Provision Of Management Services Research Articles

An Economic Assessment of the Southern Atlantic Coastal Region’s Stormwater Management Practices

This study explores one of the least studied but most widely used instruments to control stormwater runoff — retention ponds. It is surprising that so little research within the economics literature has examined the efficacy of stormwater retention ponds. We address this gap in the literature by (1) offering a brief review of the existing literature; (2) discussing the nature of retention ponds as an impure public good; (3) extending a theoretical model to explain how stormwater runoff is currently managed; and (4) offering illustrative examples of governmental stormwater management practices in the coastal region of South Carolina. We posit that the current regulatory environment leads to a less than socially optimal level of management including a general lack of compliance enforcement and a misunderstanding of resource ownership. If sea levels continue to rise due to global climate change, then the mismanagement of stormwater runoff can lead to potentially severe adverse effects within coastal watersheds and estuarine ecosystems. We propose a combination of subsidy schemes and more-stringent enforcement actions to invoke a socially optimal provision of stormwater management services.

Challenges and barriers associated with medication management for home nursing clients in Australia: a qualitative study combining the perspectives of community nurses, community pharmacists and GPs.

Increasing numbers of older people are receiving home nursing support for medication management to enable them to remain living at home. Home nursing clients frequently experience medication errors and adverse medication events. There has been little study of how medication management processes and interdisciplinary teamwork impact on medication management in the home nursing setting. To explore medication management processes and describe barriers and challenges from the perspective of community nurses, community pharmacists and GPs involved in the provision of medication management services for home nursing clients. Focus groups, in-depth interviews and stakeholder consultations were conducted with a convenience sample of community nurses, community pharmacists and GPs. Data were analysed using the framework approach (a deductive thematic analysis) to identify issues affecting the delivery of medication management services. Ten focus groups, 12 in-depth interviews and 5 stakeholder consultation meetings were conducted with 86 health practitioners (55 community nurses, 17 GPs, 10 community pharmacists and 4 nurse managers). Participants highlighted a range of barriers and challenges associated with medication management for home nursing clients, including deficiencies in interdisciplinary communication; problems related to organizational or workplace policies, processes and systems; and ineffective team function. The negative impacts of these were recognized as compromised client safety, reduced workforce efficiency and productivity and compromised interprofessional relationships. Barriers and challenges with medication management for home nursing clients and associated negative impacts were identified. Strategies are needed to improve interdisciplinary medication management and medication safety in the home nursing setting.

General public perceptions of pharmacy and pharmacist business practices in English community pharmacy

Individuals who suffer from major cardiovascular events every year have one or more risk factors. Cardiovascular disease (CVD) risk assessment is an important strategy for the early identification of modifiable risk factors and their management. There is substantial evidence that shifting the focus from treatment to primary prevention reduces the burden of CVD.To evaluate the preparedness of community pharmacists in Qatar for the provision of CVD risk assessment and management services; and to explore the pharmacists' views on the provision of these services.A cross-sectional study using simulated-client methodology. Using standardized scenarios, community pharmacists were approached for consultation on two medicines (Aspirin® and Crestor®) used for managing specific CVD risk factors. Pharmacists' competency to assess CVD risk was the primary outcome evaluated. Scores for each outcome were obtained based on the number of predefined statements addressed during the consultation.The mean cumulative score for all the competency outcomes assessed was 11.7 (SD 3.7) out of a possible score of 31. There were no differences for the majority of the competencies tested between the two scenarios used. Significantly more pharmacists exposed to the Aspirin® scenario than to the Crestor® scenario addressed hypertension as one of the risk factors needed to assess CVD risk (22% versus 11%, p = 0.03); whereas significantly more pharmacists in the Crestor® scenario compared to the Aspirin® scenario, addressed dyslipidemia as one of the risk factors needed to assess CVD risk (30% versus 7%, p = 0.02). Significantly more pharmacists exposed to the Aspirin® scenario provided explanation about CVD risk than those exposed to the Crestor® scenario 36% versus 8%, p < 0.01).The results suggest that many community pharmacists in Qatar are not displaying competencies that are necessary for the provision of CVD prevention services.

Asssesing the effectiveness and impact of agricultural water management interventions: the case of small reservoirs in northern Ghana

Agricultural water management, particularly management of multi-purpose small reservoirs (SRs) in drier savanna areas of the northern Ghana, is being promoted as a key solution to improve agricultural production, enhance food security and livelihoods of smallholder farm households. However, little empirical evidence exist on how effective these small water infrastructures are in terms of delivering multiple benefits and their impact on the livelihood of smallholder farmers. This study assessed the effectiveness and impact of the small reservoirs on smallholder vegetable farmers in northern Ghana. A participatory rating method using a 5-point Likert-scale was used to assess the effectiveness of SRs in delivering multiple livelihood benefits and an endogenous switching regression model was applied to assess the SRs’ impact using a primary data collected from 328 randomly sampled vegetable farmers. Results from the Likert scale analysis show that most of the SRs are either dysfunctional or underutilized and not effective in delivering multiple benefits. Results from the endogenous switching regression model show that there is only about 3% increase in the income of vegetable farmers participating in irrigated vegetable production using SRs against the counterfactual situation but this change is insignificant statistically. The current low level effectiveness and impact of SRs could be enhanced by improving their management, for example, through the provision of incentive mechanisms such as subsidies to the private sector involvement in rehabilitation, management and irrigation service provision and strengthening the capacity of existing water users associations. Furthermore, small reserviors should be recognized not only as water sources for small scale irrigation but also as providers of multiple livelihood benefits to local communities and consequently should attract due attention in public resource allocation in their rehabilitation and management/institutional capacity building.

Regional Variation in Pharmacist Perception of the Financial Impact of Medicare Part D.

The objective of this study was to perform a nationwide investigation of the financial performance of community pharmacies in the United States since the inception of Medicare Part D. A nationwide, cross-sectional survey of pharmacists was conducted in 2013. The 43-item online survey collected information about demographics, financial implications of Part D on community pharmacy and patients, provision of Medication Therapy Management (MTM) services and opinions about Medicare Part D 2010 updates. The adjusted response rate was 22.3% (419/1885). A majority of respondents (75.6%) reported a stable or increased prescription volume since 2006 but only 40.4% indicated that the financial performance of their pharmacy as either excellent or good during the same period. Owners and part-owners of rural independent pharmacies were more likely to report a below average or poor financial performance (75.0%). The provision of MTM services was not related to the financial performance of the pharmacy. Nearly half (44.7%) of pharmacy owners or part-owners indicated that they were considering selling their pharmacy, with most (94.1%) reporting that their decision to sell was due to the Part D financial pressures. However, the decision to sell was not related to the change in financial performance since 2006 or the volume of prescriptions dispensed.

Municipal solid waste management: Constraints and opportunities to improve capacity of local government authorities of Phnom Penh Capital.

Solid waste management is a challenge for Phnom Penh city owing to the increasing volume of waste produced and insufficient collection capacity. Sustainable management is required in response to continuing population growth and urbanisation. This article aims to examine the status and constraints of solid waste management in Phnom Penh and discuss the performance of local government authorities to propose possible mechanisms and strategies to improve the system. Data were collected through literature reviews, key informant interviews and focus group discussions with the local government authorities. Six performance measures were used as assessment variables, including technical, environmental, institutional and organisational, financial and economic, social and cultural, and policy and legal factors. Limited institutional capacity and performance are the consequence of insufficient decentralisation power and allocation of budget and workforce for promoting technological and environmentally sustainable practices. Lack of cooperation and coordination among relevant agencies led to their unwillingness to participate in management performance. A decentralisation and provision of management services in the public-private partnership would enable operational procedures that enhance accountability, transparency, efficiency, and productivity at the local level.

Use of withdrawal management services among people who use illicit drugs in Vancouver, Canada

BackgroundFor many individuals with substance use disorders, the entry point for addiction treatment can be through withdrawal management (e.g. detoxification) services. However, little is known about the factors that predict withdrawal management service use among people who use illicit drugs (PWUD). Using data derived from two prospective cohorts of PWUD, we conducted a longitudinal data analysis of factors associated with use of withdrawal management services.MethodsIndividuals participating in two cohorts of PWUD were prospectively followed between December 2005 and May 2016 in Vancouver, Canada. Bivariate and multivariate generalized estimating equations were used to examine factors associated with use of withdrawal management services.ResultsOut of a total of 2001 participants, 339 (16.9%) individuals reported having been to a withdrawal management centre in the previous 6 months at some point during the study period. In multivariate analyses, male sex (adjusted odds ratio [AOR]: 1.62, 95% Confidence Interval [CI]: 1.17–2.24), homelessness (AOR: 1.86, 95% CI: 1.45–2.38), binge use of any substance (AOR: 1.34, 95% CI: 1.08–1.67), having attended a supervised injection facility (AOR: 1.66, 95% CI: 1.3–2.11), and having accessed other addiction medicine treatment or supports (other than withdrawal management services or opioid agonist therapy; AOR: 3.34, 95% CI: 2.64–4.22) were positively associated with having accessed withdrawal management services, whereas older age (AOR: 0.81, 95% CI: 0.7–0.94) was negatively associated with the outcome.ConclusionsThis study identified specific factors associated with accessing withdrawal management services. Current evidence suggests a need to re-examine the provision of withdrawal management services. Consideration needs to be given to redesigning access to care and bridging to evidence-based addiction treatment, particularly for highly vulnerable subpopulations, identified in this study as females and older people.

Factors that influence the intent of pharmacists in the provision of medication therapy management services

Medication adherence can be divided into primary and secondary adherence. Primary medication non-adherence (PMN) occurs when a patient does not obtain medicine with their initial prescription. Secondary non-adherence measures prescription refills among patients who previously filled their first prescription. While secondary non-adherence has been studied thoroughly, PMN has been assessed less extensively, due to lack of available data. Estonian ePrescription system might prove a valuable tool for this.The aim of this study was to evaluate PMN and the interval between prescribing and dispensing of medicines using the Estonian ePrescriptions database to establish its potential use for this purpose and for other qualitative drug utilization research measures. Osteoporosis medicines were used as an example.The Estonian Prescription Centre was used to evaluate if patients purchase medicines after initial prescription of osteoporosis medicine. Prescriptions from 2012 to 2015 of all patients over 18 were included. PMN was defined as the first prescription not being dispensed before it expired (60 days). The rate of PMN was calculated.Estonian ePrescription System enabled fast evaluation of PMN of osteoporosis patients based on data about prescribing, dispensing and time intervals in-between. Of patients who started osteoporosis treatment 13.1% were primary non-adherent. Of primary non-adherent patients 42% still started treatment at some point during the study. Of patients who did purchase their first prescription 80.4% did so within a week and 95% within 25 days.The Estonian ePrescription system is a useful tool for monitoring PMN. The PMN of osteoporosis medicines was identified as lower than previously reported. More similar type of studies about other groups of medicines would be needed to understand the pattern of PMN and give valuable information to healthcare specialists about how to increase initiation of treatment.

Evaluation of community pharmacists' preparedness for the provision of cardiovascular disease risk assessment and management services: A study with simulated patients.

Individuals who suffer from major cardiovascular events every year have one or more risk factors. Cardiovascular disease (CVD) risk assessment is an important strategy for the early identification of modifiable risk factors and their management. There is substantial evidence that shifting the focus from treatment to primary prevention reduces the burden of CVD. To evaluate the preparedness of community pharmacists in Qatar for the provision of CVD risk assessment and management services; and to explore the pharmacists' views on the provision of these services. A cross-sectional study using simulated-client methodology. Using standardized scenarios, community pharmacists were approached for consultation on two medicines (Aspirin® and Crestor®) used for managing specific CVD risk factors. Pharmacists' competency to assess CVD risk was the primary outcome evaluated. Scores for each outcome were obtained based on the number of predefined statements addressed during the consultation. The mean cumulative score for all the competency outcomes assessed was 11.7 (SD 3.7) out of a possible score of 31. There were no differences for the majority of the competencies tested between the two scenarios used. Significantly more pharmacists exposed to the Aspirin® scenario than to the Crestor® scenario addressed hypertension as one of the risk factors needed to assess CVD risk (22% versus 11%, p = 0.03); whereas significantly more pharmacists in the Crestor® scenario compared to the Aspirin® scenario, addressed dyslipidemia as one of the risk factors needed to assess CVD risk (30% versus 7%, p = 0.02). Significantly more pharmacists exposed to the Aspirin® scenario provided explanation about CVD risk than those exposed to the Crestor® scenario 36% versus 8%, p < 0.01). The results suggest that many community pharmacists in Qatar are not displaying competencies that are necessary for the provision of CVD prevention services.

Beyond lifestyle interventions: exploring the potential of anti-obesity medications in the UK.

SummaryIn the UK, over one‐quarter of the adult population have obesity (body mass index ≥30 kg m−2). This has major implications for patients’ health and the National Health Service. Despite published studies showing that significant weight loss can be achieved and maintained in primary care, and guidance from the National Institute for Health and Care Excellence, weight management services are inconsistently implemented. This may be due primarily to workload and financial constraints. There is also a lack of belief that specialist weight management services and anti‐obesity medications (AOMs) are a viable alternative to bariatric surgery for long‐term maintenance of weight loss. This article discusses the challenges facing obesity management and explores the reasons for the lack of investment in AOMs in the UK to date. The aim of this article is to identify whether the newer AOMs, such as naltrexone/bupropion and liraglutide 3.0 mg, are likely to perform better in a real‐world setting than current or withdrawn AOMs. In addition, it considers whether the equitable provision of specialist weight management services and future clinical trial design could be improved to help identify those individuals most likely to benefit from AOMs and, thus, improve outcomes for people with obesity in the UK.

How Methodology Makes Topics: Ageing Immigrants as a Blind Spot in the Migration Research in Austria. A Research Note

The current research note describes a process where by applying the qualitative method of expert interviews, researchers got confronted with a new topic in their area of expertise that was not on the radar of their research. In the framework of an evaluation study on health promotion interventions for migrants in an urban setting, researchers applied a mixed methods approach. Quantitative element was a self-assessment tool, where providers of health promotion measures described their clientele and rated the quality of their services along given categories. Qualitative element was a series of semi-structured interviews with management and front line service providers. While the self-assessment tool delivered expected results, the interviews revealed an aspect concerning needs and problems of a migrant group researchers had not thought of before. This is the group of immigrants from the 1960ies, coming mainly from Turkey and Former Yugoslavia, now reaching or having reached retirement age. This group was reported as being extremely vulnerable and at risk of a double discrimination as being “old” and “migrant”.&#x0D; Desk research was conducted in reaction to such data, showing that information on this group is scarce. Given the demographic developments with rising shares of (old) aged immigrants living in Austria, it will be important to improve the respective knowledge base.

SAVM: A practical secure external approach for automated in‐VM management

SummaryIn‐VM management is usually needed by cloud service providers for cloud management, which includes monitoring the in‐VM application running state, reconfiguring VM system settings, etc. In‐VM management is also very useful in green cloud computing, because it provides the abilities of in‐VM monitoring, VM reconfiguration, performance measurement, etc. Leveraging a shell or an in‐VM agent to manage VMs is faced with generality and security challenges. In this paper, we propose a secure automated in‐VM management approach, ie, SAVM, which likes a hypervisor‐based shell managing the VMs in an out‐of‐box way. To bridge the semantic gap, we reuse the target VM's system calls to process the semantic information automatically. More importantly, we introduce a secure instruction fetch approach to enhance the system security. As a result, SAVM does not rely on the target VM's kernel integrity. In addition, we also present a dummy process selection and a system call injection method to further enhance the system security and transparency. After the implementation, we evaluate the prototype. The experimental results show that SAVM can achieve most of the in‐VM management operations. Furthermore, SAVM can work correctly under the target VM attacked by several popular rootkits.

The Professional Culture of Community Pharmacy and the Provision of MTM Services.

The integration of advanced pharmacy services into community pharmacy practice is not complete. According to implementation research understanding professional culture, as a part of context, may provide insights for accelerating this process. There are three objectives in this study. The first objective of this study was to validate an adapted version of an organizational culture measure in a sample of United States’ (US) community pharmacists. The second objective was to examine potential relationships between the cultural factors identified using the validated instrument and a number of socialization and education variables. The third objective was to examine any relationships between the scores on the identified cultural factors and the provision of MTM services. This study was a cross-sectional online survey for community pharmacists in the southeastern US. The survey contained questions on socialization/education, respondents’ self-reported provision of medication therapy management (MTM) services, and the organizational culture profile (OCP). Analyses included descriptive statistics, a principle components analysis (PCA), independent samples t-test, and multivariate ordinal regression. A total of 303 surveys were completed. The PCA revealed a six-factor structure: social responsibility, innovation, people orientation, competitiveness, attention to detail, and reward orientation. Further analysis revealed significant relationships between social responsibility and years in practice, and people orientation and attention to detail and pharmacists’ training and practice setting. Significant positive relationships were observed between social responsibility, innovation, and competitiveness and the increased provision of MTM services. The significant relationships identified between the OCP factors and community pharmacist respondents’ provision of MTM services provides an important starting point for developing interventions to improve the uptake of practice change opportunities.

Insights of a root cause analysis of long waits within a Child Development Service: Opportunities for Integrated Care

Introduction: As at 1st June 2017, children were waiting ~ 261 days for their first clinical appointment with the Children’s Health Queensland (CHQ) Child Development Service (CDS) with 25% waiting longer than their clinically indicated wait time. Objectives: The Clinical Services Redesign (CSR) methodology was applied to identify and respond to the root causes contributing to long waits and improve the provision of timely and integrated care for children with suspected developmental problems or delay. Highlights: The redesign included quantitative data analysis and consultation with 21 consumers, 110 staff surveys, 67 referrer surveys and 129 workshop participants. Issues contributing to long waits included (a) a loosely applied scope of service, (b) a complicated triage process with excessive processing; and (c) inefficient clinical service delivery processes. The findings have prompted a review of operational processes to improve efficiency and facilitate establishment of integrated care for this population. Opportunities to improve integration of care to include: (a) Empowering primary care providers with an easy to use tool to determine most appropriate care pathway for children with developmental questions, (b) Support capability development of Primary Care and Generalist Child Development service providers in assessment and management of developmental presentations and (c) Partner with internal and community providers to facilitate wrap around support for families. Conclusions: In a well-meaning effort to ‘fill the gaps’, the CDS has been operating out of scope which has delayed service delivery for all families. Opportunities to foster an integrated care continuum for this cohort will form a core component of the solution to reducing bottlenecks for this service, but more importantly, to provide families the right service at the right time. The opportunities identified will be helpful considerations for other specialist outpatient services struggling with long waits.

Techno-economic assessment of dispatchable hydrogen production by multiple electrolysers in Libya

With the worldwide growth of renewable energy generation, the value of hydrogen production by electrolysis as a demand management tool for electricity networks is likely to increase. Electrolytic hydrogen can be sold as a fuel, chemical feedstock or injected into pipelines to lower the carbon content of natural gas. The main obstacle to hydrogen’s use as a fuel or energy storage method is the price. The highest costs are in the capital expenditure and the consumption of feedstock (electricity and water). In this paper, three major techno-economic aspects of the system are investigated, including technical analyses of both the energy absorbed by the process in the provision of electricity demand management services and in its meeting of fuel demand, plus an economic assessment of the hydrogen price at the at the point of sale. Thus, the study investigates how only off-peak electricity is used to produce hydrogen via onsite electrolysis at a number of garage forecourts. In a simulated case study, six garage forecourts are assumed to be sited in Darnah, a small city on the east coast of Libya. An electricity pricing mechanism is devised to allow the energy producer (utility company) and energy consumer (garage forecourt operator) to make a profit. Short term (2015) and long term (2030) cost scenarios are applied. Matlab software was used to simulate this process. Without any government support or changes in regulation and policy, hydrogen prices were £10.00/kg, £9.80/kg, £9.60/kg, £10.00/kg, £9.40/kg and £10.30/kg for forecourts 1–6 respectively under the 2015 cost scenario. The electricity price represents around 17% of the total hydrogen cost, whereas, due to the investment cost reduction in 2030, the average prices of hydrogen dropped to £6.50/kg, £6.60/kg, £6.30/kg, £6.40/kg, £6.20/kg and £6.50/kg for stations 1–6 respectively. The feedstock cost share became 44% in the 2030 cost scenario. Nearly 53.91% and 53.77% of available energy is absorbed in short and long term scenarios respectively. Under the long term cost scenario, 65% of hydrogen demand can be met, whereas less than 60% of hydrogen demand is met under the short term scenario. The system reliability (i.e. the meeting of hydrogen fuel demand) is quite low due to the operational mode of the system. Increasing the system size (mainly electrolyser production capacity) can clearly improve the system reliability.

Are miserly budgets putting businesses at risk of cyber-attack?

If you perform a search of the term ‘ransomware’ on Google, you will see two things. The first is a definition of WannaCry, the ransomware attack that, on 12 May 2017, spread around the world and affected hundreds of targets, including public utilities, large corporations and, most notably, crippled the NHS in the UK. 1 But you'll also see a series of news stories and, regardless of what day you type ‘ransomware’ into the search bar, you're likely to see stories of attacks from just days ago, or, in some cases, just hours ago. All businesses are at risk of cyber-attacks that are all too often successful. Is this due to a lack of budget, or are budgets being spent in the wrong way? Would simply spending more money be enough to help? All businesses face budget pressures – which means they need to understand how to spend their budgets wisely. And this is where managed service providers (MSPs) can play a crucial role. Tim Brown of SolarWinds explains how MSPs can supply the skills and expertise to ensure that businesses have the right combination of technology and personnel.

Barriers to the provision of asthma services and perceived practice towards asthma management among urban community pharmacists in Selangor, Malaysia

This study aims to assess the perceived practice and barriers towards the provision of asthma management services among urban community pharmacists in Selangor, Malaysia. The study also highlights both pharmacist and patient-related barriers in asthma counseling. One hundred fifty urban community pharmacists in Selangor, Malaysia, were randomly selected and recruited for the present cross sectional baseline study. Previous studies have explored pharmacists’ perception on their roles in asthma management in different parts of the world. The data was collected through self-explanatory questionnaires (containing 47 items). The extracted data from the completed questionnaires were analyzed descriptively and inferentially using Statistical Package for Social Science (SPSS) version 19. Results showed that pharmacists perceived their roles in asthma management along three major dimensions: ‘patient self-management’, ‘medication use’ and ‘asthma control’, mean (±SD) score of the perception towards asthma management was 99.29 ± 4.58 over a maximum possible score of 110 with 90.26%. There were significant differences between the pharmacy education level and perceived practice of asthma management while there were insignificant differences between age, gender, ethnicity, number of practicing year and perceived practice of asthma management among respondents. Most common barriers towards asthma counselling including lack of time, lack of asthma knowledge, lack of counselling space and cost of asthma drugs. Conclusively, urban community pharmacists in Selangor, Malaysia, demonstrate good perceived practice of better management of asthma with multidimensional dimensional role against in disease care.

Vouchers for primary healthcare services in an ageing world? The perspectives of elderly voucher recipients in Hong Kong.

Considering the ageing population in economically advanced regions across the world, measures are necessary to enhance the health of the older population as well as contain public healthcare spending. Hong Kong implements the Elderly Health Care Voucher Scheme (EHCVS), providing older people aged 65 or above an annual subsidy of visiting private healthcare service providers for chronic disease prevention and management. The services also aim at reallocating demand from the public to private sector as well as improve quality of services. This qualitative study explored the experiences of EHCVS recipients (n=55, aged 61-94) with eight focus group interviews in Hong Kong in the year 2016. Convenience sampling was used. Research questions were: (1) Why do older people choose not to use EHCVS for preventive as well as disease management services among older people in Hong Kong? (2) What are the barriers to reallocating demand from the public to private sector? (3) In what ways did EHCVS improve the quality of primary care services for older people? Using a deductive and inductive approach, eight qualitative themes were identified. Findings suggested that the non-targeted services and inadequate knowledge on EHCVS deterred older people from using the vouchers for disease management and prevention. The relatively expensive private services, lack of trust in the private sector, low public clinic fees and good services quality of the public sector, together with inadequate private practitioners in the healthcare market were barriers that hinder demand reallocation. Nevertheless, the quality of primary care services had been improved after the implementation of EHCVS with shortened wait times and opportunities to discuss health-related issues with private practitioners. Findings were discussed with practice, policy and research implications.

Community Resident’s Opinions and Perceptions on the Effectiveness of Waste Management and Recycling Potential in the Umkhanyakude and Zululand District Municipalities in the KwaZulu-Natal Province of South Africa

Despite new environmental laws and regulations in South Africa during the last two decades, especially around municipal solid waste management, there is little emphasis towards waste minimization through recycling. Whereas most waste management research in South Africa has focused on urban municipalities, not much is known regarding the effectiveness of waste management services and recycling challenges in rural areas. This paper reports on the effectiveness of waste management practices from the perspective of community residents in selected rural districts of the KwaZulu-Natal province. A random sample comprised of 333 community residents was selected for questionnaire-administered interviews. Based on the opinions and perceptions of respondents, the provision of waste management services is generally inadequate. Apart from the successful collection of domestic solid wastes (66.7%) from households by municipalities, the collection of recyclable waste materials from illegal waste dumps (75%) and from households (68.7%) are not being adequately provided. Thus, levels of dissatisfaction regarding municipal collection services are very high (97.3%) amongst respondents. Furthermore, systematic recycling initiatives that involve communities are largely non-existent and most (96.7%) respondents lack relevant technical knowledge on waste recycling and how it can be carried out effectively through waste segregation at source and other processes.

Competencies for the provision of comprehensive medication management services in an experiential learning project.

ObjectiveTo understand students’ and tutors’ perceptions of the development of clinical competencies for the delivery of comprehensive medication management services in an experiential learning project linked to a Brazilian school of pharmacy.MethodsAn autoethnographic qualitative study was carried out based on participant observation, focus groups and individual interviews with students and tutors involved in an experiential learning project.ResultsThe study revealed the development of competencies related to the philosophy of practice, the pharmacotherapy workup of drug therapy and interprofessional relationships.ConclusionsThe experiential learning project contributed to the professional development of pharmacy students in pharmaceutical care practice, pointing to its potential benefits for incorporation into professional pharmacy curricula.