<p><strong>Background:</strong> The past three decades have seen a growth in health promotion research and practice, stimulated by the epidemiologic transition of the leading causes of death from infectious to chronic diseases. An estimated 50% of mortality from the 10 leading causes of death is due to behaviour, which suggests individuals can make important contributions to their own health by adopting some health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a brief counselling approach for behavioural modification that builds on a patient empowerment perspective by supporting self-esteem and self-efficacy. MI has become increasingly popular in a variety of health care settings as well as non-health care settings.</p><p><strong>Aims:</strong> The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on the learning and practice of MI. The aim of study I was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services. The aim of study II was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies.</p><p><strong>Methods:</strong> Participants in study I were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Participants in study II were 15 community pharmacy pharmacists in Östergötland Sweden. Data for both studies were obtained through focus group interviews with the participants, using interview guides containing open-ended questions related to the aims of the studies. Study II also included five individual interviews. Interview data were interpreted from a phenomenological perspective.</p><p><strong>Results:</strong> In study I, important barriers were nurses’ lack of recognition that overweight and obesity among children constitutes a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything, and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem, and working with obese children rather than those who were overweight. In study II, pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. The opportunity to decide on appropriate clients and/or healthrelated behaviours for counselling was also an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. They also experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations.</p><p><strong>Conclusions:</strong> Learning and practicing MI effectively is difficult for many practitioners as it requires a new way of thinking and acting. Practitioners’ use of MI is not effective unless there is recognition that there is an important health-related problem to be solved. Practitioners feel more confident using MI with clients who have health-compromising behaviours and/or risks in which the practitioners feel they have expertise. Possessing considerable MI counselling skills does not compensate for insufficient knowledge about a targeted health-related behaviour and/or risk. Feedback from clients plays an important role for the quality and quantity of practitioners’ MI use.</p>

An estimated 50% of mortality from the 10 leading causes of death is due to behaviour. Individuals can make important contributions to their own health by adopting health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a counselling approach for behavioural change that builds on a patient empowerment perspective by supporting autonomy and self-efficacy. The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on general health care professionals’ learning and practice of MI. Specific aims are; study I was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies; study II was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services; study III was to evaluate the attitudes towards MI and clinical use of MI with children´s weight issues one year after child health care nurses’ participation in MI training; study IV was to systematically review studies that have evaluated the contents and outcomes of MI training for general health care professionals. Participants in study I were 15 community pharmacy pharmacists in Östergötland, Sweden. Participants in study II were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Data for both studies were obtained through focus group interviews. Study III, participants were 76 nurses from child health care centres in Östergötland, Sweden. 1-year after MI training they answered a survey. Study IV, the material was 10 empirical studies that have evaluated different aspects of MI training. MI training for general health care providers is generally of short duration and tends to focus on specific topics such as diabetes, smoking, and alcohol. The training seems to contain more training on phase I elements, such as clients’ inner motivation, than on phase II, which involves strengthening clients’ commitment to change. MI is seen as practical and useful in work with lifestyle and health promotion issues, especially with issues that may be perceived as sensitive, such as alcohol and obesity. General health care providers have positive attitudes to MI and view MI as being compatible with their values and norms about how they want to work. Clients’ resistance reactions are difficult to handle in the first stages of learning MI, and may lead to frustration. Strategies to avoid resistance are including in the final stages of learning MI. Learning and clinical use of MI for general health care providers is influenced by interactions with their environment (colleagues, staff and organization). Unlearning of old knowledge can be a problem for general health care providers in the learning and clinical use of MI.

Uppsatsens syfta är att förmedla den syn på farmaceuters arbetsliv som förmedlas av mina informanter vilka alla tjänstgjort på apotek i mer än 25 år. Metoden som jag använt vid mina intervjuer består av anteckningar under 80-120 minuters samtal som sedan direkt skrivits ut av mig. Tre av mina informanter är apotekare och två är receptarier. Fyra påbörjade sin utbildning direkt efter studentexamen medan en arbetade i många år som apotekstekniker innan hon blev receptarie. För tre av mina informanter som är pensionärer började arbetslivet på apotek före det statliga monopolet 1970/1971 och de beskriver den tid då apotekaryrket fortfarande hade karaktären av ett skrå. De två andra började sitt yrkesliv under monopolets tid men har nu efter 2010 fått nya arbetsuppgifter. Avmonopoliseringen har inneburit en förändring i apotekens tjänster och varusortiment men också lett till nya uppgifter för farmaceuter inom sjuk-och hälsovården. Kommer apotek att finnas kvar i framtiden eller förvandlas de till en butik för hälso-och hygienprodukter ? / The pupose of this study is to describe the work experience of five pharmacists during a period of more than 25 years. I have made interviews of 80 -120 minutes duration and I have written down the result immediately after the end of the conversation. Three of the pharmacists have a Master of Pharmacy degree and two are Bachelor of Pharmacy. Four of the participants started their pharmaceutical studies directlyg after high school but one of the five was working as a pharmaceutical technician for many years before she was offered an academic education. Three of my informants are retired. They started their working carriers before 1970/1971 (the years of the Swedish state monopole of Pharmacy) and they describe that the pharmacy was organized as a craft-guild. The other two are still working and they have got new carriers after 2010 when the state monopole in Sweden ended. Do the Pharmcies in Sweden have a future or are they developing inte an American drugstore?

Abstract This research aims to study the current situation of the community pharmacists¡¦ services, such as the collaboration mode with hospitals and medical institutes corresponding to the ¡§Separation of Prescribing and Dispensing¡¨ (Separation of P&D) in Taiwan and prescription dispensing policies, the service orientation, and the operation results in Kaohsiung City, where the Separation of P&D was implemented as early as March 1997. Furthermore, this research also aims to understand the cognition of the community pharmacists upon Pharmaceutical Services and their service orientation. It was discovered from 67 effective samples that the amount of prescriptions dispensed to those registered National Health Insurance (NHI) pharmacies were still few, hence the current situation of Separation of P&D is not that satisfying. In addition, the amount of prescriptions dispensed to community pharmacies joining the NHI were significantly more than those who did not join. Moreover, as far as for those registered NHI pharmacies collaborating with hospitals and medical institutes are concerned, the opportunity for them to receive prescriptions is far from those registered NHI pharmacies that did not collaborate with hospitals and medical institutes. The amount of prescriptions dispensed has a significant and positive correlation to the increasing of pharmacy business. In light of this, it can be said that the collaboration mode between registered NHI pharmacies and hospitals and medical institutes helps with the implementation of the Separation of P&D. The cognition of pharmacist¡¦s practicing can be divided into five categories according to factor analysis, and they are; ¡§Health Maintaining¡¨, ¡§Health Enhancing¡¨, ¡§Pharmaceutical Professional Service¡¨, ¡§Pharmaceuticals Management ¡¨, and ¡§Specialists Consultation¡¨. This research discovered that when the practicing credential is a pharmacist instead of pharmaceutical student, the service cognition on health maintaining, health enhancing, pharmaceutical professional service, and specialist¡¦s consultation were significantly different. The cognition of a pharmacist upon health enhancing and pharmaceuticals control showed significant and positive correlation to his/her business volume. Although the Separation of P&D has been implemented for over six years, and most of the regions in this country have conformed to the P&D separation regulations and the business has been carried out, the outcomes have not met the expectation, and the medicine circle alone cannot solve such problem. It needs a comprehensive consideration and review to effectively implement the existing policies.

This study used the Andersen Model for Health Services Utilization to examine a pharmacist-provided telephone MTM program among Medicare Part D beneficiaries. Predisposing (age, gender, race) and need factors (number of medications, number of chronic diseases, medication regimen complexity) were assessed. The health behavior, MTM utilization, distinguished the intervention and control groups. The health outcomes were change in number of medication-related problems, change in medication adherence [using the medication possession ratio (MPR)], and change in total drug costs. Medication knowledge, medication adherence (using the Morisky Scale), and patient satisfaction were also measured in the intervention group. The intervention and control groups were not significantly different in age (71.2 ± 7.5 vs. 73.9 ± 8.0 years), number of medications (13.0 ± 3.2 vs. 13.2 ± 3.4), number of chronic diseases (6.5 ± 2.3 vs. 7.0 ± 2.1), and medication regimen complexity [21.5 (range 8 – 43) vs. 22.8 (range 9 – 42.5)], respectively. For the subset of problems that was evaluated in the intervention and control groups, 4.8 (± 2.7) and 9.2 (± 2.9) problems were identified at baseline and 2.7 (± 2.3) and 8.6 (± 2.9) problems remained at the 3-month follow-up, respectively. Cost-related and preventative care needs and drug-drug interactions were the three most common problems identified. Multivariate regression analysis revealed that the intervention group had significantly more problems resolved (p < 0.0001) when compared to the control group, while controlling for predisposing and need factors. Significantly fewer problems were resolved (p = 0.01) as number of diseases increased and significantly more problems were resolved (p = 0.01) as medication regimen complexity increased. There were no significant predictors of change in MPR or total drug costs from baseline to the 3-month follow-up. Medication knowledge and medication adherence measured by the Morisky scale did not change significantly from baseline to the 2-week follow-up. However, patients were very satisfied with the service. A pharmacist-provided telephone MTM program was an effective method for identifying and resolving medication and health-related problems. A longer follow-up period may be necessary to detect the impact of pharmacist provision of MTM on adherence, total drug costs, and knowledge. / text

Introduction: Medication errors are a major cause of illness and hospitalization of patients throughout the world. This study examines the situation regarding medication errors in the Armed Forces Hospital, Kuwait since no literature exists of any such studies for this country. Several types of potential errors were studied by physicians, nurses and pharmacists. Their attitudes to the commission of errors and possible consequences were surveyed using questionnaires. Additionally, patient medical records were reviewed for possible errors arising from such actions such as the co-administration of interacting drugs. Methods: This study included direct observations of physicians during the prescribing process, pharmacists while they dispensed medications and nurses as they distributed and administered drugs to patients. Data were collected and compiled on Microsoft Excel spreadsheet and analyses were performed using SPSS. Where applicable, results were reported as counts and/ or percentages of error rates. Nurses, pharmacists and physicians survey questionnaires: From the 200 staff sent questionnaires a total of 149 respondents comprising nurses (52.3%), physicians (32.2%) and pharmacists (16.1%) returned the questionnaires a total response rate of 74.5%. All responses were analyzed and compared item-by-item to see if there were any significant differences between the three groups for each questionnaire item. All three groups were most in agreement about their perception of hospital administration as making patient safety a top priority with regard to communicating with staff and taking action when medication errors were reported (all means 3.0 and p > 0.05). Pharmacists were most assured of administration support when an error was reported whereas nurses were least likely to see the administration as being supportive ( p < 0.001), and were more afraid of the negative consequences associated with reporting of medication errors (p = 0.026). Although nurses were generally less likely to perceive themselves as being able to communicate freely regarding reporting of errors compared to pharmacists there was no significant difference between the two groups. Both however were significantly different from physicians (p< 0.001). Physicians had the most favorable response to perceiving new technology as helping to create a safer environment for patients and to the full utilization of such technologies within the institution in order to help prevent medical errors. Scenario response - Responses to two scenarios outlining possible consequences, should a staff member commit a medication error, tended to be very similar among the three groups and followed the same general trend in which the later the error was discovered and the more grievous the patient harm, the more severe would be the consequences to the staff member. Interestingly, physicians saw themselves as less likely to suffer consequences and nurses saw themselves as more likely to suffer consequences should they have committed a medication error. All three groups were more likely to see themselves as facing dismissal from their job if the patient were to die. RESULTS OF ALL THREE OBSERVATIONS: Result of Nursing observations: For 1124 doses studied, 194 resulted in some form of error. The error rate was 17.2% and the accuracy was 82.8%. The commonest errors in a descending order were: wrong time, wrong drug, omission, wrong strength/ dose, wrong route, wrong instruction and wrong technique. No wrong drug form was actually administered in the observational period. These were the total number of errors observed for the entire month period of the study. IV Result of Pharmacist observations: A total of 2472 doses were observed during the one month period. Observations were done for 3 hours per day each day that the study was carried out. The study showed that there were 118 errors detected which were in the following categories respectively: 52 no instructions, 28 wrong drug/unordered, 21 wrong strength/dose, ignored/omission 13, shortage of medication 3 and expired date 1. Result of Prescribers in Chart review for drug-drug interactions: The analysis of the drug-drug interactions showed that out of a total of 1000 prescriptions, 124 had drug-drug interactions. None were found to fall into the highest severity rating i.e. 4 (contraindicated). Only twenty-one interactions were rated 3 (major), 87 interactions were rated moderate and 15 interactions were rated minor according the modified Micromedex scale. Patient education: All health care such as physician, pharmacist, and nurses have a responsibility to educate patient about their medication use and their health conditions to protecting them from any error can occur by wrong using drugs. Conclusion This study has contributed to the field of medication errors by providing data for a Middle Eastern country for the very first time. The views and opinions of the nurses, pharmacists and physicians should be considered to enhance the systems to minimize any errors in the future.

L’iatrogénie médicamenteuse à l’hôpital est un problème majeur de santé publique dont les causes sont multiples. La diffusion de recommandations de bonnes pratiques de prescription pourrait permettre de diminuer ce phénomène. L’objectif de cette thèse est de modéliser un vecteur possible des bonnes pratiques de prescription, celui des interventions pharmaceutiques. Ce travail se décline en trois séquences : 1.contexte et justification, 2.développement d’un outil de documentation et d’analyse des interventions pharmaceutiques, 3.évaluation d’un modèle de diffusion des recommandations associant l’intervention d’un pharmacien clinicien intégré dans l’unité de soins à un rappel informatique de l'intervention au moment de la prescription. L’ensemble de ces données assoit la pertinence d’une diffusion des interventions pharmaceutiques basée sur les outils technologiques et les activités de pharmacie clinique. / Medication errors in hospitals have become a major public health problem with multiple causes. The diffusion of prescription guidelines could reduce this phenomenon. The objective of this thesis is to modelize a potential vector of prescription guidelines: the pharmacists’ interventions. This work is declined in three sequences: 1.context and justification, 2.development of a tool for the documentation and the analyse of pharmacists’ interventions, 3.assessment of a model of prescription guidelines diffusion combining intervention of a clinical pharmacist integrated into clinical ward with a computerized reminder of the intervention. Our data supports the relevance of pharmacists’ interventions diffusion based on technological tools and clinical pharmacy activities.

No description available.

Literature indicates that pharmacists of South Africa experience high levels of stress as a result of their working conditions. Seeing that the definition of subjective well–being (SWB) entails that a person feels positive affect (positive moods) and experience infrequent feelings of negative affect (such as stress), pharmacists have low SWB since they experience high levels of stress. It is thus vital to lessen the stress seeing as this low SWB may entail a danger to the profession as well as the patients' safety. Based on this leisure proves to enhance well–being by producing positive affect (such as happiness) and reducing negative affect (such as stress or depression). Leisure (taking a holiday) is furthermore a means of buffering stress and therefore the perfect solution to pharmacists' stress. Hence the purpose of this research was to determine the role of holiday taking on South African pharmacists' overall well–being. To achieve this goal a database was obtained from The South African Pharmacy Council. This database consisted out of 8000 e–mail addresses of pharmacists registered at the Pharmacy Council. From the 1500 e–mails that were send out 207 completed questionnaires were obtained. A thorough literature analysis on socio–demographic characteristics, travel motives, independent choices and preferred activities when taking a holiday was done in Chapter 2. This chapter gives a detailed understanding of how the afore–mentioned factors influence the decision to take a holiday and the effect of taking a holiday on subjective well–being. Article 1 (Chapter 3) and Article 2 (Chapter 4) was based on this chapter's literature. Chapter 3 (Article 1) of this study determined whether holidays lead to positive SWB of pharmacists. In order to achieve this aim, the chapter made use of the Affectomer 2 and Satisfaction with life Scale to determine the pharmacists' subjective well–being before and after taking a holiday. Dependent t–tests were then applied to compare the A distinction on the other hand can be made amongst pharmacists that imply different working conditions and working hours. Therefore Chapter 4 (Article 2) of this study determined all the factors that influence the different groups of pharmacists' holiday taking which ultimately could lead to the enhancement of the profession's well–being. To achieve this, the chapter made use of factor analysis, ANOVAs and chi–square tests to find differences between different pharmacists. The results showed that the three groups of pharmacists (private, government, and industry), differ based on sociodemographic characteristics. These socio–demographic characteristics furthermore influence the different groups of pharmacists' decisions to take holidays which leads to higher subjective well–being. The results of Chapters 3 and 4 indicate that pharmacists experience enhanced wellbeing after taking a holiday and which have implications for different role players. This study is the first to determine the profile of pharmacists and give an indication of their travel behaviour that will assist destinations to alter their product/services to better suit the profile or travel behaviour of pharmacists. Employing companies on the other hand can have financial benefits in the form of low staff turnover and satisfied patients. Although pharmacists are seen as a homogeneous group, pharmacists differ based on socio–demographic characteristics and therefore the Pharmacy Council may enforce the design of different policies for the different groups of pharmacists to reduce the pharmaceutical profession's stress. / Thesis (M.Com. (Tourism))--North-West University, Potchefstroom Campus, 2011.

Literature indicates that pharmacists of South Africa experience high levels of stress as a result of their working conditions. Seeing that the definition of subjective well–being (SWB) entails that a person feels positive affect (positive moods) and experience infrequent feelings of negative affect (such as stress), pharmacists have low SWB since they experience high levels of stress. It is thus vital to lessen the stress seeing as this low SWB may entail a danger to the profession as well as the patients' safety. Based on this leisure proves to enhance well–being by producing positive affect (such as happiness) and reducing negative affect (such as stress or depression). Leisure (taking a holiday) is furthermore a means of buffering stress and therefore the perfect solution to pharmacists' stress. Hence the purpose of this research was to determine the role of holiday taking on South African pharmacists' overall well–being. To achieve this goal a database was obtained from The South African Pharmacy Council. This database consisted out of 8000 e–mail addresses of pharmacists registered at the Pharmacy Council. From the 1500 e–mails that were send out 207 completed questionnaires were obtained. A thorough literature analysis on socio–demographic characteristics, travel motives, independent choices and preferred activities when taking a holiday was done in Chapter 2. This chapter gives a detailed understanding of how the afore–mentioned factors influence the decision to take a holiday and the effect of taking a holiday on subjective well–being. Article 1 (Chapter 3) and Article 2 (Chapter 4) was based on this chapter's literature. Chapter 3 (Article 1) of this study determined whether holidays lead to positive SWB of pharmacists. In order to achieve this aim, the chapter made use of the Affectomer 2 and Satisfaction with life Scale to determine the pharmacists' subjective well–being before and after taking a holiday. Dependent t–tests were then applied to compare the A distinction on the other hand can be made amongst pharmacists that imply different working conditions and working hours. Therefore Chapter 4 (Article 2) of this study determined all the factors that influence the different groups of pharmacists' holiday taking which ultimately could lead to the enhancement of the profession's well–being. To achieve this, the chapter made use of factor analysis, ANOVAs and chi–square tests to find differences between different pharmacists. The results showed that the three groups of pharmacists (private, government, and industry), differ based on sociodemographic characteristics. These socio–demographic characteristics furthermore influence the different groups of pharmacists' decisions to take holidays which leads to higher subjective well–being. The results of Chapters 3 and 4 indicate that pharmacists experience enhanced wellbeing after taking a holiday and which have implications for different role players. This study is the first to determine the profile of pharmacists and give an indication of their travel behaviour that will assist destinations to alter their product/services to better suit the profile or travel behaviour of pharmacists. Employing companies on the other hand can have financial benefits in the form of low staff turnover and satisfied patients. Although pharmacists are seen as a homogeneous group, pharmacists differ based on socio–demographic characteristics and therefore the Pharmacy Council may enforce the design of different policies for the different groups of pharmacists to reduce the pharmaceutical profession's stress. / Thesis (M.Com. (Tourism))--North-West University, Potchefstroom Campus, 2011.