Dissertations / Theses on the topic 'Pharmacy management'

Thesis (Ed.D.)--Teachers College, Columbia University, 1992.
Includes tables. Typescript; issued also on microfilm. Sponsor: Carmine Paul Gibaldi. Dissertation Committee: L. Lee Knefelkamp. Includes bibliographical references (leaves 164-168).

Class of 2016 Abstract
Objectives: The purpose of this study is to determine if pharmacy students are more likely to use pharmacological agents to manage pain and if men and women are equally likely to use pharmacological agents. Methods: Questionnaires were administered after a regularly scheduled class for first, second and third year pharmacy students. Data collected included a pain intensity rating, whether pain was acute or chronic, how the pain was managed (medication, exercise, etc.) and if pain interfered with activities. Results: A total of 218 students (41% men, 71% aged 19-25) participated; 70% reported acute pain, 16%, chronic pain, and 14%, no pain. Pain intensity was greater in the chronic pain group (5.8 ± 1.7) than in the acute pain group (5.0 ± 2.1; p = 0.028). Chronic pain respondents were more likely to use prescription NSAIDs, muscle relaxers, physical therapy, transdermal electrical nerve stimulation, steroid injections and beta blockers (p < 0.02). There were few differences between men and women; women used OTC NSAIDs and acetaminophen at higher rates than men (p < 0.02). Women also used two non-pharmacological strategies (changed position and relaxation) at higher levels than men (p < 0.02). Students with chronic pain reported more pain interference with daily and leisure activities (p < 0.005) and work (p = 0.003) than students in the acute pain group. Conclusions: Different strategies were used for pain management between acute and chronic pain participants, and also between both men and women. Students with chronic pain reported more interference with activities than those with acute pain.

Obesity rates in Australia have reached all-time highs, and the primary healthcare setting has been identified as a key area for the management of obesity. Community pharmacies are well positioned to provide weight management initiatives due to their accessibility and potential to identify at-risk consumers. In recent years, there has been a shift in pharmacy practice, with a growing focus on the provision of professional pharmacy services to better support public health needs. Pharmacies are a major outlet for over-the-counter weight-loss products, and there is opportunity for pharmacists to deliver evidence-based and sustainable interventions in this domain. The overarching aim of this thesis was to develop and test a best practice model for weight management services in community pharmacy in Australia, and to identify competencies related to weight management required by pharmacists to inform the development of an educational workshop. The research involved a comprehensive systematic needs assessment conducted through consultation with stakeholders, including pharmacists, consumers, experts in the field and representatives of the leading pharmacy professional organisations, to inform the development of a service model, which was subsequently pilot tested in community pharmacies. In addition, an educational workshop to upskill pharmacy students in weight management was developed and evaluated.

The role of pharmacists in the healthcare sector is vital. In Indonesia, medicines accounted for 12 – 38% of hospitals’ expenses, and hospital pharmacy is the main department in the hospital charged with the responsibility to manage the safe, appropriate and judicious use of medicines. Many studies have investigated clinical and financial benefits of pharmacists and pharmaceutical services in hospitals. To assist authorised bodies in each country to establish relevant document and regulations, World Health Organization (WHO) and International Pharmaceutical Federation (FIP) have stipulated Good Pharmacy Practice (GPP) guidelines. Hospital pharmacy practice standards have also been ratified in many countries, and a global consensus was developed and called “The Basel Statements on the future of hospital pharmacists”. It reflects the importance of service provision by hospital pharmacy. However, much variation of hospital type, ownership (private or public), and stage of regional development is common in Indonesia. With constant changes in healthcare industry, such as change of health systems, patients’ demography, or advancement of medical technology and science, many hospital pharmacies face challenges to meet the practice standards. For example, with the implementation of National Health Insurance scheme in Indonesia in early 2014, the medicines funding scheme was changed. Healthcare funding which was previously dominated by private health funds has been reformed into public funding using case mix. In the old scheme, medicines costs were paid out-of-pocket by patients, or fully reimbursed by private or public health insurance bodies. In the new scheme, medication costs are paid as a package with other health costs. Hence, hospital pharmacy plays a vital role in managing medicines to improve efficiency and service quality as well as managing financial sustainability. Management is an essential factor to ‘scale up’ service delivery to strengthening health systems and improving population health in low-middle income countries. Managers in the hospital sector are key health service managers especially in low income countries. Although the importance of management in hospital pharmacy is clear, it is common for many hospital pharmacists to overlook rather than value management practice. While there has been some research reported from developed countries, there is relatively little current research from developing countries. Research exploring hospital pharmacists’ experiences in hospital pharmacy management is critical to gain more understanding about current issues, and potential future application of management in hospital pharmacy. Therefore, the aims of the research described in this thesis were to explore Australian and Indonesian hospital pharmacists’ perceptions of their roles in hospital pharmacy management, challenges and enablers in managing hospital pharmacy, and vision for the future. This research has adopted a qualitative approach using semi-structured interviews in two stages. Stage 1 explores the Australian hospital pharmacists’ and Stage 2 investigates Indonesian hospital pharmacists’ perceptions and experiences in hospital pharmacy management. The main focus of this research is on Stage 2, thus the results are presented in three chapters. However, Stage 1 provides an international perspective and commentary for the findings in Stage 2. In Chapter 1, an overview of the literature regarding hospital pharmacy management, details of the Australia’s and Indonesia health systems, and hospital pharmacy activities in each country are summarised and discussed. It also includes a structured literature review to explore international perspectives on management aspects in hospital pharmacy. The results are presented and discussed in this chapter. In Chapter 2, the Stage 1 of this research is presented comprising a qualitative study exploring the perceived roles, challenges, opportunities, and key factors in managing and optimising resources in Australian hospital pharmacy. The main themes identified from semi-structured interviews are summarised and discussed in this chapter. In Chapter 3, the first part of Stage 2 of this research is documented. A qualitative study was conducted to explore perceived roles, challenges, opportunities, and key factors in managing and optimising resources in Indonesian hospital pharmacy. This chapter focuses on Indonesian hospital pharmacists’ perceptions of roles, barriers and facilitators of roles, and attitudes toward current roles. The main themes identified from semi-structured interviews are summarised and discussed in this chapter. In Chapter 4, the second part of Stage 2 is documented. This chapter focuses on Indonesian hospital pharmacists’ experiences and concerns in the management of hospital pharmacy. The main themes identified from semi-structured interviews are summarised and discussed in this chapter. In Chapter 5, the last part of Stage 2 is documented. This chapter focuses on the views and perceptions of Indonesian hospital pharmacists related to the professions’ future direction and vision for hospital pharmacy practice. The main themes identified from semi- structured interviews are summarised and discussed in this chapter. In Chapter 6, main findings of each project stage from each stage are compared and summarised. Future directions in this area are discussed in this chapter.

Thesis (MBA)--University of Stellenbosch, 2011.
On 16 January 2004, the Parliament of the Republic of South Africa published the Draft Regulations to the Medicines and Related Substances Act No. 101 of 1965 (Republic of South Africa, 2010a) for comments due by 16 April 2004. These regulations would change the retail pharmacy landscape that generations of pharmacists had become dependent on in supporting themselves and the communities that they served. These regulations proposed a single exit price (SEP) that manufacturers might charge pharmaceutical wholesalers, which included the distribution cost. The wholesaler in turn would sell the pharmaceutical to the pharmaceutical retailer at the listed SEP, thus prohibiting discounts and in the process creating transparency in the pharmaceutical industry. This transparency would ensure that all people would pay the same price for their medication with the aim of making it affordable and available to those in need. Preceding these draft regulations was the amendment to the Pharmacy Act No. 53 of 1974 (Republic of South Africa, 2010c) concerning pharmacy ownership, which allowed non-pharmacist and legal entities to own pharmacies as of 2003. This amendment posed the first external threat to the autonomy of pharmacists regarding independent pharmacy ownership. Pharmacists now had to compete not only amongst themselves but also with large corporate food and health shops with in-house pharmacies. The resources and capabilities inherent to independent community pharmacies given the events of the past few years proved inadequate in competing with the corporate retailers. These two amendments to acts that influenced the existing pharmacy landscape posed a real threat to the sustainability of independent pharmacy business models. This paper investigates the issues that independent community pharmacies in South Africa are facing and their strategic options in the pharmaceutical and services value chain.

Buy24x7.com is an online pharmacy registered as a limited liability company with its head office in Los Angeles, CA. The sole purpose of Buy24x7.com is to provide prescription medicines at a reasonable price to its customers and we plan to achieve this by working efficiently and cutting down the operating cost. The company’s top three goals are to provide prescription medicines to the customers at a lower price in the market, make prescription medicines easily available to the customers and be known as Americas most reliable and trusted pharmacy. Buy24x7’s unique selling proposition is an overnight delivery system which promises to deliver drugs to the doorsteps. Additionally, there will be a discount for the customers within 5-km radius of the warehouse. This business plan will present an analysis of target market, company’s marketing goals and objectives and the strategies to attract customers, a SWOT analysis discussing the strengths, weaknesses, opportunities, and threats to the company, a birds-eye view of the legal and regulatory concerns surrounding the business, and finally a review of the financial viability

Studies have revealed that bilingual individuals opt their native language as the first choice for consultation with health professionals. Moreover, a concordant cooperation between patient and pharmacist is significantly impaired where one party is applying a language with which both sides are not comfortable or confident. Accordingly, a multilingual pharmacy has the potential to remove language barriers for non-compliance among customers who need pharmacy services. On the other hand, in today’s competitive market, a pharmacy may guarantee its survival, and also high revenue, if it fills a sizable amount of Medicare patients’ prescriptions since a majority of these physician orders include at least three types of chronic-disease medications. However, there are still communication barriers with some of Medicare beneficiaries because of their limited proficiency in English.

DANA, a private community pharmacy, intends to remove aforementioned obstacles in the heart of Laguna Woods and its neighboring cities where they place prescriptions for a large number of Persian and Hispanic immigrants and serve a community with the highest density of elderly people in Southern California.

DANA’s mission is to deliver highly valued health care in a manner that ensures optimal medication therapy outcomes for the whole community by performing its trilingual Farsi-Spanish-English pharmacy service and being more attentive to elderly patients.

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 design, develop, and administer an Objective, Structured Management Exam (OSME) on management skills for pharmacy students. Pharmacy preceptors for the University of Arizona College of Pharmacy participated in focus groups that identified business, management, and human resource skills needed by pharmacy graduates. Once the skills were identified, gaps were identified for inclusion into the OSMEs. The OSMEs evaluated pharmacy students' performance on four skills: 1) managerial communication (oral and written); 2) conflict resolution; 3) decision-making; and 4) professionalism. The OSME consisted of a role-playing and a writing document. Both were graded using a developed scoring rubric. The role-playing scoring rubric contained 17 skills and the written document scoring rubric contained 8 skills. During the OSME, students interacted with a trained actor and were graded by a judge on their performance. Upon completion of the OSME, students completed a 29-question survey on a) their perceived ability and confidence to accomplish 8 selected skills; b) their opinion about the OSME and suggestions to improve the process in the future; and c) their background characteristics. Many-facet Rasch analysis provided detailed information with which to evaluate content validity and student performance taking into account difficulty of skills, rating scale function of the scoring rubric, judge leniency and severity. Rasch analysis provided detailed information on the scale performance and student ability and confidence. A step-wise linear regression was used to determine if any student characteristics predicted a higher OSME performance score. Ninety-six student pharmacists completed the OSME and ninety-five students completed the questionnaire. No student failed the role-playing scenario and 1 student did not complete the written document. Significant gaps were calculated between the easiest two skills, empty sounds and eye contact. Additionally, the seventeen items did not align with student performance measures. Finally, there were two separate groups of graders. The writing document scoring rubric had poor fit with the model and significant gaps were calculated. Student measures did not adequately align with item difficulty measures. For students' perceived ability, there was no significant change in overall mean student ability scores from before the educational lectures to after the OSME. However, 46% of students (n=44) had a significant change in ability scores. Three significant gaps were calculated between skills a) between decision-making and communication and between communication and active listening on the pre-educational lectures; and b) between decision-making and communication on after the OSMEs. Students appeared confident with their ability on the 8 skills. The overall mean student confidence measure did not significantly change between the three time points: 1) before the practice cases; 2) after the practice cases; and 3) after the OSMEs. However, 46% of students (n=44) had a significant change in their confidence from before the practice cases to after the completion of the OSMEs. Item difficult measures did not appropriately align with student confidence measures, meaning the items were too easy for students. Significant gaps were also calculated: a) between the motivation and communication items and between the communication and active listening items in the before the practice cases responses; b) between the motivation and decision-making items and between the communication and active listening items for the after the practice cases responses; and c) between the motivation and decision-making items; between the decision-making and communication items; and between the communication and active listening items for after the OSME responses. Based on the result of the regression, three characteristics predicted a higher performance score on the role-playing portion of the OSME: 1) previous management experience; 2) previous leadership experience; and 3) the total grade on the educational lecture quizzes. Three characteristics predicted a higher writing document score: 1) age between 26 and 28 years; 2) English as the primary language; and 3) previous pharmacy experience classified as "other" (i.e., pharmacy experience that was not hospital, community, or managed care). This was one of the first studies to develop a role-playing exercise on management skills in pharmacy education. The grading rubrics provided an initial structure for assessing student performance on these management skills. Some changes to the ability questions and the rubrics are suggested in order to improve the content validity. The findings provide the outline for the use of an OSME at schools/colleges of pharmacy as part of their curriculum. As exposure to management scenarios showed higher performance, educators should include these skills in the education of student pharmacists in order to prepare them for a future career in pharmacy.

EMBA Project Report
EXECUTIVE SUMMARY: Supply Chain Management at the National Naval Medical Center Pharmacy The National Naval Medical Center (NNMC) in Bethesda, Maryland is the U.S. Navy’s flagship of medical centers and is the Navy’s third-largest medical center.1 NNMC provides medical services to approximately 46,000 patients annually,2 and its pharmacy has an annual budget of $46M for drugs dispensed to NNMC patients.3 This consulting project, completed with the support of the NNMC Pharmacy Department Head and facilitated through the Naval Postgraduate School Executive MBA Program, applied operations management and supply chain management principles to the processes used by the NNMC pharmacy to find potential efficiency improvements. Specifically, the consultant team evaluated drug purchasing data from the Defense Medical Logistics Supply System (DMLSS) and dispensing data from the Composite Healthcare System (CHCS) for specific high-cost and high-volume drugs to identify optimal inventory levels and order points. The NNMC Pharmacy Staff selected the following six drugs for analysis: _ Arimedex (anastrozole) – a breast cancer prevention drug. _ Intelence (extravirine) – an HIV treatment drug. _ Procrit (epoetin alfa) – an anemia treatment drug. _ Seroquel (quetiapine) – depressive disorder (bipolar & schizophrenia) treatment drug. _ Topamax (topiramate) – an anti-seizure/epilepsy medication. _ Vfend (voriconazole) – fungus and yeast infection treatment drug. 1 NNMC Public Affairs Document “National Naval Medical Center at a Glance,” www.bethesda.med.navy.mil 2 Ibid. 3 Personal Interview with LT Bradley Gotto, 29 July 2010 After analyzing historical ordering and dispensing data for these drugs and touring the NNMC drug storage facilities, the consultant team’s primary recommendation is that NNMC pharmacy should adjust re-order points, re-order quantities, and safety stock for the subject drugs to reduce high levels of inventory and unnecessary safety stock. Since the NNMC pharmacy can obtain drugs at low cost with minimal (1 day) lead time, NNMC can reduce the average inventory of these drugs and shift the burden of inventory management to the drug suppliers. This has potential to simplify the restocking process at the NNMC pharmacy and reduce the manpower required to fill new orders. Other secondary recommendations to improve the NNMC Pharmacy operations include: _ Perform a full inventory of drugs held at the NNMC Pharmacy to develop a full accounting of all drugs on hand. _ Expand analysis to determine required safety stock for other drugs. _ Promote adoption of a consolidated system to replace DMLSS and CHCS to coordinate ordering and dispensing operations.

Introduction: Literature from around the world suggests that paediatric asthma care is not in line with guidelines and inhaler technique, adherence, asthma management knowledge and written asthma action plan ownership are suboptimal. Thus there is a need for multiple primary care professionals to be involved in paediatric asthma management. Community pharmacists are in an ideal position to address the issues in paediatric asthma stated above therefore this thesis sought to strengthen and improve the current role of community pharmacists in managing paediatric asthma patients within primary care. (Chapter 1) Aim 1: To better understand the status of paediatric asthma management in the Australian and U.S.A community pharmacy setting and to identify the educational needs of community pharmacists in relation to paediatric asthma management. To achieve this aim, a cross-sectional observational study was implemented by recruiting community pharmacists across Sydney metropolitan, Australia and southeast Michigan, U.S.A. Enrolled pharmacists completed a structured, self-reported questionnaire, assessing information on four general domains related to paediatric asthma management: (1) counselling strategies/practices following the dispensing of new asthma medicines and confidence around the use of inhaled corticosteroids; (2) confidence and frequency of use of communication and self-management strategies; (3) attitudes and barriers to the appropriate delivery of education and counseling (4) guideline awareness/use and continuing education. Community pharmacists in both Australia and the U.S.A reported confidence in general communication skills, while a lower proportion reported confidence in engaging in higher order self-management activities that involved tailoring the regimen, decision-making and reviewing short-term and long-term goals with the patient and carer. Community pharmacists in both Australia and the U.S.A were not engaging in paediatric asthma continuing education and most were not using national guidelines to inform their practice. (Chapter 2) Aim 2: To gain a deeper understanding of the perception community pharmacists have of their current role, awareness, practices, interactions and needs in relation to paediatric asthma. Qualitative interviews were conducted with a convenience sample of 23 community pharmacists practising across southeast Michigan in order to address this aim. Interviews were audiotaped and transcribed verbatim, and transcripts were thematically analysed. Upon analysis of the qualitative interviews with pharmacists it was found that pharmacists do not believe their primary role is to engage patients in education and skills training on paediatric asthma self-management, but rather to supply medicine. Although most v pharmacists chose to communicate and provide patient-education, they tended to only engage in these activities if they had time or if requested by the patient/carer. Pharmacists were aware of the areas of suboptimal asthma self-management in children and reported interest in expanding their current role to include paediatric asthma counselling and education. However, numerous challenges and barriers have been identified that prevent pharmacists from delivering optimal education to carers and children with asthma. These included lack of time and reimbursement, challenges in managing the affordability of medicines and lack of a collaborative partnership with doctors in their pharmacy practice. Pharmacists also expressed the view that paediatric asthma continuing education programs are not readily available. (Chapter 3) Aim 3: To identify the needs of carers in terms of managing their child’s asthma, and explore the experiences and perceptions of carers of children with asthma with regards to the community pharmacist. An observational, cross-sectional study design was implemented. This involved the completion of a self-administered questionnaire by carers of children with asthma. Community pharmacists were the sole recruiters of study participants and were responsible for asking carers, who consented to participate, to complete the study questionnaire while waiting in the community pharmacy. Data relating to 3 domains were collected: 1. Child’s asthma status including; asthma control using the validated Childhood Asthma Control Test, emergency service utilisation, days missed from school/childcare, Written Asthma Action Plan possession and prescribed asthma medicines, 2. Carer related outcomes including; days missed from work due to their child’s asthma and carer asthma knowledge using a validated Parental Asthma Knowledge Questionnaire tool, and 3. Pharmacist-Carer interactions: satisfaction with pharmacist, communication/education around paediatric asthma management using an adaptation of the patient satisfaction with pharmacy services questionnaire. The results identified that a high proportion of carers in this study reported that their child had poorly controlled asthma, and less than half possessed a written asthma action plan. Carers missed an average of 1.96 days (s.e.m; ±0.31) of paid work over a 6-month period so that they could manage their child’s uncontrolled asthma. The asthma knowledge of carers was suboptimal particularly regarding the management of an acute attack of asthma and asthma maintenance treatment. Finally, almost all carers reported satisfaction with their pharmacist’s services. However given the status of asthma control and carer knowledge, perhaps this positive relationship is being underutilised. (Chapter 3) Aim 4: To develop an evidence-based paediatric asthma communication and education program for community pharmacists, to test the feasibility of the new program for pharmacy and to explore the impact of the program on pharmacists’ communication skills and asthma vi related practices over time. The feasibility of the newly developed Practitioner Asthma Communication and Education (PACE) for Pharmacy program was tested with 44 pharmacists practising in the Sydney metropolitan region. Pharmacists were trained in small groups in the PACE for Pharmacy program. Pharmacists’ confidence in using communication strategies pre- and post-workshop and self-reported behaviour change post workshop were evaluated. All 44 pharmacists attended the program and completed pre- and post-workshop questionnaires. The participants reported a high level of satisfaction and valued the interactive nature of the workshops. Following the PACE for Pharmacy program, pharmacists reported significantly higher levels in using the communication strategies, confidence in their application and their helpfulness. Pharmacists checked for written asthma action plan possession and inhaler device technique more regularly, and provided verbal instructions more frequently to paediatric asthma patients/carers at the initiation of a new medication. (Chapter 4) Following the feasibility study, the long-term impact of the PACE for Pharmacy program was evaluated through a parallel group, randomised, control versus intervention repeated measures study design, involving 40 control and 39 intervention pharmacists. Recruited pharmacists were assigned to the control or intervention group. Intervention group pharmacists were trained in the PACE for Pharmacy program, while control pharmacists continued with their regular practice. Both control group and intervention group pharmacists completed a selfadministered questionnaire upon initial enrolment into the study and 12 months later. This study identified that participation in the PACE for Pharmacy program was associated with significant improvements in intervention pharmacists’ self-reported scores, when compared with control, in the following areas; confidence and frequency of use of communication strategies, ability to reflect on the use/effectiveness of communication self-monitoring strategies, use of strategies when counselling on new medicines as well as confidence around monitoring/counselling on the use of inhaled corticosteroids. Improvements within these areas were sustained for at least 12 months. (Chapter 4) Aim 5: To gain an understanding of the educational/training needs of pharmacy students in relation to paediatric asthma. To achieve this aim the entire final year Bachelor of Pharmacy cohort was invited to participate in this study (212 pharmacy students). Students were asked to complete a structured, self-reported questionnaire to determine communication confidence, practices and attitudes in paediatric asthma management and multiple regression analyses were used to determine predictors towards pharmacy students’ confidence and use of communication/counselling strategies. Almost all (209) students completed the study vii questionnaire (98.6%). Most students reported confidence in forming an interactive conversation (54%), while 27% reported confidence in setting long-terms goals with patients/carers. Almost all (89%) students reported observing the patients’/carers’ behaviour as a cue for the effectiveness of their communication behaviour, while 75% reported reviewing key instructions about new medicines at the end of a consultation. Tertiary level training for pharmacy students enables the acquisition of generic communication skills. Integrating these skills within the therapeutic content may enhance the confidence levels of students when it comes to communicating about higher order self-management practices in paediatric asthma. (Chapter 5) Aim 6: To develop an evidence-based paediatric asthma communication and education program for pharmacy students and evaluate its impact on their communication skills and asthma related education practices. To address this aim a pre-post study was implemented. Pharmacy students were trained in the PACE for Pharmacy Students program. Students were asked to reflect on their encounters with paediatric asthma patients/carers during their clinical placements and to report on five domains pre and 1-month post completion of the PACE for Pharmacy student program. The first three domains related to their confidence, beliefs of the helpfulness and frequency of use of evidence-based communication strategies. The final two domains related to pharmacy students’ ability to self-reflect on the use of communication self-monitoring techniques and frequency of use of strategies when counselling on new asthma medicines. The mean pharmacy student self-reported scores for each item in domains 1–5 were calculated pre and 1-month post program completion and compared using a Paired Samples Student’s T -Test (significance 0.05, power 0.8). Pharmacy students (n=209) provided data pre and 1-month post participation in the PACE program. Pharmacy student self-reported data showed a statistically significant increase in confidence and frequency of use of evidence-based communication strategies, beliefs of the helpfulness of communication strategies, their ability to self-reflect on their use communication self-monitoring techniques and their frequency of use of strategies when counselling on new asthma medicines. The findings of this study support the value of integrating the evidence-based PACE program into the Pharmacy coursework. This may lead to an improvement in pharmacy students’ paediatric asthma related communication confidence and practices when they enter the workforce. (Chapter 5) Conclusion: The research within this thesis posits that an evidence-based communication and education program specifically tailored to focus on the needs of community pharmacists in viii paediatric asthma management, coupled with strategies to overcome barriers, can together support the development of a long-term pharmacist-patient relationship. This is essential for the achieving optimal management of a chronic disease like paediatric asthma. (Chapter 6)

After much anticipation, new dyslipidemia guidelines have been published by the American College of Cardiology (ACC) and American Heart Association (AHA). The guidelines are a major shift from specific lipid goals to a focus on risk reduction. All pharmacists will need to be familiar with these guidelines in order to provide optimal patient care. Like all ASHP eReports, this is a brief and straightforward presentation of what you need to know about dyslipidemia treatment, the new guidelines, and where you can turn for deeper understanding of the context. Dyslipidemia: Contemporary Evaluation and Management addresses pathophysiology, clinical presentation, diagnosis, and disease classification, general treatment principles, non-pharmacological treatments, pharmacotherapy, monitoring, clinical controversies, and future treatment, references, and web resources.

With advances in technology and science, life expectancy is increasing, but most of the elders must take care of themselves or live in assisted home. Between 2015 and 2060, the U.S. Census Bureau predicts that the population adult aged 65 to 84 will grow to 89%; meanwhile, the number of adult 85 and older are expected to more than triple and about 11 million people age sixty-five and older are predicted to live alone, which is almost a third of the American population. They may have problems to receive essential medications because they are unable to drive or do not have access to public transportations. The FlyMed Pharmacy will assist the elderly by providing home delivery services such as emergency or maintenance medications. Consultations and advice will be provided through a mobile app, DeliverMyMed.

Zimbabwe's catastrophic economic decline resulted in a high unemployment rate (95%), declining socioeconomic indicators, pharmacy stores' unprofitability and lower sustainability. Profitable pharmacy stores play a fundamental role in ensuring public access to medication. Lack of pharmacy profitability leads to poor healthcare delivery, resulting in increased morbidity and mortality. A healthy population is panacea to economic growth and prosperity and enhances human dignity, social cohesion, and the quality of life. In this qualitative, descriptive multicase study design, using Porter's business strategies theory and the Deming process of quality assurance as conceptual frameworks, data from 11 pharmacy stores leaders in Bulawayo, Zimbabwe were collected during interviews with open-ended questions. Participants were assumed to have influence, knowledge, and a personal stake in the pharmacy sector and that their views and experiences could address the research question of lack of pharmacy profitability and sustainability. Data were explored, categorized, and tabulated to assist drawing empirical findings and conclusions that could answer the research question. Using software the data were analyzed and themes such as the centrality of strategy in running profitable pharmacies, customer care, reimbursements by medical insurance firms, the role of the legal and regulatory frameworks on pharmacies, and mergers of single-owner pharmacies emerged. Findings from the results might provide strategies for those in the pharmacy retail sector and individuals who intend to explore the sector. Individuals who read results of the study might be influenced to lobby government on behalf of the sector to relax prohibitive regulations.

Learning Objectives: Describe the concept of patient ‐centered care from the pharmacist’s perspective. Summarize the science of patient ‐centered communication in pain management. Describe pharmacogenetic tests that are available to guide the use of opioids in pain management. Discuss research opportunities related to patient ‐centered care and genetic testing in pain management. Describe strategies used by pharmacists to implement genetic testing in clinical pharmacy practice.

Introduction Community pharmacy in Saudi Arabia faces many challenges. There is a lack of empirical research about medication safety in community pharmacy from the perspective of different stakeholders. A holistic approach is needed to identify medication safety problems. Aim To explore factors associated with medication safety in this setting. Methods Three empirical studies were undertaken. Focus groups explored medication safety problems using the Human Factors Framework and a Delphi exercise prioritised these problems. Interviews were conducted with pharmacy users to explore their willingness to share information with pharmacists during consultations using the Self-Regulatory Model. Results Four focus groups and four interviews (n=35 participants) identified seven main themes: commercialism; illegal supply of medication; lack of enforcement of regulations; the healthcare system; self-medication; trust in pharmacists; and communication and information exchange. Consensus was achieved with 28/84 items identified during the Delphi study. The top five priorities were: lack of pharmacy facilities; pharmacists' communication between pharmacists and physicians; patient databases; post-registration education; and pharmacists' long working hours. The interview study (n=21) identified that trust in pharmacists was the main enabler in sharing information. Barriers were pharmacists' perceived attitudes towards counselling, workload, lack of motivation, patient proxies, type of questions asked, gender and lack of privacy. Both the focus group study and the interview study highlighted pharmacy users' consumerist behaviour. Conclusion This research has shown that community pharmacy is a complex system involving many interacting factors. Multifactorial interventions are needed at individual (patient, pharmacist), pharmacy and organisational level. The effect of consumerist behaviour that pharmacy users exercise in purchasing medication without utilising the pharmacist's expertise and not engaging in dialogue on patient safety should be studied. Further research is needed to analyse pharmacy users' interactions with pharmacists to identify the factors that encourage communication and sharing of all relevant information with pharmacists.

Premature infants develop anemia in their first few weeks of life. This is the result of heavy laboratory blood loss, shortened red blood cell lifespan, low plasma erythropoietin levels and inadequate erythropoiesis. As treatment for clinically significant anemia, approximately 80% of very low birth weight infants weighing less than 1.5kg at birth and 95% of extremely low birth weight infants weighing less than 1.0kg at birth receive one or more red blood cell transfusions. To reduce or eliminate red blood cell transfusions is important because they are expensive and associated with complications including infection, fluid overload, electrolyte imbalance, transfusion related acute lung injury and exposure to plasticizers, lead, and other toxins. The primary objective of this thesis is to examine erythropoietin (Epo) dosing, laboratory phlebotomy reduction and the use of restrictive red blood cell transfusion criteria to determine the potential to reduce or eliminate the need for red blood cell transfusions in preterm infants. In order to accomplish this objective, data were obtained from 27 preterm infants including: erythropoietin concentrations, phlebotomy volumes, transfusion information and multiple hematologic indices. The data were analyzed and modeled according to pharmacokinetic and pharmacodynamic principles to determine, through simulation studies, the potential for avoiding blood transfusions in preterm infants. Results from this research suggests that Epo administration, phlebotomy reductions and the use of restrictive blood transfusion criteria all have the potential to reduce the need for blood transfusions in preterm infants. Specifically, a combination of the three interventions was predicted to make blood transfusions unnecessary in all infants with a birth weight between 1.0-1.5kg, and 45% of infants with a birth weight of <1.0kg. These findings are clinically important because avoiding transfusions may lead to better clinical outcomes. The results propose strategies to utilize in future clinical trials involving preterm infants. The secondary objective of this thesis is to characterize the dynamic Epo receptor behavior in newborn sheep and determine a pharmacodynamic model which utilizes information from the Epo receptor dynamics. Results from this analysis show that the Epo receptor pool is an important predictor of red blood cell production. An Epo receptor based pharmacodynamic model is proposed that successfully predicted the red blood cell production in newborn sheep. Additionally, the optimal time for Epo administration was also determined in these newborn sheep based on the pharmacodynamic model. This optimal Epo administration time corresponded to approximately the time when the Epo receptor pool was the largest. Results from the Epo receptor based studies in newborn sheep suggest Epo clinical trials in preterm infants need to consider the dynamic Epo receptor behavior to produce the most optimal outcome.

The aims of this research were to determine the level of satisfaction with pharmacy services among enrollees of a managed care organization, compare the level of satisfaction between mail pharmacy and traditional pharmacy patrons, and evaluate the relationship between satisfaction with pharmacy services and health status. Data was collected via telephone interviews with 1,362 enrollees of the managed care organization. The overall response rate was 65%. Satisfaction was measured using previously developed items for traditional pharmacy services, and newly developed, parallel items for mail pharmacy services. Scores were calculated for hypothesized multi-item dimensions of satisfaction. Health status was measured using the physical and mental health composite scores of the SF-12 Health Survey. Satisfaction with pharmacy services was compared between patron groups using ANOVA and ANCOVA models. Confirmatory factor analysis and structural equation modeling (SEM) were used to evaluate the dimensional structure of satisfaction with pharmacy services and the relationship between satisfaction with pharmacy services and health status. The results indicated that mail pharmacy patrons were more satisfied than traditional pharmacy patrons with their pharmacy services in general, and specifically with the financial aspects and technical quality of those services. When the comparisons were adjusted for general satisfaction with medical care and mental health status, mail pharmacy patrons still had greater levels of general satisfaction with pharmacy services. However, when these covariates were included in the comparison of satisfaction with financial aspects and technical quality of pharmacy services, dimension scores between the two patron groups were not significantly different. Internal consistency reliability coefficients for the multi-item dimensions of satisfaction were in the range of 0.53 to 0.77, with the exception of the Written Information dimension for mail pharmacy service, where the alpha coefficient was 0.37. A positive correlation between the dimension scores for general satisfaction with pharmacy services and general satisfaction with medical care lends support to the construct validity of the measurements. Additionally, it was concluded that, as expected, general satisfaction with pharmacy services was positively correlated with mental health status, but there was no significant relationship between physical health and satisfaction with pharmacy services.

The costs attributed to prescription errors negatively affect the profits of retail pharmacy businesses. The U.S. prescription error rate since 2010 was 0.1%, yet with more than 3.5 billion prescriptions filled annually in the United States, the outcome is more than 3.5 million prescription-dispensing errors and an annual cost of more than $16 billion. Using the performance prism theory, the purpose of this multiple case study was to explore strategies retail pharmacy managers used to increase profit by reducing prescription errors. Using purposeful sampling, 5 retail pharmacy managers in Miami, Florida, were selected as participants because they had implemented strategies to reduce prescription errors. Data were collected using semistructured, face-to-face interviews with 5 pharmacy managers, and company records consisting of quality improvement incident reports, income statements, and balance sheets. Data analysis occurred using methodological triangulation and following Yin's 5-step process of compiling, disassembling, reassembling, interpreting, and concluding the data. The 3 emergent themes were prescription error reducing strategy, profitability improvement strategy through reduced prescription errors, and technology strategy for reducing prescription error. The findings indicated that prescription error reducing strategies are essential for pharmacy managers to increase profits. The implications for positive social change include the potential for retail pharmacy managers to reduce the cost of health care in their communities, prevent prescription error-related hospitalizations and deaths, and improve employment conditions and economic activity in their communities.

Effective leadership is one of the most important factors that influence the performance of an organisation. Effective leadership together with supervision are similar in terms of their influence of others towards achieving the goals of the organisation. Therefore, effective leadership and supervision are principal activities through which organisational goals and objectives are achieved. The main objectives of this study are firstly to evaluate the leadership effectiveness of production supervisors at Lennon and Intramed. Secondly, to suggest recommendations to management to improve or eliminate shortcomings in the leadership effectiveness of the production supervisors at Lennon and Intramed. In this way, a contribution to the overall leadership effectiveness of the production supervisors at Lennon and Intramed is achieved. In order to achieve the said objectives, the following methodology was employed: Firstly, guidelines for effective leadership were identified by means of evaluating existing literature and theory. This was achieved by critically examining existing leadership theories and models. The major contributions, disadvantages, and advantages of each of these theories and models were evaluated which resulted in the list of guidelines for effective leadership. Secondly, the pharmaceutical industry and the theory surrounding supervision were critically examined and discussed. Attention was given to the pharmaceutical industry in South Africa, with special reference to Lennon and Intramed. The theory of supervision was examined with special focus on the skills, functions, power, and responsibilities of the supervisor. Thirdly, a postal questionnaire was used to gather the required empirical information. The response obtained from the questionnaire was critically evaluated against the guidelines for effective leadership and effective supervision, and the results were graphically represented in a company leadership profile. Lennon and Intramed were evaluated separately, and the major differences and similarities between the two organisations were critically evaluated. Lastly, the main findings and recommendations were formulated in order to remedy the shortcomings that were identified. The following recommendations may lead to more effective leadership among production supervisors at Lennon and Intramed: It is necessary that this study be made available to the supervisors at Lennon and Intramed, as it will give them insight into the theory of leadership and what effective leadership is about. It will furthermore give the supervisors an insight into the way that their subordinates view their leadership behaviour and effectiveness. It is further recommended that the information from this study be made available through sensitisation sessions where the necessary information is presented to a group or individual supervisors. Leadership training and development is required as it can make a meaningful contribution to equip supervisors with the necessary leadership skills to practise effective leadership. This leadership training and development can be done by means of short courses presented by a formal training institution, or by a suitably qualified in-house presenter. The last recommendation to leadership effectiveness involves the implementation of a performance management system and incentive scheme to further motivate and drive the supervisor’s leadership behaviour towards effective leadership.

Introduction Management of coronary heart disease (CHD), a major cause of mortality and morbidity in the UK, in primary care, remains sub-optimal. This work aimed to: evaluate impact of a community pharmacy-led intervention on appropriateness of treatment and quality of life of CHD patients; describe opinions and experiences of community pharmacists and GPs and use management of change literature as an explanatory framework for the findings. Methods The thesis comprises: two literature reviews (pharmacy-led interventions for CHD and NHS-based studies using change theories); an RCT evaluating the service; questionnaire surveys and qualitative interviews with community pharmacists and GPs, and comparison of a new model of change with two change theories. Results Review of pharmacy interventions revealed only small-scale studies demonstrating benefit for CHD patients. The change review revealed use of change management theories to implement change and as explanatory frameworks for change initiatives, in the NHS, but not in the pharmacy setting. The RCT recruited 1493 patients (980 intervention, 513 control), 70 pharmacies (102 pharmacists) and 48 practices (208 GPs). No significant differences were found in primary outcomes (appropriateness of treatment or quality of life). Questionnaires revealed positive attitudes to the service but need for pharmacist access to patient records and improved GP/community pharmacist relationships. Qualitative interviews indicated more divergent views. Attitudes were influenced by understanding and previous experience of medicines management, change drivers and implementation processes. Themes conceptualised into a ‘change readiness’ model, had similarities with Lewin’s planned change approach and Pettigrew’s receptivity model. All three models identified areas of sub-optimal intervention implementation and delivery. The new service did not improve appropriateness of treatment or quality of life because it was implemented and delivered sub-optimally. There is a need for greater use of an evidence based systematic approach to introduce new services, but research is required to confirm this approach would confer the hypothesised benefits.

Class of 2007 Abstract
Objectives: This study evaluated the didactic pain management curriculum from 2003 to 2006 at the University of Arizona College of Pharmacy in comparison to a compilation of current published standards. Methods: The study design was a utilization-focused evaluation conducted by two doctor of pharmacy candidates. The eleven domains of cognitive and affective abilities used for analysis were compiled from the International Association for the Study of Pain (IASP) guidelines and from published expert-panel competencies in the American Journal of Pain Management (AJPM). These documents were chosen for comparison because they were created with the purpose of developing competent and proficient pharmacy clinicians. Results: The analysis revealed that the University of Arizona College of Pharmacy was unsuccessful in meeting the recommended standards for pain management competencies. Instruction in pain management was poorly integrated, incomplete, and sporadic throughout the coursework. Conclusions: Pain management was insufficiently addressed in coursework at the University of Arizona. Separating pain from other topics, integrating pain entirely into the therapeutics course, creating a course devoted to pain management, and/or fulfilling standards through a required clerkship may improve the current curriculum. The results of the assessment will be used to provide recommendations to improve the curriculum concerning pain management.

The purpose of this study was to investigate how well the computer hardware/software industry was meeting the needs of the retail pharmacist. The needs were determined by a survey of 1000 Indiana pharmacists. A reply rate of 22% revealed that the most important problems pharmacists were facing with their computer systems were slow access of the data, the length of backup time, no drug interaction check, and no multitasking. Hardware and software means of meeting these problems were studied. Also the currently available systems were evaluated in terms of these problems. It was found that while most systems were adequately meeting some of these problems no system was addressing all of them. Some of the systems were multitasking but were much too expensive for the small pharmacy. A system can be designed that meets all of these needs without neglecting the basic needs of pharmacists and at a very reasonable cost.

Class of 2015 Abstract
Objectives: Quantify how many interventions were made during a pilot MTM program at a Costco pharmacy and assess patients’ attitudes towards MTM services offered at their local pharmacy. Methods: Contacted patients by phone and offered MTM services over 10 weeks. The patients are insured patients referred by Outcomes MTM and filled at least 50% of medications at Costco. Successful interventions were tallied and questionnaires administered to collect data on patients’ background knowledge of MTM, rating of how helpful and beneficial MTM services conducted by local pharmacy were, how frequent patients would like such services, how much they were willing to pay for such services, and demographic information. Results: Due to low response rate no meaningful statistical differences were able to be observed. However interesting trends started to emerge; more adherence related interventions, adequate compensation for a dedicated MTM pharmacist, and that MTM is unknown to most patients but do find it useful. Additionally we were able to observe challenges and difficulties with implementing MTM services at a store level. Conclusions: The original aim of the study was not able to be adequately achieved due to low response rate. However the trends that emerged let us make some subjective conclusions; adherence related interventions were fairly common, a dedicated MTM pharmacist may be a feasible in a community setting, most patients are unaware of what MTM is but do find it useful after the service, and challenges to implementing an MTM service from the store level.

Class of 2009 Abstract
OBJECTIVES: The purpose of this study is to determine if a pharmacist run diabetes management clinic assists patients in the successful management of type 1 or type 2 diabetes. METHODS: Patients must have been enrolled and participated in at least one visit to the pharmacist run diabetes management program at North Country Health Care Clinic (“NCHCC”). A retrospective chart review was completed to determine patient outcomes. RESULTS: A total of 82 charts were reviewed and 49 patients were qualified for the study. A total of 19 men (mean age 42.1; SD 12.1) and 30 females (mean age 55.0; SD 14.4) completed at least one visit to the pharmacist run diabetes management program. HbA1c levels were significantly lower after one or more visits to the pharmacist run diabetes clinic (p=<0.001) for all patients. CONCLUSIONS: Patients who participate in the pharmacist run diabetes management clinic appear to successfully lower HbA1c values after at least one visit to the program.

Media promotion of the ideal body as slimness for women and muscularity for men, has led to increasing numbers of both genders reporting dissatisfaction with their bodies and trying to change using weight control products. It has been suggested that pharmacists can play a key role in promoting healthy lifestyles and weight management. The main aim of the research study was to examine the impact of media on body image perception and to investigate the role of pharmacists in weight management. This thesis consists of three studies: an evaluation of weight control websites, a body image survey of young adults and interviews with pharmacists. The results from the evaluation study showed that the quality of most weight loss (64%) and weight gain product advertisements (80%) was generally poor, principally due to the use of misleading claims and a lack of useful information. These data complement the survey that university students reported rarely being influenced by weight control product adverts and hardly considered using these products as a method for changing weight. The survey also showed that most participants of both genders (71%) felt satisfied with their body image. However, the findings in this study indicated that there was a relationship between a high level of body image concern and self-perception of being overweight and the attempt to lose weight. Interviews with pharmacists showed that they were unlikely to be actively involved in reducing obesity problems and promoting healthy lifestyles in the community. Although the prevalence of body dissatisfaction and the use of weight control products among these young adults may not be as high as has been reported elsewhere, healthcare professionals, including pharmacists, need to be aware of this problem when providing advice or consultations for young adults. Healthcare professionals should promote the benefits of healthy lifestyles as well as providing information about potential problems of harmful weight control strategies. The effect of ethnicity and culture on body image concern warrants further. The availability of weight control products and quality of information provided should also be further examined.

Title Prehospital pain management of traumatically injured adult patients Authors Benström S Institute Uppsala University, Uppsala, Sweden Background and objective Traumatic injuries are a major cause behind moderate and severe pain in a prehospital setting. Therefore, the aim of this study is to evaluate prehospital use of analgesics among adult traumatically injured patients treated within Tartu Ambulance Foundation by analysing how ambulance personnel evaluates and treats pain. Secondary aim is to map prehospital factors influencing the process. Setting and Method A retrospective, single-centre service evaluation study with the primary selection of 7526 electronic patient records (EPR) with the main diagnosis of S00-T98 (ICD-10) was conducted and a polyvariant logistic regression model was created to map factors that influence pain management. Main outcome measures Primary outcome measures were prevalence of pain evaluation and the use of analgesics. Secondary outcome measures were significant changes in odds ratios for prehospital-related factors that affected primary outcome measures. Results Mean age of the study population was 54 years (SD 22) and 775 (58.9%) were male. Out of all the patients in this study 529 (40.3%) received analgesics. Pain assessment before administrating analgesics was documented on 15.9% of EPRs. Nurses assessed pain 3.3 times (95% CI 2.0-5.3; p<0.001) more likely than physicians. The odds for receiving analgesics were 2.3 (95% CI 1.68-3.08; p < 0,001) times smaller when patients had consumed alcohol. Brief assignment (0-10 min) and hospitalisation reduced the odds of using analgesics by 3.6 times (95% CI 1.9-6.8; p<0,001) and 1.59 times (95% CI 1.13-2.24; p<0.007) respectively while lengthy assignments (>50 min) increased the odds by 3.4 times (95% CI 1.9-6.5; p<0,001). Monotherapy was chosen for 73.2% of patients while 24.6% received a combination of 2 and 2.2% a combination of 3 analgesics.   Conclusions   Current study showed that although nurses as brigade leaders are more likely to assess pain the overall prevalence remains low. Alcohol consumption among patients, short assignment times, and hospitalization decreased the odds for pharmacological pain management. Longer assignment times on the contrary were associated with increased odds. Improvements in pain management can be made in choosing between specific therapeutic options.

The practice of pharmacy has changed over recent years with a greater emphasis on the patient and the provision of patient care services. This expanded role of pharmacists as medication managers impacts on their responsibility and potential legal liability. However, there is a dearth of information about the effectiveness of the regulation of community pharmacy practice and it is not known to what extent regulatory requirements support the changed role. Additionally, limited information is available with regard to risk management practices in community pharmacy in the context of this expanding role. This exploratory study hence examined risk management regulation and practices in community pharmacy. The type and extent of potential liability was informed by officially recognised and endorsed professional practice standards and national and international case law. However, case law regarding the professional liability in civil actions of pharmacists is limited. Therefore, judicial decisions and legal principles generated through litigation involving other health professions provided the basis for extrapolating common principles that could be used to determine pharmacists’ potential liability. Qualitative methodology was used and various methods of data gathering were employed to provide in-depth information about pharmacy regulation and risk management. The methods chosen provided information about the extent to which endorsed practice standards were applied in disciplinary proceedings by the Pharmacists Board of Queensland in cases of professional misconduct; the utilisation of practice standards by community pharmacists and the risk management procedures implemented by them; and the diversity of pharmacy practice regulatory requirements throughout Australian jurisdictions. The analysis performed as part of the study provided information about the types of errors that lead to disciplinary action and insight into the factors underpinning the decisions of the Pharmacists Board of Queensland in making determinations and formulating outcomes. The findings of interviews with community pharmacists demonstrated a need for them to increase their knowledge of the essential processes involved in practice services to improve risk management and ensure the provision of safe patient care services. Legislative inconsistencies between states and territories that directly impact on risk management in pharmacy practice were also highlighted, indicating a need for the harmonisation of regulation. The study highlighted the need to improve risk management regulation and practices in community pharmacy in the context of expanding services. The initial base of evidence suggests implications for regulatory authorities, pharmacy professional organisations and individual practitioners, which are outlined in the final chapter.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Pharmacy
Griffith Health
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Human immunodeficiency virus (HIV) is a worldwide problem, with more than 34 million people infected with HIV/AIDS in 2011. At the end of 2011, in Nigeria, an estimated 3.7% of the adult population were living with HIV/AIDS. HIV services in Nigeria are secondary-care led, involving multidisciplinary teams and access to free antiretroviral. However, evaluations of service provision from both patient and healthcare professional perspectives, especially, pharmacists in Nigeria have never been conducted, and are the aims of this research. This study involved grounded theory methodology, using In-depth semi-structured interviews with adults infected with HIV, pharmacists, and administrators involved in the management and care of those patients at Maitama District Hospital in Abuja. HIV pharmacists working for the NHS in the UK were interviewed for comparative purposes. Thirty-five patients were interviewed. Five concepts were identified that influenced how they accessed hospital services after diagnosis. These include faith in God and antiretroviral, social issues with emphasis on HIV stigma and discrimination, patient journeys at the hospital with delays and repeat visits, obstacles such as ARV unavailability and their expectations. Also, five concepts were identified from the pharmacists’ interviews which include clinical service, impressions of service provided, social issues the patients encountered, the obstacles faced with clinical service provided and expectations for improvement. Ten patients were shadowed on their clinic days to observe the patient journey articulated. Furthermore, the administrators interviewed re-affirmed the opinions of the patients and pharmacists about many patients attending HIV clinic, few staff attending to patients, medicines unavailability, especially ARV drugs, and lack of working space for staff. Delays, few pharmacists/many patients and shortage of ART as barriers to service provision ii emerged as dominant themes across the three groups of interviewees in Nigeria. Also, it has been found that there is a wide gap between HIV patients’ hospital management in the UK and Nigeria as regards availability of antiretroviral, staff strength, number of patients in attendance on clinic days and weekly clinic days. Pharmacy was found to have a substantial role in the management of HIV/AID patients but it appears from this study that service improvements, both human and material resources are needed. Twenty three recommendations, which are further synthesised into six potential areas, are made, which, if implemented, would dramatically improve the service provision for HIV/AIDS patients at Maitama District Hospital.

Class of 2008 Abstract
Objectives: A follow-up analysis of academic and training requirements found in advertisements for pharmacy management, assistant director, and clinical pharmacy director positions. Methods: Advertisements appearing in the American Journal of Hospital Pharmacy (AJHP) were analyzed for academic and training criteria that were either preferred or required for pharmacy management, assistant director, or clinical pharmacy director positions. Included advertisements were for pertinent positions found in AJHP between January 2002 and December 2007. Some of the requirements or preferences that appeared in the advertisements that were analyzed included the type of pharmacy or other degree, postgraduate training including residencies and/or fellowships, board certification, and experience qualifications. Results: There was a total of 426 advertisements that met inclusion criteria. Results were listed in percentages of advertisements either requiring or preferring a certain qualification. A significant portion of ads sought applicants who had completed a residency (24% - pharmacy manager/director, 50% - clinical director, 47% - assistant/associate manager). Preferences and requirements of the PharmD or MS degree qualification decreased in percent from a previous study. However there was an increase in the relative number of ads pertaining to the MBA preference (9%, n=27). Conclusions: Many of the results from this study were similar to previous studies which looked at job qualifications in pharmacy manager and clinical directors. It remains evident that education, training, and experience play a major role in meeting the qualifications associated with obtaining a job as a pharmacy manager, clinical director, or associate director.

The advent of effective oral, molecular-targeted drugs in oncology has changed many incurable malignancies such as chronic myeloid leukemia into chronic diseases similar to coronary artery disease and diabetes mellitus. Oral agents including monoclonal antibodies, kinase inhibitors and hormone receptor blockers offer cancer patients incremental improvements in both overall survival and quality of life. As it is imperative to recognize and manage side effects of platelet inhibitors, beta blockers, statins, HIV drugs, and fluoroquinolones by all healthcare providers, the same holds true for these newer targeted therapies, patients may present to their generalist or other subspecialist with drug-related symptoms. Cardiovascular adverse events are among the most frequent, and potentially serious, health issues in outpatient clinics, and among the most frequent side effects of targeted chemotherapy. Data support improved patient outcomes and satisfaction when primary care and other providers are cognizant of chemotherapy side effects, allowing for earlier intervention and reduction in morbidity and health care costs. With the implementation of accountable care and pay-for-performance, improved communication between generalists and subspecialists is essential to deliver cost-effective patient care.

Background: Pharmacy robotics have been implemented globally to create medication management efficiencies. However, translation to the Australian public hospital environment has not been evaluated. It is also not known what factors influence pharmacy staff to use new technologies that could guide future automation implementation strategies. Aim: The primary aim of this research is to evaluate the introduction of a Pharmacy Robotic Dispensing System (PRDS) in an Australian public hospital pharmacy and the impact it had on pharmacy staff medication supply activities in both the dispensary and imprest management. Secondly, this research aims to identify factors that influence hospital pharmacy staff acceptance of robotics during implementation and over time. Method: This study was conducted in a tertiary public hospital on the Gold Coast, Australia and took place in two phases, each phase consisting of a staff survey and a time in motion study. Phase one: May 2016; an initial assessment prior to the PRDS becoming operational for baseline data. Data for the staff survey and time and motion study were collected and analysed in this phase. Phase two: August 2017; PRDS had been operational for 15 months and the study was repeated. Data for the staff survey and time in motion study were remeasured in this phase for comparative analysis Staff survey: A single centred, prospective, longitudinal cohort quantitative study. Pharmacy staff were surveyed using the Extended Technology Acceptance Model (ETAM). Fischers exact test and correlation analysis of paired responses was used to identify significant factors influencing usage of the PRDS between the two time points. Time in motion study: A single centred, prospective, longitudinal time in motion study. Time stamped video footage was collected tracking medication orders in numbered containers throughout the pharmacy dispensary. Activities observed and recorded comprised of dispensing, labelling, assembly of items, number of items and time waiting to be actioned. Data was analysed and compared overall turnaround times; time waiting to be actioned; dispensing, assembly and labelling times; plus dispensing rates (items/person/hours). Fitbit Zip® used to anonymously track pharmacy assistant steps per day in the dispensary. Dispensing software (iPharmacy ®) supplied the location of stocked medication and electronic tracking databases provided data for imprest medication supply turnaround time, picking and waiting for action times. Median turnaround times and Mann Whitney U test used to examine relationships between phases, plus mean steps per day and two tailed t-test used to analyse changes in movement. Results: Sixty four respondents completed surveys during phase one (70%: 64/91) and 34 paired surveys were collected fifteen months later in phase two (53%: 34/64). Respondents were predominantly young, female with a tertiary qualification. Initial perceptions of the pharmacy robot did not change over time, with the exception of ‘reliability’. Participants found the robot less reliable than expected after working with it for fifteen months. Departmental leaders had greatest influence on technology acceptance during implementation and over time. Other key factors correlating with pharmacy staff acceptance included: how useful the robot was perceived to be; ease of use; and how relevant the robot was for an individual role. Higher levels of education had a negative association with usage during implementation and age was not a factor. Medication stored in the robot was limited to 46% (n=20,771 full packs) of total pharmacy holdings (n= 45,437 full packs). At baseline, 774 orders were received in the dispensary over five days increasing by 13% to 887 in phase two (p<0.01). Dispensary workload increased, staff levels remained constant and pharmacy assistant movement significantly reduced (p<0.05). However, there were no significant changes to dispensing rates and turnaround times. Conclusion: This study identified critical insights influencing staff acceptance of pharmacy robots that will help inform future implementation. The influence of pharmacy leaders emerged as key influence on technology acceptance. Leveraging on this influence a communication strategy prior to implementation should include information on useful functions and known benefits of the system customised for individual roles. In addition, pharmacy robotics has the potential to absorb increased workload and reduce staff movement in the dispensary when staffing levels remained constant. However, turnaround times alone are too simplistic as a sole measure of benefits for robotics in Australian public hospital pharmacy.
Thesis (Masters)
Master of Medical Research (MMedRes)
School of Pharmacy & Med Sci
Griffith Health
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Objectives: 1) Describe personal finance (PF) perceptions of the East Tennessee State University (ETSU) Gatton College of Pharmacy Class of 2014 upon and 1-year post-graduation; 2) Examine the association between PF elective course completion during pharmacy school and post-graduation PF behaviors. Method: Students enrolled in the ETSU Class of 2014 completed a self-administered questionnaire that assessed student characteristics (e.g, participation in a PF elective during school), PF characteristics (e.g., student loan indebtedness), perceptions (e.g., confidence in ability to manage PF), and behaviors (e.g., monthly budgeting) one week prior to graduation and 18 months post-graduation. Paired and independent samples statistical analyses were conducted to examine changes in responses over time and PF course participation. Results: Sixty percent of the cohort completed both questionnaires. Students reported an average student loan debt balance of $155,571 (±$83,853) 18 months post-graduation and average loan term length of 17.3 (±8) years. Students’ concerns about their student loan debt were significantly higher prior to graduation as compared to 18 months post (p=0.01). No significant differences were noted for student loan debt amount or student loan term length across PF elective participation. Students who took the personal finance elective were significantly more likely to develop monthly budgets (p=0.01) and report positive career satisfaction as compared to students who did not (p=0.04) 18 months post-graduation. Implications: To our knowledge, this is the first study to track PF perceptions and behaviors of pharmacy graduates longitudinally. Continued tracking and analysis will inform PF curricular integration and alumni personal and professional development.

Learning Objectives: Describe the rationale for the belief that opioids have no maximum dose Describe the data supporting the rationale that high doses of opioids increase toxicity Describe the data supporting the rationale that high doses of opioids do not improve outcomes Identify potential safety concerns with patients taking high doses of opioids

Innovative ways to engage patients in their asthma care are warranted to alleviate the burden of disease, as approximately 50% of people with asthma remain poorly controlled within the community. There is opportunity for pharmacists to add value to the care of asthma patients offered by general practitioners (GPs) and help mitigate current and future predicted asthma risk. Building on lessons learnt from evidence-based community pharmacy asthma management models, a streamlined and technology supported Pharmacy Asthma Service was developed to promote the integration of the service into routine practice, which up until now has not been achieved in Australia. Grounded in implementation science theory, this body of research used The Conceptual Model of Implementation Research to guide an exploration of the design, implementation and evaluation of the pharmacist-led novel health service in Australian community pharmacy practice. The investigation used both quantitative and qualitative research methods to discuss the efficacy and suitability of the service and discusses challenges and facilitators to the routine implementation of the service in community pharmacy practice.

Performance Management aims to develop the employee and ensure that the work which the employee does is in line with organisational goals. However, many managers and employees do not like performance management systems and very often, for this reason, such a system does not succeed in meeting the organisation’s goals. The aim of this study was to determine the perceptions towards the performance management system of pharmacists working in the public sector. A questionnaire was compiled and pharmacists working in all public sector hospitals, provincial and municipal clinics and medical depots were asked to complete the questionnaire. The response rate was 66 percent. Seventy three percent of respondents had never undergone a performance evaluation, 75 percent stated it did not motivate them, 62.5 percent felt it did not improve poor performance, 90.6 percent felt the Performance Appraisal System did not reward good performance sufficiently and 63.6 percent felt it did not help with career progression. Seventy eight percent believed that the Performance Appraisal System did not effectively measure the pharmacists’ performance, and 82 percent felt that the System needed to be developed further. At least four evaluations should have been completed per year, yet 85 percent of respondents had experienced three or fewer evaluations since the System had been introduced. The analysis of the responses indicated that there was great dissatisfaction with the current performance management system. A few of the reasons are that the system in place did not effectively measure the pharmacists performance, that additional work done was not recognised, and that the process was extremely time-consuming. It may be concluded that the government needs to address the current problems being experienced with this system, as at present, it is not meeting the objectives it was intended to meet.

Each year, NHS clinical laboratories carry out more than 700 million laboratory tests, of which 50 million are microbiology investigations. Several studies have shown that between 25% and 40% of all tests sent to the laboratory are unnecessary, and up to 46% of ordered microbiology tests are inappropriate. In light of these accounts, the present study was undertaken to evaluate the process of microbiology specimen management in order to assess microbiology test utilisation and the appropriateness of the test ordering processes. The study focussed on respiratory tract specimens using sputum microbiology as a model for the microbiology service inappropriate test utilisation. The overall main aim of this study was to determine the appropriateness of clinical microbiology test utilisation, its clinical relevance and cost-effectiveness, hence recommend better utilisation strategies. A total of 15,941 respiratory tract samples from Barts and The London NHS Trust were randomly selected from the years 2004/05 and analysed retrospectively. Seven hundred microbiology laboratory request forms from patients for whom respiratory tract cultures were requested over a three month period were examined in detail. These requests were derived from 511 sputum specimens, 100 throat swabs, 63 ear swabs and 76 samples from other respiratory tract sites. 641 (91%) of microbiology test requisition forms were completed, provided all requested details by the service users and were therefore considered as appropriate microbiology test requisitions. 660 (94%) of those examined stated the patient’s clinical diagnosis and only in 65 (13%) of these patients was the stated diagnosis as respiratory tract infection. Sixty percent of sputum specimens examined were considered as poor quality. Forty percent of respiratory specimens were reported as culture positive, based on the local hospital criteria of microbiology test reporting. In sputum culture, 39% was reported as culture positive; however, less than 18% were positive with recognised respiratory pathogens, whilst 27% of throat swabs were reported as culture positive, of which 67% had throat pathogens. From the beginning of this study and before, there were no microbiology test comments and interpretation of test results provided with the test result reporting. The test turnaround time of respiratory microbiology results reported within three days in 2004/2005 was only 20%. The total inappropriate respiratory specimens processed locally were 9,575. Extrapolating from our results, this suggests that 2,153,977 nationally were inappropriate in NHS hospitals in 2004/2005. The total cost of inappropriate respiratory microbiology test use was approximately £152,000 in local NHS hospitals. Extrapolating from our results, this suggests that £23,900, 000 nationally was the total cost of inappropriate tests in the NHS hospitals. Following implementation of this study, follow up studies in 2006 and onwards indicated that there has been an improvement in the quality of the microbiology service. The number of good quality sputum specimens was 69% compared to 40% in 2004/2005. While the total microbiology test turnaround time that was reported within three days in 2009/2010 was more than 94%. From mid 2006 onwards, test interpretation comments have been used in all microbiology test result reporting. The total workload of respiratory tract microbiology activity decreased from 18,915/year to 16,651/year over the years 2004/2005 to 2007/2008, which is down nearly 8%. Analysis of the findings showed that the usefulness of culture results was limited by the collection of inappropriate specimens, and lack of clinical information on the microbiology request form. The crucial importance of the role of clinical and nursing staff is stressed if the clinical relevance of sputum culture is to be maximised. The increasing introduction of electronic pathology test requests gives new opportunities to restrict the collection of inappropriate specimens and make substantial savings in resources, both in the ward and the laboratory. This type of study and audit can give invaluable information about the rationale behind testing, and the appropriateness of sampling and transport time. Appropriate measures for corrective actions can be identified.