Betty Chaar

Educational interventions to improve prescribing competency: a systematic review

Objective To review the literature on educational interventions to improve prescribing and identify educational methods that improve prescribing competency in both medical and non-medical prescribers. Design A systematic review was conducted. The databases Medline, International Pharmaceutical Abstracts (IPA), EMBASE and CINAHL were searched for articles in English published between January 1990 and July 2013. Setting Primary and secondary care. Participants Medical and non-medical prescribers. Intervention Education-based interventions to aid improvement in prescribing competency. Primary outcome Improvements in prescribing competency (knows how) or performance (shows how) as defined by Millers competency model. This was primarily demonstrated through prescribing examinations, changes in prescribing habits or adherence to guidelines. Results A total of 47 studies met the inclusion criteria and were included in the systematic review. Studies were categorised by their method of assessment, with 20 studies assessing prescribing competence and 27 assessing prescribing performance. A wide variety of educational interventions were employed, with different outcome measures and methods of assessments. In particular, six studies demonstrated that specific prescribing training using the WHO Guide to Good Prescribing increased prescribing competency in a wide variety of settings. Continuing medical education in the form of academic detailing and personalised prescriber feedback also yielded positive results. Only four studies evaluated educational interventions targeted at non-medical prescribers, highlighting that further research is needed in this area. Conclusions A broad range of educational interventions have been conducted to improve prescribing competency. The WHO Guide to Good Prescribing has the largest body of evidence to support its use and is a promising model for the design of targeted prescribing courses. There is a need for further development and evaluation of educational methods for non-medical prescribers.

Factors Affecting the Implementation of Clinical Pharmacy Services in China

New policies in China have recently led to the implementation of clinical pharmacy services in hospitals. We explored the views of hospital administrators, pharmacy directors, clinical pharmacists, and dispensing pharmacists about the factors affecting clinical pharmacy services in China, using the framework approach and organizational theory. We conducted 30 interviews with 130 participants at 29 hospitals (both secondary and tertiary) in Beijing, Zhengzhou, Luoyang, and Shanghai. We found that the barriers to and facilitators of implementation of clinical pharmacy services slotted into the environment and participant dimensions of Scott’s adapted version of Leavitt’s organizational model. External support from government was perceived as crucial to promoting pharmacy services. It is proposed that the internationally recognized Basel Statements of the International Pharmaceutical Federation also provide a strong foundation for guiding China in implementing clinical pharmacy services.

Professional ethics in pharmacy: the Australian experience

Objective The profession of pharmacy has the unique characteristic of having both professional and business orientations. There is today, in addition to this unique characteristic, a strong shift in pharmacy towards more involvement in patient‐centred health care, and increased emphasis on the patients best interests and autonomy, within a framework of what is known as ‘bioethics’. With this shift of professional focus comes a heightened level of responsibility due to increased expectations of the patient and greater involvement in healthcare and decision making at a personal level with the patient. There is therefore inherent in this increased involvement an increased propensity for ethical problems to arise. The aim of this study is to investigate the application of ethical theory in the practice of pharmacy in New South Wales (NSW), Australia.

Consumer perspectives about weight management services in a community pharmacy setting in NSW, Australia.

Background  Obesity is a public health challenge faced worldwide. Community pharmacists may be well placed to manage Australia’s obesity problem owing to their training, accessibility and trustworthiness. However, determining consumers’ needs is vital to the development of any new services or the evaluation of existing services.

Managing obesity in pharmacy: the Australian experience

Objective To explore pharmacists’ opinions about the provision of weight management services in community pharmacy and their attitudes towards the establishment of an accredited training course in weight management in pharmacy. Setting Interviews were conducted with practising pharmacists on site in various community pharmacies in metropolitan Sydney, Australia. Method In-depth, semi-structured interviews with twenty practising pharmacists were conducted. Of the twenty interviewed pharmacists, sixteen were involved in the provision of one or more pharmacy based weight management programs in their pharmacies. Interviews were audio-recorded, transcribed and analysed using the grounded theory approach. Main outcome measure The data were thematically analysed to identify facilitators and perceived barriers to the provision of high quality services, and pharmacists’ willingness to undertake training and accreditation. Results Participants clearly perceived a role for pharmacy in weight management. Key facilitators to provision of service were accessibility and the perception of pharmacists as trustworthy healthcare professionals. The pharmacists proposed collaboration with other healthcare professionals in order to provide a service incorporating diet, exercise and behavioural therapy. A program that was not-product-centred, and supported by ethical marketing was favoured. Appropriate training and accreditation were considered essential to assuring the quality of such services. Barriers to the provision of high quality services identified were: remuneration, pharmacy infrastructure, client demand and the current marketing of product-centred programs. Conclusion Australian pharmacists believe there is a role for pharmacy in weight management, provided training in accredited programs is made available. A holistic, evidence-based, multi-disciplinary service model has been identified as ideal.

Emergency contraception in Australian community pharmacies: a simulated patient study

BACKGROUND Australia joined the worldwide movement to increase the availability of the emergency contraceptive pill (ECP) by rescheduling from Prescription to Pharmacist Only status in 2004. However a protocol developed to aid in the provision of the ECP placed extensive requirements on the pharmacist. This study investigated the provision of the ECP by community pharmacists in Sydney, Australia. STUDY DESIGN Using a simulated patient methodology, 100 community pharmacies were visited over a five week period (Aug-Oct 2008). The simulated patient specifically requested the ECP, and details of the consultation were recorded on a standardised data collection form. RESULTS The ECP was supplied in 95% of the pharmacies visited. Patient privacy was observed in 90% of consultations, which in general were succinct and friendly. Clinical assessment of the patient that met all the requirements was observed in 18%, partial assessment in 69%, and inadequate assessment in 13% of consultations. Provision of required information to the patient was sufficient in 42%, partial in 55%, and inadequate in 3% of consultations. CONCLUSIONS This study highlighted a need to standardize procedures in regard to the ECP service to present a more consistent level of service to the public. Suggestions to improve the service include complete revision and simplification of the current protocol and improved training. Additionally, mandatory provision of private consultation areas and continuing professional education may facilitate and enhance quality counselling.

Weight management in community pharmacy: what do the experts think?

Background The increasing prevalence of obesity and overweight adults creates a significant public health burden and there is great potential for pharmacists to be involved in the provision of weight management services, other than the mundane supply of commercial products. In order to provide optimal services that can be integrated into the healthcare system, a best practice model for weight management services in community pharmacy should be in place. We sought experts’ and key stakeholders’ opinions on this matter. Objectives (1) To identify components of a best practice model of a weight management service feasible in Australian community pharmacy. (2) To identify the role of pharmacists and the training requirements to up-skill pharmacists to competently provide weight management services. (3) To elicit any practical suggestions that would contribute to successful implementation of weight management services in pharmacy. Setting Australian primary care sector. Method Semi-structured interviews were conducted with a purposive sample of 12 participants including Australian experts in obesity and representatives of main Australian professional organisations in pharmacy. Interviews were digitally recorded, transcribed verbatim and thematically analysed using the framework approach. Main outcome measure Recommended components of pharmacy-based weight management services and training requirements. Results Participants perceived two potential roles for pharmacists involved in weight management: health promotion and individualised service. Multi-component interventions targeting all three areas: diet, physical activity and behaviour change were emphasised. Physical assessment (e.g. weight, waist circumference measurements), goal setting, referral to allied healthcare professionals and on-going support for weight maintenance were also proposed. Participants suggested pharmacists should undergo formal training and identified various training topics to improve pharmacists’ knowledge, attributes and skills to acquire competencies necessary for delivery of this service. Some physical and financial barriers in providing these services were also identified including infrastructure, pharmacists’ time and cost-effectiveness. Conclusion Pharmacists are well-positioned to promote healthy weight and/or implement weight management interventions. Furthering pharmacists’ role would involve training and up-skilling; and addressing key practice change facilitators such as pharmacy layout and remuneration. This study provides some insight into the design and implementation of a best practice model for pharmacy-based weight management services in Australia.

Professional ethics in pharmacy practice: developing a psychometric measure of moral reasoning

Objective To develop and validate a psychometric measure of cognitive moral development in professional ethics in pharmacy. Setting Pharmacy practice in Australia. Method A psychometric instrument, the Professional Ethics in Pharmacy (PEP) test, was developed and validated following a systematic procedure. The theoretical foundation of the instrument was based on a hypothesised theory of cognitive moral development in professional ethics, which was integrated into a selection of scenarios experienced in practice by pharmacists in NSW, Australia. The PEP, along with the well established DIT test, was mailed in the form of a questionnaire to a randomly selected sample of 1,500 practising pharmacists. Data collected from returned questionnaires were statistically analysed to establish validity and reliability of the instrument. Main outcome measures The P-score calculated for each participant from DIT and PEP data and defined as a measure of principled moral reasoning, represented the main outcome measure for statistical testing. Pearson’s correlation coefficient was used to determine the strength of the relationship of the PEP with the DIT (regarded as the “gold standard”) in order to establish criterion and concurrent validity. Factor analysis was used to investigate construct validity. Cronbach’s Alpha, a measure of reliability of the instrument, was used for indicating internal consistency. Linear regression models further investigated construct validity in relation to predictors of moral reasoning. Results Face and content validity were established by pilot and peer review. Pearson’s coefficient of 0.53 indicated an acceptable level of concurrent validity. Factor analysis yielded factors closely related to the theoretical stages of cognitive moral development hypothesised, which indicated construct validity. Cronbach’s alpha of 0.75 demonstrated the reliability of the instrument, and linear regression models provided further evidence of construct validity. The PEP was established as a robust instrument on several dimensions of validity and reliability. Conclusion The validated PEP test has the potential to provide the pharmacy profession with valuable information for use education and research. The validation process also provided evidence supporting the hypothesis that moral reasoning in professional ethics in pharmacy is a developmental process, which has profound implications for furthering the understanding of professional behaviour.

Preparing hospital pharmacists to prescribe: stakeholders’ views of postgraduate courses

To explore pharmacy stakeholders’ views on developing a postgraduate course to prepare hospital pharmacists for collaborative prescribing in Australia.

Pharmacists' perspectives about their role in care of patients with diabetes observing Ramadan

Background: Diabetes is a common chronic condition amongst Australians. Ongoing management requires adherence to medication and diet regimens. Religious practices such as fasting, such as the Ramadan fast observed by Muslims can impact medication use and diabetes control. Pharmacists as medication experts have a key role in helping people observing religious practices, to maintain optimal control over their medication regimen. Objective: This study aimed to explore the perspective of Australian community pharmacists about professional services for patients with Type 2 diabetes (T2D) who may opt for observing the Ramadan fast. Methods: Qualitative, semi‐structured interviews with a purposive convenient sample of pharmacists practicing in areas of ethnic diversity in Sydney were undertaken. Interview data were thematically analyzed using a constructivist paradigm. Results: Twenty‐one semi‐structured interviews (57% male participants) were conducted during June–August 2015, and the analysis of verbatim transcripts established several themes. Although most participants encountered fasting patients, and were willing to engage in diabetes services for them, our analyses indicated reactive counseling, lack of perceived need for counseling patients or delegation of patient care in a few instances as well as organizational issues as a practice barrier. Some participants highlighted the need for training and skills development in this area and cited other organizational barriers such as time, infrastructure and patient expectations/attitudes that might impede service provision. Key themes related to patients included: experiencing adverse outcomes of fasting on diabetes, varying levels of self‐efficacy, help seeking behaviors and negative attitudes to pharmacist involvement. Conclusion: Pharmacists encounter patients with chronic conditions who observe religious fasts that may interrupt established medication regimens. Proactive counseling about medication use in these instances is offered only by some pharmacists. Professional awareness of the effect of religious practices is important and protocols to assist patients in these situations should be developed and disseminated. Standardized service provision is likely to facilitate positive patient expectations so that pharmacies and pharmacists are viewed as a normal channel for seeking help by fasting patients.