Academic Pharmacists Research Articles

Experience with external review panels to validate a large clinical pharmacy intervention study

ABSTRACT Assessment of the true impact al pharmacists' interventions in pharmaceutical care is crucial to the justification of investment in resources for clinical pharmacy services. In a large study of clinical pharmacy interventions in hospitals, intervening pharmacists and attending physicians assessed the impact of the intervention on three aspects: therapeutic benefit, risks, and drug costs. The study showed that hospitals providing the highest level at pharmacotherapy monitoring made more interventions per patient and that, in these institutions, the impact was greater on therapeutic benefit and risk reduction. Both pharmacists and physicians caring for the patient had assessed the impact. It was deemed important to validate these results. External panels of academic clinical pharmacists and clinical pharmacology physicians were chosen to review a sampling of cases to determine their level of agreement with their professional colleague (pharmacist or physician) at the original site. Differences were found in the assessments for both the pharmacist panel reviewing the site pharmacists and the physician panel reviewing the site physicians. In general, the review panels tended to be less positive about therapeutic benefit and risk reduction, but similar about the impact on drug costs. Although validation exercises are desirable in such research, it remains to be established whether the expert panel approach is preferred to other methods such as the more arduous measurements of health outcomes, or even the subjective impression of the physician and pharmacist involved with the care of that patient.

Perceptions of organizational culture and organizational citizenship by faculty in U.S. colleges and schools of pharmacy

Objectives(1) Describe perceptions of organizational culture and prevalence of organizational citizenship behaviors (OCBs) among faculty at United States (U.S.) colleges/schools of pharmacy; (2) determine which aspects of those phenomena are strongest and which are most problematic; (3) evaluate the psychometric properties of measures for organizational culture and OCBs in academic pharmacy; and (4) identify any relationships between organizational culture and organizational citizenship among academic pharmacy faculty. MethodsA random sample of 600 U.S. academic pharmacists acquired from the American Association of Colleges of Pharmacy were distributed an email survey through the use of Qualtrics technology. The procedures closely resembled the Total Design Method advocated to maximize survey response, including use of a pre-notification letter, reminders, and a nominal financial inducement. In addition to demographic questions, the survey employed multiple-item measures of organizational culture and OCBs described previously in the literature and derived from Delphi consensus-building procedures. The analysis plan incorporated use of factor and item analyses to evaluate psychometric properties of the measure and elicit the inherent domains comprising these phenomena, along with descriptive statistics to describe facets of organizational culture and OCBs that were most prevalent. ResultsA total of 177 responses were delivered. Factor analysis of organizational culture revealed a five-factor solution emphasizing achievement orientation, professionalism, stability, supportiveness, and reflectiveness. OCB domains were along the possibility of faculty being virtuous, disrespectful, sportsmanlike, and benevolent/malevolent. Even while multi-faceted and avoiding a simple typological descriptor, academic pharmacy cultures were reportedly healthy. Sportsmanship, while still somewhat commonly observed, was seen less frequently than other behaviors. The measures demonstrated logical, cogent factor structures and excellent internal consistency reliability. ConclusionsPsychometrically well-performing measures were used to assess the multi-faceted organizational culture of academic pharmacy programs and the organizational citizenship behaviors of its constituent faculty. The results can be used to measure these phenomena at individual organizations for benchmarking and to inform future inquiries that can assist with development of strategies that impact academic worklife and outcomes.

Practical strategies and perceptions from community pharmacists following their experiences with conducting pharmacy practice research: a qualitative content analysis.

While prior research identified barriers to conducting research in community pharmacies, there remains a need to better understand facilitators to ensure successful collaborations between academic researchers and pharmacists. Our objective was to determine the experiences and perspectives of community pharmacists who have recently conducted a pharmacy practice-based research study to gain in-depth understanding of challenges as well as facilitators and identify strategies and solutions. We conducted a qualitative study involving one-on-one semi-structured telephone interviews with community pharmacists following the completion of a practice-based research study in their pharmacies. Interview transcripts were analysed using inductive content analysis involving open coding, creating categories and abstraction into final themes. Eleven pharmacists participated in the qualitative interviews. We identified six major themes including: (1) barriers (e.g. time constraints); (2) facilitators (e.g. ideal pharmacy layout); (3) support and resources from academic researchers (e.g. helpfulness of training, easy-to-use study materials); (4) pharmacist-initiated strategies for conducting research (beyond prior suggestions from researchers); (5) suggestions for future pharmacy practice research; and (6) motivation for conducting pharmacy practice research. These findings informed practical strategies targeted at academic researchers and pharmacists, respectively, to facilitate the conduct of research in community pharmacists across various stages of the research process. Our study adds to better understanding of community pharmacists' perspectives on conducting research and identifies practical solutions that can be readily implemented by academic researchers and pharmacists participating in research.

The scholarly productivity and work environments of academic pharmacists.

Productive faculty are key to generating new knowledge and advancing pharmacy practice. The work environments of academic pharmacists are critical to their vitality, commitment, and longevity. To (1) identify correlates of faculty scholarly productivity and teaching effectiveness, considering personal and environmental characteristics; (2) determine the relationship between a faculty's perception of organizational citizenship behaviors they witness with the organizational culture of their employing college/school of pharmacy; and (3) describe the relationship between organizational climate, job satisfaction, and commitment of academic pharmacists. A self-administered survey was disseminated to a random sample of U.S. academic pharmacists acquired from AACP list-servs. The survey measured perceptions of their organization's culture, the organizational citizenship behaviors they witness at their institution, their job satisfaction, teaching load and productivity, and scholarly productivity based upon peer-reviewed scholarly papers accepted. Both bivariate and multivariate (regression) procedures were employed to identify factors most responsible for explaining academic pharmacist's work environment. Responses were received from 177 of 600 survey recipients. Faculty reported having had accepted 10.9±13.6 papers in peer-reviewed journals during the previous 5 years, with most of those in journals with relatively low Impact Factor scores. Faculty productivity was related to type of academic institution employed, teaching effectiveness, job satisfaction, and other factors. Organizational citizenship behaviors and organizational culture was seen similarly by faculty of varied ranks and experience levels. Commitment to remain at the current college/school of pharmacy was highly associated with culture, climate, and job satisfaction conditions. The results provided evidence for a strong connection or nexus between teaching and research effectiveness. Organizational culture of academic pharmacy programs is highly important for faculty vitality and commitment. The findings should be helpful for academic leaders in devising programs for mentoring, development, and retention of faculty.

Don’t forget about hospital and academic pharmacists

Don’t forget about hospital and academic pharmacists

The role of academic pharmacists in science and research

The role of academic pharmacists in science and research

PIPc study: development of indicators of potentially inappropriate prescribing in children (PIPc) in primary care using a modified Delphi technique.

ObjectiveThere is limited evidence regarding the quality of prescribing for children in primary care. Several prescribing criteria (indicators) have been developed to assess the appropriateness of prescribing in older and middle-aged adults but few are relevant to children. The objective of this study was to develop a set of prescribing indicators that can be applied to prescribing or dispensing data sets to determine the prevalence of potentially inappropriate prescribing in children (PIPc) in primary care settings.DesignTwo-round modified Delphi consensus method.SettingIrish and UK general practice.ParticipantsA project steering group consisting of academic and clinical general practitioners (GPs) and pharmacists was formed to develop a list of indicators from literature review and clinical expertise. 15 experts consisting of GPs, pharmacists and paediatricians from the Republic of Ireland and the UK formed the Delphi panel.Results47 indicators were reviewed by the project steering group and 16 were presented to the Delphi panel. In the first round of this exercise, consensus was achieved on nine of these indicators. Of the remaining seven indicators, two were removed following review of expert panel comments and discussion of the project steering group. The second round of the Delphi process focused on the remaining five indicators, which were amended based on first round feedback. Three indicators were accepted following the second round of the Delphi process and the remaining two indicators were removed. The final list consisted of 12 indicators categorised by respiratory system (n=6), gastrointestinal system (n=2), neurological system (n=2) and dermatological system (n=2).ConclusionsThe PIPc indicators are a set of prescribing criteria developed for use in children in primary care in the absence of clinical information. The utility of these criteria will be tested in further studies using prescribing databases.

Net Income of Pharmacy Faculty Compared to Community and Hospital Pharmacists

Objective. To compare the net cumulative income of community pharmacists, hospital pharmacists, and full-time pharmacy faculty members (residency-trained or with a PhD after obtaining a PharmD) in pharmacy practice, medicinal chemistry, pharmaceutics, pharmacology, and social and administrative sciences. Methods. Markov modeling was conducted to calculate net projected cumulative earnings of career paths by estimating the costs of education, including the costs of obtaining degrees and student loans. Results. The economic model spanned 49 years, from ages 18 to 67 years. Earning a PharmD and pursuing an academic career resulted in projected net cumulative lifetime earnings ranging from approximately $4.7 million to $6.3 million. A pharmacy practice faculty position following public pharmacy school and one year of residency resulted in higher net cumulative income than community pharmacy. Faculty members with postgraduate year 1 (PGY1) training also had higher net income than other faculty and hospital pharmacy career paths, given similar years of prepharmacy education and type of pharmacy school attended. Faculty members with either a PharmD or PhD in the pharmacology discipline may net as much as $5.9 million and outpace all other PhD graduates by at least $75 000 in lifetime earnings. Projected career earnings of postgraduate year 2 (PGY2) trained faculty and PharmD/PhD faculty members were lower than those of community pharmacists. Findings were more variable when comparing pharmacy faculty members and hospital pharmacists. Conclusion. With the exception of PGY1 trained academic pharmacists, faculty projected net cumulative incomes generally lagged behind community pharmacists, likely because of delayed entry into the job market as a result of advanced training/education. However, nonsalary benefits such as greater flexibility and autonomy may enhance the desirability of academic pharmacy as a career path.

Issues Affecting Medication Use Among Asian Americans, Native Hawaiians, and Pacific Islanders

Background and Purpose: Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations may have unique issues (e.g., cultural attitudes and language barriers) that impact their relatively low adherence to medication use. Research on the topic is limited because AANHPI populations are generally not included in research studies. We conducted a qualitative investigation to gain insights into low adherence to medication use among AANHPIs and how to address this health disparity. Methods: In-depth individual interviews were conducted with 14 academic pharmacists and four other health care professionals knowledgeable about AANHPI disparities. Results: The majority of participants were either unsure of appropriate medication use by AANHPIs or felt they were used inappropriately. Over half of the participants were involved in or knew of efforts which focused on appropriate medication use. Participants felt that approaches to improving medication adherence included education and counseling, collaboration between providers, and conducting additional research, a role they felt the Daniel K. Inouye College of Pharmacy could fulfill. Conclusion: The appropriate use of medications for AANHPI populations is perceived as a barrier to parity in health care by pharmacists and other health care professionals. While current efforts exist to address appropriate medication use, additional research focusing on potential solutions identified by our participants is required to further assess their effectiveness in helping to close the health care gap.

Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice.

This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed.

Perspectives on Medication-Related and Other Health Disparities Affecting Asian Americans, Native Hawaiians, and Other Pacific Islanders

Background and Purpose: The present body of literature has little information regarding factors behind gaps in health status affecting Asian American, Native Hawaiian and Pacific Islander (AANHPI) communities, and methods to address them. We sought to examine pharmacists’ and other health care professionals’ perceptions of AANHPI health disparities and their ideas for solutions involving pharmacists, pharmacy schools, and the U.S. Food and Drug Administration (FDA). Methods: In-depth individual interviews were conducted with ten academic pharmacists and four other health care professionals knowledgeable about AANHPI disparities, with a focus on medication-related disparities. Results: Commonly identified factors behind disparities included poor communication, low socioeconomic status, cultural inhibitions creating a reluctance to seek care, and limited access to care. Suggested strategies for community pharmacists to reduce disparities included one-on-one care focused on outcomes, translated materials and translation services, and tracking adherence to medications. Participants suggested that colleges of pharmacy could continue community health events, encourage students to be culturally aware, and conduct health disparities research, and that the FDA could provide translated information, research funding, and requirements for greater ethnic diversity in clinical trials. Conclusion: Experts believe that pharmacists have the potential to help close the health care gap for AANHPI populations.

A Qualitative Analysis of the Perception of Academic Pharmacists Regarding their Role in Healthcare System of Two Pakistani Cities

Purpose: To investigate the role and perception of academic pharmacists regarding their role in the healthcare system of Pakistan. Methods: Qualitative methodology was used to explore the perception of academic pharmacists, and semi-structured interview was used to collect the data. The study was conducted in the cities of Islamabad and Lahore, Pakistan from April to June 2011. Results: On the basis of the interview guide, thematic content analysis yielded five major themes: 1) the need for a more comprehensive pharmacy curriculum; 2) perception of pharmaceutical care in Pakistan; 3) collaboration with other healthcare professionals; and 4) strategies to improve the status of pharmacist. Conclusion: There is a necessity for curriculum alignment, which is considered important to enhance pharmacy practice activities, as this will ultimately yield several benefits for pharmacists, including job satisfaction.

An Audit of Renal Clinical Pharmacist Provided Drug Information Services to Nephrology Department

Background: Clinical pharmacy services in various ambulatory care settings are well-defined and documented. Nevertheless, data addressing clinical pharmacist-provided drug information services to the nephrology department are very limited. The aims of our study were to evaluate the type and quality of clinical pharmacist provided drug information services to the nephrology department. Methodology: The research clinical pharmacist participated in nephrology ward rounds for six days in a week along with an academic renal clinical pharmacist. Any medication related queries requested by the nephrologists or by other healthcare nephrology members were received and attended as per the modified systematic approach for the provision of drug information. Subsequently, the feedback information was provided to the concerned enquirer. The quality of all drug information services provided was evaluated by using drug information quality assurance assessment questionnaire. Results: Overall, 97 drug information requests were received and answered during the study period. Majority of the requests (n=72, 74.22%) were related to the management of the patient under nephrology care and good number of the requests were related to medication dosage (n=42, 43.29%) followed adverse drug reactions (n=22, 22.68%). The preponderance of the requests (n=54, 55.67%) required up to 15 minutes of search from various drug information resources and most of these requests (n=61, 62.88%) were answered verbally with the aid of single reference (n=48, 49.48%). Majority (n=62) of the drug information requests were graded as excellent. Conclusion: Our study confirms the promising role of a renal pharmacist in drug therapy management of really impaired patients and participation of renal clinical pharmacist in the regular ward rounds could be the main reason for both good number and quality of drug information provided.

Preparation, validation and user-testing of pictogram-based patient information leaflets for hemodialysis patients

Background: Patient information leaflets are universally-accepted resources to educate the patients/users about their medications, disease and lifestyle modification. Objectives: The objective of the study was to prepare, validate and perform user-testing of pictogram-based patient information leaflets (P-PILs) among hemodialysis (HD) patients. Methods: The P-PILs are prepared by referring to the primary, secondary and tertiary resources. The content and pictograms of the leaflet have been validated by an expert committee consisting of three nephrologists and two academic pharmacists. The Baker Able Leaflet Design has been applied to develop the layout and design of the P-PILs. Results: Quasi-experimental pre- and post-test design without control group was conducted on 81 HD patients for user-testing of P-PILs. The mean Baker Able Leaflet Design assessment score for English version of the leaflet was 28, and 26 for Kannada version. The overall user-testing knowledge assessment mean scores were observed to have significantly improved from 44.25 to 69.62 with p value <0.001. Conclusion: The overall user opinion of content and legibility of the leaflets was good. Pictogram-based patient information leaflets can be considered an effective educational tool for HD patients.

AB1186-HPR Compiling and Evaluating Evidence-Based Algorithms for the Monitoring of Rheumatoid Arthritis Patients Receiving Disease Modifying Antirheumatic Drugs and Biological Agents

BackgroundPharmacological management of rheumatoid arthritis patients is based on the use of complex drugs such as disease modifying anti-rheumatic drugs (DMARDs) and innovative biological agents. Safe use of these drugs...

Ohio pharmacists' opinions concerning required residency

Objective To determine the opinion of Ohio pharmacists as it concerns the necessity and value of required residencies for current Doctor of Pharmacy graduates. Methods A self-administered survey was sent to 1000 randomly selected Ohio pharmacists. The survey consisted of 15 items that had to do with residencies and used a Likert scale. Next, nine items used a semantic differential scale to assess opinions of required residencies for hospital, academic, and community pharmacy practice. The study methods were approved by the university's Institutional Review Board. Results A response rate of 44.8% was achieved. The average respondent was a 45-year-old female with a BS degree who worked full time in community practice. Most pharmacists (80.6%) thought that a one-year post graduate residency (PGY1) should not be required for a pharmacist entering community pharmacy. In comparison, 49.9% of pharmacists disagreed or strongly disagreed that a PGY1 residency should be required for a pharmacist entering hospital pharmacy. Respondents in the semantic differential scale indicated that PGY1 residencies were most important for academics (3.06 ± 1.83), then hospital practice (3.13 ± 1.73), and least important for community practice (4.59 ± 1.89). Conclusion Overall, Ohio pharmacists responded that residencies should not be required. Residencies were considered most valuable for academic pharmacists, then hospital pharmacists, and least valuable for community pharmacists. Ohio pharmacists were of the opinion that current Doctor of Pharmacy curricula adequately prepare students to successfully practice pharmacy, and further postgraduate training was not necessary.

C-B3-03: Development and Pilot Testing of Guidelines to Monitor High-Risk Medications in the Ambulatory Setting

Background: Inadequate laboratory monitoring of high-risk medications contributes to preventable adverse drug events. One barrier to appropriate monitoring is lack of standardized monitoring guidelines. The study aims were to develop guidelines to monitor high-risk medications and to assess the prevalence of laboratory testing for these medications in a multispecialty group practice. Methods: We developed guidelines for laboratory monitoring of high-risk medications as part of a patient safety intervention trial. An advisory committee of national experts and local leaders (clinicians, pharmacists, pharmacoepidemiologists, and patient safety experts) used a two-round, internet-based Delphi process to select guideline medications based on the importance of monitoring for efficacy, safety, and drug-drug interactions. Test frequency recommendations were developed by academic pharmacists based on literature review and local interdisciplinary consensus. To estimate the potential impact of the intervention, we determined the prevalence of high-risk drug dispensings and laboratory testing for guideline medications between January 1, 2008 and July 31, 2008. Results: Consensus on medications to include in the guidelines was achieved in two rounds. Final guidelines included 35 drugs/drug classes and 61 laboratory tests. The prevalence of monitoring ranged from 90%, with infrequently prescribed drugs having a lower prevalence of recommended testing. When more than one test was recommended for a selected medication, monitoring within a medication sometimes differed by > 50%. Conclusions: Even among drugs where there is general consensus that laboratory monitoring is important, prevalence of monitoring is highly variable. Further, infrequently prescribed medications are at higher risk for poor monitoring.

Public health matters: the role of the pharmacist and the academy

Heart disease and cancer are responsible for up to half of the more than 2 million deaths each year in the United States. 1 Pharmacists ought to contribute to reducing mortality when they take an active role in prevention. Academic and community pharmacists can join the cadre of existing public health pharmacists who provide access to preventive care and disease management services. The intention of this paper is to incite discussion among faculty in schools and colleges of pharmacy, with the hope that an increased interest in public health occurs in the academic environment and that pharmacists assume additional leadership roles in public health matters. Descriptions of pharmacist-designed programs that address public health concerns, as well as the results of these programs, are presented. A suggestion for how medical missions can serve as a model of interprofessional and public health education is included.

Job Sharing for Women Pharmacists in Academia

The pharmacist shortage, increasing numbers of female pharmacy graduates, more pharmacy schools requiring faculty members, and a lower percentage of female faculty in academia are reasons to develop unique arrangements for female academic pharmacists who wish to work part-time. Job sharing is an example of a flexible alternative work arrangement that can be successful for academic pharmacists who wish to continue in a part-time capacity. Such partnerships have worked for other professionals but have not been widely adopted in pharmacy academia. Job sharing can benefit the employer through retention of experienced employees who collectively offer a wider range of skills than a single employee. Benefits to the employee include balanced work and family lives with the ability to maintain their knowledge and skills by remaining in the workforce. We discuss the additional benefits of job-sharing as well as our experience in a non-tenure track job-sharing position at the University of Tennessee College of Pharmacy.

Application of STOPP and START Criteria: Interrater Reliability Among Pharmacists

Inappropriate prescribing is a well-documented problem in older people. The new screening tools, STOPP (Screening Tool of Older Peoples' Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) have been formulated to identify potentially inappropriate medications (PIMs) and potential errors of omissions (PEOs) in older patients. Consistent, reliable application of STOPP and START is essential for the screening tools to be used effectively by pharmacists. To determine the interrater reliability among a group of clinical pharmacists in applying the STOPP and START criteria to elderly patients' records. Ten pharmacists (5 hospital pharmacists, 5 community pharmacists) were given 20 patient profiles containing details including the patients' age and sex, current medications, current diagnoses, relevant medical histories, biochemical data, and estimated glomerular filtration rate. Each pharmacist applied the STOPP and START criteria to each patient record. The PIMs and PEOs identified by each pharmacist were compared with those of 2 academic pharmacists who were highly familiar with the application of STOPP and START. An interrater reliability analysis using the kappa statistic (chance corrected measure of agreement) was performed to determine consistency between pharmacists. The median kappa coefficients for hospital pharmacists and community pharmacists compared with the academic pharmacists for STOPP were 0.89 and 0.88, respectively, while those for START were 0.91 and 0.90, respectively. Interrater reliability of STOPP and START tools between pharmacists working in different sectors is good. Pharmacists working in both hospitals and in the community can use STOPP and START reliably during their everyday practice to identify PIMs and PEOs in older patients.