Dissertations / Theses on the topic 'Clinical Pharmacy and Pharmacy Practice'

Discuss two implementation outcomes (adoption and reach) and explain why they are important for clinicians to measure and report, with application to own work Name sources of data that are accessible to clinicians in health care settings, with consideration of own setting. Describe a range of dissemination strategies used to create impact, including new ideas for dissemination of own work.

Objective. To evaluate the impact of an interprofessional blended learning course on medical and pharmacy students’ patient-centered interpersonal communication skills and to compare precourse and postcourse communication skills across first-year medical and second-year pharmacy student cohorts. Methods. Students completed ten 1-hour online modules and participated in five 3-hour group sessions over one semester. Objective structured clinical examinations (OSCEs) were administered before and after the course and were evaluated using the validated Common Ground Instrument. Nonparametric statistical tests were used to examine pre/postcourse domain scores within and across professions. Results. Performance in all communication skill domains increased significantly for all students. No additional significant pre/postcourse differences were noted across disciplines. Conclusion. Students’ patient-centered interpersonal communication skills improved across multiple domains using a blended learning educational platform. Interview abilities were embodied similarly between medical and pharmacy students postcourse, suggesting both groups respond well to this form of instruction.

East Tennessee State University has successfully integrated clinical environments into its IPE curriculum, providing over 200 students from several different health professions training programs with first hand experiences in team based care. Seven partner sites host IPE groups comprised of entry-level students, providing opportunities to interact with members of the health care team, tour the active facility and interact with a patient. Our team will discuss how we navigated complex logistics and partnerships to build these experiences into our paradigm. Attendees will be challenged to think creatively about working with clinical sites outside the university setting and provided with guidance for their program. At least 40 minutes of the workshop will utilize active learning techniques. This workshop will consist of four sections, three similarly structured followed by a final reflective section. The first three sections (Building the Framework, Faculty Facilitators, and Clinical Partners) will be structured similarly. A brief introduction will prompt participants to identify potential barriers, helpful resources, and/or logistical concerns associated with each topic. This will be a small group activity where attendees share and record their discussion on a provided template. This will be followed by a brief overview of how the topic was approached for implementation of the ETSU IPE curriculum, while incorporating group responses to create a large group discussion. Our team brings the value of each representing the perspective of the various roles involved in the implementation: faculty, site leader, and director.In the fourth section, attendees will use content from the prior sections to develop a blue print for their program’s opportunities in clinical environments. Our team will answer specific questions and provide consultations with the draft of attendees’ individualized blue print. The blue print can then serve as a tool to spark the development of a strategic plan for the integration of clinical environments at their program. Learner Outcomes:At the end of this workshop, attendees are expected to be able to:1) identify potential barriers, helpful resources and logistical details for partnering with clinical sites to create IPE experiences in clinical environments;2) identify barriers and helpful resources to assist faculty in facilitating IPE groups in the clinical environment;3) create a blueprint as a guide to incorporating clinical environments into the IPE curriculum.

The purpose of this research was to evaluate the strategy of the military health service (MHS) to improve asthma outcomes through the use of clinical practice guidelines (CPGs). Outcomes were evaluated at the patient level and included inpatient/outpatient visits, prescriptions dispensed, number of exacerbations, number of beddays and direct cost of therapy. In addition, provider compliance to CPG recommendations was evaluated by measuring the proportion of subjects dispensed long-acting controller medications. A nonrandomized control-group before-after design with retrospective matched-pair DoD data was used for this research. The intervention used in this research was the formal asthma CPG-use process implemented by the Army in September of 2000. Compared to baseline measures, all outcomes improved significantly (p < 0.05) in the after period for both the subjects exposed, and not exposed, to the CPG-use process. Other than the improvement noted in the number of asthma exacerbations, which was greater in the exposed group than the non-exposed group (p < 0.001), there was no other difference between groups in the amount that outcomes improved. The proportion of subjects prescribed long-term controller medications increased significantly for subjects exposed to the CPG-use process (0.30 to 0.66, p < 0.001), and for those not exposed to the CPG-use process (0.30 to 0.66, p < 0.001). Although the findings of this research suggested that a formal CPG-use process to standardize asthma therapy was associated with decreased costs, this was not supported by results regarding the clinical outcomes. To further evaluate the effect of asthma CPGs on economic and clinical outcomes, additional research is needed.

Evaluation of: Bangalore S, Steg PG, Deedwania P et al. β-Blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. JAMA 308(13), 1340–1349 (2012). The number of myocardial infarctions (MIs) in population remains high and this event is a significant predictor of mortality. Information in the literature points to a reduction in mortality, reinfarction and sudden death in first year, especially in patients with high risk, if β-blockers (BBs) are used after MI. In a perspective study, Zuckerman et al. have determined outcome following pharmacotherapy after acute MI in older adults. It is apparent that a number of matters require consideration in evaluation of the effectiveness of BBs. It seems that not all patients benefit equally from treatment with BBs but such an intervention reduces mortality. It is also important to recognize that the beneficial effects of BBs should not be considered in isolation since the biological system is too complex to manipulate with the use of a single class of drugs.

Objective. To evaluate the impact of an interprofessional blended learning course on medical and pharmacy students’ patient-centered interpersonal communication skills and to compare precourse and postcourse communication skills across first-year medical and second-year pharmacy student cohorts. Methods. Students completed ten 1-hour online modules and participated in five 3-hour group sessions over one semester. Objective structured clinical examinations (OSCEs) were administered before and after the course and were evaluated using the validated Common Ground Instrument. Nonparametric statistical tests were used to examine pre/postcourse domain scores within and across professions. Results. Performance in all communication skill domains increased significantly for all students. No additional significant pre/postcourse differences were noted across disciplines. Conclusion. Students’ patient-centered interpersonal communication skills improved across multiple domains using a blended learning educational platform. Interview abilities were embodied similarly between medical and pharmacy students postcourse, suggesting both groups respond well to this form of instruction.

Primary Objective: According to the National Center for Health Statistics, many Americans use some type of vitamin or supplement. A recent study of cancer patients in the VA medical system found that a significant number of cancer patients do not mention the use of supplements to their healthcare providers. Many of these supplements were also found to interact with or compound side effects of chemotherapy regimens. The purpose of this study is to determine the incidence of cancer patients taking supplements and to determine the completeness of home medication lists in regard to vitamins or herbal supplements.

The Australian Government commenced Home Medicines Review (HMR) program funding in 2001 to promote safe and effective medicines use and to optimise prescribing in the community. However, little is known about accredited pharmacists' (APs') HMR work processes, and recent program restrictions limited HMR community access. This multiphase study explores how HMRs are conducted, the work complexity, and the service time investment performed by APs. The findings include justifying national health program reform to support in-home patient consultations of differing complexity to enable APs to better support patient medicines management and promote the Quality Use of Medicines.

Ongoing structural and financial changes in the health care sector have resulted in increased risks for ethical dilemmas and moral distress. It is purported that increased ethical competence will help staff manage ethical dilemmas and hence decrease moral distress. To enhance ethical competence several approaches may be used – theoretical education, and methods focusing on reflection and decision-making abilities.

Ethics rounds are a widespread systematic method hypothesized to improve ethical competence, nurture a reflective climate, and help in ethical decision-making. Despite its popularity, its effects on moral distress have hitherto never been evaluated in a controlled study.

The purpose of this thesis was to evaluate the impact of an intervention, including ethics rounds; the hypothesis being that the intervention would decrease perceived moral distress. An additional aim was exploring the concept of moral distress in various health care establishments, including pharmacies.

Focus groups were conducted to explore the concept of moral distress. To evaluate the intervention a scale assessing staff-perceived moral distress was designed, validated, and implemented.

Results showed that moral distress is evident in diverse health care settings. Some factors associated with this were lack of resources, conflicts of interest, and rules that are incompatible with practice. An expanded definition of moral distress was presented.

The training program was much appreciated by participants. However, no significant effects on perceived moral distress were found. Reasons could be that the intervention was too short or otherwise ineffective, there is no association between ethical competence and moral distress, the assessment scale was not sensitive enough, or management was not sufficiently involved.

There is a need to further refine the various aspects of ethical dilemmas in clinical settings, and to evaluate the most efficient means to enhance skills for dealing with ethical dilemmas, for the benefit of staff, patients, institutions, and society.

Tuberculosis (TB) is a major contributor to the disease burden in developing countries resulting in deaths of approximately 2 million people a year. South Africa (SA) has one of the highest annual 
TB incidences with an estimate of 558 per 100 000 population (2003) and the situation shows no sign of abating. TB remains the most common opportunistic infection and cause of death 
amongst HIV- infected patients. Both TB and HIV treatment depend exclusively on multi-drug regimens that require close monitoring among health care professionals. With increasing workload 
due to staff shortage and high patient load, the quality of care in nurse-led primary care clinics maybe compromised. Existing clinic staff may overlook drug-drug interactions, side effects and may 
not be aware of the consequences when a formulation is modified during multi-drug therapy administration. As the custodian of medicines, pharmacists are ideally placed to monitor therapy. 
Clinicbased training programmes which are offered to nurses provide an opportunity to work alongside clinic staff and engage in patient-centered care where the pharmacotherapeutic outcome of TB and HIV drug regimens could be closely monitored.

Objective: To establishing, implement and consolidate clinical pharmacy services in units of Farmácia Popular do Brasil program in state of Sergipe. Methods: Initially, systematic review was performed in the databases PubMed, Scopus, EMBASE using the key words "community pharmacy services", "quality assurance health care", "outcome assessment". A longitudinal study of three units of the Farmácia Popular do Brasil in the state of Sergipe on the establishment was carried out (2012), implementation (2013) and consolidation of clinical pharmacy services (2014). The structure of pharmacies was evaluated for physical structure, through the RDC 44/2009, and human resources, the technique of simulated patient. Then three focus groups were conducted (2012, 2013 and 2014) for the perceptions of pharmacists. Finally, we used the coaching technique for establishment, implementation and consolidation of services: dispensing, measurement of blood pressure and blood capillary glucose, medication review and medication therapy management. Results: In the systematic review 42 articles met the inclusion criteria. It was observed that the most valued results were glycosylated hemoglobin (clinical), quality of life (humanistic) and analysis of the cost-effectiveness of the service relationship (economic). In assessing the structure, interventions enabled improvements on all items that were considered non-compliant. However, the overall impression of the pharmaceutical skills for clinical services was considered regular (3) on a scale from 1 to 5. Regarding the focus groups, pharmacists reported expectations in technical support to develop skills, gain knowledge and have a constant monitoring of the researchers, also identified 13 types of barriers. Finally, was designed 520 hours of coaching in place to implement flows and processes, development of standard operating procedures and preparation of strategic plans. In the education training, pharmacists underwent 176 hours of theoretical and practical training and employees to 24h. After the coaching interventions the numbers of services were expanded: there was 767 dispensations in 2012, 1444 in 2013 and 2537 in 2014; 714 measurements of blood pressure and blood capillary glucose in 2012, 2375 in 2013 and 5039 to 2014; 49 consultations of medication review in 2012, 87 in 2013 and 355 in 2014; 15 consultations of medication therapy management in 2012, 33 in 2013 and 271 in 2014. Conclusion: From the good situational diagnosis, the coaching can be considered a technique that assists in establishment, implementation and consolidation of clinical pharmacy services. Combined with a professional training, it allows the individual follow-up in steps as: definition of services and processes, selection of indicators for the assessment and development of strategic plans. In this perspective, this results may support the construction of a differentiated and replicable model of clinical services in community pharmacies.
Objetivo: Implantar, implementar e consolidar serviços clínicos farmacêuticos em unidades do programa Farmácia Popular do Brasil do Estado de Sergipe. Métodos: Inicialmente, foi realizada revisão sistemática da literatura nas bases de dados PubMed, SCOPUS, EMBASE utilizando os descritores community pharmacy services , quality assurance health care , outcome assessment . Foi realizado um estudo longitudinal em três unidades da Farmácia Popular do Brasil do estado de Sergipe sobre a implantação (2012), implementação (2013) e consolidação dos serviços clínicos farmacêuticos (2014). Foi avaliada a estrutura das farmácias quanto à estrutura física, por meio da RDC 44/2009, e aos recursos humanos, pela técnica do paciente simulado. Em seguida, foram realizados três grupos focais (2012, 2013 e 2014) para obter as percepções dos farmacêuticos. Por fim, foi utilizada a técnica de coaching para a implantação, implementação e consolidação dos serviços de: dispensação, aferição da pressão arterial e glicemia capilar, revisão da farmacoterapia e seguimento da farmacoterapia. Resultados: Na revisão sistemática 42 artigos preencheram os critérios de inclusão. Observou-se que os resultados mais avaliados foram hemoglobina glicosilada (clínico), qualidade de vida (humanístico) e análise da relação custo-eficácia do serviço (econômico). Na avaliação da estrutura, as intervenções possibilitaram melhorias em todos os itens que foram considerados inconformes. No entanto, a impressão geral sobre as competências farmacêuticas para serviços clínicos foi considerada regular (3) numa escala de 1 a 5. Com relação aos grupos focais, os farmacêuticos relataram expectativas quanto ter suporte técnico para desenvolver habilidades, adquirir conhecimentos e ter um acompanhamento constante dos pesquisadores, além disso, identificaram 13 tipos de barreiras. Por fim, foram destinadas 520 horas de coaching in loco para implantação de fluxos e processos, elaboração de procedimentos operacionais padrão e elaboração de planos estratégicos situacionais. Na etapa de treinamento, os farmacêuticos foram submetidos a 176h de treinamento teórico-prático e os colaboradores a 24h. Após as intervenções do coaching os números dos serviços foram ampliados: obteve-se 767 atendimentos de dispensação em 2012, 1444 em 2013 e 2537 em 2014; 714 aferições da pressão arterial e glicemia capilar em 2012, 2375 em 2013 e 5039 em 2014; 49 consultas da revisão da farmacoterapia em 2012, 87 em 2013 e 355 em 2014; 15 consultas de seguimento da farmacoterapia em 2012, 33 em 2013 e 271 em 2014. Conclusão:. A partir de um bom diagnóstico situacional o coaching pode ser considerado uma técnica que auxilia nas etapas de implantação, implementação e consolidação de serviços clínicos farmacêuticos. Aliado a um treinanamento profissional, ele permite o acompanhamento individualizado em etapas como: definição dos serviços e processos, seleção de indicadores para a avaliação e elaboração de planos estratégicos situacionais. Nesta perspectiva, os resultados observados poderão embasar a construção de um modelo diferenciado e replicável de serviços clínicos farmacêuticos em farmácias comunitárias.

Background/Purpose: The American College of Cardiology/American Heart Association/Heart Failure Society of America guidelines for management of heart failure were recently updated to include use of sacubitril/valsartan due to its ability to reduce mortality and hospitalizations over the current standard of therapy. Based on these guideline updates, a champion research team at East Tennessee State University (ETSU) Family Medicine Associates worked to create and implement a process that identified patients with systolic heart failure and provided access to medications with mortality and morbidity benefits. The objective of this study is to improve provider knowledge of evidence-based heart failure pharmacotherapy and to assess provider acceptability of a process implemented at ETSU Family Medicine Associates. Methodology: This study was approved by the Institutional Review Board. On December 21, 2016 the champion research team presented a didactic session to all providers at ETSU Family Medicine Associates. Immediately prior to the education session, providers completed a pre-education clinical knowledge assessment on heart failure pharmacotherapy. A one-hour didactic session then followed focusing on evidence-based medication management of systolic heart failure and introduction of the new process being implemented. Following the presentation, providers completed a post-education clinical knowledge assessment and a pre-implementation process acceptability survey. Providers were then scheduled to complete a post-implementation process acceptability survey at two months post-process implementation and quarterly thereafter. A McNemars Test will be used to determine if statistically significant differences exist among pre- and post-education clinical knowledge assessments and pre- and post-implementation process acceptability surveys. Presentation Objective: Discuss the process implemented to improve provider knowledge of heart failure pharmacotherapy and improve patient access to evidence-based pharmacotherapy options. Self-Assessment: Did the one-hour didactic session improve provider knowledge of heart failure pharmacotherapy?

Throughout the world the population is ageing and the burden of chronic diseases and co- morbidity is growing. While the appropriate use of medicines help to decrease morbidity and mortality from chronic diseases, research consistently demonstrates that preventable medication-related problems cause unplanned hospitalisation and morbidity. The elderly and those consuming multiple medicines are at greatest risk. Pharmacist-provided medication management services aim to prevent and resolve medication-related problems for those consumers who have been identified as being at increased risk. This thesis deals with consumers' participation in pharmacist-provided medication management services with a particular focus on Australia's Home Medicines Review (HMR). HMR has been shown to improve health outcomes across a variety of research settings. The rationale for the thesis was that some consumers who have been identified as being at risk have declined the offer to use HMR. Many potential consumers of HMR are cared for by informal caregivers such as spouses or other family members (caregivers). Caregivers therefore necessarily have a key role in enhancing consumer participation in medication management services. Therefore, the aim of this thesis was to investigate consumers' and caregivers' awareness, expectations and willingness to use HMR. In order to address the aim, the thesis used cross sectional studies with mixed-methods. Studies included qualitative methods using focus group discussions and quantitative methods using surveys. Given the preliminary nature of the research, survey data was obtained from three different samples in order to validate the measurement scales and to test and re-test hypotheses. Such an approach strengthens the key findings of the thesis. Chapter One provides the background to the study. The literature review identified that consumers' most salient expectations of pharmacist-provided medication management services are those centred on the interpersonal interaction with the pharmacist during the patient-pharmacist interview. While it is acknowledged that these services improve medication safety through for example; enhanced inter-professional communication, goal setting, and optimised therapies, consumers tend to focus on the benefit of receiving personalised medicines information. Given the lack of previous research using behavioural theory to study the factors which influence willingness to use medication management services, a new framework was developed. The research was therefore guided by a conceptual model which was grounded in theories of medication information seeking behaviour. Chapter Two reports a cross-sectional survey which was distributed to patients by 264 pharmacists throughout Australia. A total of 1893 questionnaires for HMR recipients were sent to pharmacists of which 595 (31%) were returned by patients. A total of 1829 questionnaires for consumers who were eligible to use HMR (eligible non-recipients) were sent to pharmacists of which 293 (16%) were returned and met the inclusion criteria. The results showed that most recipients of HMR were very satisfied with the service, had few barriers to using it and were very willing to re-use it. Eligible non-recipients were provided with a description of HMR in the survey and encouragingly, a majority reported that they would be willing to ask for an HMR, if they had concerns about their medicines. Overall however, they were less willing to use HMR than recipients. Having prior awareness of HMR increased eligible non-recipients' willingness to use it. The research reported in Chapter Three used structural equation modelling to analyse the data from a subset of eligible non-recipient consumers (n=286) from Chapter Two who were using multiple medicines (taking more than 5 medicines daily or more than 12 doses daily). Results showed that consumers' willingness to use HMR was most strongly influenced by their positive outcome expectancy - expectations that HMR would provide them with increased medicines knowledge, help them to manage their medicines and reduce their medicine concerns (β = 0.56, P < .001). Importantly however, overall respondents recorded neutral rather than positive or negative scores on the positive outcome expectancy scale. Having determined that consumers' positive outcome expectancy had a strong influence on their willingness to use it, the thesis then focussed on a deeper understanding of the factors which may influence their positive outcome expectancy and willingness to use HMR. The theoretical framework suggested that consumers' worries about experiencing medication- related problems may increase their positive outcome expectancy. Chapter Four reports a qualitative study which was used to explore consumers' expectations of and motivation to use HMR. For this study, 12 focus groups were held using the English language, two in Mandarin and one in Arabic. The data pertaining to recipient (n=28) and non-recipient (n=52) consumers were thematically analysed with the conceptual framework of the study. A key theme was that consumers experienced worries about their medicines. Medicines were considered to be innately harmful and consumers could also experience harm from making mistakes themselves. While some lacked information about their medicines, others believed that medicines information could be confronting. Another theme was that consumers expected that HMR would be useful because they expressed a clear preference to learn about their medicines during interpersonal interactions with pharmacists, rather than from written sources. Consumers' thoughts and feelings appeared to be more focussed on the positive outcomes of HMR when they were worried about medication-related problems. Having demonstrated qualitative support for the hypothesis that increased medication- problem worry would increase positive outcome expectancy and willingness, Chapter Five aimed to test this hypothesis using quantitative methods. In addition, this study aimed to quantify the extent to which willingness was affected by the social influence of the GP - consumers' perceptions of what the GP thinks of HMR. For this study, eligible non-recipient consumers were recruited by postal survey of 1600 members of Council of the Ageing, NSW (COTA, NSW). Surveys received from 390 respondents (24.3%) who were taking multiple medicines were analysed. Similar to the results of Chapter Three, overall respondents recorded neutral rather than positive or negative scores on the positive outcome expectancy scale. Structural equation modelling revealed that consumers' medication-problem worry increased their positive outcome expectancy (β = 0.66, P < .05) and indirectly increased their willingness to use HMR (β = 0.22, P < .05). The effect of the social influence of the GP was to act directly on consumers' willingness to use HMR (β = 0.27, P < .05). The social influence of the GP did not increase positive outcome expectancy. In other words, this social influence was effective, even though it had no bearing over whether consumers thought that the HMR was personally beneficial. Having examined some of the factors influencing consumers' willingness to use HMR, Chapter Six turned to the case of caregivers. The background to Chapter Six identified that caregivers may experience knowledge hassles - daily stressors experienced whilst dealing with tasks which require knowledge about the safety and effectiveness of the care-recipients' medicines. Similar to the effect that medication-problem worry had on consumers' willingness, it was predicted that knowledge hassles would increase caregivers' positive outcome expectancy for HMR and their willingness to assist their care-recipient to use HMR. For this study, a cross sectional postal survey was conducted among members of 2350 Carers (NSW, Australia). Respondents were included in the study if they were involved in medication-related tasks for their care-recipient and were not paid as caregivers. Also, their care-recipient needed to be using multiple medicines and had not yet experienced HMR. There were 324 useable surveys which yielded a response rate of 14%. Structural equation modelling revealed that the higher the level of caregivers' knowledge hassles, the higher their positive outcome expectancy (β = 0.40, P < .05) and since positive outcome expectancy increased willingness (β = 0.55, P < .05), knowledge hassles indirectly increased willingness (β = 0.19, P < .05). Similar to research conducted with consumers (Chapters Three and Five), overall caregivers' positive outcome expectancy was neutral. Conclusion The central aim of this thesis was to investigate the factors which influence consumers' and caregivers' willingness to use HMR, before they have experienced the service. One of the most important findings of the research was that if eligible consumers were informed of HMR they would be willing to ask for it, under the right circumstances. This indicates that consumers have an important role in driving participation in medication management services. Knowledge of the factors which influence willingness to use these services may therefore be used to improve the design and delivery of them with a view to improving consumer acceptance and engagement. In this research, it was demonstrated that a strong influence on consumers' and caregivers' willingness to use HMR was the extent to which they believed that HMR would benefit them personally. In other words a very important influence on willingness was consumers' and caregivers' expectations that during the pharmacist-patient interview they would learn about their medicines, feel reassured, and be more capable managing their medicines. The fact that these expectations were not high yet very influential indicates that there is significant scope for increasing consumers' willingness to use HMR by building these expectations. While this research focussed on willingness as the dependent variable, future research could use intervention studies to determine whether increasing consumers' expectations increases consumer participation. Expectations about the benefits of participating in HMR appear to be highest if the consumer is worried about experiencing medication problems and when a caregiver is stressed about dealing with the knowledge required to manage their care-recipients medicines. Promotional programs for HMR could use this finding to appeal to consumers and caregivers who are worried or stressed about using medicines. As expected, consumers' medication- problem worry (Chapter Five) and caregivers' knowledge stress (Chapter Six) was highest during the three months after the medicine-user had experienced a change in the medication regimen. At these times medicine-users are at greater risk and their and their caregivers' emotional response to medicine changes may increase expectations and demand for HMR. This indicates that, as suggested in available service information sources (Appendix Two), HMR should ideally be offered within three months after a change in medication regimen. The research also showed that efforts should be made to make the process of asking for an arranging HMR as transparent and easy as possible for eligible consumers and their informal caregivers. There are a variety of ways with which this could be addressed. Possibly the most influential would be to have community pharmacists initiate conversations with eligible non-recipients using consumer-directed promotional materials. They could explain how the HMR process works and offer to assist consumers overcome communication barriers. Finally, this research showed that consumers will need to believe that their GP has positive attitudes towards HMR if service participation is to be consumer-driven. It is likely that some form of GP endorsement of HMR such as promotional messages within GPs surgeries would increase consumers' intentions to ask their GP about the service. This could be achieved with posters or brochures about the service, or perhaps on GP network television commercials.

In the modern society, chronic diseases have become the leading causes of death. With early recognition and proper management, however, many of the complications from chronic diseases could be prevented or delayed. Taking such a proactive approach in managing a population often requires the use of team-based approaches and delegation of certain clinical and nonclinical tasks to nonphysician team members. This three-study dissertation used a combination of methods to explore contextual factors that influence primary care teamwork and physician-pharmacist collaboration. The first study quantitatively examined baseline barriers and facilitators of physician-pharmacist collaboration in clinics participating in the Collaboration Among Pharmacists and Physicians To Improve Outcomes Now (CAPTION) Trial. Pharmacist expertise and clinic staff support were found to be the most important facilitators for physicians, while insurance reimbursement and task design factors were important for pharmacists. The second study characterized clinic personnel experience participating in the CAPTION trial and explored determinants of disease state control. Higher proportions of indigent and minority populations and higher baseline pharmacy structure scores were found to be associated with lower blood pressure control. The third study qualitatively examined organizational influences on primary care team effectiveness and the roles of pharmacists in a separate sample of primary care clinics. A lack of organizational rewards for teamwork in primary care was identified and pharmacists were integrated into clinic workflow in various degrees. These findings will be informative for practice managers and health care professionals seeking to redesign their practice to meet increasing needs of patients with chronic diseases.

Chronotherapy is the administration of medications in accordance with biological rhythms to optimise therapeutic outcomes and/or control/minimise adverse effects. Community pharmacists play a significant role in public health and its promotion. They are in a unique position to provide their expertise and help patients manage illness, and medication administration/consumption. Despite the increasing recognition of chronotherapy in the literature and its application in clinical practice, the impact of these developments on health care professionals, particularly on pharmacists is largely unknown in Australia. The overarching aim of this thesis is to explore the evidence for the use of chronotherapy principles and the extent of their application in Australian pharmacy practice setting. The specific objectives of this research project included: To provide the research context for the thesis. To explore Australian drug-information sources for the currency of ‘time of administration’ recommendations based on chronotherapy for commonly prescribed medications. To explore the application of chronotherapy in pharmacy practice, including: Community pharmacists’ opinions of, and experience with, the application of chronotherapy principles in their practice. Development, implementation, and evaluation of an educational intervention on chronotherapy for final-year pharmacy students. To our knowledge, this study presents the first series of research steps investigating the application of principles of chronotherapy within the community pharmacy sector in Australia.

The latter part of the 20th century has witnessed significant advances in the scientific understanding of the link between a person's genes and their response to medication. The term 'pharmacogenetics' was first used to describe clinical observations of inherited difference in response to medicines in the 1950s. Research in this field has gained momentum in recent years fuelled by the completion of the Human Genome Project in 2001. Aims The aim of this thesis was to determine the implications of developments in pharmacogenetics for community pharmacy practice. Methods A qualitative methodology was employed to generate data to address the research questions posed. Semi-structured interviews were used as a data collection method. Two samples of respondents were interviewed, one composed of community pharmacists and one of individuals in a position to influence their practice, referred to as 'influencers'. 2 'I ' Results Community pharmacists' knowledge and understanding of the term 'pharmacogenetics' and associated technological developments was found to be low, There was resistance to engaging in educational opportunities in this area, with the majority of pharmacists feeling that the subject has limited relevance to their current practice, Data were obtained from respondents involved in pharmacogenetic research and development which showed that the likely impact of pharmacogenetics .will, in the short term, be in very specific clinical areas. The concept of a 'pharmacogenetic revolution' in which. the prescribing process will be altered for all medicines was dismissed by all of these respondents. Conclusions Pharmacogenetics is influencing prescribing practice in certain clinical areas and this has the potential to increase as scientific understanding continues to move forward. This thesis shows that community pharmacists are inhibited in the way they are able to respond to new scientific and technological developments such as pharmacogenetics. Both internal and external barriers are faced by the profession when attempting to respond to changing healthcare arenas. Pharmacists should be encouraged to engage in educational opportunities around pharmacogenetics such that they can aid the transition of scientific developments into clinical practice.

Decision-making by hospital pharmacy directors when deciding which clinical pharmacy services to implement and/or continue to provide was assessed. Also examined was how these decision-making activities, hospital characteristics, pharmacy characteristics, and pharmacy director demographics might be associated with the number and quality of clinical pharmacy services provided, as well as the number of clinical services implemented under the current pharmacy director. Hospital pharmacy directors reported considering a relatively large number of perceived goals for a clinical service and also indicated they use a rather broad range of decision-making methodologies in evaluating those goals when determining clinical services. Numerous variables were found to be significantly associated with the number of clinical services provided by the pharmacy department and the number of clinical services implemented under the current pharmacy director. However, relatively few variables were found to be significantly related to the quality of clinical pharmacy services being provided.

This integrative doctoral report describes how I have used my underpinning experience as a practising pharmacist to make a substantial contribution to pharmacy education. Using separate models for undergraduate and postgraduate students I have planned and delivered high quality innovative programmes which prepare undergraduate pharmacy students for practice and postgraduate professional students for advanced practice. Using an action research methodology I have planned and led a team in the development of a suite of M.Sc. programmes (modular master’s degrees) which matches stakeholder requirements (i.e. students and employers). These programmes offer flexible learning opportunities requiring limited contact. With support systems in place, this model allows the busy healthcare professional to work in a full time capacity whilst studying for a postgraduate qualification. Using this model I have developed short courses and led a team to successfully operate them both in the UK and in Hong Kong. Taking an early lead in the development of supplementary and then independent prescribing courses, has allowed our graduates to develop to meet their potential and allow these practitioners to specialise in their chosen clinical fields. My work with the Centre for Excellence in Healthcare Professional Education (CETL4HealthNE) is perhaps one of the most important and major suggested changes to pharmacy undergraduate education for many years. This is the introduction of Inter-Professional Education (IPE) and practice-based learning. I am a firm advocate for IPE and practice-placements being at the heart of, and becoming a substantial component of, undergraduate pharmacy education. This allows clinical patient-focused teaching to be maximised. I believe that this is of critical importance to ensure that new graduates have both underpinning theoretical knowledge and practical application ability. This is all with the same goal: for the safe and effective care of patients. From my own experiences gained from my collaborative research work and CETL4HealthNE, I propose a model where pharmacists work together with other healthcare professionals, both in practice and in IPE, for the benefit of patient care.

Pharmacists have often faced “situations in which there is a choice between at least two courses of action, neither of which is obviously morally preferable”. With the increased patient-centeredness in pharmacy practice nowadays, they are now expected to provide solutions for such ‘dilemmas’, relying on ethical judgment, principles of professional ethics, standards of practice and moral reasoning capabilities. Pharmacists necessarily need to be competent in ethical decision-making, which will enable them to act in a morally preferable and justifiable manner. Literature has shown that moral reasoning skills are teachable competencies in healthcare. This domain remains relatively unexplored in developing countries, and there is a paucity of research conducted in the area of pharmacy ethics particularly in Jordan. The overarching aim of this thesis was to investigate ethical decision-making in pharmacy practice in developing countries such as Jordan. This thesis also investigates the manner in which ethical dilemmas are handled by Jordanian pharmacists, the resources used to address such dilemmas, and their attitudes towards them. The secondary objective was the development of an educational component about ethical decision-making in pharmacy practice for the undergraduate curriculum for pharmacy students in Jordan. The scoping review (Chapter 2 of this thesis) highlighted a gap in pharmacy ethics literacy in developing countries and variances in pharmacists’ ethical attitudes in handling ethical dilemmas. It also illuminated the lack of familiarity with ethical principles and codes of ethics., and pharmacists being prone to financial pressure were found to have a significant impact on pharmacy practice in most developing countries. Chapter 3 explored ethical decision-making in pharmacy practice in Jordan. elucidating that it was influenced by pharmacists’ personal moral values, legal requirements and managed by exercising common sense and experience. Giving emphasis to the need for professional ethics training, and incorporating pharmacy ethics courses in pharmacy undergraduate curricula, as well as to professional development courses. Chapter 4 then explored the impact of Vertically Integrating Teaching in Ethical Decision-Making (VIT-EDM), as a pedagogical approach influencing moral reasoning capabilities of pharmacy students whilst progressing in pharmacy studies, using a validated instrument as a surrogate measure of moral reasoning capabilities. This underlined the positive impact of this relatively novel mixed-method pedagogy in teaching pharmacy ethics, which highlighted students’ enhanced confidence levels in deciding morally preferable choices when facing ethical dilemmas. The seminal part of this thesis was the development, implementation, and evaluation of the utility of a tailored ethics education component in the pharmacy curriculum for students enrolled at a well-ranked Jordanian University (Chapter 5). This chapter highlighted the importance of implementing an ethics course in pharmacy undergraduate curricula. It also emphasized the positive impact this course made on the students’ learning experiences and provided a strong environment for discussion and group learning. In conclusion, the investigations carried out in this thesis emphasized the importance and significance of ethical pharmacy practice. Hopefully, this body of work is the beginning of further research and intervention-testing intended for teaching pharmacy ethics in developing countries. This paves the way for developing countries to adopt principles/rights-guided professional practice in pharmacy, to protect and provide patient-centered care in reality.

Class of 2011 Abstract
OBJECTIVES: To design a tool to assess for bias in studies for pharmacy services. METHODS: This study will involve reviewing published reports of studies comparing pharmacists’ services to usual services to identify the key study design components and methods for addressing study design limitations. We will then design a tool to assess further such studies for bias. RESULTS: The aspects of a good pharmacy services study that can be controlled include: large study population, equivalence of population at baseline, experimental mortality, multi-centered study, adequate adherence to treatment, and independence from study staff/manufacturer influence. If these things are controlled and/or accounted for it increases the strength of the study. CONCLUSION: The tool we have designed can successfully evaluate the quality of studies of pharmacy services.

This research is about enhancing the continuity of patient care. It focuses on medication management at the time of patient discharge from a cardiology unit in an Australian acute care hospital. That is, during the time of the patients’ transition from tertiary to primary care. The philosophical concept underpinning the research is centred on continuity of patient care which is defined, and then described, in the context of each chapter study undertaken. The main aim of the overall research was to conduct an original, empirical research project to identify, characterise, and investigate a cohort of patients in need of ongoing care after discharge. Those subjects recruited into the Continuity of Care Project were 281 acute on chronic, cardiovascular patients. In this research, the individual chapter studies investigated the need for continuity of care by analysing the quality of prescribing recorded at hospital discharge and at medication review in the community.

Tea consumption has been suggested to have beneficial effects for human health, especially in cancer prevention. At present, epidemiological evidence of the protective effect of tea consumption against the development of human cancer is not conclusive. Interpretation of epidemiological data and extrapolation of rodent data to humans are generally hampered by inadequate information on the bioavailability and pharmacokinetics of tea constituents. We have performed studies to determine the pharmacokinetics of green tea in humans after single and multiple oral dose administration of tea polyphenols and the contribution of hepatic first-pass elimination to the low oral bioavailability of green tea catechins in animals. EGCG was present in the systemic blood in the unchanged form in humans after oral administration of two green tea polyphenol products, EGCG and Polyphenon E (a mixture of major green tea polyphenols). Oral administration of EGCG and Polyphenon E resulted in similar systemic exposure of EGCG. EGC and EC were present in glucuronic acid/sulfate conjugates in blood and urine samples after the Polyphenon E administration. Large inter-subject variations in the systemic levels of green tea catechins were observed following oral administration of green tea polyphenols. We found that it is safe for healthy human subjects to take green tea polyphenols for four weeks in amounts equivalent to those contained in 8 to 16 cups of green tea once a day or in divided doses twice a day. Systemic availability of EGCG increased more than 60% after chronic green tea polyphenol administration at high doses once a day. Oral administration of green tea polyphenols at the selected doses and dosing schedules did not elicit overall changes in the selected pharmacodynamic measurements. Oral bioavailability of green tea catechins was demonstrated to be low in animals and possibly in humans. Based on our pre-clinical study, we found that first-pass hepatic elimination of green tea catechins didn't play a significant role in the presystemic elimination of orally administered catechins. Factors within the gastrointestinal tract such as limited membrane permeability, transporter mediated intestinal secretion, or gut wall metabolism may contribute more significantly to the low oral bioavailability of green tea catechins.

As the population ages, the use of information technology and telecommunications in healthcare delivery (often known as Connected Health, telehealth or e-health) has been proposed as a means of providing . patient-centred care to those with chronic conditions. Little research has been conducted into the involvement of community pharmacists in Connected Health delivery. This thesis aimed to investigate the potential role of community pharmacists in the delivery of Connected Health services. A systematic content analysis of print media was performed to explore reporting of Connected Health in UK and US newspapers. A qualitative interview study was conducted with community pharmacists and key stakeholders in Canada and Northern Ireland to gather their views on community pharmacist involvement in Connected Health. Informed by the latter qualitative study, an online questionnaire was distributed to community pharmacists in Northern Ireland to explore their views regarding their potential role in Connected Health. Finally, a feasibility study was carried out, in which community pharmacists sent patients mobile telephone medication reminders and remotely monitored their blood pressure . . Connected Health was positively reported by the print media in the US and the UK. Community pharmacist and key stakeholder interviewees were supportive of community pharmacist involvement in Connected Health, believing it would extend and promote ' their role. However, they had concerns regarding appropriate remuneration. Similar views were obtained from community pharmacist questionnaire respondents. The feasibility study showed that a community pharmacy-based Connected Health programme could be successfully implemented on a small scale. Participants involved were positive about community pharmacist involvement in Connected Health. Community pharmacist involvement in Connected Health has the potential to improve patient outcomes and ease pressure on the health service. However, barriers such as funding and general practitioner acceptance would need to be overcome and a sound evidence base established before routine pharmacist involvement becomes a reality.

Collaborative pharmacy practice rules went into effect on February 20, 2017. With these rules come new opportunities for pharmacists to work with prescribers to improve patient outcomes and increase access to pharmacist-provided care. This one-hour webinar, presented live by the Tennessee Pharmacists Association on March 9, 2017, provides information about how to properly implement collaborative pharmacy practice in pharmacy settings.

The thesis explores the various instances in which pharmacists may incur delictual liability for harm suffered by their patients or third parties. As such, it is primarily concerned with the field of professional negligence. The work focuses specifically on the wrongfulness, fault and causation enquiries in pharmacy malpractice cases. The discussion is set against the backdrop of the pharmacy profession's shift towards patient-orientated service in recent years and explores whether this change in the profession's social role has had any effect on the legal duties and standard of care to which pharmacists are currently bound. It is argued that, in light of the dangers posed by modern medicines and the extent to which pharmacists are professionally expected to involve themselves in patient care, pharmacists can no longer escape liability simply by accurately dispensing pharmaceutical products. Rather, they are expected to participate actively in avoiding drug-related injury by, for example, providing patient counselling, detecting invalid or erroneous prescriptions and monitoring prescription refills. Although the thesis places particular emphasis on the role of pharmacists in achieving risk management, it also argues that pharmacists are, in very limited circumstances, required to participate in the risk assessment process traditionally thought to fall exclusively into the realm of physicians. It is furthermore demonstrated that pharmacists can incur liability regardless of whether a patient's harm can also be partially attributed to the blameworthy conduct of another healthcare professional. Although the thesis concludes that pharmacists are currently exposed to greater risks of liability than they were in the past, it also shows that plaintiffs who seek damages from pharmacists will usually experience a number of difficulties in establishing liability. In particular, problems are likely to be encountered in satisfying a court as to the presence of factual causation, which is notoriously difficult to establish in drug-related cases.

Objectives: To characterize the preferred learning styles of pharmacy students at two colleges of pharmacy in the southeastern United States. Method: The Pharmacists’ Inventory of Learning Styles (PILS) was developed and validated as an instrument specific to pharmacists. We administered the PILS via email using Survey Monkey. Pharmacy students at the Medical University of South Carolina (MUSC) or South Carolina College of Pharmacy (SCCP-MUSC campus) were surveyed in 2007. Pharmacy students at the Gatton College of Pharmacy (GCOP) at East Tennessee State University (ETSU) were surveyed in 2010. An email was sent to each student on a Monday in the fall semester, followed by reminder emails each of the following three weeks. Students were not allowed to take the survey twice and participation was voluntary. Results: Response rates from MUSC and ETSU students were 48% and 71%, respectively. Pharmacy students at both MUSC and ETSU displayed similar preferred learning styles. The most common learning style at each institution was the Producer (61%), while the second most common learning style at each institution was the Director (30.5%), as defined by Austin. Implications: These results are the first to characterize the preferred learning styles of pharmacy students using the PILS. The almost identical results between both schools support the idea that the majority of pharmacy student in the southeastern United States prefer structured learning environments, which is true of both Producers and Directors. Future research assessing the relationship between preferred learning style and educational outcomes in different learning environments is warranted.

Background: The purpose of drug treatment is to reduce morbidity and mortality, and to improve health-related quality of life. However, there are frequent problems associated with drug treatment, especially among the elderly. The aim of this thesis was to investigate the impact of clinical pharmacy services within a multiprofessional healthcare team on quality and safety of patients’ drug therapy, and to study the frequency and nature of medication history errors on admission to hospital. Methods: A model for clinical pharmacy services within a multiprofessional healthcare team (the Lund Integrated Medicines Management model, LIMM) was introduced in three hospital wards. On admission of patients to hospital, clinical pharmacists conducted medication reconciliation (i.e. identified the most accurate list of a patient’s current medications) to identify any errors in the hospital medication list. To identify, solve and prevent any other drug-related problems, the clinical pharmacists interviewed patients and performed medication reviews and monitoring of drug therapy. Drug-related problems were discussed within the multiprofessional team and the physicians adjusted the drug therapy as appropriate. Results: On admission to hospital, drug-related problems, such as low adherence to drug therapy and concerns about treatment, were identified. Different statistical approaches to present results from ordinal data on adherence and beliefs about medicines were suggested. Approximately half of the patients were affected by errors in the medication history at admission to hospital; patients who had many prescription drugs had a higher risk for errors. Medication reconciliation and review reduced the number of inappropriate medications and reduced drug-related hospital revisits. No impact on all-cause hospital revisits was demonstrated. Conclusion: Patients admitted to hospital are at high risk for being affected by medication history errors and there is a high potential to improve their drug therapy. By reducing medication history errors and improving medication appropriateness, clinical pharmacy services within a multiprofessional healthcare team improve the quality and safety of patients’ drug therapy. The impact of routine implementation of medication reconciliation and review on healthcare visits will need further evaluation; the results from this thesis suggest that drug-related hospital revisits could be reduced.
Läkemedelsgenomgångar och läkemedelsavstämning - LIMM-modellen

This thesis describes the author's contribution, from 1997-2017, to medicines optimisation through use of a person-centred care approach to pharmacy practice. It outlines the author's publications in the area of pharmacy practice and older people together with copies of key publications and relevant authorship statements. The thesis is divided into four key themes: pharmacy and older people, clinical leadership, reducing preventable medicines-related hospital readmission and the development of a coaching approach in pharmacy practice. The thesis begins with describing the growth of the author's skills as a hospital pharmacist working with older people, which provides the content for the first theme. This includes development of the author's research skills and the start of collaboration with a cross-sector multidisciplinary team, led by a national leader in the care of older people. The second theme, of clinical leadership, incorporates the author's role as the first consultant pharmacist working with older people in England and also as a pharmacist prescriber in intermediate and long-term care. This includes the creation and leadership of the national consultant pharmacist group for England and information about pharmacist prescribing through publications and describes how practice focussed on what mattered to patients. The third theme focuses on reducing preventable medicines-related re-admissions and includes description of the development of the Integrated Medicines Management Service (IMMS), an award winning service, including delivery of person-centred consultations. The fourth and final theme outlines the development of a coaching approach to pharmacy practice including the use of health coaching. This includes development of the nationally utilised 'Four Es' (Explore, Educate, Empower, Enable), a structured approach to person-centred pharmacy consultations to support medication review, medicines adherence, reducing inappropriate polypharmacy and optimising safe deprescribing. This section of the thesis also describes collaboration with colleagues to develop the nationally recognised 'patient-centred polypharmacy process', joint-editing a peer-reviewed themed journal issue on deprescribing and devising and delivering learning events to provide pharmacy support for special populations. This thesis demonstrates that the author has contributed to the development of person-centred care in pharmacy practice. The author's work in this area supports medicines optimisation, thus improving the patient experience and the provision of safe, effective pharmacy services, which are embedded within everyday pharmacy practice.

The pharmacy profession is formed of different sectors. The two main ones are community and hospital pharmacists. Sociologists have examined if community pharmacists are a profession or not as a result of their marginalised role in healthcare and links with commerce. Few sociological studies have included hospital pharmacists. This study engaged with the theories from the sociology of the professions such as the neo-Weberian social closure perspective, professions as an interrelated system and Foucault’s concept of knowledge and power to explore the nature of pharmacy practice in healthcare in England, United Kingdom. Its purpose was to reveal new insights into pharmacists’ perceptions of the nature of pharmacy practice linking this to their status in society. This qualitative collective case study consisted of four cases studies. Each case study included five pharmacists from community pharmacy, acute hospital, mental health or community health services, respectively. A total of twenty pharmacists were included. Only pharmacists registered for 5 years or more, who had worked in the relevant healthcare setting for at least 2 years and provided written consent were entered. Data were obtained from one in-depth individual semi-structured interview using a guide covering how they viewed their practice, contributions made to healthcare, their future and how others viewed pharmacists. Each pharmacist was asked to complete a diary for 5 days to include any positive contributions or frustrations experienced. The data for each case were analysed using inductive thematic analysis followed by a cross-case analysis. Five themes were identified; (i) the hidden healthcare profession, (ii) important relationships, (iii) pharmaceutical surveillance, (iv) re-professionalisation strategies and (v) two different professions. The core function defining the pharmacy profession is pharmaceutical surveillance, shifting the sociological understanding of pharmacists’ practice away from dispensing. There is an internal split between community pharmacists and pharmacists in other healthcare settings due to differences in practice, re-professionalisation strategies and relationships with doctors including lacking ideological professional solidarity. Pharmacists are not recognised as healthcare professionals by the public but as ‘typical community pharmacists’ with an image as shopkeepers. Pharmacists interpret professionalism as a controlling rather than an enabling ideology. The status of pharmacists in society today remains unclear.

Class of 2011 Abstract
OBJECTIVES: To assess the effectiveness of the institutional objectives for the Introductory to Pharmacy Practice Experience (IPPE) course at the University of Arizona, College of Pharmacy. METHODS: This observational study included 83 first-year PharmD students, of which 36 were enrolled in the IPPE course during the Spring 2009 semester. At the beginning and end of the semester, each student was given a multiple-choice test with questions related to the institutional objectives for the IPPE course. At the end of the semester, the tests were scored and the pre- and post-tests were matched for each student. RESULTS: No significant difference was found between the pre- and post-test scores, although most students had an improved score on the post-test. Of the students in IPPE, test scores were divided based on the type of practice site attended. No difference was found for the pre- or post-test scores between the different practice sites (p>0.1 for all comparisons) and a medium impact was found between community and hospital practice settings (affect size = 0.49). CONCLUSION: It was concluded that although student competencies improved over the course of the semester, participation in the IPPE course during the first-year of pharmacy school did not significantly contribute to this improvement.

Objectives: To examine the extent to which pharmacy students’ attitudes, subjective norm beliefs, and perceived behavioral control beliefs explain gray dispensing decisions, using the theory of planned behavior (TPB) as a framework. Method: Third professional year pharmacy students (n=159) from two academic cohorts were provided three written case scenarios: (1) a dentist prescribing outside of his scope of practice; (2) a physician prescribing for a family member; and (3) a patient who was out of refills on insulin. A brief questionnaire assessed TPB constructs, whether or not the student would dispense the medication, and the number of times the student would dispense in 10 similar situations. Composite scores were calculated for TPB constructs after analyzing internal consistency reliability. Linear regression techniques were used to analyze the influence of the constructs on mean intent to dispense in similar scenarios. Results: The percent of students who indicated they would dispense in each scenario was 68% in scenario 1, 74% in scenario 2, and 81% in scenario 3. For all case scenarios, mean intent to dispense in similar scenarios was explained by attitude scores (p≤0.006). For the insulin refill and family prescribing cases, mean intent to dispense was also explained by subjective norm beliefs (pImplications: Student attitudes consistently predicted intention to dispense across the gray scenarios. These findings can be used to develop and target upstream TPB construct interventions in pharmacy education that influence students’ downstream dispensing decisions. Additional research is warranted to determine if TBP constructs similarly explain the dispensing behaviors of practicing pharmacists.

Objective To describe common facilitators, challenges, and lessons learned in 5 schools and colleges of pharmacy in establishing community pharmacy research fellowships. Setting: Five schools and colleges of pharmacy in the United States. Practice description: Schools and colleges of pharmacy with existing community partnerships identified a need and ability to develop opportunities for pharmacists to engage in advanced research training. Practice innovation: Community pharmacy fellowships, each structured as 2 years long and in combination with graduate coursework, have been established at the University of Pittsburgh, Purdue University, East Tennessee State University, University of North Carolina at Chapel Hill, and The Ohio State University. Evaluation: Program directors from each of the 5 community pharmacy research fellowships identified common themes pertaining to program structure, outcomes, and lessons learned to assist others planning similar programs. Results: Common characteristics across the programs include length of training, prerequisites, graduate coursework, mentoring structure, and immersion into a pharmacist patient care practice. Common facilitators have been the existence of strong community pharmacy partnerships, creating a fellowship advisory team, and networking. A common challenge has been recruitment, with many programs experiencing at least one year without filling the fellowship position. All program graduates (n = 4) have been successful in securing pharmacy faculty positions. Conclusion: Five schools and colleges of pharmacy share similar experiences in implementing community pharmacy research fellowships. Early outcomes show promise for this training pathway in growing future pharmacist-scientists focused on community pharmacy practice.

Potential Pharm.D. students and graduate students -- lots of choices! This session targeted by Pharm.D. and graduate admissions stake-holders will describe how understanding career-decision-making processes can assist colleges and schools in developing and implementing interventions to foster Pharm.D. and graduate student recruitment. Attendees will explore mechanisms through which Pharm.D. and graduate programs can collaborate to promote evidence- and experience-informed career decisions among potential matriculants.

Increasing emphasis has been placed on improving clinician resilience and well-being due to concerning rates of burnout, depression, and suicide in healthcare professionals. Session participants will learn how multiple instiutions have created initiatives that promote a culture of health and well-being for students, staff, and faculty. Particpants will learn about practical strategies for performing an environmental scan of current culture and incorporating assessment tools, educational programs, and workplace wellness into their own organizational initiatives.