Delivery Of Pharmaceutical Services Research Articles

Outcomes of pharmacy facility inspections: implications on pharmaceutical services

Abstract Objectives Good Pharmacy Practice (GPP) ensures access to quality medicines, a well-trained and adequate workforce of health professionals, and affordable healthcare. The Namibia Medicines Regulatory Council ensures the sale of medicines and the premises in which such sales are carried out comply with the Medicines and Related Substances Control Act of 2003. The purpose of this study was to report facility inspection outcomes. Methods This was a retrospective review of inspection records archived over a period of 5 years (2017–2021) by the Namibia Medicines Regulatory Council. Compliance by facilities to 13 indicators as stipulated in the Namibia Medicines Regulatory Council inspections checklist adopted from international GPP guidelines was the main measure of outcomes. Results were summarized using descriptive statistics such as median, range, and percentages in R. The Mann–Whitney U test was used to compare medians. Key findings General compliance by community pharmacies (operated by pharmacists) was statistically higher (P = .0043) than dispensaries at clinics (mostly operated by nurses) with median (range) values of 84% (30.8–100) and 38% (0.0–100), respectively. There was an improvement in compliance over the 5 years for both pharmacies and clinics. Conclusions The Ministry of Health & Social Services should implement policies that will ensure appropriately trained pharmaceutical cadres are stationed at all levels of the healthcare system to improve the delivery of pharmaceutical services. In addition, more inspectors need to be recruited for more frequent inspections.

A descriptive cross sectional study of job satisfaction among pharmacists in a clinical setting

Background: Job satisfaction has been linked to improved job performance. Pharmacists as key healthcare providers with the ultimate duty of improving and maintaining the quality of life through the responsible provision of drug therapy, are expected to be highly productive. Low performance by Pharmacists can result to loss of lives especially through undetected actual and potential drug therapy problems which have been documented to be associated with high mortality and high rate of hospital admissions. Job satisfaction is the feeling of fulfilment that employees derive from their job which has a significant deal on their productivity. Assessing Pharmacists’ job satisfaction is therefore very paramount. Objective: This study accessed job satisfaction among Pharmacists working in a tertiary hospital and identified factors affecting job satisfaction among the study population Method: The study was a descriptive cross sectional study that employed the use of questionnaires as a research instrument for data collection with 30 participants completing the questionnaires. Simple percentages were used to analyse demographic characteristics and level of satisfaction. Relationship between variables was tested using chi square. Level of significance was measured at 95% confidence interval (p=0.05) Result: There was male participants’ preponderance (76.7%). Majority of the participants had practice years between 11-20 years (56.7%). 63.3% had Masters Degrees, 93.3% were Christians and 80% married. Level of job satisfaction was 33.3% among the participants. Hospital culture (76.7%), work environment (60%), reward system (60%) and remuneration (53.3%) were found to be factors recorded with the highest level of dissatisfaction. The Pharmacists were some-what satisfied with how their contribution were valued and the value placed on them by the organisation (53.3% each). However, satisfaction with their position was moderate (40.0%). Conclusion: Hospital pharmacists are important healthcare professionals that play critical roles in determining the effectiveness, efficiency, and sustainability of health care systems vial the delivery of pharmaceutical services. Showing concerns for Pharmacists welfare is an important factor to enhancing their job satisfaction with resultant improvement in the quality healthcare delivery. It is paramount that Government of Nigeria upgrades the remuneration of Pharmacists and provides conducive work environment as these would enhance productivity and effective pharmaceutical delivery to our teeming patient population.

Exploring the pharmacist role and challenges during COVID-19 pandemic in the public healthcare setting: A qualitative study

Background: Pharmacists working in the Public Health Center (PHC) setting are at the frontline response and often have to adapt to the COVID-19 crisis. However, there is a deficit of studies examining their roles and challenges regarding providing pharmaceutical care and how they adapt to the COVID-19 situation in Indonesia. Objective: This study aims to explore the views and experiences of pharmacists in the PHC during the COVID-19 pandemic. Methods: Four Focus Group Discussions (FGDs) involving 40 PHC pharmacists working in Surabaya were conducted in May 2021. The FGDs were audio recorded, transcribed verbatim and subsequently analysed for any emerging theme. Results: Most participants viewed that the restriction of face-to-face interaction hampered the provision of pharmaceutical care in the PHC. Protective equipment and partition screens during patient visits have challenged pharmacists to communicate effectively. Services such as direct one-on-one drug information and patient counselling were still provided, often facilitated with written aids, but for a limited time, providing opportunities for pharmacists to deliver messages through WhatsApp and telephone. Conclusion: The COVID-19 pandemic significantly impacted pharmaceutical service delivery in PHC. However, it has preserved the important role of pharmacists to ensure safe and quality services, particularly with the presence of the COVID-19 vaccination programme.

The relationship between service quality and customer satisfaction: a case study at Nh Beji Pharmacy

Customer satisfaction is a critical indicator of the quality of pharmaceutical services and products pharmacies provide. It holds strategic importance in the pharmacy sector, significantly influencing repeat patronage and referrals. Satisfied customers are more likely to recommend the pharmacy to others, which can substantially contribute to the business's long-term growth. This study identifies service variables at Nh Beji Pharmacy that enhance customer satisfaction and evaluates their impact on patients' loyalty and their propensity to refer new customers. By exploring the link between customer satisfaction, repeat business, and referrals, the study aims to highlight the value of customer-focused services in pharmacies. Through interviews with 55 patients randomly selected from service records and provided informed consent for the 2019-2020 period, the study identified seven service variables that significantly boost customer satisfaction at Nh Beji Pharmacy. The findings demonstrate a notable correlation between customer satisfaction and patients' willingness to return and recommend the pharmacy, underscoring the importance of prioritizing customer satisfaction in pharmaceutical service delivery.

Advancing a global pharmacy support workforce through a global strategic platform.

The pharmacy support workforce (PSW) is the mid-level cadre of the global pharmacy profession, referring to pharmacy technicians, assistants and other cadres that assist in the delivery of pharmaceutical services in a variety of practice contexts. The PSW undertake technical tasks delegated under the supervision of a pharmacist or performed collaboratively. The PSW are not intended to replace pharmacists, but rather work side-by-side with the pharmacist to achieve a shared goal. However, extensive variation in the PSW exists globally, ranging from an educated, regulated, and highly effective workforce in some countries to unrecognized or non-existent in others. Vast differences in education requirements, specific roles, regulatory oversight, and need for pharmacist supervision, inhibit the development and advancement of a global PSW. As clinical care providers, pharmacists worldwide need for a competent support workforce. Without the confidence to delegate technical responsibilities to a well-trained and capable PSW, pharmacists will be unable to fully deliver advanced clinical roles. A clear vision for the role of the PSW in the expanding scope of pharmacy practice is needed. One organization working to unite global efforts in this area is the International Pharmaceutical Federation (FIP). The FIP Workforce Development Hub Pharmacy Technicians & Support Workforce Strategic Platform was established to address the pharmacy workforce shortage in low and middle-income countries. Further developments were made in 2019, with the creation of a representative global PSW advisory panel, to provide guidance towards the development of the global PSW. Provision of frameworks and strategic input to support quality in education, development of legislative frameworks, guidelines for registration and licensure, and advice on appropriate role advancement are critical to move the PSW forward. In order to produce substantial advancement of roles and recognition of the PSW and advancement of pharmacists as patient care providers, global collaborative work is needed.

Community pharmacy cognitive services during the COVID-19 pandemic: A descriptive study of practices, precautions taken, perceived enablers and barriers and burnout.

ObjectiveThe objectives of this study were to identify community pharmacist (CP)‐led cognitive services and CPs’ precautions taken related to COVID‐19, perceived enablers and barriers related to pharmaceutical services and burnout levels during the COVID‐19 pandemic.MethodIn this descriptive study, the survey was administered online to CPs in all regions of Turkey. The frequency of their provision of patient counselling, provision of medication information and practices towards precautions during the pandemic were evaluated based on CP self‐reports. The Turkish version of the Burnout Measure Short Form was used, and a 30‐item questionnaire based on the 12‐domain Theoretical Domains Framework was developed to determine CPs’ perceived enablers of and barriers to pharmaceutical service delivery during the COVID‐19 pandemic. Data were collected using convenience sampling methods. Besides internal consistency reliability, principal component analysis, and correlation analysis, Mann‐Whitney U‐test was conducted in group comparisons.ResultsA total of 1098 complete responses were received, for a response rate of 4.11% among 26 747 CPs. The CPs’ median burnout score was 3.3 (2.5‐4.2). More than half of the CPs (54.5%) referred probable patients with COVID‐19 to the hospital. Commonly delivered cognitive CP‐led services included preventive health services (89.5%) and medication information services (86.3%). Perceived barriers to delivering pharmaceutical services were a lack of environmental resources and support and a lack of innovation in pharmaceutical services. Perceived enablers were CPs’ knowledge, skills, self‐confidence, actions, impacts, emotions and perceived behavioural control.ConclusionTo increase the preparedness of pharmacists for future pandemics or disasters, this study highlighted CP‐led cognitive services, precautions taken related to COVID‐19, perceived enablers and barriers and burnout during the COVID‐19 pandemic. Pharmaceutical services guidelines that could be followed during a pandemic or other disaster should be designed by addressing these findings.

Does pharmaceutical information systems data inform decision-making in public healthcare? Utility of a national system in a limited resource setting.

Globally, weak pharmaceutical information systems (PIS) negatively affect universal health coverage and outcomes. Few studies in sub-Saharan Africa qualitatively and quantitatively assess drivers and utility of data from PIS in public healthcare. A nationwide cross-sectional descriptive study interviewed PIS focal persons in all 14 regions of Namibia. The primary outcome was extent and predictors of utility of PIS data. The extent of utility of PIS data was determined using descriptive statistics and predictors by logistic regression in SPSSv24 or thematic analysis for qualitative data. The study recruited 58 key informants at facility-based 56 (96.6%) and national 2 (3.4%) levels. Of the 56 facility-based respondents, 29 (51.8%) were female and 27 (48.2%) pharmacists. The mean age and PIS work experience were 33.5±7.6years and 4.5±3.3years respectively. The utility level of PIS data was 34 (60.7%) (target >80%). A total of 103 uses of PIS data were cited; of which 38 (36.9%) were informing decisions on rational medicine use, 27 (26.2%) on pharmaceutical stock management and 24 (23.3%) on strengthening pharmacy workforce. The utility of PIS data significantly decreased with lack of systems on routine reporting by health facility in-charge (cOR=0.25, 95%CI: 0.06,0.90, p=0.035). Longer work experience (cOR=1.05, 95%CI: 0.88,1.25, p=0.58), formal consultations (cOR=1.29, 95%CI: 0.14,11.54, p=0.82), and availability of feedback systems (cOR=1.08, 95%CI: 0.33,3.56, p=0.89) appeared to increase utility of PIS data. Two thematic drivers of utility of PIS data were programmatic "feedback and action on PIS; structures,technical supportfor PIS discussion"; technical "training/technical capacity of staff; tools and resources for data collection and utilization"; and human-resource "staff availability and workload; attitude and commitment". The nationwide study shows sub-optimal utility of PIS data in public healthcare in Namibia, which negatively affects delivery of pharmaceutical services. This calls for action to enhance capabilities for utilization of automated real-time pharmaceutical information decision support systems to enhance real-time analysis and feedback on medicines data in resource-limited settings.

Sub-Standard Pharmaceutical Services in Private Healthcare Facilities Serving Low-Income Settlements in Nairobi County, Kenya.

Background: Quality pharmaceutical services are an integral part of primary healthcare and a key determinant of patient outcomes. The study focuses on pharmaceutical service delivery among private healthcare facilities serving informal settlements within Nairobi County, Kenya and aims at understanding the drug procurement practices, task-shifting and ethical issues associated with drug brand preference, competition and disposal of expired drugs. Methods: Forty-five private facilities comprising of hospitals, nursing homes, health centres, medical centres, clinics and pharmacies were recruited through purposive sampling. Structured electronic questionnaires were administered to 45 respondents working within the study facilities over an 8-week period. Results: About 50% of personnel carrying out drug procurement belonged to non-pharmaceutical cadres namely; doctors, clinical officers, nurses and pharmacy assistants. Drug brand preferences among healthcare facilities and patients were mainly pegged on perceived quality and price. Unethical business competition practices were recorded, including poor professional demeanour and waiver of consultation fees veiled to undercut colleagues. Government subsidized drugs were sold at 100% profit in fifty percent of the facilities stocking them. In 44% of the facilities, the disposal of expired drugs was not in conformity to existing government regulatory guidelines. Conclusions: There is extensive task-shifting and delegation of pharmaceutical services to non-pharmaceutical cadres and poor observance of ethical guidelines in private facilities. Strict enforcement of regulations is required for optimal practices.

E-pharmacies in India: Can they improve the pharmaceutical service delivery?

E-pharmacies in India: Can they improve the pharmaceutical service delivery?

Implementing an Integrated Pharmaceutical Management Information System for Antiretrovirals and Other Medicines: Lessons From Namibia.

The success of the Namibian government's "treatment for all" approach to control and stop the country's HIV epidemic is dependent on an uninterrupted supply of antiretrovirals (ARVs) for people living with HIV. The public health system in Namibia, however, was constrained by an inefficient paper-based pharmaceutical information system resulting in unreliable and inaccessible data, contributing to persistent stock-outs of ARVs and other essential pharmaceuticals. This article describes the incremental implementation of an integrated pharmaceutical management information system to provide timely and reliable commodity and patient data for decision making in Namibia's national antiretroviral therapy (ART) program and the Ministry of Health and Social Services (MoHSS). The system has 4 interlinked information tools: (1) the Electronic Dispensing Tool (EDT) that manages the dispensing and inventory of antiretrovirals at service delivery points; (2) the EDT national database, which facilitates the flow, storage, and collation of ART data at the central level; (3) the Facility Electronic Stock Card used to manage pharmaceutical stocks and report inventory movement data to the national level; and (4) the Pharmaceutical Management Information Dashboard that integrates all 3 tools plus the warehouse management tool used by the central and regional medical stores into 1 dashboard that serves as a platform for the analysis and dissemination of pharmaceutical information throughout the health system. Implementing the pharmaceutical management information system was a prolonged and complicated process, with key challenges related to user acceptance and human resource constraints. The integrated pharmaceutical management information system enables Namibia to collect more than 90% of transactional commodity and patient dispensing data from more than 85% of all ART sites. Health managers use information from the system for medicine quantification decisions and to improve pharmaceutical service delivery. The MoHSS and its partners in the national ART program use the information for monitoring the World Health Organization early warning indicators for HIV drug resistance; ART defaulter tracing; and for planning, reporting, and research purposes. Namibia's pharmaceutical management information system demonstrates the feasibility and benefits of integrating related tools while maintaining their specialized functionality to address country-specific information and inventory management needs.

A review of factors that influence the use of community pharmacies as a primary health care resource

Abstract This review paper provides an analysis of a range of pharmacy practice, health services and sociological literature relevant to understanding how the public in the United Kingdom use and view community pharmacies as a primary health care resource. Papers published between 1980 and 1997 inclusive were identified, based on on-line searches of databases, and hand searches of a published literature index, relevant journals, and bibliographies of published papers. Papers included in the review are those which report findings on any aspect of consumers' views and use of community pharmacies. No attempt is made to evaluate the adequacy of the findings since the level of reporting in most short papers does not allow for this type of evaluation. Instead, the review paper “maps out” what is currently known about pharmacy utilisation. Key variables that have been used to explain pharmacy use, including a number of demographic and organisational factors, are identified, as well as factors associated with need and demand issues. The paper summarises the main empirical findings, and provides a view of where further work could add to a greater understanding of the relationship between the delivery of pharmaceutical services and primary health care. Potential strategies that could positively influence consumer demand for community pharmacy services are discussed.

Assessing pharmaceutical services at primary care clinics in KwaZulu-Natal: an indicator-based approach

Abstract Objective To obtain baseline data on the provision of pharmaceutical services at primary care clinics Method Internationally used standard and objective indicators were adapted for this study and used to assess the availability and quality of key drugs, and the quality of dispensing practice in a sample of primary care clinics in 1994 Setting The study was undertaken in three regions of the province of KwaZulu-Natal, South Africa Key findings It was found that the delivery of pharmaceutical services at primary care facilities was good, considering South Africa is a developing country in transition. However, some deficiencies were apparent. Recommendations for addressing these shortcomings are described. The challenge now is to maintain and improve the delivery of pharmaceutical services at primary care facilities in KwaZulu-Natal Conclusion The study provided baseline data against which progress in the implementation of the South African National Drug Policy (NDP) can be measured

Leading edge practitioners in community pharmacy: approaches to innovation

Abstract Despite the recommendations of the Nuffield (1986) and Pharmaceutical Care (1992) reports, implementation of the “wider role” in pharmacy practice has been piecemeal. While individual pharmacists have successfully introduced innovations in tasks and working methods, others have not. The paper explores the hypothesis that innovation is related to a set of (largely) generic characteristics possessed by those who promote professional change, together with enabling elements in the work environment. The hypothesis is explored by the identification of leading edge practitioners (LEPs) by key stakeholders in pharmaceutical service delivery and tested using critical incident analysis, an extended interview schedule and a psychometric test (KAI). LEPs were found to initiate more actions, to be more patient-centred, to be effective “soft” networkers, more focused on staff development and more effective influencers. There are wide implications for both providers and purchasers of pharmaceutical care, together with those who have a responsibility for training and development.

Pharmacists' Attitude to the Introduction of Automated Techniques in the Delivery of Pharmaceutical Services in Selected Nigerian Teaching Hospitals

This study has investigated the attitude of hospital pharmacists toward the introduction of automated techniques in the delivery of pharmaceutical services in three Nigerian Teaching Hospitals. The results obtained from this survey showed that pharmacists have a good understanding of the various forms of automated techniques in pharmacy operations. The general perception showed that these techniques will impact positively on different aspects of the pharmacists' functions including routine dispensing, drug inventory management, and administrative tasks. Computerization of the appropriate database and ease of accessibility including an online communication network within the health system would ease the pharmacists' administrative functions. The respondents felt that their pharmaceutical care functions would be enhanced greatly as the routine manual tasks are taken care of with the automation. In particular, the pharmacists' time would be released for a close monitoring of patient drug therapy and provision of drug information services. The general consensus was that appropriate training workshops and continuing pharmacy education programs would provide practicing pharmacists with the required skill to manage automated pharmacy systems.

Extemporaneous preparation teaching in UK schools of pharmacy: Anachronism or badge of office?

In this study, we aimed to establish the attitudes and beliefs of pharmacy staff currently teaching extemporaneous preparation in UK schools of pharmacy, regarding their perception of extemporaneous preparation teaching; their perceived significance of its inclusion in current MPharm degree programms, and their beliefs concerning the subject’s future sustainability.Fourteen individuals, each responsible for teaching extemporaneous preparation at a UK school of pharmacy, were interviewed by telephone using an inductive qualitative approach. Interviews were transcribed and the qualitative data wasmapped using a framework approach and analysed for underlying themes. Five main themes emerged from the transcriptions of the interviews: Logistical constraints associated with teaching; whether extemporaneous preparation is pharmaceutical science or practice, is in fact an art or not; whether extemporaneous preparation is outdated and irrelevant; the teaching of transferable skills; risk management associated with extemporaneous dispensing.These themes raise serious questions regarding the long-term sustainability of extemporaneous dispensing both as a professional activity for pharmacists and as a component of the MPharm degree. Yet whilst these teachers readily articulatedthat there had been a sharp decline in opportunities for practicing pharmacists to engage in small-scale medicines manufacturing, the scientific, practical and transferable skills enshrined in the teaching of extemporaneous preparation were defended as relevant to pharmacists’ contemporary professional practice. The responses by the university teachers interviewed indicate that they are fully aware of changes in pharmaceutical service delivery over recent years, and suggest that extemporaneous preparation teaching in UK schools of pharmacy has necessarily adapted to the changing environment in which pharmacy is practiced.

American Pharmacy: A Profession in the Final Stage of Dividing?

ABSTRACTThe organization and delivery of pharmaceutical services in the United States is undergoing sweeping changes, with implications to the future of pharmacy as a profession. This paper provides an overview of major educational, organizational, and economic changes in pharmacy during the twentieth century. Three main challenges have been faced by the pharmacy profession during the twentieth century: (1) the conflict between commercialism and professionalism in the practice of pharmacy, (2) the isolation of pharmacy education from the practice of pharmacy, (3) the choice between the drug product or the patient as pharmacy's social object. Using the professional dominance, deprofessionalization, and proletarianization theoretical perspectives, the authors conclude that the pharmacy profession is approaching the final stage of dividing into two groups: (1) a new patient-centered profession and (2) a new technical field.

Clinical pharmacy in primary care.

Clinical Pharmacy in the secondary care sector began to develop in the 1970s and has evolved into a service known as pharmaceutical care. The developments of such services in the primary care sector have not occurred at the same pace because of a remuneration structure which, to this day, largely depends on the speed and accuracy of dispensing a prescription. A complete examination and re-arrangement of the dual roles of the professional and trader is required in order to provide a more effective, efficient and easily accessible pharmaceutical care service within primary care. It has been suggested that up to 11.4% of hospital admissions [1–3] are related to the patient’s drug therapy and that if corrected at the dispensing stage would save considerable primary care costs [4]. An analysis of adverse drug reaction (ADRs) rates from 49 hospitals published in 36 articles stated that ADRs were responsible for 0.2–21.7% of hospital admissions [5]. Overall 71.5% of these were related to side effects, 16.8% were excessive effects, 11.3% were hypersensitivity reactions and 0.4% idiosyncratic. In 1989 Neville et al. [6], from a General Practitioner (GP) survey, stated that 1.06% of prescriptions had therapeutic errors but this may now be greater due to the inadequate control of a computerised repeat prescribing system [7]. This analysis of the prescribing in 50 GP surgeries revealed that 72% of repeat drugs had not been reviewed by a doctor for 15 months. Harris [8] reported that 75% of all prescribed items were repeats. These accounted for 81% of prescribing costs and 48.4% of patients obtained their next medicine supply by this method. Thus up to three quarters of all prescriptions may be generated by a patient initiating a repeat prescription. There is therefore a need for involvement by a clinical pharmacist at the prescribing and dispensing stages. This paper will focus on the limited reports of pharmaceutical care in the primary healthcare sector during the dispensing process. Pharmaceutical care The term ‘pharmaceutical care’ to replace clinical pharmacy was introduced by Brodie et al. [9] in 1980, when they suggested a complete change in the delivery of pharmaceutical services. Further developments of ‘pharmaceutical care’ were described by Hepler [10], as a covenantal relationship between a patient and a pharmacist, suggesting that pharmacists should accept more responsibility for drug use control. These concepts were further developed in 1989 by Hepler & Strand [11] who provided the now widely accepted definition of ‘pharmaceutical care’ as ‘the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life’. In 1986 the Nuffield Report [12] suggested that community pharmacists must be more patient-orientated. It also indicated that Pharmacy Practice (within the primary healthcare system) is an ‘area of health services research in which the greatest weaknesses are to be found. There is too little information available, relatively weak structures and very little funding’ [12]. The next dozen years have seen little change, and much of the Government funding has been spent on developing pilot services rather than their evaluation. Consequently when the funding has run out many of the services have ceased. Working party reports between 1986 and 1994 [13–16] have encouraged community pharmacy to assess its level of practice and research. Value for money and health outcomes will play a major role in the future and studies need to highlight the added value of community pharmaceutical services during the dispensing process. These studies should be based on the principles of pharmaceutical care especially the responsible provision of drug therapy, definite outcomes and quality of life issues. They also need to highlight the possible advantages for the development of multi-disciplinary teamwork amongst providers of care.

Quality Assessment and Quality Assurance of Pharmacy Services

OBJECTIVE: To review the concept of quality, the processes of quality assurance, and the methods of quality assessment as they relate to the delivery of pharmaceutical services. DATA SOURCES: Recent management and pharmacy literature. STUDY SELECTION: Not applicable. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: Quality implies value, worth, and degree of excellence. The structure-process-outcome paradigm of Donabedian is an often applied measure of quality. Quality assurance (QA) is the process by which we ensure that services are appropriate, effective, and efficient. Examples of QA programs in pharmacy are those of the performance indicators of the Joint Commission on Accreditation of Healthcare Organizations, criteria used in drug-use evaluations, disease-specific profiles used in disease management, and profiling of provider care systems using instruments such as the Health Plan Employer Data and Information Set (HEDIS, now in version 2.0). CONCLUSION: The next few years will witness much experimentation in QA processes and exciting new opportunities for pharmacists as more active participants in patient care.

Pharmaceutical service delivery by community pharmacies in areas of contrasting medical provision

The clinical content of community pharmacists' work was studied in a well-doctored and a poorly-doctored area. A total of 315 interactions between clients and pharmacy staff were observed. Some level of clinical work was recorded in approximately one-third of these interactions, with this proportion being significantly higher in the poorly-doctored area. Alternative interpretations of these findings are examined.

Delivery of Pharmaceutical Services in Poverty Areas

Delivery of Pharmaceutical Services in Poverty Areas