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Objectives (1) To compare the resources and practitioner activities in community pharmacies that have changed practice with those in pharmacies that have not changed; and (2) in pharmacies that have changed practice, to identify factors affecting a pharmacy's ability to support pharmacy practice change. Design Multiple-case design, in which six pharmacies were studied in depth. Setting Six independent community pharmacies in Iowa. Participants Pharmacy owners. Intervention A mail survey and an on-site personal interview were used to collect information about the pharmacy's practice changes and influences on the practice change process. Main Outcome Measures 14 criteria of pharmacy practice change and 5 types of influences on change (environmental variables, organizational variables, owner/manager characteristics, strategy-making features, attributes of change). Results Three pharmacies had made considerable change, one had made some change, and two had made little or no change. After a broad set of initial changes, subsequent changes tended to be made incrementally. A variety of factors were identified that support pharmacy practice change. Most of the factors were associated with improving resources, such as upgraded staff skills, involvement in demonstration projects, regular environmental scanning, and regular interaction with advocates for pharmacy practice change (e.g., college of pharmacy, pharmacy associations, innovative practitioners). Also, experienced owners who looked to the future and actively addressed constraints were associated with making pharmacy practice change. Conclusion Practitioners and other interested parties should consider a broad array of activities when trying to facilitate pharmacy practice change. Researchers can use these findings to develop studies that will provide stronger scientific evidence that can contribute to a model of pharmacy practice change. The continued study of pharmacy practice change can assist pharmacists working to translate a philosophy of pharmaceutical care into daily practice.

We evaluated the demographics and beliefs regarding safety and efficacy of herbal therapy among individuals in Iowa and assessed the willingness to discuss the use of these products with health care providers. We distributed 1300 surveys to two random samples: patients attending eight clinics, and residents of the state (mailing). Data were categorized according to herb use and compared between users and nonusers. The response rate was 61% (794 people), with 41.6% of respondents reporting herb use. They were predominately white women and were likely to have had education beyond high school (p

The purpose of this study was to examine the relationships between the availability of community pharmacies and 4 types of market factors. A composite data set was created that linked, at the county level, data on: (1) type and number of pharmacies; (2) population characteristics; (3) payer variables; (4) health care system factors; and (5) competitive factors. In this exploratory study, secondary data were used to assess the association between the availability of community pharmacies and the influence of market factors. To assess the market influences on availability of community pharmacies, 2 regressions were performed. In 1 model, the number of community pharmacies per 10,000 population was the dependent variable, whereas the dependent variable in the other regression was the proportion of independently owned community pharmacies. The independent variables in each regression were the market factors--population characteristics, payer variables, health care system factors, and competitive variables. Squared terms were included for 8 of 15 market factors to account for nonlinearities in the relationships. Multiple market factors were correlated with both the number of community pharmacies and the proportion of independently owned pharmacies in an area. Several of the relationships were not linear and changed direction within the range of data. Counties with either a low or a high percentage of elderly people had fewer pharmacies and a lower proportion of independently owned pharmacies compared with counties with a moderate percentage of elderly people. Counties that were scarcely or highly rural had fewer community pharmacies but a higher proportion of independently owned pharmacies than counties that were moderately rural. Areas with a greater percentage of the population earning less than the poverty level had more pharmacies, especially independently owned ones. Fewer community pharmacies were found in areas with higher health maintenance organization penetration rates. The number of hospital admissions was positively associated with the number of pharmacies but negatively associated with the proportion of independently owned pharmacies. The availability of community pharmacies varies across the country. In light of the trend toward fewer independently owned pharmacies, potential problems in accessing pharmacy services could develop in certain areas, including those that are highly rural and those with a high percentage of people earning less than the poverty level. Future research and policy issues are identified.

The purpose of this exploratory study was to: (1) test the rote learning response; and (2) investigate the effects of selected consumer demographic/psychographic, information-access, and health-related knowledge/experience variables on rote learning after exposure to a televised direct-to-consumer prescription drug advertisement that was developed and broadcast under new US Food and Drug Administration guidelines. A judgment (nonprobability) sample of 202 individuals waiting for their appointments at a university-based general medicine clinic was selected to view a televised advertisement and complete a questionnaire. One participant returned an unusable form; 24 others held positions in health care occupations and were omitted from the analysis. Results based on responses from the 177 eligible participants showed that the presentation of both promotional and risk-related product information in the same broadcast advertisement may lead to viewer problems with rote learning of each type of information.

Objective. To compare practice settings and activities of pharmacists with bachelor of science (BS) in pharmacy and doctor of pharmacy (PharmD) degrees. Methods. Data from the 2009 National Pharmacist Workforce Survey instrument were analyzed. Multivariate regression was used to examine the association of the PharmD degree with time spent in dispensing and patient care. Results. The survey response rate by pharmacists was 52%, and 562 usable responses met our inclusion criteria. Sixty-three percent of BS and 39% of PharmD pharmacists were employed in community pharmacies, compared with 21% of BS and 38% of PharmD pharmacists employed in hospital pharmacy settings. Practicing in a community setting had the strongest influence on time spent in dispensing and time spent in patient care. Among respondents with PharmD degrees, a residency was associated with less time in dispensing and more time in patient care. Conclusion. Time spent in dispensing and patient care were influenced more by practice setting than...

Background Studies have demonstrated that blood pressure (BP) control can be improved when clinical pharmacists assist with patient management. The objective of this study was to evaluate if a physician and pharmacist collaborative model in community-based medical offices could improve BP control. Methods This was a prospective, cluster randomized, controlled clinical trial with clinics randomized to a control group (n = 3) or to an intervention group (n = 3). The study enrolled 402 patients (mean age, 58.3 years) with uncontrolled hypertension. Clinical pharmacists made drug therapy recommendations to physicians based on national guidelines. Research nurses performed BP measurements and 24-hour BP monitoring. Results The mean (SD) guideline adherence scores increased from 49.4 (19.3) at baseline to 53.4 (18.1) at 6 months (8.1% increase) in the control group and from 40.4 (22.6) at baseline to 62.8 (13.5) at 6 months (55.4% increase) in the intervention group ( P = .09 for adjusted between-group comparison). The mean BP decreased 6.8/4.5 mm Hg in the control group and 20.7/9.7 mm Hg in the intervention group ( P P Conclusions A physician and pharmacist collaborative intervention achieved significantly better mean BP and overall BP control rates compared with a control group. Additional research should be conducted to evaluate efficient strategies to implement team-based chronic disease management. Trial Registration clinicaltrials.gov Identifier:NCT00201019

Objective. Determine the effectiveness of TIMER (Tool to Improve Medications in the Elderly via Review) in helping pharmacists and pharmacy students identify drug-related problems during patient medication reviews. Methods. In a randomized, controlled study design, geriatric patient cases were sent to 136 pharmacists and 108 third-year pharmacy students who were asked to identify drug related-problems (DRPs) with and without using TIMER. Results. Pharmacists identified more tool-related DRPs using TIMER (p = 0.027). Pharmacy students identified more tool-related DRPs using TIMER in the first case (p = 0.02), but not in the second. Conclusion. TIMER increased the number of DRPs identified by practicing pharmacists and pharmacy students during medication reviews of hypothetical patient cases.

Objective Using a conceptual model of collaborative working relationships between pharmacists and physicians, a measure for physician–pharmacist collaboration from the physician perspective was developed. The measure was analyzed for its factor structure, internal consistency, construct validity, and other psychometric properties. Methods An initial 27-item Physician–Pharmacist Collaboration Instrument (PPCI) was developed to assess seven themes about professional relationships using Likert scales. The PPCI was mailed to a random sample of 1000 primary care physicians. Principal component analysis was used to assess the structure and uncover underlying dimensions of the initial instrument. Items were evaluated for inclusion or exclusion into a refined instrument. Internal consistency was assessed by calculating Alpha coefficients for each identified factor. Convergent validity was assessed using Spearman correlations between the identified factors and a previous measure of collaborative care. After measure refinement, confirmatory factor analysis was used to evaluate the fit of both versions of the instrument. Results Three hundred forty usable surveys were returned for a response rate of 34%. Almost 70% of the respondents were male with a mean age of 45.8. A majority were family practice physicians (72.1%) in private practice (67.3%). Three unique factors were identified during principal component analysis and utilized in a confirmatory factor analysis. Both a full and a 14-item reduced model were constructed and tested. Cronbach's alpha for the three factors of the full model ranged from 0.91 to 0.97, while the reliability for the reduced model ranged from 0.86 to 0.96. Comparative fit indexes of 0.97 and 0.98 were obtained, indicating good fit for the models. Conclusions The results indicate good reliability and validity of the refined (14-item) PPCI. This instrument can be useful as a research tool for assessment of the physicians' perspective about a physician–pharmacist relationship. Further research is warranted to examine if the extent of relationship development, as measured with the PPCI, can affect patient care outcomes.

ObjectiveTo assess the impact of risk management activities on patient risk of glucocorticoid-induced osteoporosis.MethodsNinety-six adult patients taking chronic glucocorticoid therapy in 15 community pharmacies. Patients in the control group received usual and customary care. Patients in the treatment pharmacies received education and an educational pamphlet about the risks of glucocorticoid-induced osteoporosis. In addition, the treatment group pharmacists monitored the patients' drug therapy, to identify and address drug-related problems. Data including the glucocorticoid taken by the patient, medications, and osteoporosis risk factors were collected at baseline and after 9 months of monitoring, via Web-based survey completed in the pharmacy. Using an intent to treat approach, the pre–post frequency changes were compared with contrasts for presence of bisphosphonate therapy, presence of estrogen therapy, presence of calcium supplement, discussion of glucocorticoid-induced osteoporosis risk, discussion of bone density test, presence of bone mineral density test, reported inactivity, and reported low calcium diet.ResultsThe contrast was significant in favor of the treatment pharmacies for the frequency of patients taking a calcium supplement (Control [−6.9%] vs. Treatment [17.1%], P < 0.05). No other contrast was significant.ConclusionsCommunity pharmacists are capable of increasing calcium supplementation among patients at risk for glucocorticoid-induced osteoporosis. Pharmacists who educate at-risk patients can impact the self-care of these patients.