No description available.

<p>&nbsp / </p> <p align="left">Oral ulcers and oral thrush could be indicative of serious illnesses such as oral cancer, HIV and other sexually transmitted infections (STIs), among others. There are many different health care workers that can be approached for advice and/or treatment for oral ulcers and oral thrush (sometimes referred to as mouth sores by patients), including pharmacists. In fact, the mild and intermittent nature of oral ulcers and oral thrush may most likely lead the patient to present to a pharmacist for immediate treatment. In addition, certain aspects of access are exempt at a pharmacy such as long queues and waiting times, the need to make an appointment and the cost for consultation. Thus pharmacies may serve as a reservoir of undetected cases of oral cancer, HIV and other STIs. <b><font face="Times New Roman">Aim</font></b><font face="TimesNewRomanPSMT" size="3"><font face="TimesNewRomanPSMT" size="3"><font face="Times New Roman">: To determine how community pharmacists in the Western Cape manage </font>oral ulcers and oral thrush.</font></font></p>

<p>&nbsp / </p> <p align="left">Oral ulcers and oral thrush could be indicative of serious illnesses such as oral cancer, HIV and other sexually transmitted infections (STIs), among others. There are many different health care workers that can be approached for advice and/or treatment for oral ulcers and oral thrush (sometimes referred to as mouth sores by patients), including pharmacists. In fact, the mild and intermittent nature of oral ulcers and oral thrush may most likely lead the patient to present to a pharmacist for immediate treatment. In addition, certain aspects of access are exempt at a pharmacy such as long queues and waiting times, the need to make an appointment and the cost for consultation. Thus pharmacies may serve as a reservoir of undetected cases of oral cancer, HIV and other STIs. <b><font face="Times New Roman">Aim</font></b><font face="TimesNewRomanPSMT" size="3"><font face="TimesNewRomanPSMT" size="3"><font face="Times New Roman">: To determine how community pharmacists in the Western Cape manage </font>oral ulcers and oral thrush.</font></font></p>

Magister Chirurgiae Dentium - MChD / Oral ulcers and oral thrush could be indicative of serious illnesses such as oral cancer, HIV and other sexually transmitted infections (STIs), among others. There are many different health care workers that can be approached for advice and/or treatment for oral ulcers and oral thrush (sometimes referred to as mouth sores by patients), including pharmacists. In fact, the mild and intermittent nature of oral ulcers and oral thrush may most likely lead the patient to present to a pharmacist for immediate treatment. In addition, certain aspects of access are exempt at a pharmacy such as long queues and waiting times, the need to make an appointment and the cost for consultation. Thus pharmacies may serve as a reservoir of undetected cases of oral cancer, HIV and other STIs. Aim: To determine how community pharmacists in the Western Cape manage oral ulcers and oral thrush. Objectives: The data set included the prevalence of oral complaints confronted by pharmacists, how they manage oral ulcers, oral thrush and mouth sores, their knowledge about these conditions, and the influence of socio-economic status (SES) and metropolitan location (metro or non-metro) on recognition and management of the lesions. Method: A cross-sectional survey of community pharmacists in the Western Cape was conducted. A random sample of pharmacies was stratified by SES (high and low), and metropolitan location. A structured questionnaire was used to conduct a telephonic interview. The questionnaire was faxed to pharmacists 24 hours prior to the interview. Pharmacists were also telephoned 24 hours prior to the interview, but after the questionnaire was faxed, in order to gain informed consent for participation in the study, and to confirm a convenient time to conduct the interview. Results: Two thirds (63%) of pharmacists managed oral problems nearly everyday, and 30% managed these more than once a week. More pharmacists in high SES (73%) areas managed oral problems nearly everyday (Fisher Exact, p=0.0005). Just over half (56%) and 49.2% of pharmacists said that ulcers and thrush, respectively, was the most common oral problem that they encounter. The prevalence of oral thrush was significantly higher in non-metro areas (58%) (RR=0.7 (0.5-1.0) ChiSquared=4.0, p=0.04), and it was also significantly lower in low SES areas (RR=1.6 (1.1-2.4), Chi Squared=6.5, p=0.01). Half the pharmacists reported that they would manage the patient comprehensively. Most would take a history but the quality of the history is poor, thereby compromising their ability to manage these cases appropriately. Only a third would refer a simple oral ulcer, thrush or mouth sore to a doctor/dentist but all pharmacists would have referred a longstanding ulcer to a doctor/dentist. In terms of knowledge, only 33% of pharmacists were aware that oral ulcers and thrush could be indicative of HIV infection, and only 8% linked oral ulcers with oral cancer. There was no discernable pattern of management of oral ulcers and thrush, or of knowledge of the link between these lesions with underlying diseases, by SES and metropolitan locations (Chi Squared, Fisher Exact, p>0.05). Conclusion: The result of this study strengthens the current view of pharmacists as oral health advisors as they encounter oral problems regularly, most commonly oral ulcers and oral thrush. Therefore, the pharmacist can play an important role in the early detection of HIV and oral cancer. However many pharmacists fail to refer these cases to a dentist. Most pharmacists lacked specific knowledge about the relationship of oral ulcers and thrush with underlying conditions, which may explain why many pharmacists are not managing these cases correctly. There is a definite need to train pharmacists at both an under- and post-graduate level with specific emphasis on the proper management of oral ulcers, oral thrush and mouth sores, as well as comprehensive training that outlines why vigilant management of oral ulcers and oral thrush is necessary. / South Africa

Magister Pharmaceuticae - MPharm / The global movement towards enhancing inter-professional collaboration in patient care is in light of the increasing potency of drugs and complexity of drug regimens, particularly in the chronically ill where poly-pharmacy is rife, collaborative patient management by general practitioners and community pharmacists, in particular, has the potential to enhance patient therapeutic outcomes in primary healthcare. Literature from other parts of the world has enumerated the advantages of collaboration. South Africa with its unusual quadruple burden of disease and human resource deficient public healthcare system would benefit from collaboration between general practitioners and community pharmacists through expanded roles for community pharmacists to enable them to make more meaningful contributions to primary healthcare regimens. Particularly with the introduction of the National Health Insurance (NHI) programme. This dissertation aims to assess from general practitioners‟ perspectives: the current level and stage of collaboration (using the collaborative working relationship (CWR) model proposed by McDonough and Doucette, 2001) between general practitioners and community pharmacists in patient care, if general practitioners‟ perceptions of the professional roles of community pharmacists in patients‟ care can influence desired collaboration (prospects of enhanced future collaboration) and how do general practitioners envision enhanced future collaboration between them and community pharmacists in patient care, possible barriers to the envisioned collaboration between the two practitioners, and how general practitioners‟ demographic characteristics influence inter-professional collaboration with community pharmacists. Sixty randomly selected consenting general practitioners in private practice participated in a cross-sectional, face- to-face questionnaire study. The questionnaire contained a range of statements with Likert scale response options. Data was initially entered into Epi Info (version 3.5.1., 2008) and then exported to IBM SPSS Statistical software for analysis (version19, 2010). Medians were used to summarize descriptive data and Spearman‟s correlation coefficient, Mann-Whitney U Test and Kruskal-Wallis Test was used for bivariate analysis. Ethical approval was granted by the Senate Research and International Relations Committee, University of the Western Cape (Ethical Clearance Number: 10/4/29). The results indicated low-levels of current collaboration at stage 0 of the CWR model between general practitioners and community pharmacists. A statistically significant correlation was observed between general practitioners‟ perceptions of the professional roles of community pharmacists and desired collaboration (prospects of enhanced future collaboration), [p=0.0005]. Good prospects of enhanced future collaboration between general practitioners and community pharmacists were observed. General practitioners identified barriers to collaboration to include: the lack of remuneration for collaboration, absence of a government mandate or policy supporting collaboration, inability of general practitioners to share patients‟ information with community pharmacists and questionable professional ethics exhibited by community pharmacists particularly over financial gains. Most general practitioners agreed that joint continuing professional education organized by pharmaceutical companies or other groups will increase interaction and enhance collaboration. Enhanced Inter-professional collaboration between general practitioners and community pharmacists‟ can be possible in the future but hindrances need to be eliminated for this to be achieved. Future research can be aimed at exploring the perspectives‟ of community pharmacists to inter-professional collaboration in South Africa and interventions that will enhance collaboration.

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.

Prescription drug abuse and misuse (PDA/M) prevalence has increased dramatically in the United States over the last two decades. Community pharmacists are intimately involved in the dispensing of a majority of eventually abused/misused prescription drugs and are thus well positioned to engage in PDA/M prevention and treatment. A known barrier to engagement in prevention efforts among providers is discomfort with PDA/M communication. The objective of this study was to explore relative situational self-perceived PDA/M communication confidence among Tennessee community pharmacists. Using the validated Self-Perceived Communication Competence instrument as a framework, an 18-item survey instrument (0-100 scale; 0=completely unconfident, 100=completely confident) was developed and administered to 2000 Tennessee pharmacists. Items elicited communication confidence across multiple contexts and receivers, including PDA/M situations and common community pharmacy situations. Parametric statistical tests were used to examine differences in communication confidence across demographic variables. A 40% response rate was obtained. Mean self-perceived communication confidence ratings ranged from 54.2 to 92.6. Statistically significant differences were noted across receiver type and context. Addiction communication confidence was significantly lower than all other scenarios involving patient communication, including items that could be considered accusatory to patients (non-adherence, smoking cessation). Differences in communicative self-confidence were noted across gender, practice setting, years in practice, hours worked per week, and number of prescriptions filled per week. Pharmacists’ self-perceived communication confidence is situational and varies across pharmacist and practice setting characteristics. Efforts to engage community pharmacists in PDA/M prevention and treatment should foster development of communicative self-confidence across multiple PDA/M situations.

The Patient Protection and Affordable Care Act (PPACA) represents one of the most significant pieces of legislation in the history of United States healthcare. The PPACA has two main goals: to increase the insured patient population in the US and to reduce the overall cost while improving the quality of healthcare in the US. To accomplish the latter goal, healthcare providers are experiencing a movement toward integrated, team-oriented models that place increasing accountability on the providers and institutions. At the same time, these integrative models emphasize effective preventive care, which is critical in reducing the country’s overall healthcare costs. As more health care institutions and providers across the country adopt the healthcare reform models of the Patient-Centered Medical Homes (PCMH) and Accountable Care Organizations (ACOs) directly under the PPACA, the demand for pharmacists is increasing. In addition, the role of the pharmacist through Medication Therapy Management (MTM) is growing as more public and private sectors adopt MTM and its standards are being used as the medication-related cornerstone for the ACOs. There is a call for lower costs and higher quality outcomes in healthcare, and the pharmacists are increasingly integrated into direct patient care and medication management. The newly integrated responsibilities of the pharmacist are numerous and almost limitless. The roleof pharmacists is expanding, and as many studies suggest, their contributions produce auspicious results.

No description available.

Introduction : L’ostéoporose constitue un problème de santé publique important vu les conséquences graves des fractures ostéoporotiques. Toutefois, le dépistage et le traitement de l’ostéoporose sont grandement sous-optimaux. De nouvelles interventions visant à améliorer le dépistage et le traitement de l’ostéoporose sont donc nécessaires. Objectifs : L’objectif global de ce programme de recherche était d’évaluer quelles avenues devraient être privilégiées pour le développement de futures interventions visant à améliorer le dépistage et le traitement de l’ostéoporose en soins de première ligne. Pour ce faire, trois projets ont été réalisés, dont les objectifs étaient les suivants : 1) évaluer l’impact d’un atelier de formation offert à des médecins de famille sur les pratiques préventives associées à l’ostéoporose (premier projet de recherche); 2) évaluer l’efficacité globale des interventions dans le domaine de l’ostéoporose en soins de première ligne (deuxième projet de recherche); et 3) explorer les perceptions des pharmaciens communautaires, des directeurs d’agences de santé publique et du Ministère de la santé et des services sociaux du Québec (MSSSQ) concernant le rôle des pharmaciens dans la prévention des maladies et la promotion de la santé et spécifiquement dans le domaine de l’ostéoporose et de la prévention des chutes (troisième projet de recherche). Méthodologie : D’abord, une étude de cohorte a été réalisée avec les données administratives de la Régie de l’assurance maladie du Québec (premier projet de recherche). Ensuite, une revue systématique avec méta-analyse concernant l’efficacité des interventions visant à améliorer le dépistage et le traitement de l’ostéoporose en soins de première ligne a été effectuée (deuxième projet de recherche). Finalement, une étude transversale avec volet qualitatif a été réalisée chez des pharmaciens communautaires, des directeurs d’agences de santé publique et la directrice de la prévention des maladies chroniques du MSSSQ (troisième projet de recherche). Résultats : Dans le premier projet de recherche, bien que la participation des médecins de famille à l’atelier entraînait une amélioration des pratiques préventives liées à l’ostéoporose, celles-ci sont demeurées grandement sous-optimales. Au niveau du deuxième projet de recherche, il a été observé que les interventions comprenant plusieurs composantes et ciblant les médecins de famille et leurs patients pouvaient améliorer les pratiques préventives de l’ostéoporose, mais ces améliorations étaient souvent modestes du point de vue clinique. Finalement, le troisième projet de recherche a démontré que les pharmaciens communautaires, les directeurs d’agences de santé publique et la direction de la prévention des maladies chroniques du MSSSQ considèrent que les pharmaciens devraient jouer un rôle significatif dans la prévention des maladies et la promotion de la santé et spécifiquement dans le domaine de l’ostéoporose et de la prévention des chutes. Néanmoins, à cause de nombreuses barrières organisationnelles, un large écart existe entre le niveau d’implication idéal et réel des pharmaciens dans l’offre de ces services. Conclusion : Les futures interventions à être développées devront être multidisciplinaires, comprendre plusieurs composantes et cibler les barrières à l’application des recommandations des guides de pratiques cliniques. L’implication plus intensive des pharmaciens communautaires et des infirmières cliniciennes constitue une avenue particulièrement intéressante pour le développement de futures interventions. / Background: Osteoporosis is a major public health problem given the consequences of fragility fractures. However, the detection and treatment of osteoporosis remain sub-optimal. New interventions aiming at improving the detection and treatment of osteoporosis are therefore necessary. Objectives: The global objective of this research program was to determine which strategies should be adopted for the development of future primary care interventions in osteoporosis. To do so, three different research projects were conducted, which objectives were to: 1) assess the impact of an osteoporosis workshop offered to primary care physicians on osteoporosis-related medical practices (first research project); 2) evaluate the global effectiveness of primary care interventions in osteoporosis (second research project); and 3) explore the perceptions of community pharmacists, directors of public health agencies and Québec’s Department of Health regarding the role of community pharmacists in health promotion and prevention, and more particularly in the management of osteoporosis and the risk of falls (third research project). Methods: First, a cohort study was conducted using the Régie de l’assurance maladie du Québec’s administrative databases (first research project). Afterward, a systematic review with meta-analysis regarding the effectiveness of interventions aiming at improving the detection and treatment of osteoporosis in primary care was performed (second research project). Finally, a cross-sectional study with a qualitative component was conducted with community pharmacists, directors of public health agencies and the chronic disease prevention director of Québec’s Department of Health (third research project). Results: The first research project showed that although the attendance at a primary care physician workshop was associated with higher rates of osteoporosis medical practices, these rates remained greatly sub-optimal. In the second research project, it was observed that multifaceted interventions targeting primary care physicians and their at-risk patients may improve the management of osteoporosis, but improvements are often clinically modest. Finally, the third research project showed that community pharmacists, directors of public health agencies and the chronic disease prevention director of Québec’s Department of Health consider that community pharmacists should play a significant role in health promotion and prevention, and more particularly in the management of osteoporosis and the risk of falls. However, because of many organizational barriers, an important gap exists between pharmacists’ ideal and actual levels of involvement in the provision of these services. Conclusions: Futures primary care interventions to be developed in osteoporosis should be multidisciplinary, include several components and address the barriers to the application of clinical practice guidelines. Targeting community pharmacists and nurse practitioners more intensively may be an interesting avenue for developing future strategies.