Patient-centred Role Research Articles

Development of hospital clinical pharmacy services in Denmark from 2008 to 2023

ObjectivesThe role of the hospital pharmacist is evolving, and in many countries pharmacists play an increasingly patient-centred role in healthcare. This study aimed to investigate the development of Danish hospital...

TH5.12 Impact of Nurse Specialist to Clinical Outcomes after Emergency Laparotomy

Abstract Aims The role of the Emergency Laparotomy nurse specialist (EmLapNS) is under-researched. In addition to data collection for ELLSA (Emergency Laparoscopic and Laparotomy Scottish Audit), the EmLapNS may provide: education; ERAS principles (daily chest exercises and early mobilisation); advocacy; multidisciplinary meetings; emotional support. We report on clinical outcomes before and after the appointment of an EmLapNS. Methods Retrospective analysis was performed on data collected from one site as part of ELLSA. The data were compared between 6 months of 2017 (pre-EmLapNS) and 6 months of 2021 (post-EmLapNS). The role of ELLSA nurse was explored using key ELLSA clinical outcome markers. Results 95 patients underwent EmLap in 2017 and 68 in 2021. Comparing pre-EmLapNS vs post-EmLapNS, the median age was 66 vs 61 years, 52.6% vs 45.6% were females and 63.2% vs 60.3% were ASA ≥3. Post-operative chest physiotherapy post op day 1–3 was performed in 8.8% pre-EmLapNS versus 48.4% post-EmLapNS (p<0.05); 30-day morbidity was 52.6% vs 33.8% (p<0.05) and length of stay was 11 days vs 8 days. 30-day mortality and rates of readmission were unchanged (11.6% vs 8.8% and 10.5% vs 11.8% respectively). Conclusions The introduction of EmLapNS has significantly improved morbidity and perioperative care. These clinical improvements are likely to be complemented by other aspects of this patient-centred role which require further analysis.

Pharmacists' perceptions on real-time prescription monitoring (RTPM) systems – a cross-sectional survey

BackgroundReal-time prescription monitoring (RTPM) systems are an effective tool to help health practitioners monitor opioid use and reduce opioid-related harm but little has been reported about the support required by pharmacists to engage with them effectively in practice. ObjectiveTo evaluate the current understanding and perceptions of Western Australian pharmacists regarding RTPM systems and opioid-related harm, and investigate their self-reported training and support requirements prior to RTPM system implementation. MethodsThis cross-sectional, prospective study involved an online Qualtrics survey distributed to Western Australian community or hospital pharmacists involved in dispensing and patient-centred roles via local professional pharmacy newsletters and social media. Data collection included demographic information, responses to authentic case scenarios and Likert-scale questions regarding perceptions and training requirements of a RTPM system, pain management and opioid-related harm. Descriptive analysis was utilised. ResultSixty-two pharmacists responded to the questionnaire. Most (58/61; 95.1%) had a positive attitude towards RTPM systems, but only 33/61 (54.1%) reported being prepared for its implementation. Perceived barriers to successful implementation included lack of remuneration (46/60; 76.6%), conflict with prescribers (40/60; 66.7%), increased workload (37/60; 61.7%), staff safety concerns (34/60; 56.7%) and lack of knowledge regarding RTPM systems (32/60; 53.3%). Even though most participants were satisfied with training previously received, over 90% reported requiring further training and education, especially regarding RTPM systems (51/57; 96.2%) and opioid-related harm (56/57; 98.2%). ConclusionAmong a small sample of participants, there was a strong positivity regarding the value of RTPM systems and a high degree of receptiveness to further training in preparation for RTPM implementation.

Evaluation of pharmaceutical education in the State of Libya: An academic perspective

Objective: This study evaluates the quality of educational standards in the colleges of pharmacy in the State of Libya using FIP-QA framework which is made of five sections representing the five pillars of quality, namely: context, structure, process, outcomes and impact. Method: A questionnaire was constructed based on the indicators in each section of the framework. Answers were collected by distributing the questionnaire to eight colleges of pharmacy at public universities. Results: 42 out of 50 professors completed the questionnaire. Most participants believe that the context, structure and process of pharmaceutical education in Libya require significant improvement in order to comply with international standards. Conclusions: Since the impact of pharmacy education depends on the previous pillars, it is clear that the current curricula are inefficacious in producing graduates who have the competencies to exercise patient-centred roles, and to address the limitations in providing pharmaceutical care-related services.

Health-related stakeholders\u2019 perceptions of clinical pharmacy services in Qatar

Background In Qatar, the National Vision 2030 and the National Health Strategy 2018–2022 articulate the need to improve healthcare delivery by better utilisation of the skilled workforce. In this regard, pharmacy practice is rapidly advancing and several extended pharmacy services are now available in institutionalised settings. Objective This study aimed to determine health-related stakeholders’ perceptions of current clinical pharmacy services in Qatar, and the potential development and implementation of further patient-centred roles. Setting All major organisations and institutions relating to the practice, education, regulation, and governance of pharmacy in Qatar. Method Qualitative, face-to-face semi-structured interviews were conducted with individuals in key strategic positions of policy development and influence (i.e. health-related academic leaders, healthcare policy developers, directors of medicine/pharmacy/nursing, and patient safety leaders). Participants were recruited via a combination of purposeful and snowball sampling, until the point of data saturation was reached. The interview guide was grounded in the Consolidated Framework for Implementation Research domains of innovation characteristics, outer and inner setting, characteristics of individuals, and implementation process. The interviews were digitally recorded, transcribed and independently analysed by two researchers using the Framework approach. Main outcome measure Perceptions of stakeholders regarding current and potential for future clinical pharmacy services in Qatar. Results Thirty-seven interviews were conducted with stakeholders of policy influence in healthcare. The interviewees reported a variety of clinical pharmacy services available in Qatar, which they perceived as positively impacting patient care outcomes, pharmacists’ professional autonomy, and the healthcare system in general (innovation characteristics). However, they perceived that these services were mainly performed in hospitals and less in community pharmacy setting (inner setting) and were undervalued by patients and the public (outer setting). Expansion of pharmacists’ clinical activities was supported, with recognition of facilitators such as the skillset and training of pharmacists, potential time release due to automation and well-considered implementation processes (characteristics of individuals, inner setting, process). Conclusion Health-related stakeholders in Qatar have positive perceptions of current clinical pharmacy services and support the expansion of pharmacist’s roles. However, service development needs to consider the issues of patient and public awareness and initially target institutionalised healthcare settings.

Ethics Education for Contemporary Clinical Pharmacy Practice in Nigeria: Shortfalls and Needs

The past decade has witnessed a shift in the ambitions of pharmacists away from the core role of dispensing medicines towards more interesting and rewarding relationships and responsibilities with other healthcare providers and patients. The patient-centred role of pharmacists has allowed ethical issues experienced in medical practice to surface in pharmacy practice, resulting in an increase in the number and variety of ethical dilemmas that pharmacists face in their routine pharmacy practice. Pharmacy education prepares pharmacy students for practice and must be in tune with the professional dynamics. Many countries that provide patient-centered pharmacy services have redesigned pharmacy ethics education while others are in various stages of revision of their curriculum in order to adequately equip future pharmacists with the rudiments required to handle ethical issues in clinical pharmacy practice. In contrast, in Nigeria, little or no pharmacy ethics is taught to pharmacy students and the challenge lies with the curriculum design and method of teaching.

Pharmacists of the future: What determines graduates' desire to engage in patient-centred services?

Pharmacists increasingly need to provide patient centred activities like medicine management (e.g., medicine use review/home medicine review), screening for chronic illness (e.g., point of care testing for cardiovascular diseases including hypertension and hypercholesterolemia), treatment for chronic conditions (e.g., warfarin for thrombotic prophylaxis), and primary care treatment (trimethoprim, emergency contraceptive pill, and sildenafil). However, the adoption of patient-centred services into practice is still low, and it not known which pharmacist characteristics are associated with the adoption of these services. The primary objective of this study was to investigate whether personality and other characteristics of pharmacy graduates are associated with their intention to provide patient-centred services in the future. The study design was a cross-sectional survey of pharmacy graduates from the University of Otago at the end of 2017. The web-based survey involved several potential determinants: (1) the Achievement Goals Questionnaire (Revised), (2) five-factor ('Big Five') model of personality, (3) decision-making style using the Rational Experiential inventory, (4) general self-efficacy, (5) sense of belonging to the pharmacy profession. Additionally, interest in provision of services was assessed. A total of 83 graduates completed the survey (response rate 63%, female 64%, age 22.5 years, SD: 1.7). Intention to provide patient-centred services was associated with higher: conscientiousness, agreeableness, and extraversion; mastery-approach; self-efficacy; and sense of belonging to the profession. Relative to the New Zealand population norms, these students were higher in conscientiousness and lower in neuroticism. Graduates were more interested in providing new patient-centred roles than more traditional services. Overall, pharmacy graduates were very positive regarding their future involvement in patient-centred services. Pharmacy graduates' sense of self-efficacy and a sense of belonging in the profession were associated with interest in patient-centred roles. Increasing their self-efficacy and sense of belonging to the profession and building on their enthusiasm as new graduates are key to greater provision of patient-centred activities.

Why shouldn't we do that on placement if we're doing it in the real world? Differences between undergraduate and graduate identities in speech and language therapy.

Healthcare graduates are often characterised as ill-prepared for workplace entry. Historically, research on health professional's work preparedness has focused on the quality of graduates' clinical knowledge, skills and problem-solving. This ignores the role of professional identity formation in determining readiness for clinical practice. Yet, professional identity defines graduate self-perception, how others perceive them and informs clinical behaviour. The scholarship of identity formation at the transition from undergraduate to graduate is characterised by individual (cognitive) rather than relational (sociocultural) perspectives. Yet there is growing recognition that identity formation is not just individually mediated, but is also constructed between individuals and social context. The aim of this study was to explore professional identity formation among undergraduates and graduates from one healthcare profession (speech and language therapy-SLT) using a sociocultural theoretical standpoint. A qualitative descriptive methodology was used. Final (4th) year SLT undergraduate students and graduate SLTs with less than 2years' clinical experience participated in individual semi-structured interviews. Thematic analysis was used to describe patterns in the data, which were subsequently subjected to interpretation informed by the constructs of Figured Worlds. Data analysis revealed that undergraduate professional identity was characterised by dependency, self-centredness (as opposed to patient-centredness), and a naïve role concept. Graduate identity on the other hand included expectations of self-sufficiency, patient-centredness and a more nuanced perception of the professional role. Undergraduates have naïve, prototypical understandings of what it is to be a graduate practitioner. The nature of undergraduate clinical placement hinders meaningful identity development. This suggests that curriculums should facilitate undergraduates to act with meaningful autonomy and to be positioned in more patient-centred roles, e.g. involvement in the decision-making process for patients. Graduates may then feel more authentic as autonomous professionals in their early graduate posts. This leads to better graduate, patient and service outcomes.

The Need to Introduce Simulation-Based Teaching in Pharmacy Education in Saudi Arabia.

Pharmacists worldwide, including Saudi Arabia, are now increasingly expected to play a more patient-centred role. The transition of pharmacists from a dispensing role to a more patient-centred clinical role requires the adoption of innovative learning techniques in pharmacy teaching and learning to transform the future pharmacy workforce. One such innovation in pharmacy education is simulation-based pharmacy teaching. The use of simulation in pharmacy education allows pharmacy students to not only improve their clinical knowledge and skills, but also serves as a tool to improve their critical thinking that is a pre-requisite in sound clinical decision-making. Given the importance of patient-oriented teaching in pharmacy education, the majority of institutions offering pharmacy education in the developed countries have successfully integrated simulation-based teaching in their respective curricula to meet both patient and practice needs. However, most of the universities offering undergraduate pharmacy programs in the developing world, including Saudi Arabia, have limited application of patient-focused teaching in their respective programs. This article aims to highlight the importance of introducing simulation-based teaching in pharmacy education in Saudi Arabia.

Role of the pharmacist in parenteral nutrition therapy: challenges and opportunities to implement pharmaceutical care in Kuwait.

Background:Pharmacists can provide beneficial pharmaceutical care services to patients receiving Parenteral Nutrition (PN) therapy by working within Nutrition Support Teams (NSTs).Objective:This study was designed to explore pharmacists’ role in PN therapy in hospitals of Kuwait, sources of PN-related information, opinions on NSTs, perceptions about the barriers to pharmaceutical care implementation and views on how to enhance their practices.Methods:Data were collected via face-to-face semi-structured interviews with the senior Total Parenteral Nutrition (TPN) pharmacists at all the hospitals which provide TPN preparation services (six governmental hospitals and one private hospital) in Kuwait. Descriptive statistics were used to describe pharmacists’ demographic details and practice site characteristics. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.Results:The pharmacists mainly performed technical tasks such as TPN compounding with minimal role in providing direct patient care. They used multiple different sources of TPN-related information to guide their practice. They reported positive and negative experiences with physicians depending on their practice environment. None of the hospitals had a functional NST. However, pharmacists expressed preference to work within NSTs due to the potential benefits of enhanced communication and knowledge exchange among practitioners and to improve service. Pharmacists perceived several barriers to providing pharmaceutical care including lack of reliable sources of TPN-related information, lack of a standard operating procedure for TPN across hospitals, insufficient staff, time constraints and poor communication between TPN pharmacists. To overcome these barriers, they recommended fostering pharmacists’ education on TPN, establishing national standards for TPN practices, provision of pharmacy staff, development of NSTs, enhancing TPN pharmacists’ communication and conducting TPN-research research.Conclusion:TPN pharmacists in Kuwait are confined to performing TPN manufacturing processes. There are promising avenues for future development of their role in patient care. This can be achieved by overcoming the barriers to pharmaceutical care practice and providing pharmacists with educational opportunities to equip them with the clinical competencies needed to practise as nutrition support pharmacists with patient-centred roles.

Experiential Training for Pharmacy Students: Time for a New Approach

The pharmacy profession in Canada finds itself in the midst of transformational change. The regulation and expanded scope of practice of pharmacy technicians that is under way across the country, combined with the advent of new drug distribution technologies in both the hospital and community practice settings, have created the opportunity for pharmacists to largely relinquish their traditional role in the drug distribu tion system. This change will permit pharmacists to take on new and expanded patient-centred roles and responsibilities. However, patient-centred care requires a different set of skills and training (e.g., clinical practice skills, critical thinking skills, decision-making skills under conditions of uncertainty, collab orative interpersonal practice skills) than those that were needed to be a good pharmacist in the past (e.g., attention to detail, accuracy, risk aversion). Pharmacy educational programs will have to produce confident graduates who are able and willing to assume responsibility and accountability for drug therapy management. Experiential training is viewed as an essential requirement for the development of these skills. As the profession moves forward with implementation of the Vision for Pharmacy contained within the Blueprint for Pharmacy, 1 there has been

There is More Wrong with Medical Education than Accreditation

The failures of health professional education are multi-faceted. The governance issues described by de Leeuw represent ‘the tip of the iceberg’ of the problems. Other, probably more important issues, are the loss of the ‘core values’ underpinning the healing professions, and a scientism-based approach to practice based on a naive view of evidence that fails to register ‘one’s delusion of certainty’. The selection of students lacking humanistic trades perpetuates the demise of the healing (meaning making whole again of all of the dis-ease domains) professions. The change required to achieve ‘balanced’ health professionals that treat the human condition of dis-ease with the scientific advances of managing disease is a change in core values and a selection of patient-centred role models. An example shows how patients can ultimately be our best allies in achieving these ‘long-overdue’ changes.

Pharmacy Faculty Members' Perception of Contemporary Pharmacy Practice

Objective: Previous research has shown that community pharmacists describe their role mostly in product-focused rather than patient-centred terms. We wondered if pharmacy faculty members think similarly, which might influence how students, and subsequently, new pharmacists think. The objective of this study was to examine how pharmacy faculty members describe the health care role of pharmacists. Method: We telephoned 101 randomly selected Canadian pharmacy faculty members. The surveyor posed as a sociology student studying the use of language. We asked a single question: “What does a pharmacist do?,” asking respondents to answer in a few short phrases that were recorded verbatim. Responses were analyzed by content and categories were established from previous studies, coded as “patient-centred,” “product-focused (dispensing),” “research” or “business-related.” Results: Ninety-four faculty members (71% were pharmacists) provided 200 responses. Of the responses, 40% were categorized as patient-centred, 32.5% were product-focused and 5% were research- or business-related. Evaluating participants' first responses, faculty members who were pharmacists offered a patient-centred description in 59% of responses, while non-pharmacists provided a more pro duct-focused description. The most frequently used terms to describe a pharmacist's role were: patient, medication, educate, dispense, responsible, safety and ensure. Conclusions: Pharmacy faculty members' perception of the role of pharmacists may influence the culture of the profession. We found that faculty members were more idealistic about patient-centred roles for pharmacists than community or hospital pharmacists, but a large proportion (mainly nonpharmacist faculty members) still describe a product-focused role.

Improving the working relationship between doctors and pharmacists: is inter-professional education the answer?

Despite their common history, there are many cultural, attitudinal and practical differences between the professions of medicine and pharmacy that ultimately influence patient care and health outcomes. While poor communication between doctors and pharmacists is a major cause of medical errors, it is clear that effective, deliberate doctor-pharmacist collaboration within certain clinical settings significantly improves patient care. This may be particularly true for those patients with chronic illnesses and/or requiring regular medication reviews. Moreover, in hospitals, clinical and antibiotic pharmacists are successfully influencing prescribing and infection control policy. Under the new Irish Pharmacy Act (2007), pharmacists are legally obliged to provide pharmaceutical care to their patients, thus fulfilling a more patient-centred role than their traditional 'dispensing' one. However, meeting this obligation relies on the existence of good doctor-pharmacist working relationships, such that inter-disciplinary teamwork in monitoring patients becomes the norm in all healthcare settings. As discussed here, efforts to improve these relationships must focus on the strategic introduction of agreed changes in working practices between the two professions and on educational aspects of pharmaceutical care. For example, standardized education of doctors/medical students such that they learn to prescribe in an optimal manner and ongoing inter-professional education of doctors and pharmacists in therapeutics, are likely to be of paramount importance. Here, insights into the types of factors that help or hinder the improvement of these working relationships and the importance of education and agreed working practices in defining the separate but inter-dependent professions of pharmacy and medicine are reviewed and discussed.

Doctors’ perception and expectations of the role of the pharmacist in Punjab, Pakistan

Purpose: To investigate doctors’ perception and expectations of the role of pharmacists in Pakistan’s healthcare system.Methods: This was a cross-sectional study and the study population consisted of 462 medical doctors from three Pakistani cities in Punjab State, namely, Islamabad, Faisalabad and Lahore. The doctors were selected from government hospitals in these three cities.Results: Three hundred and fifty four questionnaires were returned, giving a response rate of 76.6 %. Sixty eight percent of the doctors appeared comfortable with pharmacists playing patient-centred roles. A majority (84.5 %, n=299; p=0.022) expected pharmacists to take personal responsibility for resolving any drug-related problem. Furthermore, 76 % of them considered pharmacists as knowledgeable drug therapy experts. Only 50 % of the doctors thought that pharmacists apply their drug knowledge in practice while 11 % indicated that pharmacists routinely counselled their patients. Conclusion: The doctors considered pharmacists drug information experts but their expectation of pharmacists as providers of quality clinically-focused pharmacy services was low. The doctors were also uncomfortable with pharmacists providing direct patient care.Keywords: Doctor, Pharmacist, Perception, Expectation, Patient care, Pakistan.

2007 guidelines for the management of dyslipidemia and prevention of cardiovascular disease by pharmacists

Introduction Despite the observation that age-specific mortality rates from coronary heart disease (CAD) have declined by nearly 40% in Canada over the past several decades, this disease continues to be the leading cause of death and morbidity for Canadians. Hyperlipidemia (especially an elevated low-density lipoprotein cholesterol [LDL-C] level and/or elevated total cholesterol to high-density lipoprotein cholesterol [TC:HDL-C] ratio) is recognized as a major independent risk factor for CAD. Recently, the large international case-controlled INTERHEART study demonstrated that an abnormal lipid profile was the most important modifiable risk factor associated with myocardial infarction. Consequently, national guidelines have been promulgated and regularly updated on the basis of accumulating clinical trial evidence to assist health care practitioners with diagnosis and treatment of patients with dyslipidemia. In Canada, these guidelines were updated and published in September 2006. Given advancements in pharmacy practice and current expectation that pharmacists take a more active role in and responsibility for medication management and patient health outcomes, pharmacists should be taking steps to identify and collaboratively manage patients with dyslipidemia. To emphasize where the knowledge and skills of pharmacists should be applied in the management of patients with dyslipidemia, the 2006 Canadian Cardiovascular Society [CCS] position statement (Recommendations for the Diagnosis and Treatment of Dyslipidemia and Prevention of Cardiovascular Disease) has been adapted and expanded. These Canadian pharmacist practice guidelines are a part of the continuing national effort to recognize and advance “the responsible and patient-centred role of the pharmacist” in chronic disease management. As key players in the health care system, pharmacists should use their knowledge, skills, and relationship with patients to improve the management of dyslipidemia and prevent cardiovascular disease. Consequently, these guidelines emphasize the role of the pharmacist in all aspects of managing the disease: • Identification and screening of patients • Individual cardiovascular (CV) risk assessment • Establishing appropriate lipid targets, based on CV risk • Lifestyle modification • Recommending and monitoring appropriate drug treatment • Ensuring patient adherence with treatment • Specialty clinic referral Readers interested in more detail or background on any of the above should refer to the full recommendations.

The evolution of the doctor-patient relationship

The doctor-patient relationship has undergone a transition throughout the ages. Prior to the last two decades, the relationship was predominantly between a patient seeking help and a doctor whose decisions were silently complied with by the patient. In this paternalistic model of the doctor-patient relationship, the doctor utilises his skills to choose the necessary interventions and treatments most likely to restore the patient's health or ameliorate his pain. Any information given to the patient is selected to encourage them to consent to the doctor's decisions. This description of the asymmetrical or imbalanced interaction between doctor and patient [Parsons T. The social system. Free Press, New York, 1951.] 1 has been challenged during the last 20 years. Critics have proposed a more active, autonomous and thus patient-centred role for the patient who advocates greater patient control, reduced physician dominance, and more mutual participation. This patient-centred approach has been described as one where “the physician tries to enter the patient's world, to see the illness through the patient's eyes” [McWhinney I. The need for a transformed clinical method. In: Stewart M, Roter D, Communicating with medical patients. London: Sage, 1989.] 2 , and has become the predominant model in clinical practice today.

Nursing perspectives for intensive care.

Within health care, market forces increasingly determine what services have economic value. For nursing to survive this economic onslaught, nurses must clarify their values and roles. While nurses working in intensive care develop useful technical skills and normally work within a constructive multi-disciplinary team framework, they have a potentially unique contribution to care, focusing on the patient as a whole person rather than intervening to solve a problem. The need for both physiological and psychological care creates a need for holistic values, best achieved through humanistic perspectives. Humanistic nursing places patients as people at the centre of nursing care, as illustrated by the limitations of reality orientation compared with the potentials of validation therapy. Intensive care nurses asserting and developing such patient-centred roles offer a valuable way forward for nursing to develop into the 21st century.

Hypertension screening and management in general practice: I. R. McWhinney, University of Western Ontario Medical School, London, Ontario, Canada; A. Donner; M. Bass; J. A. Farmilo

The doctor-patient relationship has undergone a transition throughout the ages. Prior to the last two decades, the relationship was predominantly between a patient seeking help and a doctor whose decisions were silently complied with by the patient. In this paternalistic model of the doctor-patient relationship, the doctor utilises his skills to choose the necessary interventions and treatments most likely to restore the patient's health or ameliorate his pain. Any information given to the patient is selected to encourage them to consent to the doctor's decisions. This description of the asymmetrical or imbalanced interaction between doctor and patient [Parsons T. The social system. Free Press, New York, 1951.]1 has been challenged during the last 20 years. Critics have proposed a more active, autonomous and thus patient-centred role for the patient who advocates greater patient control, reduced physician dominance, and more mutual participation. This patient-centred approach has been described as one where “the physician tries to enter the patient's world, to see the illness through the patient's eyes” [McWhinney I. The need for a transformed clinical method. In: Stewart M, Roter D, Communicating with medical patients. London: Sage, 1989.]2, and has become the predominant model in clinical practice today.