Thesis (Ph. D.)--University of Wisconsin-Madison, 2002. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (p. 240-252).

Thesis (Ph.D.)-- University of Wisconsin--Madison, 2006. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (p. 152-169).

Thesis (Ph.D.)--University of Wisconsin--Madison, 2006 / Includes bibliographical references (p. 125-129). Also available on the Internet.

No description available.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Homoeopathy, Technikon Natal, 1997. / The aim of this study was to assess pharmacists' perception of complementary medicine in the health care system of South Africa / M

Class of 2012 Abstract / Specific Aims: To evaluate the effect on the incidence and nature of pharmacists’ drug utilization review (DUR) interventions of including patient diagnosis on electronic prescription (e-prescription) orders. Methods: This prospective pre-post evaluation was conducted in the outpatient pharmacy of a federally funded community health center over two consecutive four-week periods. During the pre-phase, a clinical pharmacist in the clinic’s onsite pharmacy prospectively reviewed the e-prescriptions received from the clinic’s primary care providers using a standard prospective DUR process and recorded all therapy-related interventions. In the post-phase, providers added a diagnosis on each e-prescription. Interventions were documented using a standard intervention form that has been used in previous research. Chi square and t-tests were used to assess the nominal and interval data, respectively (α=0.05). The Institutional Review Boards of the two collaborating universities approved the study. Main Results: Pharmacist intervention rates on problematic e-prescription orders significantly decreased (4% pre vs. 1% post, p<0.001). Drug-drug interactions (17.5% pre vs. 20% post) and missing information (15% pre vs. 20% post) were the most frequently cited problems that prompted the need for the pharmacist’s intervention. The medication classes most frequently involved in interventions were antibiotics (53% pre vs. 50% post) and central nervous system agents (17% pre vs. 10% post). After receiving clarification, the pharmacist most often dispensed the prescription (33.3% pre vs. 38.4% post) and educated the patient regarding their treatments (18.8% pre vs. 7.7% post). Conclusions: In this small pilot project, including the patient’s diagnosis on e-prescription orders significantly reduced the incidence of pharmacists’ DUR-related interventions. If duplicated in larger studies, our results suggest that providing pharmacists with additional targeted clinical information could reduce confusion and uncertainty thereby decreasing the number of unnecessary pharmacist contacts with prescribers and improving workflow and efficiency for both.

[Introduction] The 1980s have ushered in an era of extreme competitive pressure for the modern business organisation. In previous times many business organisations have succeeded simply because of the excellence of their products, with little concern or attention being paid to the wants and needs of potential customers. As the business environment has become more competitive, however, the point of focus has changed. There is ample evidence which suggests a correlation between success in business and firms which have adopted a marketing-orientated philosophy of business. The evolution of marketing as a discipline has been hastened in recent times by the need of the firm to survive in the face of increasing competition. This "increasing attention" is occurring because of the realisation that sheer product excellence alone will not necessarily mean that the firm will succeed in establishing a group of satisfied customers in the long term. It is the adoption of the so-called "marketing concept" which provides the opportunity for the firm to develop a competitive edge which will more likely eventuate in success.

Magister Public Health - MPH / Background: Adverse Drug Reactions (ADRs) contribute to potentially expensive hospital admissions and are regarded as a major public health priority. ADRs in South Africa are mainly detected by a spontaneous reporting system but it is plagued by under-reporting. Previous records indicated under-reporting of ADRs in the Cape Winelands District amongst healthcare workers. Pharmacists, in particular, did not report ADRs compared to other healthcare cadres whilst they are generally considered to be the custodians of medicines. Study Aim: This study aimed to explore and describe the perceptions and experiences of rural public sector pharmacists’ reporting of ADRs and to understand why pharmacists in this rural health district under-reported ADRs. Study Design: A qualitative study design was appropriate for this research question as the researcher wanted to gain an in-depth understanding of human behavior related to the phenomena of under-reporting. Study Population and Sampling: The primary study population consisted of 24 public sector pharmacists in the Cape Winelands District. A purposive sampling strategy enabled the selection of 16 pharmacists ranging in gender, age, experience and rank. Eight pharmacists were supervisor pharmacists while the rest were production pharmacists, including a community service pharmacist and an intern pharmacist. Supervisor pharmacists are more involved with managerial tasks and the attendance of meetings compared to production pharmacists that focus on patient care and dispensing of medication. Two key informants involved in the Western Cape Pharmacovigilance System were included in the study. One key stakeholder was a policy specialist pharmacist working at Directorate: Pharmacy Services and primarily involved with the Provincial Pharmacy and Therapeutics Committee. The other key policy stakeholder, at the time of the study, was the manager of the Medicines Information Centre which forms part of the University of Cape Town’s (UCT) Pharmacology Division. Both were highly experienced pharmacists familiar with the pharmacovigilance system. Data Collection: In-depth interviews were conducted using a semi-structured interview guide consisting of open- ended questions. The semi-structured interview guide was tested on a participant outside the primary study population. Interviews were conducted in English and Afrikaans. Interviews were tape-recorded and the interviewers made field notes to supplement the data recorded. Two researchers with experience in qualitative data collection, briefed by the investigator, interviewed the pharmacists who worked in the district and the investigator interviewed the two key stakeholders. Data Analysis: The tape recordings were translated, where applicable, and all were transcribed verbatim by the investigator. The transcribed recordings were analyzed by the investigator by assigning codes to material on an Excel spreadsheet. This approach enabled the identification of themes which aided the understanding of the research phenomena. Ethics: Ethical approval was obtained from the University of the Western Cape Senate Research Committee and permission from the Western Cape Department of Health Research Committee. Written informed consent (See Appendix 1, page 73) was obtained from each participant prior to conducting the interviews and interviewees were assured of confidentiality throughout the research. Key Results and Discussion: Pharmacists in the study strongly acknowledged the importance of ADR reporting which is linked with pharmacists seeing themselves as the custodians of medication. Pharmacists in the study associated the reporting of ADRs with medication safety and felt responsible for ensuring it. In spite of this acknowledgement of the importance of ADR reporting, pharmacists rarely reported an ADR themselves. This finding was in line with previous research conducted and linked with barriers pharmacists faced in practice. The study revealed that pharmacists identified ADR reporting opportunities during their normal clinical work and enabled other health care professionals (HCPs) to confirm the occurrence of an ADR and report it. Pharmacists primarily identified ADRs when they scanned patient folders for clues that could indicate that an ADR had occurred. Other research conducted confirmed that the use of patient records could be used in the identification of ADRs. This finding was important to inform future training workshops to promote reporting of ADRs. Some pharmacists in the study associated an ADR with a therapeutic or clinical intervention. In general, therapeutic interventions usually involved a clinical action more closely associated with medical officers and were viewed by pharmacists in the study as being outside their legal and clinical scope of practice. A clinical intervention could include a change of medication, change of dose, and other prescription changes or might involve the medical officer referring the patient to a higher level of care depending on the severity of the suspected ADR experienced. A clinical intervention could include performing complex diagnostic tests, observations and laboratory investigations. Pharmacists’ association of an ADR experience with a clinical intervention was an important factor limiting their reporting of ADRs. The implication of this belief is that patients were referred from the pharmacy back to medical officers for the clinical intervention. In this way, although pharmacists do not directly report an ADR, their referral to medical officers would help improve reporting of ADRs. An unexpected and contrasting finding compared to previous research was the strong belief of some pharmacists in this study that common ADRs should be reported. Pharmacists believed that by reporting common ADRs en masse, authorities might decide to remove the problematic medication from the approved public sector formulary. This was in contrast to previous research where pharmacists either acknowledged that authorities only want novel or serious ADRs from newly marketed medication or believed that reporting well-known ADRs was a waste of time. Pharmacists reported that they faced several barriers in reporting ADRs. The main barriers that were mentioned were a lack of adequate feedback, heavy workload and time constraints, uncertainty in identifying the cause of an ADR and issues pharmacists had with the reporting process. These barriers were consistent with previous research conducted. Finally, pharmacists suggested various means of facilitating ADR reporting including use of electronic reporting aids, creating increased awareness amongst healthcare professionals, conducting continuous training and making amendments to the reporting form, some of which were in line with previous research conducted. Conclusion: Exploring the perceptions and experiences of pharmacists with respect to the under-reporting of ADRs revealed key knowledge about the spontaneous reporting system that could be applied to strengthen the current reporting system and enable more reporting. Whilst it was clear that pharmacists play an important role as the gatekeepers and drivers of the reporting process enabling other HCPs to report ADRs, more should be done to empower pharmacists in managing ADR reporting opportunities. This could benefit the healthcare system in ensuring that more ADRs are reported, as well as decrease the waiting time of patients and the workload of medical officers. In addition, engaging with pharmacists and HCPs to overcome barriers to reporting would facilitate increased ADR reporting. Recommendations: Several recommendations emerged from the study. Future circulars, training workshops and awareness posters about the ADR reporting process should inform all HCPs to report any medication suspected of being the cause of an ADR and not waste time in trying to identify the medication that caused it. A training workshop should be conducted with pharmacists to improve their skills in terms of identifying ADRs, how and what to report and of the appropriate referral of patients to the medical officers. An annual assessment on the availability of reporting forms in all health facilities should be conducted. In addition, the MIC should conduct a survey on the user-friendliness of the reporting form and enable HCPs to provide recommendations to help improve the reporting form template. Pharmacovigilance should be a standing item on the agendas of sub-district PTC meetings at which supervisor pharmacists should give quarterly updates to sub-district management on ADRs reported. As this study focused primarily on the experiences and perceptions of pharmacists in a rural health district, a follow-up study should explore perceptions and knowledge of medical officers and nurses of ADR reporting, specifically on the availability and complexity of the reporting form. Finally, the MIC should explore the development of a basic ADR causality assessment tool that could assist pharmacists and other HCPs in identifying a possible ADR and improve confidence amongst pharmacists and HCPs in reporting ADRs.

Magister Public Health - MPH / Background: South African medical scheme members needlessly purchase high cost originator prescription medicines which attract out of pocket co-payments at pharmacies. This is despite availability of low priced generic medicines that are paid for in full by medical schemes. Co-payments result from misalignment between prices of the dispensed medicine and that of the alternative medicine which appears on the medical scheme's formulary list and for which the scheme is prepared to pay for in full. To establish what factors caused such misalignment, perspectives of medical scheme members and key informants which included pharmacists, regulators and representatives of medical schemes were explored. The study focused on co-payments for prescription medicines dispensed at private sector retail pharmacies in Pretoria, South Africa. Aim: The aim of the study was to explore views about co-payments and identify factors that motivate and influence Pretoria medical scheme members to co-pay when purchasing prescription medicines at pharmacies, despite being insured by medical scheme insurance organizations. Methodology: An exploratory qualitative research study was performed. Semi-structured interviews were conducted among purposefully selected medical scheme members (12) and 9 key informants. Key informants consisted of dispensing pharmacists (6), regulators of health professionals and medical schemes (2) and a senior official (1) with experience in the regulation of medicines and operations within medical scheme organizations. From a total of twelve interviewed medical scheme members, eight were interviewed at preselected retail pharmacies after they had made a co-payment and the other four selected because they did not make a co-payment. To ensure diversity in views about co-payments and related factors, dispensing pharmacists, co-paying and non co-paying medical scheme members were accessed from six pharmacies that are located in two separate locations of different socioeconomic status in Pretoria, that is, the Pretoria East suburban area and Pretoria city centre which is close to Pretoria central station and taxi routes. Three pharmacies were identified from each of the two different geographical locations, one independent and two corporate pharmacies per socioeconomic area. One pharmacist was interviewed from each of the selected pharmacies and medical scheme members were accessed from across the six pharmacies. The remainder of the key informants such as the regulators, were interviewed during office hours at venues of their choice which included areas of work. A pilot study was conducted among medical scheme members and pharmacists to test the applicability of interview tools. All interviews were conducted face-to-face by the researcher and recorded. The electronic record was independently compared with the researcher's enhanced notes for data accuracy. Codes identified during data analysis were derived from the interview notes and recordings and translated into organized text for theme development in a manner that referenced them to each study objective. Themes were arrived at after combining similar codes which were noted as representing a particular description for use during data interpretation and report writing. Ethics: Ethical clearance was sought from the UWC Senate Research Committee and granted. Prior to conducting interviews, written consent was obtained from all participants. Research details were explained and also provided on the participant information sheet wherein voluntary participation was emphasized. Anonymity and confidentiality was maintained throughout. Results: All patients and pharmacists expressed confusion about the medical scheme rules and related co-payments. There were differing co-payment perspectives among scheme members depending on socioeconomic status, with affordability being a key factor among those of lower socio-economic status whilst convenience and lack of comprehensible information about co-payments was prioritised amongst those members of higher socioeconomic status. Key influences on patient's purchasing decisions were health professionals (both doctors and pharmacists), with friends, family members and advertisements less influential. Patients and medical schemes generally preferred to utilise large chain pharmacies and patients, in particular, had a poor perception of the quality of generics. In general, the first prescribed medicine was highly favoured by patients and this influenced medicine preferences during subsequent prescriptions, especially for non communicable disease (NCD) medicines. Pharmacists did not apply the generic substitution policy in a manner that benefited the consumer because the lowest priced generic was frequently not kept as pharmacy stock. Co-payments appeared to create a divide between corporate and independent pharmacies. Some regulators tended to blame patients, pharmacists and medical schemes rather than the lack of adequate enforcement of national policies and regulations. Inadequate monitoring and enforcement of pro-consumer policies were found to be the main factors that contributed to co-payments. Conclusions and Recommendations: The introduction of regulations on minimum requirements for stock available at private sector retail pharmacies should be considered to ensure availability of the lowest priced generic at all times. This would ensure that co-payments are reduced and the desired consumer benefits that should accrue from the existing generic substitution policy are realized and maximized. To prevent perception-based and self-initiated co-payment behavior among consumers, vigorous and continued education about the value and equivalence of generics should be championed at the highest level of government with the execution of this critical responsibility not left to those with profit driven motives. Consumers might benefit from extensive education about the purchasing choices made at pharmacies and, in particular, the negative financial consequences associated with choosing a preferred but highly priced originator versus a low cost generic medicine which is used to treat the same ailment. Enforcement of policies by dedicated government agencies could further protect consumers from preventable high cost of healthcare and of medicines in particular.

Class of 2005 Abstract / Objective: To determine the effect that a pharmacist run diabetes mellitus (DM) care clinic has on glycemic control, as measured by glycosylated hemoglobin (HbA1c) levels. The baseline comparison group is the current standard of care consisting of physician only treated DM patients. Methods: This project is a retrospective cohort analysis of clinical data obtained from patient charts, patients were matched on age. The pharmacist treated group, from a community health center clinic with a collaborative care agreement for the treatment of DM (Group 1), provided comprehensive DM treatment based upon a prearranged treatment protocol with clinic physicians. The physician treated group, is from an outpatient clinic situated at a community hospital (Group 2). The primary outcome was change in HbA1c over at least a 6 month period of time. Patients from both groups were diagnosed with type 2 diabetes mellitus, >18 years of age, and enrolled in an Arizona Health Care Cost Containment System (AHCCCS) Medicaid insurance program. Patients could be treated with oral antidiabetic medication, an insulin product, or a combination of both. Results: A total of 321 patients were included in the study, Group 1 n=161, Group 2 n=160. Ages were similar, mean age=57.7 (SD=12.2) for Group1 and mean age=57.4 (SD=12.3) for Group 2. Gender (male=33.5% and 37.5% respectively) and ethnicity were also similar (p>0.45). The average HbA1c levels at baseline and at the end of treatment were as follows; Group 1 (9.8 and 7.8), and Group 2 (8.8 and 8.9) p<0.001 for post treatment comparison. Implications: This study indicates that physician pharmacist collaborative care improves glycemic control, as shown by significantly lower HbA1c levels than the physician treated group.