Shane Scahill

Is There a Role for Pharmacoeconomics in Developing Countries

The special issue of PharmacoEconomics pertaining to developing nations was a welcome move, with authors discussing various themes relating to pharmaceutical economics. The topics discussed included cost-effectiveness analyses and the future of health technology assessment (HTA) in healthcare decisionmaking in the greater Asia region. However, papers in this special issue did not provide an answer to a fundamental question: why is pharmacoeconomics vital for developing countries? Pharmacoeconomics is a complex science and its practical utility depends on the context in which it is being applied. To appreciate the true value of this ‘science’ as a decision-making tool, it is important to elaborate on the context within which healthcare decisions are being made. Furthermore, an understanding of the local health system is also required in order to establish whether complex economic techniques need to be applied and whether they are feasible and valuable tools for a particular jurisdiction. We argue that there is a need for a model that could aid in determining the perceived need and benefits of using pharmacoeconomics in formulary development in a given developing country. However, we do not present a full model; rather, we highlight some of the components that could be used to build such a model. Health and pharmaceutical indicators from international agencies, evidence-based pharmacy-system research as well as the literature concerning ‘how people perceive pharmacoeconomics’ in developing countries could serve as these components. 1. The Use and Understanding of Pharmacoeconomics in Developing Countries

Organisational culture: an important concept for pharmacy practice research

Throughout the developed world, community pharmacy is under considerable pressure to play a greater part in delivering effective primary health care. The requirement to adopt new roles continues to challenge community pharmacy and drive change. The factors that determine the ability of community pharmacy to effectively deliver services for health gain are complex and include; policy, professional, financial and structural elements. There is also evidence to suggest that organisational culture may influence the effectiveness of an organisation. In order to address this there is a need to understand the dimensions of organisational culture that lead to successful implementation of the change necessary for community pharmacy to become a more effective primary health care organisation. In this commentary, we introduce the concept of organisational culture, outline two frameworks for studying culture, and argue the benefits of pursuing an organisational culture research agenda for the evolution of pharmacy practice and research.

‘The way we do things around here’: an international comparison of treatment culture in nursing homes.

OBJECTIVES In this study, we sought to measure treatment culture (beliefs, values, and normative practices associated with medication prescribing and administration) in two samples of nursing homes (in Northern Ireland and New Zealand) and to document the range of scoring achieved by staff in both countries. Responses between nurse managers and registered nurses were also compared. DESIGN A cross-sectional study using an adapted treatment culture questionnaire was distributed by mail (in June and September 2008) to 159 nursing homes in Northern Ireland and completed by the nurse manager and registered nurses. In New Zealand, staff in 14 facilities participated and questionnaires were distributed by a research assistant who visited the homes (March to November 2008). MEASUREMENTS Completed questionnaires were scored using a prespecified scoring system, with a higher score indicating a more resident-centered treatment culture and a lower score indicating a more traditional approach to care. The maximum score possible was 75. Scores were compared between countries and between different categories of staff. Views were also sought and knowledge tested (from structured questions) on the use of psychotropic prescribing in the nursing home environment. RESULTS The response rates for nurse managers and nurses in Northern Ireland were 35.5% and 10.1%, respectively; in New Zealand, the response rate was 90.9% for managers and 71% for nurses. The mean score for the Northern Ireland and New Zealand homes was 39.5 and 39.1, respectively (P > .05). There were also no differences between scores achieved by nurse managers and registered nurses between and across both countries. There were some cross-country differences on the approach to challenging behavior in residents and nurses (in both countries) were more likely than nurse managers to report (incorrectly) that haloperidol is indicated for short-term insomnia. CONCLUSION This quantitative assessment has raised interesting issues in relation to the measurement of treatment culture in the nursing home setting in two countries. Further insights into the importance of treatment culture will be pursued in qualitative studies.

Migrant health in New Zealand: exploring issues concerning medicines access and use

Every year a cohort of new migrants enters New Zealand (NZ), bringing challenges that impact on medicines use and health outcomes. The prescribing of medicines is a common therapeutic intervention and access to medicines and optimal use cannot be assumed for these populations. Internationally the literature exploring issues relating to medicines access and use by migrants in high‐income countries is scarce. This study aims to explore attitudes, beliefs and perceptions of a cohort of migrants about medicines access and use in NZ.

Describing the organisational culture of a selection of community pharmacies using a tool borrowed from social science

Objective of the study To describe the dimensions of organisational culture within a selection of community pharmacies. Setting Community pharmacy in the New Zealand primary care sector which is partially government funded and currently undergoing major reform. Community pharmacy is under pressure to take on new roles, integrate within the wider primary care team and deliver the expectations of contemporary health policy. Method The mixed methods approach of concept mapping was undertaken with 10 representatives from six community pharmacies selected as case sites. The process was split into three parts (a) face to face brainstorming to generate statements describing culture, followed by (b) statement reduction, piloting and approval of statement list by participants, followed by (c) sorting the statements into ‘like’ groups. Multidimensional scaling analysis of participant sorting allows the development of discrete clusters of statements that describe aspects of organizational culture. Results A set of 105 statements were generated at the brainstorming meeting. Eight clusters of organisational culture resulted from participant sorting: leadership and staff management; valuing each other and the team; free thinking, fun and open to challenge; trusted behaviour; customer relations; focus on external integration; providing systematic advice; embracing innovation. Conclusion Community pharmacy is under pressure to take on new roles and deliver and there is some evidence organisational culture of pharmacy may be a barrier. Our paper outlines the development of a survey instrument for describing organisational culture through Concept mapping, a tool borrowed from social sciences. This tool can be used for exploration of aspects of culture that may be important in the change management process for improving the effectiveness of community pharmacy as expected by contemporary primary health care policy.

Placing “culture” at the center of social pharmacy practice and research

Young et al make a significant contribution to scholars in socialpharmacybyprovidingaplatform for discussion that goes beyond the provision of pharmaceutical services to Spanish-speaking peoples (SSPs) within the United States. Further, Young et al address a recognized gap in this field by adopting a theoretical approach to direct the study of a complex social phenomenon. Their study is underpinned by the concept of “culture” at several levels that warrants consideration with respect to practice and research. Their findings suggest that the number of SSPs served by an individual pharmacy, and that pharmacists’ self-efficacy (opening the encounter and sharing information) and communicatingwith SSPs is directly associatedwithoptimal provision of medicines information to these folk. Further, the presence of interpreter services and Spanish-speaking staff has a direct influence through self-efficacy, to positively impact service provision.

Exploring an increased role for Australian community pharmacy in mental health professional service delivery: evaluation of the literature*

Abstract Background: Australian general practitioners primarily treat mental health problems by prescribing medication dispensed by community pharmacists. Pharmacists therefore have regular interactions with mental health consumers and carers. Aims: This narrative review explored the potential role of community pharmacy in mental health services. Method: Medline, CINAHL, ProQuest, Emerald, PsycINFO, Science Direct, PubMed, Web of Knowledge and IPA were utilised. The Cochrane Library as well as grey literature and “lay” search engines such as GoogleScholar were also searched. Results: Four systematic reviews and ten community pharmacy randomised controlled trials were identified. Various relevant reviews outlining the impact of community pharmacy based disease state or medicines management services were also identified. Conclusion: International studies involving professional service interventions for mental health consumers could be contextualised for the Australian setting. Australian studies of pharmacy professional services for chronic physical health conditions provided further guidance for the expansion of community pharmacy mental health professional services.

Funding for change: New Zealand pharmacists’ views on, and experiences of, the community pharmacy services agreement

To explore pharmacists views on the shift in ethos, funding and service delivery model introduced through the New Zealands Community Pharmacy Services Agreement (CPSA).

Mapping the terrain: A conceptual schema for a mental health medication support service in community pharmacy

Objective: Mental health–related problems pose a serious issue for primary care, and community pharmacy could make a significant contribution, but there is a dearth of information. Methods: This article reports synthesis of the literature on mental health interventions across a range of pharmacy models, and pharmacy services in contexts beyond mental health. To best inform the design of a community pharmacy medication support intervention for mental health consumers, the literature was reported as a conceptual schema and subsequent recommendations for development, implementation and evaluation of the service. A broad conceptualisation was taken in this review. In addition to mental health and community pharmacy literature, policy/initiatives, organisational culture and change management principles, and evaluative processes were reviewed. Key words were selected and literature reviews undertaken using EMBASE, PubMed, CINAHL and Web of Science. Results: Recommendations were made around: medication support intervention design, consumer recruitment, implementation in community pharmacy and evaluation. Surprisingly, there is a scarce literature relating to mental health interventions in community pharmacy. Even so, findings from other pharmacy models and broader medicines management for chronic illness can inform development of a medication support service for mental health consumers. Key learnings include the need to expand medicines management beyond adherence with respect to both intervention design and evaluation. Conclusion: The conceptual framework is grounded in the need for programmes to be embedded within pharmacies that are part of the health system as a whole.

Barriers to effective pharmacy practice in low- and middle-income countries

The role of the pharmacist within health care systems is undergoing significant development with the continual introduction of new medicine entities, the emergence of new resistant microbes, and changes in the delivery of health services. In developed countries, pharmacists are playing a key role in promoting safe and effective use of medicines; however, in the majority of low- and middle-income countries, they still have to reach their true potential. This article set out to explore the barriers to effective practice in low- and middle-income coun- tries, and concluded that a) health systems; b) level and quality of services provided by community pharmacies; and c) educational and professional factors are the three main barriers.