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Background: Pharmacists are commonly tasked with recommending the appropriate dietary supplement and advising the patients of their correct and safe use. Previous research, conducted on pharmacy students, showed that they did not always use the evidence based sources of information, with personal use identified as a significant predictor influencing the decision to recommend a supplement. Objectives: To compare use, perceptions and knowledge of dietary supplements of pharmacists with different years of work experience and to explore factors that could influence their recommendation of supplements. Methods: A questionnaire based cross-sectional study was conducted on Croatian community pharmacists in September 2017. The questionnaire explored pharmacists’ demographic characteristics, use, perceptions and knowledge of dietary supplements. Pharmacists (N=102) were divided in two groups based on their work experience: P0 (

Background Throughout Europe, legal online pharmacies increasingly sell online drugs as well as other products such as dietary supplements. Online sale of pharmaceuticals however is closely connected to the phenomenon of drug falsification. Objective The aim of this study was to assess the opinions of a sample of Italian community pharmacists towards the sale of pharmaceuticals on the web, as well as their knowledge and experience with falsified drugs. Methods A self-administered questionnaire was distributed by means of an online platform between October 2016 and January 2017. Collected information included: demographics, workplace and role, opinions towards the online sale of pharmaceuticals, whether the pharmacy has a website, knowledge and opinions about falsified drugs. Results A total of 668 community pharmacists completed the questionnaire (mean age: 48.5, SD 12.4 years, 52.3% women). Favourable opinions about online sale of pharmaceuticals were expressed by 4.9% of participants for prescription drugs, 25.4% for nonprescription drugs, and 51.6% for other products. Favourable opinions occurred more often among males and owners/directors of pharmacies in comparison to females and employees, and among pharmacists working in pharmacies with websites doing e-commerce. Knowledge about falsified drugs was limited, with 24.5% of respondents failing to indicate that falsified drugs may contain less or different ingredients, 46.4% less and/or different excipients, and 72.3% ignoring that falsified drugs may be lethal. One in 3 respondents didn't know about falsified drugs in Italy, however 51 participants had previous experience with falsified drugs and 21 provided specific information. Conclusions Italian community pharmacists have low confidence in the online sale of pharmaceuticals, as well as alarmingly limited knowledge about falsified drugs, even if many of them reported previous experiences. Results may support targeted interventions to increase pharmacists' knowledge about pharmaceuticals and the web, as well as concerning falsified drugs, and suggest community pharmacies as key components of integrated systems aimed at monitoring falsified drugs.

Objective: Explore the perceptions, attitudes and experiences of pharmacists relating to the up-scheduling of low dose codeine containing analgesics and the impact on pharmacy practice. Methods: A mixed design method was used consisting of an anonymous online questionnaire survey to quantitatively capture broad pre-scheduling change perceptions paired with a series of in-depth post-scheduling semi-structured interviews to provide a qualitative picture of the impact of codeine up-scheduling on pharmacy practice in Australia. Results: A total of 191 pharmacists completed the quantitative survey and 10 participated in the in-depth interview. The majority of respondents supported the decision to up-schedule over-the-counter combination products containing codeine to some degree. Three main themes emerged from the data: pharmacists’ perceptions of the codeine up-scheduling decision, preparing for the up-schedule and impact of the up-schedule on pharmacy practice. Pharmacists were concerned about the impact of up-scheduling on the pharmacy business, patient access to pain relief and the diminishment of their professional role. Conclusions: There were diverse perceptions, preparedness and impact on practice regarding the up-scheduling of low dose codeine products. Further research should be conducted to gauge if and how these perceptions have changed over time and to identify whether pain is being managed more effectively post codeine up-scheduling.

Background: There is an acknowledged lack of robust and rigorous research focusing on the perspectives of those prescribing direct acting oral anticoagulants (DOACs) for non-valvular atrial fibrillation (AF). Objective: The objective was to describe prescribers’ experiences of using DOACs in the management of non-valvular AF, including perceptions of benefits and limitations. Methods: A cross-sectional survey of prescribers in a remote and rural area of Scotland. Among other items, the questionnaire invited free-text description of positive and negative experiences of DOACs, and benefits and limitations. Responses were independently analysed by two researchers using a summative content analysis approach. This involved counting and comparison, via keywords and content, followed by interpretation and coding of the underlying context into themes. Results: One hundred and fifty-four responses were received, 120 (77.9%) from physicians, 18 (11.7%) from nurse prescribers and 10 (6.4%) from pharmacist prescribers (6 unidentified professions). Not having to monitor INR was the most cited benefit, particularly for prescribers and patients in remote and rural settings, followed by potentially improved patient adherence. These benefits were reflected in respondents’ descriptions of positive experiences and patient feedback. The main limitations were the lack of reversal agents, cost and inability to monitor anticoagulation status. Many described their experiences of adverse effects of DOACs including fatal and non-fatal bleeding, and upper gastrointestinal disturbances. Conclusions: While prescribers have positive experiences and perceive benefits of DOACs, issues such as adverse effects and inability to monitor anticoagulation status merit further monitoring and investigation. These issues are particularly relevant given the trajectory of increased prescribing of DOACs.

Background: Physicians’ acceptance of clinical pharmacy services is dependent on exposure to those services, with use increasing as resident physicians progress through their training. Resident physicians train within environments that have a multidisciplinary teaching and clinical care approach, working closely with other healthcare professionals. Ambulatory care pharmacists are increasingly working with resident physicians in clinic settings as part of the multidisciplinary team, and identification of resident physicians’ perceptions may influence future collaboration. Objective: The objective of this research is to evaluate the perception of ambulatory care clinical pharmacy services from the perspective of resident physicians. Methods: A statewide network of ambulatory care pharmacists was identified and received an electronic questionnaire. Pharmacists working within clinics that serve as training sites for resident physicians then completed and distributed questionnaires to the resident physicians within their clinical site. Items related to demographics and perception of involvement and interactions with clinical pharmacists. Results: Forty-five resident physicians responded from four unique clinical sites (response rate = 42%). They agreed or strongly agreed that pharmacists help patients obtain their therapeutic goals (97.8%), are able to educate patients effectively (95.6%), provide high quality care (97.8%), and do a good job helping co-manage patients (91.1%). Previous exposure to pharmacists was limited primarily to the drugstore (48.9%) and hospital (51.1%) settings. Resident physicians in the third year of training and those reporting a friend was a pharmacist, were more likely to have a positive perception of the pharmacist’s role as a resident educator (p=0.048 and p=0.044, respectively). Conclusions: Resident physicians with a longer duration of exposure and personal friendship with a pharmacist are more likely to express positive perceptions. Areas for further enhancements in this interprofessional relationship related to perceptions about pharmacist autonomy and patient relationships were identified.

Background: Having a local code of ethics, based on moral obligations and virtues, known to all practicing pharmacists is important in order to guide them in relationships with patients, health professionals, and society. Objective: To investigate pharmacists’ attitude and barriers towards applying the ethical principles published by the Jordanian Pharmacists Association in the Jordanian code of ethics. Methods: The study objectives were addressed in a cross-sectional study completed by a convenience sample of community pharmacists, in both cities; Amman and Irbid A questionnaire was used to achieve the study objective. The questionnaire was developed and validated, investigating pharmacists’ socio-demographic and practice characteristics, perceived attitude toward certain practice scenarios, and perceived barriers towards applying the locally published ethical principles while dealing with their patients. The questionnaire was self-completed by pharmacists between January and August 2017. Collected data was analyzed using SPSS version 21. Descriptive statistics and parametric tests were used with p

Background: Continuing education (CE) is an internationally recommended approach as a lifelong learning model for pharmacists, enabling them to maintain the necessary knowledge, skills and ethical attitudes so as to remain current and competent in their practice. Objectives: The objective of this study is to 1) describe factors associated with taking different types of CE courses among pharmacists in Lebanon, and 2) assess the correlation between types of CE activity and the attitude of Lebanese pharmacists (motivation and value) and their computer literacy. Methods: This is a cross-sectional observational study conducted between February and May 2017, using a random sample of Lebanese pharmacists from all districts of Lebanon. All pharmacists were eligible to participate; the sample consisted of those who agreed to complete the questionnaire. The questionnaire includes questions about computer literacy, motivation and value about CE, in addition to sociodemographic characteristics of pharmacists. Results: Out of the 750 questionnaires distributed, 628 (83.73%) were filled out and returned to be analyzed. The mean age of the participants was 39.04 (SD 10.57) years, 66.9% of them were females, and 41.1% of them had a bachelor degree in pharmacy and worked in Mount Lebanon. Among the 628 respondents, 567 (90.3%) have earned at least one CE credit. Of those, 5.4% took mainly online courses, 15.4% took mainly live courses and the remaining took both types of CE. Higher motivation (aOR=1.05; CI 0.994-1.109) and higher value (aOR=1.076; CI 0.968-1.197) were associated with higher odds of taking live CE courses. Higher motivation (aOR=1.07; 95%CI 0.994-1.152) was associated with higher odds of taking online CE courses. Higher motivation (aOR=1.059; 95%CI 1.006-1.114) and higher general confidence with computer use (aOR=1.058; 95%CI 1.012-1.106) were significantly associated with higher odds of taking both types of CE courses. Conclusions: A high percentage of Lebanese pharmacists enrolled in the CE system, mainly driven by motivation and value of CE, in addition to a higher general confidence in computer use. Further efforts should be exerted by the Lebanese Order of Pharmacists to motivate pharmacists and help them improve their computer literacy, which is expected to improve not only enrollment in CE activities, but also the completion of their CE requirements.

Background: The CDC has reported 399,230 opioid-related deaths from 1999-2017. In 2018, the US surgeon general issued a public health advisory, advising all Americans to carry naloxone. Studies show that enhanced naloxone access directly reduces death from opioid overdose. Despite this, health care professional learners report low knowledge and confidence surrounding naloxone. Therefore, it becomes critical that medical education programs incorporate didactic and experiential sessions improving knowledge, skills and attitudes regarding harm reduction through naloxone. Objectives: 1. Describe the components and evaluation of a replicable and adaptable naloxone didactic and skills session model for medical providers; 2. Report the results of the evaluation from a pilot session with family medicine residents and physician assistant students; and 3. Share the session toolkit, including evaluation surveys and list of materials used. Methods: In July 2017, a literature search was completed for naloxone skill training examining best practices on instruction and evaluation. A training session for family medicine residents and physician assistant learners was designed and led by University of Cincinnati College of Medicine and College of Pharmacy faculty. The same faculty designed a pre and post session evaluation form through internal review on elements targeting naloxone knowledge, attitude, and self-efficacy. Results: The training session included one hour for a didactic and one hour for small group live skills demonstration in four methods of naloxone administration (syringe and ampule, nasal atomizer, branded nasal spray and auto injector). Forty-eight participants showed statistically significant (p

Objective. To measure undergraduate pharmacy and medical students’ collaborative attitudes regarding Pharmacist–Physician collaboration. Methods. A cross-sectional descriptive study was conducted from September 2016 to February 2017 in Northeast Brazil. Pharmacy and medical students from the first and the last year of courses were invited to complete Portuguese version of Scale of Attitudes Toward Pharmacist-Physician Collaboration (SATP2C). Descriptive and comparative analyses were performed using IBM SPSS (22 version). Differences were considered significant when p

A comprehensive literature review was conducted on the concept of job satisfaction in the pharmacist workforce field and the facets it comprises, as well as its measurement, aiming to (i) review the nature, mechanisms, and importance of job satisfaction in the context of the pharmacist workforce, (ii) survey some of the most salient facets that configure job satisfaction, and (iii) discuss validity and measurement issues pertaining to it. Although female pharmacists generally hold less appealing jobs, earn lower wages and salaries, and are promoted less frequently than their male counterparts, they report higher levels of job satisfaction. Age has a U-shape effect on job satisfaction, with middle-age pharmacists less satisfied than both younger and older practitioners. Workload, stress, advancement opportunities, job security, autonomy, fairness in the workplace, supervisors, coworkers, flexibility, and job atmosphere are facets contributing to pharmacists’ job satisfaction. Finally, discrepancy exists among researchers in measuring job satisfaction as a single global indicator or as a composite measure derived from indices of satisfaction with key aspects of a job. Understanding the mechanisms that affect pharmacists’ job satisfaction is important to employers in their pursuit to respond to practitioners’ needs, decrease turnover, and increase productivity. As pharmacists’ response to work-related conditions and experiences depends on gender and age, a unique set of rewards and incentives may not be universally effective. Additional research into the dynamics of the forces shaping pharmacists’ perceptions, opinions, and attitudes is needed in order to design and implement policies that allocate human resources more efficiently within the various pharmacy settings.

Background: Interprofessional collaboration between pharmacists and physicians in primary care has been linked to improved patient outcomes. How professionals position themselves and each other can shed light upon their relationship, and positioning theory can be used as a tool to better understand intergroup relations. Objectives: 1) To identify how community pharmacists position themselves, and how they are positioned by general practitioners. 2) To assess how well these positions correspond, how the positions align with a proactive position for the pharmacists, and discuss how the positions could potentially impact collaboration. Methods: In this qualitative study, data were collected through six focus group interviews held between June and October 2019, three with pharmacists and three with physicians. The focus group interviews were conducted using a semi-structured interview guide. Data were audio recorded, transcribed verbatim, and analyzed using the Systematic text condensation method. Positioning theory was used as a theoretical framework to identify the positions assigned to community pharmacists by the pharmacists themselves and by the physicians. Results: Twelve pharmacists and ten physicians participated. The pharmacists positioned themselves as the “last line of defense”, “bridge-builders”, “outsiders” - with responsibility, but with a lack of information and authority - and “practical problem solvers”. The physicians positioned pharmacists as “a useful checkpoint”, “non-clinicians” and “unknown”. Conclusions: The study revealed both commonalities and disagreements in how community pharmacists position themselves and are positioned by general practitioners. Few of the positions assigned to pharmacists by the physicians support an active role for the pharmacists, while the pharmacists´ positioning of themselves is more diverse. The physicians´ positioning of pharmacists as an unknown group represents a major challenge for collaboration. Increasing the two professions´ knowledge of each other may help produce new positions that are more coordinated, and thus more supportive towards collaboration.

Background: While pharmacists are well positioned to implement pharmacogenomic testing in healthcare systems, uptake has been limited. Objective: The primary objective of this survey was to determine how post-graduate education and training influences pharmacist’s knowledge and attitudes of pharmacogenomic testing. Methods: Survey questions were developed by the study team, and responses were collected electronically using REDCapTM. The electronic survey was sent to all pharmacists (n=161) within a large, multi-state healthcare system by email. Results: A total of 75 (47%) respondents completed all aspects of the survey. The majority of respondents were female (60%), worked in acute care settings (57%), were full-time employees (80%), and worked in an urban area (85%), with many graduating in or after 2010 (43%). For post-graduate education, 36% of respondents completed a Post-Graduate Year One Residency (PGY-1), and 27% had a board certification. Those that completed a PGY-1 residency were significantly more likely to have received formal training or education on pharmacogenomics than those who had not. They also assessed their own knowledge of pharmacogenomic resources and guidelines higher than those without PGY-1 training. More recent graduates were also significantly more likely to have received formal training or education on pharmacogenomics. Additionally, pharmacists who completed a PGY-1 residency were more likely to respond favorably to pharmacogenomics being offered through pharmacy services. Pharmacists with board certification were more comfortable interpreting results of a pharmacogenomic test than those without board certification. Conclusions: Pharmacists who have completed a PGY-1 residency or received board certification appear more comfortable with interpretation and implementation of pharmacogenomic testing.

Background: Currently, clinical pharmacists have in-depth therapeutic knowledge and scientific skills to act as drug therapy experts in healthcare settings. Objective: The aim of this study was to assess the opportunities and challenges of clinical pharmacy services from the health practitioners’ perspective in University of Gondar (UOG) hospital Ethiopia. Methods: A qualitative study was performed using face-to-face in-depth interviews with health practitioners who were directly involved in clinical pharmacy services (clinical pharmacists, physicians, and nurses) in UOG hospital. Results: A total of 15 health professionals from various specialties were interviewed to express their views towards clinical pharmacists’ competencies and identified challenges and opportunities regarding their clinical services. Based on interviewees report, the opportunities for clinical pharmacists includes acceptance of their clinical services among health specialties, new government policy and high patient load in hospital. However, inadequacy of service promotions, lack of continuity of clinical pharmacy services in wards, poor drug information services, lack of commitment, lack of confidence among clinical pharmacists, conflict of interest due to unclear scope of practice, and absence of cooperation with health workers were some of the challenges identified by the interviewees. Conclusion: We identified health professionals working in UOG hospital are receptive towards clinical pharmacy services, but identified some of the potential challenges that needed to be focused to strengthen and promote clinical pharmacy services. Further, the opportunities at hand also need to be utilized astutely to boost the services.

Objective: To investigate the views and assess motivation, attitudes of pharmacists in Lebanon towards mandatory continuous education (CE), its transition to Continuous Professional Development (CPD), and identify barriers to participation in CPD. Methods: A cross-sectional observational study, conducted between February and May 2017, enrolled 591 pharmacists. The questionnaire used in this study was developed after an extensive literature review and based on previous similar studies in different countries. Results: Half of the pharmacists who completed the questionnaire agreed that all the factors that were mentioned in the questionnaire motivated completing CPD, whereas 55.4% felt confident that CPD meets their needs. 78.4% felt confident in their abilities to assess what they have learned. 71.6% felt confident in their abilities to assess what additional CPD activity may be necessary. The majority of the pharmacists agreed that accessibility of group learning activities (location/distance) (69.6%), job restrictions (76.3%) and lack of time (80.6%) were the most essential barriers against participation in CPD. Motivation was significantly and positively correlated with attitude (r= 0.718), but negatively correlated with barriers (r= -0.243). Attitude was significantly and negatively correlated with barriers (r= -0.120). Conclusion: Our findings contribute to informing the forward pathway for the profession. Attitude and motivation to CPD were positive in this study. Accessibility of group learning activities due to distance and location, job restrictions and lack of time were the major barriers to participation in CPD. Potential solutions can be sought to address these issues.

Background\ud \ud Bacterial resistance to antibiotics is considered as natural phenomenon that occurs over the time due to genetic changes. Bacterial resistance to antibiotics is significantly increasing in the UAE. Self-medication with antibiotics has been identified as a major factor for the development of antibiotic resistance, which is significantly increasing in the UAE.\ud \ud Objectives\ud \ud The purpose of this study was to explore the factors that contribute to the use of antibiotics without prescriptions among first year healthcare university students in UAE.\ud \ud Methods\ud \ud Based on the findings of an earlier survey study, a qualitative interview study was designed to explore common themes related to student's knowledge, awareness, attitude, views, and perceptions. Data were analyzed thematically for the identification of themes and subthemes within the data through the use of coding.\ud \ud Results\ud \ud The interview study identified four main themes with multiple subthemes related to the use of antibiotics without a physician's prescription by first-year healthcare students. The thematic analysis of the interviews revealed four main themes; medication habits and practices; reasons for self-medication; access to antibiotics without a prescription and gaps in students' knowledge regarding antibiotic resistance.\ud \ud Conclusions\ud \ud Healthcare students in UAE are influenced by several factors including parents and friends influence, successful previous experience and investment of time and money to visit a physician. Our sample of healthcare students has a misconception about the use of antibiotics. The current interview study identified six new reasons for using antibiotics without prescriptions as compared to our earlier survey study. There is a need of multifaceted strategies to decrease unnecessary antibiotic use in our population sample.

Background: Recent implementation of national health coverage and the increasing health burden in Indonesia require health professionals, including pharmacists, to work more collaboratively to improve access and quality of health care. Nevertheless, relatively little is known about Indonesian pharmacists’ attitude towards collaboration. Objective: To assess and compare the attitude of Indonesian pharmacy students and pharmacists towards collaboration with physicians. Methods: A survey of 95 pharmacy students (Universitas Surabaya) and 114 pharmacists (public health facilities in East Java) in Indonesia was conducted using the validated questionnaire, Scale of Attitudes Toward Physician-Pharmacist Collaboration (SATP2C), which was translated in Bahasa Indonesia. The questionnaire contained 16 items which were based on a 4-point Likert scale. Descriptive statistics were used to summarise the responses, (i.e., individual scores, factor scores and total scores). Results: Response rates of 97.9% and 65.8% were reported for students and pharmacists, respectively. The mean total score of SATP2C among Indonesian students and pharmacists were 56.53 versus 56.77, respectively; indicating positive attitudes toward collaboration. Further analysis of each item of SATP2C confirmed the positive attitudes in which mean and median scores of ≥3 were reported for most items in both groups. Significant differences between students and pharmacists were found regarding the following items: (i) ‘there are many overlapping areas of responsibility between pharmacists and physicians’ (3.28 versus 2.89, respectively; p

Background: Recent studies have revealed that pharmacists have interest in conducting research. However, lack of confidence is a major barrier. Objective: This study evaluated pharmacists’ self-perceived competence and confidence to plan and conduct health-related research. Method: This cross sectional study was conducted during the 89th Annual National Conference of the Pharmaceutical Society of Nigeria in November 2016. An adapted questionnaire was validated and administered to 200 pharmacist delegates during the conference. Result: Overall, 127 questionnaires were included in the analysis. At least 80% of the pharmacists had previous health-related research experience. Pharmacist’s competence and confidence scores were lowest for research skills such as: using software for statistical analysis, choosing and applying appropriate inferential statistical test and method, and outlining detailed statistical plan to be used in data analysis. Highest competence and confidence scores were observed for conception of research idea, literature search and critical appraisal of literature. Pharmacists with previous research experience had higher competence and confidence scores than those with no previous research experience (p

Objective: To assess and compare the attitudes of medical and pharmacy students towards physician-pharmacist collaboration and explore their opinions about the barriers to collaborative practice in Kuwait. Methods: A cross-sectional survey of pharmacy and medical students (n=467) was conducted in Faculties of Medicine and Pharmacy, Kuwait University. Data were collected via self-administered questionnaire from first-year pharmacy and medical students and students in the last two professional years of the pharmacy and medical programs. Descriptive and comparative analyses were performed using SPSS, version 22. Statistical significance was accepted at p

Background: Medication education is vital for positive patient outcomes. However, there is limited information about optimal medication education by nurses during hospitalization and care transitions. Objective: Examine nurses’ attitudes and behaviors regarding the provision of patient medication education. The secondary objectives were to determine if nurses’ medication education attitudes explain their behaviors, describe nurses’ confidence in patient medication knowledge and abilities, and identify challenges to and improvements for medication education. Methods: A cross sectional survey was administered to nurses servicing internal medicine, cardiology, or medical-surgical patients. Results: Twenty-four nurses completed the survey. Greater than 90% of nurses believed it is important to provide information on new medications and medical conditions, utilize resources, assess patient understanding and adherence, and use open ended question. Only 58% believed it is important to provide information on refill medications. Greater than 80% of nurses consistently provided information on new medications, assessed patient understanding, and utilized resources, but one-third or less used open-ended questions or provided information on refill medications. Most nurses spend 5-9 minutes per patient on medication education and their attitudes matched the following medication education behaviors: assessing adherence (0.57; p

To date, research on the prescribing decisions of physician lacks sound theoretical foundations. In fact, drug prescribing by doctors is a complex phenomenon influenced by various factors. Most of the existing studies in the area of drug prescription explain the process of decision-making by physicians via the exploratory approach rather than theoretical. Therefore, this review is an attempt to suggest a value conceptual model that explains the theoretical linkages existing between marketing efforts, patient and pharmacist and physician decision to prescribe the drugs. The paper follows an inclusive review approach and applies the previous theoretical models of prescribing behaviour to identify the relational factors. More specifically, the report identifies and uses several valuable perspectives such as the ‘persuasion theory - elaboration likelihood model’, the stimuli–response marketing model’, the ‘agency theory’, the theory of planned behaviour,’ and ‘social power theory,’ in developing an innovative conceptual paradigm. Based on the combination of existing methods and previous models, this paper suggests a new conceptual model of the physician decision-making process. This unique model has the potential for use in further research.

Objective: 1) To evaluate the relationship between physician-pharmacist agreement about the off-label drug use and 2) and to identify the most common off-label medication category/indications and prescriber clinical disciplines in private settings in Baghdad area, Iraq Methods: This study evaluated 980 off-label use requests in the private clinical settings within Baghdad area, Iraq from October 2013 to September 2015. The efficacy, safety, and convenience of each drug request and its alternative options were evaluated according to the patient health and demographic characteristics and standard guidelines. Results: Of the 980 physician off-label requests, only 22.7% were approved by the pharmacists. Rheumatology and Nephrology accounted for the highest ratio of off-label use requests for adults (30.3% and 26.3%). The pharmacist rejection ratio of off-label use was comparable between the two groups (p>0.05). Most of the issued requests were attributed either to unapproved indication or to combination of more than one drug (38% and 35.3%). A low acceptance rate was reported in the requests issued for treatment in different clinical lines to the authorized one (11.9%). The lowest rate of acceptance was reported in the requests that had very low evidence level (9.1%). The mostly prescribed medications were musculoskeletal agents (28.9%). Finally, 78.2% of the requests came from clinical branches for adults. Although the agreement rate for requests in adults was higher than that in pediatrics, the two rates were not significantly different. Conclusion: Community pharmacists should effectively take responsibility for assessing off-label drug requests in Iraqi private settings. The quality of evidence does not represent the major factor influencing the approval rate of off-label drug use. The availability of safer and/or affordable alternatives and prescribing for a different patient age category highly impacted the pharmacists’ approval rate.

Background: The provision of professional pharmacy services by community pharmacists continues to be limited, particularly in low and middle income countries. It was postulated that multiple management challenges faced by community pharmacists contribute to this situation. Objective: The primary aim of the research was to determine the challenges faced in the management of community pharmacies in Sarawak (the largest state in Malaysia), and practical strategies to cope and overcome the challenges. Methods: Semi-structured interviews were carried out with community pharmacists practising in Sarawak. Purposive and snowball sampling were employed to ensure a diverse group of informants. The interviews were audio-recorded and transcribed verbatim, with the resultant data analysed using thematic analysis. Data collection, coding, interpretation were carried out iteratively until theoretical saturation. Results: Twenty respondents from different demographic characteristics were recruited. Six major themes were identified. Management challenges faced by community pharmacists traverse five major domains: market competition, legislative issues, customers’ knowledge and expectations, macroeconomic impacts and operational challenges. Most of these challenges require government intervention to be resolved. In the meantime, improving customer service and expanding the range of professional services were seen as the most viable strategies to cope with existing challenges. The main concern is that current legislative and economic landscape may hinder these strategies. Enactment of dispensing separation and more protective measures against market competition were suggested to alleviate the challenges faced. Conclusion: Numerous management challenges faced by community pharmacists that distract them from delivering professional pharmacy services have been highlighted. Urgent affirmative actions by the government are warranted in supporting community pharmacists to realise and maximise their potentials.

Background: Mobile Authentication Service (MAS) is a mobile health technology deployed to hinder the retailing of falsified medicines to consumers in Nigeria. But, some community pharmacists reported that points of failures of MAS have negatively impacted their practices. Objectives: The objectives of this study were (1) to assess the acceptance of MAS by community pharmacists; (2) to explore the views of MAS providers on the challenges and successes of MAS deployment in Nigeria. Methods: A quantitative cross sectional survey was used to investigate community pharmacists’ acceptance of MAS. A validated structured questionnaire, based on Technology Acceptance Model, was distributed to 326 community pharmacists. In addition, a structured interview guide was employed to explore MAS providers’ views of challenges and successes of MAS deployment in Nigeria. Results: Just about half (53%) of responding community pharmacists were keen on using MAS. In addition, 51% of them would recommend the service to other practitioners and 54% would encourage their clients to use it. The results of the study indicated that both awareness and perceived reliability played important role in the behavioural intention to use the MAS. The findings from the exploration of MAS providers’ views showed that the problems encountered with MAS (no response and wrong response) were mainly due to contextual challenges in the Nigerian setting. These contextual challenges like the Global System Mobile downtime, incessant power outages and limited ability of consumers to use the Short Message Service, all contributed to the limited success of MAS in Nigeria. Conclusions: Acceptance of mobile authentication service by community pharmacists is moderate. Perceived reliability and awareness are important factors that affect behavioural intention to use MAS. The limited success of MAS deployment appeared to be as a result of its interaction with the local context, where it has been deployed.

Background: The expansion of pharmacist scope of practice to include provision of immunizations has occurred or is being considered in various countries. There are limited data evaluating the experiences of Canadian pharmacists in their role as immunizers. Objective: To describe the experiences of pharmacists in the Canadian province of New Brunswick as immunizers, including vaccines administered and perceived barriers and facilitators to providing immunizations. Methods: An anonymous, self-administered, web-based questionnaire was offered via email by the New Brunswick Pharmacists’ Association to all its members. The survey tool was adapted, with permission, from a tool previously used by the American Pharmacists Association and validated using content validity and test-retest reproducibility. Pharmacist reported immunization activities and perceived facilitators and barriers to providing immunization services were assessed. Results: Responses from 168 (response rate of 26%) were evaluable.b Approximately 90% of respondents worked in community practice full time, 65% were female and 44% were practicing for 20 or more years. Greater than 75% reported administering: hepatitis A and B, influenza, and zoster vaccines. The majority of respondents felt fully accepted (agreed or strongly agreed) as immunization providers by patients, local physicians, and the provincial health department (97%, 70%, and 78%, respectively). Most commonly reported barriers were: lack of a universally funded influenza immunization program, insufficient staffing and space, and concerns around reimbursement for services. Conclusions: Pharmacists in New Brunswick, Canada are actively participating in the provision of a variety of immunizations and felt fully supported by patients and other healthcare providers. Barriers identified may provide insight to other jurisdictions considering expanding the role of pharmacists as immunizers.

Background: Public health priorities can be addressed by pharmacists through channels such as medication therapy management (MTM) to optimize patient and population outcomes. However, no studies have specifically assessed pharmacists’ perceptions of addressing public health priorities through MTM. Objective: The objective of this study was to assess pharmacists’ opinions regarding the feasibility and appropriateness of addressing seven areas of public health priority through MTM services to impact public health in direct patient care settings. Methods: An anonymous 37-question electronic survey was conducted to evaluate Ohio pharmacists’ opinions of advancing seven public health priorities identified from Healthy People 2020 (family planning, preconception care, smoking cessation, immunizations, nutrition/biometric wellness assessments, point-of-care testing, fall prevention) through MTM activities; to identify potential barriers; and to collect demographic information. The cross-sectional survey was sent to a random sample of 500 pharmacists registered with the Ohio State Board of Pharmacy. Results: Seventy-six pharmacists responded to the survey, resulting in a 16% response rate. On average, it took respondents 5-10 minutes to complete the survey. The majority of respondents thought that each of the seven public health priorities were “important” or “very important” to patient health; the most commonly identified areas included smoking cessation, immunizations, and fall prevention (97.5%). When asked to indicate which of the seven areas they thought they could potentially have a role to provide services through MTM, on average pharmacists picked 4 of the priority areas. Only 6.6% indicated there was no role for pharmacists to provide MTM services for any of the listed categories. Staffing, time, and reimbursement represented the most commonly perceived barriers for pharmacists in providing MTM services. Fifty-seven percent indicated an interest in learning more about MTM, with 98% of responders selecting continuing education as the preferred source. Conclusion: The majority of pharmacists indicated they could make an impact on public health priorities through MTM services.

Background: The role of community pharmacists is very important due to their access to primary care patients and expertise. For this reason, the interaction level between pharmacists and patients should be optimized to ensure enhanced delivery of pharmacy services.Objective: To gauge perceptions and expectations of the public on the role of community pharmacists in Dubai, United Arab Emirates (UAE).Methods: Twenty five individuals were invited to participate in 4 separate focus group discussions. Individuals came from different racial groups and socio-economic backgrounds. Interviews were audio-recorded and transcribed. Using thematic analysis, two reviewers coded all transcripts to identify emerging themes. Appropriate measures were taken to ensure study rigor and validity.Results: All facilitators and barriers that were identified were grouped into 5 distinct themes. The pharmacist as a healthcare professional in the public mind was the most prominent theme that was discussed in all 4 focus groups. Other themes identified were, in decreasing order of prevalence, psychological perceptions towards pharmacists, important determinants of a pharmacist, the pharmacy as a unique healthcare provider, and control over pharmacies by health authorities.Conclusions: This study provided insight into the way that the public looks at the role of community pharmacists in Dubai. Determinants that influence their perception are the media, health authorities, pharmacist’s knowledge level, attire, nationality, age, and pharmacy location.

Objective: The current study was carried out to assess community pharmacists’ perceptions towards online health information, to examine the type of information seek from Internet and to identify the barriers when they retrieved online health information. Methods: The study was designed as a cross-sectional questionnaire-based survey whereby all (300) community pharmacists practicing in Federal Territory of Kuala Lumpur, Malaysia were targeted for data collection. A 35-itemed questionnaire was posted out along with a stamped addressed envelope, invitation letter and support letter. Responses were also accepted via online response. Both descriptive and inferential statistics were used for data analysis. All statistical analysis was performed using SPSS v. 20.0. Results: A total of 67 responses were received with a response rate of 22.3%. The top three frequently health information searched by respondents were medicine information, general healthcare information and disease-related information. High number of respondents agreed that Internet had too much health information to scan through. Gender (p=0.018) showed significant association with visiting established health websites. Meanwhile, statistical significant was observed between age and searching medicine information (p=0.037), undertaking online continuing professional development (p=0.023), as well as searching clinical guidelines (p=0.047). Respondents’ education level showed significant association with uncertainty about the reliability of online health information (p=0.023) and unsure about filtering the information (p=0.007). Conclusions: Majority of the respondents expressed positive perception with the use of Internet for health information. The findings of the current study showed the widely use of Internet for health information among community pharmacists. Hence, this study provides opportunity for future works to further examine community pharmacist’s retrieval and appraisal skills for online health information, as well as application of this information into their daily pharmacy practice.

Objectives: We explored factors influencing Indonesian primary care pharmacists’ practice in chronic noncommunicable disease management and proposed a model illustrating relationships among factors. Methods: We conducted in-depth, semistructured interviews with pharmacists working in community health centers (Puskesmas, n=5) and community pharmacies (apotek, n=15) in East Java Province. We interviewed participating pharmacists using Bahasa Indonesia to explore facilitators and barriers to their practice in chronic disease management. We audiorecorded all interviews, transcribed ad verbatim, translated into English and analyzed the data using an approach informed by “grounded-theory”. Results: We extracted five emergent themes/factors: pharmacists’ attitudes, Puskesmas/apotek environment, pharmacy education, pharmacy professional associations, and the government. Respondents believed that primary care pharmacists have limited roles in chronic disease management. An unfavourable working environment and perceptions of pharmacists’ inadequate knowledge and skills were reported by many as barriers to pharmacy practice. Limited professional standards, guidelines, leadership and government regulations coupled with low expectations of pharmacists among patients and doctors also contributed to their lack of involvement in chronic disease management. We present the interplay of these factors in our model. Conclusion: Pharmacists’ attitudes, knowledge, skills and their working environment appeared to influence pharmacists’ contribution in chronic disease management. To develop pharmacists’ involvement in chronic disease management, support from pharmacy educators, pharmacy owners, professional associations, the government and other stakeholders is required. Our findings highlight a need for systematic coordination between pharmacists and stakeholders to improve primary care pharmacists’ practice in Indonesia to achieve continuity of care.

Background: Adverse Drug Reactions (ADRs) are a major public health problem. Prompt reporting of suspected ADRs is fundamental in the post-marketing surveillance of medicines and helps in ensuring medicine safety. However, fewer ADRs are reported in general and in particular by community pharmacists. There is limited knowledge about the factors which are preventing community pharmacists in the UK from reporting an ADR. Objectives: To identify the barriers to ADR reporting among community pharmacists practicing in the UK. Methods: A cross sectional study using a 25-items questionnaire (both online and paper based) including 10 barriers to ADR reporting was conducted from 1st April 2012 to September 2012. Community pharmacists practicing in the West Midlands, UK, were approached for the participation in this study. Chi-Square and regression were applied to identify covariates for the barriers to ADR reporting. A significant value of 0.05 was assigned for analysis. Results: Of the 230 invited community pharmacists, 138 pharmacists responded (response rate 60%). The median age of respondents was 31 years. All pharmacists reported that they would report both serious and mild ADRs from drugs with black triangle among children as well as adults. About 95% (n=131) of the pharmacists were familiar with the paper based ADR reporting system. Store-based pharmacists were more likely to be more confident about which ADRs to report [0.680, 95% Confidence Interval 0.43-3.59]. Lack of time 46.4% (n=64), and pharmacists perception that ADR is not serious enough to report (65.2%; n=90) were identified as barriers to ADR reporting. Majority 63.0% (n=87) of the pharmacists identified training and information about what to report and access to Information Technology (IT) (For example access to internet connection) 61.6% (n=85) as facilitators to ADR reporting process. Conclusion: Lack of time and ADRs considered not serious enough by pharmacists to report were barriers to ADR reporting. Further training and education about the types of ADRs to be reported can help to improve the reporting of ADRs.

Background: Whether the available Continuing Education (CE) programs meet pharmacists' continuously increasing needs and preferences is open to question. Objectives: to investigate pharmacists' perceptions and attitudes concerning available CE programs, evaluate the pharmacists' choices with regard to selecting among different CE programs, and investigate the factors that are associated with preference to utilize online CE programs. Method: A 17-question survey was developed and mailed to a random sample of 600 Texan pharmacists. In addition to collecting basic demographic information, the survey investigated pharmacists' choices with regard to delivery and content of CE programs, motivations to participation in CE programs, and pharmacists' preferences for future CE programs. Results: A total of 161 pharmacists completed the survey and mailed back their responses. Excluding the 75 undeliverable surveys, the response rate was 31%. Approximately 83% of respondents found that currently available CE programs met their educational needs. The most important factors influencing pharmacists' choices with regard to CE programs were the scope programs, the location where programs are held, and the cost associated with enrolling in such programs. Online CE was the most preferred mode of CE among participants. The factors that were associated with pharmacists' preferences to complete 50% or more of required CE through online programs were previous use of online CE programs, preference to limit the duration of CE programs to 1 or 2 hour-long, and perceived ability to find adequate CE programs among currently available CE programs. Conclusion: The findings suggest modalities for CE programs providers on how to improve CE programs in the future in order to meet the preferences of local pharmacists.

Pharmacovigilance can be helpful in protecting consumers from harmful effects of medicines. Healthcare professionals should consider Adverse Drug Reaction (ADR) reporting as their professional obligation and should be aware of the existing pharmacovigilance mechanisms in their countries. In Nepal, pharmacovigilance activities were initiated in 2004.Objectives: The present study evaluated the knowledge, attitude and practices (KAP) of the healthcare professionals towards ADRs and pharmacovigilance in Manipal Teaching Hospital (MTH), a tertiary care teaching hospital attached to the regional pharmacovigilance center in western Nepal.Methods: A cross-sectional study was carried out in 2007 using a pretested (Cronbach alpha=0.72) questionnaire having 25 questions (15 questions on knowledge, 5 on attitude and 5 on practice). The correct/positive responses were given a score of ‘2’ and the wrong/negative responses ‘1’, maximum possible score of ‘50’.Results: A total of 131 responses were obtained among which 42 were incomplete and remaining 89 [females 49 (55.1%)] were analyzed. Of the 89 professionals, 29 (32.6%) were doctors, 46 (51.8) nurses and 14 (15.7%) pharmacists. The mean age was 28.32 (SD=8.46) years and the median (interquartile range) of duration of the service 14.5 (6-36) months. The total KAP scores was 40.06 (SD=3.51) for doctors, 38.92 (SD=4.83) for pharmacists, and 35.82 (SD=3.75) for nurses. Among the 89 professionals, 59 (62.3%) had not reported even a single ADR to the pharmacovigilance center.Conclusion: The healthcare professionals at the MTH had a poor KAP towards ADRs and pharmacovigilance and there is a need for educational and awareness intervention for these professionals. Keywords: Adverse Drug Reaction Reporting Systems. Attitude of Health Personnel. Nepal.

In order for community pharmacy practice to continue to evolve, pharmacy practice research on potential new services is essential. This requires the active participation of community pharmacists. At present the level of involvement of community pharmacists in pharmacy practice research is minimal. Objectives: To ascertain the attitudes of a group of research-experienced community pharmacists towards participating in research; to investigate the barriers and facilitators to participation; to identify potential strategies to increase the involvement of community pharmacists in research. Methods: A focus group was conducted with a purposive sample of 11 research-experienced community pharmacists. A pharmacist academic moderated the focus group using a semi-structured interview guide. The participants were asked about their attitudes towards research, previous involvement in research, barriers to their involvement and strategies to overcome these barriers. The session was audio-taped and notes were taken by an observer. Thematic analysis of the notes and audio-tape transcripts was conducted. Results: Three themes emerged around pharmacists' attitudes towards research: pharmacists' perception of the purpose of research, pharmacists' motivation for involvement in research, and pharmacists' desired role in research. Barriers to research participation were grouped into four themes: pharmacists' mindset, communication, infrastructure (time, money and staff), and skills/knowledge. Strategies to address each of these barriers were suggested. Conclusions: Participants recognised the importance of research towards advancing their profession and this was a motivating factor for involvement in research. They perceived their role in research primarily as data collection. A series of practical strategies to overcome the barriers to participation were offered that researchers may wish to consider when promoting research outcomes and designing research projects. Para que la práctica farmacéutica continúe evolucionando, es esencial la investigación de farmacia práctica sobre nuevos servicios. Esto requiere la participación activa de farmacéuticos comunitarios. Actualmente, el nivel de participación de los farmacéuticos comunitarios en la investigación en farmacia práctica es mínimo. Objetivos: Evaluar las actitudes de un grupo de farmacéuticos comunitarios con experiencia en investigación; investigar las barreras y facilitadores para la participación; identificar las posibles estrategias para aumentar la participación de los farmacéuticos comunitarios en investigación. Métodos: Se realizó un grupo focal con una muestra conveniente de 11 farmacéuticos comunitarios con experiencia en investigación. Un profesor de farmacia moderó el grupo focal utilizando una guía de entrevista semi-estructurada. Se preguntó a los participantes sobre sus actitudes hacia la investigación, participación previa en investigaciones, barreras para su participación y estrategias para superar esas barreras. La sesión fue grabada y un observador tomó notas. Se realizó un análisis temático de las notas y de las transcripciones del as cintas. Resultados: Emergieron tres temas sobre las actitudes de los farmacéuticos hacia la investigación: la percepción de los farmacéuticos del propósito del a investigación, la motivación para la participación de los farmacéuticos en investigación y el papel que desean los farmacéuticos en la investigación. Las barreras para la investigación se agruparon en cuatro temas: mentalidad de los farmacéuticos, comunicación, infraestructura (tiempo, dinero y personal) y habilidades/conocimientos. Se sugirieron estrategias para afrontar cada una de esas barreras. Conclusiones: Los participantes reconocieron la importancia de la investigación para el avance de su profesión y este era el factor motivador para su participación en la investigación. Percibían su papel en la investigación fundamentalmente como de recogida de datos. Se ofrecieron varias estrategias para superar las barreras a la participación que los investigadores deberían considerar cuando promocionen los resultados de investigaciones y cuando diseñen proyectos de investigación.

Background: In Lebanon, mandatory continuing education (CE) for pharmacists was implemented in January 2014. Objective: The objectives of this study are to assess 1) the overall adherence to the mandatory CE program, 2) pharmacists’ preferences related to CE, and 3) barriers to adherence to CE. Methods: By the end of October 2017, an evaluation of pharmacists’ participation in the mandatory CE program was conducted using electronic reports available in the Learning Management System (LMS). Descriptive results were presented as frequencies and percentages. In addition, a cross-sectional survey was conducted among pharmacists to better understand their preferences and barriers to their participation to the CE program. Finally, a focus group was organized with pharmacists who did not start their CE. Results: Out of all registered pharmacists in Lebanon, 68.30% started their CE and 25.6% already achieved their required credits. Among pharmacists enrolled in the CE system, the majority (69%) used the online courses at least once. Moreover, CE enrolment was similar among old and young pharmacists except for those newly registered. The majority of pharmacists preferred clinical and pharmacological topics, followed by preventive medicine and transferable skills. Barriers to engaging in CE were mainly work and family obligations, lack of interest, lack of time, and difficulties in commuting and technology use. Conclusion: Although results of the present study are similar to those in developing countries, the resistance to change is higher. The Lebanese Pharmacists Association [Ordre des Pharmaciens du Liban] should develop strategies to motivate and enroll more pharmacists in the CE system, based on the barriers and preferences cited in the results, while continuing to offer high quality and cost-favorable CE programs to Lebanese pharmacists.