Academic literature on the topic 'Pharmacists New Zealand'

ABSTRACT IntroductionPharmacist integration into general practice is gaining momentum internationally, with benefits noted in reducing medication errors, improving chronic disease management and alleviating general practitioner workforce shortages. Little is known about how general practice pharmacists are working in New Zealand. AimThis study characterised the current landscape of pharmacist integration into general practice in New Zealand. MethodsAn online questionnaire was developed, piloted and distributed to all pharmacists in New Zealand. ResultsThirty-six responses were analysed. Respondents were more likely to be female, have been pharmacists for at least 10 years and all but one held formal postgraduate clinical pharmacy qualifications. Seven pharmacists were working as pharmacist prescribers. Primary health organisations (PHOs) were the most common employer, with funding primarily derived from either PHOs or District Health Boards. Pharmacist integration into general practice appears to have progressed further in particular regions of New Zealand, with most respondents located in the North Island. Tasks performed by respondents included medication reviews, managing long-term conditions and medicines reconciliation. Increased job satisfaction compared with previous roles was reported by most respondents. Funding and a general lack of awareness about pharmacists’ professional scope were seen as barriers to further expansion of the role. DiscussionThis study describes the characteristics of pharmacists currently working in general practices in New Zealand and provides insights into key requirements for the role. Understanding the way practice pharmacists are currently employed and funded can inform general practices considering employing pharmacists.

INTRODUCTION: One of the recommended methods for households to dispose of unused medications in many countries is to return them to community pharmacies. However, such a practice will only reduce the environmental levels of pharmaceuticals if the medications are also disposed of and destroyed properly by the pharmacies. AIM: This study reports the results of a questionnaire sent to New Zealand community pharmacists regarding disposal practices for unused or expired medications in their workplaces. METHODS: A pre-tested, self-administered questionnaire was sent to 500 randomly selected community pharmacies from all areas of New Zealand. The participants were asked how they disposed of a variety of medications. In addition, participants were also asked about whether they knew how unused medications were destroyed if their pharmacy used a third-party contractor or distributor to dispose of them. RESULTS: Of the 265 respondents, 80.4% and 61.1% respectively reported that solid and semi-solid medications were removed by contractors. However liquid and Class B controlled drugs were predominantly disposed of down the pharmacy sink. Over 60% of the participating pharmacists indicated that they believed the contractors incinerated the collected pharmaceutical waste, and over 90% of the participating pharmacists indicated their wish for a state-run disposal and destruction system. DISCUSSION: Liquid medications and Class B controlled drugs, which were commonly reported to be disposed of down the sewerage system, may increase the potential for environmental pollution by pharmaceuticals in New Zealand. There is a need for increased environmental awareness amongst community pharmacists in New Zealand. KEYWORDS: Medication disposal; pharmaceutical waste; environment; excess medication; community pharmacist

INTRODUCTION: Very few studies have investigated pharmacists’ views, experiences and practices regarding the use of antibiotics without prescription. This study aimed to explore through self-report and hypothetical scenarios what factors determine New Zealand pharmacists’ behaviour and attitudes towards non-prescription use of antibiotics. METHODS: A purposeful sample of 35 registered community pharmacists of differing ethnic backgrounds was selected from a mixture of pharmacies that predominantly either serve New Zealand European customers or customers of other ethnicities. Semi-structured interviews including general background questions and six hypothetical scenarios were used for the investigation. Pharmacists’ ethnicity, education, years of experience, and customers’ ethnicity may influence their views, experiences and practices regarding the use of antibiotics without prescription. Customer demand or expectation, business orientation and competitiveness within community pharmacies, standards and practice of fellow pharmacists, ethics and professionalism, legislation, enforcement of the legislation, and apprehension of the consequences of such practice were hypothesised to have an effect on antibiotic use or supply without prescription by pharmacists. FINDINGS: The supply of antibiotics without prescription is not common practice in New Zealand. However, personal use of antibiotics without prescription by pharmacists may have been underestimated. Pharmacists were aware of legalities surrounding selling and using antibiotics and practised accordingly, yet many used antibiotics without prescription to treat themselves and/or spouses or partners. Many pharmacists also reported that under certain legislative, and regulatory and situational conditions they would sell antibiotics without a prescription. CONCLUSION: Views and practices regarding antibiotic use without prescription by community pharmacists require further exploration. KEYWORDS: Non-prescription antibiotics; hypothetical scenarios; legislation enforcement; New Zealand

Introduction: Community pharmacies are high-performance workplaces; if the environment is not conducive to safe practice, mistakes can occur. There has been increasing demand for pharmacists during the COVID-19 pandemic as they have become integral to the response. Suboptimal practices in the work environment and with pharmacists and their teams can impact the safe delivery of services. New Zealand pharmacists’ perceptions of the current work environment and beliefs around whether suboptimal practice have increased within the last five years and the effect of the COVID-19 pandemic on their practices are unknown. Aim/Objectives: To assess what New Zealand pharmacists associate with suboptimal practice in their workplace and investigate the effect of the COVID-19 pandemic on pharmacists and their workplaces. Methods: We employed an anonymous online questionnaire derived from a human factors framework utilised in the aviation industry to explore the potential environment, team and organisational factors as the determinants of suboptimal work practices. The software, hardware, environment and liveware (S.H.E.L.L) model was adapted to create questions classifying the risk factors to potentially identify aspects of work systems that are vulnerable and may provide risks to optimal practice. Additional perceptions around the effect of COVID-19 on their workplace and roles as pharmacists were explored. Participants were community pharmacists working in New Zealand contacted via a mailing list of the responsible authority for the profession. Findings: We received responses from 260 participants. Most participants indicated that suboptimal practice had increased in the last 5 years (79.8%). The majority of participants indicated that COVID-19 had impacted their workplaces (96%) and their roles as pharmacists (92.1%). Participants perceived that suboptimal practice was associated with a lack of leadership and appropriate management; poor access to resourcing, such as adequate staff and narrow time constraints for work tasks; a lack of procedures; competition; and stress. A lack of experience, professionalism and poor communication between staff, patients and external agencies were also issues. COVID-19 has affected pharmacists personally and their work environments. Further study in this area is required. Conclusions: We have identified that pharmacists across all sectors of New Zealand agreed that suboptimal practices had increased in the last 5 years. A human factors S.H.E.L.L framework can be used to classify themes to understand the increases in suboptimal practice and the role of COVID-19 on pharmacist practice. Many of these themes build on the growing body of the international literature around the effect of the pandemic on pharmacist practice. Areas for which there are less historical data to compare longitudinally include pharmacist wellbeing and the impact of COVID-19.

INTRODUCTION: Internationally, non-medical practitioners are increasingly involved in tasks traditionally undertaken by general practitioners (GPs), such as medication review and prescribing. This study aims to evaluate GPs’ perceptions of pharmacists’ contributions to those services. METHODS: Semi-structured interviews were carried out in two localities with GPs whose patients had and had not undergone a pharmacist-led adherence support Medication Use Review (MUR). GPs were asked their opinions of pharmacists’ provision of MUR, clinical medication review and prescribing. Data were analysed thematically using NVivo 8 and grouped by strengths, weaknesses, opportunities and threats (SWOT) category. FINDINGS: Eighteen GPs were interviewed. GPs mentioned their own skills, training and knowledge of clinical conditions. These were considered GPs’ major strengths. GPs’ perceived weaknesses were their time constraints and heavy workloads. GPs thought pharmacists’ strengths were their knowledge of pharmacology and having more time for in-depth medication review than GPs. Nevertheless, GPs felt pharmacist-led medication reviews might confuse patients, and increase GP workloads. GPs were concerned that pharmacist prescribing might include pharmacists making a diagnosis. This is not the proposed model for New Zealand. In general, GPs were more accepting of pharmacists providing medication reviews than of pharmacist prescribing, unless appropriate controls, close collaboration and co-location of services took place. CONCLUSION: GPs perceived their own skills were well suited to reviewing medication and prescribing, but thought pharmacists might also have strengths and skills in these areas. In future, GPs thought that working together with pharmacists in these services might be possible in a collaborative setting. KEYWORDS: Community pharmacy services; general practitioners; New Zealand; primary health care; professional role

Objectives: To describe primary care pharmacists’ current scope of practice in relation to laboratory testing. Method: A 2-tiered search of key databases (PubMed, EMBASE, MEDLINE) and grey literature with the following MeSH headings: prescribing, pharmacist/pharmacy, laboratory test, collaborative practice, protocols/guidelines. We focused on Canada, the United States, the United Kingdom, New Zealand and Australia for this review. Results: There is limited literature exploring primary care pharmacists’ scope of practice in relation to laboratory testing. The majority of literature is from the United States and Canada, with some from the United Kingdom and New Zealand and none from Australia. Overall, there is a difference in regulations between and within these countries, with the key difference being whether pharmacists access and/or order laboratory testing dependently or independently. Canadian pharmacists can access and/or order laboratory tests independently or dependently, depending on the province they practise in. US pharmacists can access and/or order laboratory tests dependently within collaborative practice agreements. In the United Kingdom, laboratory testing can be performed by independent prescribing pharmacists or dependently by supplementary prescribing pharmacists. New Zealand prescribing pharmacists can order laboratory testing independently. Most publications do not report on the types of laboratory tests used by pharmacists, but those that do predominantly resulted in positive patient outcomes. Discussion/Conclusion: Primary care pharmacists’ scope of practice in laboratory testing is presently limited to certain jurisdictions and is often performed in a dependent fashion. As such, a full scope of pharmacy services is almost entirely unavailable to patients in the United States, the United Kingdom, New Zealand and Australia. Just as in the case for pharmacists prescribing, evidence indicates better patient outcomes when pharmacists can access/order laboratory tests, but more research needs to be done alongside the implementation of local guidelines and practice standards for pharmacists who practise in that realm. Patients around the world deserve to receive a full scope of pharmacists’ practice, and lack of access to laboratory testing is one of the major obstacles to this. Can Pharm J (Ott) 2019;152:xx-xx.

INTRODUCTION: Reducing health disparities is a priority for the New Zealand (NZ) Government and the health care sector and, although not mandatory until 2012, Competence Standard 1 for NZ pharmacists has been revised to reflect this. AIM: The main aim was to understand the information needs of pharmacists in the context of reducing health inequalities in NZ through undertaking a baseline study of pharmacists’ knowledge of health status disparities, identifying relevant resources most commonly read by pharmacists, soliciting ideas on how the profession can contribute to reducing health disparities and gauging pharmacists’ willingness to undergo further training. METHOD: An anonymous, semi-structured questionnaire was posted out to 500 randomly selected practising pharmacists registered in NZ. RESULTS: A 27% response rate was achieved. In general, responding pharmacists had good health disparity knowledge about asthma and the prevalence of cardiovascular disease, but were less knowledgeable about differences in life expectancies and some mortality rates. Responding pharmacists made a variety of achievable suggestions where pharmacists can contribute to decreasing health disparities. Eighty percent of respondents indicated they were interested in learning more about cultural competence and health disparities in their community. DISCUSSION: Our results indicate a need for pharmacists to up-skill in the area of health disparities and cultural competence and for more effective promotion of the resources available to pharmacists to improve their knowledge in this area. The pharmacists in this study appear willing to undertake such study; however, due to the low response rate generalisations to all pharmacists practising in New Zealand cannot be made. KEYWORDS: Pharmacists; New Zealand; health disparities; cultural competency

ABSTRACT INTRODUCTION Recognition of the need to reduce harm and optimise patient outcomes from the use of medicines is contributing to an evolution of pharmacy practice in primary health care internationally. This evolution is changing community pharmacy and leading to new models of care that enable pharmacist contribution beyond traditional realms. There is little information about the extent of these changes in New Zealand. AIM The aim of this study was to investigate emerging roles of pharmacists in primary health care. METHODS A 10-question electronic survey was used to collect quantitative data about location, employment and roles of pharmacists practising in primary health care. RESULTS There were 467 survey responses. Although most pharmacists are employed by (78%, n = 357/458) and located in (84%, n = 393/467) community pharmacies, small numbers are dispersed widely across the primary health care sector. Of the 7% (n = 31/467) working in general practices, most are employed by Primary Health Organisations or District Health Boards. Limited cognitive pharmacy service provision is evident in the sector overall, but is much greater for pharmacists spending time located within general practices. DISCUSSION The large proportion of pharmacists practising in community pharmacies emphasises the importance of the Community Pharmacy Services Agreement in facilitating increased cognitive pharmacy service provision to optimise patient outcomes. The small numbers of pharmacists located elsewhere in the primary health care sector suggest there is scope to improve collaboration and integration in these areas. Flexible funding models that promote innovation and support sustainable practice change are key.

PurposeThis study explores nurses' views as to whether they see community pharmacists as “entrepreneurial” and what this might mean for working together in primary care. Pharmacists are expected to fully integrate with their colleagues – particularly nurses – under the New Zealand health policy. Yet, there is scarce literature that examines multidisciplinary teamwork and integration through an entrepreneurial identity lens. This is particularly important since around the world, including New Zealand, community pharmacies are small businesses.Design/methodology/approachThis was an exploratory qualitative study. A total of 18 semi-structured interviews were conducted with nurses from primary care, nursing professional bodies and academics from nursing schools. Interviews were audio recorded and transcribed verbatim. Coding was undertaken through general inductive thematic analysis.FindingsIn total three key themes emerged through analysis: the entrepreneurial profile of the community pharmacist, the lack of entrepreneurship across the profession, and the role identity and value that community pharmacists hold, as viewed by nurses. There appeared to be pockets of entrepreneurship in community pharmacy; nurses did not express a blanket label of entrepreneurship across the whole sector. Nurses also discussed several forms of entrepreneurship including commercial-oriented, clinical and social entrepreneurship. The social entrepreneurship identity of community pharmacists sat most comfortably with nurse participants. Overall, nurses appeared to value community pharmacists but felt that they did not fully understand the roles that this profession took on.Research limitations/implicationsThis paper contributes to the academic literature by identifying three domains of entrepreneurship relevant to community pharmacy as well as multi-level barriers that will need to be jointly tackled by professional bodies and policy-makers. Improving nurses' and other healthcare professionals' knowledge of community pharmacists' role and expertise is also likely to facilitate better inter-professional integration.Originality/valueThere is scarce literature that attempts to understand how entrepreneurial identity plays out in health organisation and management. This study adds to the knowledge base of factors influencing integration in healthcare.

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

This study set out to explore the nature of the relationship between organisational culture (OC) and organisational effectiveness (OE) within six New Zealand community-based pharmacies. Internationally, community pharmacy is under pressure to integrate within the rest of primary care, and to ‘reprofessionalise’ through role extension via the provision of enhanced clinical services. A previous New Zealand organisational climate study identified that pharmacist attitudes and behaviours are barriers to implementing a policy-aligned vision. This climate study provided the impetus for the in-depth cultureeffectiveness study described here. Historically, management literature has adopted linear, causal, and unidirectional approaches to studying the relationship between OC and OE. Within the health sector, there has been movement away from this by informed and intellectually curious academics. They recognise the need for a deeper, richer understanding of the relationship between OC and OE and the notion of linearity is largely being replaced by one of patterns of culture and contingent relationships. This thesis describes conceptual research; a theory building exercise, in which OC is framed as socially constructed, and OE as multi-constituent, value-laden, and politically charged. The ontological assumptions are founded on social constructionism; the epistemological stance is interpretative. Concept mapping exercises were undertaken to inductively generate the OC and OE constructs as anchor points for discussion with all staff in six pharmacies; 47 interviews in total. A construct labelled Valued Outcomes (VO) emerged to supersede OE as the end-point in the discussion about the influence of OC on OE. In this study, OE manifest as technical performance, supported by cultural orientation toward procedure and process. The attainment of VO was contingent upon technical performance, but also upon the internal four-wall culture and co-production of OC with external actors. Both OC and VO reflected the duality of community pharmacy as retailer and as health care provider. OE influences OC in complex, non-linear, and recursive ways. Together, the contingent and recursive relationships support the idea of mutual constitution of OC and OE. In this study OC was dominant, and despite the development of OC and OE as separate constructs they emerged as overlapping and partially conflated. This study’s findings of complex, non-linear, and recursive interplays between OC and organisational outcomes further supports contemporary literature’s gradual movement away from direct causal relationships between OC and OE. The observation in this study, of conflation and mutual constitution, explains the difficulty seen in previous studies with conceptualising and operationalising both OC and OE as completely separate constructs. Emergence of the VO construct and the manifestation of OE as technical performance support the notion of construct identity, and in this thesis the argument is made for sound definition and conceptualisation of organisational constructs within future OC-OE studies. The observation of recursive relationships between OE and OC adds to existing health services research literature, with a call for its consideration in the design of future OC-OE studies. There are implications for future research, policy, and practice within the community pharmacy sector. Community pharmacy provides a rich context for the application of organisational theory, and this research provides a platform for future pharmacy-based health services research.

Founded in 2007 by couple Kam and Reet Phulwani, Medsurge is among the fastest-growing family-owned pharmaceutical companies in Australia, supplying specialised life-saving medicines to healthcare professionals across Australia and New Zealand. Medsurge was born from the humble beginnings of Kam and Reet, who were motivated by their like-minded passion to help people and make a difference through medicine. Coming from a family of doctors, Kam followed in their footsteps to become a pharmacist with a goal of healing people and benefitting society. Meanwhile, Reet's entrepreneurial spirit was forged through her family background, with many family members engaged in business and technology roles. The duo initially faced challenges getting their business started while working full-time and receiving no bank loans. Today, Medsurge employs 40 staff to service 6,500 hospitals, supplying upwards of 700 medicines. This chapter explores how Kam and Reet grew their start-up into a thriving global business.