Magister Pharmaceuticae - MPharm / Diabetes mellitus is a complex chronic condition and has become a major public health concern worldwide. Many diabetic patients are accessing primary health care (PHC) clinics for diabetes care. Diabetic patients who are considered stable are referred to chronic diseases of lifestyle club at the PHC facility. Effective management of this chronic condition requires a multidisciplinary team approach to diabetes care. Pharmacists are not often included in a multidisciplinary team and would consist of doctors, nurses and dieticians. Teams may be expanded and require specialist healthcare members’ expertise who can assist in the management of this disease, for example, ophthalmologists and podiatrists. Adherence to standard treatment guidelines (STGs) for the management of diabetes by healthcare professionals at a primary care level can improve glycemic control, decrease health costs and reduce the development of long-term diabetic complications.

No description available.

Yes / Educational interventions by pharmacists for patients with cancer pain aim to improve pain management, but little is known about the different components of interventions and their effectiveness. Our aim was to assess the benefit of pharmacist delivered educational interventions for patients with cancer pain. A systematic review and meta‐analysis of experimental trials testing pharmacist delivered educational interventions for cancer pain was carried out to identify the components of interventions and effectiveness at improving pain‐related outcomes for patients with cancer. A literature review was conducted in EMBASE, MEDLINE, CINAHL, PsycINFO, ASSIA, Web of Science and CENTRAL from inception until January 2018 searching for educational interventions involving a pharmacist for patients with cancer pain. Four studies were included involving 944 patients. Meta‐analysis was carried out where possible. Meta‐analysis of three of the four studies found that mean pain intensity in the intervention group was reduced by 0.76 on a 0–10 scale (95% confidence interval), although only two of the studies used validated measures of pain. Improvements in knowledge, side effects and patient satisfaction were seen although with less reliable measures. Pharmacist educational interventions for patients with cancer pain have been found to show promise in reducing pain intensity. Studies were few and of varying quality. Further, good quality studies should be carried out in this area and these should be comprehensively reported. Trials measuring patient self‐efficacy and patient satisfaction are needed before the impact of the pharmacist delivered interventions on these outcomes can be established.

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).

This aim of the research was to explore pharmacist prescribing (PP) with a focus on antimicrobials, in hospitals in Scotland. A mixed-methods approach was used to collect, generate and synthesise data. A systematic review of peer-reviewed published literature on evidence-based roles for the pharmacist as part of an antimicrobial multidisciplinary team, identified roles for pharmacists within the teams but limited evidence relating to outcomes associated with these roles. Six qualitative focus groups, with 37 hospital pharmacists in 5 Scottish Health Boards, contextualised perceptions of barriers to, and facilitators of, implementation of PP in hospitals. Key themes were: perceived lack of pharmacy management support to take on a prescribing role and little strategic attention paid to PP implementation and sustainability. These issues were discussed in relation to PP in general and not only for antimicrobials. Participants perceived successful implementation of PP to be associated with factors including ward type and patient’s clinical condition. None of the pharmacists were prescribing antimicrobials and consequently further studies focused on PP in general. A scoping exercise, utilising various sources of information, reinforced findings from Phase 1; it highlighted the absence of any national or Health Board frameworks to support implementation of PP in secondary care in Scotland. Consensus-based research was undertaken, therefore, to provide guidance to facilitate service redesign involving PP in secondary care in Scotland. A Delphi approach undertaken with 40 experts, mainly in strategic posts, resulted in a high level of agreement in areas relating to succession planning, rather than role development; more variability was obtained in areas relating to future orientation of service, competencies required by prescribers and potential development of non-medical prescribing teams. The guidance was developed into a self-assessment toolkit providing an analytical strategy for implementation and role development of PP in secondary care. While the results and conclusions generated through this research need to be interpreted with caution, the data generated is an original contribution to the evidence base relating to PP.

The U.S. healthcare system is a complex segment of our society that is constantly evolving with changes to various areas such as education, financing, safety, and health. There continues to be a critical examination of how healthcare professionals are trained and utilized as healthcare demands increase. One category of healthcare professionals that has evolved over time to address societal needs is pharmacists. Pharmacists have kept their traditional function of dispensing medications while expanding into multiple areas of expertise and training from patient counseling and drug therapy, to being part of multidisciplinary teams treating acute care patients. According to the National Association of Boards of Pharmacy (NABP) in 2009 there were approximately 265,000 licensed pharmacists in the U.S. (NABP, 2010). The Health Resources and Services Administration (HRSA) reported the settings with the largest number of positions are chain pharmacies (77,300), hospitals (49,200), and independent pharmacies (36,200) (DHHS, 2008). The ratio of pharmacists per 100,000 population is expected to increase from 68.9 pharmacists per 100,000 population to 76.7 per 100,000 between 1995 and 2020 (Gershon, Cultice, & Knapp, 2000). This increase in the pharmacist to population ratio is consistent with a growth rate of 13% during this time period of time. Until 1998, the supply of pharmacists in the U.S. appeared to be in reasonable balance with demand. Market forces gradually upset the delicate balance between the supply of pharmacists and the demand for their services between 1998 and 2009. In particular, a precipitous increase in the volume of prescription written and filled during this time period contributed to upsetting this delicate balance between the supply of pharmacists and demand (Cooksey, Walton, Stankewicz, & Knapp, 2003). Researchers have noted a number of environmental factors affecting the pharmacist supply in the U. S. This inquiry explores these factors within the context of the population ecology theoretical framework. In addition to the volume of prescriptions, additional environmental factors believed to have a discernible impact on the pharmacist supply include, the number of physicians, size of the business industry and insurance coverage. Previous studies on pharmacists supply have pointed to income, physician population, and population among other variables that predict the demand for pharmacists (Walton, Cooksey, Knapp, Quist, & Miller, 2004; Cherry, D.K., Woodwell, D.A., & Rechtsteiner 2007; Walton, Knapp, Miller, & Schumock 2007). U. S. physicians wrote over 4 billion prescriptions in 2007 (Medical Expenditure Panel Survey, 2008). Physicians are the primary healthcare providers that generate prescriptions to be filled. Consequently, the number of physicians is believed to be a significant environmental factor affecting the supply of pharmacists. There were approximately 940,000 physicians in the U. S. in 2008. Projections call for continuous growth of the number of physicians well into the future (Smart, 2010). Another important environmental factor potentially impacting the demand for pharmacists is the size of the business industry. In 2006, the health plan offer rate for large or medium organizations (50 or more employees) was 96.7% compared to 61.2% for small organizations (50 or less employees) (Sommers & Crimmel, 2008; Crimmel & Sommers, 2008). Insurance cov¬erage has the potential to have a positive impact on the demand for pharmacists because it provides the opportunity to obtain required prescriptions (Ranji, Wyn, Salganicoff, & Yu, 2007; Weinick, Byron, & Bierman, 2005). The population ecology theoretical framework has been used in the study of restaurants, newspapers, and physicians and their interactions with their surrounding environments. The theoretical framework proved to be beneficial in the exploration of the pharmacist supply vis-á-vis the environment. The primary constructs in the population ecology theory are carrying capacity and density. Carrying capacity consists of two sub-constructs: munificence and concentration. Density points to the current pharmacists supply and its impact on the future pharmacist supply. Numerous variables have been used in previous empirical studies of the pharmacist supply. Among the indicators of munificence in previous studies in the extant literature on pharmacist supply are total population, elderly population, hospitals, and median household income. In the present inquiry, total population was found to be a statistically significant environmental factor affecting the pharmacist supply. This was hypothesized that there is a positive linear relationship between total population and the pharmacist supply. The number of hospitals with pharmacies was also found to be a statistically significant environmental factor affecting the pharmacist supply. Hospital pharmacies are important venues wherein pharmacists can demonstrate their unique expertise and make discernible contributions to desirable health care outcomes when pharmaceutical interventions are required. In light of this empirical finding, it seems reasonable that a growth in hospital pharmacies corresponds with an increased demand for pharmacists (Kaboli, Hoth, McClimon, & Schnipper, 2006). Measures of the concentration dimension included the number of hospital beds per 100,000 population, employer volume and size and the number of insured. The only putative indicator of concentration that was found to be statistically significant in this inquiry was the number of employers with 20 or more employees. Previous pharmacist supply was found to be a significant environmental factor affecting the pharmacist supply in the future. Thus, density is a significant environmental factor affecting the pharmacist supply. Five of the 13 hypotheses tested in this inquiry were accepted. These findings are consistent with related findings in the extant literature on the pharmacist supply. Empirical findings from this inquiry are believed to make significant contributions to the literature on the pharmacist supply. The population ecology theoretical framework appears to be a suitable tool for exploring environmental factors affecting the pharmacist supply. Recommendations for future research are presented in the final chapter.

O estudo emergiu a partir da experiência da autora como preceptora em Unidade Básica de Saúde que recebe residentes farmacêuticos. Constitui-se como objeto de estudo a construção de competências pelo preceptor de Farmácia na Atenção Primária na formação de residentes farmacêuticos e teve como objetivo construir um manual educativo a ser utilizado como apoio pelo preceptor farmacêutico da Atenção Primária à Saúde a fim de orientá-lo na formação de residentes farmacêuticos. Compreendendo como ocorre o ensino desenvolvido por farmacêutico assistencial em serviços que são cenários para o processo de ensino-aprendizagem, a partir das Diretrizes Curriculares Nacionais, projetos políticos pedagógicos, metodologias de ensino aprendizagem, e suas articulações teóricas e práticas, segundo o modelo de saúde integral preconizado pelo SUS. Trata-se de uma pesquisa documental, com abordagem qualitativa, com consultas em artigos publicados em periódicos nacionais e internacionais indexados nas principais bases de dados, utilizando as questões norteadoras: qual é a atuação do farmacêutico preceptor na Atenção Básica tendo em vista a formação do residente farmacêutico?; que competências o farmacêutico preceptor necessita desenvolver para atuar na formação de residentes farmacêuticos?; que estratégias podem ser utilizadas para o exercício da preceptoria farmacêutica na Atenção Básica? O tratamento dos dados ocorreu por meio da análise de conteúdo de Bardin. Os resultados revelaram que, no \"cenário ideal\" do processo ensino-aprendizagem, os protagonistas são os preceptores, que acolhem e ensinam os residentes ao mesmo tempo que precisam dar conta da demanda do serviço. Simultaneamente, convertem seu local de trabalho em um cenário de aprendizagem para si também, e cedem esse espaço para que se construa algo novo, considerando as opiniões, experiências e os conhecimentos de todos os envolvidos: residentes, preceptores e tutores. / The study emerged from the author\'s experience as a preceptor in the Basic Health Unit that receives pharmaceutical residents. The object of study is the construction of competences by the Preceptor of Pharmacy in Primary Care in the training of pharmaceutical residents and had as objective to construct an educational manual to be used as support by the pharmacist preceptor of Primary Health Care in order to guide him in the training of pharmaceutical residents. Understanding how the teaching developed by pharmacist care in services that are scenarios for the teaching-learning process, from the National Curricular Guidelines, pedagogical political projects, learning teaching methodologies, and their theoretical and practical articulations, according to the health model integral approach advocated by SUS. It is a documentary research, with a qualitative approach, with consultations in articles published in national and international journals indexed in the main databases, using the guiding questions: what is the performance of the pharmacist preceptor in Primary Care with a view to the formation of pharmaceutical resident ?; what competences does the pharmaceutical preceptor need to develop to act in the training of pharmaceutical residents ?; what strategies can be used to exercise the pharmaceutical preceptor in Primary Care? The treatment of the data occurred through the Bardin content analysis. The results revealed that, in the \"ideal scenario\" of the teaching-learning process, the protagonists are the preceptors, who welcome and teach the residents while also having to deal with the demand of the service. Simultaneously, they convert their workplace into a learning scenario for themselves as well, and they give up this space to build something new, considering the opinions, experiences and knowledge of all involved: residents, preceptors and tutors.

O perfil de formação do farmacêutico se modificou ao longo do tempo e os currículos das instituições formadoras passaram por alterações no propósito de preparar esse profissional de forma mais adequada, oferecendo, ao farmacêutico, melhores condições para exercer o elenco diversificado de atividades presentes na sua rotina de trabalho, nos diferentes espaços de atuação profissional. Este trabalho objetivou identificar o perfil de formação do farmacêutico das Unidades de Saúde da Secretaria Municipal da Saúde de Ribeirão Preto, caracterizar a frequência com que eles exercem as atividades pertinentes às suas atribuições e determinar a percepção desses profissionais, quanto à sua formação e às suas necessidades de educação continuada. Este foi um estudo exploratório descritivo e analítico, predominantemente quantitativo, do tipo corte transversal, utilizando questionário estruturado contendo duas escalas, sendo uma para identificação das atividades profissionais atualmente exercidas e a frequência deste exercício e a outra para avaliar a percepção do participante sobre a utilidade da sua formação na graduação para o exercício das diversas atividades profissionais. Os resultados revelaram que o farmacêutico que atua nas unidades ambulatoriais do município de Ribeirão Preto é na sua maioria do sexo feminino (84%), com faixa etária entre 25 e 57 anos. A graduação desses profissionais ocorreu entre os anos de 1981 a 2014, sendo 56,8% graduados em instituições públicas, com menor proporção deles tendo formação \"Generalista\" (34%). A formação pós-graduada foi relatada por 90,9% desses farmacêuticos, com destaque para a Especialização (75%). Houve grande variação na frequência com que os farmacêuticos exercem as suas atividades profissionais, predominando, porém, aquelas que implicam em contato direto com o usuário. Houve também grande variação na percepção desses profissionais quanto à utilidade da formação recebida durante o curso de graduação para exercer o elenco de atividades presentes na sua rotina de trabalho, sendo constatadas proporções elevadas de participantes que relataram que não tiveram nenhuma formação para várias delas. Grande parte das atividades mais frequentemente desenvolvidas pelos farmacêuticos participantes deste estudo foram aquelas que, em relação às quais, o curso de graduação foi percebido como tendo maior utilidade. Proporções muito expressivas dos participantes atribuíram graus elevados de necessidade às diferentes atividades de educação continuada. Os dados obtidos indicam a importância do curso de graduação em Farmácia na formação profissional. Essa importância, no entanto, parece ser relativa, visto que a maioria dos farmacêuticos teve formação pós-graduada e percebe as atividades de educação continuada como muito necessárias. A educação profissional constitui, portanto, um contínuo, que se inicia no curso de graduação, completa-se com atividades formais logo após a graduação e se prolonga ao longo do período de atuação do farmacêutico nos serviços de saúde. / Education and training of the pharmacist has been changing over time and, accordingly, curricula of educational institutions have also undergone changes in the purpose of better preparing professionals to work in different occupational spaces. This study aimed at identifying the education and training profile of the pharmacists working in the healthcare services of the Municipal Department of Health, Ribeirão Preto, State of São Paulo, Brazil. The study also aimed at determining the frequency with which they perform their various professional activities, and determining their perceptions regarding the utility of their training in the undergraduate programs and their continuing education needs. This was an exploratory, descriptive and analytical cross-sectional study, using a structured questionnaire containing two scales, one to measure the frequency of the various professional activities currently performed and the other to evaluate the participant\'s perception of the usefulness of their undergraduate training in the exercise of their professional activities. Results showed a predominance of female pharmacists (84%), aged between 25 and 57 years. They were graduated between 1981 and 2014, with 56.8% of them graduating in public institutions, with a lower proportion of them having a \"Generalist\" degree (34%). Post-graduate training was reported by 90.9% of them, with the majority (75%) taking the Specialization modality. The frequency with which pharmacists usually perform their various professional activities was rather variable, predominating, however, those activities that imply in direct contact with patients. The perception of the pharmacists about the usefulness of their undergraduate training was also rather variable. However, a high proportion of participants reported that they had no undergraduate training for performing some of their routine professional activities. Many of the activities more frequently performed were those that, in relation to which, the undergraduate course was perceived as having more usefulness. The large majority of the pharmacists participating in this study reported as highly needed a number of different continuing education activities. The results obtained in this study point out to the importance of the undergraduate course in Pharmacy, which however seems to be relative, since the majority of the pharmacists had further postgraduate training and perceive continuing education activities as highly needed. The pharmacist professional education and training must therefore be seen as a continuum, beginning in the undergraduate course, progressing with other formal educational activities shortly after graduation and continuing throughout the professional activity in healthcare services.

Over the past several years, both government and the profession of pharmacy have acknowledged that pharmacists are not being used to their full potential in our health care system. In order to advance the profession of pharmacy in this area, guidance on how pharmacists can be integrated need to be investigated.<p>The purpose of this study was to identify how to integrate a pharmacist into an already established primary health care team, at the Student Health Centre at the University of Saskatchewan. The project was divided into three phases: defining the role of the pharmacist, implementing the proposed role and then evaluating and prioritizing the role. Using action research, an expert panel consisting of established primary health/ambulatory care pharmacists from across Canada helped to identify possible clinical activities for a Student Health Centre pharmacist. The results were presented to the primary health care team, who then collaborated with the pharmacist and researchers to define the role of the pharmacist. Once an agreement was reached, a pharmacist provided eight weeks of full-time clinical services. Upon completion, focus groups with the primary health care team members were used to evaluate the pharmacists clinical services.<p>The role of the pharmacist was tailored specifically for the student health care centre selected for the study. However, the process of integrating and evaluating the role of the pharmacist, will serve as a template for other pharmacists desiring to be involved in any primary health care team interested in expanding their multidisciplinary service.