Magister Pharmaceuticae - MPharm / In recent years the focus of pharmacy practice has changed from being primarily 'drug-centred to' one which is 'patient-centred' (El-Awady et al., 2006, p. l ). Developments in pharmacy curricula worldwide are reflecting this change. Pharmacy courses no longer concentrate primarily on theoretical content, but increasingly on the ability of students to apply their theoretical knowledge in practice. The South African Pharmacy Council (SAPC) requires that pharmacy education and training in South Africa equips pharmacists for the roles they will take on in practice. In order to accomplish this, the SAPC has prescribed competency unit standards for entry level pharmacists which may serve as a guide for pharmacy educators. A significant challenge in pharmacy education is the application of theory in practice settings (Bucciarelli et al., 2007), which possibly affects the ability of entry-level pharmacists to meet the SAPC unit standard competencies. The dire shortage of pharmacists in public sector health settings further emphasizes the need for a level of competency of entry level pharmacists so that they may enter the workplace ready to serve the medicine related needs of society. Service-learning is defined as experiential learning in which students engage in structured activities that address community needs and promote learning. The purpose of this study was to design, implement and evaluate a Service-learning in Pharmacy (SLIP) intervention which is intended to serve as a generic model which can be used in tertiary hospital pharmacies. The SLIP intervention aimed to promote student learning by providing opportunities for students to engage in structured activities, while simultaneously alleviating pharmacy workload.

The role of the community pharmacist has changed over the past two decades. The traditional specialist roles of pharmacists, such as compounding and preparation of medications, are now infrequent activities and the profession has moved to a more patient-centred focus. Furthermore, pharmaceutical care has been developed and adopted as a practice philosophy to add value and bring care for patients back into the profession. However, there is still much debate in academic and policy literature concerning the reluctance of community pharmacists to adopt and implement pharmaceutical care in practice environments. Empirical evidence has suggested that the professional identity of pharmacists is both ambiguous and multifaceted. However, the practice of pharmaceutical care has been demonstrated to increase organisational identity of pharmacists, as well as their job satisfaction. In addition, pharmacists in a clinical role have been shown to have higher levels of job satisfaction than their counterparts in nonclinical roles. This study has identified, described and analysed the self-perceived professional identities of community pharmacists within a South African context. Furthermore, it sought to determine their current levels of job satisfaction. The relationships between professional identity, job satisfaction and role were analysed in an attempt to understand the influence of professional identity on job satisfaction and behaviour of pharmacists. This study made use of a mixed method of inquiry, online questionnaire, administered to a large sample, which allowed the researcher to take a broad view of the research foci at a specific moment in time. This study found the existence of six professional identities amongst South African Community Pharmacists; namely the practitioner, the jaded pharmacist, the social carer, the professional, the medicine supplier and the entrepreneur. South African community pharmacists were, generally, satisfied with their jobs, professed to practice pharmaceutical care and adopted it as a practice philosophy. South African Community pharmacists were, in general, committed to their profession. Correlation between a pharmacist’s professional identity and their job title, job satisfaction and their commitment were found to be statistically significant. A pharmacist’s level of job satisfaction was statistically correlated to their practice of pharmaceutical care. No statistically significant relationship was found to exist between a pharmacist’s identity and their work load or tasks performed. Characterising South African community pharmacists’ identities is of great significance in an effort to better understand the forces that drive our profession of pharmacy. In doing so, have found that identity affects many elements of work life such as job satisfaction, professional commitment and the practice of patient care.

The thesis explores the various instances in which pharmacists may incur delictual liability for harm suffered by their patients or third parties. As such, it is primarily concerned with the field of professional negligence. The work focuses specifically on the wrongfulness, fault and causation enquiries in pharmacy malpractice cases. The discussion is set against the backdrop of the pharmacy profession's shift towards patient-orientated service in recent years and explores whether this change in the profession's social role has had any effect on the legal duties and standard of care to which pharmacists are currently bound. It is argued that, in light of the dangers posed by modern medicines and the extent to which pharmacists are professionally expected to involve themselves in patient care, pharmacists can no longer escape liability simply by accurately dispensing pharmaceutical products. Rather, they are expected to participate actively in avoiding drug-related injury by, for example, providing patient counselling, detecting invalid or erroneous prescriptions and monitoring prescription refills. Although the thesis places particular emphasis on the role of pharmacists in achieving risk management, it also argues that pharmacists are, in very limited circumstances, required to participate in the risk assessment process traditionally thought to fall exclusively into the realm of physicians. It is furthermore demonstrated that pharmacists can incur liability regardless of whether a patient's harm can also be partially attributed to the blameworthy conduct of another healthcare professional. Although the thesis concludes that pharmacists are currently exposed to greater risks of liability than they were in the past, it also shows that plaintiffs who seek damages from pharmacists will usually experience a number of difficulties in establishing liability. In particular, problems are likely to be encountered in satisfying a court as to the presence of factual causation, which is notoriously difficult to establish in drug-related cases.

Research indicates that tobacco cessation rates are at least doubled when smokers receive assistance from a clinician; receiving tobacco cessation advice from multiple types of clinicians increases quit rates even further.¹ To address a decades-long deficiency in the tobacco cessation training of health professionals in general, a shared curriculum, Rx for Change: Clinician-Assisted Tobacco Cessation, was developed in 1999 as a collaboration of the schools of pharmacy in California.^2,3 Between 2003 and 2005, pharmacy faculty members (n=191) participated in national train-the-trainer workshops designed to equip faculty with the necessary knowledge and skills to implement the Rx for Change curriculum at their academic institutions.⁴ <div><br></div><div> The studies that comprise this dissertation are a logical extension of this national initiative, applying a mixed-methods approach to: (a) evaluate the long-term impact of training pharmacy faculty using the Rx for Change program, (b) delineate recommendations for developing and disseminating shared curricula for health-care programs, and (c) evaluate utilization of the Rx for Change website, which hosts faculty resources and curricular files for download. In combination, these (along with a previously-conducted qualitative study) provide a comprehensive “view” of the long-term impact of this unique shared curriculum. </div><div><br></div><div>Results from the three studies provided evidence for: (1) reach to the majority of pharmacy institutions, (2) a high level of adoption of the Rx for Change in health professional schools, (3) a positive impact on faculty trainees’ careers and their level of confidence for teaching, precepting clinical students, and assisting tobacco users, (4) implementation of the Rx for Change curriculum with a variety of teaching methodologies, and (5) continuity of use within the core curriculum of pharmacy institutions. Seven key factors were found to have contributed to the success of the Rx for Change program, and thus the following are recommended for future shared curriculum developers: (1) appeal to attendees, (2) relate content to clinical practice, (3) deliver live training (in-person), (4) develop high quality materials delivered by experts, (5) meet accreditation standards, (6) provide support for teaching, and (7) demonstrate effectiveness. Data from the website analysis provided evidence for interprofessional reach of the Rx for Change website to educators, learners, and professionals.<br></div>

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Objective. To evaluate the impact of an interprofessional blended learning course on medical and pharmacy students’ patient-centered interpersonal communication skills and to compare precourse and postcourse communication skills across first-year medical and second-year pharmacy student cohorts. Methods. Students completed ten 1-hour online modules and participated in five 3-hour group sessions over one semester. Objective structured clinical examinations (OSCEs) were administered before and after the course and were evaluated using the validated Common Ground Instrument. Nonparametric statistical tests were used to examine pre/postcourse domain scores within and across professions. Results. Performance in all communication skill domains increased significantly for all students. No additional significant pre/postcourse differences were noted across disciplines. Conclusion. Students’ patient-centered interpersonal communication skills improved across multiple domains using a blended learning educational platform. Interview abilities were embodied similarly between medical and pharmacy students postcourse, suggesting both groups respond well to this form of instruction.

As community pharmacy transitions from a fee-for-service model to a focus on value-based care, the desired skills of pharmacist graduates in contemporary practice is an evolving paradigm. Meanwhile, most student pharmacists pursuing a career in community pharmacy upon graduation rely solely upon their pharmacy school training as preparation for entering practice. Community pharmacy preceptors are stakeholders in a unique position to compare the dichotomy of the current climate of community practice with the preparedness of graduating students to enter this field. Therefore, these preceptors’ perceptions of contemporary practice services and skills essential for new graduates may be useful in identifying methods of educating and assessing PharmD candidates in their preparation to enter the evolving landscape of community practice. The objective of this research was to identify essential skills for new graduates in contemporary community pharmacy as perceived by these current practitioners. To accomplish this, researchers developed an anonymous web-based survey using REDCap which was emailed to active Advanced Pharmacy Practice Experiences (APPE) community preceptors. The survey included 3 sections: (1) preceptor demographics; (2) perceptions of “contemporary” services and an evaluation of services offered at their sites; and (3) essential skills for graduates entering contemporary community practice. Following a 30-day window of the survey being open, 25% of preceptors responded (n = 42). Survey responses provided clarity in comparing the proportionality in services offered versus services viewed as contemporary. This information may be useful in identifying transformations that have already seen implementation in practice compared to emerging areas yet to be implemented. We also found broad consensus in the perceived importance of most skill areas offered in the survey with just a few showing broader discrepancies with a minority of respondents suggesting skills which held less importance. Monitoring fluctuations of these parameters over time may disclose trends in community pharmacy practice transformation, further delineating service areas that are trending toward adoption in contemporary practice. Therefore, continued use of preceptor surveys may offer insights on the incremental progression of community pharmacy curricula.

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<p><b>Background/ Objective:</b> In our current healthcare system, information seekers have a bulk of the responsibility to initiate conversations about medications. Although older adults report the need for more information about their medications, many do not accept offers to receive more information from pharmacists during the dispensing of prescription medications. Very little previous work focuses on how older adults make decisions about seeking and avoiding information about medicines, or how these decisions impact medication outcomes. Therefore, the specific aims of this study were to: 1) describe older adults’ attitudes about medication information seeking and the relationships between those attitudes and medication information management behaviors and 2) characterize the relationship between medication information management behaviors (MIMB), medication knowledge, medication beliefs, and attitudes towards medication information seeking. </p><p><b>Methods:</b> Older adults prescribed a new, chronic medication were recruited from a specialty geriatric clinic to participate in interviews that occurred either in-person or over the phone. Participates were randomized 1:1 to usual care or to patient-prompted medication counseling (PPMC). Participants in the PPMC group agreed to ask a pharmacist questions about their new medication at their next medication refill and received a brief education. A survey instrument based on the Theory of Motivated Information Management (TMIM) was adapted from past studies to assess participants’ attitudes about information seeking. Participants were asked to report their information seeking and avoidance over the previous six-months prior to the study and at baseline and month one. Open-ended questions from a national medication safety campaign were utilized to assess medication knowledge. A rubric was developed to score participants’ answers as incorrect knowledge, no knowledge, incomplete knowledge, or complete knowledge and used by two community pharmacists to determine patient medication knowledge (PMK) scores. Structural equation modeling was utilized to identify predictors of MIMB, and hierarchical and logistic regression were used to determine the relationship between MIMB and medication outcomes. </p><p><b>Results: </b>A total of 132 participants completed baseline surveys, and 126 participants completed the month one surveys. Overall, a structural model based on the TMIM met the a priori criteria for good fit (Bollen-Stine bootstrap=0.269). Participants’ positive outcomes assessments, negative outcomes assessments were direct, positive predictors of information seeking and direct, negative predictors of information avoidance. After controlling for baseline medication knowledge, the effect of the intervention, and information seeking there were statistically significant differences in medication knowledge between those participants that sought information from a pharmacist during refill dispensing and those who did not (B=0.259, p<0.001). Of those that sought information from a pharmacist, 70% gained information from baseline to month one, while 36.9% of those that did not seek information from a pharmacist gained information baseline to month. There were no differences in medication beliefs between those that sought information from a pharmacist and those that did not.</p><p><b>Discussion/ Conclusion:</b> Patient knowledge deficits continue well beyond the initial dispensing of a medication, and older adults are also at risk for knowledge loss over the course of prescription use. Receiving additional information from a pharmacist at the time of medication refill may be protective against this information loss, and even increase the change of gaining medication knowledge over time. However, medication counseling in its current form is likely not sufficient to alter older adults’ beliefs about medications. Only one pharmacist initiated a conversation with a participant at medication refill indicating that those participants who want additional information about their medications after the initial dispensing may have to initiate the conversation with a pharmacist.</p>