Perspectives of pharmacists about collaborative asthma care model in primary care.

BACKGROUND: The newly recognized General Practice Pharmacist (GPP) model in Australia, where non-dispensing pharmacists work in collaboration with general practitioners (primary care physicians) within their general practice/clinics represent an efficient yet novel approach for the management of chronic diseases. In chronic conditions, such as asthma, these models can help achieve optimal health outcomes, given current gaps between guidelines and practice. OBJECTIVE: The aim of this study was to elicit pharmacists' views and recommendations about pragmatic models of collaboration between GPPs and general practitioners in providing asthma management services in future service delivery models. METHODS: Community pharmacists were recruited via convenience sampling and passive snowballing techniques. Qualitative, semi-structured, in-depth interviews were conducted. Recorded interviews were transcribed verbatim and analyzed utilizing NVivo® 11 software. Obtained data were content analyzed for emergent themes using the Braun and Clarke framework. RESULTS: Twenty-five interviews were conducted. Asthma management challenges in current practice and the implementation practicality of asthma care GPP models comprised the two major emerging themes. Pharmacists' time and workload constraints and patients' reluctance to seek pharmacists' assistance to dispel misconceptions about asthma control were reported to be major barriers for the implementation of optimal asthma management services in community pharmacy. While a GPP dependent on several criteria. The development of specified channels for inter-professional communication for sharing of patient information and the willingness of stakeholders to accept and access such a model were reported. Funding and remuneration were considered critical factors by most participants. The professional self-autonomy of each healthcare professional involved in the GPP model was also highlighted as pertinent issue. CONCLUSIONS: This study provides significant insights to create pragmatic scalable versions of a GPP care model that could facilitate better asthma care after key barriers and facilitators identified by participants are carefully addressed.

Evaluation of a Flipped Examination Model Implemented in a Final-Year Undergraduate Pharmacotherapeutics Course.

Objective. To assess final-year pharmacy students' performance on and evaluate their experience with a "flipped examination" vs a traditional examination for an advanced clinical pharmacy course. Methods. Students devised multiple-choice questions for the flipped examination. The Biggs revised 2-factor Study Process Questionnaire was administered before and after the examination to assess any possible changes in the students' perceptions of their level of engagement in the learning process. Focus group discussions also were conducted to further gauge the students' feedback and insights into the flipped examination experience. Results. Changes in mean total study process scores at the deep and surface levels of learning were significant. The flipped examination experience was enjoyable, facilitated a less-stressful learning environment, and improved the students' learning satisfaction, knowledge, and assessment grades. Conclusion. The flipped examination model is an innovative instructional approach that can bring about significant educational gains if designed well pedagogically.

The role of community pharmacists in the identification and ongoing management of women at risk for perinatal depression: A qualitative study.

BACKGROUND: While pharmacists are among the most accessible primary health professionals within a mother's healthcare team to identify potential cases of perinatal depression (PND), very little in the literature suggests that this role has been explored. AIM: The aim of this study was to explore community pharmacists' perspectives on their potential roles in perinatal mental health promotion (recognition and health education) and the factors affecting these roles. METHODS: In total, 20 semi-structured, in-depth interviews were conducted with community pharmacists. RESULTS: Most pharmacists highlighted their significant roles in recognising PND symptoms and providing medication-related support to perinatal mothers. Barriers to service provision included inter-professional role boundaries, the lack of established referral systems and service remuneration and the lack of adequate training in mental health. CONCLUSION: Pharmacists could potentially reinforce their involvement in mental health promotion activities.

Development and evaluation of a school-based asthma educational program.

OBJECTIVES: To develop, implement, and evaluate the effects of a school-based asthma educational program on Saudi primary school teachers' asthma awareness and competence in delivering asthma-related first aid interventions. METHODS: An asthma educational intervention program entitled "School Asthma Action Program" (SAAP) was designed based on pedagogical principles and implemented among teachers randomly selected from girls' primary schools in Riyadh, Saudi Arabia. This pilot study employed a pre-test/post-test experimental design. A previously tested asthma awareness questionnaire and a custom-designed asthma competence score sheet were used to evaluate the effects of the educational intervention program on teacher's asthma awareness and competence in providing asthma-related first aid interventions at schools. RESULTS: Forty-seven teachers from five different primary schools participated in the program. Of the 47 teachers, 39 completed both the pre- and post-program questionnaires. The SAAP improved teachers' awareness of asthma (teachers' median pre-program score was 11 (range 5-18) and their post-program score was 15 (range 7-18), p < 0.001) and their attitudes toward asthma management at schools (teachers' median pre-program score was 74 (range 15-75) and their post-program score was 75 (range 15-75), p = 0.043). Further, it improved teachers' competence in providing asthma-related first aid interventions (teachers' mean pre-program score was 1.4 ± 2.3 and their mean post-program score was 9.8 ± 0.5, p < 0.001). After completing the SAAP, a high proportion of teachers reported increased confidence in providing care to children with asthma at school. CONCLUSION: School-based asthma educational programs can significantly improve teachers' knowledge of asthma and their competence in providing asthma-related first aid interventions during emergencies.

Education Intervention on Chronotherapy for Final-Year Pharmacy Students.

Chronotherapy involves altering the timing of medication administration in coordination with the body's circadian rhythms to improve the overall control of disease and to minimise treatment side effects. Training on chronotherapy requires students to map different topics learnt in earlier years of their professional degree and apply these concepts clinically. This requires strategic educational design. Therefore, the aim of the study was to develop, implement and evaluate an educational intervention focusing on the application of chronotherapy for final-year undergraduate pharmacy students. An educational intervention utilizing multiple learning strategies for enhancing chronotherapy related awareness was designed and implemented in the final year undergraduate pharmacy cohort at the University of Sydney Australia (2013). A custom-designed questionnaire measuring awareness about (13 items scored 0 or 1), and attitudes (12 items scored on a Likert scale of 1-5) towards chronotherapy was administered pre and post intervention to evaluate its impact. The pre-intervention mean total awareness and attitude scores were 6.5 ± 2.0 (score range 0-13) and 47.4 ± 6.9 (score range 12-60) respectively. The mean total post-intervention scores were significantly higher for total awareness (10.1 ± 1.9) and attitude (54.0 ± 6.0). Carefully designed educational interventions utilising pedagogic principles for pharmacy students can improve awareness of and enhance positive attitudes toward pharmacists' roles in optimizing drug therapy using chronotherapy.

Asthma and smoking--healthcare needs and preferences of adults with asthma who smoke.

OBJECTIVE: People with asthma smoke at least as much as, if not more than, people without asthma. The aim of this study was to explore the unique healthcare needs and preferences of smokers with asthma, in terms of smoking topography and initiation, perceived interplay between asthma and smoking, motivation and readiness to quit, and proposed smoking cessation techniques. METHODS: Qualitative, semi-structured, in-depth telephone interviews with adult smokers who have concurrent asthma were conducted. Participants were recruited through flyers displayed at community pharmacies, general practice surgeries, university campuses, and respiratory clinics of tertiary hospitals and through an advertisement on the "Asthma Foundation" website. Recorded interviews were transcribed verbatim and analysed using NVivo 10 software (QSR International, Melbourne, Victoria, Australia). Obtained data were content-analysed for emergent themes using the 'framework approach'. RESULTS: Twenty-four semi-structured interviews were conducted. Most participants believed that smoking often worsens their asthma and increases the frequency and severity of their symptoms. Fear of asthma-related exacerbations and poor self-control appeared to be the major triggers for quitting smoking. Most patients reported being motivated to quit smoking; however, in many cases, determination and strong will power need to be coupled with public, social, professional, and therapeutic support to achieve and maintain success. CONCLUSIONS: Given the unique needs of people with asthma who smoke, it is imperative that evidence-based smoking cessation programs be designed and tailored to assist them in effectively quitting smoking.

Provision of smoking cessation services in Australian community pharmacies: a simulated patient study.

BACKGROUND: With the rising interest in expanding pharmacists' role in smoking cessation, it is pertinent that community pharmacists be equipped with up-to-date knowledge and competence to provide optimal therapeutic services that meet the demands of various presenting subsets of smokers. OBJECTIVE: To investigate and evaluate responses to requests of quitting smoking from 'high risk' smokers seeking assistance and treatment within the pharmacy venue. SETTING: Community pharmacies located within Sydney greater metropolitan area, New South Wales, Australia. METHOD: A simulated patient methodology was utilised. Two scenarios were developed and enacted by two trained simulated patients in 100 randomly selected pharmacies. Scenario 1 involved a 28-year-old pregnant female who presents with a request for help in quitting smoking. Scenario 2 involved a 22-year-old female requesting a quit smoking product for her 55-year-old father who has cardiovascular problems. A standardised scoring key was designed to assess the performance of pharmacists during each encounter. MAIN OUTCOME MEASURE: The primary outcome measure was the supply/non-supply of nicotine replacement products and the corresponding provision of counselling and advice to facilitate smoking cessation. RESULTS: A product(s) was supplied in 42 % of the 100 encounters, while a product was adequately suggested pending doctor's referral in 45 %. In 13 % of the cases, a product was not supplied based on inappropriate notions of nicotine replacement therapy not being safe in the presented scenario. Pharmacists performed better in dispensing scores (counselling about product use) as compared to pre-dispensing scores (eliciting patient history). ANOVA followed by regression analysis indicated that the estimated age and gender of the pharmacist/staff were significant predictors affecting total scores. CONCLUSION: Whilst pharmacists' counselling about smoking cessation aids seems satisfactory, further education is required to improve practice standards in terms of matching a patient's history and smoking status to an appropriate product.

A workshop on smoking cessation for pharmacy students.

OBJECTIVE: To develop, implement, and evaluate a targeted educational intervention focusing on smoking cessation with final-year undergraduate pharmacy students. DESIGN: A smoking-cessation educational workshop entitled Smoking Cessation in Pharmacy (SCIP) was designed on the principles of adult learning and implemented with a full cohort of final-year undergraduate pharmacy students at the University of Sydney. A previously validated questionnaire testing the knowledge and attitudes of respondents was administered both before and after implementation of the designed workshop to evaluate changes resulting from the intervention. Informal feedback was obtained from students. ASSESSMENT: Pre-course mean total knowledge and attitude scores calculated were 65.8±9.1 and 86.4±12.1, respectively. The post-course mean total knowledge score was 74.9±8.1, and the attitude score was 88.8±9.1 Improvement in knowledge and attitudes was significant (p<0.05). CONCLUSION: Educational interventions for pharmacy students designed with careful attention to pedagogic principles can improve knowledge about evidence-based smoking-cessation strategies and enhance positive attitudes to pharmacist roles in smoking cessation.

Smoking cessation in community pharmacy practice-a clinical information needs analysis.

BACKGROUND: With the emerging role of pharmacists in implementing smoking cessation services and the recent evidence about smoking cessation pharmacotherapies, a needs analysis to assess baseline knowledge about current smoking cessation practice is needed; hence, training and development in this area can target possible 'gaps'. OBJECTIVE: This study aimed at exploring pharmacy students' knowledge about and attitudes toward smoking cessation, as compared to practicing community pharmacists and smoking cessation educators. The overall objective was to uncover underlying 'gaps' in pharmacy-based smoking cessation practice, particularly clinical gaps. SETTING: Final-year pharmacy students at the University of Sydney, practicing community pharmacists and smoking cessation educators in Australia. METHOD: As no previous standard pharmacist-focused smoking cessation knowledge questionnaires exist, a review of the literature informed the development of such a questionnaire. The questionnaire was administered to a cohort of fourth-year pharmacy students at the University of Sydney, practicing pharmacists and smoking cessation educators. Data analysis was performed using Predictive Analytics SoftWare (PASW® Statistics 18). Mean total scores, independent t-tests, analysis of variances and exploratory factor analysis were performed. MAIN OUTCOME MEASURE: To determine areas of major clinical deficits about current evidence related to smoking cessation interventions at the pharmacy level. RESULTS: Responses from 250 students, 51 pharmacists and 20 educators were obtained. Smoking educators scored significantly higher than pharmacists and students (P < .05), while score differences in the latter two groups were not statistically significant (P > .05). All groups scored high on 'general' knowledge questions as compared to specialised pharmacologic and pharmacotherapeutic questions. All respondents demonstrated positive attitudes toward the implications of smoking cessation. Factor analysis of the 24-item knowledge section extracted 12 items loading on 5 factors accounting for 53% of the total variance. CONCLUSIONS: The results provide a valid indication of 'gaps' in the practice of up-to-date smoking cessation services among Australian pharmacy professionals, particularly in clinical expertise areas involving assessment of nicotine dependence and indications, dosages, adverse effects, contraindications, drug interactions and combinations of available pharmacotherapies. These gaps should be addressed, and the results should inform the design, implementation and evaluation of a pharmacy-based educational training program targeting current clinical issues in smoking cessation.