Search results

The purpose of this paper is to lay out how advanced practitioner development occurs in New Zealand primary health care settings. The paper specifically focuses on mechanisms occurring across policy creation and in practice leading to successful role development.

The authors applied a realist approach involving interviews, document review and field log observations to create refined theories explaining how successful development occurs.

Three final mechanisms were found to influence successful advanced practitioner role development: engagement in planning and integrating roles; establishing opportunities as part of a well-defined career pathway; and championing role uptake and work to full scopes of practice.

This research focuses on one snapshot in time only; it illustrates the importance of actively managing health workforce change. Future investigations should involve the continued and systematic evaluation of advanced practitioner development.

The successful development of advanced practitioner roles in a complex system necessitates recognising how to trigger mechanisms occurring at times well beyond their introduction.

Potential candidates for new roles should expect roadblocks in their development journey. Successfully situating these roles into practice through having a sustainable and stable workforce supply provides patients with access to a wider range of services.

This is the first time a realist evaluation has been undertaken, in New Zealand, of similar programmes operating across multiple sites. The paper brings insights into the process of developing new health programmes within an already established system.

Pharmaceutical companies' marketing strategies have traditionally targeted only physicians and, more recently, consumers. The purpose of this paper is to explore the role of the pharmacist as prescriber, influencer, switcher, and dispenser of pharmaceutical drugs in one developing country, Egypt.

The authors surveyed pharmacists in Cairo, Egypt. The pharmacists were asked to estimate the percentages of patients who came in with a prescription, with only a box or a recommendation for a medicine and with only symptoms, and whether he/she switched the patient to another medicine. Pharmacies were classified as to the social class of the pharmacy neighborhoods. Cluster analysis was used to further classify pharmacists as “Influencers” and “Non‐influencers”.

Overall the pharmacists influence 39 percent of all purchase decisions for pharmaceuticals with higher levels of influence in lower social class neighborhoods. Approximately one out of four pharmacists was classified as an Influencer.

In developing countries, the pharmacist plays a key role in which medicines patients ultimately purchase. Marketing activities directed toward the pharmacist may provide an important opportunity to maximize the pharmaceutical firms' return on marketing investment.

Few studies have looked at the marketing of pharmaceutical drugs in developing countries. This paper is unique in that it examines the role of the pharmacist in these markets, thus providing an important addition to the understanding of the challenges to the industry in these countries and important implications for pharmaceutical marketing strategies.

This study aims to explore the views of pharmacy professionals (PPs) in Portugal about generic medicines and international non-proprietary name (INN) prescribing and compare them with the views of general practitioners (GPs).

A self-administered questionnaire was used to collect data from a sample of 185 community PPs and 85 GPs. Their perceptions were examined using a five-point Likert scale applied to statements focusing on five main topics of interest: motivation, safety, users’ perceptions and knowledge, advantages and disadvantages of generic medicines and INN prescribing. Daily experiences and suggestions for decreasing health and pharmaceutical expenses were explored through open-ended questions. Nonparametric tests were used to compare attitudes between both groups and to explore associations between the level of agreement and respondents’ demographic characteristics. Content analysis was used to categorize the answers to the open-ended questions.

Generally, GPs expressed more negative opinions toward generics and INN prescribing than PPs. GPs perceived generics as less effective, less safe, inferior in quality, more likely to cause side effects and believed that users do not trust them. Both groups believed that patients remain very confused and ill-informed about generics, only adhering to them because of their low cost and expressed concerns about the existence of an excessive number of generic medicines and the lack of patients’ responsibility toward medicines costs.

To the best of the authors’ knowledge, this study represents the first attempt to elicit and compare Portuguese GPs and PPs opinions concerning INN prescribing.

The purpose of this paper is to determine pharmacists’ knowledge of legal highs (novel psychoactive substances (NPS)).

A questionnaire was handed out at two London pharmacist continuing education events in mid-2014. These events update pharmacists about developments of interest/relevance to the profession and to improve their practice. A total of 54 forms were returned; a response rate of 26 percent.

Most pharmacists had poor knowledge of NPS and many considered that NPS were not important to their work, with few having had to advise customers in this area. Despite this, the majority thought that they had insufficient information about NPS. There was a negative correlation between the age of the pharmacist and knowledge of NPS.

The sample is a self-selected one drawn from registered pharmacists working in community pharmacies in northwest London, and thus does not include hospital pharmacies. Self-selection means that respondents may only reflect those who are interested in the NPS phenomenon and not the wider pharmacy community. The geographical area covered may not be representative of London as a whole, or indeed other parts of the UK or other EU countries.

It is clear that pharmacists do not know much about NPS but would like to know more. This information might improve their practice.

Pharmacists, easier to see than general practitioners, could be a useful source of information for NPS misusers.

There have been no previous attempts to gauge the level of knowledge by pharmacists of legal highs/NPS in the UK or elsewhere to our knowledge.

Using the example of medication safety, this paper aims to explore the impact of three managerial interventions (adverse incident reporting, ward‐level support by pharmacists, and a medication safety subcommittee) on different professional communities situated in the English National Health Service (NHS).

Semi‐structured interviews were conducted with clinical and managerial staff from two English NHS acute trusts, supplemented with meeting observations and documentary analysis.

Attitudes toward managerial intervention differ by professional community (between doctors, nurses and pharmacists) according to their existing norms of safety and perceptions of formal governance processes.

The heterogeneity of social norms across different professional communities and medical specialties has implications for the design of organisational learning mechanisms in the field of patient safety.

The paper shows that theorisation of professional “resistance” to managerialism privileges the study of doctors' reactions to management with the consequent neglect of the perceptions of other professional communities.

Institutional pharmaceutical services have widely evolved over the past 20‐30 years. Hospital pharmacy practice has changed from a profession concerned chiefly with the bulk preparation and distribution of drug products to one centred on ensuring optimal drug therapy. Whereas hospital pharmacists were charged with maintaining large drug stock on nursing units, many of them now provide individualised patient therapies. The practice of hospital pharmacy has therefore become one encompassing all aspects of drug therapy, from the procurement of drugs and drug delivery devices, their preparation and distribution, to their most appropriate selection and use for each patient. Hospital pharmacy services have traditionally had little involvement at the key stages in patients’ hospital care. This leads to the conclusion that the model of clinical pharmacy practice adopted by many pharmacy department hospitals is no longer appropriate for the demands of today’s health‐care services. Reviews many new models proposed for clinical pharmacy practice including an integrated model for providing a pharmaceutical care management approach in the health‐care system. This model is a response to the failures of traditional drug therapy. It is primarily an idea about how health professionals and patient should integrate their work to obtain outcomes important to patients and clinicians.

The purpose of this paper is to investigate if positive behavioural support (PBS) can be an effective alternative to medication, and can aid medication reduction in people with a learning disability, autism or both who are prescribed psychotropic medication for behaviour thought to be challenging. STOMP is an initiative supported by NHS England which aims to reduce inappropriate prescribing of psychotropic medication, i.e. antipsychotics used for challenging behaviour in the absence of a documented mental health diagnosis. PBS has been described as the first line of intervention for behaviours which challenge, (NICE, 2015) and has been highlighted as a non-pharmacological alternative to, medication.

A two-group, experimental design was utilised. Both groups were considered for medication reduction. The experimental group of 25 people received input from a specialist PBS team, while the control group of 29 people underwent unsupported medication challenge.

There was a significantly higher success rate for medication reduction and discontinuation when PBS assessment and intervention was provided as an alternative to medication.

This study indicates that providing PBS is associated with decreased medication and if replicated should be become standard practice for specialist teams.

This is the first study to investigate the effect of PBS on medication reduction in patients prescribed psychotropic medication for behaviour thought to be challenging.

The purpose of this paper is to investigate the percentage of generic inventory pharmacists have in stock, to comprehend why pharmacists in Jordan recommend and dispense generic products.

In total, 104 pharmacists were surveyed using a structured questionnaire. The questionnaire contained statements about perception of generic products, inclination to recommend generic products, importance of promotions, factors influencing a recommendation, stock of generics, and among others. Correlational and discriminant analyses were used to establish associations between variables to distinguish characteristics between groups.

More than half of the Jordanian pharmacists sampled carry between 20 and 39 per cent stock of generic drugs and 46 per cent carry more than 40 per cent stock. One‐third (33 per cent) substitutes branded products by generic ones and slightly more (36 per cent) recommend more generic than branded products as opposed to those who recommend more branded products (24 per cent). Male pharmacists (49 per cent) tend to recommend more generic products than do females (24.6 per cent) and those who recommend more branded products are more influenced by sales visits rather than manufacturer's name or bonuses.

The paper provides valuable information about the pharmaceutical industry in Jordan and the empirical study adds insights from pharmacists about generic medicine.

Off-label drug prescribing by healthcare providers is a growing practice. Yet, the US Food and Drug Administration bans the marketing of drugs for off-label uses. In recent years, legal challenges by the pharmaceutical industry have chipped away government restrictions on off-label drug promotion. Although the changing legal landscape has been discussed, this paper aims to examine how key stakeholders and policy-makers might interact to provide a more transparent marketing environment for off-label drug discussions in the patient–provider relationship.

Drawing on a variety of sources, the authors assess the current marketing landscape of off-label drugs and some of the issues that challenge the healthcare provider–patient relationship. The authors then examine opportunities to improve the off-label promotion environment and the relevant decision-making theories that key stakeholders need to consider when formulating marketing efforts and policies.

The authors suggest that fewer restrictions on truthful, non-misleading off-label drug promotion provide an opportunity to improve drug knowledge and, importantly, healthcare provider and consumer decision-making. Key stakeholders should consider, among other solutions, criteria for defining truthful information on off-label drugs, alternative methods of approval of off-label uses and ubiquitous icons to identify off-label prescribing to all stakeholders.

Rather than rehash the legal landscape of off-label drug promotion, this paper focuses on how the healthcare provider–patient relationship is impacted and how stakeholders can improve information flow in this changing environment.

As healthcare reform takes shape, many challenges face hospital pharmacists. An opportunity exists to combine the principles of patient‐focused care and pharmaceutical care to redesign the role of pharmacy. To achieve this objective, pharmacy departments should adopt business concepts such as process re‐engineering. Process re‐engineering is a change management tool which aims to produce dramatic improvement in performance measures by re‐designing the process. The goal of restructuring is to increase the amount of time pharmacists spend providing pharmaceutical care to patients. The pharmaceutical care concept is a method of delivering pharmaceutical care services that match individual patient needs with the services provided. This article describes many hospital pharmacy department transitions to a patient focused care environment by adopting the patient focused care concept and the process re‐engineering to improve the quality of patient care through systems improvement.