that surveillance activity for chlamydia increased only transiently (i.e. in 2009 only). The annual surveillance target for women aged 15-24 years, of 300 tests / 1000 population, was achieved in 2009 only, but targets for males aged 15-24 years (of 100 tests / 1000 population) were not achieved. With respect to the evaluation studies, the training needs survey (i) had a 53% pharmacy response rate from the pharmacies comprised 41% pharmacists, 32% technicians and 26% counter assistants. The survey showed differences in selfassessed training needs between pharmacy staff groups (pharmacists/ technicians/ counter staff). With regard to pharmacist-only competencies, the highest rates of substantial training needs were for clarity regarding the medico-legal aspects (Fraser guidelines), taking a sexual history, criteria for referral and reviewing own and staff competencies for the CT&T service (83% to 77%). With respect to all staff competencies, the greatest self-reported training need was for inter-communicative aspects of providing the service – for respondents overall, 56% to 83% across competencies within this domain. For the stakeholder survey (ii), the response rate was 52% (n=17). Sixteen stakeholders indicated their strong or moderate concern regarding young peoples’ knowledge about the service. The stakeholders also acknowledged the difficulty inherent in promoting the service to those who might benefit from using it. A view commonly expressed by respondents was that sexual health counselling concomitant with testing would be difficult to deliver through the CT&T service, due to: the difficulty in achieving privacy; a busy retail environment; and pharmacists tending not to have the necessary skills. However, they also acknowledged that chlamydia service delivery is problematic everywhere and not just in pharmacies. The key benefits of the service suggested for young people included increase accessibility, normalization of chlamydia testing and its ability of provision of sexual health service to hard-to-reach population. Such a service was perceived to enhance the role of pharmacist in public health provision. The survey also sought input of strategic stakeholders to ensure that the evaluation questions of most importance to them were included. All the proposed evaluation questions were marked as important. Some suggested questions such as client’s satisfaction with the service or related to the service logistical planning could not be incorporated in the later components of the intended evaluation as the service uptake was too low to answer those questions. The survey of potential service users (iii) had an overall response rate of 20% (n=78). Young people who responded indicated that they felt confident that a pharmacy would offer complete confidentiality for testing, provide reliable test results and have knowledgeable staff to provide the service (90% to 93%). That said, these respondents indicated a preference to be tested in GUM clinic (32%) or drop-in clinics (34%), with only 11% indicating a preference for being tested in a pharmacy. Those who had not previously been tested for chlamydia placed more importance on a toilet facility in a pharmacy they would chose for chlamydia testing, whereas younger respondents (≤ 19 years) placed more importance on a less busy pharmacy. Analysis of in-depth interviews with pharmacists (iv) comprising interviews with 11 lead pharmacists (4 respondents from pilot pharmacies and 7 from non-pilot pharmacies) found that pharmacists were enthusiastic about their newly developed public health role. The respondents foresee a shift to pharmacies for being a first port of call for clients. They were also generally positive about the anticipated attitude of general practitioners and pharmacy support staff towards their provision of chlamydia service. From a pharmacist’s perspective, barriers to delivering the CT&T service were identified as workload and lack of adequate physical infrastructure within a pharmacy such as a consultation room and a toilet facility. On the other hand, the assurance of financial incentives for providing the service was a facilitator.

Class of 2012 Abstract / Specific Aims: The purpose of this study was to assess the overall satisfaction of Tucson area pharmacists in the community retail setting and to identify the facets of community practice that have the greatest contribution to job satisfaction and dissatisfaction. Methods: Surveys were sent by facsimile to all community retail pharmacies in the Tucson area. All pharmacists working in these stores were encouraged to respond to the survey by faxing back the paper copy or by responding to the online version of the survey at surveymonkey.com. Respondents were asked to rate their job satisfaction and demographic data were also collected. Main Results: Questionnaires were completed and returned by 32 pharmacists, an estimated response rate of 10%. After reviewing the returned surveys, four questions were chosen from the satisfaction portion to determine their relationship to the job satisfaction ratings. Those four variables were “recognition one receives for good work”, “opportunity to use abilities”, “hours of work”, and “patient contact”. Those four satisfaction variables were then analyzed using the demographic grouping variables “other experience”, “store type” and “degree earned”. Following analysis, only hours of work was found to play a significant role with pharmacy job satisfaction when grouped by other experience. Conclusions: The area of community pharmacy practice that affects job satisfaction the most is hours of work, which is especially true when pharmacists have work experience outside of community practice.

Due to the changes in the environment of pharmacy industry, consumers have slowly altered their mode of consumption from going to the pharmacy for the treatment of illness to going there for the enhancement of health. Products used to be the key concern in traditional pharmacies of which the sales-oriented objective results in seeking for the sales of products, but now pharmacies tend to adopt a multifunctional managing strategy, which is demand-oriented aiming at the fulfillment of customer needs by providing the best-selling products while eliminating the dead stock. The transformation of the mode of consumption fosters the managers of pharmacies to identify the importance of multifunction, professionalism, convenience, chain operation, and computerization. This research adopts both open-ended and focused one-on-one interviews. It examines the factors that would influence the success of strategic coalition between pharmacies in their inner and outer context, and also the discrepancy in the recognition of factors affecting the success of strategic coalition in this industry in different areas. By means of this approach, this research sums up the key factors leading to successful strategic coalition in different areas. The key factors that need to be considered when conducting strategic coalition between pharmacies are obtained through case studies, and these factors are: ¡§the making of governmental policies,¡¨ ¡§the reputation of pharmacies in strategic coalition,¡¨ ¡§an excellent team for business development,¡¨ ¡§developing private brands with a high quality and a low price,¡¨ ¡§the establishment of the web,¡¨ ¡§the administrating and distributing system between businesses,¡¨ ¡§the stipulation of marketing strategies and objectives,¡¨ ¡§the application of finance,¡¨ and ¡§the privacy and trust between businesses.¡¨ Due to the geographical difference among the northern, the central, and the southern areas, chain pharmacies in the north prefer indirect franchise through which all businesses can distribute products together to lower their cost in their market distribution, while in the central area chain pharmacies are usually made of one or two pharmacies, collaborating with each other to create private brands. Pharmacies in the southern area achieve a common ideal through participating as a member in the social meeting for study and learning. ¡§Simplification,¡¨ ¡§standardization,¡¨ ¡§professionalism,¡¨ and ¡§centralization¡¨ must be achieved in strategic coalition between pharmacies with which the professional knowledge of the staff as well as their service would be strengthened to meet the customer needs. The strategic coalition between businesses in different areas requires mutual trust, but the sharing of interest, the information exchange, and how to achieve joint promotion, joint training, joint purchase, joint logo, as well as joint development are all serious issues that should also be dealt with.

Thèse d'exercice : Pharmacie : Nancy 1 : 2008. / Titre provenant de l'écran-titre.

Reproduction de : Thèse d'exercice : Pharmacie : Nantes : 2009. / Bibliogr.

Thesis (Ph. D.)--University of Texas at Austin, 2002. / Vita. Includes bibliographical references. Available also from UMI Company.

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Made available in DSpace on 2013-01-07T15:59:32Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 8.pdf: 4242312 bytes, checksum: 8b278d24e6e04c5009da68aa07091d51 (MD5) Previous issue date: 2007 / Fundação Oswaldo Cruz. Casa de Oswaldo Cruz, Rio de Janeiro, RJ, Brasil. / Tem por fim refletir sobre o início do processo de institucionalização da farmácia, através de duas associações de cunho científico-profissional, que se formaram em meados do século XIX na capital do Império: Sociedade Farmacêutica Brasileira (1851) e o Instituto Famacêutico do Rio de Janeiro (1858). O período entre 1851-1887 correspondeu ao tempo de vida das sociedades, preenchido pela circulação de seus periódicos e pela existência de seus respectivos gestores. / The study aims to think about the beginning of the process of institutionalization of pharmacy through the analysis of two professional-scientific societies, that were created in the middle of the XIX century in the capital of the Empire: the Sociedade Farmacêutica Brasileira (1851) and the Instituto Farmacêutico do Rio de Janeiro (1858). These institutions presented some proposals designed to give the status of science to pharmacy: the improvement of pharmacy education, the control of the illegal practice of pharmacy and the creation of a brazilian pharmaceutical code. The 1851-1887 period corresponded to the lifetime of those societies, the circulation of their periodicals and the existence of the respective directors. The relations established between those societies and the Sociedade Farmacêutica Lusitana, created in 1834, in the city of Lisbon, reveal that the history of the two countries remained intertwined, even after the independence of Brazil, allowing some common points to be identified: the inferiority stigma regarding medicine and the nations considered as civilized; the structuring of pharmacy education linked to medical education; the sanitary legislation; the political regime among others. The relation between art, science and politics is shown by the reconstitution of the life of the main pharmacy founders on the two sides of the Atlantic. Drugs stand out as the main object of this science. Tensions between pharmacists and chemists, and/ or homeopaths, and/ or doctors in medicine, the last representing health institutions of the imperial government, are analyzed through drug uses and meanings/ These tensions are characterized by the contrasts between the scientific and commercial natures of its activities, besides the magical and/or sacred meaning of drugs, wich remains latent in the daily life of the imperial society. Actions related to education, expressed by the inclusion of the Sociedade Farmacêutica Brasileira in the Faculdade de Medicina do Rio de Janeiro, and the creation of a college by the Instituto Farmacêutico do Rio de Janeiro, reveal the search for a scientific nature for its activities, intending to enlarge its scope of action beyond the preparation and conservation of drugs. For developing this study, dialogs have been established between a varied documentary material and the literature available on the subject, or related to it. Among the main documentary material, periodicals of the Brazilian societies and of the Sociedade Farmacêutica Lusitana, reports of the Minister of the Empire and of the Central Board of Public Hygiene, historical memories of the Faculdade de Medicina do Rio de Janeiro and the sanitary legislation of the period have been used. Consulted bibliography includes works in the areas of History of Pharmacy, Medicine and Drugs; History and History of Science; History of Brazil and History of Portugal, besides some literary and dramaturgic works.