Pharmacy Staff Members Research Articles

Acceptance of a medication refill reminder service in German community pharmacy practice.

Medication refill reminder services (MRRS), having the potential to support the detection of non-adherence and to promote periodic medication refilling by addressing forgetfulness, are not generally available in community pharmacy practice. Based on a new software module, a MRRS was developed. The acceptance of this service was tested in community pharmacies in Germany. Patients were recruited by trained pharmacy staff. Supported by the software, the pharmacies reminded patients to refill their prescription. After 7 months, the service was evaluated by patients and pharmacy staff. The pharmacy owners/managers were interviewed. Ten pharmacies applied the service to 148 patients, with 806 refill reminders for 391 drugs. Seventy-five patients (50.7%) chose to be reminded by a phone call, followed by text message (n=25), and email (n=18). Of all patients, 75 (50.7%) completed the paper-based questionnaire. Sixty-eight (90.7%) rated the service as good or very good and 54 (72.0%) felt more satisfied with their pharmacy. Sixty-four patients (85.3%) considered the service as supportive and wanted to continue. Thirty-nine pharmacy staff members (61.9%) answered the online questionnaire. Twenty-four (61.5%) stated that they found it difficult to use and apply the MRRS; twenty-six (66.6%) experienced technical problems. The service was rated good by 16 (41.0%) pharmacy staff members. They regarded the service helpful for some patients and wanted to continue after the end of the study. The majority of the ten interviewed pharmacy owners/managers expressed the opinion that the service was not very suitable for increasing customer loyalty and not cost-effective. Nevertheless, six (60.0%) of them wanted to continue using the service. The MRRS seems to be feasible, apart from technical difficulties. Patients rated the service as supportive, and the personal contact seems to be of high importance; most patients would like to continue the service. However, offering the service to patients turned out to be challenging in daily German community pharmacy practice.

Speed journal clubs: A novel application of literature evaluation and presentation at a non-teaching hospital

BackgroundTraditional journal clubs are incorporated into pharmacy education and are typically thirty to sixty minutes in duration. Multiplying this by the number of students and residents makes journal club discussions a significant time commitment for participants, preceptors, and pharmacy staff members. The purpose of this study was to develop an activity that enhances participants’ ability to interpret and summarize the findings of a study in a brief and concise manner. EducationalActivity and setting: After independently evaluating their chosen journal article, students/residents were grouped into pairs. One presenter in each pair had five minutes to present to their partner, with two minutes for questions and answers; the partner presented in the same manner. Groups then rotated and repeated the activity. Assessment of the activity included session debriefing and an online questionnaire. FindingsTwenty-six questionnaires were returned (response rate 90%). The majority of respondents (88%) felt they learned how to concisely summarize and present pertinent information from a published journal article. Respondents (81%) also felt that they will use these skills in their practice. Furthermore, respondents found that their presentation and listening skills improved with each round (89% and 85%, respectively). Time spent on journal clubs decreased per experiential time frame from approximately four hours to 90 minutes. SummaryA novel journal club activity that is termed “speed journal clubs” was well received, offered opportunities for education on several topics in a short time, enhanced skills in concise communication, and decreased the amount of time spent on journal clubs.

Experiences Among African American Community Members With Pharmacy-Based Immunization Services in Detroit, Michigan

Background: Although vaccination rates improved modestly in the United States during the 2014-2015 season, racial and ethnic disparities in the use of vaccines persist. Pharmacy-based immunization programs expand access to immunization services; however, African Americans in one metropolitan community did not have the same level of access to this service as non-Hispanic whites. Objective: To examine the experiences of African Americans with pharmacy-based services and identify how pharmacies and pharmacy organizations can better service patients in urban communities with similar dynamics. Methods: This qualitative study utilized focus group discussions among African American residents in Detroit, Michigan, where there are reported disparities in access to pharmacists that immunize to learn more about their experiences with pharmacy-based immunization services. Results: Three major themes emerged: the pharmacy location is often more convenient and accessible than doctors’ offices, there is clear communication with the pharmacist, and perceived lower immunization fees at pharmacies. Participants found pharmacies easier to access in their community for immunization services. Consistent interaction with familiar pharmacists and pharmacy staff members facilitated strong relationships and dialogue between pharmacists and patients. Patients perceived costs for vaccines to be less at the pharmacy than at their physicians’ offices. Conclusions: Participants reported positive experiences with pharmacy-based immunization services and expansion of these services may influence more African Americans to receive recommended vaccines in this community.

Evaluation of community pharmacy tech-check-tech as a strategy for practice advancement

ObjectiveThe purpose of this study was to design, pilot, and evaluate a community “tech-check-tech” (TCT) program as a strategy for pharmacy practice advancement. SettingCommunity pharmacy with both mail order and outpatient pharmacy services. Practice descriptionThe policies, technician training requirements, prescription eligibility requirements, and quality assurance measures necessary for the pilot were developed. The TCT workflows and procedures were integrated into the existing prescription dispensing framework at a pilot site. An analysis of pharmacist and technician checking accuracy was conducted with a 4-week data collection period for each role. To determine TCT technician accuracy, the TCT technician performed the first product verification check after the prescription was filled by a pharmacy staff member. If the TCT technician found an error, they documented the error and returned the prescription to the filling technician for correction. If the prescription was filled correctly, the TCT technician passed the prescription to a pharmacist for final verification. The pharmacist documented any incorrect prescriptions that the TCT technician verified. Pharmacist accuracy was measured through direct pharmacist observation. Direct observation was also used to measure and record pharmacist and technician prescription checking time. The data were then used to evaluate pharmacist time savings as a result of community TCT, while ensuring prescription dispensing accuracy. Practice innovationTCT was piloted in a community pharmacy. EvaluationAn analysis of pharmacist and technician checking accuracy was conducted with a 4-week data collection period for each role. To determine TCT technician accuracy, the TCT technician performed the first product verification check after the prescription was filled by pharmacy staff. If the TCT technician found an error, they documented the error and returned the prescription to the filling technician for correction. If filled correctly, the TCT technician passed the prescription to a pharmacist for final verification. The pharmacist documented any incorrect prescriptions that the TCT technician verified. Pharmacist accuracy was measured through direct pharmacist observation. Direct observation was also used to measure and record pharmacist and technician prescription checking time. This data was then used to evaluate pharmacist time savings as a result of community TCT, while ensuring prescription dispensing accuracy. ResultsA TCT workflow was piloted successfully in the community pharmacy setting. Technicians were at least as accurate as pharmacists, as validated with statistical analysis (99.95% [95% CI 99.89%–99.99%] versus 99.74% [95% CI 99.61%–99.87%]), and patient safety was maintained. Time studies allowed for the quantification of potential pharmacist time savings (23 days per year) resulting from the implementation of a community TCT program. ConclusionThis study demonstrates the feasibility of a TCT program in the community pharmacy setting.

Implementation of a medication therapy management collaborative within a pediatric health system

ObjectivesTo describe the implementation of a medication therapy management (MTM) collaborative within a pediatric health system to ensure the safe use of medication. SettingOutpatient pharmacies and clinics within a pediatric health system in Central Ohio. Practice descriptionThe outpatient pharmacies conducted the daily operations of a community pharmacy following a standard, 4-point workflow. The ambulatory clinical pharmacists served on interdisciplinary teams within outpatient clinics to ensure the appropriate use of medication. Practice innovationA collaborative model was developed to offer MTM services to patients within outpatient pharmacies and clinics throughout the health system. The pharmacist responsibilities varied, with outpatient pharmacists focused on targeted medication reviews (TMRs) and ambulatory clinical pharmacists focused on comprehensive medication reviews (CMRs) and TMRs. EvaluationThe use of multiple plan-do-study-act cycles allowed for program improvements throughout implementation. Data collection included a pharmacy staff perception survey, mapping of MTM opportunities, and a quantitative report on the number, type, and intervention rate of all MTM activities. ResultsFour hundred nine MTM interventions, 349 TMRs (70 clinic based and 279 pharmacy based) and 60 CMRs, were completed throughout the first 6 months. Two hundred thirty-eight of the TMRs were pharmacist-initiated interventions that allowed pharmacists to provide medication counseling and follow-up with patients beginning new therapy. Ambulatory clinical pharmacists identified and resolved drug-related problems in greater than one-half of the CMRs completed. The intervention rates were 39% for CMRs and 44% for TMRs. ConclusionThe implementation of a collaborative MTM model provided an opportunity to address drug-related problems to ensure the appropriate use of medication. The model consisted of pharmacy staff members within 2 different patient care environments working together to complete MTM services for patients throughout the health system. The key elements of the program included the use of training sessions tailored to the pharmacy staff member’s role in MTM, incorporation of technician champions, and creation of pharmacist-initiated interventions.

Comparison of two training methods in community pharmacy: Project VACCINATE

ObjectiveTo compare the impact of a whole-staff training strategy with a train-the-trainer strategy on 1) the number of influenza, pneumococcal, herpes zoster, and pertussis vaccines administered by community pharmacists to adults; 2) staff confidence; and 3) fidelity to the intervention. SettingEight Quality Food Centers (QFC) Pharmacies in Seattle, Washington. Practice descriptionQFC Pharmacy is a grocery store division of The Kroger Co. with 30 pharmacies located in Washington State. QFC provides all routine and travel vaccines to adolescents and adults and has a culture of improving vaccine access to its community. Practice innovationPharmacists and pharmacy technicians from 8 QFC pharmacies received training to enhance their immunization care for adults. The entire staff from 4 pharmacies received whole-staff training, and staff members from the other 4 pharmacies received a train-the-trainer approach. The whole-staff training group had all staff members attend a live, 2-hour training. The train-the-trainer group sent 1 pharmacist and 1 pharmacy technician champion to attend the live training and then return to their pharmacy to train the other staff members. EvaluationThe number of immunizations administered, staff confidence, and self-reported fidelity to the intervention were measured before and after training. All data were analyzed using descriptive statistics. ResultsThe number of total influenza, pneumococcal, herpes zoster, and pertussis vaccines administered increased 12.6% in the whole-staff training group and 15.2% in the train-the-trainer group. Both training strategies increased confidence in identifying patients eligible for vaccines, talking to patients about vaccine needs, and using the bidirectional immunization platform. Pharmacy staff members in both groups indicated fidelity to key steps in the intervention process. ConclusionBoth whole-staff training and train-the-trainer approaches were associated with an improvement in the number of vaccines administered, staff confidence, and fidelity to the intervention. Community pharmacy organizations could use either training strategy when implementing enhancements to an existing patient care service. The train-the-trainer strategy may be less resource intensive.

Pharmacy Staff Perspectives on Alcohol and Medication Interaction Prevention Among Older Rural Adults.

Older adults are at high risk for alcohol and medication interactions (AMI). Pharmacies have the potential to act as ideal locations for AMI education, as pharmacy staff play an important role in the community. This study examined the perspectives of pharmacy staff on AMI prevention programming messaging, potential barriers to and facilitators of older adult participation in such programming, and dissemination methods for AMI prevention information. Flyers, telephone calls, and site visits were used to recruit 31 pharmacy staff members who participated in semistructured interviews. A content analysis of interview transcriptions was conducted to identify major themes, categories, and subcategories. The main categories identified for AMI prevention messaging were Informational, Health Significance, and Recommendations. Within barriers to participation, the main categories identified were Health Illiteracy, Personal Attitudes, and Feasibility. The main categories identified for program facilitators were Understanding, Beneficial Consequences, and Practicality. Multimethod dissemination strategies were commonly suggested. This study found positive pharmacy staff perspectives for the planning and implementation of AMI prevention programming, and future development and feasibility testing of such programming in the pharmacy setting is warranted.

Expansion of inpatient clinical pharmacy services through reallocation of pharmacists.

The redesign of an inpatient pharmacy practice model through reallocation of pharmacy resources in order to expand clinical services is described. A pharmacy practice model change was implemented at a nonprofit academic medical center to meet the increasing demand for direct patient care services. In order to accomplish this change, the following steps were completed: reevaluation of daily tasks and responsibilities, reallocation of remaining tasks to the most appropriate pharmacy staff member, determination of the ideal number of positions needed to complete each task, and reorganization of the model into a collection of teams. Data were collected in both the preimplementation and postimplementation periods to assess the impact of the model change on operational workflow and clinical service expansion. The mean ± S.D. times to order verification were 17 ± 52 minutes during the preimplementation period and 21 ± 70 minutes in the postimplementation period (p < 0.001). During the 3 months before and after implementation of the model change, the mean number of medication reconciliations performed increased from 114 to 144. After implementation of the model change, total interventions increased 194%. Notably, there was a 736% increase in the number of interventions focused on facilitating safe discharge. A pharmacy practice model change was successfully implemented by reallocating existing pharmacist and technician roles and increasing incorporation of pharmacy residents and students. This change led to an expansion of direct patient care coordination services without negatively affecting the operational responsibilities of the pharmacy or the need to hire additional staff.

Evaluation of the knowledge and attitude of pharmacists about the national malaria control policy in southern Benin

BackgroundThe national strategy against malaria in an endemic country should involve all the health stakeholders. In Benin, the private sector is rarely present in the activities of the National Malaria Control Programme (NMCP), and its surveillance system does not cover private sector outlets that are a non-negligible part of the healthcare system.ObjectiveThe aim of this study was to describe the drug delivery practices within private pharmacies of Cotonou and Porto-Novo and the awareness of medicine providers concerning the national policy of malaria treatment.MethodsA survey was performed among pharmacy staff members responsible for dispensing medicines and providing advice to patients within pharmacies of Cotonou and Porto-Novo. Dispensing/pharmacy assistants (‘dispensators’) from 82 pharmacies in Cotonou and 19 in Porto-Novo were surveyed. Data entry was performed using Epidata 3.1 software and data analysis was carried out using SPSS software version 21.1. Chi square test was used to compare proportions. A significance threshold of 0.05 was defined for the p value.Results46% of providers did not know the artemisinin-based combination therapy recommended by the NMCP for treating uncomplicated malaria. 58.7% were not able to recognize the gravity signs of malaria. 89.8% of dispensators were used to deliver an anti-malarial upon patient request, without prior biological confirmation as requested by the NMCP policy.ConclusionsDispensing practices within the studied pharmacies from Cotonou and Porto-Novo were not in adequacy with the NMCP guidelines for uncomplicated malaria, which is a striking weakness in the training of drug providers on key elements of the guidelines for managing malaria. The NMCP needs to help dispensator from private pharmacies sector to standardize drug delivery practices according to its guidelines.

Nonprescription naloxone and syringe sales in the midst of opioid overdose and hepatitis C virus epidemics: Massachusetts, 2015

ObjectivesTo determine the prevalence of nonprescription naloxone and sterile syringe sales, factors associated with nonprescription sales, geospatial access to nonprescription naloxone and syringe-selling pharmacies, and targets for potential interventions. DesignCross-sectional study. Setting and participantsMassachusetts has experienced steep increases in reported opioid overdoses and hepatitis C virus cases in the past decade. Pharmacists have the potential to play a substantial role in increasing access to nonprescription naloxone and sterile syringes, which can reverse opioid overdoses and decrease hepatitis C virus transmission, respectively. We completed brief telephone surveys with 809 of 1042 retail pharmacies across Massachusetts (response rate = 77.6%) during 2015 to assess experience with nonprescription sales of naloxone and sterile syringes. Outcome measuresOur primary outcomes were the stocking and selling of naloxone in the pharmacy (yes or no) for nonprescription sales and nonprescription syringe sales (yes or no). We conducted multivariable regression analyses and created maps using a geographic information system to identify factors associated with nonprescription sales of naloxone and sterile syringes, and to improve our understanding of geospatial access to pharmacy-based naloxone and syringe sales. ResultsMore than 97% of pharmacies reported selling sterile syringes without requiring a prescription, and 45% of pharmacies reported stocking and selling naloxone. Factors associated with nonprescription sales included hours of operation, experience with and interest in harm reduction activities, and presence in an opioid overdose hotspot. Geographic access to nonprescription sale of sterile syringes is widespread, whereas geospatial access to naloxone is limited. Training to understand the benefits, applications, and distribution needs of naloxone is of interest to surveyed pharmacists. ConclusionAccess to sterile syringes through nonprescription sales is strong across Massachusetts, and although more than 350 pharmacies (45%) reported stocking and selling naloxone to prevent opioid overdose deaths, there is much room for improvement in access and training among pharmacy staff members.

Pharmacy communications with physician offices to clarify prescriptions

ObjectivesOur study was conducted to: (1) characterize the type and extent of prescription clarification communications between community pharmacies and physician offices, (2) describe the interventions made by community pharmacists, and (3) determine the time frame to clarify prescriptions prior to dispensing. DesignA convenience sample and cross-sectional study. SettingFive independent community pharmacies. ParticipantsPharmacists and pharmacy technician staff members. InterventionParticipating pharmacy staff members documented the type of interventions and length of time to resolve prescription clarifications. Main outcome measuresNumber, type, and reason for pharmacist interventions to clarify prescriptions. ResultsPrescriptions that required clarification with physicians’ offices were mostly new (n = 105; 74%) compared with refill prescriptions (n = 36; 26%). Electronic prescriptions (n = 51; 36%) required clarification more often than other types of prescription transmission. New prescriptions transmitted by e-prescribing required pharmacy-physician office communications 4-fold more frequently than faxed prescriptions and nearly 2-fold more frequently than written prescriptions. The most frequent reasons for pharmacy communications with the physician office were prior authorization approval (n = 45; 32%) and missing prescription information (n = 22; 16%). The most frequent resolutions involved dispensing a different dosage strength (n = 19; 11%) and different drug (n = 17; 10%). At the end of the study period, 30 (17%) prescription clarification cases were unresolved; most of the unresolved cases involved prior authorizations. Person-to-person telephone contacts had an 80% resolution rate compared with a 55% resolution rate for fax communications (P <0.001). The time frame to clarify prescriptions ranged from 6 minutes to more than 14 days. ConclusionPerson-to-person telephone contacts may be more efficient than fax communications for resolving prescription clarifications, especially for more complex information needs. This study lends to ongoing improvement efforts in e-prescribing interfaces with pharmacy information systems to reduce the burden of prescription clarification.

Community pharmacy staff motivations and barriers to working with mental health consumers

AbstractBackgroundMental health is an Australian national priority area, yet evidence indicates pharmacy staff members focus more frequently on other chronic diseases. A need was identified to facilitate community pharmacy staff engagement with mental health initiatives.AimThis study explored community pharmacy staff motivations and barriers to working with mental health consumers and carers.MethodA questionnaire assessing baseline attitudes, knowledge and skills towards mental illness was completed by 791 community pharmacy staff members. Participants rated their agreement with statements regarding factors that motivate them (11 items) or present a barrier to working with mental health consumers and carers (12 items) on a 7‐point Likert scale. Qualitative comments were invited.ResultsIn total, 465 pharmacists (58.8%) and 326 support staff (41.2%) completed the questionnaire. Statements reflecting motivations were strongly endorsed: 83% of participants agreed that they were motivated to work with mental health consumers and carers, and 96% agreed that community pharmacists are integral members of the healthcare team. The most frequently endorsed barriers related to lack of training to assist people and belief that consumers feel ashamed about their illness. Themes that emerged from qualitative comments identified staff skills and knowledge as both motivators and barriers.ConclusionThe findings identified that both pharmacists and pharmacy support staff required more training, confidence and practical strategies to support best practice in meeting the needs and expectations of mental health consumers and carers.

Counseling of children and adolescents in community pharmacies: Results from a 14-day observational study

ObjectivesTo characterize community pharmacists' interactions with children and their caregivers. MethodsThis observational study was conducted over a 14-day period in 3 community pharmacies. Trained researchers used an observation guide to document information about prescriptions that were picked up for children 7 to 17 years of age. Research assistants recorded: 1) when the prescription was picked up; 2) who picked up the prescription; 3) who was counseled by the pharmacist; 4) which pharmacy staff members interacted with the family; 5) pick-up location; 6) wait time; 7) how many questions the child or caregiver asked pharmacy staff; and 8) caregiver gender. Additional details such as the child's age, sex, and medication information were obtained from the prescription. ResultsOne hundred sixteen prescriptions were dispensed to 97 families. Most families picked up prescriptions on weekdays (84%) and after school (53%). Fifty-four percent of prescriptions were refills, and most (38%) were for mental health conditions. Only 28 children (29%) accompanied their caregivers to pick up their prescription. Nineteen caregivers (20%) received counseling; children were never counseled separately by pharmacists. Families with younger children were more likely to receive counseling than older children (β = −0.28; P = 0.01). ConclusionChildren infrequently accompany their parents to pick up their prescriptions, which limits pharmacists' opportunities to counsel children about their medications. Even when children are present, they rarely receive counseling from pharmacists.

Abstracts of Papers Presented at the Health Services Research & Pharmacy Practice Conference, 7-8 April 2016, University of Reading, UK.

To explore the views of pharmacy and rheumatology stakeholders about system-related barriers to medicines optimisation activities with young people with long-term conditions. A three-phase consensus-building study comprising (1) focus groups with community and hospital pharmacists; (2) semi-structured telephone interviews with lay and professional adolescent rheumatology stakeholders and pharmacy policymakers, and (3) multidisciplinary discussion groups with community and hospital pharmacists and rheumatology staff. Qualitative verbatim transcripts from phases 1 and 2 were subjected to framework analysis. Themes from phase 1 underpinned a briefing for phase 2 interviewees. Themes from phases 1 and 2 generated elements of good pharmacy practice and current/future pharmacy roles for ranking in phase 3. Results from phase 3 prioritisation and ranking exercises were captured on self-completion data collection forms, entered into an Excel spreadsheet and subjected to descriptive statistical analysis. Institutional ethical approval was given by Aston University Health and Life Sciences Research Ethics Committee. Four focus groups were conducted with 18 pharmacists across England, Scotland and Wales (7 hospital, 10 community and 1 community/public health). Fifteen stakeholders took part in telephone interviews (3 pharmacist commissioners; 2 pharmacist policymakers; 2 pharmacy staff members (1 community and 1 hospital); 4 rheumatologists; 1 specialist nurse, and 3 lay juvenile arthritis advocates). Twenty-five participants took part in three discussion groups in adolescent rheumatology centres across England and Scotland (9 community pharmacists; 4 hospital pharmacists; 6 rheumatologists; 5 specialist nurses, and 1 physiotherapist). In all phases of the study, system-level issues were acknowledged as barriers to more engagement with young people and families. Community pharmacists in the focus groups reported that opportunities for engaging with young people were low if parents collected prescriptions alone, which was agreed by other stakeholders. Moreover, institutional/company prescription collection policies – an activity largely disallowed for a young person under 16 without an accompanying parent - were identified by hospital and community pharmacists as barriers to open discussion and engagement. Few community pharmacists reported using Medicines Use Review (England/Wales) or Chronic Medication Service (Scotland) as a medicines optimisation activity with young people; many were unsure about consent procedures. Despite these limitations, rheumatology stakeholders ranked highly the potential of pharmacists empowering young people with general health care skills, such as repeat prescription ordering. The pharmacy profession lacks vision for its role in the care of young people with long-term conditions. Pharmacists and rheumatology stakeholders identified system-level barriers to more engagement with young people who take medicines regularly. We acknowledge that the modest number of participants may have had a specific interest and thus bias for the topic, but this underscores their frank admission of the challenges. Professional guidance and policy, practice frameworks and institutional/company policies must promote flexibility for pharmacy staff to recognise and empower young people who are able to give consent and take responsibility for medicines activities. This will increase mutual confidence and trust, and foster pharmacy’s role in teaching general health care skills. In this way, pharmacists will be able to build long-term relationships with young people and families.

Patient-provider communication about medication use at the community pharmacy counter.

The objectives of this study were to, first, describe the information exchanged between pharmacy staff and patients about prescribed medication at the community pharmacy counter, and second, to investigate to what extent this met professional medication counselling guidelines. Pharmaceutical encounters were videotaped in four community pharmacies in the Netherlands. Patients were included if they collected a prescription for their own use. An observation protocol, including the MEDICODE checklist, was used to analyse the video recordings. A distinction was made between first and repeat prescriptions. One hundred fifty-three encounters were videotaped. When dispensing first prescriptions, pharmacy staff provided most information on instructions how to use the medication (83.3%), form of the medication (71.4%) and treatment duration (42.9%). Topics for repeat prescriptions (such as the effects of the medication and the incidence of observed adverse effects) were rarely discussed. Pharmacy staff rarely encouraged patients to ask questions. Pharmacy staff members provided little medication-related information at the counter, especially for repeat prescriptions, did not encourage active patient participation, and thereby did not adhere to the guidelines of their professional organisation. Further research is needed to understand the reasons for this.

Challenges to the implementation of a nationwide electronic prescribing network in primary care: a qualitative study of users' perceptions.

The objective of this study was to identify physicians' and pharmacists' perceptions of the challenges and benefits to implementing a nationwide electronic prescribing network linking medical clinics and community pharmacies in Quebec, Canada. Forty-nine people (12 general practitioners, 2 managers, 33 community pharmacists, and 2 pharmacy staff members) from 40 points of care (10 primary care clinics (42% of all the connected sites) and 30 community pharmacies (44%)) were interviewed in 2013. Verbatim transcripts were analyzed using thematic analysis. A low level of network use was observed. Most pharmacists processed e-prescriptions by manual entry instead of importing electronically. They reported concerns about potential errors generated by importing e-prescriptions, mainly due to the instruction field. Paper prescriptions were still perceived as the best means for safe and effective processing of prescriptions in pharmacies. Speed issues when validating e-prescription messages were seen as an irritant by physicians, and resulted in several of them abandoning transmission. Displaying the medications based on the dispensing data was identified as the main obstacle to meaningful use of medication histories. Numerous challenges impeded realization of the benefits of this network. Standards for e-prescription messages, as well as rules for message validation, need to be improved to increase the potential benefits of e-prescriptions. Standard drug terminology including the concept of clinical medication should be developed, and the implementation of rules in local applications to allow for the classification and reconciliation of medication lists from dispensing data should be made a priority.

Tech trends we are watching in 2015: health information technology developments.

As a new year begins, we look ahead to several important topics that we will closely follow over the next 12 months. The list is certainly not exhaustive, but we believe these topics should be on all hospital pharmacy staff members' radar screens.

Medication adherence in adolescents in current practice: community pharmacy staff's opinions.

To explore pharmacy staff's perspectives regarding medication use behaviour in adolescent patients. Structured face-to-face interviews were conducted with 170 community pharmacy staff members. Medication-related problems in adolescents had been experienced by 80 respondents; non-adherence was frequently mentioned (n = 73). An important reason for medication-related problems in adolescents not being recognised was that prescriptions are often collected by the parents (with or without the teenager). Solutions suggested by the interviewees to improve adolescents' medication use behaviour included (improving) counselling with emphasis on necessity/benefits of medication (n = 130) and more direct contact with adolescents instead of parent(s) (n = 77). Use of digital media for educational purposes or reminder services was suggested to support medication use (n = 67). Almost half of pharmacy staff experienced problems related to medication use in adolescents. Pharmacy staff see a primary role for counselling on the benefits of therapy but foresee difficulties in obtaining direct contact with adolescents. Use of new media could be useful.

Cosgriff transforms care for chemotherapy patients

Sean Cosgriff, PharmD, BCOP, is one of a kind at the Portland Veterans Affairs (VA) Medical Center. Patients travel as far as 300 miles to receive cancer care at the VA's chemotherapy infusion clinic and at the oral chemotherapy clinic, a pilot program currently being tested by Cosgriff. As the only clinical pharmacy specialist in hematology/oncology, Cosgriff touches the lives of patients in Oregon and Southwest Washington by providing efficient, lifesaving care

Unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in the outpatient pharmacy: Table 1

Electronic prescribing systems have often been promoted as a tool for reducing medication errors and adverse drug events. Recent evidence has revealed that adoption of electronic prescribing systems can lead to unintended consequences such as the introduction of new errors. The purpose of this study is to identify and characterize the unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in an outpatient pharmacy. A multidisciplinary team conducted direct observations of workflow in an independent pharmacy and semi-structured interviews with pharmacy staff members about their perceptions of the unrealized potential and residual consequences of electronic prescribing systems. We used qualitative methods to iteratively analyze text data using a grounded theory approach, and derive a list of major themes and subthemes related to the unrealized potential and residual consequences of electronic prescribing. We identified the following five themes: Communication, workflow disruption, cost, technology, and opportunity for new errors. These contained 26 unique subthemes representing different facets of our observations and the pharmacy staff's perceptions of the unrealized potential and residual consequences of electronic prescribing. We offer targeted solutions to improve electronic prescribing systems by addressing the unrealized potential and residual consequences that we identified. These recommendations may be applied not only to improve staff perceptions of electronic prescribing systems but also to improve the design and/or selection of these systems in order to optimize communication and workflow within pharmacies while minimizing both cost and the potential for the introduction of new errors.