Perspectives of pharmacists and pharmacy students on business management in community pharmacy

Braedon Davey's study has made a novel contribution to how business management should be delivered in pharmacy curricula. He has proposed a business management skills framework for use by both the university and in the practice by gaining the perspectives of the key stakeholders: the pharmacists and pharmacy students, which will better equip pharmacists for their dual role in practice, operating a business as well as a healthcare environment

Design, implementation and evaluation of a new eHealth pharmaceutical service for cooperative disease management using an interactive platform: opportunities to improve health systems performance

RESUMO Introdução: As doenças crónicas são a principal causa de mortalidade em toda a Europa. O aumento da prevalência de doenças crónicas está a gerar a necessidade de reformas nos sistemas de saúde. Estas reformas abordam a gestão de doenças crónicas com base em equipas multidisciplinares, com novos papéis atribuídos a profissionais não-médicos, como enfermeiros e farmacêuticos comunitários (CP). A comunicação entre profissionais e cidadãos é fundamental em todos os modelos multidisciplinares, o que torna o uso de Sistemas e Tecnologias de Informação (IST) cada vez mais indispensável. É de extrema importância para a ciência e a sociedade entender como serviços suportados por IST - eHealth - podem ser desenvolvidos e utilizados para enfrentar os constrangimentos e desafios dos futuros sistemas de saúde. Objetivo: O objetivo principal deste projeto foi o de desenvolver, implementar e avaliar um serviço farmacêutico de gestão de doença suportado por IST, no contexto da farmácia comunitária, utilizando a metodologia Design Science Research (DSRM) como metodologia de investigação. Métodos: A aplicação de DSRM decorre em seis fases, desde a definição e caracterização do problema até à avaliação da solução (ou artefacto). A primeira fase foi constituída por um exercício de cenarização, um estudo observacional de tempo e movimento e um questionário de preenchimento online, para avaliar as futuras possibilidades para os farmacêuticos comunitários no sistema de saúde, e a atual prestação de serviços farmacêuticos suportados por IST em farmácia comunitária. Na segunda fase, foram realizadas entrevistas qualitativas com utentes de serviços de saúde. Estas duas fases informaram o desenho da plataforma web de suporte ao serviço, que foi o objetivo da terceira fase. De seguida, nas duas etapas seguintes, a plataforma web foi testada e a usabilidade avaliada através de um estudo de caso com utentes selecionados numa universidade sénior. Resultados: A partir do exercício de cenarização, foi possível identificar as incertezas críticas que serão os “motores da mudança” para os farmacêuticos comunitários. Estas são a “capacidade de inovar e desenvolver serviços” e o “ambiente legislativo”. Tanto no estudo observacional como no inquérito, verificou-se que todas as farmácias utilizam os IST para a dispensa de medicamentos e tarefas administrativas; apenas 15% das farmácias respondentes usam os IST para responder a questões de saúde dos utentes; 50% do tempo diário do farmacêutico é despendido em interação com os utentes da farmácia e 38% em tarefas administrativas. Em média, os farmacêuticos observados têm 54 minutos de tempo livre por dia, maioritariamente em micropausas distribuídas pelo dia de trabalho. Os custos calculados para os serviços farmacêuticos observados foram muito semelhantes nas três farmácias. O custo médio do serviço de dispensa de medicamentos foi de €3,66 e do serviço de aconselhamento €1,34. Dos utentes entrevistados, 46% admitiram que procuraram o farmacêutico para informações sobre questões de saúde ligeiras antes de ir a um médico, enquanto a entrega de medicamentos ao domicílio foi o novo serviço mais solicitado. Na fase de demonstração da plataforma, verificou-se que o registo, monitorização e armazenamento de dados bioquímicos e fisiológicos, tanto pelo utente como pelo farmacêutico, contribuiu para aumentar o interesse comum na gestão da doença, o que poderá permitir uma melhoria nos resultados da saúde. Na avaliação de usabilidade, verificou-se a necessidade de melhorar o acesso rápido à informação, bem como a vi necessidade de melhorar a legibilidade da informação para melhorar a experiência de utilização dos utentes seniores. Conclusão: Atualmente, o uso de IST nas farmácias comunitárias portuguesas está principalmente focado na dispensa de medicamentos. Parece existir uma necessidade de reorganização interna das farmácias de forma a permitir aumentar a eficiência da prestação de serviços farmacêuticos e permitir a prestação de serviços farmacêuticos de eHealth. Para os serviços farmacêuticos de eHealth estarem mais integrados no modelo de negócio atual, é necessário melhorar o marketing do serviço, de forma a aumentar o recrutamento de utentes e demonstrar o valor do serviço para os doentes crónicos e médicos. A qualidade e usabilidade da plataforma eHealth é fundamental. No entanto, também o acompanhamento por um profissional de saúde e a integração dos serviços farmacêuticos com os cuidados de saúde primários são importantes para uma melhor gestão da doença. A DSRM demonstrou ser útil no desenvolvimento e implementação de serviços de eHealth, proporcionando um maior envolvimento dos utilizadores, aumentando a utilidade percebida do serviço. No próximo ciclo de DSRM, vão ser necessários os inputs de médicos de cuidados primários e outros profissionais de saúde, de modo a desenvolver um novo artefacto, para testar e avaliar o valor clínico e económico dos serviços farmacêuticos eHealth.Background: Chronic diseases are the main cause of mortality throughout Europe. The increasing prevalence of chronic diseases is leading to the necessity of health system reforms. These reforms address chronic-disease management based on multidisciplinary teams, with major roles for non-physicians, such as nurses and community pharmacists (CP). A cornerstone on every multidisciplinary model is the communication between stakeholders, for which the use of Information Systems and Technologies (IST) is increasingly indispensable. It is of importance to science and society to understand how IST supported services – eHealth - could be developed and used to address the challenges and constrains of future health systems. Aim: The main goal of this project was to design, implement and evaluate a disease management web-based interactive pharmaceutical service, within a community pharmacy setting, using Design Science Research Methodologies (DSRM). Methods: The application of DSRM six stages’ is described, from the definition and characterization of the problem to the evaluation of the artefact. The first stage consisted of a scenario exercise, a time and motion observational study and an online survey, to assess future roles for community pharmacists and current pharmaceutical services provision supported by IST in community pharmacy. In the second stage, qualitative interviews with health services’ users were performed. These two stages helped to inform the design of the web-platform, which was the goal in the third stage. After this, the web-platform was tested and the usability evaluated in the two following stages, through a case study with selected patients from the participant pharmacies and from a senior university. Results: The scenario exercise allowed to identify the critical uncertainties that will be the drivers of change for the Community Pharmacists. These were found to be the “Ability to develop Services”, and the “Legislative Environment”. From both the survey and observational study, it was found that pharmacies’ IST is mainly used for dispensing medicines and administrative tasks with only 15% of the respondent pharmacies using IST to answer patients’ queries; 50% of pharmacists daily time is spent with patients, 38% on administrative tasks, while still having an average of 54 minutes of idle time spread through the day, mainly in micro-pauses. The overall costs of Pharmaceutical services across three pharmacies were found to be very similar, with the average dispensing service cost at €3.66 and €1.34 for the counselling service; 46% of the interviewed users admitted that they sought healthcare provision with the CP for minor issues before going to a physician, while home delivery was the most requested new service. In the demonstration stage, we found that the registration, monitoring and storage of biochemical and physiological data, recorded by the CP and the patients in the platform, contributed to a common interest that may allow an improvement in patients’ health outcomes. From the usability evaluation, concerns about the quick access to information were perceived as well as the need to improve legibility, addressing senior users’ difficulties. Conclusion: The current state of IST usage in Portuguese community pharmacies is mainly focused on medicine dispensing. There seems to exist a need for internal reorganization of pharmacies allowing for more efficient pharmaceutical services provision and to enable eHealth pharmaceutical services provision. To make eHealthpharmaceutical services more integrated in the current pharmacy daily business, marketing efforts need to be done, to recruit and demonstrate value to the chronic patients and physicians. The quality and usability of the web-based platform is critical, as is the close professional follow-up and integration of pharmacy and primary care services focused in disease management. DSRM helps in developing and implementing eHealth services through a higher involvement of the stakeholders, increasing the perceived usefulness of the service. The next DSRM cycle will need to use the input of primary care physicians and other health professionals in order to develop an artifact to test and evaluate the clinical and economic value of eHealth pharmaceutical services

The impact of regulatory change on pharmacy practice: the implementation of the European Union falsified medicines directive in the United Kingdom

The use of technological solutions within the healthcare environment is becoming widespread. The implementation of the Falsified Medicines Directive (FMD) is a large-scale regulatory mandated example of this innovation to impact pharmacy practice in modern times. At the core of the innovation lies the practice of visual and digital authentication and verification by clinicians supported by the digital systems. Few implementation studies for policy-driven digital health system changes of this magnitude have taken place previously in the area of pharmacy practice. A preliminary literature review found that existing digital solutions focusing on prevention and detection of falsified medicines were limited, with little evidence of integrated national and international policy supported initiatives. In the empirical component of this study, I sought to i) explore the implementation process within community pharmacy; ii) understand the challenges and opportunities pertaining to adoption, scale-up and sustainability of FMD technologies at the local level; iii) place findings within a wider national and international policy context; and vi) inform clinicians’ and policy makers’ practice for future policy-driven driven innovations. Fieldwork consisted of a three phased approach including 10 elite and expert participant semi-structured interviews, semi-structured interviews with 17 clinicians at each study site, and 112 hours of ethnographic observations in participating community pharmacies. Analysis was informed by a multi-level theoretical lens known as the Non-adoption or Abandonment of technology by individuals and difficulties achieving Scale-up, Spread and Sustainability (NASSS) framework alongside Shiffman’s Political Priority Framework (PPF). My approach has generated a rich qualitative dataset comprising of interviews, ethnographic fieldnotes, video and digital imagery, and extracts from documents. My findings support a number of provisional conclusions. Primarily that my chosen framework, NASSS, is a suitable model in explaining the complexities with large-scale system implementation within pharmacy, becoming the first ever study to utilise this framework within this context. Secondly, for a digital solution of high complexity to be adopted, embedded, maintained, and interacted with by clinicians, the digital infrastructure must have capabilities to provide added value for clinical work. Thirdly, policy-driven reform is only an instigator for change, which also requires expert and clinician input to shape and develop policy at the front line of implementation

Delivery of pharmaceutical services and care at three primary healthcare clinics with different dispensing models in the Nelson Mandela Bay Health District

As South Africa moves into an era of National Health Insurance (NHI), the idea of primary health care (PHC) re-engineering is placed at the forefront; however, the role of the pharmacist in this process remains vague. Task-shifting of the dispensing process to pharmacist’s assistants and nurses in PHC clinics is a common phenomenon, but the implications of this on the provision of pharmaceutical services and care to patients is largely unstudied. Thus, this study aims to explore these pharmacist-based, pharmacist’s assistant-based and nurse-based dispensing models present in PHC clinics. A two-phase, mixed methods approach was utilised, comprising of a pharmaceutical services audit and semi-structured interviews. The interviews provided insight into the lived experiences of personnel and patients of pharmaceutical care provision. Results revealed that although basic pharmaceutical services may be available at clinics with each of the three dispensing models, the quality is of a varying standard due to challenges in infrastructure and maintenance and poor personnel support. Furthermore, the provision of quality pharmaceutical care is minimal with all three dispensing models, resulting in a missed opportunity to optimise patient health outcomes in patient-centred PHC

Management Strategies to Address the Substance-Impaired Healthcare Professional in the Workplace

Healthcare professionals who practice while impaired by alcohol or drugs endanger the well-being of patients. In the workplace, the substance-impaired healthcare professional poses challenges for healthcare leaders who are responsible for the provision of safe patient care and safe work environments. The purpose of this multiple case study was to explore management strategies used by some healthcare organizational leaders to address the substance-impaired healthcare professional in the workplace. The conceptual framework for this study drew upon the legal and ethical concepts of due diligence. Data collection consisted of surveys of 40 managers and supervisors, and 3 senior leaders, semi structured interviews of executive leaders from one large hospital, and a review of company documents. A software program was used to organize the data for analysis. Five themes emerged that yielded 6 possible strategies that leaders could use to address the substance-impaired healthcare professional in the workplace: an affective healthcare business model, healthcare leader training, monitoring and surveillance systems, synergistic integration of work and life balance, and legal and ethical incident reporting. These research findings may contribute to positive organizational and social change by reducing the risk patients have from substance-impaired healthcare professionals

Expanded pharmacy practice in rural Australia

Selina Taylor studied pharmacists, consumers, health professionals and stakeholders perspectives of expanded pharmacy practice and integrated her findings to develop and pilot an ear health intervention for rural community pharmacy. This study highlights the challenges and enablers of expanded services for rural and remote community pharmacy in Australia

Ethics of the health-related internet of things: a narrative review

The internet of things is increasingly spreading into the domain of medical and social care. Internet-enabled devices for monitoring and managing the health and well-being of users outside of traditional medical institutions have rapidly become common tools to support healthcare. Health-related internet of things (H-IoT) technologies increasingly play a key role in health management, for purposes including disease prevention, real-time tele-monitoring of patient’s functions, testing of treatments, fitness and well-being monitoring, medication dispensation, and health research data collection. H-IoT promises many benefits for health and healthcare. However, it also raises a host of ethical problems stemming from the inherent risks of Internet enabled devices, the sensitivity of health-related data, and their impact on the delivery of healthcare. This paper maps the main ethical problems that have been identified by the relevant literature and identifies key themes in the on-going debate on ethical problems concerning H-IoT

Pharmacist Services

The overall goal of this book is to give the reader a state-of-the-art synopsis of the pharmacist services domain. To accomplish this goal, the authors have addressed the social, psychosocial, political, legal, historic, clinical, and economic factors that are associated with pharmacist services. In this book, you will gain cutting-edge insights from learning about the research of experts throughout the world. The findings have relevance for enhancing pharmacist professionalism, pharmacist practice, and the progression of pharmacist services in the future

Drug-related activity in the United Kingdom of Great Britain and Ireland between 1900 and 1922: what evidence can be found through systematic searches of the Times digital achive.

Much has been written about drug-taking during the nineteenth century, particularly in relation to opium. However, the early twentieth century has received considerably less attention, despite being a crucial period in the history of drug-taking within Britain. During 1916, the Defence of the Realm Act Regulation 40b made it an offence to supply or to possess particular drugs without authorisation. This was a fundamental shift in government thinking that presaged the modern era in which the legal status of particular drugs continues to be an issue of public debate. Previous research focused on changes in the law and analysed the relationships between key individuals and influential groups with an interest in drug control. In part, this reflects the significance of the decision to alter the law but also the lack of available evidence concerning drug-takers of the era. This study seeks to address this gap in understanding and develops a new perspective on drug-taking, that of the participants. The study developed an innovative and, at times, speculative approach to tracing drug-takers of that era. This led to the use of articles from The Times identified from systematic searches of The Times Digital Archive. These articles by their nature were mediated accounts of drug-related activity but no other source could offer such a range of drug-takers over the selected time period (1900-1922). Furthermore, the large number of articles identified meant that it was easier to detect press influences and take these into account when analysing their content. The wealth of information that emerged from the articles was beyond initial expectations and led to an additional piece of analysis concerning the geographical spread of drug-taking activity within the period. Although the evidence did not allow the development of many in-depth accounts as had been the intention at the outset, it did provide insight to particular aspects of drug-taking activity. For example, the collated information regarding female participants suggested specific behavioural traits that possibly made female consumers harder to detect compared to their male counterparts. Drug-taking among military personnel and the operation of supply networks were other aspects illuminated by the articles. An association emerged between military conflicts and increased drug-taking by military personnel. It indicated, too, that periods of conflict could have implications for domestic prevalence from the cessation of hostilities. Geographical analysis illuminated the supply networks both in terms of drug procurement and relationships between drug-takers within their areas of settlement. Furthermore, some of the areas associated with drug-taking during the early twentieth century remain linked to drugs in the present day raising questions about how and why specific areas might become drug hot-spots. Further research arising from this thesis would involve the replication of the method during the later period, 1923 to 1950. This period would allow the female narrative of drug-related activity begun by this thesis to be developed further and to establish whether the First World War was a unique period for female participation or whether their participation evolved. Similarly, considering the articles from this later period could help illuminate further the subsequent spread and operation of supply networks. Replicating the method would also test whether it is transferable to other periods or whether changes to reporting style made the method era specific

An investigation into the experiences, and associated issues, concerning children and young people prescribed regular medication

There is little information concerning the treatment-related experiences when children or young people are prescribed long-term medication. To identify treatment-related problems following the initiation of a new medication, a telephone survey of parents or children/young people was undertaken. Participants were asked about information requirements, medication-related concerns, administration, adverse effects, adherence and their experiences of arranging medication supply. The role of community pharmacists in supporting children taking medication was explored through a postal survey. Pharmacists were asked about their experiences of undertaking medication review in this group and the types of medication-related support this cohort sought from them. These included: advice about adherence, requests for information and the type of problems reported to them including administration and supply issues. The treatment-related experiences of children, young people and their parents/carers when a child takes regular medication were identified through interviews with patients and their parents/carers. Participants were asked to describe their experiences of: the impact of medication on their daily lives, the formulation, adverse effects, negotiating the healthcare system around supply of medication and the social burden of medication. The first three studies identified that some parents made changes to their child’s medication without informing a healthcare professional. Therefore, a postal survey of parents/carers of children prescribed long-term medication was undertaken. Parents/carers were asked about delaying/with-holding/not initiating treatment, making changes to the administration, altering the dose and adjustments to the regimen to make it compatible with daily life. This research has identified that parents/carers and patients experience many challenges when a child is prescribed long-term medication. Greater engagement is required to ensure that the treatment choice and regimen are achievable for patients and their parents/carers. Further research is required to identify effective interventions to support this cohort, one of which could be a paediatric medication review