Exercer l'Art pharmaceutique tout en pratiquant le commerce : tel est le défi quotidien du pharmacien. Cette dualité pharmaceutique s'impose comme une problématique de fond dans l'ensemble du circuit du médicament dès qu'il s'agit de définir le rapport juridique du principal à l'accessoire entre les deux composantes fondamentales de l'activité du domaine. L'approche traditionnelle de la question va dans le sens d'une opposition de principe et conduit à opérer une distinction entre l'exercice d'un acte pharmaceutique galiénique primordial et la pratique d'un acte pharmaceutique économique secondaire qui n'en serait que le corollaire. L'accroissement du périmètre de commercialité laisse apparaître l'influence grandissante de l'économique sur le galiénique et remet en cause la doctrine traditionaliste principiste en déplaçant la question sur le terrain d'une ambivalence constructive. La primauté de l'intérêt supérieur de la Santé publique est le socle de l'activité pharmaceutique. Mais peut-elle s'affranchir de la pratique du commerce ? Le droit va-t-il dans le sens d'une opposition de principe ou dans celui d'une réciprocité de sujétion ? Quelle est la résonance des réponses apportées à ces interrogations sur l'évolution juridique de la profession de pharmacien ? / Exercise the pharmaceutical Art while practising the business : this is the daily challenge of the pharmacist. This pharmaceutical duality stands out as a basic problem in the whole of the circuit of the medicine as soon as it is a question of defining the legal relationship of the main thing in the accessory between the two fundamental components of the activity area. The traditional approach of the question goes to the sense of an opposition of principle and led to a distinction between the exercise of the essential galenic pharmaceutical act and the practice of a secondary economic pharmaceutical act wich would be there only the corollary. The increase of the perimeter of merchantability lets appear the growing influence of the economic on the galenic and calls into question the traditionalist principist doctrine by moving the question on the ground of a constructive ambivalence. The primacy of the superior interest of the Public Health is the foundation of the pharmaceutical activity. But can it be freed from the practice of business? Does the law go to the sense of an opposition of principle or in that of reciprocity of subjection? What is the resonance of the answers to these interrogations on the legal evolution of the occupation of pharmacist?

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Objectives: 1) To determine 2010 pharmacy-related ambulatory care sensitive condition (ACSC) hospital discharges by Tennessee (TN) county; 2) To explore pharmacy-related ACSC hospital discharges across county characteristics for Tennessee counties, including community pharmacies per county, age, and county rurality; 3) To explore pharmacy-related ACSC hospital discharges across age for northeastern Tennessee counties. Methods: Data were obtained from the TN Department of Health Statistics (hospital discharge data), TN Board of Pharmacy (licensed community pharmacies), the United States (US) Census Bureau (county-level populations), the Office of Rural Health Policy (rural designations), and the US Health Resources and Services Administration (health professional shortage area designations). ACSC discharges were determined using the Agency for Healthcare Research & Quality's (AHRQ's) Prevention Quality Indictors (PQIs) for asthma, bacterial pneumonia, congestive heart failure, chronic obstructive pulmonary disease, hypertension, uncontrolled diabetes, and short-term and long-term diabetes complications. County-level analyses were population adjusted and analyzed across age. Analyses were conducted using SPSS and ArcGIS software. Results: In 2010, 79,683 hospital discharges were noted for pharmacy-related ACSCs, 55% of which were for residents 65 and over. For northeast Tennessee counties, 8,538 were documented accounting for 11% of Tennessee pharmacy-related ACSCs discharges. Bacterial pneumonia, heart failure, and COPD accounted for nearly 65% of discharges in northeastern Tennessee counties. The number of community pharmacies per Tennessee county was statistically significantly negatively correlated with county-level bacterial pneumonia (r=-0.339; p=0.001), CHF (r=-0.215; p=0.036), and COPD (r=-0.403; p<0.001) hospital discharges. Implications/Conclusions: Community pharmacies have the potential to positively impact the health needs of Tennesseans by targeting services (e.g., MTM, immunizations, adherence assistance) based on ambulatory care sensitive conditions. Future research is warranted to quantify current services and determine the capacity to provide such services.

Objectives: To evaluate the extent to which students’ personal finance perceptions, projected student loan indebtedness, and demographic characteristics predict post-PharmD career intentions. Methods: Students at three pharmacy colleges completed a 31-item survey instrument that assessed personal finance perceptions, self-efficacy beliefs, anticipated student loan debt upon graduation, postgraduate intentions, anticipated practice setting upon graduation, and demographic characteristics. Logistic regression models were used to examine the extent to which personal finance perceptions, student loan indebtedness, and demographic characteristics predicted postgraduate intentions and anticipated practice setting. Results: A total of 763 usable responses were obtained (response rate=90.3%). Students reported an anticipated personal student loan debt mean at graduation of $162,747±87,093 and an estimated 7.4±5.8 years to pay off non-mortgage debt post-graduation. Fifty-three percent of students reported planning to practice in a community pharmacy setting post-graduation, and 54% indicated intentions to enter practice directly. Student loan indebtedness was not a significant predictor of planning to pursue postgraduate training. There was a significant association between debt influence and pressure perceptions and pursuance of postgraduate training (aOR=0.78;p=0.009). The odds of indicating hospital (vs. chain community) pharmacy as the anticipated setting decreased 36% with every 1-point increase in debt influence and pressure perceptions (aOR=0.64;p<0.001 Conclusions: Perceived debt pressure and influence predicted intention to enter practice directly (vs. pursuing postgraduate training) and selection of chain community pharmacy (vs. hospital pharmacy). Student loan indebtedness was not a significant predictor of postgraduate training intentions. Interventions that equip students to manage pressure associated with student loan debt should be explored.

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Practice-based research networks (PBRNs) are groups of health care practitioners who engage in translational research and quality improvement activities, with the overarching goal of improving patient care in primary care settings. The Appalachian Research Network (AppNET), a rural primary care PBRN, was created in 2009 and comprises 17 clinics in 16 rural communities in South Central Appalachia. Nationally, only 4 of 152 PBRNs registered with the Agency for Healthcare Research and Quality (AHRQ) place particular emphasis on community pharmacies and pharmacists in research efforts. Researchers at ETSU seek to integrate community pharmacies into AppNET, thereby establishing a novel interprofessional rural PBRN. The objective of this study was to assess pharmacist perceptions regarding practice-based research and interest in participating in AppNET. Barriers to participation in a PBRN, perceived benefits of participation, and practice-specific characteristics were also assessed. Contact information was obtained via telephone calls made to individual pharmacies in AppNET communities. Thereafter, paper-based surveys were mailed to 69 pharmacist contacts, along with a personalized cover letter and a stamped return envelope. A total of two mailings were used to recruit pharmacists to participate in the study. A response rate of 42% was obtained. Respondents were on average 44 years of age and had been licensed as a pharmacist for an average of 19 years. A large majority of respondents (86%) were very or somewhat interested in participating in AppNET. The majority of respondents felt that time constraints and workflow interruptions were the greatest barriers to participation. One hundred percent of respondents indicated that research on prescription drug abuse, medication adherence, and medication safety are very or somewhat applicable to their practice settings. Ninety-two percent felt that research on value-added services (e.g., immunizations, diabetes education) and medication therapy management was somewhat or very applicable to their practice. Overall, pharmacist respondents in AppNET communities indicated interest in research that benefits the care of their patients and interest in AppNET. Researchers are presently conducting a third recruitment attempt and will thereafter develop AppNET enrollment mechanisms that minimize barriers to participation of community pharmacies in practice-based research.

Objectives: 1) Describe relationships between student pharmacists’ personal finance perceptions and projected post-graduation indebtedness; 2) Examine the association between personal finance perceptions, demographic characteristics, and post-PharmD career intentions. Method: Student cohorts at two colleges of pharmacy (N= 226) completed a self-administered 39-item questionnaire assessing personal finance perceptions, behaviors, student loan indebtedness, and post-PharmD career intentions. Parametric and nonparametric independent t-test and one-way ANOVA equivalents, and logistic regression techniques were used to examine differences across and relationships between study variables. Results: A 73% usable response rate was obtained. On average, students anticipate $169,323 (± $81,641) in post-graduation student loan debt and expect to pay off debt in 8.0 (± 6.4) years. Over 75% of students feel pressured to get out of debt upon graduation and 55% have a plan for debt repayment. Projected student loan debt did not differ across students who anticipate pursuing postgraduate training versus those planning to enter practice directly. However, students intending to directly enter practice were 2.6 times as likely to indicate debt influences their post-PharmD career plans compared to individuals intending to pursue postgraduate training (p=0.001). Students intending to practice in community pharmacy settings were 3.3 times as likely to indicate debt influences their post-PharmD career plans compared to individuals planning to enter all other practice settings (pImplications: Our study adds to recent literature exploring the relationship between student indebtedness and career decision-making. Further research is warranted to explore interventions that foster increased personal finance self-awareness in student pharmacists and minimize student indebtedness.

The next presentation will examine common gray areas of community pharmacy practice. For example: under what circumstances do pharmacists fill early, transferred controlled substance prescriptions for out-of-town patients; when do pharmacists sell syringes to patients without proof of medical need; and how do pharmacists determine that a buprenorphine prescriber is acting in a patient's best interest? These and other ethical or legal dilemmas challenge pharmacists as they try to balance identifying and preventing potential drug abuse and diversion with providing evidence-based, quality patient care. Based on data from pharmacists and pharmacy students, as well as established theory, presenters will describe typical approaches to decision-making. Multiple pharmacy cases will be discussed. Participants will learn how to integrate best-practice patient care systematically into common practice scenarios.