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Health Informatics Journal Mar 2020Pharmacy plays a pivotal role in supporting acute clinical care pathways. However, across hospital environments, pharmacies are often stretched by growing service...
Pharmacy plays a pivotal role in supporting acute clinical care pathways. However, across hospital environments, pharmacies are often stretched by growing service demands and conflicted by increased medication and service costs. Ultimately, such factors contribute towards process inefficiencies that impact on the provision of healthcare services. Following a literature review, we examined clinical pharmacy services by undertaking three acute hospital pharmacy case studies. We adopted an ethnographic approach, observing and interviewing pharmacists, pharmacy staff and nurses. With a view to improving healthcare information systems (ISs), we identified the enablers and barriers in service efficiency, thus identifying opportunities for pharmacy IS implementation across acute hospital environments. The findings also reveal some of the key enablers and barriers towards the introduction of hospital IS innovation. We present recommendations to overcome such barriers.
Topics: Attitude of Health Personnel; Community Pharmacy Services; Humans; Information Systems; Pharmacies; Pharmacy; Pharmacy Service, Hospital
PubMed: 30841781
DOI: 10.1177/1460458219832056 -
BMC Health Services Research Jan 2022Guidelines and practice standards exist to communicate the conduct and behaviour expected of health care professionals and ensure consistent quality practice. It is... (Review)
Review
BACKGROUND
Guidelines and practice standards exist to communicate the conduct and behaviour expected of health care professionals and ensure consistent quality practice. It is important that they describe behaviours explicitly so they can be interpreted, enacted and measured with ease. The AACTT framework specifies behaviour in terms of the: Action to be performed, Actor who performs the action, Context where the action occurs, Target who the action is performed with/for and Time when the action is performed (AACTT). It provides the most up to date framework for specifying behaviours and is particularly relevant to complex behavioural problems that involve sequences of behaviours performed by different people. Behavioural specificity within pharmacy practice standards has not been explored.
AIM
To determine if behaviours described in the Professional Practice Standards for Australian Pharmacists specify Action, Actor, Context, Target and Time.
METHODS
Two researchers independently reviewed the scope and structure of the practice standards and one extracted action statements (behaviours) verbatim. Through an iterative process, the researchers modified and developed the existing AACTT definitions to operationalise them for application to review of the action statements in the practice standards. The operational definitions, decision criteria and curated examples were combined in a codebook. The definitions were consistently applied through a directed content analysis approach to evaluate all extracted action statements by one researcher. For consistency 20% was independently checked for agreement by a second researcher.
RESULTS
A novel codebook to apply AACTT criteria to evaluate practice standards was developed. Application of this codebook identified 768 independent behaviours. Of these, 300 (39%) described at least one discrete observable action, none specified an actor, 25 (3%) specified context, 131 (17%) specified target and 88 (11%) specified time.
CONCLUSION(S)
The behaviours detailed in practice standards for Australian pharmacists do not consistently specify behaviours in terms of Action, Actor, Context, Target and Time. Developers in the pharmacy profession, and beyond, should consider the behavioural specificity of their documents to improve interpretability, usability and adherence to the behaviours detailed. This also has implications for the development and evaluation of interventions to change such behaviours and improve quality of care.
Topics: Australia; Humans; Pharmaceutical Services; Pharmacies; Pharmacists; Pharmacy
PubMed: 35031027
DOI: 10.1186/s12913-021-07358-4 -
BMJ Open Aug 2021We explore how older patients affected by polypharmacy manage the 'hidden work' of organising their medicines, how they make sense of this work and integrate it into...
OBJECTIVES
We explore how older patients affected by polypharmacy manage the 'hidden work' of organising their medicines, how they make sense of this work and integrate it into their lives.
DESIGN AND SETTING
Ethnographic study observing patients over 18-24 months in patients' homes, general practice and community pharmacy, in England, UK.
PARTICIPANTS AND METHODS
Ethnographic case study including longitudinal follow-up of 24 patients aged 65 or older and prescribed ten or more items of medication. Our dataset includes: 562 hours of ethnographic observation across patients homes, community pharmacies and general practices; 47 audio-recorded interviews with patients about their lives and medicines practices; cultural probes (photographs, body maps, diaries and imagined 'wishful thinking' conversations); fieldnotes from regular home visits; telephone calls, and observation/video-recording of healthcare encounters. We apply a 'practice theory' lens to our analysis, illuminating what is being accomplished, why and by whom.
RESULTS
All patients had developed strategies and routines for organising medicines into their lives, negotiating medicine taking to enable acceptable adherence and make their medicines manageable. Strategies adopted by patients often involved the use of 'do-it-yourself' dosette boxes. This required careful 'organising' work similar to that done by pharmacy staff preparing multicompartment compliance aids (MCCAs). Patients incorporated a range of approaches to manage supplies and flex their regimens to align with personal values and priorities. Practices of organising medicines are effortful, creative and often highly collaborative. Patients strive for adherence, but their organisational efforts privilege 'living with medicines' over taking medicines strictly 'as prescribed'.
CONCLUSIONS
Polypharmacy demands careful organising. The burden of organising polypharmacy always falls somewhere, whether undertaken by pharmacists as they prepare MCCAs or by patients at home. Greater appreciation among prescribers of the nature and complexity of this work may provide a useful point of departure for tackling the key issue that sustains it: polypharmacy.
Topics: Community Pharmacy Services; Humans; Pharmacies; Pharmacists; Pharmacy; Polypharmacy
PubMed: 34446490
DOI: 10.1136/bmjopen-2021-049218 -
BMC Health Services Research Nov 2022Pharmacists in Canada are assuming an increasingly important role in the provision of primary care services. This raises questions about access to pharmacy services...
BACKGROUND
Pharmacists in Canada are assuming an increasingly important role in the provision of primary care services. This raises questions about access to pharmacy services among those with medical care needs. While there is evidence on proximity of residents of Ontario and Nova Scotia to community pharmacies, there is little evidence for the rest of Canada. I thus measured the availability of pharmacist services, both the number of community pharmacies and their hours of operation, at both the provincial and sub-provincial level in Canada. Next, I measured associations of indicators of medical need and the availability of pharmacist services across sub-provincial units.
METHODS
I collected data, for each Forward Sortation Area (FSA), on medical need, measured using the fraction of residents aged 65 + and median household income, and pharmacist service availability (the number of community pharmacies and their hours of operation, divided by the FSA population). Linear regression methods were used to assess associations of FSA-level service availability and medical need.
RESULTS
There are between 2.0 and 3.3 community pharmacies per 10,000 population, depending on the province. There are also provincial variations in the number of hours that pharmacies are open. Quebec pharmacies were open a median of 75 h a week. In Manitoba, pharmacies were open a median of 53 h a week. The per capita number of pharmacies and their total hours of operation at the FSA level tend to be higher in less affluent regions and in which the share of residents is aged 65 or older. Provincial differences in pharmacy availability were still evident after controlling for medical need.
CONCLUSION
Community pharmacies in Canada tend to locate where indicators of health needs are greatest. The impact on patient health outcomes of these pharmacy locational patterns remains an area for future research.
Topics: Humans; Pharmacies; Community Pharmacy Services; Pharmacists; Pharmacy; Nova Scotia
PubMed: 36329439
DOI: 10.1186/s12913-022-08709-5 -
BMC Health Services Research Dec 2023Medication prescribing and discontinuation processes are complex and involve the patient, numerous health care professionals, organizations, health information...
BACKGROUND
Medication prescribing and discontinuation processes are complex and involve the patient, numerous health care professionals, organizations, health information technology (IT). CancelRx is a health IT that automatically communicates medication discontinuations from the clinic electronic health record to the community pharmacy dispensing platform, theoretically improving communication. CancelRx was implemented across a Midwest academic health system in October 2017. The health system also operates 15 outpatient community pharmacies.
OBJECTIVE
The goal of this qualitative study was to describe how both the clinic and community pharmacy work systems change and interact over time regarding medication discontinuations, before and after CancelRx implantation.
APPROACH
Medical Assistants (n = 9), Community Pharmacists (n = 12), and Pharmacy Administrators (n = 3), employed by the health system were interviewed across 3-time periods between 2017 and 2018- 3-months prior to CancelRx implementation, 3-months after CancelRx implementation, and 9-months after CancelRx implementation. Interviews were audio recorded, transcribed, and conducted a hybrid analysis with deductive content analysis following the Systems Engineering Initiative for Patient Safety (SEIPS) framework and inductive analysis to capture additional codes and themes.
KEY RESULTS
CancelRx changed the medication discontinuation process at both clinics and community pharmacies. In the clinics, the workflows and medication discontinuation tasks changed over time while MA roles and clinic staff communication practices remained variable. In the pharmacy, CancelRx automated and streamlined how medication discontinuation messages were received and processed, but also increased workload for the pharmacists and introduced new errors.
CONCLUSIONS
This study utilizes a systems approach to assess disparate systems within a patient network. Future studies may consider health IT implications for systems that are not in the same health system as well as assessing the role of implementation decisions on health IT use and dissemination.
Topics: Humans; Pharmacies; Community Pharmacy Services; Pharmacy; Pharmacists; Health Personnel
PubMed: 38057835
DOI: 10.1186/s12913-023-10396-9 -
Journal of the American Pharmacists... 2023Community pharmacies in the United States are beginning to serve as patient care service destinations addressing both clinical and health-related social needs (HRSN)....
BACKGROUND
Community pharmacies in the United States are beginning to serve as patient care service destinations addressing both clinical and health-related social needs (HRSN). Although there is support for integrating social determinant of health (SDoH) activities into community pharmacy practice, the literature remains sparse on optimal pharmacy roles and practice models.
OBJECTIVE
To assess the feasibility of a community pharmacy HRSN screening and referral program adapted from a community health worker (CHW) model and evaluate participant perceptions and attitudes toward the program.
METHODS
This feasibility study was conducted from January 2022 to April 2022 at an independent pharmacy in Buffalo, NY. Collaborative relationships were developed with 3 community-based organizations including one experienced in implementing CHW programs. An HRSN screening and referral intervention was developed and implemented applying a CHW practice model. Pharmacy staff screened subjects for social needs and referred to an embedded CHW, who assessed and referred subjects to community resources with as-needed follow-up. Post intervention, subjects completed a survey regarding their program experience. Descriptive statistics were used to report demographics, screening form, and survey responses.
RESULTS
Eighty-six subjects completed screening and 21 (24.4%) an intervention and referral. Most participants utilized Medicaid (57%) and lived within a ZIP Code associated with the lowest estimated quartile for median household income (66%). Eighty-seven social needs were identified among the intervention subjects, with neighborhood and built environment (31%) and economic stability challenges (30%) being the most common SDoH domains. The CHW spent an average of 33 minutes per patient from initial case review through follow-up. All respondents had a positive perception of the program, and the majority agreed that community pharmacies should help patients with their social needs (70%).
CONCLUSIONS
This feasibility study demonstrated that embedding a CHW into a community pharmacy setting can successfully address HRSN and that participants have a positive perception toward these activities.
Topics: Humans; United States; Pharmacies; Community Health Workers; Pharmaceutical Services; Community Health Services; Pharmacy
PubMed: 36710147
DOI: 10.1016/j.japh.2023.01.006 -
JCO Oncology Practice Aug 2022To decrease the financial burden on people with cancer, clinicians and patients increasingly use medication price comparison websites to seek pharmacies where...
PURPOSE
To decrease the financial burden on people with cancer, clinicians and patients increasingly use medication price comparison websites to seek pharmacies where medications may be cheaper. Shopping around at different pharmacies can add additional time and logistic burden to patients and care partners. We sought to determine whether a single pharmacy consistently offered the lowest price for symptom control medications.
METHODS
We compiled medications/formulations used to manage two common cancer-associated symptoms: nausea/vomiting and anorexia/cachexia. We extracted discounted, lowest price with coupon prices for a typical fill of these medications at nine pharmacies in Minneapolis, MN, using GoodRx. We compared prices across formulations and pharmacies to assess whether a pharmacy consistently offered the lowest price.
RESULTS
We included 24 formulations for nausea/vomiting (14 generic and 10 brand-name) and 19 for anorexia/cachexia (12 generic and seven brand-name). Prices for brand-name formulations were similar across pharmacies, but prices of generic formulations varied widely across pharmacies. For example, the prices of a seven-unit fill of generic 5-mg olanzapine tablets ranged from $4 to $57 US dollars. No single pharmacy consistently offered the lowest price across the formulations studied. For example, for the 12 generic formulations for anorexia/cachexia, one pharmacy had the highest price for four formulations and the lowest price for two others.
CONCLUSION
In this study of discounted medication prices, we found that no single pharmacy in an urban zip code consistently offered the lowest price for medications used to manage two common cancer-associated symptoms. Well-intentioned efforts to pursue the cheapest source of each medication by visiting multiple pharmacies may add extra time and logistic toxicity to patients and care partners. This approach can increase redundant scripts and expose patients to medication-related adverse events.
Topics: Anorexia; Cachexia; Drugs, Generic; Humans; Nausea; Neoplasms; Pharmacies; Pharmacy; Vomiting
PubMed: 35623024
DOI: 10.1200/OP.22.00051 -
Yakugaku Zasshi : Journal of the... 2023Based on its founding spirit of "Strong, Correct and Clear" Gifu Pharmaceutical University (hereinafter referred to as "the University") has adopted the human and... (Review)
Review
Based on its founding spirit of "Strong, Correct and Clear" Gifu Pharmaceutical University (hereinafter referred to as "the University") has adopted the human and environmentally friendly Pharmacy (Green Pharmacy) as its basic philosophy. As the University fulfills its social mission to enrich and strengthen education, research, and social activities, it faces many challenges. These include incorporation, fostering academia-industry-government collaboration, life-science center development and expanding the role of the affiliated pharmacy. The University will continually strive to recognize trends in the social environment and make the effort to respond to challenges when they arise. This effort will allow the University faculty and staff to maintain a sustainable institution that can respond to social challenges while continuing to share the benefits of education, research, and drug discovery/development with the community. The University is committed to train world class Pharmacist-Scientist. This review explains the rationale for the University's transition to a single six-year program. It also gives an update on the current status of education, research, and the mobile pharmacy (MP) since its introduction. Furthermore, it highlights advancements in academic-industry-government collaboration.
Topics: Humans; Pharmacists; Education, Pharmacy; Pharmacy; Community Pharmacy Services; Pharmacies
PubMed: 37779008
DOI: 10.1248/yakushi.23-00083-2 -
PloS One 2022Conducting high quality investigator-initiated trials (IITs) is challenging and costly. The costs of investigational medicinal products (IMPs) in IITs and the role of...
BACKGROUND
Conducting high quality investigator-initiated trials (IITs) is challenging and costly. The costs of investigational medicinal products (IMPs) in IITs and the role of hospital pharmacies in the planning of IITs are unclear. We conducted a mixed-methods study to compare planned and actual costs of IMPs in Swiss IITs, to examine potential reasons for differences, and to gather stakeholder views about hospital services for IITs.
METHODS
We included all IITs with IMP services from the Basel hospital pharmacy invoiced between January 2014 and June 2020 (n = 24). We documented trial and IMP characteristics including planned and actual IMP costs. Our working definition for a substantial cost difference was that the actual IMP costs were more than 10% higher than the planned IMP costs in a trial. We conducted semi-structured interviews with investigators, clinical trials unit and hospital pharmacy staff, and qualitatively analyzed transcribed interviews.
RESULTS
For 13 IITs we observed no differences between planned and actual costs of IMPs (median, 11'000 US$; interquartile range [IQR], 8'882-16'302 US$), but for 11 IITs we found cost increases from a median of 11'000 US$ (IQR, 8'922-36'166 US$) to a median over 28'000 US$ (IQR, 13'004-49'777 US$). All multicenter trials and 10 of 11 IITs with patients experienced substantial cost differences. From the interviews we identified four main themes: 1) Patient recruitment and organizational problems were identified as main reasons for cost differences, 2) higher actual IMP costs were bearable for most investigators, 3) IMP services for IITs were not a priority for the hospital pharmacy, and 4) closer collaboration between clinical trial unit and hospital pharmacy staff, and sufficient staff for IITs at the hospital pharmacy could improve IMP services.
CONCLUSIONS
Multicenter IITs enrolling patients are particularly at risk for higher IMP costs than planned. These trials are more difficult to plan and logistically challenging, which leads to delays and expiring IMP shelf-lives. IMP services of hospital pharmacies are important for IITs in Switzerland, but need to be further developed.
Topics: Humans; Organizations; Pharmacies; Pharmacy Service, Hospital; Research Personnel
PubMed: 35245312
DOI: 10.1371/journal.pone.0264427 -
Research in Social & Administrative... Jul 2021Few studies have documented rural community pharmacy disaster preparedness.
BACKGROUND
Few studies have documented rural community pharmacy disaster preparedness.
OBJECTIVES
To: (1) describe rural community pharmacies' preparedness for and responses to COVID-19 and (2) examine whether responses vary by level of pharmacy rurality.
METHODS
A convenience sample of rural community pharmacists completed an online survey (62% response rate) that assessed: (a) demographic characteristics; (b) COVID-19 information source use; (c) interest in COVID-19 testing; (d) infection control procedures; (e) disaster preparedness training, and (f) medication supply impacts. Descriptive statistics were calculated and differences by pharmacy rurality were explored.
RESULTS
Pharmacists used the CDC (87%), state health departments (77%), and state pharmacy associations (71%) for COVID-19 information, with half receiving conflicting information. Most pharmacists (78%) were interested in offering COVID-19 testing but needed personal protective equipment and training to do so. Only 10% had received disaster preparedness training in the past five years. Although 73% had disaster preparedness plans, 27% were deemed inadequate for the pandemic. Nearly 70% experienced negative impacts in medication supply. There were few differences by rurality level.
CONCLUSION
Rural pharmacies may be better positioned to respond to pandemics if they had disaster preparedness training, updated disaster preparedness plans, and received regular policy guidance from professional bodies.
Topics: COVID-19; COVID-19 Testing; Community Pharmacy Services; Humans; Pharmacies; Pharmacists; SARS-CoV-2
PubMed: 34155979
DOI: 10.1016/j.sapharm.2020.10.008