Dissertations / Theses on the topic 'Hospital pharmacies – Management'

The extent and quality of strategic planning by institutional pharmacy directors was assessed. Also examined was how the extent and quality of strategic planning, institutional characteristics, pharmacy characteristics, and pharmacy director characteristics might be associated with the pharmacy's overall level of performance in selected areas. The majority of institutional pharmacy directors reported utilizing strategic planning for their departments. The global quality of strategic planning reported by pharmacy directors was average. However, directors conducting strategic planning reported a high level of strategic planning. The directors' rated time available, knowledge, and importance of strategic planning were found to be significantly associated with pharmacy directors' rated quality of strategic planning. Additionally, pharmacy directors' rated quality of strategic planning was found to be significantly associated with pharmacy performance for clinical, distributive, and administrative services.

The purpose of this study was to develop and empirically test the Supply Chain Integration Framework (SCI framework) in order to develop a framework to address the inefficiencies experienced in the public hospital pharmacies’ Supply Chain (SC) in Kenya. Supply Chain Management (SCM) can be regarded as a vibrant business entity that is changing and evolving continually because of constant changes in technology, competition and customer demands. The study investigated and analysed how the independent variables, namely SCI initiatives, performance improvement drivers, organisation environmental forces, workforce and management support, financial factors, flow and integration, regulatory framework and information sharing and technology influenced the SCI. The SCI was categorised into three components namely: customer order fulfilment, supplier collaboration and dedicated SC as the dependent variable. The literature reviewed established that globalisation and intensive worldwide competition, alongside technological developments, creates a completely new operating environment for organisations. The researcher reviewed various models and theories related to SCI which include systems theory, value chain models and value ecology models among others. An SCI framework was then developed to capture the interacting variables within the SCI network that could be adopted for the public hospital pharmacies in Kenya. The study was conducted using a survey questionnaire (Annexure B) that comprised both open and closed ended questions that were distributed to managers in public hospitals and pharmacies in Kenya. The population for the survey was 154 public hospital pharmacies in Kenya, with the final sample comprised of 280 respondents. The study was conducted using a survey questionnaire (Annexure B) that comprised both open and closed ended questions that were distributed to 325 respondents in 154 public hospitals and pharmacies in Kenya. The population for the survey was 154 public hospital pharmacies in Kenya, with the final sample comprised of 280 respondents. Exploratory factor analysis was used to ascertain the validity of the measuring instrument and the Cronbach alpha coefficients were used to measure the reliability of the measuring instruments. Key preliminary tests performed were the Kaiser-Meyer-Olkin test (KMO test) of sample adequacy, the Bartlett’s test of sphericity and the Kolmogorov-Smirnov test (Z-Statistic test) for normality and multi-collinearity diagnostic. Analysis of Variance (ANOVA) and multiple linear regressions were the main statistical procedures used to test the regression model fit and the significance of the relationships hypothesised among various variables in the study. Statistical softwares, namely Statistica 10 (2010) and Statistical Package for Social Sciences (SPSS) Version 18, were used to analyse quantitative data. The study identified five statistically significant relationships between customer order fulfilment and workforce and management support, financial factors, flow and integration, information sharing and technology, supplier collaborations and dedicated SCI. In addition, a total of six statistically significant relationships exist between the supplier collaborations and SCI initiatives i.e. performance improvement drivers, workforce and management support, financial factors, flow and integration, information sharing and technology adoption as well as dedicated SCI. Furthermore, four statistically significant relationships were found between dedicated SCI and SCI initiatives, workforce and management support, financial factors, flow and integration, information sharing and technology adoption.

With increasingly complex safety-critical systems like healthcare being developed and managed, there is a need for a tool that allows us to understand their complexity, design better strategies and guide effective change. System dynamics (SD) has been widely used in modelling across a range of applications from socio-economic to engineering systems, but its potential has not yet been fully realised as a tool for understanding trade-off dynamics between safety and efficiency in healthcare. SD has the potential to provide balanced and trustworthy insights into strategic decision making. Participatory SD modelling and learning is particularly important in healthcare since problems in healthcare are difficult to comprehend due to complexity, involvement of multiple stakeholders in decision making and fragmented structure of delivery systems. Participatory SD modelling triangulates stakeholder expertise, data and simulation of implementation plans prior to attempting change. It provides decision-makers with an evaluation and learning tool to analyse impacts of changes and determine which input data is most likely to achieve desired outcomes. This thesis aims to examine the feasibility of applying participatory SD modelling approach to safe and efficient staffing level management within hospital pharmacies and to evaluate the utility and usability of participatory SD modelling approach as a learning method. A case study was conducted looking at trade-offs between dispensing backlog (efficiency) and dispensing errors (safety) in a hospital pharmacy dispensary in an English teaching hospital. A participatory modelling approach was employed where the stakeholders from the hospital pharmacy dispensary were engaged in developing an integrated qualitative conceptual model. The model was constructed using focus group sessions with 16 practitioners consisting of labelling and checking practitioners, the literature and hospital pharmacy databases. Based on the conceptual model, a formal quantitative simulation model was then developed using an SD simulation approach, allowing different scenarios and strategies to be identified and tested. Besides the baseline or business as usual scenario, two additional scenarios (hospital winter pressures and various staffing arrangements, interruptions and fatigue) identified by the pharmacist team were simulated and tested using a custom simulation platform (Forio: user-friendly GUI) to enable stakeholders to play out the likely consequences of the intervention scenarios. We carried out focus group-based survey of 21 participants working in the hospital pharmacy dispensaries to evaluate the applicability, utility and usability of how participatory SD enhanced group learning and building of shared vision for problems within the hospital dispensaries. Findings from the simulation illustrate the knock-on impact rework has on dispensing errors, which is often missing from the traditional linear model-based approaches. This potentially downward-spiral knock-on effect makes it more challenging to deal with demand variability, for example, due to hospital winter pressures. The results provide pharmacy management in-depth insights into potential downward-spiral knock-on effects of high workload and potential challenges in dealing with demand variability. Results and simulated scenarios reveal that it is better to have a fixed adequate staff number throughout the day to keep backlog and dispensing errors to a minimum than calling additional staff to combat growing backlog; and that whilst having a significant amount of trainees might be cost efficient, it has a detrimental effect on dispensing errors (safety) as number of rework done to correct the errors increases and contributes to the growing backlog. Finally, capacity depletion initiated by high workload (over 85% of total workload), even in short bursts, has a significant effect on the amount of rework. Evaluative feedback revealed that participatory SD modelling can help support consensus agreement, thus gaining a deeper understanding of the complex interactions in the systems they strive to manage. The model introduced an intervention to pharmacy management by changing their mental models on how hospital winter pressures, various staffing arrangements, interruptions and fatigue affect productivity and safety. Although the outcome of the process is the model as an artefact, we concluded that the main benefit is the significant mental model change on how hospital winter pressures, various staffing arrangements, interruptions and fatigue are interconnected, as derived from participants involvement and their interactions with the GUI scenarios. The research contributes to the advancement of participatory SD modelling approach within healthcare by evaluating its utility and usability as a learning method, which until recently, has been dominated by the linear reductionist approaches. Methodologically, this is one of the few studies to apply participatory SD approach as a modelling tool for understanding trade-offs dynamics between safety and efficiency in healthcare. Practically, this research provides stakeholders and managers, from pharmacists to managers the decision support tools in the form of a GUI-based platform showcasing the integrated conceptual and simulation model for staffing level management in hospital pharmacy.

Background: In September 2001, in addition to their existing management of primary care pharmaceutical expenditure, PHARMAC, the New Zealand government�s Pharmaceutical Management Agency, was authorized to manage pharmaceutical expenditure in public hospitals.[1] In February 2002 PHARMAC launched a three-part Strategy, the National Hospital Pharmaceutical Strategy (NHPS), for this purpose.[2] The Strategy focused on Price Management (PM), the Assessment of New Medicines (ANM), and promoting Quality in the Use of Medicines (QUM). Major initiatives planned were: for PM, to negotiate new, national (as opposed to current, local) contracts for frequently used pharmaceuticals; for ANM, to provide economic assessments of new hospital medicines; and for QUM, to coordinate activities in hospitals. Aims: To assess the impact of each of the three parts of the National Hospital Pharmaceutical Strategy, and assess any impact of the Strategy�s new contracts on the availability of those medicines. Methods: Price Management was assessed in 2003, 2004 and 2005 using data from eleven selected hospitals to estimate savings for all 29 major hospitals, and by tracking hospital pharmaceutical expenditure from 2000 to 2006. For other aspects, cross-sectional surveys were administered to chief pharmacists at all hospitals employing a pharmacist; 30 hospitals in 2002, 29 in 2004. Surveys were undertaken in 2002 and 2004 to examine ANM and QUM activity in hospitals before and after the Strategy. Surveys were undertaken in 2004 and 2005 to examine any changes in the availability of medicines on new contracts, in hospitals. In 2005 a survey was undertaken of opinions on PHARMAC�s specially-developed pharmacoeconomic (PE) assessments. Results: PM results indicated that, by 2006, savings of $7.84-13.45m per annum (6-8%) had been made on hospital pharmaceutical expenditure, and growth in inpatient pharmaceutical expenditure appeared to slow for all types of hospitals in 2003/4. ANM surveys indicated that, by 2004, hospital new medicine assessment processes, predominantly formal, became more complex, more focused on cost-effectiveness, and the use of pharmacoeconomic information increased. The PE survey indicated that PHARMAC�s economic assessments of new medicines were mainly viewed favourably but were not sufficiently timely to be widely used in hospital formulary decisions. Availability surveys indicated that new contracts occasionally caused availability problems e.g. products that were "out of stock", or products considered inferior by respondents. Problems were usually resolved within weeks, but some took over a year. QUM activities showed little change between surveys, but during the period an independent organisation was formed by the District Health Boards of New Zealand, with representation from PHARMAC, to coordinate the Safe and Quality Use of Medicines in New Zealand. Conclusion: The National Hospital Pharmaceutical Strategy has been moderately successful in New Zealand. Savings of NZ$7.84-13.45m per annum were made, and growth in inpatient pharmaceutical expenditure appeared to slow in the year following the Strategy�s launch. The study has indicated some important short-term effects from the Strategy, but further research is needed to ensure that favourable effects are sustained and unfavourable effects kept to a minimum. Similar, centralized, multifaceted, approaches to managing pharmaceutical expenditure may be worth considering in other countries. 1. New Zealand Parliament. New Zealand Public Health and Disability Act. In: The Statutes of New Zealand 2000. No 91.Wellington: New Zealand Parliament; 2000 2. Pharmaceutical Management Agency. National Hospital Pharmaceutical Strategy Final Version. Wellington: PHARMAC; 2002

Le droit à la santé est un droit universel des peuples, reconnu internationalement par l’Organisation mondiale de la santé et en France par le code de la santé publique. Mais l’évolution de la démographie et de l’épidémiologie expliquent les volontés de rationalisation des politiques publiques et de maîtrise des coûts des systèmes de santé. L’hôpital, institution multiséculaire, a toujours tenté d’adapter son organisation pour répondre aux besoins sanitaires des populations ; il occupe une place centrale du dispositif de santé et sa pharmacie un rôle clé dans la bonne gestion du médicament, en partenariat avec les services cliniques utilisateurs.La littérature en sciences de gestion présente de précieuses grilles de lecture pour éclairer le fonctionnement de l’hôpital. La théorie socio-économique propose un traitement des dysfonctionnements organisationnels et une approche managériale intégrée. Les théories de la coopération et de la légitimité organisationnelle complètent les concepts académiques mobilisés au service de la reconnaissance et de l’efficience de la pharmacie à usage intérieur de l’hôpital.La recherche des terrains d’observation a été guidée par la posture épistémologique et le choix méthodologique ; la recherche-intervention a favorisé une approche globale du terrain, facilité l’intégration d’autres outils de management et participé à renforcer le processus médico-pharmaceutique à travers diverses actions menées avec les acteurs du service pharmacie, à destination des utilisateurs du médicament. Ce travail a permis la mise en évidence de couples de « coopération-légitimité » permettant de mieux identifier les zones de coopération et de légitimité traditionnelle, fonctionnelle, relationnelle et décisionnelle de la pharmacie hospitalière avec les parties prenantes
The right to health is a universal right of peoples, internationally acknowledged by the World Health Organization and , in France, by the Code of Public Health. But, the evolution of demography and epidemiology explains the will to rationalize public policies and to master the costs of health systems. Hospitals, centuries old institutions, have always tried to adapt their organizations to meet the health needs of populations ; they occupy central places in health systems and their pharmacies play key roles in the good management of medicines, in partnership with clinical services.The literature of management sciences provides precious reading grids to shed light on the running of hospitals. The socio-economic theory provides a way of dealing with organization misgovernments and an integrated management approach. The theories of cooperation and legitimacy in organizations supplement the academic concepts summoned up in favour of the recognition and the efficiency of pharmacies inside hospitals.The research of fields of observation was guided by an epistemiological posture and a methodogical choice; intervention-research favoured a global approach of those fields, made the integration of other management tools easier and took part in the strengthening of the medico-pharmarceutic process via various actions taken with pharmacy service actors aimed at medicine users.This work provided help to bring to the fore “cooperation-legitimacy” couples and to make possible a better identification of zones of cooperation and legitimacy at the same time traditional, functional, relational and involving decisions as well , in hospital pharmacies with the interested parties

Pharmacists experience high levels of stress at work, especially from factors intrinsic to their jobs and management roles. In South Africa, the public sector is confronted with situational difficulties such as a shortage of staff and poor working conditions Accordingly, a comparative survey was conducted using a self–constructed questionnaire to obtain individual responses from the pharmacists in the public, as well as the private sector. The focus population was the pharmacists in the public, as well as the private hospitals in the North–West Province. The public sector consists of 30 hospitals and the private sector of 20. By using the convenient sampling method, 100 samples were taken. The questionnaire measured six factors of job satisfaction, namely: job design, salary/remuneration satisfaction, performance management, working arrangements, organisational climate, and professional development. The questionnaire was distributed to 100 pharmacists in total, and a response rate of 66% was obtained. The only medium practical significance shown in the results was between the averages of the private sector (2.89) in contrast with the public sector (3.38). This indicates that the public sector demonstrates less satisfaction with their performance management than the private sector. The data also indicated that the public sector pharmacists are less satisfied with job design, performance of management, professional development, and their working arrangements. The private sector showed only a small difference in the means, when compared to the public sector. It is clear that both sectors illustrate a moderate level of job satisfaction. Recommendations, therefore, included the revisiting of the job design by increasing job rotation and task identity. The need for self–actualization has to be acknowledged and the opportunity for promotion needs to be provided. The link between the actual activity and the bonus, with regards to performance management, has to be re–established, and there has to be transparency throughout. Decision–making control is extremely important and seeing that 82% of the pharmacists were female, the employer can consider accommodating family responsibilities, compressed working weeks, flexible working hours, job sharing, and part–time work. Professional development is also very important within any company and it is vital that the employer deposits time, money and skill into the staff.
Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2011.

Objectivos: Identificar e compreender as barreiras e os facilitadores à prática do Acompanhamento Farmacoterapêutico (AFT) nos serviços farmacêuticos hospitalares portugueses. Método: Estudo qualitativo mediante realização de entrevistas semi-estruturadas a farmacêuticos hospitalares com e sem experiência no AFT e análise de conteúdo, retroactiva e temática. Resultados: Estrutura dos serviços farmacêuticos: barreiras (1) falta de tempo, organização das actividades orientadas para a logística, instabilidade dos recursos humanos, barreiras físicas à comunicação, relações em divergência; facilitadores (2) reestruturação, trabalho em equipa. Farmacêutico: (1) resistência à mudança, qualificação inadequada; (2) atitude positiva, legitimação, formação. Meio externo: (1) falta de apoio institucional, relacionamento com o doente, o médico e farmacêutico comunitário, ensino inadequado; (2) apoio institucional, procura do doente, cooperação com o médico e o farmacêutico comunitário, ensino adequado. Tecnologia: (1) acesso aos dados clínicos e a informação, método inadequado; (2) acesso à informação, método adequado, documentação, informatização, marketing, boas práticas. Conclusão: As entrevistas semi-estruturadas fornecerem uma visão ampla, detalhada e pragmática dos potenciais determinantes de uma prática generalizada do AFT nos serviços farmacêuticos hospitalares portugueses. /ABSTRACT: Objectives: To identify and understand the barriers and facilitators for the practice of Medication Therapy Management (MTM) in portuguese’s hospital pharmacy. Method: Qualitative study trough semi-structured interviews with MTM experienced and inexperienced hospital pharmacists followed by retroactive content and thematic analysis. Results: Structure of hospital pharmacy: barriers (1) lack of time, activities focused on logistics, instability of human resources, physical barriers to communication, divergent relationships; facilitators (2) restructuring, teamwork. Pharmacist: (1) resistance to change, inadequate skills, (2) positive attitude, legitimating, formation. Environment: (1) lack of institutional support, relationship with patient, physician and community pharmacist, inadequate teaching, (2) institutional support, patient's demand, cooperation with physician and community pharmacist, appropriate teaching. Technology: (1) lack of access to clinical data and information, inadequate method, (2) access to information, appropriate method, documentation, computerization, marketing, good pharmacy practices. Conclusion: The semi-structured interviews provide a broad, comprehensive and pragmatic view of potential determinants for wide practice of MTM in Portuguese’s hospital pharmacy.

O objetivo desse estudo foi avaliar o impacto da atenção farmacêutica em desfechos clínicos e na qualidade de vida de pacientes portadores de diabete melito tipo 2 (DM2) atendidos em um hospital de nível terciário de atenção à saúde. O estudo foi clínico controlado randomizado com 70 pacientes portadores de DM2, com mais de 45 anos, em uso de insulina e hemoglobina glicada (HbA1c) 8%. Os pacientes do grupo controle (GC) (n=36) receberam tratamento usual e os do grupo intervenção (GI) (n=34) receberam acompanhamento farmacoterapêutico individualizado e educação para o DM2. A amostra total foi composta principalmente por mulheres (61,4%), com uma média de idade aproximada de 61 anos e tempo de DM2 de cerca de 14 anos, sendo que os grupos eram homogêneos quanto a essas características (p>0,05). Após seis meses de intervenção, os conhecimentos sobre o diabetes e sobre os medicamentos aumentaram significativamente no GI, de 9,91±2,69 para 15,74±3,03 e de 4,47±0,84 para 6,58±1,29, respectivamente, ambos permanecendo inalterados no GC. A adesão ao tratamento farmacológico, para o GI, segundo o questionário Morisky-Green e o Questionário de Adesão a Medicamentos passou de 17,6% para 70,6% e de 29,4% para 52,9%, respectivamente (p<0,05), permanecendo inalterada no GC. Houve aumentos significativos na realização correta das técnicas de aplicação de insulina e de monitorização de glicemia capilar ao final após a intervenção. No início do estudo, a média de HbA1c era para o GC 9,61±1,38 e, para o GI 9,78±1,55 (p>0,05). Após a intervenção, a média de HbA1c do GI diminuiu significativamente para 9,21±1,41, o que não ocorreu para o GC (9,53±1,68) (p>0,05). Ao final do estudo houve melhora significativa da qualidade de vida relacionada ao diabete no GI enquanto que para o GC esse desfecho piorou significativamente. A atenção farmacêutica resultou em melhora significativa de desfechos clínicos e humanísticos dos pacientes com DM2 após seis meses de intervenção
The aim of this study was to evaluate the impact of a pharmaceutical care program on health outcomes and quality of life in patients with type 2 diabetes mellitus (T2DM) attending in a tertiary care center. The study was a randomized controlled, parallel-group trial with a 6-month follow-up carried out with 70 adults (45 years of age) with T2DM, taking insulin, with an HbA1c 8%. Patients in control group (CG) (n=36) received usual care and for those patients in intervention group (IG) (n=34) an individualized pharmacotherapeutic care plan and diabetes education were provided. Total sample was composed primarily of women (61,4%), with mean age of 61 years and duration of T2DM of 14 years and these characteristics were similar in the groups (p>0,05). After a 6-month follow-up, diabetes knowledge and medication knowledge significantly improved in IG, from 9,75±2,69 to 15,74±3,03 and from 4,47±0,84 to 6,58±1,29, respectively, and both outcomes remained unchanged in the CG. Adherence to medication for the IG according to the Morisky-Green questionnaire and to the Questionário de Adesão a Medicamentos varied, respectively, from 17,6% in baseline to 70,6% at end of the study and from 29,4% to 52,9% (p<0,05), with no changes in CG. There were significant improvements in the correct execution of insulin injections and home blood glucose monitoring techniques in the IG at the end of the study. At the beginning of the study HbA1c mean values were 9,61±1,38 in the CG and 9,78±1,55 in the IG (p>0,05). After the intervention, HbA1c mean values was reduced significantly to 9,21±1,41 in the IG and remained unchanged in the CG (9,53±1,68) (p>0,05). After the intervention the diabetes related quality of life significantly improved in IG while it worsened significantly in the CG. Pharmaceutical care resulted in significant improvement in health outcomes in patients with T2DM after 6-month follow-up

A Thesis submitted to the faculty of Commerce, Law and Management, University of Witwatersrand, School of Governance in 50% fulfilment for the Master of Management in the field of Monitoring and Evaluation 9 May 2016
The purpose of the study was to analyse the Supply Chain Management (SCM) approaches used in the Public Hospital Outpatients Pharmacy and compare the findings with successful supply chain practices from other industry sectors. The study of academic literature locates the unavailability of drugs in the public hospital pharmacies to the domino effect of the lack of governance and accountability in the public hospital. The data for the study was gathered from public and private hospitals in Gauteng, and large FMCG manufacturers and retailers. The study finds that the public sector adoption of SCM in the absence of a coherent technology and human resource support environment results in a lack of accountability and coherence across systems. The research study corroborated the view of academics and the interviewees that the unavailability of drugs in the public hospital is a multidimensional problem that has its roots in the lack of governance throughout the drug supply chain. It is a complex manifestation of policy, processes, practices, structure, people, communication and donor funding that contribute to the problem. Resolving the drug availability issues will require the ‘whole supply chain re-engineering’ with the added focus on developing the operational capability and capacity of the actors within the supply chain continuum.
MT2017

Orientação: António Augusto Teixeira da Costa
A dissertação tem por objetivo geral entender como a atuação do enfermeiro enquanto gestor da farmácia do Hospital Adventista de Belém modificou a sua administração e otimizou as metas do hospital no setor farmacêutico para o tratamento eficiente do paciente. E, como objetivos específicos: apresentar resumidamente o papel do enfermeiro no hospital; mostrar, de uma forma breve, o papel do farmacêutico hospitalar e por fim, apresentar e analisar dados pertinentes a pesquisa. Metodologia: a pesquisa se configurou em um estudo de caso e pesquisa-ação, com classificação exploratória, experimental, com caráter descritivo, qualitativo e para seu desenvolvimento fez-se uso da revisão de literatura, na qual contribui para o aprofundamento do conhecimento do objeto pesquisado. Em seguida, para a recolha de dados empíricos, observações feitas in loco, adotou-se o uso de questionário com perguntas fechadas, registros fotográficos, confecção de gráficos e tabulação de resultados. A pesquisa teve como unidade de analise a Farmácia do Hospital Adventista de Belém. Foram ao todo 49 entrevistados, composto de 43 atendentes de farmácia e 6 farmacêuticos. Conclusão: a atuação do enfermeiro, gestor, no setor de farmácia do Hospital Adventista de Belém foi positiva e que o trabalho, ainda, está sendo executado no molde deixado pelo mesmo.
This dissertation is to understand how the nurse's role as manager of the pharmacy of the Adventist Hospital of Belém modified its administration and optimized the goals of the hospital in the pharmaceutical sector for the efficient treatment of the patient. And as specific objectives: to present briefly the role of the nurse in the hospital; show, briefly, the role of the hospital pharmacist and, finally, present and analyze data pertinent to research. Methodology: the research was configured in a case study and action research, with exploratory, experimental classification, with descriptive and qualitative character and for its development the literature review was used, in which it contributes to the deepening of the knowledge of the object researched. Then, for the collection of empirical data, observations made in loco, the use of questionnaire with closed questions, photographic records, drawing of graphs and tabulation of results was adopted. The research had as unit of analysis the Pharmacy of the Hospital Adventista de Belém. There were in total 49 interviewees, composed of 43 pharmacy attendants and 6 pharmacists. Conclusion: the performance of the nurse, manager, in the pharmacy sector of the Belém Adventist Hospital was positive and that the work is still being carried out in the mold left by it.

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Aims and Objectives The vision for the future Great Britain pharmacy workforce development has been proposed as of August 2015 and this starts/reignites discussions as to how pharmacists continue to operate as a body whilst maintaining and extending their professional acumen and experience [1]. The pharmacy sector has grown substantially and qualified pharmacists are often assumed to be managers, without having completed management modules during their degree [2]. The aim of this study was to determine how CPD supports management skills development (MSD) of pharmacists in these sectors.
The full text will be available on permission from the publisher.

碩士
東海大學
工業工程與經營資訊學系
99
The hospitals in Taiwan have been using various styles of hospital accreditation since 1978, when the teaching hospital accreditation was first introduced. Under the current health care regulations in Taiwan, the result of the evaluation of a hospital alone can determine the amount of compensation it receives. Therefore, the evaluation system has deeply influenced the development of regulations inside hospitals, from lower to higher levels, as well as the role values of medical personnel, including the in-hospital pharmacists. This research explores in detail, from the perspective of the value chain concept, how the hospital accreditation system has impacted the value added of in-hospital pharmacists throughout the changes adopted within the hospital accreditation over the years. According to this research, it is shown that the amount of compensation awarded for the pharmaceutical services in a hospital follows a quantitative setup under the current health care regulations. However, it is difficult to apply the same setup to measure the value of pharmaceutical care and services provided by in-hospital pharmacists. Presently in Taiwan, the result of the hospital accreditation of a hospital alone directly impacts the total amount of compensation it receives. Aiming to improve the quality of health care services provided by the hospitals, the implementation of the hospital accreditation on each hospital has indirectly increased the value added of in-hospital pharmacists. Consequently, the value of pharmaceutical support provided by in-hospital pharmacists become subjected to the quantitative setup utilized by the current evaluation regulations. As the hospital accreditation system places more and more emphasis on the aspects of drug safety, drug treatment received by patients, and drug effect reported by patients, it is evident that the added value of care and services, particularly in the areas such as management of drug quality, and clinical pharmaceutical care, provided by in-hospital pharmacists also become more considerable.

碩士
東海大學
工業工程與經營資訊學系
100
In Taiwan, the result of the hospital accreditation can determine the amount of hospital remuneration. The hospitals in Taiwan have been using various styles of hospital accreditation since 1978, when the teaching hospital accreditation was first introduced. Hospital accreditation and new hospital accreditation followed. Therefore, the hospital accreditation system has deeply influenced the development of regulations inside hospitals, from lower to higher levels, as well as the role values of medical personnel, including the in-hospital physicians . This research explores in detail, from the perspective of the value chain concept, how the hospital accreditation system has impacted the value added of in-hospital physicians throughout the changes adopted within the hospital accreditation over the years. According to this research, it is shown that the amount of remuneration awarded for the medical services in a hospital follows a quantitative setup under the current health care regulations. However, it is difficult to apply the same setup to measure the value of medical care and services provided by in-hospital physicians. Presently in Taiwan, the result of the hospital accreditation of a hospital alone directly impacts the total amount of remuneration it receives. Aiming to improve the quality of health care services provided by the hospitals, the implementation of the hospital accreditation on each hospital has indirectly increased the value added of in-hospital physicians. Consequently, the value of medical support provided by in-hospital physicians become subjected to the quantitative setup utilized by the current evaluation regulations. As the hospital accreditation system places more and more emphasis on the aspects of “patient center” and :”patient safety”, it is evident that the added value of care and services, particularly in the areas such as health research and hospital management, health education, provided by in-hospital physicians also become more considerable.

Background:- The HIV and AIDS epidemic is a major catastrophe that affects millions of people worldwide. Antiretroviral medication combinations have revolutionised HIV treatment since 1996, transforming the virus from a death sentence to a manageable condition. In order to obtain full therapeutic benefits it is vitally important that patients adhere to their prescribed medication. Being informed about the disease and medication contributes to patient adherence and management. Pharmacists are considered to be the most accessible health professional and can help HIV -infected patients deal with barriers to medication access, manage adverse effects and medication interactions, and adhere to medication regimens by appropriate counselling. The public sector is defined as that part of an economy that is controlled by the state. At the study site, which is a public sector facility, the roll out of antiretroviral medication started in 2006. At the time all patients were counselled by trained counsellors, before seeing a doctor. At the pharmacy the medication was collected with no intense counselling by a pharmacist as the patients would have visited the trained counsellors first. Subsequently it was found that there were many queries regarding HIV and AIDS. It was then decided in October 2007, that the pharmacist support the counselling done by the counsellors in that they should reinforce what was said by the counsellors, together with giving detailed information to patients on their health and medication. This study was therefore undertaken to measure pharmacists' role in the management and adherence of HIV infected patients at this institutional facility. Method: The study was undertaken at a public sector health facility using anonymous structured questionnaires and was divided into 3 phases: Pre-Intervention, Intervention and Post-Intervention phases. After obtaining patient consent the questionnaires were administered during the 1st phase. A month later all patients visiting the pharmacy were counselled intensely on various aspects of HIV and the antiretroviral medication. Thereafter patients who took part in phase 1 were asked to participate in the 2nd phase. After obtaining their consent again, the same questionnaire was administered to them. Quantitative variables were compared between pre and post intervention using paired t-tests or Wilcoxon signed ranks tests. Categorical variables were compared using McNemar's chi square test (Binary) or McNemar-Bowker test for ordinal variables. Results: A response rate of 87.5% was obtained with the majority of the patients being female. Almost 70% of the participants were in the age-range of 21-40 years old. The majority of the participants did not have post school education. Most of the participants (95.4%) did not know that HIV is a virus that causes AIDS in the pre intervention phase, but this decreased to 93.7% in the post intervention phase. The participants knowledge of people who have sexually transmitted diseases are least at risk of getting HIV, healthy food will cure HIV and smoking and drinking alcohol will weaken the HIV virus, increased significantly from the pre-intervention phase to the post intervention phase. Knowledge on the modes of transmission either increased or remained unchanged. Overall the mean knowledge score on the disease itself had increased significantly (SD 6.6%) [p<0.01] after the pharmacists' intervention (pre-intervention was 82.1 %, post-intervention was 86.3%). In both phases, over 40% of all patients stored their medication in the cupboard. The majority of the patients took their medication either with or without food at both phases of the study. After the intervention, the frequency of taking medication with a fatty meal or any time they remember was decreased to 0. A significant improvement was noted in the overall knowledge score with regards to medication taking and storage (p<0.05). Conclusion: Pharmacist intervention had a positive impact on HIV infected patients' HIV and AIDS knowledge on the disease and on the antiretroviral medication use and storage.
Thesis (M.Pharm.)-University of KwaZulu-Natal, Durban, 2011.

碩士
高雄醫學大學
藥學系碩士在職專班
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According to statistics of the Ministry of the Interior, Taiwan officially entered the “aged society” in March 2018, with the elderly/total population ratio of 14.05%, and Aging Index (elderly/children population*100%) reaching 107.4. Numer of long-term care institutions increased from 1,067 in 2015 to 1,100 in 2017, with the accommodated elderly/disabled elderly requiring long-term care reaching 27.98%. Medication use by admitted residents were complex and with varieties, but there is little emphasis on medication use safty management at present. Despite the emphasis on drug regimen review, the discussion of policy and procedure on safe medication use process and management by the institutions remain scarce. Therefore, this study adopted the “Assessment tool on the quality of medication safety and management in Long-term Care Facilities” established by Taiwan Pharmacist Association for the pharmaceutical services in long-term care institutions. After carrying out the reliability and validity tests on the assessment tool, two institutions were evaluated. Recommendations were provided after each assessment to exhort improvement. After three assessment sessions, differences before and after the intervention of pharmacists were compared. The expert validity of the assessment tool reached 0.99. As for the consistency reliability after revising the scoring method and adding scoring criteria, the CVI value increased from 0.625 to 0.890, indicating high reliability. After the pharmacist interventions, Institution 1 improved by 9.87%, p=0.008 and Institution 2 improved by 32%, p=0.003, indicating high significance of changes. The results showed that the pharmacist recommendations based on the assessment tool and the support and cooperation of the institutions’ medical teams effectively improved the quality of medication use process and management in the institutions. The study amended the scoring method of the assessment tool to increase its accuracy. Also, the assessment tool truly reflects the actual situations of the quality of medication use and management in long-term care institutions, which is considered a sound measurement tool for continuous quality improvement. This study further proposed a revised version of the assessment tool based on expert opinions, actual assessment findings, and existing long-term care institution accreditation criteria. The 2 aspects, 18 dimensions, and 58 assessment questions were changed into 3 aspects, 18 dimensions, and 65 questions, in the hopes of providing a more comprehensive assessment to help pharmacists promptly and completely examine the medication use process and management situations in the institutions. Finally, this study, with references to accrediatation methods used in the United States to evaluate pharmacists performance, suggested an “Assessment form for the quality of pharmacist services in Long-Term Care Facilities”, which shall serve as a reference for pharmacists in institutions to carry out the quality assessments of pharmacy professional services in the future.