Dissertations / Theses on the topic 'Pharmacist and patient'
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1
Sinnott, Patricia A. "Pharmacists' illness experience and the pharmacist-patient relationship." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ29338.pdf.
2
Grainger-Rousseau, T. "Contributions of the community pharmacist to patient care." Thesis, Queen's University Belfast, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.317506.
3
Watman, Geoffrey P. "Pharmacist monitoring of patient health in the community." Thesis, Aston University, 1996. http://publications.aston.ac.uk/10935/.
Abstract:
This research has explored the potential role of the community pharmacist in health promotion in the pharmacy, and at general medical practices. The feasibility of monitoring patients' health status in the community was evaluated by intervention to assess and alter cardiovascular risk factors. 68, hypertensive patients, monitored at one surgery, had a change in mean systolic blood pressure from 158.28 to 146.55 mmHg, a reduction of 7.4%, and a change in mean diastolic bood pressure from 90.91 to 84.85 mmHg, a reduction of 6.7%. 120 patients, from a cohort of 449 at the major practice, with an initial serum total cholesterol of 6.0+mmol/L, experienced a change in mean value from 6.79 to 6.05 mmol/L, equivalent to a reduction of 10.9%. 86% of this patient cohort showed a decrease in cholesterol concentration. Patients, placed in a high risk category according to their coronary rank score, assessed at the first health screening, showed a consistent and significant improvement in coronary score throughout the study period of two years. High risk and intermediate risk patients showed improvements in coronary score of 52% and 14% respectively. Patients in the low risk group maintained their good coronary score. In some cases, a patient's improvement was effected in liaison with the GP, after a change or addition of medication and/or dosage. Pharmacist intervention consisted of advice on diet and lifestyle and adherence to medication regimes. It was concluded that a pharmacist can facilitate a health screening programme in the primary care setting, and provide enhanced continuity of care for the patient.
4
Lee, Stephanie, Kristin Peterson, Matthew Noble, and Richard Herrier. "Survey on Patient Safety and Pharmacist Working Conditions." The University of Arizona, 2015. http://hdl.handle.net/10150/614139.
Abstract:
Class of 2015 AbstractObjectives: To assess pharmacists’ perspectives on patient safety in relation to their working conditions. Methods: The survey was sent to 1000 pharmacists within Arizona. Results for the item evaluating pharmacists’ level of agreement with the statement regarding their employers providing a work environment optimized for safe patient care were compared to those from the Oregon Working Conditions Survey using Mann Whitney U. Mann Whitney U was also used to compare agreement between Arizona pharmacists who filled less than and more than 200 prescriptions per shift, and between Arizona community and hospital pharmacists. Chi-squared test was used to compare community pharmacists in Arizona and Oregon. A priori alpha level was 0.05 for all statistical tests. Results: Arizona pharmacists were significantly more likely than Oregon pharmacists to agree with the statement that their employer provided a work environment conducive to patient safety (p < 0.001). Arizona pharmacists who filled less than 200 prescriptions per shift agreed significantly more than those who filled more than 200 prescriptions per shift (p < 0.001). Hospital pharmacists were significantly more likely to agree with the patient safety statement than community pharmacists (p < 0.001). Conclusions: The pharmaceutical climate may play a role in the difference between Oregon and Arizona. With a lower percentage of chain/mass merchandiser community pharmacy respondents in Arizona, the overall agreement with the patient safety statement could have been influenced by practice type. Regardless, higher prescription volume still remains as a factor that can have potentially deleterious effects on optimization of patient safety.
5
Gade, Carmin Jane. "An exploration of the pharmacist-patient communicative relationship." Columbus, Ohio : Ohio State University, 2003. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1061259087.
Abstract:
Thesis (Ph. D.)--Ohio State University, 2003.Title from first page of PDF file. Document formatted into pages; contains xii, 123 p.; also includes graphics (some col.). Includes abstract and vita. Advisor: Donald J. Cigala, Dept. of Communication. Includes bibliographical references (p. 117-123).
6
Garcia, Miguel. "Descriptive Study of Student Pharmacist Perceptions of Patient Health Literacy and Self Assessment of Student Pharmacist Communication Techniques." The University of Arizona, 2012. http://hdl.handle.net/10150/623610.
Abstract:
Class of 2012 AbstractSpecific Aims: The objective of this study is to first assess whether student pharmacist interns feel they can gauge patient health literacy levels with confidence, second to assess which methods are used most commonly in practice by student pharmacists to assess patient health literacy, and third to determine what techniques student pharmacist interns most often employ to communicate more effectively to patients with low health literacy. Methods: The questionnaire consisted of questions about demographics, and knowledge/experiential based questions. Key questions were: How well do you feel you are able to assess patient health literacy? How often do you use the following techniques to assess patient health literacy? (Observe contextual clues, Observe patient word pronunciation, Observe patient willingness to talk, Assess by demographics) When counseling low health literacy patients, how often do you use the following communication techniques? (Speak slowly, Give extra written material, Repeat information, Ask patient to repeat information, Ask if patient understands English, Avoid complicated medical terms). The answers to these questions are measured on a likert scale. Data from the questionnaire was analyzed using one sample t tests and paired t tests. Main Results: Regarding the first primary objective, on a scale of 1 to 5, with confidence measured 3 or greater and no confidence measured 2 or less, student intern pharmacists are statistically significantly confident in their ability to gauge patient health literacy (p< 0.001). There is no statistically significant difference in confidence in ability to gauge patient health literacy between males and females. The method student pharmacist interns used for assessing patient health literacy with the highest average use was observing patient willingness to talk (3.65 +/- 1.01) followed by observing patient word pronunciation (3.57 +/- 0.97), assessing patient demographics (race, age, ability to pay, culture, gender) (3.23 +/- 1.16) and observing contextual clues (patients identify pills by color, asks to be read to, etc) (3.04 +/- 1.04). There was no statistically significant difference between observing patient willingness to talk versus observing patient word pronunciation (p=0.55). There is a statistically significant difference between observing patient willingness to talk versus assessing patient demographics (p=0.011). The technique for improving communication with patients with low health literacy with the highest average use was avoiding complicated medical terms (3.97 +/- 0.95) followed by speaking slowly (3.91 +/- 0.89), repeating information (3.85 +/- 0.73), giving extra written material (3.02 +/- 1.36), asking patients if they understand English (2.85 +/- 1.21) and asking patients to repeat information. (2.39 +/- 1.02). There is a statistically significant difference between avoiding complicated medical terms and giving out extra written material (p<0.001) and speaking slowly and giving out extra written material (p<0.001). Conclusions: We conclude that students pharmacists working as interns are quite confident in their ability to assess patient health literacy, that observing patient willingness to talk is be the most commonly used method to assess patient health literacy, and that avoiding complicated medical terms is be the most commonly used technique student pharmacist interns use to communicate more effectively with patients who have low health literacy.
7
Jarernsiripornkul, Narumol. "Pharmacist input into patients' self-reporting of adverse drug reactions." Thesis, Robert Gordon University, 1999. http://hdl.handle.net/10059/2717.
Abstract:
Adverse drug reactions (ADRs) are common and should be reported to the CSM, particularly for newly marketed drugs. There is under-reporting of ADRs by doctors. Involving the patient in self-reporting, particularly when initiated by pharmacists is feasible and could help to improve reporting rates. This study investigated a comprehensive checklist questionnaire listed symptoms in all body systems to facilitate patient self-reporting using both established and new 'black triangle' centrally-acting drugs. Symptoms reported were compared to their documentation in medical notes and for new drugs to reports from other sources. A novel classification system for ADRs was developed to take account of the minimal data available and used to evaluate the potential accuracy of symptom attribution by patients. An external comparison of a sample of symptom classifications by an ADR expert was also obtained. The questionnaire was sent to 464 patients prescribed carbamazepine, sodium valproate, trazodone, doxepin and co-proxamol from three participating medical practices in a pilot study. Subsequently, it was sent to all patients (n=2307) prescribed tramadol, fentanyl patch, venlafaxine, nefazodone, citalopram, moclobemide, gabapentin, lamotrigine and topiramate from 79 participating medical practices in Grampian during January-March 1997. The overall response rates were 44.6% (n=207) for the pilot study and 36.3% (n=837) for the main study. The most frequently reported symptoms were: drowsiness for carbamazepine, unusual tiredness for sodium valproate, constipation for co-proxamol, dry mouth for trazodone, doxepin, tramadol, venlafaxine, nefazodone, moclobemide and citalopram, weight gain for gabapentin, loss of memory for lamotrigine, weight loss for topiramate and constipation for fentanyl patch. Overall only 22.4% (522/2330) of symptoms reported by patients were recorded by GPs in the 310 medical notes accessed. In general, common symptoms were reported more frequently by patients than in CSM reports and PEM data. Patients tended to report minor and known ADRs which bothered them, while CSM and PEM reports received were of more severe ADRs. Respondents were more likely to report symptoms (6040/8630,70%) potentially caused by the study drugs than those not to be caused by the study drugs. Moderate agreement (Kappa = 0.4-0.5) was found between expert and researcher classifications of symptom causality. It is suggested that interpretation by pharmacists of patient self-reporting using the checklist questionnaire could result in much higher ADR reporting rates, in particular for new drugs.
8
Ioffe, Viktoriya. "Patient Satisfaction with Pharmacist Intervention, Consultation, and Services Provided by Pharmacist for Hormone Replacement Therapy at Don’s Compounding Pharmacy." The University of Arizona, 2007. http://hdl.handle.net/10150/624401.
Abstract:
Class of 2007 AbstractObjectives: To assess the level of women’s satisfaction with pharmacist intervention, consultation, and services provided in HRT in order to analyze, and improve patient care at Don’s Compounding Pharmacy, Reno, NV. Methods: This descriptive study was done by offering to complete the 14-th questions survey to 300 female patients who had completed their HRT consultation at Don’s Compounding pharmacy. The data collection was performed from September, 19 2006 till January, 15 2007. The returned surveys were then organized and analyzed using Microsoft Excel. Results: Of the 300 surveys offered to complete, 40 were filled out (a response rate of 13.3%). 90% of the participants were customers of the pharmacy up to 5 years. 65% of the participants have used HRT for up to 5 years. The Biest in combination with progesterone or alone was the most prescribed medication (27.5% and 20% respectively). The most often prescribed dosage form was the cream (47.5%). 57.5% of participants answered that a pharmacist has spent 0-5 minutes in average per consultation. All sources of information (pharmacist, physician, mass media, and family/friends) were helpful or very helpful; a pharmacist had the first place among all of them. However, the difference in helpfulness was not statistically significant (benefits and adverse event: P=0.26 and 0.42 respectively). The total satisfaction score with pharmacist’s intervention, education and services was 3.4 (agree, very agree). Conclusions: The majority of the patients from this local pharmacy were satisfied with services provided, and the education received. Despite this fact, time to spend with patients and the education regarding adverse drug events should be improved. The overall patient satisfaction was above the average. Future studies may be considered in studying improvement of the pharmacist’s services and interventions.
9
Beechey, Riley Tegan Anne. "Pharmacist Utilization of Opioid Misuse and Abuse Interventions: Acceptability Among Pharmacists and Patients in Detox." Kent State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=kent1499974262218499.
10
Venter, Ignatius Johannes Erhardt. "The role of the community pharmacist in cardiovascular disease management." Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/652.
Abstract:
Cardiovascular disease contributes to mortality and morbidity statistics worldwide and in South Africa. The current focus in health care revolves around activities aimed at preventing the development of cardiovascular disease, rather than the treatment of disease. The identification of risk factors that can predispose a patient to the development of cardiovascular disease is an essential component of any cardiovascular disease management programme. It is necessary that in the management of these risk factors, they are not considered to be isolated, but inter-related. Through the provision of point-of-care cardiovascular risk screening and monitoring services as well as disease-related counselling, the community pharmacist, as a readily accessible source of healthcare, can play an essential role in the cardiovascular disease management process. The aim of this study was to describe the nature of the services provided by community pharmacists with respect to cardiovascular risk and disease management in the Nelson Mandela Metropole. The research design was a non-experimental, descriptive study using a crosssectional survey method. Data was obtained through the utilisation of a questionnaire. The questionnaire consisted of three sections and was administered to community pharmacies in the Nelson Mandela Metropole, that provided cardiovascular point-of-care screening services. The community pharmacists correctly identified cardiovascular risk factors such as obesity (76.6 percent; 36, n=47) and smoking (27.7 percent; 13, n=47). Other cardiovascular risk factors such as abdominal obesity (4.2 percent; 2, n=47), gender (2.1 percent; 1, n=47) and family history (4.2 percent; 2, n=47) were largely ignored by the pharmacists. Point-of-care testing services were readily available in the pharmacies, with all of the pharmacies providing blood glucose and blood pressure measurements. Blood cholesterol measurements were only provided in 87.8 percent (36, n=41) of the pharmacies. The services were generally provided in a clinic facility, with 90.2 percent (37, n=41) of the pharmacies having a clinic facility available. Pharmacists were involved in the provision of point-of-care services, with 85.4 percent (35, n=41) of the pharmacies indicating that the pharmacists participated. Pharmacists readily provided counselling prior (70.7 percent; 29, n=41) to and after (80.5 percent; 33, n=41) the conduction of the screening services on areas such as lifestyle modification and treatment options. Only 15 percent (7, n=47) of the pharmacists indicated that they were aware of Cardiovascular Risk Calculator Tools and none of the pharmacists indicated that they had utilised such a tool. Pharmacists recommended frequent monitoring (60.5 percent; 26, n=43) and lifestyle modification (67.4 percent; 29, n=43) to patients, if the result of their screening service was within normal limits. However, the majority of the pharmacists indicated that they would refer patients, if the results obtained were out of the normal range. Conclusions based on the findings indicated that the pharmacists are readily providing cardiovascular risk screening services. The pharmacists were also able to identify the presence of any risk factors that can lead to the development of cardiovascular disease in the patients. However, active pharmaceutical involvement in further cardiovascular disease monitoring seemed to be lacking. Recommendations were made on areas such as reimbursement for pharmaceutical care services, increased utilisation of support staff and Continuing Professional Development events that could assist in improving the role of the community pharmacist in cardiovascular disease management.
11
Greenhill, Nicola H. "An exploration of pharmacist-patient communication in clinic-style consultations." Thesis, University of Nottingham, 2010. http://eprints.nottingham.ac.uk/11659/.
Abstract:
The importance of communication skills for pharmacists has been widely acknowledged. Research has shown that the use of good communication skills can improve patient health outcomes but little research has focussed on communication within new consultation based roles of pharmacists. This study aimed to explore the communication between pharmacists and patients in clinic style consultations and to investigate participant perceptions of communication and consultations. Eleven pharmacists were recruited to the study and were responsible for the recruitment of patients from their own practice; five pharmacists recruited a total of 18 patients. A semi-structured interview was conducted with each pharmacist and with each patient before and after their consultation. Consultations were audio-recorded and observed and all recordings were transcribed verbatim. Thematic analysis based on the principles of grounded theory was conducted. Consultations were additionally coded according to the Calgary–Cambridge guide. NHS Ethics and local research and development approvals were obtained. The data show that patient reports of communication skills during consultations can lack detail, indicating that actual consultation data is required in order to assess communication skills. Pharmacists reported a lack of communication skills training and stated that additional training would need to be focussed on specific, relevant skills and should involve underpinning theory combined with observation of practice and personalised feedback. Pharmacists observed in this study used of a variety of methods for structuring consultations including official computerised or paper based forms, rehearsed segments of speech, and mental checklists. Some difficulties in using computers in a way that did not interfere with communication were identified. Further training may help pharmacists to more effectively structure their consultations. The participants reported that location has important effects on the communication within consultations. Both pharmacists and patients valued privacy in enabling open and honest consultations, particularly in community pharmacy. While it was reported that infrequent use of consultation rooms can lead to stigma being associated with private consultations, the data suggest that having a dedicated space for pharmacist-patient consultations is important. Application of the Calgary-Cambridge guide to recorded consultations showed good usage of many of the skills by the study pharmacists but skills linked to creating a patient centred consultation were under-represented. Some data did not correspond to a specific skill within the guide. Analysis showed the key theme of social conversation, which is essential for relationship building, was present in the non-coded data. Building up a relationship was reported by both pharmacists and patients as important in facilitating communication and that trust in particular played an important part in achieving successful consultations. The study methods enabled collection of rich data about pharmacist-patient communication. The data show that many factors can influence communication within consultations including pharmacist training, location, relationships, structure and use of computers. Pharmacists may need to think widely when aiming to achieve effective consultations. The data suggest that pharmacists made good use of communication skills during consultations but could improve use of the skills that create patient-centred consultations. The Calgary-Cambridge guide could be used to focus both training and research in this area.
12
Cady, Paul Stevens. "Patient counseling and satisfaction/dissatisfaction with prescription medication." Diss., The University of Arizona, 1988. http://hdl.handle.net/10150/184469.
Abstract:
This study was undertaken to test the satisfaction process as it relates to the consumption of prescription medication. The disconfirmation of expectations model was used as a framework for the study. The study sought to evaluate the impact the provision of drug information has on the satisfaction/dissatisfaction process. To accomplish this, consumers recruited from two community pharmacies were provided with a scenario that described the purchase, and consequences of taking a prescription product intended for the treatment of migraine headache. Each subject received a scenario that contained one of four (4) levels of drug information. The four levels were: (1) no drug information; (2) information about side effects; (3) information about effectiveness; and (4) information about effectiveness and side effects. Each subject also received a scenario that described one of four therapeutic outcomes. They were: (1) no side effects with total elimination of headaches; (2) no side effects with partial elimination of headaches; (3) side effects with total elimination of headaches; and (4) side effects with partial elimination of headaches. The disconfirmation of expectation model was supported by the study. Using an ANOVA model, analyses revealed that the provision of drug information resulted in more positive disconfirmation and higher levels of satisfaction when the outcome of therapy was less than optimal. The measures of future intention were also affected by the provision of drug information. Further analyses revealed satisfaction was a function of expectation and disconfirmation.
13
Garcia, Miguel, and Marti Lindsey. "Descriptive Study of Student Pharmacist Perceptions of Patient Health Literacy and Self Assessment of Student Pharmacist Communication Techniques." The University of Arizona, 2012. http://hdl.handle.net/10150/614471.
Abstract:
Class of 2012 AbstractSpecific Aims: The objective of this study is to first assess whether student pharmacist interns feel they can gauge patient health literacy levels with confidence, second to assess which methods are used most commonly in practice by student pharmacists to assess patient health literacy, and third to determine what techniques student pharmacist interns most often employ to communicate more effectively to patients with low health literacy. Methods: The questionnaire consisted of questions about demographics, and knowledge/experiential based questions. Key questions were: How well do you feel you are able to assess patient health literacy? How often do you use the following techniques to assess patient health literacy? (Observe contextual clues, Observe patient word pronunciation, Observe patient willingness to talk, Assess by demographics) When counseling low health literacy patients, how often do you use the following communication techniques? (Speak slowly, Give extra written material, Repeat information, Ask patient to repeat information, Ask if patient understands English, Avoid complicated medical terms). The answers to these questions are measured on a likert scale. Data from the questionnaire was analyzed using one sample t tests and paired t tests. Main Results: Regarding the first primary objective, on a scale of 1 to 5, with confidence measured 3 or greater and no confidence measured 2 or less, student intern pharmacists are statistically significantly confident in their ability to gauge patient health literacy (p< 0.001). There is no statistically significant difference in confidence in ability to gauge patient health literacy between males and females. The method student pharmacist interns used for assessing patient health literacy with the highest average use was observing patient willingness to talk (3.65 +/- 1.01) followed by observing patient word pronunciation (3.57 +/- 0.97), assessing patient demographics (race, age, ability to pay, culture, gender) (3.23 +/- 1.16) and observing contextual clues (patients identify pills by color, asks to be read to, etc) (3.04 +/- 1.04). There was no statistically significant difference between observing patient willingness to talk versus observing patient word pronunciation (p=0.55). There is a statistically significant difference between observing patient willingness to talk versus assessing patient demographics (p=0.011). The technique for improving communication with patients with low health literacy with the highest average use was avoiding complicated medical terms (3.97 +/- 0.95) followed by speaking slowly (3.91 +/- 0.89), repeating information (3.85 +/- 0.73), giving extra written material (3.02 +/- 1.36), asking patients if they understand English (2.85 +/- 1.21) and asking patients to repeat information. (2.39 +/- 1.02). There is a statistically significant difference between avoiding complicated medical terms and giving out extra written material (p<0.001) and speaking slowly and giving out extra written material (p<0.001). Conclusions: We conclude that students pharmacists working as interns are quite confident in their ability to assess patient health literacy, that observing patient willingness to talk is be the most commonly used method to assess patient health literacy, and that avoiding complicated medical terms is be the most commonly used technique student pharmacist interns use to communicate more effectively with patients who have low health literacy.
14
Paluck, Elan Carla Marie. "Pharmacist-client communication : a study of quality and client satisfaction." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0027/NQ34606.pdf.
15
Alam, Farhana, Peter D. Semonche, and Dana Reed-Kane. "Patient Satisfaction with Pharmacist Intern Intervention and Consultation in Hormone Replacement Therapy." The University of Arizona, 2016. http://hdl.handle.net/10150/614016.
Abstract:
Class of 2016 AbstractObjectives: Specific Aim #1: Assess no difference in patient satisfaction. Our working hypothesis is that there is no difference in satisfaction with follow-up calls in women receiving HRT from pharmacists or pharmacy intern students at Reed’s Compounding Pharmacy. Specific Aim #2: Assess patient satisfaction with follow-up calls from pharmacy student interns. Our working hypothesis is that women receiving HRT are satisfied with follow-up calls for their therapy when it is conducted by pharmacy student interns, which enhances proper treatment guidance and adherence. Methods: This study will be a descriptive, direct comparison study that will use data obtained through an online questionnaire consisting of the following: four questions determining the patient’s demographics and eighteen questions on patient satisfaction with follow-up calls from Reed’s Compounding Pharmacy with pharmacy student interns. Results: Of the estimated 60 patients sample size, only 31 questionnaires were completed. The largest proportion of patients was between the ages of 51 and 60 (58%). The length of therapy in participating women varied quite significantly with one-fourth of patients on HRT for 4-5 years or more (26%). The patient satisfaction of follow-up calls conducted by pharmacy intern students survey results indicated, in general, that patients agreed that they were satisfied with the service that they were receiving from the pharmacy interns. There was no disagreement with the items, the intern provides education that will help me understand how to take my medications, being pleased that the intern is following-up, having input on hormone therapy, and with the items regarding intern professionalism and intern knowledge. The greatest disagreement was with three items asking about comfort talking with either a female or male intern, and the item about paying extra to ensure follow-up calls. Results from this study were compared with results from five questions adapted using a questionnaire from DiMaggio et al. Note that this study used 7 response fields: strongly disagreed, somewhat disagreed, disagreed, no opinion, agreed, somewhat agreed, strongly agreed. Data from DiMaggio et al used 5 response fields: strongly disagreed, disagreed, no opinion, agreed, strongly agreed. Responses were grouped by strongly disagreed, somewhat disagreed, disagreed, and no opinion in one and strongly agreed, somewhat agreed, and agreed in the second. The data from both studies were compared by considering proportion of patients who agreed at some level with each item. There was no statistical difference between the two groups (p > 0.08); both groups showed a high level of agreement on the five satisfaction items. Conclusions: The women receiving hormone replacement therapy in this study were satisfied with follow-up calls from pharmacy student interns at Reed’s Compounding Pharmacy. There is no difference in satisfaction with follow-up calls in women receiving HRT from pharmacists or pharmacy student interns. In addition to satisfaction, women are satisfied with follow-up calls for their therapy when it is conducted by pharmacy student interns, which enhances proper treatment guidance and adherence.
16
Porntaveevut, Uraiwan. "Elderly people with chronic disease : the role of pharmacist in patient compliance." Thesis, University of Birmingham, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368373.
17
Pilnick, Alison. ""Pharmacy counselling" : a study of the pharmacist/patient encounter using conversation analysis." Thesis, University of Nottingham, 1997. http://eprints.nottingham.ac.uk/10377/.
Abstract:
Pharmacy as a profession is changing rapidly in the UK. Over recent years, the increased utilization of ready-prepared drugs has led to a decline in the need for the traditional skills of formulation, while computerization has resulted in a situation where much of the routine dispensing work can be undertaken by less qualified personnel. The decline in the traditional aspects of pharmacy has been matched by the emergence of a much greater advisory role. Pharmacy practice researchers have been drawn to support these developments by investigating related areas, but the common factor linking this research is its focus on clinical as opposed to communication issues. Rather than investigating the nature of face-to-face interaction between pharmacists and clients as a topic in itself, researchers instead have been largely concerned with patient/health care system mteractions as a function of drug therapy. Those few studies that have focused exclusively on communication have done so from a quantitative, social psychology framework, thus ignoring the two way, reactive nature of the interaction process. This study, using data collected from patients' and carers' consultations with pharmacists in a hospital paediatric oncology outpatient clinic, uses the sociological methodology of Conversation Analysis (CA) in order to analyze the encounters which take place. In so doing, it aims to shed some light upon what is actually involved in the process of "patient counselling" in this setting. The body of CA literature which considers advice-giving in health care settings provides the starting point for a consideration of the ways in which pharmacists give advice in this setting, and how this is responded to. The aims are thus twofold: to enlarge the methodological resources of PPR, and also to begin an examination of the communicative competencies required of pharmacists in this setting. NB. This ethesis has been created by scanning the typescript original and may contain inaccuracies. In case of difficulty, please refer to the original text.
18
Hu, Fei-Shu. "Update of Patient Satisfaction with Pharmacist Intervention and Consultation in Hormone Replacement Therapy." The University of Arizona, 2005. http://hdl.handle.net/10150/624753.
Abstract:
Class of 2005 AbstractObjectives: To assess whether the satisfaction of women with the pharmacist administered bio-identical hormone replacement therapy consultation service has improved since the implementation of a follow up call program at Reed’s Compounding Pharmacy. Methods: A questionnaire was mailed to 200 randomly selected women who had completed their HRT consultation and received all three follow-up calls provided by Reed’s Compounding Pharmacy within the time frame from July 22, 2003 to April 22, 2004. The returned surveys were then organized and analyzed using Microsoft Excel. Additionally, independent t-tests were used to compare data collected in 2001 vs. 2004 on relevant questionnaire items of interest. Main results: Of the 200 surveys sent out to patients, 125 replied (a response rate of 62.5%). Over 50% heard about it through referral from their provider, and almost 35.2% from a friend or a relative. Regarding the follow-up call service, 95.9% of the patients either agreed or strongly agreed that it was helpful; however, only 73.8% feel comfortable discussing their concerns with student interns, who are responsible for the follow-up calls. In the assessment of new health conditions developed after natural hormone therapy initiation, 94.3% of the respondents reported with no new health conditions. T-tests revealed an improvement in patient satisfaction items between 2001 and 2004 with p-values < 0.05. Principal Conclusions: The results of the study showed that there was an improvement in patient satisfaction with the consultation service since 2001, and most of the differences found were statistically significant. The survey result also showed that participants were happy about the follow-up calls, which in terms, perhaps contributed to the increase in satisfaction.
19
Smith, David Harold. "Medication compliance and cost and utilization outcomes associated with pharmacist's cognitive service interventions /." Thesis, Connect to this title online; UW restricted, 1998. http://hdl.handle.net/1773/7941.
20
Salter, Charlotte I. "'Medication Review' : a study of the pharmacist-older patient encounter, using discourse analysis." Thesis, University of East Anglia, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.426815.
21
Oladimeji, Olayinka Omobolanle Farris Karen B. "Concern beliefs in medicines description, changes over time and impact on patient outcomes /." Iowa City : University of Iowa, 2009. http://ir.uiowa.edu/etd/314.
22
Knoesen, Brent Claud. "Exploring the communication skills of community pharmacists in the Nelson Mandela Metropole." Thesis, Nelson Mandela Metropolitan University, 2015. http://hdl.handle.net/10948/7981.
Abstract:
Pharmacy is an information-driven profession that requires effective face-to-face pharmacist-client communication. With the addition of corporate community pharmacies to traditional independent community pharmacies in South Africa (SA), new challenges may hamper pharmacist-client interactions. This study aimed to identify, adapt and improve the communication skills pharmacists require for a changing community pharmacy environment. Specific objectives were to identify basic communication skills, to evaluate the use of these skills by community pharmacists in the Nelson Mandela Metropole (NMM), to identify communication barriers, and to identify any differences in pharmacist-client communication in the two community pharmacy sectors. A mixed methods research design was implemented. The empirical activities consisted of three client focus groups (17 citizens from the NMM), a client survey (220 clients visiting seven independent and seven corporate community pharmacies in the NMM), a pseudo-client study (the same 14 community pharmacies in NMM), and a Delphi study. Twenty-one pharmacists from the 14 community pharmacies participated in Phase one of the Delphi study; nine academic pharmacists from five pharmacy departments/schools/faculties in SA participated in Phase two. Various qualitative and quantitative techniques were used to analyse and interpret the results. Results indicated that clients consult on many occasions with community pharmacists. Community and academic pharmacists listed listening and nonverbal skills as most important communication skills to ensure effective pharmacist-client communication. Counselling privacy and language barriers were listed as major problems influencing the interaction. The results obtained allowed the researcher to propose a practical communication model to assist future community pharmacists in communication skills training
23
Davis, Erica, Sarah Norman, Lisa Goldstone, and Terri Warholak. "Evaluation of a Pharmacist-Led Medication Education Group on Patient-Reported Attitudes and Knowledge, Including a Rasch Analysis of the Questionnaire Used." The University of Arizona, 2013. http://hdl.handle.net/10150/614232.
Abstract:
Class of 2013 AbstractSpecific Aims: To assess the effect of a pharmacist-led education group on psychiatric patient-reported attitudes, knowledge, and confidence in self-managing medications. The reliability and validity of the questionnaire given to patients who attended a pharmacist-led medication education group was also evaluated. Methods: A retrospective pre-post questionnaire was distributed patients and collected variables collected including patient self-reported medication knowledge and attitudes, demographics, previous psychiatric hospitalizations, length of group attended, and outpatient pharmacist relationships. Knowledge and attitude items were measured on a 4-point Likert-type scale with response options ranging from “agree” to “disagree.” Rasch analysis was conducted to ensure all items measured the same construct and the probability of the person responding to an item was not dependent on other assessment items. Rasch measurement includes several diagnostic indices that allow item-specific and person-specific examinations of data reliability and measurement fit. In addition, the Rasch technique makes it possible to evaluate the contribution of each person’s measures on each item. A z-test was used to evaluate for instrument content gaps and a dependent t-test was performed to measure for statistical differences before and after the intervention. Main Results: Sixty patients responded to the Medication Attitude and Knowledge Questionnaire over a 16-week period. Gaps identified were not statistically significant (p=0.1064 and 0.5305) indicating that content validity is comprehensive. On a group level, no significant differences were identified in patient answers before and after the intervention (p=0.2162, p=0.8292). When each patient was analyzed separately, only one patient out of 60 showed a significant difference in answers after the intervention. Results also demonstrated that after attending a group, 100% of patients indicated they intended to adhere to their medication regimen post-discharge. Conclusion: This evaluation was unique because patient attitudes were explored before and after medication education group attendance. Medication Attitude and Knowledge items were valid and reliable.
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Alyssa, Chen. "An assessment of pharmacist & patient knowledge of and attitudes toward reporting adverse drug reactions in patients with epilepsy." Connect to resource, 2008. http://hdl.handle.net/1811/32132.
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Barreda, Alison M. "Determining Patient Preference for a Pharmacist-Administered Influenza Vaccination Program: Type of Visit and Contact Method for Annual Notification." The University of Arizona, 2009. http://hdl.handle.net/10150/623906.
Abstract:
Class of 2009 AbstractOBJECTIVES: To determine patient preference for the type of visit for the receipt of the influenza vaccine from the pharmacist and to determine patient preference for contact method for annual notification of the influenza vaccine program. METHODS: This was a descriptive study using a short telephone survey. The first dependent variable was the preferred type of visit comparing appointment-based and predetermined walk-in clinics. The second dependent variable was the preferred method of contact for annual notification of a pharmacist administered influenza vaccination program (telephone, US post mail, email). RESULTS: The telephone survey was completed by 206 patients. Overall, study participants preferred appointment-based visits ( 81.2 %; p < 0.05) compared to a predetermined walk-in clinic (18.8%). Overall, study participants significantly preferred to be contacted for annual notification of a pharmacist administered influenza vaccination program via telephone (75.7%; p< 0.05) compared with US post mail and email. Based on the percentages observed, the second preferred method of contact was email (12.6%) and US post mail was the third preferred method of contact (11.7%). CONCLUSIONS: Patient preference for type of visit for pharmacist-administered influenza vaccine was appointment-based as opposed to predetermined walk-in clinic based. Patient preference for contact method for annual notification was telephone as opposed to email or postal mail.
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Thompson, Jessica. "Clinical simulations using virtual patient avatars for pre-registration pharmacist training : a mixed methods evaluation." Thesis, Keele University, 2018. http://eprints.keele.ac.uk/5175/.
Abstract:
Virtual patients (VPs) are routinely used in the training of medicine and nursing professionals but uptake into pharmacy has been slower. The pharmacy pre-registration training year takes place in the workplace and a disparity in the perceptions of support provided and the pre-registration examination pass rates has been established between the training sectors. This programme of work aimed to evaluate the effectiveness of virtual patients (VPs) at supporting pre-registration training when compared to a non-interactive (NI) learning tool. Following institutional ethical approval, a mixed methods approach was adopted to evaluate the VP technology. A purposive sample of 165 pre-registration trainees (2014-2015) who were completing their training in a UK-based community or hospital pharmacy were recruited. Participants were randomly stratified to receive three VP or NI case studies. Knowledge surrounding the case studies was assessed using a quasi-experimental evaluation and thoughts on the two learning tools were obtained and compared via questionnaires and semi-structured telephone interviews. Quantitative data was analysed using descriptive and inferential statistics and qualitative data was analysed using content analysis (questionnaire) and framework analysis (interviews).No significant differences in knowledge improvement between pre-registration trainees in the VP and NI groups were obtained. Significant improvements in knowledge were found between the sectors of training for the three case studies. Pre-registration trainees reported that the VP enabled them to apply their learning and engage in experiential learning. The VP case studies were associated with greater satisfaction and were reported to provide a more realistic, interactive and enjoyable learning experience. Pre-registration trainee’s perspectives of the VP technology as a learning tool were more favourable regarding the development of real-life complex skills and aspects of learning, which provides a remit for further evaluation of the technology in undergraduate and postgraduate pharmacy training.
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Hill, Peter William. "The South African community pharmacist and Type 2 Diabetes Mellitus a pharmaceutical care intervention." Thesis, Rhodes University, 2009. http://hdl.handle.net/10962/d1003238.
Abstract:
Type 2 diabetes mellitus is a chronic disease of pandemic magnitude, increasingly contributing to the disease burden of countries in the developing world, largely because of the effects of unhealthy lifestyles fuelled by unbridled urbanisation. In certain settings, patients with diabetes are more likely to have a healthcare encounter with a pharmacist than with any other healthcare provider. The overall aim of the study was to investigate the potential of South African community pharmacists to positively influence patient adherence and metabolic control in Type 2 diabetes. The designated primary endpoint was glycated haemoglobin, with the intermediate health outcomes of blood lipids, serum creatinine, blood pressure and body mass index serving as secondary endpoints. Community pharmacists and their associated Type 2 diabetes patients were recruited from areas throughout South Africa using the communication media of various nonstatutory pharmacy organisations. Although 156 pharmacists initially indicated interest in participating in the study, only 28 pharmacists and 153 patients were enrolled prior to baseline data collection. Of these, 16 pharmacists and 57 patients participated in the study for the full twelve months. Baseline clinical and psychosocial data were collected, after which pharmacists and their patients were randomised, nine pharmacists and 34 patients to the intervention group and 8 pharmacists and 27 patients to the control group. The sample size calculation revealed that each group required the participation of a minimum of 35 patients. Control pharmacists were requested to offer standard pharmaceutical care, while the intervention pharmacists were provided with a scope of practice diabetes care plan to guide the diabetes care they were to provide. Data were again collected 12-months postbaseline. At baseline, proportionally more intervention patients (82.4%) than control patients (59.3%) were using only oral anti-diabetes agents (i.e. not in combination with insulin), while insulin usage, either alone or in combination with oral agents was conversely greater in the control group (40.7%) than in the intervention group (17.6%) (Chi-squared test, p=0.013). Approximately half of the patients (53.8% control and 47.1% intervention) reported having their HbA1c levels measured in terms of accepted guidelines. There was no significant difference in HbA1c between the groups at the end of the study (Independent t-test, p=0.514). In the control group, the mean HbA1c increased from 7.3±1.2% to 7.6±1.5%, while for the intervention patients the variable remained almost constant (8.2±2.0% at baseline and 8.2±1.8% at post-baseline). Similarly, there were no significant differences between the groups with regard to any of the designated secondary clinical endpoints. Adherence to medication and self-management recommendations was similarly good for both groups. There were no significant differences between the two groups for any of the other psychosocial variables measured. In conclusion, intervention pharmacists were not able to significantly influence glycaemic control or therapeutic adherence compared to the control pharmacists.
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Lewis, Melissa Geane. "Aspects of delictual liability in pharmacy practice." Thesis, Rhodes University, 2007. http://hdl.handle.net/10962/d1005963.
Abstract:
The thesis explores the various instances in which pharmacists may incur delictual liability for harm suffered by their patients or third parties. As such, it is primarily concerned with the field of professional negligence. The work focuses specifically on the wrongfulness, fault and causation enquiries in pharmacy malpractice cases. The discussion is set against the backdrop of the pharmacy profession's shift towards patient-orientated service in recent years and explores whether this change in the profession's social role has had any effect on the legal duties and standard of care to which pharmacists are currently bound. It is argued that, in light of the dangers posed by modern medicines and the extent to which pharmacists are professionally expected to involve themselves in patient care, pharmacists can no longer escape liability simply by accurately dispensing pharmaceutical products. Rather, they are expected to participate actively in avoiding drug-related injury by, for example, providing patient counselling, detecting invalid or erroneous prescriptions and monitoring prescription refills. Although the thesis places particular emphasis on the role of pharmacists in achieving risk management, it also argues that pharmacists are, in very limited circumstances, required to participate in the risk assessment process traditionally thought to fall exclusively into the realm of physicians. It is furthermore demonstrated that pharmacists can incur liability regardless of whether a patient's harm can also be partially attributed to the blameworthy conduct of another healthcare professional. Although the thesis concludes that pharmacists are currently exposed to greater risks of liability than they were in the past, it also shows that plaintiffs who seek damages from pharmacists will usually experience a number of difficulties in establishing liability. In particular, problems are likely to be encountered in satisfying a court as to the presence of factual causation, which is notoriously difficult to establish in drug-related cases.
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Mushunje, Irvine Tawanda. "Willingness to pay for pharmacist-provided services directed towards reducing risks of medication-related problems." Thesis, Nelson Mandela Metropolitan University, 2012. http://hdl.handle.net/10948/d1008053.
Abstract:
Pharmacists as members of health care teams, have a central role to play with respect to medication. The pharmaceutical care and cognitive services which pharmacists are able to provide can help prevent, ameliorate or correct medication-related problems. There are however many barriers to the provision of these services and one of the barriers commonly cited by pharmacists is the lack of remuneration for their expert services. The aim of this study is to ascertain if patients in South Africa are willing to pay for pharmacist-provided services which may reduce medication related problems, and thereby determine the perceived value of the pharmacist-provided services, by patients. The study will also seek to determine factors that influence willingness to pay (WTP), including financial status, gender, race, age and level of education. In addition the perceived value of the pharmacist‘s role in patient care, by third party payers (SA Medical Aid providers) and their WTP for pharmacist-provided services (such as DSM) on behalf of patients through their monthly premiums will also be investigated. The study was conducted as a two-phase process: the first phase focused on the opinions of patients and the second phase on the medical aid companies. In phase-1 a convenience sample of 500 patients was recruited by fifty community pharmacies distributed throughout the nine South African provinces. Data collection, consisting of telephonic administration of the questionnaires, was conducted and the survey responses were captured on a Microsoft Excel® spreadsheet. All the captured information was analyzed using descriptive statistics, box and whisker plots, analysis of variance (ANOVA) and regression analysis. In phase-2, medical aid schemes that are registered with the Council of Medical Schemes (CMSs) of South Africa were included in this research. A fifteen point questionnaire was completed electronically via e-mail by willing medical aid participants. Data was analyzed using descriptive statistics only. Only 233 or 88.6 percent, of the 263 participating respondents, were willing to pay at least one rand towards pharmacist-provided services. On average respondents were willing to pay R126.76 as out-of-pocket expenses. Respondents‘ WTP increased as the risk associated with medication-related problems was reduced due to pharmaceutical care intervention. Of the 263 respondents who took part in this research, fifty percent were willing to pay at least R100 for a risk reduction of 30 percent, R120 for a 60 percent reduction and approximately R150 for a greater than 90 percent risk reduction. It was also found that the respondents‘ willingness to pay was influenced by their age, earnings, racial grouping, employment status, medical aid status and their level of satisfaction with pharmacist-provided care services. Of the thirty-one open medical aid schemes only eight (25.8 percent) participated in the study. Findings indicate that all the participating medical aid respondents were unwilling to pay for pharmacist-provided care services, although they perceived pharmacists as very influential healthcare providers and as having a significant role to play in reducing medication-related problems. In conclusion it was found that majority of participants were willing to pay for pharmacist-provided services directed towards reducing risks associated with medication-related problems. Until pharmacists are able to prove pharmaceutical care‘s utility and cost-effectiveness to third-party payers, pharmacists must look to the patient for reimbursement.
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Brelsford, Brooke, and Angie Arvallo. "Effects on Direct Patient Care of Different Socioeconomic Populations: A Meta-Analysis." The University of Arizona, 2011. http://hdl.handle.net/10150/623564.
Abstract:
Class of 2011 AbstractOBJECTIVES: To examine the effects of pharmacist-provided direct patient care with consideration to the patients’ socioeconomic status as determined by the patients’ health insurance. METHODS: A meta-analysis was conducted to evaluate the effects of pharmacist-provided direct patient care on different socioeconomic populations as determined by the patients’ health insurance by including results from several independent randomized control trials. A standardized and tested data extraction form was used to collect primary data on outcome category (therapeutic, safety, and humanistic), disease category (diabetes, hypertension, cardiovascular, dyslipidemia, asthma, and other), insurance status (Medicaid, Medicare, Veterans Affairs/ Department of Defense, private and uninsured), and outcome measures. The potential for bias data were analyzed by calculating a total potential for bias score and by construction a forest plot ordered by bias score. RESULTS: Twenty-two studies were included in the meta-analysis. The insurances most often reported were Medicaid (13.6%), Medicare (18.2%), the Veterans Affairs/ Department of Defense (VA/DoD) (41%), and private insurance (27.2%). All insurance groups benefited from pharmacist intervention (p<0.01). The Medicare patients benefited the least from the pharmacist interventions [standard mean difference (SMD) = 0.21], and the benefit of intervention was significantly less than the benefit for subjects having Medicaid, Private Insurance or VA/DoD coverage (p<0.02). CONCLUSION: While patients in all insurance type benefited from pharmacist intervention, Medicare patients seemed to benefit the least; further studies are needed to verify the findings and to explore why the benefit is less than for other groups.
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Chong, Wei Wen. "Medication adherence in depression: Exploring roles and practices of healthcare providers." Thesis, The University of Sydney, 2013. http://hdl.handle.net/2123/9559.
Abstract:
Non-adherence to antidepressant medications is a major barrier to the effective treatment of depression. Healthcare providers are an important point of intervention in addressing adherence-related problems. The objective of the research in this thesis was to explore the potential roles and current practices of healthcare providers in improving antidepressant medication adherence, particularly from a patient-centred approach. Findings from a systematic review highlight the importance of multifaceted interventions involving a collaborative effort from all healthcare providers. In a qualitative study, healthcare providers from various disciplines identified patient education and building partnerships with patients as key approaches to improving antidepressant medication adherence. Although healthcare providers expressed support towards shared decision-making (SDM) in mental healthcare, a number of barriers were perceived to hinder an interprofessional approach to SDM. In addition, a simulated patient study identified areas for improvement in community pharmacists’ practice, including the provision of key educational messages on antidepressant medications and patient-centred communication behaviours. This study also demonstrated the utility of Roter Interaction Analysis Method (RIAS) in analysing brief consultations at community pharmacy counters. The findings gained collectively from this research may inform the development of future adherence interventions that target the improvement of collaborative patient-centred practices in depression care.
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Renet, Sophie. "Patients atteints de maladies chroniques pulmonaires et pharmaciens : identification et modélisation des échanges de savoirs." Thesis, Paris 10, 2016. http://www.theses.fr/2016PA100117.
Abstract:
Dans une période marquée par un bouleversement des systèmes d’information et de santé et de la place de la maladie dans la société, la question du rapport au savoir en santé devient essentielle. La relation soignant-soigné, anciennement vécue sur un mode passif, est aujourd’hui un échange actif de savoirs entre deux individus et deux mondes sociaux, partenaires. Ces constats remettent en cause les rapports soignant-soigné, entre savoir savant et savoir profane, et les modèles de pratiques existants. En alliant les atouts des sciences de l’éducation à celles des modélisations mathématiques, nous avons caractérisé comment les patients atteints d’asthme ou d’hypertension artérielle pulmonaire échangeaient de l’information et des savoirs avec les pharmaciens de ville et hospitaliers. La méthodologie générale faisait appel à la stratégie de triangulation et se divisait en 4 parties : une analyse de la littérature, un remue-méninges, une analyse de contenu de 39 entretiens semi-dirigés, une étude statistique utilisant l’analyse des correspondances simples basée sur un questionnaire diffusé à 124 patients. La nature de l’échange de savoirs (ES) était composée de 3 dimensions interdépendantes que nous avons modélisée : « Modèle 3 C : cure, care et coordination ». L’intensité et la nature de l’ES variaient selon le type de pharmacien impliqué, la maladie, sa durée, son grade de sévérité, l’âge, le niveau d’apprenance, les représentations des patients vis-à-vis des pharmaciens et des médicaments. Le partenariat avec les professionnels de santé, le patient et les aidants, constituait une composante indispensable et facilitatrice de l’ES. L’ES contribuait à l’autoformation des patients pour acquérir des compétences d’autosoins et mieux gérer leur maladie chronique et ses impacts. Nous avons mis en évidence que le pharmacien s’apparentait à un facilitateur de l’autoformation des patients, de l’éducation diffuse et du bricolage des savoirs ; la pharmacie, officinale ou hospitalière constituait l’embryon d’un tiers-lieuIn this period of change characterized by a disruption of information and health systems, the relationship issue of knowledge becomes more essential. The healthcare professional-patient relationship, formerly based on a passive mode, has become an active exchange of knowledge between two individuals and two social worlds, seen as partners. These observations challenge the healthcare professional -patient relationship, between scholar and lay knowledge, and existing practice models. Combining the strengths of Education Sciences to those of mathematical modeling, this work allows us accurately characterizing how patients with asthma or pulmonary arterial hypertension shared information and knowledge with both community and hospital pharmacists. This study uses a triangulation strategy and combines 4 parts: a literature analysis, a brainstorming, a content analysis of 39 semi-directed interviews and a correspondance analysis based on a questionnaire submitted to 124 patients. The nature of knowledge exchange consisted in 3 interrelated dimensions that we modeled : “3C Model: Cure, Care and Coordination”. The exchange intensity and nature varied with the type of pharmacist involved, the pathology, the severity and disease duration, the patient age, the knowledge level. The patient representations towards pharmacists and medicine also influenced the nature. We identified that the partnership between healthcare professionals, patients and caregivers was a fundamental component and a facilitator of knowledge exchange. We found that the knowledge exchange contributed to the self-training of patient to acquire self-care skills and better manage their chronic disease and its impacts. Finally, this study allowed highlighting (1) the pharmacist was a facilitator of patients selftraining, diffuse education and self-made knowledge; (2) the community and hospital pharmacies were the location where all these take place, as a third place
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Riley, Ruth. "How do GPs, nurse and pharmacist prescribers manage patients' emotional cues and concerns in healthcare encounters?" Thesis, University of Bath, 2014. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.642041.
Abstract:
In healthcare encounters, patients communicate wide-ranging concerns relating to their health and illness experience, treatment or wider psychosocial world. This research draws upon a normative understanding of patient centred approaches which recognise the clinical and psychotherapeutic value in having the opportunity to talk to someone who will listen empathetically and to have expressed concerns acknowledged and understood. The aim of this research was to understand how GPs, nurse and pharmacist prescribers manage patients’ emotional cues and concerns in healthcare encounters. This research employed a mixed method study underpinned by an interpretative epistemology to understand, in particular, how nurse and pharmacists as ‘new prescribers’ manage emotionality during consultations in primary care. The study also critically reflected on the value and limitations of the study methodology to explore this topic. Phase one employed a coding framework to code 528 consultations with 20 GPs, 19 nurses and 12 pharmacist prescribers. The nature and content of patients’ cues and concerns and healthcare professionals’ responses were coded and analysed quantitatively. Phase two undertook qualitative analysis on a sub-sample of 30 transcribed recordings to understand barriers and facilitators to offering emotional labour during the consultation process. Phase one found that patients communicate on average 3.4 cues and concerns per consultation and of those concerns expressed, half related to biomedical concerns. Other cue and concern types related to medication, the impact of a patient’s condition/symptoms on their day-to-day life and cues and concerns related to psychosocial issues, including job stress, family problems, or bereavement. Phase one found that there were significant differences between the type of positive/missed responses to patients’ cues and concerns across the groups. 81% of pharmacists’ responses were coded as positive compared with 72% of nurse prescriber responses and 52% of GP responses. Male GPs were significantly more likely to miss patients’ cues and concerns compared to female GPs. Phase two drew upon emotion work theory and models of patient centred care to identify the ways in which emotions are communicated and managed within healthcare encounters recorded for this study. Phase two identified facilitators (such as attuning to the patient’s world, evidence of listening, providing space, validating and legitimising patients’ concerns) and barriers (emotional disengagement, task focused and structured/agenda driven consultations) to the employment of emotional labour. These findings identify that a complex inter-play of individual, socio-cultural and political factors have potential to influence the way in which emotionality is managed during the consultation process. The findings reinforce the importance of patient centred approaches and communication skills training and the need for support, supervision and training to enable healthcare professionals to manage their emotionality and that of their patients.
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Mekonnen, Alemayehu B. "Medication Reconciliation as a Medication Safety Initiative." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/18050.
Abstract:
Medication errors and their adverse outcomes are the most common cause of patient injuries in hospitals. Medication reconciliation is the safety strategy usually called for, to prevent medication errors that occur at care transitions. This strategy has been adopted as a standard practice in many developed countries. However, in Ethiopia, there were no published studies on medication reconciliation, nor evidence-based interventions aimed to tackle the burden of medication errors. This thesis was a medication safety initiative focusing on medication reconciliation intervention overall, and explored the journey to medication reconciliation service implementation as a medication safety strategy in Ethiopian public hospitals. Given the lack of consistent reports regarding the impact of this strategy, the journey to implementation was guided by synthesise of the evidence supporting the effectiveness of this intervention. The findings of our systematic reviews have shown that medication reconciliation interventions carried out through pharmacist assessment at hospital transitions were found to be an effective strategy for improving clinical outcomes (e.g. adverse drug event-related hospital visits, all-cause readmissions, and emergency department visits), as well as process outcomes, such as the occurrence of medication errors. Therefore, the overarching aim of this thesis was to implement a pharmacist-led medication reconciliation intervention in resource-limited settings. Implementation of medication reconciliation is not an ultimate end but sustainability is an issue, and this should be corroborated by corresponding changes in attitudes, teamwork, communication, culture and leadership. For this purpose, the thesis employed methods from both safety and implementation sciences for successful implementation of the medication reconciliation program. System approaches to patient safety, such as patient safety culture has been explored, and patients’ experiences of medication-related adverse events have been discussed followed by a theoretically robust evidence-based exploration of the barriers to implementation. Patient safety culture in Ethiopian public hospitals has been found lower than the benchmark studies. Importantly, understaffing followed by problems during handoffs and care transitions and punitive response to error were identified as major safety problems. Particularly, handoffs and care transitions were largely affected by the lack of teamwork across units, punitive response to error reporting and managerial inaction for promoting patient safety. In addition to system factors presumed to affect patient safety, other factors such as individual healthcare professionals, patient, and task factors have been identified as challenges to achieve an optimal patient safety in the Ethiopian public hospitals. Resource limitations (e.g. material deficiencies, poor infrastructure) have been indicated as the greatest barriers for patient safety. Patients expressed a range of perceived experiences related to their medication, and a number of strategies required to improve patient safety practices have been suggested. Changes in practice, processes, structure, and systems were believed to help improve patient safety in the Ethiopian health care system. The results of this thesis have demonstrated that hospital pharmacists were very much enthusiastic for their extended roles and were positive towards the future of the profession; however, there were many factors that likely influenced their behaviour in the clinical practice, and these behavioural determinants were predominantly related to ‘Knowledge’, ‘Skills’, ‘Environmental constraints’, ‘Motivation and goals’, ‘Social influences’, and ‘Social/professional role’. While medication errors were highly prevalent at the time of hospital admission, this thesis has also found that pharmacist-led medication reconciliation was able to minimize medication errors significantly. Thus, implementation of medication reconciliation as a medication safety strategy is feasible, and pharmacists may be regarded as key resource personnel for the safe use of medications at the time of hospital admission. However, the sustainability of this service utilization is highly dependent on other behavioural determinants, such as knowledge and skill, competing priorities, and reimbursement for clinical services.
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Kubashe, Nomachina Theopatra. "The influence of corporatization on the professional identity of community pharmacists." Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/18189.
Abstract:
As a potential main player in the primary health care sector and the impending National Health Insurance (NHI), community pharmacists could make a significant contribution to easing the health care burden in South Africa. Recent legislative and organizational changes related to the corporatization of pharmacy in South Africa have impacted significantly on the profession and stand to weaken the already ‘tenuous’ professional identity of pharmacists in the country. Since community pharmacists are viewed as potential main players in the primary health care sector, the influence of corporatization on pharmacists’ identities and their concomitant ability to contribute to easing the health care burden in South Africa need to be considered. In this regard, this study examined the influence that corporatization has had on the professional identity of community pharmacists practicing in the Nelson Mandela Bay area of South Africa. That is, in an effort to understand the influence that corporatization has had on changing professional identities and practices the attitudes, beliefs, and behaviours of community pharmacists regarding the philosophy and practice of pharmacy were explored. This included ascertaining community pharmacists’ self-perception of their professional identity and the perception of users of these community pharmacies. The study was conducted from an interpretative epistemological paradigm, based on a philosophy of pragmatism. Data collection was conducted in two phases and a qualitative approach, which included in-depth and semi-structured interviews, was adopted as a design. Phase one investigated the self-perceptions of sixteen community pharmacists, equally distributed between independent and corporate pharmacies in the Nelson Mandela Bay (NMB). Phase two examined the perceptions of thirty-two end-users of the pharmacies included in the study. Data from both phases were then analysed and interpreted. Following the identification of seven core professional identities, namely pharmacists as custodian or keeper of medicines; primary health care givers; confidante and carer; jaded; astute and credible; corporate; and independent, it was determined that corporatization has, to various degrees, had an effect on the undermining of Nelson Mandela Bay community pharmacists’ view of themselves as skilled professionals in the health care sector. In short, it was found that corporatization is believed to have blurred the boundaries related to what it means to be a pharmacist and what role pharmacists should play in the provision of public health care. Corporatization does not appear to have influenced the patients’ or pharmacy end-users’ perceptions of the pharmacist, and furthermore does not play a major role in their choice of pharmacy. It is the perception of pharmacists in this study that with the introduction of legislative changes, more so corporatization, they experienced an undermining of their professional skill and disregard for costs involved in becoming a pharmacist. The perceived undermining of the professional skill of pharmacists threatens the valuable contribution that community pharmacists can make to balancing the country’s socio-economic status by appropriately and efficiently assisting in preventing, managing and/or reducing the disease burden in South Africa. Corporatization of the community pharmacy sector seems to have realized the government’s intention of making medication affordable to its citizens, however, the certainty of whether corporatization benefits patients that are in need of access remains to be seen. Community pharmacists could in fact, capitalize on the identification and enactment of their clinical skill (pharmaceutical and social caregiving) as this skill appears to be a tool that will allow pharmacists meaningful transition to being real contributors of primary health care in the imminent introduction of the NHI. At the same time, recognition of the role a pharmacist plays in primary health care will be supporting the government in its endeavours to making medicine accessible and affordable to all South African citizens without compromising their health needs. Ultimately, pharmacists can assist in the balancing and/or improvement of the socio-economic status of our society and the country.
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Koo, Michelle Mui Sze. "The use of written medicine information by consumers." Phd thesis, Faculty of Pharmacy, 2005. http://hdl.handle.net/2123/9989.
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Belaiche, Stéphanie. "Adhésion thérapeutique et variation des taux sanguins des anti-calcineurines chez le patient greffé rénal." Thesis, Lille 2, 2017. http://www.theses.fr/2017LIL2S018/document.
Abstract:
La non-adhésion (NA) est un enjeu majeur en transplantation rénale (TR). Nous avons réalisé une revue systématique dans laquelle les facteurs liés à la NA sont discutés. Et, sachant que la variabilité des taux sanguins d'anti-calcineurine (CNI) pose la question de NA, nous avons essayé d'identifier les facteurs qui lui sont associés. 37 articles sur l'adhésion ou NA en TR, publiés entre 2009 à 2014, ont été analysés. La NA fluctuait entre 2 et 96% et plusieurs facteurs lui étaient associés : a. jeune, homme, faible support social, sans emploi, faible éducation h. >3 mois post Tx, donneur vivant, >6 comorbidités c. >5 médicaments/j, >2 prises/j d. Croyances et/ou comportements négatifs e. Dépression et/ou anxiété. Puis, nous avons réalisé une étude transversale sur une cohorte de patients à 1 an post greffe de rein. . Les données cliniques, de l'entretien du pharmacien clinicien (PC) et de 6 questionnaires ont été collectées. 408 patients ont été inclus (61.2% d'hommes, âge médian 54 ans). Nous avons comparé 2 groupes selon le coefficient de variation (CV) des CNI : CV<30% (n=302) et >30% (n=106). En analyse univariée la distance hôpital-domicile, la ciclosporine, le délai post greffe et la présence de divergences à la conciliation médicamenteuse, étaient associés à un risque élevé de CV>30%. A l'inverse, le tacrolimus LP conférait un risque plus faible. En analyse multivariée, la présence de divergences était significative (OR=3.2 IC95% [1.21-9.01], p=0.02). Un CV>30% des CNI après 1 an de greffe semble refléter un phénomène de NA pouvant être confirmé par l'entretien avec le PC et constituer un outil simple pour la pratique cliniqueNon-adherence (NA) is a major issue after kidney transplantation (Tx). We realized a systematic review, in which criteria related to NA were discussed. And, considering that calcineurin inhibitors (CNI) blood levels variability raises the question of NA, we tried to identify factors associated to it. 37 studies on adherence and NA in TX, published between 2009 and 2014 were reviewed. NA fluctuated from 2 to 96% and sseveral factors were related to NA: a.Young age, male, low social support, unemployed, low education b. >3 months after Tx, living donor, >6 comorbidities c. >5 drugs/d, > 2 intakes/d d. Negative beliefs and/or behaviors e. Depression and anxiety. Then, we realised a cross sectional study on a cohort of kidney recipients grafted for more than 1 year. We recorded: clinical data, data from a clinical pharmacist (CP) interview and from 6 self-reports. 408 recipients were enrolled (61.2% male, median age 54 years old). We compared 2 groups according to a coefficient of variation (CV) for CNI blood levels: CV<30% (n=302) and >30% (n=106). In univariate analysis, the distance hospital-home, cyclosporine, time since Tx, discrepancies in the reconciliation process were associated with a greater risk of CV>30%. By contrast, tacrolimus once daily conferred a lower risk of CV >30%. In multivariate analysis discrepancies remained significant (OR=3.2 CI 95% [1.21-9.01], p=0.02). ACV >30% for CNI blood levels after lyear post Tx seems to reflect NA, and could easily be confirmed by the CP interview. This could be a simple method to detect NA in clinical routine
38
Coffindaffer, Jarrett W. "Pharmacists and tobacco cessation counseling attitudes and beliefs, impact of cessation training on practice, and feasibility of training and implementation into the pharmacy practice setting /." Morgantown, W. Va. : [West Virginia University Libraries], 2008. https://eidr.wvu.edu/etd/documentdata.eTD?documentid=5772.
Abstract:
Thesis (Ph. D.)--West Virginia University, 2008.Title from document title page. Document formatted into pages; contains x, 179 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 153-164).
39
Kritikos, Vicky. "INNOVATIVE ASTHMA MANAGEMENT BY COMMUNITY PHARMACISTS IN AUSTRALIA." Thesis, The University of Sydney, 2007. http://hdl.handle.net/2123/2064.
Abstract:
Excerpt Chapter 2 - A review of the literature has revealed that asthma management practices in the Australian community are currently suboptimal resulting in significant morbidity and mortality. In adolescent asthma there are added challenges, with problems of self-image, denial and non-adherence to therapy where self-management skills assume a greater importance (Forero et al 1996, Price 1996, Brook and Tepper 1997, Buston and Wood 2000, Kyngäs et al 2000). In rural and remote areas in Australia, asthma management practices have been shown to be poorer and mortality rates from asthma are considerably higher compared to metropolitan areas (AIHW ACAM 2005, AIHW 2006). Limited access and chronic shortages of specialist services in rural areas are shifting the burden more and more towards the primary sector (AIHW 2006). It becomes paramount that people with asthma in rural settings become involved in self-management of their asthma and that community based health care providers be more proactive in facilitating these self-management behaviours by appropriate education and counselling. Health promotion activities, which are a broad range of activities including health education, have been acknowledged as having the potential to improve the health status of rural populations (National Rural Health Alliance 2002). Community pharmacy settings have been shown to be effective sites for the delivery of health promotion, screening and education programs (Anderson 2000, Elliott et al 2002, Cote et al 2003, Hourihan et al 2003, Watson et al 2003, Boyle et al 2004, Goode et al 2004, Paluck et al 2004, Sunderland et al 2004, Chambers et al 2005, Saini et al 2006). In the case of asthma, outreach programs have been shown to have beneficial effects in terms of reducing hospital admissions and emergency visits and improved asthma outcomes (Greineder et al 1995, Stout et al 1998, Kelly et al 2000, Legorreta et al 2000, Lin et al 2004). We proposed to extend the role of the community pharmacist beyond the traditional realm of the “pharmacy” into the community in rural Australia with the first asthma outreach programs designed for community pharmacy. The outreach programs were designed to include two health promotion strategies, the first targeting adolescents in high schools and the second targeting the general community. The project aimed firstly, to assess the feasibility of using community pharmacists to deliver two asthma outreach programs, one targeting adolescents and one for the wider community in a rural area and secondly, to assess the programs’ impact on adolescent asthma knowledge and requests for information at the community pharmacy. Excerpt Chapter 3 - Patient education is one of the six critical elements to successful long-term asthma management included in international and national asthma management guidelines, which have emphasised education as a process underpinning the understanding associated with appropriate medication use, the need for regular review, and self-management on the part of the person with asthma (Boulet et al 1999, National Asthma Council 2002, National Asthma Education and Prevention Program 2002, British Thoracic Society 2003, NHLBI/WHO 2005). The ongoing process of asthma education is considered necessary for helping people with asthma gain the knowledge, skills, confidence and motivation to control their own asthma. Since most health care professionals are key providers of asthma education, their knowledge of asthma and asthma management practices often needs to be updated through continuing education. This is to ensure that the education provided to the patient conforms to best practice guidelines. Moreover, health care professionals need to tailor this education to the patients’ needs and determine if the education provided results in an improvement in asthma knowledge. A review of the literature has revealed that a number of questionnaires have been developed that assess the asthma knowledge of parents of children with asthma (Parcel et al 1980, Fitzclarence and Henry 1990, Brook et al 1993, Moosa and Henley 1997, Ho et al 2003), adults with asthma (Wigal et al 1993, Allen and Jones 1998, Allen et al 2000, Bertolotti et al 2001), children with asthma (Parcel et al 1980, Wade et al 1997), or the general public (Grant et al 1999). However, the existing asthma knowledge questionnaires have several limitations. The only validated asthma knowledge questionnaire was developed in 1990 and hence, out of date with current asthma management guidelines (Fitzclarence and Henry 1990). The shortcomings of the other knowledge questionnaires relate to the lack of evidence of the validity (Wade et al 1997, Grant et al 1999, Bertolotti et al 2001), being outdated 81 with current concepts of asthma (Parcel et al 1980) or having been tested on small or inadequately characterised subject samples e.g. subject samples consisting of mainly middle class and well educated parents (Brook et al 1993, Wigal et al 1993, Moosa and Henley 1997, Allen and Jones 1998, Allen et al 2000, Ho et al 2003). Furthermore, most of the published asthma knowledge questionnaires have been designed to assess the asthma knowledge of the consumer (i.e. a lay person with asthma or a parent/carer of a person with asthma). There is no questionnaire specifically developed to assess the asthma knowledge of health care professionals, who are key providers of asthma education. It is hence important to have a reliable and validated instrument to be able to assess education needs and to measure the impact of training programs on asthma knowledge of health care professionals as well. An asthma knowledge questionnaire for health care professionals might also be used to gauge how successful dissemination and implementation of guidelines have been. Excerpt Chapter 4 - Asthma self-management education for adults that includes information about asthma and self-management, self-monitoring, a written action plan and regular medical review has been shown to be effective in improving asthma outcomes (Gibson et al 1999). These interventions have been delivered mostly in a hospital setting and have utilised individual and/or group formats. Fewer interventions have been delivered in a primary care setting, usually by qualified practice nurses and/or general practitioners or asthma educators and, to date, their success has not been established (Fay et al 2002, Gibson et al 2003). Community pharmacy provides a strategic venue for the provision of patient education about asthma. Traditionally, patient education provided by community pharmacists has been individualised. However, group education has been shown to be as effective as individualised education with the added benefits of being simpler, more cost effective and better received by patients and educators (Wilson et al 1993, Wilson 1997). While small group education has been shown to improve asthma outcomes (Snyder et al 1987, Bailey et al 1990, Wilson et al 1993, Yoon et al 1993, Allen et al 1995, Kotses et al 1995, Berg et al 1997, de Oliveira et al 1999, Marabini et al 2002), to date, no small-group asthma education provided by pharmacists in the community pharmacy setting has been implemented and evaluated.
40
Kritikos, Vicky. "INNOVATIVE ASTHMA MANAGEMENT BY COMMUNITY PHARMACISTS IN AUSTRALIA." University of Sydney, 2007. http://hdl.handle.net/2123/2064.
Abstract:
Doctor of PhilosophyExcerpt Chapter 2 - A review of the literature has revealed that asthma management practices in the Australian community are currently suboptimal resulting in significant morbidity and mortality. In adolescent asthma there are added challenges, with problems of self-image, denial and non-adherence to therapy where self-management skills assume a greater importance (Forero et al 1996, Price 1996, Brook and Tepper 1997, Buston and Wood 2000, Kyngäs et al 2000). In rural and remote areas in Australia, asthma management practices have been shown to be poorer and mortality rates from asthma are considerably higher compared to metropolitan areas (AIHW ACAM 2005, AIHW 2006). Limited access and chronic shortages of specialist services in rural areas are shifting the burden more and more towards the primary sector (AIHW 2006). It becomes paramount that people with asthma in rural settings become involved in self-management of their asthma and that community based health care providers be more proactive in facilitating these self-management behaviours by appropriate education and counselling. Health promotion activities, which are a broad range of activities including health education, have been acknowledged as having the potential to improve the health status of rural populations (National Rural Health Alliance 2002). Community pharmacy settings have been shown to be effective sites for the delivery of health promotion, screening and education programs (Anderson 2000, Elliott et al 2002, Cote et al 2003, Hourihan et al 2003, Watson et al 2003, Boyle et al 2004, Goode et al 2004, Paluck et al 2004, Sunderland et al 2004, Chambers et al 2005, Saini et al 2006). In the case of asthma, outreach programs have been shown to have beneficial effects in terms of reducing hospital admissions and emergency visits and improved asthma outcomes (Greineder et al 1995, Stout et al 1998, Kelly et al 2000, Legorreta et al 2000, Lin et al 2004). We proposed to extend the role of the community pharmacist beyond the traditional realm of the “pharmacy” into the community in rural Australia with the first asthma outreach programs designed for community pharmacy. The outreach programs were designed to include two health promotion strategies, the first targeting adolescents in high schools and the second targeting the general community. The project aimed firstly, to assess the feasibility of using community pharmacists to deliver two asthma outreach programs, one targeting adolescents and one for the wider community in a rural area and secondly, to assess the programs’ impact on adolescent asthma knowledge and requests for information at the community pharmacy. Excerpt Chapter 3 - Patient education is one of the six critical elements to successful long-term asthma management included in international and national asthma management guidelines, which have emphasised education as a process underpinning the understanding associated with appropriate medication use, the need for regular review, and self-management on the part of the person with asthma (Boulet et al 1999, National Asthma Council 2002, National Asthma Education and Prevention Program 2002, British Thoracic Society 2003, NHLBI/WHO 2005). The ongoing process of asthma education is considered necessary for helping people with asthma gain the knowledge, skills, confidence and motivation to control their own asthma. Since most health care professionals are key providers of asthma education, their knowledge of asthma and asthma management practices often needs to be updated through continuing education. This is to ensure that the education provided to the patient conforms to best practice guidelines. Moreover, health care professionals need to tailor this education to the patients’ needs and determine if the education provided results in an improvement in asthma knowledge. A review of the literature has revealed that a number of questionnaires have been developed that assess the asthma knowledge of parents of children with asthma (Parcel et al 1980, Fitzclarence and Henry 1990, Brook et al 1993, Moosa and Henley 1997, Ho et al 2003), adults with asthma (Wigal et al 1993, Allen and Jones 1998, Allen et al 2000, Bertolotti et al 2001), children with asthma (Parcel et al 1980, Wade et al 1997), or the general public (Grant et al 1999). However, the existing asthma knowledge questionnaires have several limitations. The only validated asthma knowledge questionnaire was developed in 1990 and hence, out of date with current asthma management guidelines (Fitzclarence and Henry 1990). The shortcomings of the other knowledge questionnaires relate to the lack of evidence of the validity (Wade et al 1997, Grant et al 1999, Bertolotti et al 2001), being outdated 81 with current concepts of asthma (Parcel et al 1980) or having been tested on small or inadequately characterised subject samples e.g. subject samples consisting of mainly middle class and well educated parents (Brook et al 1993, Wigal et al 1993, Moosa and Henley 1997, Allen and Jones 1998, Allen et al 2000, Ho et al 2003). Furthermore, most of the published asthma knowledge questionnaires have been designed to assess the asthma knowledge of the consumer (i.e. a lay person with asthma or a parent/carer of a person with asthma). There is no questionnaire specifically developed to assess the asthma knowledge of health care professionals, who are key providers of asthma education. It is hence important to have a reliable and validated instrument to be able to assess education needs and to measure the impact of training programs on asthma knowledge of health care professionals as well. An asthma knowledge questionnaire for health care professionals might also be used to gauge how successful dissemination and implementation of guidelines have been. Excerpt Chapter 4 - Asthma self-management education for adults that includes information about asthma and self-management, self-monitoring, a written action plan and regular medical review has been shown to be effective in improving asthma outcomes (Gibson et al 1999). These interventions have been delivered mostly in a hospital setting and have utilised individual and/or group formats. Fewer interventions have been delivered in a primary care setting, usually by qualified practice nurses and/or general practitioners or asthma educators and, to date, their success has not been established (Fay et al 2002, Gibson et al 2003). Community pharmacy provides a strategic venue for the provision of patient education about asthma. Traditionally, patient education provided by community pharmacists has been individualised. However, group education has been shown to be as effective as individualised education with the added benefits of being simpler, more cost effective and better received by patients and educators (Wilson et al 1993, Wilson 1997). While small group education has been shown to improve asthma outcomes (Snyder et al 1987, Bailey et al 1990, Wilson et al 1993, Yoon et al 1993, Allen et al 1995, Kotses et al 1995, Berg et al 1997, de Oliveira et al 1999, Marabini et al 2002), to date, no small-group asthma education provided by pharmacists in the community pharmacy setting has been implemented and evaluated.
41
Mostert, Zhan. "The impact of pharmaceutical care services on the management of asthma patients in a primary health care clinic." Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/574.
Abstract:
Optimal management of a chronic disease, like asthma, requires the active participation of patients. To achieve this, patients require education about asthma. Many of the recommended components of asthma care and management might not be effective without adequate patient education. Pharmacists in community, hospital and clinic practice are well placed to provide continued information and reinforcement of key messages, in order to improve compliance with medication and the outcomes of asthma management plans. Pharmacists may be able to increase medication adherence with patient counselling and monitoring systems and by facilitating communication with physicians. However, regardless of this, it remains uncertain whether pharmacist-patient interactions improve patient outcomes, and in spite of recommendations for teamwork and a multidisciplinary approach in the education of asthma patients, medical doctors and nurses are still largely responsible for carrying out the greatest part of patient education. The objectives of this study were therefore to determine the impact of pharmaceutical care services at a primary health care level on the management and well-being of asthmatic patients; to determine the effect of complex or multi-faceted pharmaceutical interventions, in patients with asthma, on lung function, asthma knowledge, attitudes and perceived self-management efficacy, asthma related quality of life and asthma control; and to determine the extent to which pharmacotherapeutic interventions, with regards to medication changes and dosage changes, are accepted and implemented by doctors. A randomised-control study was conducted at a primary health care clinic in the Eastern Cape. A total of 120 patients were allocated to two groups of sixty patients each (a Control Group and an Intervention Group). Baseline values were measured and follow-up interviews and post-intervention data collection were conducted three months afterwards for each group. Patients in the Control Group were attended to by the clinic staff as usual. Patients in the Intervention Group were educated on their disease by a pharmacist. The use of a customised 500ml plastic bottle as a spacer was suggested and each patient’s medication was evaluated against the Standard Treatment Guidelines for the management of asthma in adults at the primary health care level and where necessary, prescribing recommendations were made. Following assessment of the medication regimens of the patients in the Intervention Group, a total of 49 prescribing recommendations were made, of which 73 percent were accepted by both the doctor and patient. After educating the patients in the Intervention Group on inhaler technique, a significant improvement in technique was observed at the 3-month follow-up assessment (p<0.05). Using a short form of the Asthma Quality of Life Questionnaire (AQLQ(S)), a significant improvement post-intervention in mean total quality of life score (p<0.05) and mean average quality of life score (p<0.05) in the Intervention Group, were demonstrated. An improvement in mean activity limitation score in the Intervention Group post-intervention was also recorded for the activity limitation subscale of the AQLQ(S) (p<0.05). On measuring changes in asthma related knowledge, attitudes and self-efficacy, using a questionnaire (KASE-AQ), a significant improvement in mean knowledge score in the Intervention Group after the intervention (p<0.05) was also shown. With regards to lung function, both vital capacity (percent FVC) and expiratory flow volumes (percent FEV1) improved significantly in the Intervention Group (p<0.05). This study therefore demonstrated that multi-faceted pharmacist interventions, including medication assessment, asthma education, education on inhaler technique and the provision of medication aids in the form of spacers, can significantly improve the management of asthma patients and improve their well-being and quality of life.
42
Al-Hameli, Fahad M. "A study of the prescribing, dispensing and administration of medicines with reference to medication errors in the Armed Forces Hospital, Kuwait : an experimental investigation to determine the accuracy of the prescribing process, dispensing process and nurse administration of medication as compared with the prescriptions of physicians in the Armed Forces Hospital in Kuwait." Thesis, University of Bradford, 2010. http://hdl.handle.net/10454/4480.
Abstract:
Introduction: Medication errors are a major cause of illness and hospitalization of patients throughout the world. This study examines the situation regarding medication errors in the Armed Forces Hospital, Kuwait since no literature exists of any such studies for this country. Several types of potential errors were studied by physicians, nurses and pharmacists. Their attitudes to the commission of errors and possible consequences were surveyed using questionnaires. Additionally, patient medical records were reviewed for possible errors arising from such actions such as the co-administration of interacting drugs. Methods: This study included direct observations of physicians during the prescribing process, pharmacists while they dispensed medications and nurses as they distributed and administered drugs to patients. Data were collected and compiled on Microsoft Excel spreadsheet and analyses were performed using SPSS. Where applicable, results were reported as counts and/ or percentages of error rates. Nurses, pharmacists and physicians survey questionnaires: From the 200 staff sent questionnaires a total of 149 respondents comprising nurses (52.3%), physicians (32.2%) and pharmacists (16.1%) returned the questionnaires a total response rate of 74.5%. All responses were analyzed and compared item-by-item to see if there were any significant differences between the three groups for each questionnaire item. All three groups were most in agreement about their perception of hospital administration as making patient safety a top priority with regard to communicating with staff and taking action when medication errors were reported (all means 3.0 and p > 0.05). Pharmacists were most assured of administration support when an error was reported whereas nurses were least likely to see the administration as being supportive ( p < 0.001), and were more afraid of the negative consequences associated with reporting of medication errors (p = 0.026). Although nurses were generally less likely to perceive themselves as being able to communicate freely regarding reporting of errors compared to pharmacists there was no significant difference between the two groups. Both however were significantly different from physicians (p< 0.001). Physicians had the most favorable response to perceiving new technology as helping to create a safer environment for patients and to the full utilization of such technologies within the institution in order to help prevent medical errors. Scenario response - Responses to two scenarios outlining possible consequences, should a staff member commit a medication error, tended to be very similar among the three groups and followed the same general trend in which the later the error was discovered and the more grievous the patient harm, the more severe would be the consequences to the staff member. Interestingly, physicians saw themselves as less likely to suffer consequences and nurses saw themselves as more likely to suffer consequences should they have committed a medication error. All three groups were more likely to see themselves as facing dismissal from their job if the patient were to die. RESULTS OF ALL THREE OBSERVATIONS: Result of Nursing observations: For 1124 doses studied, 194 resulted in some form of error. The error rate was 17.2% and the accuracy was 82.8%. The commonest errors in a descending order were: wrong time, wrong drug, omission, wrong strength/ dose, wrong route, wrong instruction and wrong technique. No wrong drug form was actually administered in the observational period. These were the total number of errors observed for the entire month period of the study. IV Result of Pharmacist observations: A total of 2472 doses were observed during the one month period. Observations were done for 3 hours per day each day that the study was carried out. The study showed that there were 118 errors detected which were in the following categories respectively: 52 no instructions, 28 wrong drug/unordered, 21 wrong strength/dose, ignored/omission 13, shortage of medication 3 and expired date 1. Result of Prescribers in Chart review for drug-drug interactions: The analysis of the drug-drug interactions showed that out of a total of 1000 prescriptions, 124 had drug-drug interactions. None were found to fall into the highest severity rating i.e. 4 (contraindicated). Only twenty-one interactions were rated 3 (major), 87 interactions were rated moderate and 15 interactions were rated minor according the modified Micromedex scale. Patient education: All health care such as physician, pharmacist, and nurses have a responsibility to educate patient about their medication use and their health conditions to protecting them from any error can occur by wrong using drugs. Conclusion This study has contributed to the field of medication errors by providing data for a Middle Eastern country for the very first time. The views and opinions of the nurses, pharmacists and physicians should be considered to enhance the systems to minimize any errors in the future.
43
Ahmadvand, Alireza. "Augmented reality for information exchange between pharmacists and patients with diabetes mellitus." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/134407/1/Alireza_Ahmadvand_Thesis.pdf.
Abstract:
This higher–degree research project addressed the important issue of low health literacy in diabetes mellitus and high blood pressure by introducing a novel custom-built augmented reality app for smartphones and evaluating the effects of this app on people's self-efficacy in managing their diabetes and high blood pressure. This research project formally evaluated the new augmented reality app, trademarked MedAugment™, from multiple perspectives, i.e. the perspective of researchers, general practitioners, people living with diabetes, diabetes educators, and app/game developers. The project was a multidisciplinary partnership between six organisations, including academia, not-for-profit organisations, community organisations, private industries and service providers.
44
Trameaux, Gilles. "La pharmacie vétérinaire et le pharmacien." Paris 5, 1998. http://www.theses.fr/1998PA05P223.
45
Al-Saeed, Eman. "A mixed methods study of the feasibility and acceptability of an opportunistic community pharmacy based CVD risk assessment service in Alexandria, Egypt." Thesis, University of Cambridge, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.709157.
46
Schmitt, Michael Ronald. "The relationship among health literacy, physician and pharmacist counseling, written medicine information and non-steroidal anti-inflammatory drug risk awareness in older adults." Oklahoma City : [s.n.], 2009.
47
Capstick, Toby Gareth David. "The effectiveness of pharmacist interventions in improving asthma control and quality of life in patients with difficult asthma." Thesis, University of Bradford, 2014. http://hdl.handle.net/10454/13962.
Abstract:
Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma. Fifty-two patients attending a hospital difficult asthma clinic were randomised (1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists. Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50). At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates < 80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020). This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements.
48
Capstick, Toby G. D. "The Effectiveness of Pharmacist Interventions in Improving Asthma Control and Quality of Life in Patients with Difficult Asthma." Thesis, University of Bradford, 2014. http://hdl.handle.net/10454/13962.
Abstract:
Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma.
Fifty-two patients attending a hospital difficult asthma clinic were randomised
(1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists.
Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50).
At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates <80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020).
This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements.The Pharmaceutical Trust for Educational and Charitable Objects (PTECO) (now known as Pharmacy Research UK).
49
Cassini, Bäckström Cristina. "Safety and efficacy ofguanfacine in treating ADHD in children and adolescents: current status of knowledge : A literature study including important factors to consider as a pharmacist in a patient-counselling role." Thesis, Umeå universitet, Farmakologi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-136678.
50
Marrades, Camille Pineau Alain. "Oligo-éléments et santé le conseil à l'officine /." [S.l.] : [s.n.], 2008. http://castore.univ-nantes.fr/castore/GetOAIRef?idDoc=46801.