Ohio pharmacy personnel's burnout and wellbeing: The impact of the COVID-19 pandemic.

BACKGROUND: While burnout is a well-known phenomenon among physicians and nurses, burnout among pharmacists and pharmacy personnel is understudied and less recognized. OBJECTIVES: The primary objectives of this study were to describe and compare Ohio pharmacy personnel's self-reports of burnout and wellbeing prior to and during the COVID-19 pandemic. METHODS: A one-time online survey was completed by over 13,000 health care professionals in Ohio in July and August 2021. This brief report describes a subanalysis of the 1452 participating pharmacy professionals licensed by the State of Ohio Board of Pharmacy. RESULTS: Most survey respondents identified as White (90.84%) and female (70.04%), including pharmacists (59.16%) and pharmacy technicians (38.15%). Findings demonstrated a 360.55% increase in feeling emotionally drained "every day" during the pandemic. Participants felt emotionally drained more frequently; cared less about what happened to patients; felt less accomplished; felt down, depressed, or hopeless more frequently; had more thoughts of suicide; and were more concerned about their substance use during the pandemic than prior to it. CONCLUSION: Pharmacy personnel are experiencing some dimensions of burnout and poor wellbeing more frequently. These issues were present prior to the COVID-19 pandemic and now require even swifter attention as outcomes have worsened. Increased awareness of burnout among pharmacy personnel is required. Additionally, policy and organizational interventions are recommended to improve pharmacy personnel wellbeing.

The association between number of learners and pharmacist and technician levels of burnout.

PURPOSE: Little is known about the relationship between learner load and pharmacist and pharmacy technician burnout. Therefore, the purpose of this study was to examine the association between burnout and the number of learners (residents, students, and new employees) assigned to pharmacists or pharmacy technicians. METHODS: A validated survey to measure burnout and professional fulfillment was administered to employees of a university health system's pharmacy service in 2019. A threshold analysis determined the optimal cutoff for number of learners trained that maximized the ability to predict binary outcomes. Chi-square and Fisher's exact tests were used, and effect sizes between percentages were reported. Finally, the adjusted associations between number of learners and outcomes were assessed using logistic regression. RESULTS: A total of 448 pharmacy staff members were included in the analysis. Of those, 57% (n = 254) worked in ambulatory care, 27.4% (n = 122) worked in an inpatient setting, and 15.7% (n = 70) worked in infrastructure. Pharmacists working in an inpatient setting who reported training 4 or more learners per year indicated significantly higher rates of burnout than those training fewer learners on both a single-item burnout assessment (64.3% vs 31.0%; P = 0.01; effect size, 0.68) and a 10-item burnout assessment (54.8% vs 13.8%; P = 0.01; effect size, 0.91). Similar results were not observed in pharmacists working in ambulatory care and infrastructure positions or in pharmacy technicians. CONCLUSION: Added precepting and training responsibilities may be associated with higher levels of burnout among pharmacy team members, particularly inpatient pharmacists.

Pharmacy work: Intrinsic motivation and extrinsic rewards across role and setting.

BACKGROUND: Pharmacists' and pharmacy technicians' stress and job turnover are at an all-time high. Both intrinsic motivations and extrinsic rewards play key roles in workplace satisfaction. Differences in workplace satisfaction have been identified when comparing chain pharmacies, independent pharmacies, and health systems work settings. OBJECTIVES: Cognitive evaluation theory was applied to explore the influence of intrinsic motivations and extrinsic rewards on both pharmacists' and pharmacy technicians' perceptions of motivations and rewards across various workplace settings. METHODS: A 92-item questionnaire was administered to 129 pharmacists and 111 pharmacy technicians. Participants were primarily recruited at a state pharmacy association annual meeting and via online forums. The questionnaire captured participant demographics including role and work setting (i.e., chain, independent, or health systems), demographic variables, and perceptions about work including autonomy, competence, relationships, pay satisfaction, and benefit satisfaction. RESULTS: A 2-way multivariate analysis of covariance was conducted to test hypothesized differences by role (pharmacist or pharmacy technician) and setting (chain, independent, or health systems). Results show pharmacy personnel in independent and hospital systems settings felt more positive about relationships, competence, pay satisfaction, and benefit satisfaction than those in chain settings. There were no role differences between pharmacists and pharmacy technicians on these outcomes. DISCUSSION: These findings highlight challenges of working in chain pharmacy environments. Results reveal that although pay does not differ across work settings, feelings about both the work and compensation satisfaction do vary across settings. Because role did not drive these relationships, this suggests a need to attend to working conditions for pharmacy personnel. CONCLUSION: Intrinsic motivation elements of competence and relationships are statistically different among employment settings. Relationships and feelings of competence are perceived more favorably in independent and health systems, rather than chain settings. More studies on intrinsic motivations of pharmacy employees within these settings are needed.

Multi-center survey on the training status of staff working in pharmacy intravenous admixture services (PIVAS) in mainland China: Perspectives of PIVAS staff.

ABSTRACT: The technical level and comprehensive quality of pharmacy intravenous admixture services (PIVAS) staff are central to ensure the safety and effectiveness of intravenous infusions. However, these aspects are lacking in traditional pharmacy education. This study aimed to investigate the training status of staff working in PIVAS and explore factors that affected training status, which might contribute to the establishment of a comprehensive, standardized training system.A multi-center cross-sectional survey was conducted via a WeChat Group targeting PIVAS staff in hospitals to investigate the differences of current training status between different regions, hospital levels, genders, job titles, educational degrees, employment types, and working years.In total, 501 participants completed the questionnaires. The main contents of training for PIVAS staff included: professional theoretical knowledge (99.40%, 498/501), practical operation abilities (97.01%, 486/501), pre-job training (92.61%, 464/501), and standard operating procedures (90.22%, 452/501). The most common frequency of staff training was 1-2 times a month (51.9%, 260/501). Overall, 56.5% (283/501) of participants thought staff training was sufficient and 60.1% (301/501) of participants thought PIVAS attached importance to staff training. However, only 45.7% (229/501) of the participants were satisfied with the training modes.The contents of training for PIVAS staff in mainland China were relatively rich, but the aspects of management tools, comprehensive ability development, and career development planning tend to be relatively weak. It is necessary to develop training standards for PIVAS staff to improve employee capabilities and job satisfaction.

Impact of guideline awareness in public pharmacies on counseling of patients with acute or chronic constipation in a survey of pharmacy personnel.

BACKGROUND: Constipation is often self-managed by patients and guidelines are available to aid healthcare professionals in the counseling of patients for self-management. Therefore, we have explored the knowledge and attitude of pharmacy personnel towards guidelines for the management of acute and functional chronic constipation and how they affects their recommendations. METHODS: An online survey was conducted among 201 pharmacists and pharmacy technicians from an existing panel. They were presented with two typical cases, a 62-year old woman with functional chronic constipation and a 42-year old woman with travel plans. For each case, they were asked about their treatment recommendations and the underlying rationale. Thereafter, they were provided with contents from an applicable national guideline and asked again about their recommendations and the underlying rationale. In line with the exploratory nature, data were analyzed in a descriptive manner only. RESULTS: Before exposure to guideline content, the most frequent recommendations for chronic constipation were macrogol, fiber and lactulose and for acute constipation sodium picosulfate, bisacodyl and enemas. Following guideline exposure, the most frequent recommendations for chronic constipation were macrogol, bisacodyl and sodium picosulfate and for acute constipation bisacodyl, sodium picosulfate and macrogol (all three equally recommended by the guideline for the management of acute and chronic constipation). Correspondingly, the rationale behind the recommendations shifted with guideline conformity becoming a leading reason. CONCLUSIONS: Awareness of the content of an applicable guideline on the management of constipation was poor among pharmacy personnel. Accordingly, recommendations in many cases were not in line with the guideline. Greater awareness of guideline content is desirable to enable more evidence-based recommendations in the management of constipation.

Partners in pharmacy: An intraprofessional educational event with pharmacy and pharmacy technician students.

BACKGROUND AND PURPOSE: Upon graduation and licensing, pharmacists work very closely with pharmacy technicians. Despite this, opportunities for learning together as students are limited. We developed and implemented a pilot intraprofessional event for pharmacy and pharmacy technician students. The purpose of this study was to evaluate the perceived value and learner confidence through analysis of participant feedback. EDUCATION ACTIVITY AND SETTING: Pharmacy students from the University of Waterloo School of Pharmacy and pharmacy technician students from Lambton College participated in an intraprofessional event that included a three-station practice objective structured clinical exam (OSCE) and a case discussion regarding a methadone dispensing error, followed by a facilitated debrief. Upon completion of the event, students were invited to complete an online feedback questionnaire. FINDINGS: Twenty-one pharmacy students and 22 pharmacy technician students participated in the event. Twenty-one students completed the questionnaire, for a response rate of 49%. The majority of respondents agreed or strongly agreed that the event enhanced learning and confidence in working together to provide interprofessional care. Students seemed to find the OSCE to be particularly valuable. Feedback suggestions for improvement indicated a desire for more activities and time allocated to the event. SUMMARY: We designed and implemented a pilot intraprofessional event that was well-received by pharmacy students and pharmacy technician students. This supports the development of future similar events.

Understanding and expectation towards pharmaceutical care among patients, caregivers and pharmacy service providers: a qualitative study.

Background: Over the past decades, the pharmacist's role has changed from being 'compounders and dispensers' to one of 'medication therapy manager' providing pharmaceutical care (PC). The transformation of pharmacy practice and its benefits, however, seem to be poorly understood by patients and caregivers (consumers) even in advanced health systems. Objective: This study aims to assess the comprehension of consumers in Singapore towards PC and expectations on the scope of pharmacy services today. Methods: This qualitative study was conducted among 51 consumers and pharmacy staff (pharmacy providers) in a tertiary acute care hospital in Singapore through 45 semi-structured interviews. Participants were sampled from inpatient and outpatient settings. Data were transcribed, coded and analysed by thematic analysis. Results: Thirteen pharmacy technicians, 14 pharmacists and 14 out of 24 patients and caregivers, agreed to be interviewed. Reasons such as minimal English and unsure of pharmacy services were cited for declining interviews. From the interviews, the majority of the consumers did not understand the differences in roles between pharmacists and doctors beyond the basics of doctors diagnosing and pharmacists dispensing. Eighteen (75%) consumers remain unaware that pharmacists are trained to provide additional services such as medication enquiry services and optimisation of drug therapy. In addition, consumer expectations have expanded beyond transactional encounters, with 15 (63%) consumers expecting personalised services. Five (19%) pharmacy providers also expect the use of automation to boost efficiency and improve patients' convenience. Seven (15%) of the participants hope to see better prediction with analytics and, therefore, pre-emptive management of medication errors. Conclusions: There is an incomplete understanding regarding PC and the roles of pharmacy providers among healthcare consumers today. Beyond basic service provisions, expectations of pharmacy practice have become more experience-oriented. Policy changes that expand pharmacists' roles must be matched with corresponding publicity and education efforts to encourage service utilisation.

The impact of a Calderdale Framework designed advanced pharmacy assistant role on inpatient pharmacy services.

Background Pharmacists in Australian hospitals do not see all inpatients. Effectively utilising pharmacy assistants in non-traditional roles may provide an opportunity to increase the number of patients seen by pharmacists. Objective To implement a Calderdale Framework designed advanced pharmacy assistant role on an inpatient unit and evaluate the impact of the role on the provision of clinical pharmacy services provided by the pharmacist in an Australian University hospital. Setting The study was conducted in a single 24-bed medical IPU at a tertiary hospital in Queensland, Australia. Method A quasi-experimental two-cohort comparison design, completed over three phases from 30/5/2016 to 30/9/2016 was employed. To evaluate the impact of the advanced pharmacy assistant on an inpatient unit an 8-week period of usual care was compared to the same time period on the same unit where the pharmacist provided usual care with the support of an advanced assistant. Pharmacist and assistant satisfaction was also surveyed. A training and lead-in phase was completed to ensure the advanced pharmay assistant was competent in completing the delegated tasks. Main outcome measure The primary outcome was percentage change of medication management plans documented by the pharmacist with an advanced assistant comparative to the pharmacist without. Results The number of documented medication management plans significantly increased by 9.5% (p = 0.019; CI 1.86-17.14). Plans documented within 24 h and time to documentation remained unchanged. Completeness increased in community pharmacy documentation. The percentage of completed discharge medication records rose by 15.6%, (p < 0.001; CI 7.78-23.16). Interventions documented increased by 55 and the percentage of patients with clinical reviews documented increased by 35%. There were fewer missed doses recorded and pharmacists spent more time on clinically based tasks. Pharmacist and assistant satisfaction also improved. Conclusion The use of the Calderdale Framework enabled structured pharmacy assistant role redesign that impacted significantly on the provision of clinical pharmacy services on an inpatient unit.

Differences in knowledge about epilepsy and antiepileptic drugs among pharmacy-dispensing workers in Cambodia and in Lao PDR.

Epilepsy is the most common neurological disorder encountered in primary care in Southeast Asia. People with epilepsy require long-term therapy management. Nonadherence to antiepileptic drugs (AEDs) has been identified as a major factor in suboptimal control of epilepsy. Pharmacies offer patients a first-line point of contact with the healthcare system. Many pharmacies operate with limited or nonqualified human resources that can lead to insufficient knowledge, inappropriate supply of medicines, and insufficient counseling. OBJECTIVE: The aim of this study was to evaluate the qualification and knowledge concerning epilepsy and AEDs among pharmacy-dispensing workers who sell drugs to people with epilepsy. METHOD: A cross-sectional qualitative study was conducted in public and private pharmacies, in both urban and rural areas of Cambodia and Lao People's Democratic Republic (Lao PDR). The knowledge was collected through a questionnaire. RESULTS: A total of 180 respondents from 123 outlets in the two countries were included in this study. A proportion of 40.8% (31) of respondents in Cambodia and 38.5% (40) in Lao PDR were pharmacists, followed by sellers who did not received any healthcare training with a proportion of 18.4% (14) in Cambodia compared to 20.2% (21) in Lao PDR. Head trauma was cited as the main cause of epilepsy by 72.4% (55) in Cambodia and 27.2% (28) in Lao PDR (p < 0.001). Epilepsy was considered as a contagious disease by 6.6% (5) of respondents in Cambodia compared to 18.4% (19) in Lao PDR (p = 0.03). Eighty-seven percent (66) of respondents in Cambodia knew at least one long-term AED versus 67.3% (70) in Lao PDR (p = 0.003). Phenobarbital was mentioned in more than 90.0% of cases in both countries. In overall, 15.4% (21) thought that if seizures are controlled for some months, people with epilepsy could stop taking their AEDs. Only one respondent from Lao PDR was aware of drug-drug interaction between AEDs and oral contraception. CONCLUSION: An educational intervention should be implemented to improve the knowledge of epilepsy and AEDs for pharmacy-dispensing workers. This could include advice for all pharmacy-dispensing workers in order to improve AED management and follow-up of therapeutic adherence.

Assessment of perceived workload in academic health center community pharmacies before and after implementation of a central call center.

PURPOSE: Results of a study to determine whether reducing pharmacy phone call workload through implementation of a pharmacy services call center (PSCC) led to decreased employee workload, improved efficiency, and increased pharmacist availability for patient care are reported. METHODS: A pre-post study was conducted using the NASA Task Load Index (NASA-TLX) instrument. Pharmacists, pharmacy technicians at 7 academic health center community pharmacies, and PSCC staff provided NASA-TLX data over 5 days during 3 data collection periods before and after PSCC implementation. Perceived workload was measured as an overall workload score (OWS) and mean scores for 6 NASA-TLX workload dimensions (mental demand, physical demand, temporal demand, performance, effort, and frustration). RESULTS: Relative to pre-PSCC values, mean postimplementation OWS scores significantly decreased in all 7 pharmacies (from 33.3 to 29.1 overall, p < 0.001) but especially in small pharmacies (from 31.7 to 27.6, p < 0.001). Scores for the physical demand and frustration dimensions were low in both the PSCC and in the 7 pharmacies, while scores for the performance dimension remained high (range, 6.8-8.3). In general, scores for all other measured NASA-TLX dimensions decreased after PSCC implementation, more so at smaller pharmacies. The PSCC staff mean OWS score increased over time (from 26.8 to 28.6, p < 0.0001) but remained near the overall pharmacy average of 29.1. CONCLUSION: Use of the NASA TLX allowed for a direct subjective measurement of workload as perceived by pharmacy and PSCC employees before and after PSCC implementation. Long-term effects of the PSCC on workload should be assessed.

Impact of a chemotherapy workload and productivity dashboard on pharmacy technician turnover.

PURPOSE: To describe the methods used in the development of an intravenous chemotherapy workload and productivity dashboard and its impact on symptoms of burnout and technician turnover. SUMMARY: In February 2017, chemotherapy sterile preparation pharmacy technicians reported symptoms of burnout as a result of perceived increase in workload. In response, an i.v. chemotherapy workload and productivity dashboard was developed at an academic medical center to validate workload in comparison to the reported job stress of pharmacy technicians. The dashboard provided pharmacy leadership objective data to validate staff concerns and leveraged lean principles to level-load the work prior to requesting additional full-time equivalents (FTEs) to senior leadership. The rate of turnover of i.v. chemotherapy technicians was assessed before (December 2016-June 2017) and after (July 2017-January 2018) dashboard implementation and approval of an additional i.v. chemotherapy technician FTE. The addition of the new FTE resulted in a decrease in productivity from an average of 106% (range 67%-151%) to 84% (range 65%-110%). The interventions allowed for the ability to leverage a staffing-to-demand model, resulting in the observed improvement in technician symptoms of burnout and a notable decrease in the overall turnover rate of i.v. chemotherapy technicians. CONCLUSION: The i.v. chemotherapy workload and productivity dashboard confirmed frontline staff perception and provided data to support the addition of labor resource and an opportunity to leverage a staffing-to-demand model to decrease symptoms of burnout and technician turnover.

Effect of a central call center on employee perceptions of safety culture within community pharmacies in an academic health system.

PURPOSE: This study evaluated employee perceptions of safety culture in 9 health-system-owned community pharmacies using a safety culture survey before and after implementation of a Pharmacy Services Call Center (PSCC) designed to reduce distractions through reduction of phone volume related to refills and prescription readiness. METHODS: The Agency for Healthcare Research and Quality (AHRQ) Community Pharmacy Survey on Patient Safety Culture (CPSPSC) was used to collect employee safety culture perceptions pre-post PSCC implementation. A percent positive score (PPS) was calculated for each of 11 CPSPSC composite questions and for 1 overall rating of patient safety question based on AHRQ-suggested analytic procedures. Pre-post PSCC implementation, PPSs were compared using a chi-square test. RESULTS: Overall, the lowest composite PPS (Staffing, Work Pressure, and Pace) and the highest composite PPS (Patient Counseling) ranked the same in both survey periods. Of the nine PSCC pharmacies, statistically significant (p < 0.05) PPS improvements occurred in 4 composites including Teamwork (11.9%), Communication About Mistakes (18%), Staff Training and Skills (20.6%), and Staffing, Work Pressure, and Pace (11.8%). PSCC pharmacies also reported a 9.3% (NS) improvement in overall rating of pharmacy patient safety post PSCC implementation. Separate analysis of pharmacist responses was consistent with pharmacy level results, but technician results differed slightly in overall rating of safety perceptions. CONCLUSION: Presence of the PSCC appeared to increase pharmacy employees' perceptions of safety culture in the community pharmacies, an integral part of overall patient safety.

Use of multiple methods to measure impact of a centralized call center on academic health system community pharmacies.

PURPOSE: The process and methods used in an impact assessment of a centralized pharmacy call center on community pharmacy employee patient safety climate perceptions, telephone distractions/interruptions, and prescription filling efficiency are described. SUMMARY: A broad-based team designed a multi-faceted, pre-post call center implementation analysis that included multiple change assessment measures. First, yearly administration of the Agency for Healthcare Research and Quality Community Pharmacy Survey on Patient Safety Culture was used to assess patient safety climate based on employee perceptions of a safe working environment and potential for errors due to interruptions and distractions. Evaluative measures of staff workload that assessed telephone interference with prescription filling activities pre and 3 months post implementation included (1) the NASA Task Load Index, (2) multi-tasking observations through shadowing of pharmacists and technicians to count number of interruptions/distractions per prescription "touched," and (3) self-reported work sampling to assess proportional time estimates of clinical, professional, and technical activities. Finally, pharmacy efficiency and prescription filling capacity were assessed using operational measures (prescriptions filled, patients served, phone call volume changes, prescription rework counting). Data analysis included summary statistics, Student's t-test, and chi-square analysis, as appropriate, in addition to assessing convergence and agreement among measures. Every evaluative method showed a positive outcome from call center implementation, although individual pharmacies may have accrued greater benefit from call reduction than others. CONCLUSION: Multiple analysis methods can be used to evaluate the impact of workflow changes.

Implementation of a pharmacy technician residency program in a tertiary care teaching hospital.

PURPOSE: Leveraging pharmacy technicians to take on advanced roles can enable pharmacists to practice at the highest level of their license. Technicians trained through traditional venues may not have the necessary knowledge and skills to adequately take on these roles. To meet this need, a technician residency program was developed and implemented in a health-system pharmacy. SUMMARY: The technician residency program was designed to develop competency in the medication use process as assessed through achievement of 30 objectives based on successful completion of rotations, projects, and didactic examination. The program duration was 50 weeks with rotations which included compounding, technician-check-technician cart fill and floor stock replenishment, investigational drug services, regulatory compliance, and other functions. The resident also completed several projects to improve data analytics, communication, and leadership skills. By the end of the program, the residency program director and preceptors determined that the resident achieved 83% (25/30) of objectives and had developed competency in the medication use process superior to technicians with several years of experience. The resident was ultimately hired in a specialty technician position and was found to perform effectively in that role. CONCLUSION: The program allowed the technician resident to gain a comprehensive understanding of health-system pharmacy practice and continue to develop skills and abilities that would typically take several years of work experience to be achieved.

Work overload is related to increased risk of error during chemotherapy preparation.

PURPOSE: Chemotherapy preparation units face peaks in activity leading to high workloads and increased stress. The present study evaluated the impact of work overloads on the safety and accuracy of manual preparations. METHOD: Simulating overwork, operators were asked to produce increasing numbers of syringes (8, 16, and 24), with markers (phenylephrine or lidocaine), within 1 h, in an isolator, under aseptic conditions. Results were analyzed using qualitative and quantitative criteria. Concentration deviations of < 5%, 5%-10%, 10%-30%, and >30% from the expected concentration were considered as accurate, weakly accurate, inaccurate, and wrong concentrations, respectively. RESULTS: Twenty-one pharmacy technicians and pharmacists carried out 63 preparation sessions (n = 1007 syringes). A statistically significant decrease in the manufacturing time for one syringe was observed when workload increased (p < 0.0001). Thirty-nine preparation errors were recorded: 30 wrong concentrations (deviation > 30%), 6 mislabeling, 2 wrong diluents, and 1 wrong drug. There was no statistically significant difference in the mean concentration accuracy of final preparations across the three workloads. The overall error rate increased with the number of preparations made in 1 h: 1.8% for 8 preparations, 2.7% for 16 preparations, and 5.4% for 24 preparations (p < 0.05). CONCLUSION: Although pharmacy technicians and pharmacists were able to increase production speeds with no effect on mean concentration accuracy under stressful conditions, there were greater probability errors being made. These results should encourage actions to spread workloads out over the day to avoid peaks in activity.

Factors influencing national implementation of innovations within community pharmacy: a systematic review applying the Consolidated Framework for Implementation Research.

BACKGROUND: To meet emergent healthcare needs, innovations need to be implemented into routine clinical practice. Community pharmacy is increasingly considered a setting through which innovations can be implemented to achieve positive service and clinical outcomes. Small-scale pilot programmes often need scaled up nation-wide to affect population level change. This systematic review aims to identify facilitators and barriers to the national implementation of community pharmacy innovations. METHODS: A systematic review exploring pharmacy staff perspectives of the barriers and facilitators to implementing innovations at a national level was conducted. The databases Medline, EMBASE, PsycINFO, CINAHL, and Open Grey were searched and supplemented with additional search mechanisms such as Zetoc alerts. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. RESULTS: Thirty-nine studies were included: 16 were qualitative, 21 applied a questionnaire design, and 2 were mixed methods. Overarching thematic areas spanning across the CFIR domains were pharmacy staff engagement (e.g. their positive and negative perceptions), operationalisation of innovations (e.g. insufficient resources and training), and external engagement (e.g. the perceptions of patients and other healthcare professionals, and their relationship with the community pharmacy). Study participants commonly suggested improvements in the training offered, in the engagement strategies adopted, and in the design and quality of innovations. CONCLUSIONS: This study's focus on national innovations resulted in high-level recommendations to facilitate the development of successful national implementation strategies. These include (1) more robust piloting of innovations, (2) improved engagement strategies to increase awareness and acceptance of innovations, (3) promoting whole-team involvement within pharmacies to overcome time constraints, and (4) sufficient pre-implementation evaluation to gauge acceptance and appropriateness of innovations within real-world settings. The findings highlight the international challenge of balancing the professional, clinical, and commercial obligations within community pharmacy practice. A preliminary theory of how salient factors influence national implementation in the community pharmacy setting has been developed, with further research necessary to understand how the influence of these factors may differ within varying contexts. TRIAL REGISTRATION: A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42016038876 ).

Perceptions, knowledge, and perceived barriers of Yemeni pharmacists and pharmacy technicians towards evidence-based practice.

RATIONAL, AIMS, AND OBJECTIVE: The aim of this study was to assess the knowledge and perception towards evidence-based practice (EBP) and identify the perceived barriers to practicing EBP among Yemeni pharmacists and pharmacy technicians. METHODS: A cross-sectional survey study was carried out among 153 Yemeni pharmacists and pharmacy technicians who are working in hospitals or community pharmacies. This study took place between the 15th of August and the 8th of November 2017 using a self-administered validated questionnaire. The study was approved by the ethics committee/scientific research center of Yemen University, Yemen (Reference number: ERC/2017/103). RESULTS: Completed questionnaires were received from 153 (46.6% response rate). Most of the respondents showed a positive attitude towards EBP; however, their understanding of the basic terms used in EBP was poor (34.6%). The types of source that the respondent used in high percentage to make their decisions were own judgement and consulting the colleagues that can no longer be accurate and evidence based. The barriers to practicing EBP identified by most respondents were the limited access to EBP sources and lack of personal time. CONCLUSION: These results reveal strong support for EBP among pharmacists and pharmacy technicians in Yemen but only a minority indicated that they understood the technical terms of EBP. Training and continuing education programs on EBP and guidelines for pharmacists are strongly needed. These findings may help in planning the use and the application of EBP process in pharmacy practice.

The caring behaviours of Danish pharmaconomists: insight for pharmacy technician practice around the world.

OBJECTIVES: Pharmacy workforce support personnel are being accorded greater scopes of practice, especially Danish pharmaconomists [pharmacy technician, experts in pharmaceuticals with a 3-year degree]. The aims of this study were to assess pharmaconomists' caring behaviours and identify factors related to those behaviours. METHODS: A self-administered survey was distributed to a random sample of pharmaconomists in Denmark. The survey assessed caring behaviours using the Caring Behaviours Assessment and acquired data to ascertain their employers' culture, respondent's need for achievement, personality traits, commitment and work-related characteristics. Descriptive statistics provided insight into pharmacomomists' predispositions, and bivariate analyses were used to identify associations of pharmaconomists' caring with other variables under study. KEY FINDINGS: Over 300 pharmaconomists responded (52.2% response rate). Pharmaconomists reported generally high levels (well above the median on the 5-point scale) of caring behaviours. They reported higher levels (upper range of 5-point scale) of empathic behaviours, such as treating patients with respect and seeing things from the patient's point of view but somewhat lower levels of encouraging the patient to talk about how they feel and praising the patient's efforts, which could otherwise help patients cope with and improve their self-efficacy for disease management. Pharmaconomist caring was associated with practice setting, organisational culture and commitment to their employer. CONCLUSIONS: Pharmaconomists reported performing behaviours that were empathic, but less frequently those associated with facilitating greater patient autonomy. Caring behaviours were associated with a number of variables related to practice setting. The findings can help to inform educational pedagogy and pharmacy personnel management.

Pharmacy Technicians Are People, Too! Let's Consider Their Personal Outcomes Along With Other Pharmacy Outcomes.

Studies have found that expanded pharmacy technician roles can help "free up" pharmacist time, leading to role optimization. However, these studies and the positions taken by many are quite pharmacist-centric. We seem to have underestimated the importance of support staff in pharmacy operations. If research demonstrates that technicians can perform a function safely and effectively, that alone should compel the function's allowance in practice. Freeing up pharmacist time for higher-order care is a positive corollary to technician advancement, but it need not be a precondition for it.