Autonomy Of Pharmacists Research Articles

CURRENT TRENDS OF TRAINING SPECIALISTS IN THE PHARMACEUTICAL INDUSTRY THROUGH THE PRISM OF ETHICAL AND PROFESSIONAL STANDARDS

The article focuses attention on the need to research modern trends in the training of pharmaceutical industry specialists through the prism of deontological and professional standards. It was established that the modern system of professional training of future specialists in the pharmaceutical industry was influenced by the changes that the industry underwent after Ukraine gained independence: a significant reduction in the range and volume of production of domestic pharmaceutical products, orientation towards European standards of professional training of specialists, compliance with the ethical principles of the work of pharmaceutical specialists. It is noted that the Code of Ethics of Pharmaceutical Workers of Ukraine became the basic regulatory regulator of pharmacist professional ethics in Ukraine, but the further development of international legislation requires adaptation of the domestic pharmaceutical education system to its requirements. The article analyzes the key normative documents that determine the deontological and professional standards for the training of pharmaceutical industry specialists. Modern trends in the training of specialists in the pharmaceutical industry are defined as: the focus on increasing the prestige of the pharmacist profession, raising its status and improving its image in society; compliance with high standards of professional behavior of pharmaceutical industry specialists; strengthening of patient- and client-oriented professional activity in the field of pharmacy, which meets the modern requirements of deontological and professional standards regarding the transfer of emphasis from subject-object interaction in the specialist-client-patient plane to subject-subject interaction; strengthening the professional autonomy of pharmacists among other specialists of the health care system.

Collaborative drug therapy modification (CDTM): Facilitators, barriers, and perceptions of individual pharmacist participation in Georgia

BackgroundGeorgia Board of Pharmacy (BOP) regulations permit pharmacists to engage in collaborative drug therapy modification (CDTM) with physicians, allowing them to perform patient assessments, adjust pharmacotherapy, and order laboratory tests. Pharmacist-led CDTM can positively affect health outcomes leading to reduced healthcare expenditures. CDTM is underutilized, with < 1% of Georgia pharmacists holding an active license to practice CDTM. Objective(s)The objective of this study was to examine CDTM licensed pharmacists’ perceptions of facilitators and barriers in providing CDTM. MethodsGeorgia-licensed CDTM pharmacists were invited to participate in a 60-minute qualitative interview. Interview questions were developed from electronic survey responses. The interview was designed to elicit information regarding perceived benefits and barriers to CDTM implementation. Guided by the Consolidated Framework for Implementation Research, thematic analysis was applied to identify themes using ATLAS.ti software to code. Themes were described qualitatively and prevalence of each was reported. ResultsNine interviews were conducted, and data saturation was achieved at interview 6. After resolution of discrepancies, 100% coding agreement was reached among 2 independent researchers. Nine themes were identified, and each was categorized as a facilitator or barrier to establishing pharmacist-led CDTM in Georgia. Themes associated with facilitating were (prevalence %) (1) practice autonomy (100), (2) personal attributes (100), (3) having support (100), and (4) institutional logistics (88). Barrier themes included issues concerning (5) the Georgia BOP (100), (6) pharmacist autonomy (88), (7) lack of provider status (88), (8) institutional restrictions (75), and (9) personal development (e.g., confidence) (22). ConclusionFacilitators to the establishment of pharmacist-led CDTM exist and pharmacists can capitalize on these to create successful CDTM programs. Barriers are varied, and it may be difficult to systematically address individual barriers such as pharmacist autonomy and personal development. Barriers associated with institutional restrictions, the Georgia BOP, and lack of provider status can likely be removed or addressed by policy.

“Reigns but does not govern": A reflection on professionalism and the autonomy of the pharmacist

IntroductionIn recent decades, the professionalization of pharmacy has been debated worldwide. With the advent of industrialization, pharmacist autonomy has weakened, especially in the retail pharmacy market. Manegers and mentors of pharmacy chains serve as links between the profession and drug users. This study sought to understand the perceptions of retail pharmacy stakeholders regarding pharmacist autonomy and how to improve it, and to reflect on theories of professionalism. Method19 semi-structured interviews were conducted. The interviews were transcribed and analyzed through analyst triangulation and categorical content analysis, using the ATLAS.ti software. ResultsInterviews were conducted with nine mentors and ten managers in retail medicine. They reported aspects related to managerial and technical autonomy regulated by law, and strategies for enhancing professional autonomy in retail pharmacy. Autonomy was considered limited by pharmacists’ dependence on employability and self-devaluation; and market control exposed the weaknesses in pharmaceutical professionalism. Entrepreneurship and ownership attitude strategies were feasible only in a retail micro-political context. ConclusionThe retail medicine continues to have business model centered on the product and controlling the pharmaceutical practice model. To ensure autonomy and professional strengthening, it is necessary that pharmacy recognizes itself as a clinical profession and develops a stable professional identity.

A Proposal on the Pharmacy Specialists in Japan

In Japan, each society has developed its own certification system for the pharmacy specialists in a specific area of pharmaceutical care. Since 2020, we have conducted research activities supported by a Grant-in-Aid for Scientific Research from the Ministry of Health, Labour and Welfare to assure the quality of pharmacy specialists similar as other medical professionals. We proposed three reform plans. First, we defined a pharmacist career path after obtaining a license by redefining the name of a qualified pharmacist: Step 1, Training-Certified Pharmacist; Step 2, Board-Certified Pharmacist; and Step 3, Pharmacy Specialist. Second, we proposed common external standards for the Pharmacy Specialist. Third, we proposed the need for third-party certification for pharmacy specialists. New reforms for the pharmacy specialists are required under the autonomy of pharmacists.

Expanding pharmacists’ roles: Pharmacists’ perspectives on barriers and facilitators to collaborative practice

ObjectiveThe pharmacy profession is shifting from transactional dispensing of medication to a more comprehensive, patient-centered model of care. Collaborative practice agreements (CPAs) extend the role of a pharmacist to initiate, monitor, modify, and discontinue drug therapies and provide other clinical services. Although collaborative practice has been shown to improve health system efficiency and patient outcomes, little is known about how pharmacists perceive CPAs. To explore pharmacists’ perspectives of CPAs, including barriers and facilitators to CPA implementation. MethodsSemistructured key informant interviews were used to elicit information from licensed pharmacists practicing in a variety of settings in Arizona. Thematic analysis was used to identify key qualitative themes. ResultsSeventeen interviews of pharmacists with (n = 11, 64.7%) and without (n = 6, 35.3%) CPAs were conducted in April-May 2019. The pharmacists saw their role in CPAs as supportive, filling a care gap for overburdened providers. A heightened sense of job satisfaction was reported owing to increased pharmacist autonomy, application of advanced knowledge and clinical skills, and ability to have a positive impact on patients’ health. Challenges to the implementation of CPAs included liability and billing issues, logistic concerns, some experiences with provider hesitancy, and lack of information and resources to establish and maintain a CPA. The barriers could be overcome with conscious team-building efforts to establish trust and prove the worth of pharmacists in health care teams; strategic engagement of stakeholders in the development of CPAs, including billing and legal departments; and mentorship in the CPA creation process. ConclusionsThe pharmacists in this study enjoyed practicing collaboratively and had overall positive perceptions of CPAs. As health worker shortages become more dire and pharmacy practice evolves to expand the role of pharmacists in providing direct patient care, CPAs will be an important tool for restructuring care tasks within health systems.

A New Care Model Reduces Polypharmacy and Potentially Inappropriate Medications in Long-Term Care

ObjectivesAssess the impact of a new pharmaceutical care model on (1) polypharmacy and (2) potentially inappropriate medication (PIM) use in long-term care facilities (LTCFs). DesignPragmatic quasi-experimental study with a control group. This multifaceted model enables pharmacists and nurses to increase their professional autonomy by enforcing laws designed to expand their scope of practice. It also involves a strategic reorganization of care, interdisciplinary training, and systematic medication reviews. Setting and ParticipantsTwo LTCFs exposed to the model (409 residents) were compared to 2 control LTCFs (282 residents) in Quebec, Canada. All individuals were aged 65 years or older and residing in included LTCFs. MeasuresPolypharmacy (≥10 medications) and PIM (2015 Beers criteria) were analyzed throughout 12 months between March 2017 and June 2018. Groups were compared before and after implementation using repeated measures mixed Poisson or logistic regression models, adjusting for potential confounding variables. ResultsOver 12 months, for regular medications, polypharmacy decreased from 42% to 20% (exposed group) and from 50% to 41% (control group) [difference in differences (DID): 13%, P < .001]. Mean number of PIMs also decreased from 0.79 to 0.56 (exposed group) and from 1.08 to 0.90 (control group) (DID: 0.05, P = .002). Conclusions and ImplicationsCompared with usual care, this multifaceted model reduced the probability of receiving ≥10 medications and the mean number of PIMs. Greater professional autonomy, reorganization of care, training, and medication review can optimize pharmaceutical care. As the role of pharmacists is expanding in many countries, this model shows what could be achieved with increased professional autonomy of pharmacists and nurses in LTCFs.

Pharmacist value-added to neuro-oncology subspecialty clinics: A pilot study uncovers opportunities for best practices and optimal time utilization.

To evaluate neuro-oncology clinician time utilization for medication management and identify a cost beneficial role for integration of a dedicated pharmacy specialists. A pharmacist was temporarily integrated into a neuro-oncology clinic for a 30-day period to evaluate the clinical practice and perform a 14-day clinical chart evaluation and patient interactions as part of a single institutional exploratory analysis. The pharmacist completed screenings for drug-drug interactions, new therapies, medication reconciliation, and advanced interventions as part of a collaborative practice agreement for pharmacist autonomy. Pharmacist time spent was calculated and documented within the patient encounters to support physician decision-making. A comparative estimate of pharmacist versus physician time utilization and cost for each was completed to derive a savings analysis for integration of a dedicated clinic pharmacist. During the 14-day clinical assessment, the pharmacist completed 147 encounters with 338 interventions. Of the encounters, 90% (n = 132) were higher complexity requiring plan modification, and approximately 48% (n = 162) of all interventions required ≥10 minutes of the pharmacist's time. Physician non-patient-facing time devoted to medication tasks was 5-hours weekly (0.125 FTE, full time equivalents), an estimated direct salary cost of $937/week ($45,000 yearly). Hire of a part-time pharmacist at 0.50 FTE would cover the clinical need with supported documentation and medication monitoring at a cost of $45,000/year. Defining the roles for dedicated neuro-oncology clinic pharmacists allows for cost-savings through re-allocation of physician time and improves subspecialty clinic operations as well as patient care.

Resident physicians' perceptions of ambulatory care pharmacy.

Background:Physicians’ acceptance of clinical pharmacy services is dependent on exposure to those services, with use increasing as resident physicians progress through their training. Resident physicians train within environments that have a multidisciplinary teaching and clinical care approach, working closely with other healthcare professionals. Ambulatory care pharmacists are increasingly working with resident physicians in clinic settings as part of the multidisciplinary team, and identification of resident physicians’ perceptions may influence future collaboration.Objective:The objective of this research is to evaluate the perception of ambulatory care clinical pharmacy services from the perspective of resident physicians.Methods:A statewide network of ambulatory care pharmacists was identified and received an electronic questionnaire. Pharmacists working within clinics that serve as training sites for resident physicians then completed and distributed questionnaires to the resident physicians within their clinical site. Items related to demographics and perception of involvement and interactions with clinical pharmacists.Results:Forty-five resident physicians responded from four unique clinical sites (response rate = 42%). They agreed or strongly agreed that pharmacists help patients obtain their therapeutic goals (97.8%), are able to educate patients effectively (95.6%), provide high quality care (97.8%), and do a good job helping co-manage patients (91.1%). Previous exposure to pharmacists was limited primarily to the drugstore (48.9%) and hospital (51.1%) settings. Resident physicians in the third year of training and those reporting a friend was a pharmacist, were more likely to have a positive perception of the pharmacist’s role as a resident educator (p=0.048 and p=0.044, respectively).Conclusions:Resident physicians with a longer duration of exposure and personal friendship with a pharmacist are more likely to express positive perceptions. Areas for further enhancements in this interprofessional relationship related to perceptions about pharmacist autonomy and patient relationships were identified.

Hepatitis B Virus (HBV) Screening and Associated Outcomes in Malignant Hematology Patients Receiving Rituximab Therapy within the Rossy Cancer Network

Introduction. Hepatitis B Virus (HBV) reactivation is an important risk of Rituximab therapy, a potent immunosuppressant used as part of chemotherapy regimens against non-Hodgkin's lymphoma. HBV reactivation is a potentially fatal complication that can be largely prevented with antiviral prophylaxis and monitoring of HBV DNA. American Society of Clinical Oncology (ASCO) 2015 guidelines recommend that all patients be screened for both hepatitis B core antibody (anti-HBc) and surface antigen (HBsAg) before initiating Rituximab therapy. According to ASCO, the rates of screening for non-Hodgkin's lymphoma patients before the administration of Rituximab were less than 70% in 2014 for US centers participating in ASCO's Quality Oncology Practice Initiative. A 2014/15 study at the McGill University Health Centre found that about a third of patients were inadequately screened (A Lawandi, et al).Methods. The objective of this retrospective study was to assess the quality of HBV screening and monitoring at the partner hospitals of the Rossy Cancer Network (RCN). From the pharmacy database of the Jewish General Hospital, McGill University Health Centre, and St. Mary's Hospital Center, we obtained the set of patients with hematologic malignancies who began Rituximab treatment between April 2014 and March 2016. We then collected laboratory data on the screening of anti-HBc and HBsAg. Screening was considered appropriate if performed for both anti-HBc and HBsAg in the 6-month window preceding Rituximab administration and considered suboptimal if patients were tested outside this time frame, or for only one of the two tests. Additionally, patient chart reviews were used to collect follow-up information and outcomes for screened patients. Follow-up was considered appropriate when anti-viral treatment was given for infected patients and when patients at risk for reactivation received prophylactic treatment or HBV DNA monitoring.Results. Four hundred and seventy-four patients initiated Rituximab-containing treatment. Of those, 213 (45%) met the criteria for appropriate HBV screening and 138 (29%) for suboptimal screening. Of the patients that were screened (N=351), 6 were actively infected (HBsAg+/ anti-HBc+) and 41 were at risk for reactivation (HBsAg-/ anti-HBc+). All actively infected patients received antiviral treatment as per ASCO guidelines but only 18 (44%) of patients at risk for reactivation received appropriate follow-up, prophylactic treatment or HBV DNA monitoring. HBV reactivation was noted in 2 patients, one of whom died of a hepatic flare.Conclusion. Between 2014 and 2016, less than 50% of Rituximab-treated hematologic cancer patients within the RCN partnered hospitals were appropriately screened for HBV, and 44% of patients at risk for reactivation received appropriate follow-up. In response to these findings, the RCN Hematology Disease Site Group is developing RCN clinical practice guidelines to standardize HBV testing and management of patients at-risk for HBV reactivation. In close collaboration with virologists and hepatologists, the group will provide targeted education sessions to improve compliance with clinical practice guidelines. Additionally, the group aims to implement pharmacy-based interventions, such as coupling Rituximab prescriptions with standard orders for HBV testing, and providing pharmacist autonomy to order HBV testing. DisclosuresAssouline:Novartis: Research Funding; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Honoraria, Research Funding, Speakers Bureau; Pfizer: Honoraria, Research Funding, Speakers Bureau; Roche: Honoraria, Research Funding, Speakers Bureau.

Current perspectives on pharmacist home visits: do we keep reinventing the wheel?

The scope of clinical pharmacy services available in outpatient settings, including home care, continues to expand. This review sought to identify the evidence to support pharmacist provision of clinical pharmacy services in a home care setting. Seventy-five reports were identified in the literature that provided evaluation and description of clinical pharmacy home visit services available around the world. Based on results from randomized controlled trials, pharmacist home visit interventions can improve patient medication adherence and knowledge, but have little impact on health care resource utilization. Other literature reported benefits of a pharmacist home visit service such as patient satisfaction, improved medication appropriateness, increased persistence with warfarin therapy, and increased medication discrepancy resolution. Current perspectives to consider in establishing or evaluating clinical pharmacy services offered in a home care setting include: staff competency, ideal target patient population, staff safety, use of technology, collaborative relationships with other health care providers, activities performed during a home visit, and pharmacist autonomy.

Improving hepatitis B screening prior to rituximab at a multispecialty urban hospital.

176 Background: Rituximab(R) is a novel anti-CD20 monoclonal antibody used in multiple hematologic and rheumatologic diseases. Patients who are hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HBcAb) positive are at risk for hepatitis-B reactivation with R-based treatments. Therefore, the VA’s medication use evaluation tracker recommends serological testing for HBsAg, HBsAb and HBcAb within 6 months prior to initiating R. We conducted a PDSA cycle to improve Hepatitis-B serological testing in patients receiving R at Birmingham VA medical center (BVAMC). Methods: For baseline evaluation, patients at BVAMC who were treated with R between 2004- march 2014 were retrospectively evaluated for HBV serology results 6 months prior to first treatment. Presence of all 4- HBsAg, HBsAb and HBcAb (IgM and total) was complete; absence of all 4 was ‘not done’ with remaining being incomplete. After conducting a RCA, 3 pharmacy-based interventions were implemented- 1) pharmacy education; 2) pharmacist autonomy to order hepatitis B serology eliminating physician dependence; 3) pharmacy reminders to health care providers to order HBV serology. We aimed to improve ‘complete’ screening rates to &gt; 90% in the post-intervention period (april 2014-sep 2016). Results: In the pre-intervention group (n = 162), majority (81%) had hematologic indications and complete testing was performed in 38%, reminder being incomplete (13%) or not done (49%). Post-intervention (n = 86), majority (54%) had rheumatologic indications with complete testing in 71%, incomplete in 15% and not done in 14%. No Hepatitis B reactivations were identified in either study periods. Conclusions: Pre-intervention, ‘complete’ testing was performed in only one-third of patients and our intervention was effective in almost doubling screening rates. We also demonstrate increasing use of Rituximab in non-hematologic conditions and with second-generation anti-CD20 Ofatumumab and Obinutuzumab also requiring similar testing; our study could standardize Hep-B screening for these agents. A second PDSA cycle with a reflex ‘forcing-function’ EMR-based tool to decrease reliance on human factors is planned to meet the study goal of &gt; 90%.

When procedures meet practice in community pharmacies: qualitative insights from pharmacists and pharmacy support staff

ObjectivesOur aim was to explore how members of community pharmacy staff perceive and experience the role of procedures within the workplace in community pharmacies.SettingCommunity pharmacies in England and Wales.Participants24 community...

Evaluation of a Pharmacy-Managed Pharmacokinetic Dosing Program

Purpose: The objective of this study was to determine the impact of a pharmacy-managed pharmacokinetic dosing program on appropriate dosing of famotidine, enoxaparin, and ketorolac. Methods: A large community teaching hospital implemented a pharmacy-managed pharmacokinetic dosing program for famotidine, enoxaparin, and ketorolac. Subjects were included if they received famotidine and had a creatinine clearance (CrCl) of <50 mL/min; received therapeutic enoxaparin and had a CrCl of <30 mL/min; or received ketorolac and had a CrCl <30 mL/min, age > 65 years or weight <50 kg. Results: One hundred and forty-six patients were included in the preimplementation group (famotidine [n = 50], enoxaparin [n = 46], and ketorolac [n = 50]) and 143 patients were included in the postimplementation group (famotidine [n = 50], enoxaparin [n = 43], and ketorolac [n = 50]). In all, 66% of patients were dosed appropriately in the preimplementation group (famotidine 28%, enoxaparin 85%, and ketorolac 86%) compared to 94% in the postimplementation group (famotidine 92%, enoxaparin 95%, and ketorolac 94%), P < .001. Conclusion: Implementation of a pharmacy-managed pharmacokinetic dosing program significantly improved appropriate dosing of famotidine, enoxaparin, and ketorolac. These findings could justify expansion of pharmacist autonomy through institution–approved, pharmacy-managed programs for other medications to improve appropriate dosing. Analyses specifically evaluating patient-oriented or financial outcomes may provide additional support for expansion.

A cross-sectional study of applied bioethical reasoning in pharmacy students and preceptors

To compare ethical principles most often utilized by pharmacy students and preceptors to determine plan of action for an ethical dilemma and to determine if ethical principles utilized are the same for individuals in the postconventional range. A two part survey was administered to a convenience sample of pharmacy students and preceptors. The first part was comprised of an original measure, the Pharmacy Ethical Dilemmas Survey (PEDS), that was developed to assess participants' action choices on healthcare-related ethical dilemmas and which moral rule or ethical principle was most influential in their decision. The second part was comprised of the Defining Issues Test. Patient autonomy and non-maleficience were the primary bioethical principles applied by students but pharmacists applied non-maleficience, patient autonomy, and also pharmacist autonomy. For all scenarios, students were more likely to rely on the principle of beneficence, while preceptors were more likely to rely on the pharmacist's right to autonomy. In the analysis of application of bioethical principles by higher and lower principled reasoning individuals, only in the assisted suicide scenario did the two groups agree on the primary principle applied with both groups relying predominantly on patient autonomy. Students and preceptors utilize different bioethical principles to support how they would handle each ethical dilemma but P-scores do not play a role in determining which bioethical principles were used to justify their action choices.

The corporatization of community pharmacy: Implications for service provision, the public health function, and pharmacy's claims to professional status in the United Kingdom

Background Pharmacy has experienced both incomplete professionalization and deprofessionalization. Since the late 1970s, a concerted attempt has been made to re-professionalize pharmacy in the United Kingdom (UK) through role extension—a key feature of which has been a drive for greater pharmacy involvement in public health. However, the continual corporatization of the UK community pharmacy sector may reduce the professional autonomy of pharmacists and may threaten to constrain attempts at reprofessionalization. Objectives The objectives of the research: to examine the public health activities of community pharmacists in the UK; to explore the attitudes of community pharmacists toward recent relevant UK policy and barriers to the development of their public health function; and, to investigate associations between activity, attitudes, and the type of community pharmacy worked in (eg, supermarket, chain, independent). Methods A self-completion postal questionnaire was sent to a random sample of practicing community pharmacists, stratified for country and sex, within Great Britain (n = 1998), with a follow-up to nonresponders 4 weeks later. Data were analyzed using SPSS (SPSS Inc., Chicago, IL, USA) (v12.0). A final response rate of 51% (n = 1023/1998) was achieved. Results The level of provision of emergency hormonal contraception on a patient group direction, supervised administration of medicines, and needle-exchange schemes was lower in supermarket pharmacies than in the other types of pharmacy. Respondents believed that supermarkets and the major multiple pharmacy chains held an advantageous position in terms of attracting financing for service development despite suggesting that the premises of such pharmacies may not be the most suitable for the provision of such services. Conclusions A mixed market in community pharmacy may be required to maintain a comprehensive range of pharmacy-based public health services and provide maximum benefit to all patients. Longitudinal monitoring is recommended to ensure that service provision is adequate across the pharmacy network.