Skills Of Pharmacists Research Articles

Pharmaceutical Review: Resource Implications for the Pharmacy Component in Australian Public Hospitals

ABSTRACTBackgroundPharmaceutical review requires a facility‐wide approach and multidisciplinary collaboration between all involved in the use of medicines. Standards of practice for clinical pharmacy services and distribution of medicines, provide a blueprint for two activity groups provided by pharmacy services that contribute to pharmaceutical review.AimTo explore the pharmacy components required to deliver pharmaceutical review in Australian public hospitals and examine the resource implications to meet these objectives.MethodWorkforce data were collected from a questionnaire sent to hospital pharmacy managers in 2005. Respondents were asked to detail the pharmacist full‐time equivalents (FTEs) devoted to clinical, distribution and management activities. They were also asked to detail clinical service delivery models and the number of beds at their facility according to clinical pharmacy categories. Ratios of the number of pharmacists to clinical pharmacy bed type were used to calculate the national workforce requirements estimated after extrapolation.ResultsApproximately 768 pharmacist FTEs would be required to provide a basic clinical pharmacy service (3 clinical pharmacy activities: accurate medication history, assessment of current medication management, provision of medicines information to patients) for all patients in Australian public hospitals; approximately 1300 pharmacist FTEs would be required for a comprehensive clinical pharmacy service. This equates to 58 minutes of pharmacist time during an inpatient stay, for each overnight admission. At least 40% of clinical pharmacy services are required for general medical type beds and this should be considered when identifying the skills base required in the hospital pharmacy workforce.ConclusionRetaining the current highly skilled pharmacist workforce and attracting pharmacists into the hospital sector to fill vacant establishment positions is the first step. The number of establishment positions will then need to be increased nationally to fully deliver pharmaceutical review in Australia's public hospitals.

Patient outcomes following an intervention involving community pharmacists in the management of depression

Documentation and evaluation of patient outcomes in a pilot study into the role of rural community pharmacists in the management of depression. Parallel groups design with a control and intervention group. Thirty-two community pharmacies in rural and remote New South Wales, Australia. One hundred and six patient participants, mean age of 46 years, predominantly female, not currently employed, recruited by participating pharmacists. Intervention pharmacists were given video-conference training on the nature and management of depression by a psychiatrist, psychologist and general practitioner and asked to dispense medication with extra advice and support. Control pharmacists were asked to provide usual care. Adherence by self-report, K10, Drug Attitude Index. The results indicated that adherence to medications was high in both groups (95% versus 96%) and that both groups had improved significantly in wellbeing (a reduction K10 score of 4 (control) versus 4.7 (intervention)). No significant change was found in attitude to drug treatment once baseline scores were controlled for. Because both groups improved in wellbeing it is not possible to claim that the training provided to the intervention pharmacists was responsible for the success. However, the improvements gained in such a short time (two months) suggest that the involvement of pharmacists has had a beneficial rather than negative effect. Further research into the most appropriate ways in which to integrate the skills of pharmacists into a model of mental health care delivery in rural communities is recommended.

Improving Laboratory Monitoring at Initiation of Drug Therapy in Ambulatory Care

The importance of laboratory monitoring for drugs is reflected in product labeling and published guidelines, but monitoring recommendations are followed inconsistently. Opportunity exists to improve monitoring, with the potential to decrease therapy complications. The objective of this randomized trial was to determine whether computerized alerts were effective at increasing the percentage of ambulatory patients with laboratory monitoring at initiation of drug therapy. Physicians and pharmacists teamed up to develop organization-specific guidelines for monitoring selected drugs. In collaboration with physicians, pharmacists were alerted to missing laboratory test results, ordered missing tests, reminded patients to obtain tests, assessed test completion, reviewed test results, and managed abnormal results. Eligible individuals included patients with therapy initiated for any of 15 drugs among 400,000 health plan members. In the intervention group, 79.1% (n = 4076; 95% confidence interval [CI], 78.0%-80.2%) of dispensings were monitored compared with 70.2% (n = 3522; 95% CI, 68.9%-71.5%) in the usual-care group (P < .001). For example, 78.6% of amiodarone (95% CI, 73.1%-83.5%) dispensing was monitored in the intervention group vs 51.4% (95% CI, 44.4%-58.4%) in the group receiving usual care (P < .001). This study demonstrates the effectiveness of a computerized tool plus collaboration among health care professionals at increasing the percentage of patients receiving laboratory monitoring at initiation of therapy. Coupling data available from information systems with the knowledge and skills of physicians and pharmacists can result in improved patient monitoring.

Book Review: Communication Skills for Pharmacists: Building Relationships, Improving Patient Care, 2nd Edition

Book Review: Communication Skills for Pharmacists: Building Relationships, Improving Patient Care, 2nd Edition

"It Made Me Feel Like a Pharmacist, Not Just a Science Student": Pharmacy Undergraduates' Attitudes Towards Extemporaneous Dispensing Practical Classes

Community and hospital pharmacists rarely make medicines, and current health policy requires that pharmacists become increasingly patient-centred. Consequently, university courses in extemporaneous preparation of medicines may seem at best anachronistic and at worst an expensive irrelevance. To address these issues the teaching of extemporaneous preparation at the School of Pharmacy, University of London was revised, to include the active input into the teaching of pharmacy practice and pharmaceutics teaching staff. This study describes findings from a questionnaire distributed to students in 1998 after the first year of the course, and again in 2003 following minor modifications. From its inception the course was well received by students, whose views as paying consumers of educational services have become increasingly important. There has been a general improvement in the approval rating over the five year period, in spite of a 28% increase in student numbers over the same time period. Most students perceived the skills taught in the classes were of direct relevance to a future career in pharmacy. The medicines-centred nature of the revised course has proved a useful means of introducing students to concepts of formulation science, therapeutics and dispensing together with transferable skills, such as accurate working. Through this course the unique skills of pharmacists in relation to medicines are nurtured, whilst for both teaching staff and students, clear links are forged between pharmaceutical science and practice. © 2004 Taylor & Francis Ltd.

京都薬科大学大学院におけるコミュニケーション教育：臨床薬学演習への模擬患者の参画とその有用性

To improve the communication skills of our students, training involving the participation of simulated patients (SPs) was introduced into the curriculum of the Master' s Clinical Pharmacy Course in the graduate school of Kyoto Pharmaceutical University. In 2002, we carried out this training for the first-year graduate students.The training was initiated under the direction of a facilitator, who set up role-plays between patients and pharmacists in specific scenarios. Next, all the students played the role of either patient or pharmacist with each other and then four students role-played with two SPs for 10 minutes in turn. After the role playing had finished, SPs gave their feedback concerning their impressions of the pharmacists and how they had felt in the role-plays.We also had students fill out questionnaires anonymously before and immediately after the training to obtain their views on communication skill training using SPs. The responses were used to evaluate the effectiveness of the training and clarify the problems.Among the 22 participating students, 19 had some idea about SPs beforehand, suggesting that there was interest in improving communication in the clinical situation. Afterwards, all of the students felt that it was important to have such training and that it had been useful to them. Some students said that they had become aware of the difficulty in communication between patients and pharmacists and the gap between them. Thus, we were able to confirm that training using SPs was very useful for developing the communication skills of pharmacists in the clinical setting.

Coaching Skills for Pharmacists: Coaching methods need to be tailored to the individual personalities of employees to inspire improved performances.

Coaching is an important component of the overall job that managers are expected to perform. Managers should determine whether a behavior that requires coaching relates to an issue with competence, confidence, or commitment and tailor methods appropriately. Identifying the attributes of the job that are most important to an individual employee is crucial to develop rewards that will motivate that person. Coaches should attempt to identify the behavioral style of each employee and use methods complementary to the individual's style.

Continuous Quality Improvement, Continuous Pharmacy Improvement

C J H P – Vol. 56, No. 4 – September 2003 J C P H – Vol. 56, n 4 – septembre 2003 Although it has been suggested that these changes merely reflect a profession that is trying to redefine itself, I see them more as components in a process of continuous improvement: such efforts are required to meet both the changing needs of our patients and the demands of society at large. In particular, the demands of society are increasing exponentially. Over the past year, the Romanow report, the Kirby report, common drug review, and many regional initiatives have highlighted the potential needs and demands of society with regard to health care. The increased provision of home-based care, concerns about patient safety, and primary health care reform are only some of the challenges that hospital pharmacists continue to address day-to-day. Others include pharmacy specialization, pharmacist prescribing, implementation of new technology, and staff shortages. As a result of these influences, many institutions and provincial health ministries are reviewing their regulations to optimize use of pharmacist skills. Given the changes now taking place in society and more specifically in health care, I feel that my professional experiences will help me to draw attention to pharmacists’ potential impact. I have witnessed pharmacists in various practice sites proposing, implementing, and refining programs and policies that aim to increase the effectiveness and value of pharmacist interventions. In the position of President Elect, I can help to identify further changes that are INTRODUCING CSHP’S PRESIDENT ELECT

Developing and maintaining up-to-date training for pharmacy technicians.

Q:I am currently the education coordinator in a health-system pharmacy in a 400-bed metropolitan teaching hospital. Our patient population requires highly skilled pharmacists and pharmacy technicians. At present there are no formalized pharmacy technician-training programs in our geographicarea. I have just hired five new pharmacy technicians who will ultimately be responsible for duties throughout the department (i.e., inpatient and outpatient pharmacy, sterile intravenous medication preparation, and supply management). The members of our pharmacy team are responsible for ensuring that all measures, from the initial receipt of the medication order to the delivery of the drug, are handled with the utmost safety. What kind of tool is available to train our new pharmacy technicians to ensure that they have the skills to function as a member of our pharmacy?

A Team Approach to Address Antiretroviral Therapy Adherence Barriers in a Managed Care Organization

OBJECTIVE: A pilot project was designed to utilize the knowledge and skills of pharmacists and social workers/mental health professionals to facilitate readiness and informed decision making to optimize antiretroviral therapy adherence for HIV-positive patients considering or beginning drug therapy. SETTING: Group Health Cooperative in collaboration with Kaiser Permanente Northwest, both group-model health maintenance organizations (HMOs) in the Pacific Northwest. DESIGN: The Anti-Retroviral Medication Adherence Program (ARMAP) Team at each site consisted of one pharmacist and one social worker or mental health therapist. Together, the team provided education and psychosocial support to patients contemplating, initiating, or reinitiating antiretrovirals. The focus was on increasing patient knowledge, identifying and addressing adherence barriers, and helping patients cope with lifestyle changes associated with integrating antiretroviral medications into their lives. Specific self-management adherence behaviors and therapy goals were designed individually. MAIN OUTCOME MEASURES: Adherence as measured by refill data and patient satisfaction. Laboratory values for HIVRNA viral load and CD4+ cell count, self-reported adherence, health status, and provider satisfaction were secondary measures. RESULTS: Pharmacy refill data and adherence questionnaires showed three-month adherence rates of 83% and 91%, respectively. All patient respondents indicated overall satisfaction with ARMAP. Ninety-two percent reported increased understanding of antiretroviral medications. Ninety-two percent of providers were satisfied with ARMAP. CONCLUSION: Adherence to antiretrovirals was high for ARMAP participants. Patients and providers were satisfied with ARMAP and were able to better understand readiness to initiate therapy.

The perceived role and skills of pharmacists in asthma management after in-house training.

To evaluate perceived roles and skills of pharmacists in asthma management before and after a training intervention that consisted of six in-house training sessions. Altogether 315 pharmacists in the intervention group and 121 pharmacists in the control group participated in the study. The data on study variables were collected by a questionnaire during the first and last training sessions. Pharmacists' perceptions of their role, perceived skills, estimates of patients receiving counselling and experienced problems. Based on their ratings for 16 topics, the pharmacists' perceptions about their role in counselling asthma patients remained rather stable. Handling of the inhalers and inhalation technique were considered as the most important aspects of counselling and issues dealing with the disease were regarded as the least important. Using a self-rated scale (4-10 scale), pharmacists' perceived counselling skills improved in the intervention group (6.5 vs 7.6), but not in the control group (6.5 vs 6.4). In the intervention group, the pharmacists' estimates of the proportion of new users of asthma medicines receiving counselling increased from 48% to 61% and that of old users from 18% to 26%. Before the training, the most commonly experienced problem in counselling was the pharmacists' lack of knowledge and skills. After the training, pharmacists experienced problems mainly with communication. When pharmacists are included in the support system for any patients group, their capabilities of fulfilling their role have to be assessed. In particular, communication skills and outcome-oriented counselling require attention.

A Survey of the Literature Evaluation Skills of Health-System Pharmacists

If pharmacists are to apply evolving medical information to patient care, they must have adequate literature evaluation skills. To assess pharmacists' literature evaluation skills, a survey that included a case study similar to an original research abstract and five multiple choice questions related to the case study were designed. Of the 2,500 surveys mailed to pharmacists, 545 usable responses were returned. The average score was 2.2 (SD = 1.1) out of 5. Overall, 42.6% of the multiple choice questions were answered incorrectly, and 13.0% were answered “I don't know.” Most pharmacists (93.4%) were able to identify the objective of the study and many recognized that the study had not enrolled enough subjects to obtain meaningful results (52.1%). Fewer pharmacists recognized that, according to the data given, none of the “study” medications normalized blood pressure (32.8%), that the confidence intervals reported were too wide to yield accurate estimates (25.7%), and that an incorrect statistical approach was used (18.3%).

A contemporary perspective on pharmacy's traditional strengths.

To present a framework for recognizing, appreciating, and applying the specific skills used during the processes of medication order screening and therapy monitoring in daily practice. The health care system in which the profession of pharmacy serves is undergoing significant change. The profession is continually reacting to this change. Recently these reactions have included a shift in focus from the medication order processing skills all pharmacists possess to such things as medication prescribing, clinical pathway development, and formulary management. Although some of these activities have merit, we believe that the disregard of pharmacy's traditional strengths applied to medication order processing may damage both patient care and the system in which we practice. Renewed focus must be applied to the development of practice models that include the application of unique pharmacist skills (e.g., optimizing drug doses, safety, routes of administration, and compliance) as integral components. Variances in knowledge and training among pharmacists may result in differences in the level of service provided to a given patient. However, all pharmacists are equipped to provide unique professional services at a level that has demonstrable impact on patient care. Pharmacists are uniquely skilled in ensuring the safe and effective use of medications. The authors believe that the specific skills applied during the processes of medication order screening and therapy monitoring can and should be incorporated into daily practice. Failure to do so will deprive patients of optimal care and pharmacists of professional satisfaction. We encourage pharmacists to recognize and develop their unique, traditional strengths, and subsequently allow these strengths to provide the health benefits for which they were intended.

A pharmacy-controlled lithium clinic

A pharmacy-run lithium clinic was set up In a district general hospital in order to save medical staff time, utilise pharmacist skills and provide an efficient lithium monitoring service. After one year the clinic was evaluated in terms of the control of serum lithium levels, the acceptability of the arrangements to the patients and the patients' knowledge of and attitude towards lithium therapy. We suggest this model of a lithium clinic could be usefully adopted In other psychiatric departments.

Computer-based patient simulations: Hospital pharmacists' performance and opinions

The performance of pharmacists in using an interactive computer-based patient simulation program and their attitudes toward the simulations are reported. The Institutional Patient Medication Simulation program is designed to enhance and evaluate the medication problem-solving skills of pharmacists. Each simulation consists of patient data-gathering, case question, and therapy decision modules with initial assessment and monitoring nodes. Five simulations were tested: gout, urinary-tract infection, congestive heart failure, antimicrobial prophylaxis in surgery, and hypertension. Pharmacists from nine hospitals were recruited for the study. Participants were asked to perform the simulations within a specified period and to complete attitudinal questionnaires. Of the 91 pharmacists who volunteered, 72 (79%) completed the simulations and the questionnaires. The practitioners indicated that the simulations adequately tested their knowledge and that they would recommend them to colleagues. Performance scores for data gathering were less than 70%, with no significant differences among the simulations. Case question scores exceeded 80% and again were consistent among simulations, whereas therapy decision scores were more variable, with the lowest scores being recorded for antimicrobial-related simulations. Pharmacists with more hospital experience tended to perform better. Pharmacists completing a patient simulation program found the simulations to be worthwhile. Performance scores indicated some difficulty in gathering patient data and showed that correct therapeutic decisions may not always occur even if adequate information is obtained.

Diabetes Education: A Multidisciplinary Team Approach

Diabetes mellitus is one of the leading causes of mortality and morbidity in the United States, showing an incidence of over 14 million individuals, with the numbers increasing yearly. Current evidence suggests that maintaining normal blood glucose levels will result in preventing or lessening the degree of acute and chronic complications of diabetes. Therefore, because many of the complications of diabetes may be prevented or lessened by strict glycemic control, it is of the utmost importance that the individual with diabetes understand the roles of diet, exercise, and insulin/oral hypoglycemics in the management of his or her diabetes. This is an area in which diabetic education plays an important role. The properly educated individual with diabetes can learn to increase or decrease insulin, to change diet, or to modify exercise regimens based on results of home blood glucose-monitoring to achieve normoglycemia. This article discusses a multidisciplinary team approach to educating the diabetic patient. This involves using the skills of physicians, pharmacists, nurses, dieticians, and other health care professionals, as well as teaching tools such as diabetes patient assessment forms, diabetes education, and teaching documentation records. It should become clear from this discussion the active role that pharmacists can play as an important member of the diabetic education team.

The Effectiveness of Microtraining in Developing Pharmacists Communication Skills: A study of personality and attitudes

This paper examines the effectiveness of a microtraining programme in developing the communication skills of pharmacists. In particular, it investigates the influence of this programme upon self-reported communication activities in the actual work environment. Inter-relationships are also obtained between the personality of participants, their attitude to the microtraining technique and the degree of self-reported influence on work performance. Overall, participants demonstrated a strongly positive attitude to, and indicated that they had been highly influenced by, the microtraining programme. It was also found that there was a significant and positive correlation between extroversion and attitude to microtraining (p less than 0.005). Furthermore, a positive correlation was also obtained between attitude and influence although this did not reach the 0.5 level of significance. It is concluded that microtraining is a promising technique for developing the communicative competence of pharmacists, but may need to be modified to cater for personality differences within trainees.

Drug points: Alveolitis and haemolytic anaemia induced by azapropazone

<b>Objective.</b> To assess the impact of a simulated legislative visit on the Political Skill Inventory (PSI) scores of Doctor of Pharmacy (PharmD) students and assess their perceptions of their role as an advocate. <b>Methods.</b> Anonymous pre- and post-intervention surveys were administered online to third year student pharmacists at one school of pharmacy in North Carolina. Measures included gender, age, previous pharmacy experience, engagement in pharmacy organizations, legislative awareness and engagement, political skill inventory, and perceptions of the simulated legislative visit. Data are presented as medians or proportions, where appropriate. Paired t tests and Cohen <i>d</i> were used to analyze the data. <b>Results.</b> Thirty student pharmacists provided complete and matchable results for the pre- and post-intervention surveys (analysis response rate=36%). The mean PSI score was 5.4 before the intervention and increased to 5.7 after the intervention. The networking ability and interpersonal influence subscales showed significant and medium-to-large increases in effect size whereas the social astuteness and apparent sincerity subscales showed low-to-medium increases in effect size. Student pharmacists’ agreement with advocacy skills or responsibilities increased overall from pre-to post-intervention. <b>Conclusion.</b> The political skill inventory scores of student pharmacists significantly improved following participation in a simulated legislative visit and listening to a corresponding advocacy lecture. Determining the effectiveness of educational interventions to develop advocacy skills in student pharmacists is essential to ensure efficacy and potential for PharmD students and graduates to make real-world impacts.

Managing training programs for pharmacy employees

Principles for managing training programs for supportive personnel and new pharmacist employees in hospital pharmacy departments are discussed, and ongoing staff development activities are described. General management objectives of training programs are outlined. Training programs for supportive personnel should include general theory, such as basic pharmacology and metric conversions, and practice in the specific skills required for the job. The practical component of the training program should be based on a job analysis, and behavioral objectives of the training program should be developed. Various approaches for structuring and monitoring training programs for supportive personnel are described. Besides mastering specific practice skills, new pharmacist employees must become thoroughly familiar with the pharmacy department's policy and procedure manual. Hospital pharmacy managers should implement ongoing activities for developing the decision-making, interpersonal, and practice skills of staff pharmacists. Well-organized training programs can effectively raise the performance standards of pharmacy departments and decrease the time spent in monitoring, evaluating, and correcting performance deficiencies of the staff.

Effect of a consultant pharmacist on medication use in an institution for the mentally retarded

The effect of a consultant pharmacist on medication use in an institution for the mentally retarded was studied. One year after hiring the consultant pharmacist and the implementation of a multidisciplinary approach to patient care at institution A, a previous medication survey was repeated for 715 patients. Medication use at a nearby mental retardation institution (institution B) with 1049 patients was surveyed once. The overall percentage of patients receiving antipsychotics or anticonvulsants in institution A was not different in the two surveys. There was a significant increase in the percent of patients receiving single drug entities in the second survey (for antipsychotics, 4.9% versus 9.1%; for anticonvulsants, 2.7% versus 15.1%). The use of long-term medications decreased from 76.1% to 56.8% of the population, and the use of individual antipsychotic agents changed significantly. The survey at institution B, a similar facility with less direct pharmacy involvement, showed significantly more use of antipsychotics than at institution A (34.2% versus 16.8%) and fewer patients receiving no long-term medications (29.2% versus 43.2%). The results suggest that the direct clinical involvement of skilled pharmacists in cooperation with other health professionals can significantly alter the patterns of medication use in a long-term care facility for the mentally retarded.