No description available.

Thesis (M.Sc. (Biostatistics))--Mahidol University, 1976.

The environment in which hospital pharmacists currently function demands more of them than did any previous period. Employees in pharmacy companies have to cope with the demands that arise from fulfilling various roles, as well as with increased pressures such as managed health care and primary health care. Tracking and addressing their effectiveness in coping with new demands and stimulating their growth in areas that could possibly impact on the standard of pharmacy services are therefore of great importance. The first step in the enhancement of the work-related well-being of hospital pharmacists is the successful diagnosis of occupational stress, burnout and work engagement. However, in order to measure these constructs, it is important to use reliable and valid instruments, and at the same time take biographical differences into account. The objectives of this study were to validate the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), Utrecht Work Engagement Scale (UWES) and the Pharmacist Stress Inventory (PSI) for hospital pharmacists in South Africa, to assess the effect of biographical factors on the levels of burnout, engagement and occupational stress, and to investigate the role of job stress and coping strategies in the work-related well-being (burnout and work engagement) of hospital pharmacists in South Africa. A cross-sectional survey design was used. The study population consisted of an accidental sample (N = 187) of South African hospital pharmacists in both public and private hospital facilities on a national basis. The MBI-HSS, UWES, PSI, the Coping Orientation for Problem Experienced (COPE) as well as a biographical questionnaire were administered. Descriptive statistics, Cronbach alpha coefficients, confirmatory and exploratory factor analyses, multivariate analysis of variance (MANOVA), one-way analysis of variance (ANOVA), t-tests and multiple regression analysis were used to analyse the data Confirmatory factor analysis by means of structural equation modelling of the MBI-HSS, confirmed a three-factor model of burnout, consisting of Emotional Exhaustion, Depersonalisation and Personal Accomplishment. The scales showed acceptable reliabilities. The results indicated that 35% of the hospital pharmacists showed high levels of emotional exhaustion, while 25% showed high levels of depersonalisation. Biographical factors such as age, years in pharmacy practice, home language, average number of hours worked per week, as well as the level of job satisfaction were related to the burnout levels of hospital pharmacists. Exploratory factor analysis of the UWES resulted in two factors, namely Vigour/dedication and Absorption. These factors showed acceptable Cronbach alpha coefficients. In the same sample (but in a different analysis where the two factors were used separately), it was indicated that compared to a South African norm, 38,5% and 48,9% of the hospital pharmacists showed low levels of vigour and dedication respectively. Position, home language, and the educational level were related to work engagement of hospital pharmacists. The PSI was developed as a measuring instrument for the purposes of this study. Three internally consistent factors, namely Job Demands, Pharmacy-Specific Stressors and Lack of Resources were extracted. The level of severity of the various stressors was calculated and the unavailability of medicine proved to be the most severe stressor. Other severe stressors included frequent interruptions, co-workers not doing their jobs, workload and insufficient salaries. Finally it was investigated whether job stress and coping strategies could predict the work related well-being of hospital pharmacists in South Africa. The results showed that job stress (as a result of job demands and lack of job resources), as well as three coping strategies (approach coping, avoidance coping and turning to religion) predicted burnout and work engagement of South African hospital pharmacists. Recommendations for future research were made. / Thesis (Ph.D. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2006.

The environment in which hospital pharmacists currently function demands more of them than did any previous period. Employees in pharmacy companies have to cope with the demands that arise from fulfilling various roles, as well as with increased pressures such as managed health care and primary health care. Tracking and addressing their effectiveness in coping with new demands and stimulating their growth in areas that could possibly impact on the standard of pharmacy services are therefore of great importance. The first step in the enhancement of the work-related well-being of hospital pharmacists is the successful diagnosis of occupational stress, burnout and work engagement. However, in order to measure these constructs, it is important to use reliable and valid instruments, and at the same time take biographical differences into account. The objectives of this study were to validate the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), Utrecht Work Engagement Scale (UWES) and the Pharmacist Stress Inventory (PSI) for hospital pharmacists in South Africa, to assess the effect of biographical factors on the levels of burnout, engagement and occupational stress, and to investigate the role of job stress and coping strategies in the work-related well-being (burnout and work engagement) of hospital pharmacists in South Africa. A cross-sectional survey design was used. The study population consisted of an accidental sample (N = 187) of South African hospital pharmacists in both public and private hospital facilities on a national basis. The MBI-HSS, UWES, PSI, the Coping Orientation for Problem Experienced (COPE) as well as a biographical questionnaire were administered. Descriptive statistics, Cronbach alpha coefficients, confirmatory and exploratory factor analyses, multivariate analysis of variance (MANOVA), one-way analysis of variance (ANOVA), t-tests and multiple regression analysis were used to analyse the data Confirmatory factor analysis by means of structural equation modelling of the MBI-HSS, confirmed a three-factor model of burnout, consisting of Emotional Exhaustion, Depersonalisation and Personal Accomplishment. The scales showed acceptable reliabilities. The results indicated that 35% of the hospital pharmacists showed high levels of emotional exhaustion, while 25% showed high levels of depersonalisation. Biographical factors such as age, years in pharmacy practice, home language, average number of hours worked per week, as well as the level of job satisfaction were related to the burnout levels of hospital pharmacists. Exploratory factor analysis of the UWES resulted in two factors, namely Vigour/dedication and Absorption. These factors showed acceptable Cronbach alpha coefficients. In the same sample (but in a different analysis where the two factors were used separately), it was indicated that compared to a South African norm, 38,5% and 48,9% of the hospital pharmacists showed low levels of vigour and dedication respectively. Position, home language, and the educational level were related to work engagement of hospital pharmacists. The PSI was developed as a measuring instrument for the purposes of this study. Three internally consistent factors, namely Job Demands, Pharmacy-Specific Stressors and Lack of Resources were extracted. The level of severity of the various stressors was calculated and the unavailability of medicine proved to be the most severe stressor. Other severe stressors included frequent interruptions, co-workers not doing their jobs, workload and insufficient salaries. Finally it was investigated whether job stress and coping strategies could predict the work related well-being of hospital pharmacists in South Africa. The results showed that job stress (as a result of job demands and lack of job resources), as well as three coping strategies (approach coping, avoidance coping and turning to religion) predicted burnout and work engagement of South African hospital pharmacists. Recommendations for future research were made. / Thesis (Ph.D. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2006.

Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma. Fifty-two patients attending a hospital difficult asthma clinic were randomised (1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists. Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50). At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates < 80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020). This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements.

Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma. Fifty-two patients attending a hospital difficult asthma clinic were randomised (1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists. Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50). At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates <80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020). This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements. / The Pharmaceutical Trust for Educational and Charitable Objects (PTECO) (now known as Pharmacy Research UK).

Yes / Aims and Objectives The vision for the future Great Britain pharmacy workforce development has been proposed as of August 2015 and this starts/reignites discussions as to how pharmacists continue to operate as a body whilst maintaining and extending their professional acumen and experience [1]. The pharmacy sector has grown substantially and qualified pharmacists are often assumed to be managers, without having completed management modules during their degree [2]. The aim of this study was to determine how CPD supports management skills development (MSD) of pharmacists in these sectors. / The full text will be available on permission from the publisher.

Depuis la découverte des médicaments, leur consommation est en constante augmentation. Cependant, leur utilisation n’est pas dépourvue de risques ; ainsi, la sécurité du médicament occupe un intérêt particulier dans les systèmes de soins et l’iatrogénie médicamenteuse représente un problème majeur de santé publique. La sécurisation du circuit du médicament impliquant les différents professionnels de santé et le patient favorise la réduction de cette iatrogénie. Plusieurs travaux de recherche ont démontré que les problèmes iatrogènes survenaient en majorité au cours de la prescription. Ainsi, l’implication du pharmacien dans la politique des soins et son intervention lors de l’analyse des prescriptions constituent des éléments clés dans la prévention des événements iatrogènes médicamenteux. Par conséquent, nous nous sommes intéressés au thème des bonnes pratiques d’interventions pharmaceutiques, leur codification, leur documentation, leur impact et leur diffusion. D’abord, nous avons mené un état des lieux sur les observatoires documentant des interventions pharmaceutiques. Cette revue systématique de la littérature a mis en lumière la rareté des observatoires documentant des pratiques de pharmacie clinique (i.e. : pratiques d’interventions) par rapport à ceux s’intéressant uniquement à la détection des problèmes iatrogènes. Ensuite, nous avons étudié les données de l’observatoire Act-IP© afin d’analyser une masse importante d’interventions pharmaceutiques pour caractériser les pratiques d’analyse pharmaceutique en France. Cette analyse a révélé une variabilité des pratiques entre les disciplines. De plus, elle a révélé que le problème de surdosage est le plus identifié par les pharmaciens cliniciens. Un nombre faible de médicaments était à l’origine de tous les problèmes pharmacothérapeutiques identifiés. Concernant la pertinence de l’intervention pharmaceutique, nous avons identifié que le type de l’intervention, la classe médicamenteuse impliquée et l’intégration du pharmacien dans les unités de soins peuvent influencer l’acceptation de l’intervention par le prescripteur. Puis, nous avons mené l’étude DACLI-DIP visant à tester un modèle de diffusion de ces pratiques bien structurées et bien développées en France, dans un autre contexte en l’appliquant à la pratique hospitalière au Liban. Après la mise en œuvre, la formation des pharmaciens libanais et le contrôle-qualité de la documentation, les interventions pharmaceutiques menées ont été codifiées et documentées selon la même méthode que dans l’observatoire Act-IP©. L’analyse des données collectées a révélé un profil de problèmes et d’interventions en cohérence avec ceux d’autres travaux internationaux. Elle a montré que les interventions pharmaceutiques ont un impact clinique significatif positif et un impact organisationnel favorable. L’analyse a mis en évidence que les problèmes de « non-conformité aux référentiels/CI » à impact clinique modéré conduisaient aux interventions pharmaceutiques les plus acceptées par les prescripteurs. Au vu de ces résultats, il apparaît que le déploiement de l’outil Act-IP© associé à une standardisation des pratiques de codification et de documentation des interventions pharmaceutiques, est un moyen de promouvoir les activités de pharmacie clinique et leur impact bénéfique sur le système de soins. Pour les études futures, le modèle testé dans le contexte libanais pourrait servir de modèle de diffusion des services pharmaceutiques dans d’autres pays n’ayant pas encore développé les activités de pharmacie clinique. / Since the discovery of drugs, their consumption is constantly increasing. However, their use is not without risks; thus, patient safety is the main goal of each therapeutic strategy in the system of health care, and iatrogenic problems are a major public health problem. Securing the circuit of the drug involving different health care professionals and the patient promotes the reduction of these iatrogenic problems. Several studies have shown that the majority of iatrogenic problems occur during prescribing. Thus, the involvement of the pharmacist in the care policy and its intervention during medication review are key elements in the prevention of iatrogenic drug events. As a result, we focused on the good pharmacists’ interventions’ practices, their coding, their documentation, their impact and their diffusion. First, we conducted a state of knowledge on observatories documenting pharmacists’ interventions. This systematic review has highlighted the scarcity of observatories documenting clinical pharmacy practices (i.e. interventions’ practices) compared to those focusing solely on the detection of iatrogenic problems. Next, we studied data from the Act-IP© observatory in order to analyze a big data of pharmacists’ interventions to characterize the pharmaceutical analysis practices in France. This analysis revealed a variability of practices across ward specialties. In addition, it revealed that the problem of overdose is the most identified by clinical pharmacists. It highlights also that problems and interventions in daily routine practices concern few drugs. Regarding the relevance of the pharmacist’s intervention, we have identified several factors that may affect the acceptance of the intervention by the prescriber such as the drug class involved, the intervention’s type and the integration of the pharmacist in the care units. Then, we conducted the study DACLI-DIP to test a model of diffusion of these well-structured and well-developed practices in France, in another context by applying it to the hospital practices in Lebanon. After the implementation, the training of Lebanese pharmacists and the quality control of the documentation, pharmacists’ interventions carried out were codified and documented according to the same method as in the Act-IP© observatory. The analysis of the collected data revealed a profile of problems and interventions in coherence with those of other international works. It has shown that pharmacists’ interventions have a significant positive clinical impact and a favorable organizational impact. The analysis revealed that the problems of “non-conformity to guidelines/CI” with moderate clinical impact led to the most accepted pharmacists’ interventions by the prescribers. In view of these results, it appears that the deployment of the Act-IP© tool associated with a standardization of codification’s practices and documentation of pharmacists’ interventions, is a way to promote clinical pharmacy activities and their beneficial impact on the system of care. For future studies, the model tested in the Lebanese context could help as a model for the diffusion of pharmaceutical services in other countries that have not yet developed clinical pharmacy activities.