Development of Community Pharmacy Competencies.

Objective: This study aimed to develop a consensus statement of competencies for community pharmacists in Thailand. Methods: A 2-round modified Delphi process was used to develop consensus among a panel of community pharmacy experts. A total of 18 experts from 6 stakeholders represented a panel of each pharmacy organization in Thailand. In the first experts were asked to rate their degree of agreement on whether a competency was essential using a 7-point Likert scale (1 = "not essential competency" to 7 = "the most essential competency"). Also, in the second round, they were asked to rate the competencies from a scale of "must be included" to "must be excluded." Competencies considered "must be excluded" by a consensus of 80% or more of experts were removed from the community pharmacy competency list. Results: Nearly half the experts had experience in their position for more than 10 years. The expert panels were typically committee members of the Community Pharmacy Association (Thailand) and community pharmacy clerkship preceptors (29.4% and 23.5%, respectively). The number of community pharmacy competencies on the initial list was 55 competencies. None of them was eliminated after the first round. Of 55 competencies, 11 were eliminated after the second round. The final list of competency statements was 44 competencies divided into 4 domains: personal competencies, pharmacy professional competencies, patient care competencies, and management competencies. Conclusion: Community pharmacy competencies include having a positive attitude and being accountable for individual patient care, providing disease prevention and health promotion, and addressing morality and ethics in business.

A transition from the BPharm to the PharmD degree in five selected countries.

This review focuses on the studies and opinions around issues of transition from the BPharm to the PharmD degree in the U.S., Japan, South Korea, Pakistan and Thailand. The transition to the clinically orientated PharmD degree in many countries was seen to be a means of developing the profession. However, some countries have both clinically-oriented and pharmaceutical sciences-oriented PharmD programme that are designed to meet the needs of their countries. Each country created a different process to handle the transition to an all-PharmD programme, but mostly had the process of school accreditation mandated by the regulatory bodies. The main barrier to the transition in most of the countries was the issue of educational quality. A set of indicators is needed to measure and monitor the impact/outcome of the PharmD degree. Each country has different needs due to the different contexts of health care systems and the scope of pharmacy practice. In order to increase their chances of benefiting from the new programme, academic leaders should critically assess their countries' needs before deciding to adopt a PharmD programme.

A transition from the BPharm to the PharmD degree in five selected countries

This review focuses on the studies and opinions around issues of transition from the BPharm to the PharmD degree in the U.S., Japan, South Korea, Pakistan and Thailand. The transition to the clinically orientated PharmD degree in many countries was seen to be a means of developing the profession. However, some countries have both clinically-oriented and pharmaceutical sciences-oriented PharmD programme that are designed to meet the needs of their countries. Each country created a different process to handle the transition to an all-PharmD programme, but mostly had the process of school accreditation mandated by the regulatory bodies. The main barrier to the transition in most of the countries was the issue of educational quality. A set of indicators is needed to measure and monitor the impact/outcome of the PharmD degree. Each country has different needs due to the different contexts of health care systems and the scope of pharmacy practice. In order to increase their chances of benefiting from the new programme, academic leaders should critically assess their countries' needs before deciding to adopt a PharmD programme

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Are we on the right track? Answers from a national survey of Thai graduates' perceptions during the transition to the 6-year PharmD program.

PURPOSE: To serve the higher demands of pharmaceutical services, pharmacy education in Thailand has shifted from 5-year BPharm program to 6-year PharmD program with two specialization tracks: pharmaceutical care (PC) and industrial pharmacy (IP). This study aimed to compare the perceptions regarding professional competencies, pharmacy profession, and planned workplace between graduates with 5-year BPharm and 6-year PharmD and between those with PC and IP specialty. METHODS: A cross-sectional national survey using a paper-pencil self-administered questionnaire was distributed to all new graduates attending the pharmacy licensure examination in March 2015. RESULTS: Of all 1,937 questionnaires distributed, 1,744 were returned and completed (90% response rate). Pharmacy graduates rated highest on their competencies in professional ethics, followed by PC services and system management. They rated low confidence in medication selection procurement and pharmaceutical industry competencies. The 6-year PharmD graduates showed higher confidence in ethics and professional pride than the 5-year BPharm graduates. Graduates with PC specialty rated higher perceived competency in PC, system management, primary care, and consumer protection domains, while the IP graduates were superior in IP and medication selection and procurement domains, and most graduates (PC and IP) intended to work mainly in a hospital or a community pharmacy. Hospital was preferred for the PC graduates, and the IP graduates were more likely to work in pharmaceutical industry, regulation and consumer protection, sales and marketing, and academia. CONCLUSION: With some gaps still to be filled, the transition from 5-year BPharm to 6-year PharmD program with specialty tracks gave extra confidence to graduates in their specialty competencies and professional pride, leading to differences in preferred workplace. The findings of this study reflect that Thai pharmacy education continues to adjust to the needs of the society and the changing health care environments. Longitudinal monitoring to observe this transition is needed for both curriculum adjustment and competency of the graduates.

Does a transition in education equate to a transition in practice? Thai stakeholder's perceptions of the introduction of the Doctor of Pharmacy programme.

BACKGROUND: Pharmacy education and pharmacy practice are facing remarkable changes following new scientific discoveries, evolving patient needs and the requirements of advanced pharmacy competency for practices. Many countries are introducing or undertaking major transformations in pharmacy education. The Thai pharmacy curriculum has been changed from a 5-year BPharm and a 6-year PharmD to only a 6-year PharmD programme. Curriculum change processes usually involve stakeholders, including both internal and external educational institutions, at all levels. This study aims to understand the experiences and perceptions of stakeholders regarding the transition to an all-PharmD programme in Thailand. METHODS: Semi-structured interviews were conducted in Thailand with 130 stakeholders (e.g., policy makers, pharmacy experts, educators, health care providers, patients, students and parents) from August-October 2013. The interviews were audio recorded, transcribed verbatim and analysed using an inductive thematic analysis. RESULTS: Three main themes were derived from the findings: 1. influences on curriculum change (e.g., the needs of pharmacists to provide better patient care, the US-Thai consortium for the development of pharmacy education); 2. perceived benefits (e.g., improve pharmacy competencies from generalists to specialists, ready to work after graduation, providing a high quality of patient care); and 3. concerns (e.g., the higher costs of study for a longer period of time, the mismatch between the pharmacy graduates' competency and the job market's needs, insufficient preceptors and training sites, lack of practical experience of the faculty members and issues related to the separate licenses that are necessary due to the difference in the graduates' specialties). CONCLUSIONS: This is the first study to highlight the issues surrounding the transition to the 6-year PharmD programme in Thailand, which was initiated due to the need for higher levels of competency among the nation's pharmacists. The transition was influenced by many factors. Many participants perceived benefits from the new pharmacy curriculum. However, some participants were concerned about this transition. Although most of the respondents accepted the need to go forward to the 6-year PharmD programme, designing an effective curriculum, providing a sufficient number of qualified PharmD preceptors, determining certain competencies of pharmacists in different practices and monitoring the quality of pharmacy education still need to be addressed during this transitional stage of pharmacy education in Thailand.

Hospital pharmacists' perceptions of the suitability of doctor of pharmacy graduates in hospital settings in Thailand.

BACKGROUND: Thai pharmacy education has moved to an all Doctor of Pharmacy (PharmD) programme. However, there has been no previous research about the perceptions regarding the suitability of PharmD graduates employed in hospital settings, which is the major pharmacy workforce in Thailand. METHODS: A cross-sectional survey questionnaire was distributed to 180 hospital pharmacists at the 2013 Association of Hospital Pharmacy (Thailand) conference. This study aimed to explore Thai hospital pharmacists' perceptions concerning the suitability of the PharmD graduates employed in hospital settings and the competency differences between the Bachelor of Pharmacy (BPharm) and PharmD graduates. Descriptive statistics were used to present the participants' demographics and their perceptions. An inductive thematic analysis was used to analyse the open-ended written answers. RESULTS: Ninety-eight valid responses were included in the data analysis (response rate of 55.6 %). The majority of the respondents (76.5 %) felt that the PharmD graduates were suited for the hospital setting and addressed its need for more professionals working in pharmaceutical care and with multi-disciplinary teams. Approximately 55 % of respondents agreed that there were competency differences between the BPharm and PharmD graduates. Major themes emerged in response to the open-ended written answers showing that PharmD graduates had high competency in patient care services and readiness to work, particularly in large hospitals, due to their training to work in specialised areas (e.g., special clinics, ward rounds). However, PharmD graduates require more training in health promotion and humanistic skills and need the system to promote the role of PharmD in pharmaceutical care. CONCLUSIONS: PharmD graduates were suited for hospital settings. However, there were concerns regarding the suitability of the PharmD graduates for the community hospital and primary care hospital settings because of their insufficient training in health promotion and disease prevention. Half of the respondents perceived PharmD graduates as having higher competencies in clinical activities and being more prepared to work than BPharm graduates. However, the other half of the respondents perceived the competency of both pharmacy qualifications as being similar, as PharmD graduates provide non-clinical activities similar to BPharm graduates due to the high workload in dispensing services and the shortage of hospital pharmacists, which prevent PharmD graduates from providing direct pharmaceutical care services.

A Survey of Pharmacy Education in Thailand.

OBJECTIVE: To explore the current status of pharmacy education in Thailand. METHODS: The International Pharmaceutical Federation of the World Health Organization's (FIP-WHO) Global Survey of Pharmacy Schools was used for this study. The survey instrument was distributed to the deans of the 19 faculties (colleges) of pharmacy in Thailand. RESULTS: More than half the colleges have been in existence less than 20 years, and the government owns 80% of them. There were 2 paths of admission to study pharmacy: direct admission and central admission system. The doctor of pharmacy (PharmD) programs can be divided into 4 types. Approximately 60% of all teaching staff holds a doctoral degree. Regarding the work balance among teaching staff, around 60% focus on teaching activities, 20% focus on research, and less than 20% focus on patient care services concurrent with real practice teaching. The proportion of student time dedicated to theory, practice, and research in PharmD programs is 51.5%, 46.7%, and 1.8%, respectively. Sites owned by the colleges or by others were used for student training. Colleges followed the Office of the National Education Standards' Internal Quality Assurance (IQA) and External Quality Assurance (EQA), and the Pharmacy Council's Quality Assessment (ONESQA). CONCLUSION: This study provides a picture of the current status of curriculum, teaching staff, and students in pharmacy education in Thailand. The curriculum was adapted from the US PharmD program with the aim of meeting the country's needs and includes industrial pharmacy and public health tracks as well as clinical tracks. However, this transition in pharmacy education in Thailand needs to be monitored and evaluated.

Clinical outcomes of patients infected with carbapenem-resistant Acinetobacter baumannii treated with single or combination antibiotic therapy.

OBJECTIVE: To evaluate treatment outcomes in patients with carbapenem-resistant Acinetobacter baumannii (CRAB) nosocomial infections treated with antimicrobial agent either alone or in combination. MATERIAL AND METHOD: Clinical data were retrospectively evaluated in patients with CRAB nosocomial infections admitted to Songklanagarind Hospital, Songkhla, Thailand from January-December 2008. RESULTS: One hundred ten patients with CRAB nosocomial infections were identified. Most patients (57.3%) had site of infection in the lower respiratory tract and the majority of them (61.8%) received a single antimicrobial agent. Crude mortality was 30%. The presumptive success rate was 60.3% (41/68) for patients given monotherapy and 81.0% (34/42) for patients given combination therapy (p = 0.024). Patients given combination therapy were more likely to have been given at least one antibiotic to which the organism was susceptible (p = 0.004). In multivariate analysis, renal impairment, bloodstream infection, and inappropriate antimicrobial regimen were independent predictors of treatment failure. CONCLUSION: The combination therapy regimen yielded more presumptive treatment success by increasing the likelihood of an appropriate antimicrobial therapy. Additionally, inappropriate antimicrobial treatment, renal impairment, and bloodstream infection were associated with poor treatment outcomes in patients with CRAB nosocomial infections.

In vitro activity of colistin or sulbactam in combination with fosfomycin or imipenem against clinical isolates of carbapenem-resistant Acinetobacter baumannii producing OXA-23 carbapenemases.

This study investigated the in vitro activity of colistin or sulbactam in combination with fosfomycin or imipenem against eight strains of carbapenem-resistant A. baumannii (CRAB). The eight CRAB clinical isolates were collected from hospitalized patients admitted to Songklanagarind Hospital in southern Thailand during January-December 2008. The isolates were divided into 4 different patterns of clonal relationships using the Repetitive Extragenic Palindromic-Polymerase Chain Reaction method (REP-PCR). The in vitro activity of combination antibacterial agents against theses isolates were determined by chequerboard and time-kill methods. All isolates producing OXA-23 carbapenemases were universally susceptible to colistin but intermittently susceptible to other antimicrobial agents. A chequerboard assay showed the synergistic effects of sulbactam plus fosfomycin and colistin plus fosfomycin in 75% and 12.5% of isolates, respectively. Sulbactam at a concentration of 1 x MIC plus fosfomycin at 1 x MIC or at 1/4 x MIC showed synergism in 75% and 37.5% of clinical isolates, respectively. Bactericidal activity was observed for up to 12 hours of incubation. There was no synergism between colistin and sulbactam, sulbactam and imipenem, and colistin and imipenem, against the tested isolates. Combined use of sulbactam and fosfomycin may provide an alternative therapeutic option for CRAB infections.

Unified algorithm for real-time detection of drug interaction and drug allergy.

This algorithm aims at unifying and generalizing the algorithm for detecting all types of documented drug interactions such as drug-drug interactions, drug-disease interactions, drug-patient interactions (drug allergy) from patient profile information and drug-laboratory test interactions in real-time prescribing system. Ideally, the system should conform to the following criteria: (1) data independence; (2) software interconnectability; (3) knowledge expandability; (4) flexibility; and (5) computation resource efficiency. We propose a robust Structured Query Language (SQL) algorithm to detect drug interactions and drug allergy according to such criteria. We believe that this is the first public domain algorithm in SQL that could be easily implemented into most open-system prescribing software which support SQL language. The algorithm comprises two major stages: 'expand' and 'extract'. The former expands all information in the prescription with their synonyms, groups, or components. The latter extracts the documented interactions by inner-joining knowledge-base with two independent copies of the expanded prescription list simultaneously. Simulation study for speed performance indicates that this algorithm is well behaved, for the speed of computation does not grow faster than the growth in prescription size.