Class of 2011 Abstract / OBJECTIVES: To design a tool to assess for bias in studies for pharmacy services. METHODS: This study will involve reviewing published reports of studies comparing pharmacists’ services to usual services to identify the key study design components and methods for addressing study design limitations. We will then design a tool to assess further such studies for bias. RESULTS: The aspects of a good pharmacy services study that can be controlled include: large study population, equivalence of population at baseline, experimental mortality, multi-centered study, adequate adherence to treatment, and independence from study staff/manufacturer influence. If these things are controlled and/or accounted for it increases the strength of the study. CONCLUSION: The tool we have designed can successfully evaluate the quality of studies of pharmacy services.

Class of 2011 Abstract / OBJECTIVES: The purpose of this study was to survey prescribers who manage patients with chronic pain to evaluate how pharmacy services are perceived to affect patients’ quality of life. METHODS: Surveys were sent to prescribers who manage patients with chronic pain. Prescribers rated pharmacy services on a scale of 0 – 5 (0 being not important at all, and 5 being extremely important) to the quality of life of patients with chronic pain. RESULTS: Surveys were completed by 23 subjects. Prescribers ranked pharmacy services as follows: the pharmacy fills opioid prescriptions for all pain conditions (mean = 4.2; SD = 1.0), the patient is able to obtain the entire quantity of pain medication (mean = 4.1; SD = 1.5), the pharmacy treats the patient as dependent on, not addicted to opioids (mean = 3.9; SD = 1.6), the pharmacy collaborates with the prescriber to manage opiate therapy (mean = 3.9; SD = 1.5), the pharmacy stocks new and recently approved pain medications (mean = 3.8; SD = 1.1), the pharmacy provides the patient with information on adverse effects of pain medications (mean = 3.8; SD = 1.5), the pharmacy is able to use manufacturer co-pay cards to minimize out-of-pocket costs (mean = 3.5; SD = 1.7), the patient can have prescriptions delivered to their home (mean = 2.1; SD = 1.8) and the patient can obtain a prescription without having to wait a specified time period determined by their pharmacy (mean = 1.8; SD = 1.5). CONCLUSION: Prescribers in this study felt that certain pharmacy services are very important in the treatment of patients with chronic pain. Pharmacies may improve patients’ quality of life in the management of their chronic pain by providing these services.

Background and Objectives: Community pharmacy screening for chronic disease risk factors can promote early detection. Little is known about how pharmacy services are used post-screening. The PIAAF Pharmacy study screened elderly participants for hypertension, diabetes, and atrial fibrillation (AF) in 26 pharmacies in Ontario and Alberta. The primary objective was to determine whether patients screening at risk for AF, hypertension and diabetes had increased odds and rates of pharmacy service receipt than those at lower risk. Methods: Participants’ pharmacy data were extracted. A conceptual framework of potentially influential factors was constructed. Measurable factors were used as variables in regression analyses. Generalized estimating equations (GEE) were created to model 1) receipt of all pharmacy services, 2) receipt of medication review, and 3) receipt of influenza vaccination. Results: 165 of 535 patients received 229 pharmacy services. 64% were medication reviews and 25% were influenza vaccinations. Screening at high risk for diabetes, hypertension, and AF was not associated with increased receipt of pharmacy services, except for influenza vaccine, which was associated with screening as high risk for diabetes (OR = 1.69 [95% CI 1.09, 2.64]). Screening in October (IRR = 2.85 [95% CI 1.67, 4.84]), eligibility for annual-only medication reviews (IRR = 2.15 [95% CI 1.53, 3.01]), number of medications (IRR = 1.92 [95% CI 1.07, 3.46]), new medications (IRR = 2.00 [95% CI 1.37, 2.93]), and living in Alberta (IRR = 1.46 [95% CI 1.07, 2.01]) were associated with increased rates of receiving pharmacy services. Discussion and Conclusions: Screening results were not associated with increased receipt of pharmacy services, with the exception of influenza vaccine and high risk of diabetes. A gap exists between screening and pharmacy service receipt. Pharmacists can use screening interventions and individual screening results as an opportunity to provide pharmacy services to those with chronic disease risk factors. / Thesis / Master of Health Sciences (MSc) / Community pharmacies may be ideal locations for screening of chronic diseases such as diabetes, high blood pressure, and abnormal heart rhythms. It is not well understood how pharmacy services are used in people after screening for these risk factors. This project aims to see if people screening at higher risk levels were more likely to receive pharmacy services than those at lower risk. We used patients’ pharmacy data to see what services they had received after screening, and then created statistical models to determine which patient-, pharmacy-, community-, and screening-related factors were associated with a greater chance of receiving pharmacy services. Being at risk of diabetes, high blood pressure, and irregular heart rhythms were not associated with a greater likelihood of receiving pharmacy services, except in those at high risk for diabetes—these patients were found be associated with a higher chance of receiving flu shots.

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.

Class of 2010 Abstract / OBJECTIVES: To compare the INR-based results of pharmacist anticoagulation management services to non-pharmacist managed anticoagulation therapy. METHODS: A meta-analysis was performed using studies that reported on pharmacists’ services and interventions in anticoagulation. Two reviewers independently assessed each record retrieved by the literature search, and studies were eliminated if both reviewers agreed that the study did not meet the inclusion criteria. The analysis found eight studies that were eligible for inclusion. The primary independent variable was the presence or absence of pharmacist services. The primary dependent variables were the proportion of patients within INR range, the duration of time within that range, and the time required to achieve that range. Extracted data were pooled and entered into the meta-analysis, and a forest plot was constructed. The a-priori alpha level was 0.05. RESULTS: The eight studies were divided into two groups: The INR group consisted of four studies which used INR test data points as the unit of analysis. The Patient group included four studies which measured the patient’s INR only at the end of the study. The INR group demonstrated a significant difference favoring pharmacist services, with a p-value of 0.02 for the group. There was no significant difference between pharmacist services and the control group with respect to the Patient group. When all eight studies were pooled together, the overall forest plot did demonstrate significant favorability for pharmacist services, with an odds ratio of 1.58, indicating that pharmacist provided services improved care by 58% (Z = 2.8;p p = 0.01). CONCLUSIONS: The advantage of a pharmacist service in reaching goal INR was significant compared to the control group of non- pharmacist care.

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.