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Background: Generic substitution (GS), is a cost-containment strategy meant to contain pharmaceutical expenditure without compromising health objectives. In order to shape GS into a policy that is both efficient and safe it is crucial to understand which factors are most important for patients’ trust in GS. Objective: To assess Swedish patients’ level of trust in the bioequivalence of cheap and expensive generic medicines, and the association between trust and various factors. Methods: A cross-sectional study was conducted. Questionnaires were handed out at 12 community pharmacies in Sweden, selected through stratified sampling, between March and April 2015. The questionnaire included seven socio-demographic questions in addition to 18 items divided into three sections: the ‘views on generic medicine’-scale, information on and prior experiences of GS, financial aspects and change of color/name. Odds Ratios (ORs) were estimated applying adjusted logistic regression analyses with trust in the bioequivalence of generic medicines used as outcome variable and various factors as predictors. Results: A total of 719 patients participated (response rate 85.7%). The results show that 70.7% of the respondents’ trust that cheap and expensive interchangeable generic medicines are equal. Of the respondents 36.0% considered the change in appearance and 40.8% the change in names to complicate adherence. Lower trust in the bioequivalence of generic medicines were associated with being female (aOR=1.82, 95%CI 1.20:2.75, p

Background: All changes in the regulation of pharmacies have an impact on the work carried out in pharmacies and also on patient safety, regardless of whether this is the intention or not. Objective: To compare staff apprehension regarding some aspects of patient safety and quality in community pharmacies prior to and after the 2009 changes in regulation of the Swedish community pharmacy market. Methods: Questionnaires targeted at pharmacy staff before and after the changes in regulation (in 2008, 2011/12, and 2012/13 respectively) used four identical items, making comparisons of some aspects possible. Results: All four items demonstrated a significant decrease in the first survey after the changes as compared to before. In the second survey significant differences were found on the two items representing safety climate whereas the items representing team climate and management showed no significant differences. Conclusions: The comparison carried out in this study indicates a negative effect in Swedish community pharmacies on safety and quality issues, as experienced by pharmacy staff. It is recommended that the possible effects of healthcare reforms are assessed before implementation, in order to counteract conceivable decline in factors including patient safety and working conditions.

In some countries, pharmacists have obtained prescribing rights to improve quality and accessibility of care and reduce physician workload. This case study explored pharmacists' current roles in and potential for prescribing in primary care in the Netherlands, where prescribing rights for pharmacists do not exist. Participatory observations of pharmacists working in either general practice or community pharmacy were conducted, as were semi-structured interviews about current and potential practice. The latter were extended to patients and other healthcare professionals, mainly general practitioners, resulting in 34 interviews in total. Thematic analyses revealed that pharmacists, in all cases, wrote prescriptions that were then authorized by a physician before dispensing. General practice-based pharmacists often prescribed medications during patient consultations. Community pharmacists mainly influenced prescribing through (a) medication reviews where the physician and/or practice nurse often were consulted to make treatment decisions, and (b) collaborative agreements with physicians to start or substitute medications in specific situations. These findings imply that the pharmacists' current roles in prescribing in the Netherlands resemble collaborative prescribing practices in other countries. We also identified several issues that should be addressed before formally introducing pharmacist prescribing, such as definitions of tasks and responsibilities and prescribing-specific training for pharmacists.

Background: Hospital discharge of older patients is a high-risk situation in terms of patient safety. Due to the fragmentation of the healthcare system, communication and coordination between stakeholders are required at discharge. The aim of this study was to explore communication in general and medication information transfer in particular at hospital discharge of older patients from the perspective of healthcare professionals (HCPs) across different organisations within the healthcare system., Methods: We conducted a qualitative study using focus group and individual or group interviews with HCPs (physicians, nurses and pharmacists) across different healthcare organisations in Sweden. Data were collected from September to October 2021. A semi-structured interview guide including questions on current medication communication practices, possible improvements and feedback on suggestions for alternative processes was used. The data were analysed thematically, guided by the systematic text condensation method., Results: In total, four focus group and three semi-structured interviews were conducted with 23 HCPs. Three main themes were identified: 1) Support systems that help and hinder describes the use of support systems in the discharge process to compensate for the fragmentation of the healthcare system and the impact of these systems on HCPs' communication; 2) Communication between two separate worlds depicts the difficulties in communication experienced by HCPs in different healthcare organisations and how they cope with them; and 3) The large number of medically complex patients disrupts the communication reveals how the highly pressurised healthcare system impacts on HCPs' communication at hospital discharge., Conclusions: Communication at hospital discharge is hindered by the fragmented, highly pressurised healthcare system. HCPs are at risk of moral distress when coping with communication difficulties. Improved communication methods at hospital discharge are needed for the benefit of both patients and HCPs., (© 2023. The Author(s).)

Background: Pharmacogenetic testing enhances patient safety by improving medical treatment and reducing side effects. It has shown potential in both primary and secondary care. However, implementation in healthcare, particularly in primary care, is slow., Objective: The objective was to review articles published on the attitudes towards, and knowledge on pharmacogenetic testing in primary care, among general practitioners, pharmacists, and patients., Methods: The review was performed according to the PRISMA checklist. A systemized literature search was followed by a 2-step screening process. Apart from the content of articles being within the scope of the review, inclusion criteria included: articles in English; primary research articles; qualitative, quantitative, or mixed methods. Content analysis was conducted as a qualitative meta-synthesis. The methodological rigor of included articles was assessed., Results: Fifteen studies were included. The analysis resulted in the following main themes: i) benefits of pharmacogenetic testing, ii) barriers to pharmacogenetic testing, iii) pharmacists' role in pharmacogenetic counselling, and iv) pharmacists' knowledge on pharmacogenetics. Methodological rigor was generally medium/high., Conclusions: More studies are needed in this area, and there is a need for more education on pharmacogenetic testing for healthcare professionals. Issues like patient autonomy, economy, and access to tests also need to be addressed., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: When discharged from hospital patients are often assumed to have sufficient health literacy (HL) to participate in their medical treatment and manage medical self-care after discharge. However, limited HL is a widespread concern and patient participation during discharge is lacking. In this study, we explore how HL influences medication communication during hospital discharge., Design: A qualitative case study, comprising unstructured observations of patient-healthcare personnel (HCP) encounters followed by semistructured interviews. Data were analysed using content analysis., Setting: An internal medicines ward at a university hospital in Norway., Participant: Fifteen patients aged 40-89 years were included close to the day of discharge., Results: The following themes describing dimensions of HL emerged: (1) access, (2) understand, (3) appraise and (4) apply. Most patients sought access to medication information from HCP, while some felt dependent on HCP to provide it. However, their abilities to understand, evaluate and make informed decisions were challenged, partly because HCPs' ability to adapt their communication to the patient's knowledgebase varied., Conclusion: The results give a broader understanding of how HL influences medication communication during hospital discharge. To consider central dimensions of HL is important to achieve optimal medication communication, as the communication only can be exercised within the frames of the patient's HL. The findings in this study support that HL should be described as a shared responsibility between the patients and HCP. Attention should be focused to the HCP's responsibility to adapt the communication to the patient's knowledgebase., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In the field of pharmaceuticals, there is a shift away from the traditional "one-size-fits-all" concept to a more patient-centered one. A potential approach to obtain personalized medicine is with printed Data-Enriched Edible Pharmaceuticals (DEEPs). DEEPs that are printed in the pattern of QR codes contain both the patient-tailored dose and data that can be used to give patients personalized drug information and combat counterfeit medicines., Objectives: The study aims to explore patients' preferences, perceptions, and acceptability of DEEPs, and the digital aspects of them., Methods: Thirteen participants, living in Denmark, were interviewed twice using a semi-structured approach. Interviews were conducted face-to-face or via video calls. The interviews were transcribed, translated, and analyzed using thematic coding analysis., Results: The participants found it useful to participate in the design of their own medicine. The orodispersible nature of DEEPs and the possibility to select color, embedded images, flavors, and physical dimensions of DEEPs were considered beneficial for patients' adherence. Patients' personal preferences, convenience, and aesthetics were the main drivers for their favored design of DEEPs. The acceptability of digital healthcare in connection to DEEPs was found to be related to the participants' level of digital literacy., Conclusions: The participants generally had a positive attitude towards DEEPs and the digital aspects of them. However, to accept digital healthcare in connection to DEEPs, it should be adaptable and easy to use for everyone. The combination of digital healthcare and on-demand fabricated DEEPs could potentially contribute to higher patient adherence and safety in the future., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Healthcare systems have reached a critical point regarding the question of whether biosimilar substitution should become common practice. To move the discussion forward, the study objective was to investigate the views of experts from medicines agencies and the pharmaceutical industry on the science underpinning interchangeability of biosimilars. We conducted an empirical qualitative study using semi-structured interviews informed by a cross-disciplinary approach encompassing regulatory science, law, and pharmaceutical policy. In total 25 individuals with experience within biologics participated during September 2018-August 2019. Eight participants were EU national medicines authority regulators, and 17 had pharmaceutical industry background: five from two originator-only companies, four from two companies with both biosimilar and originator products, and eight from seven biosimilar-only companies. Two analysts independently conducted inductive content analysis, resulting in data-driven themes capturing the meaning of the data. The participants reported that interchangeability was more than a scientific question of likeness between biosimilar and reference products: it also pertained to regulatory practices and trust. Participants were overall confident in the science behind exchanging biosimilar products for the reference products via switching, i.e., with physician involvement. However, their opinions differed regarding the scientific risk associated with biosimilar substitution, i.e., without physician involvement. Almost all participants saw no need for additional scientific data to support substitution. Moreover, the participants did not believe that switching studies, as required in the US, were appropriate for obtaining scientific certainty due to their small size. It is unclear why biosimilar switching is viewed as scientifically safer than substitution; therefore, we expect greater policy debate on biosimilar substitution in the near future. We urge European and UK policymakers and regulators to clarify their visions for biosimilar substitution; the positions of these two frontrunners are likely to influence other jurisdictions on the future of biosimilar use., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: LCD was funded by a PhD fellowship grant to the University of Copenhagen from LEO Pharma A/S, but the company has no commercial interest in the research. This does not alter our adherence to PLOS ONE policies on sharing data and materials. ” There are data restrictions which we have described in the data availability statement: “The minimal data set underlying the results has been supplied in the manuscript (the quotes are raw data), additional data cannot be shared publicly because this would compromise anonymity and confidentiality of the participants.

Background: 3D printing is a promising new technology for medicines' production. It employs additive manufacturing techniques, and is ideal for producing personalized medicines (e.g., patient-tailored dose, dosage form, drug release kinetics)., Objective: To investigate how 3D printing technologies can be implemented in a European pharmaceutical system, by suggesting different scenarios and assessing aspects that could affect its implementation., Method: Qualitative, semi-structured interviews were conducted with key stakeholders (e.g., from ministry, authorities, research organizations, pharmacies) in the Netherlands to elicit perspectives on 3D printing of personalized medicines. The Netherlands were chosen since it has a strong tradition in compounding. Five general scenarios were investigated: placing the 3D printers in industry, community pharmacies, hospital pharmacies, compounding facilities, and in patients' homes. Content analysis was used, building on verbatim transcripts., Results: Fifteen stakeholders were interviewed. Regulatory, economic, ethical and organizational challenges were identified to varying degrees in the different scenarios. The industry and home scenarios were associated with the most challenges, hospital pharmacies and compounding facilities with the least. Other important aspects identified were the role of community pharmacies, and who should design the tablets to be printed., Conclusion: All potential scenarios for 3D printing of personalized medicines include challenges. These should be taken into account when pursuing the use of 3D printing of medicine., (© 2021 The Authors.)

Objective: Effective communication and patient empowerment before hospital discharge are important steps to ensure medication safety. Patients discharged from hospitals are often expected to assume self-management, frequently without healthcare personnel (HCP) having ensured patients' knowledge, motivation and/or skills. In this substudy of a larger study, we explore how patients experience medication communication during encounters with HCPs and how they are empowered at hospital discharge., Design: This is a qualitative case study. Data collection was done through qualitative observations of patient-HCP encounters, semistructured interviews with patients and drug reconciliation. Data were analysed using content analysis., Setting: An internal medicines ward at a university hospital in Norway., Participants: Nine patients aged 49-90 years were included close to the day of discharge., Results: The analysis revealed the following themes: (1) patient-centred care (PCC), which included 'understanding and involvement in the patient-as-person', 'establishment of a therapeutic alliance', and 'sharing power and responsibility'; and (2) biomedical (conventional) care, including the subthemes 'HCPs in power and control' and 'optimising medical outcomes, following guidelines'. Even though the elements of PCC were observed in several encounters, overall communication was not sufficiently fostering patient empowerment. Spending time with patients and building relations based on mutual trust seemed undervalued., Conclusions: The results provide a broader understanding of how patients experience medication communication at hospital discharge. Both the patients and the HCPs appear to be inculcated with biomedical traditions and are uncertain about the roles and opportunities associated with PCC. Attention should be paid to patient preferences and to the core elements of the PCC model from admission to discharge to empower patients in medication self-management., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Patients are expected to participate in the hospital discharge process, assume self-management after discharge and communicate relevant information to their general practitioner; however, patients report that they are not being sufficiently empowered to take on these responsibilities. The aim of this study was to explore and understand the discharge process with a focus on medicines communication, from the patient perspective., Methods: Patients were included at a hospital ward, observed during health-care personnel encounters on the day of discharge and interviewed 1-2 weeks after discharge. A process analysis was performed, and a content analysis combined data from observations and data from patient interviews focusing on medicines communication in the discharge process., Results: A total of 9 patients were observed on the day of discharge, equalling 67.5 hours of observations. The analysis resulted in the following themes: (a) the observed discharge process; (b) patient initiatives; and (c) the patient role. The medicines communication in the discharge process appeared unstructured. Various patient preferences and needs were revealed. The elements of the best practice structured discharge conversation were observed; however, some patients did not have a discharge conversation at all., Conclusions: The study contributes to a broader understanding of the discharge process, how patients experience it, including their role. It is evident that the discharge process is not always tailored to meet the patients' needs. More focus on early patient involvement and communication, in order to better prepare patients for self-management of their medications, is important for their health outcomes., (© 2021 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background: A biosimilar is a biological medicine highly similar to another already approved biological medicine (reference product). The availability of biosimilars promotes competition and subsequently lower prices. Changing the current biosimilar clinical comparability trial requirements may lead to lower biosimilar development costs that potentially could increase patients' access to biologics., Objective: The aim was to determine the perceptions of industry and medicines agency regulators regarding the value, necessity, and future developments of the European biosimilar clinical comparability trial requirements for establishing biosimilarity., Methods: Semi-structured interviews were conducted with eight European national medicines agency regulators and 17 pharmaceutical company employees or consultants with experience in biologics between September 2018 and August 2019. Data were subjected to content analysis., Results: In general, the participants expected that clinical comparability trial requirements will continue to be reduced, in particular based on advancements in analytical testing and knowledge generated from prior biosimilar approvals. However, there are also competing issues at play, such as competition, physician's trust, and ethical considerations. Participants also reported that any new initiative to reduce or waive biosimilar clinical requirements needs to be scientifically sound and could potentially lower biosimilar development costs., Conclusion: The main findings are that biosimilar clinical comparability trial requirements are likely to change in the near future. Clarity is needed on how to ensure adequate correlation between physicochemical data, pharmacokinetic/pharmacodynamic studies, and the drugs' performance in the clinic, as well as how to continue sufficient immunogenicity assessment. Obtaining this clarity can facilitate regulatory assessment of the next biosimilars.

Background: Decision-making for using medicine treatment of attention-deficit hyperactivity disorder (ADHD) is complex., Objective: The aim of this study is to investigate decision-making about ADHD medicine and its use among young adults with ADHD by exploring and analysing their beliefs, experiences and behaviours from a Foucauldian perspective., Methods: Participants were recruited using convenience sampling. In-depth individual interviews were conducted with 7 participants, and 4 participated in a focus group; 1 took part in both. The interviewees were aged 22-29. Data were collected in Denmark from March to August 2016., Results: Deductive analysis identified the sociological, bio-psychosocial and biomedical discourses as falsified, present and dominant, respectively. In a Foucauldian perspective, ADHD medicine use seems to be a disciplinary act intended to make the individual change his/her 'undesirable' ADHD behaviour. Interviewees' descriptions show power as operating internally in the form of self-monitoring in an attempt at normalisation, as well as externally through society's subjectification of them as young adults with ADHD. Although resistance towards using medicine as ADHD treatment existed, it was sparse., Conclusions: The findings show that what may appear to be the choice of an individual on the surface can also be seen as a complex interaction of networks of power. Further, that medicine adherence also can appear to be disciplinary. Pharmacists can use these findings to improve how advice-giving about ADHD medicine may be perceived by young adults with ADHD., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background 3D-printing, compared to conventional medicine manufacturing technologies, is a versatile and highly modifiable technique that has the flexibility to produce medicine that meet patients' specific requirements such as individualized dosing, but also to customize the appearance of the dosage form, e.g., shape and colour. Objective To explore polypharmacy patients' perceptions and preferences regarding 3D-printed medicine, including their acceptability of patient-designed medicine. Setting The study was conducted in Zealand, Denmark. Method Polypharmacy patients were recruited using convenience sampling (mostly on Facebook) and interviewed twice using semi-structured interviews. Interviews were analysed thematically into five predetermined themes (shapes, colours, embossing designs, polypills, and patient-designed dosage forms). At the first interview patients were asked about their perceptions and preferences towards 3D-printed solid dosage forms, and were presented to different shapes, colours, embossing designs and examples of polypills. They were also invited to design their own medicine from the ones presented. Their self-designed medicines were presented at the second interview, where acceptability of both their self-designed medicine and the concept of designing one's own medicine, was investigated. Main outcome measure Patients' perceptions, preferences towards and acceptability of 3D-printed medicines. Results Eight patients were included. They tended to prefer shapes similar to conventional medicine. Different colours were preferred by different people. The presented embossing designs seemed to be irrelevant. Polypills were generally believed to be a good idea due to the reduction of number of medicines. Acceptability of patient-designed medicine was mainly determined by whether patients thought 3Dprinting technology was reliable or not. Conclusions The patients had various perceptions and preferences of 3D-printed medicine. Factors affecting the patient views were aesthetic (appealing), physiological (swallowing), practical (handling), pedagogical (understanding) and psychological (relate to). Trust in the technology seemed to be important for acceptability.

As the pharmacy profession evolves, good communication skills are vital for securing the safer and more rational use of medicines. Currently there is a lack of qualitative studies researching European student pharmacists' and their experience with communication skills training (CST). This qualitative study aimed to fill this gap by exploring Danish student pharmacists' attitudes towards, and experiences of, CST. Focus group interviews were conducted with a heterogeneous sample of Danish student pharmacists in 2016. Interviews were audio recorded, transcribed verbatim and analyzed inductively. Fifteen students participated in three focus groups. Five categories identified as key aspects were: professional communication vs. normal conversation, motivation to engage in training, how to learn communication skills, experience with CST and universities' role in teaching communication skills. In conclusion, there were both positive and negative attitudes towards CST among the participants. However, they had little experience with CST. Bloom's taxonomy of the affective domain and Kolb's experiential learning model appear to be useful in understanding students' attitudes towards CST. Pharmacy educators can use this study to structure and improve their CST curricula by knowing what influences students' attitudes towards CST.

Widespread liberalizing reform of the Swedish community pharmacy and primary care sectors took place in 2009-2010, including opening the market to private providers. One important rationale for the reforms was to increase diversity in the health-care system by providing more choices for individuals. The aim of this study was to increase the understanding how policy makers understood and defined diversity as a concept, and as a rationale for the reforms. The method used was document analysis of preparatory work and plenary parliament debate protocols. The results show that policy makers held vague and unclear definitions of diversity, which complicated its implementation. Diversity was sometimes seen as an effect of competition-a goal-while in other cases it was seen as a condition to be met in order to achieve competition-a means. Thus, policy makers viewed diversity both as a goal and as a means, making the underlying mechanisms unclear. The findings also revealed that policy makers failed to consistently demonstrate how the introduction of competition would lead to diversity., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: The news media has become a major source of health information for the public, and hence vital in the individuals' opinions and decisions about health topics. The first decrease in the usage of antidepressants in Denmark in over a decade happened alongside an intensive period of media coverage about antidepressants., Objectives: The aim of this study was to examine the Danish media's coverage of antidepressants during 2010-2011 in order to explore what influence it could have had on the change in the use of antidepressants., Methods: Three media theoretical concepts, agenda-setting, priming and framing, were used to explain the media influence with regard to which subject the public should think about, which criteria the public should judge the subject by, and how the public should think about the subject. All articles about antidepressants in the main Danish Internet newspapers from 2010-2011 were analyzed via quantitative and qualitative content analyses. The quantitative analysis was used to determine agenda-setting (number of articles) and, by coding articles, how priming was used in the descriptions of antidepressants. In the qualitative analysis, all articles were analyzed and condensed to determine which frames were used., Results: Quantitative results: 271 articles were included. Agenda-setting was shown by a marked increase in the number of articles about antidepressants. Eight main codes were identified, with the negatively-associated side effects being the major one, thereby priming the public to use side effects as a criterion when judging antidepressants. Qualitative results: Two main frames were identified: 1) economic profits vs. medicine safety, and 2) the necessity of antidepressants. Both frames presented a critical view on antidepressants., Conclusion: It is believed that the media's agenda-setting, priming and framing of antidepressants led the public to have a more skeptical view on antidepressants, which may have probably contributed to a decrease in the usage of antidepressants., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Attention-deficit hyperactivity disorder (ADHD) causes difficulties with hyperactivity, impulsivity and inattention. Treatment of ADHD includes both medication and non-pharmacological options. Knowledge of treatment preferences by young adults with ADHD is sparse. The objective of this study was to explore the beliefs and experiences of young adults with ADHD related to their medication treatment decisions. Data were collected in Denmark in 2016 through a focus group and individual in-depth interviews. Conventional content analysis was used. Ten young adults with ADHD (22-to 29-year-old) participated. Three major themes were identified: (1) the patient’s right to choose concerning ADHD medicine; (2) the patient’s decision of whether or not to treat ADHD with medication; and (3) factors affecting the patient’s decision on whether to take ADHD medication or not. The latter theme contained 15 factors, which were distributed across three levels: individual, between-individuals, and societal. The dominant factors were increasing quality of life and improving oneself e.g., improving social skills. For counselling at the pharmacy and by prescribers, it is important to be aware of the different factors that affect young adult patients’ decisions on whether to take ADHD medication or not. This knowledge will aid to understand reasons for non-adherence and to determine appropriate treatment for the individual patient.

Background Studies have reported misuse of sildenafil citrate for recreational purpose, not least by healthy young men. This is becoming a major concern, for medical and other reasons. Objective The aim of this study was to document the characteristics of sildenafil citrate users and to explore the dispensing practices of the medicine in selected community pharmacies in Addis Ababa, Ethiopia. Setting Data was collected in community pharmacies in Addis Ababa, Ethiopia. Method A survey, using a self-administrated questionnaire, was conducted among customers who purchased sildenafil citrate from community pharmacies. Simple descriptive statistics were used to analyse data. Also, semi-structured interviews were conducted with community pharmacists. These were analysed thematically. Main outcome measures Socio-demographic characteristics (survey), themes (interviews). Results All survey respondents (n = 197) were men, 57.9% were below 40 years old, 53.8% had never been married and 58.4% had used sildenafil citrate before. A minority (16.2%) were diagnosed with erectile dysfunction. The main reason for buying sildenafil citrate was experimentation (45.7%). Pharmacists reported that sildenafil citrate was often dispensed without a prescription. The reason for this was, according to the interviewees, competition in the market. Also, the medicine was often dispensed without adequate information or counselling. Conclusions Selling and buying sildenafil citrate without a prescription seems to be common practice in pharmacies in Addis Ababa. It is crucial to strengthen the regulatory activity to protect customers from health risks. In addition pharmacy professionals should be supported to work in accordance with professional and legal standards.

Objectives: The objective was to study the relationship between the length and content of patient-pharmacist communication in community pharmacies, and generic substitution., Methods: The study was conducted in six community pharmacies in Sweden. Non-participant observations with audio recordings and short structured interviews were conducted. Out of 32 pharmacists 29 agreed to participate (90.6%), as did 282 out of 407 patients (69.3%). Logistic regression analysis was applied to calculate odds ratio for occurrence of generic substitution. Linear regression (β-coefficients) was applied to test for differences in time spent on different categories., Key Findings: In encounters where generic substitution occurred more time (19.2 s) was spent on non-medical (for instance administrative or economical) issues (P = 0.01, 95% confidence interval 4.8-33.6). However, the total time of the encounter was not significantly longer. The amount of time spent on non-medical issues increased with age of patient (age 60+: β, 33 s, P < 0.001). The results indicate that more time was spent on medical issues with patients who have a higher education (high school: β, 10.8 s, P = 0.07, university: β, 10.2 s, P = 0.11) relative to those with only elementary school education., Conclusions: Occurrence of generic substitution was correlated with more time spent on communicating on non-medical, but not on medical, issues. No extra time was spent on medical information for the groups normally overrepresented among those with low health literacy. This study suggests that pharmacists need to further embrace their role in promoting rational use of medicines, not least when generic substitution occurs., (© 2016 Royal Pharmaceutical Society.)

Introduction: Additive manufacturing (AM) techniques, such as drug printing, represent a new engineering approach that can implement the concept of personalized medicine via on-demand manufacturing of dosage forms with individually adjusted doses. Implementation of AM principles, such as pharmacoprinting, will challenge the entire drug distribution chain and affect the society at different levels. Areas covered: This work summarizes the concept of personalized medicine and gives an overview of possibilities for monitoring patients' health. The most recent activities in the field of printing technologies for fabrication of dosage forms and 'polypills' with flexible doses and tailored release profiles are reviewed. Different scenarios for the drug distribution chain with the required adjustments in drug logistics, quality systems and environmental safety are discussed, as well as whether AM will be used for production of on-demand medicine. The impact of such changes in the distribution chain on regulation, healthcare professionals and patients are highlighted. Expert opinion: Drug manufacturing by traditional methods is well-established, but it lacks the possibility for on-demand personalized drug production. With the recent approval of the first printed medicine, society should be prepared for the changes that will follow the introduction of printed pharmaceuticals.

Introduction: The health supply chain is often the weakest link in achieving the health-related Millennium Development Goals and universal health coverage, requiring trained professionals who are often unavailable. In Ethiopia there have been recent developments in the area of health supply chain management. The aim of this study was to explore the current status of the development of human resources in health supply chain management in Ethiopia and to identify important factors affecting this development., Methods: A series of face-to-face interviews with key stakeholders was carried out in 2014. The interviews were conducted using a semi-structured interview guide. The interview guide comprised 51 questions. A qualitative analysis of transcripts was made., Results: A total of 25 interviews were conducted. Three themes were identified: General changes: recognition, commitment and resources, Education and training, and Barriers and enablers. Results confirm the development of human resources in health supply chain management in many areas. However, several problems were identified including lack of coordination, partly due to the large number of stakeholders; reported high staff mobility; and a lack of overall strategy regarding the job/career structures necessary for maintaining human resources. Rural areas have a particular set of problems, including in transportation of goods and personnel, attracting and keeping personnel, and in communication and access to information., Conclusions: Ethiopia is on the way to developing a nationwide viable system for health supply chain management. However, there are still challenges. Short-term challenges include the importance of highlighting strategies and programs for human resources in health supply chain management. In the long term, commitments to financial support must be obtained. A strategy is needed for the further development and sustainability of human resources in the health supply chain in Ethiopia.

Social Pharmacy (SP) is a multidisciplinary field to promote the adequate use of medicine. The field of SP is increasingly important due to a numbers of new trends all posing challenges to society. The SP group at the University of Copenhagen has for several years used a broad approach to SP teaching and research, often illustrated by the four levels: individual, group, organizational, and societal. In this paper the relevance of maintaining a broad approach to SP research is argued for and examples of the importance of such type of research is presented.

Objective: The development of more patient-centred care is not always visible in community pharmacies. The aim of this study was to explore Norwegian pharmacists' motivation and perceived responsibility regarding role development and involvement in patient-centred care., Methods: A semi-structured interview guide was developed. Four focus group interviews were conducted with a heterogeneous sample of 21 community pharmacists and transcribed verbatim. An inductive analysis was performed, supplemented with an agent perspective., Key Findings: Two main categories and nine subcategories were identified, with the main categories being 'reality vs. vision' and the overall 'agent' category. A gap was found between what the pharmacists said they were doing in their day-to-day work and what they expressed as their ideal tasks in the pharmacy. The pharmacists seem to transfer the need for their role as active medicine experts in patient-centred care to other agents such as authorities and pharmacy chains., Conclusions: There is a gap between what the Norwegian community pharmacists express as their vision and current practice. The identified agent relationships appear to hamper the pharmacists' perceived ability to be active and take full responsibility in their role development and further implementation of patient-centred care. Adopting a fairly inactive position when it comes to increasing patient-centred care might be a result of a traditional product-focused pharmacy culture., (© 2014 Royal Pharmaceutical Society.)

Background: Patient self-reported data are important in drug utilization research, but often logistically difficult to collect. During 2006-2012, 72 Swedish community pharmacies regularly collected such data through structured survey interviews at the pharmacy counter, performed by the dispensing pharmacists. This study is part of a validation of that data acquisition method., Objectives: (1) To explore the experiences of the pharmacists involved, (2) to explore a random or systematic exclusion of eligible patients by the pharmacists, and (3) to find areas of improvement to the applied method of surveying., Setting: 72 Swedish community pharmacies, distributed all over the country., Method: (a) A questionnaire was distributed to approximately 400 dispensing pharmacists at the pharmacies conducting the patient surveys; (b) semi-structured telephone interviews conducted with 19 pharmacists at 12 of the pharmacies., Main Outcome Measure: Proportions of pharmacists reporting positive and negative experiences of structured survey interviews, the nature of their experiences, proportion of pharmacists reporting to avoid survey interviews and reasons for doing so, and suggested areas of improvement., Results: A total of 126 pharmacists (32 %) completed the questionnaire. A majority (82 %) reported positive experiences of interviewing. In addition to the data generated as the primary goal of surveying, secondary benefits such as an improved patient-pharmacist dialogue and an increased detection and resolution of drug related problems were reported. However, a majority (63 %) of the pharmacists also reported negative experiences related to a perceived lack of time to fulfil one's professional obligations. Almost half of the pharmacists (44 %) in the survey admitted that they occasionally avoided interviewing eligible patients, due to the immediate increase in work load. The limited availability of staff resources was the most apparent area of improvement., Conclusion: Under certain conditions, community pharmacies are feasible as a setting for conducting patient surveys in drug utilization research, and dispensing pharmacists suitable for conducting them. When regular dispensing staff perform the survey interviews as a part of the drug dispensing process, additional resources to manage the immediate increase in work load have to be considered. Otherwise, data quality may be compromised.

Background: It is important that pharmacists counsel patients about their prescribed medicines, as it leads to improved therapeutic outcome, increases compliance, and decreases confusion and insecurity. Studies have shown that the number of patients getting any pharmaceutical counseling varies greatly. Swedish pharmacists claim that the focus of the dialog with the patient has switched from pharmaceutical counseling to economy and regulations., Objective: The aim of this study was to determine the content and time disposition of the patient-pharmacist communication during dispensing of prescribed medicines at Swedish community pharmacies., Method: Non-participant observations and audio recordings were used as data-collecting methods. The content of the dialog was categorized into 2 deductively decided main categories-medicinal and non-medicinal issues-and 12 inductively decided subcategories., Results: A total of 282 pharmacy encounters were observed and recorded, of which 259 fully coincided with the inclusion criteria. After categorizing the content of each encounter the results showed that there was little or no dialog regarding medicinal issues during the pharmacy encounter in Swedish community pharmacies. Forty percent of the dialog concerns non-medical issues and almost half of the encounter was silent., Conclusion: Medicines are an essential treatment method in healthcare, and pharmaceutical expertise is available to patients who enter a community pharmacy. The results of this study show that today's pharmacy encounter is not focused on improving the use of medication, possibly resulting in the patient not gaining the most benefit from his or her treatment., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: Generic drug substitution reduces costs for medicines, but the downsides include unintentional double medication, confusion and anxiety among patients. Information from pharmacists affects patients' experiences of substitution with generic drugs. The aim of this study was to explore experiences and attitudes to generic substitution among Swedish community pharmacists., Methods: An interview guide was developed. Semi-structured interviews with community pharmacists were conducted and transcribed verbatim. Analysis was inductive; extracts from the transcripts were compared and combined to form themes and subcategories. Pharmacists from a heterogeneous convenience sample of pharmacies were interviewed until data saturation had been achieved., Key Findings: Sixteen pharmacists were interviewed. Three main themes and twelve subcategories were identified, with the main themes being the role of the pharmacist, pharmacists' concerns regarding patients, and the generic drug. Pharmacists found it positive that generic substitution decreases the costs for pharmaceuticals but also emphasized that the switch can confuse and worry patients, which could result in less benefit from treatment. Respondents claimed that generic substitution has changed the focus in the pharmacist-patient meeting towards economics and regulations., Conclusion: According to the interviewed pharmacists generic substitution is not primarily an issue of generic versus brand-name products, but concerns above all the challenges that the switch implies for patients and pharmacists. To prevent known confusion and concerns among patients it is important that community pharmacists acquire the necessary tools and knowledge to manage this situation; pharmacists themselves as well as pharmacy owners and authorities share responsibility for this., (© 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.)

Background: The potential for unsafe acts to result in harm to patients is constant risks to be managed in any health care delivery system including pharmacies. The number of reported errors is influenced by a various elements including safety culture. The aim of this study is to investigate a possible relationship between reported dispensing errors and safety culture, taking into account demographic and pharmacy variables, in Swedish community pharmacies., Methods: A cross-sectional study was performed, encompassing 546 (62.8%) of the 870 Swedish community pharmacies. All staff in the pharmacies on December 1st, 2007 were included in the study. To assess safety culture domains in the pharmacies, the Safety Attitudes Questionnaire (SAQ) was used. Numbers of dispensed prescription items as well as dispensing errors for each pharmacy across the first half year of 2008 were summarised. Intercorrelations among a number of variables including SAQ survey domains, general properties of the pharmacy, demographic characteristics, and dispensing errors were calculated. A negative binomial regression model was used to further examine the relationship between the variables and dispensing errors., Results: The first analysis demonstrated a number of significant correlations between reported dispensing errors and the variables examined. Negative correlations were found with SAQ domains Teamwork Climate, Safety Climate, Job Satisfaction as well as mean age and response rates. Positive relationships were demonstrated with Stress Recognition (SAQ), number of employees, educational diversity, birth country diversity, education country diversity and number of dispensed prescription items. Variables displaying a significant relationship to errors in this analysis were included in the regression analysis. When controlling for demographic variables, only Stress Recognition, mean age, educational diversity and number of dispensed prescription items and employees, were still associated with dispensing errors., Conclusion: This study replicated previous work linking safety to errors, but went one step further and controlled for a variety of variables. Controlling rendered the relationship between Safety Climate and dispensing insignificant, while the relationship to Stress Recognition remained significant. Variables such as age and education country diversity were found also to correlate with reporting behaviour. Further studies on the demographic variables might generate interesting results.

Objectives: To design and evaluate a national web-based dispensing error reporting system for all Swedish pharmacies, replacing the currently used paper-based system., Methods: A working group designed the new system. The number of reports before (1999-2003) and after (2004-2005) introduction was studied in a descriptive analysis. The completeness of reports was evaluated through the study of 100 randomly selected reports from the third quarter of 2003 and 2004 from each system. Evaluation was done by chi-square analysis; P>0.05. Perceptions on introduction were collected in semi-structured interviews (working group and one assistant) and subjected to descriptive analysis., Key Findings: Reported error rate per 100,000 dispensed items was 12.9 pre- and 21.4 post implementation. Completeness-analysis revealed that information was more comprehensively reported in the new system. A significant difference existed in the extent to which incidents were described as well as details provided of the medicine and the patient. According to the interviewees, users initially found the web-based system difficult to handle. It took more than 6 months to change this perception., Conclusions: Introducing a web-based system for reporting dispensing errors had an impact on quantity of reports and completeness. Time and patience was needed to implement the changes., (© 2011 The Authors. IJPP © 2011 Royal Pharmaceutical Society.)

Background: Pharmacy practice is evolving according to general health-care trends such as increased patient involvement and public health initiatives. In addition, pharmacists strive to find new professional roles. Clients' expectations of service encounters at pharmacies is an under-explored topic but crucial to understanding how pharmacy practice can evolve efficiently., Objective: To identify and describe different normative expectations of the pharmacy encounter among pharmacy clients., Methods: Q methodology, an approach to systematically explore subjectivity that retains complete patterns of responses and organizes these into factors of operant subjectivity., Setting and Participants: Eighty-five regular prescription medication users recruited at Swedish community pharmacies and by snowballing., Results: Seven factors of operant subjectivity were identified, and organized into two groups. Factors that emphasized the physical drug product as the central object of the pharmacy encounter were labelled as independent drug shopping; logistics of drug distribution; and supply of individual's own drugs. Factors that emphasized personal support as desirable were labelled competence as individual support; individualist professional relations, just take care of me; and practical health-care and lifestyle support., Discussion and Conclusions: The systematic Q-methodological approach yielded valuable insights into how pharmacy clients construct their expectations for service encounters. They hold differentiating normative expectations for pharmacy services. Understanding these varying viewpoints may be important for developing and prioritizing among efficient pharmacy services. Clients' expectations do not correspond with trends that guide current pharmacy practice development. This might be a challenge for promoting or implementing services based on such trends., (© 2010 Blackwell Publishing Ltd.)

Background: Since 2004, a web-based reporting system enables monitoring of dispensing errors in all Swedish pharmacies. The adoption of this system was followed by an overall increase in reports, mainly explained by the dispensing of medicines of improper strength. In 2006 an intervention was implemented, aimed at reducing these errors. The objective of this study was to assess the impact of the intervention on the number of errors., Methods: Monthly data on the reported number of dispensing errors from July 2004 until December 2007 were used. These were analysed in total and subdivided by type and cause of error. A time-series design was applied, and linear segmented regression analysis used to analyse whether changes in slope or level occurred; shifts in intercept or slope where p<0.01 were considered as statistically significant., Results: The intervention coincided with a distinct decrease in error reports and a statistically significant change in slope that switched from a slight increase, 0.09, to a decrease, -0.26 (p = 0.0035). Medicines dispensed with wrong strength also displayed a significant change in slope, from 0.08 to -0.27 (p<0.0001), as well as dispensing errors caused by registration failure, that is, failure of the registration of a prescription in pharmacy computers, which changed from 0.05 to -0.29 (p<0.0001)., Conclusion: The intervention was associated with a decrease in the number of reports on drugs dispensed with the wrong strength, but also had a decreasing effect on errors caused by registration failure and on the dispensing errors in total as well.

Objective: To characterise the counselling behaviour of practitioners providing a pharmaceutical care (PC) service in community pharmacy, and to describe the content of the consultations., Setting: Community pharmacies in Sweden., Methods: Non-participant observations, including audio recording, of five practitioners in five different pharmacies counselling 16 patients, were analysed qualitatively using an iterative, stepwise, interpretivist approach., Main Outcome Measure: Descriptions of counselling behaviour and content of consultations., Results: The counselling behaviour was characterised by attempts to understand the patients' narratives by listening and asking questions and a willingness to help. The computer often had an important role in consultations, being used for documentation and as a supportive tool for identification of drug-drug interactions. The practitioners often took command in the initial phase of the consultation, and omitted to determine the patients' most urgent drug-related needs. However, counselling behaviour that identified and focused on the patient's needs, giving the computer little attention during the consultation was also observed. Practitioners provided vague descriptions of the purpose and outline of the service. Consultations included a wide variety of issues, which potentially could help patients' achieve optimal outcomes of medical treatment., Conclusion: The practitioners provided important advice and different forms of support to patients. Focus on the computer screen limited their abilities to practise patient centred care.

Background: Safety culture assessment is increasingly recognized as an important component in healthcare quality improvement, also in pharmacies. One of the most commonly used and rigorously validated tools to measure safety culture is the Safety Attitudes Questionnaire; SAQ. This study presents the validation of the SAQ for use in Swedish pharmacies. The psychometric properties of the translated questionnaire are presented, Methods: The original English language version of the SAQ was translated and adapted to the Swedish context and distributed by e-mail. The survey was carried out on a national basis, covering all 870 Swedish community pharmacies. In total, 7,244 questionnaires were distributed. Scale psychometrics were analysed using Cronbach alphas and intercorrelations among the scales. Multiple group confirmatory factor analysis (CFA) was conducted., Results: SAQ data from 828 community pharmacies in Sweden, including 4,090 (60.22%) pharmacy personnel out of 6,683 eligible respondents, were received. There were 252 (28.97%) pharmacies that met the inclusion criteria of having at least 5 respondents and a minimum response rate of 60% within that pharmacy.The coefficient alpha value for each of the SAQ scales ranged from .72 to .89. The internal consistency results, in conjunction with the confirmatory factor analysis results, demonstrate that the Swedish translation of the SAQ has acceptable to good psychometric properties. Perceptions of the pharmacy (Teamwork Climate, Job Satisfaction, Perceptions of Management, Safety Climate, and Working Conditions) were moderately to highly correlated with one another whereas attitudes about stress (Stress Recognition) had only low correlations with other factors. Perceptions of management showed the most variability across pharmacies (SD = 26.66), whereas Stress Recognition showed the least (SD = 18.58). There was substantial variability ranging from 0% to 100% in the percent of positive scores for each of the factors across the 252 pharmacies., Conclusions: The Swedish translation of the SAQ demonstrates acceptable construct validity, for capturing the frontline perspective of safety culture of community pharmacy staff. The psychometric results reported here met or exceeded standard guidelines, which is consistent with previous studies using the SAQ in other healthcare settings and other languages.

Objective: To identify prescriptionists', pharmacists' and doctors' perceptions and experiences of a pharmaceutical care service supported by patient medication records (PMRs)., Method: Qualitative study employing focus group interviews with 16 prescriptionists and five pharmacists, and semi structured telephone interviews with 11 doctors., Main Outcome Measures: Prescriptionists', pharmacists' and doctors' views, experiences and perceptions of a pharmaceutical care service on Swedish community pharmacies., Results: The provision of pharmaceutical care aided by PMRs had a positive influence on the prescriptionists' and pharmacists' daily work, and on their view of their professional role. They assumed greater professional responsibility, and described greater use of their pharmaceutical knowledge, greater confidence in practice and an increased awareness of their counselling role. They appreciated that the pharmaceutical care service provided an over-all picture of patients' drug use, allowed for follow-up on counselling and made the prescriptionists' and pharmacists' competence tangible for patients. Perceived problems with the pharmaceutical care service included being time-consuming, record keeping being difficult, difficulty in getting understanding/support from colleagues and managers, and difficulty involving doctors. The majority of the doctors reported that they had not taken an active interest in the project, and their opinions of the pharmaceutical care service varied., Conclusion: When prescriptionists and pharmacists apply the pharmaceutical care concept and work with PMRs, the patients are more likely to meet confident professionals that are more aware of the individual behind the drug therapy. This will hopefully contribute to informed, motivated medicine users that feel secure in their interactions with their pharmacy and receive, not only drugs, but treatment support. For such a service to be effective, however, it is vital to ensure that the doctors are fully co-operative.

Increased work complexity and financial strain in the health care sector have led to higher demands on staff to handle ethical issues. These demands can elicit stress reactions, that is, moral distress. One way to support professionals in handling ethical dilemmas is education and training in ethics. This article reports on a controlled prospective study evaluating a structured education and training program in ethics concerning its effects on moral distress. The results show that the participants were positive about the training program. Moral distress did not change significantly. This could be interpreted as competence development, with no effects on moral distress. Alternatively, the result could be attributed to shortcomings of the training program, or that it was too short, or it could be due to the evaluation instrument used. Organizational factors such as management involvement are also crucial. There is a need to design and evaluate ethics competence programs concerning their efficacy.

Objective: This study has three main objectives (1) to identify the major problems or difficulties pharmacy staff in Sweden experience regarding pharmacy care of patients receiving antiretroviral therapy, (2) to identify the perceptions of pharmacy staff regarding what are patient-related concerns with antiretroviral therapy and (3) to compare the extent to which pharmacy staff awareness matches patient perceptions regarding what are the major problems or difficulties associated with antiretroviral therapy., Methods: A problem detection study (PDS) containing two questionnaires was conducted: one to be completed by pharmacy staff and another to be completed by both pharmacy staff and patients. In the latter survey, staff were asked about what they thought that patients would have responded. Staff and patient responses were then matched and compared with one another., Results: The pharmacy staff expressed their need for continuous education so as to assist the patients with their complex regimens. The staff were aware that patients were worried about therapy failure and viral resistance, medication-related problems and negative attitudes from the public. The staff however were less aware of the extent to which patients worried about not having their HIV infection under control. The staff also valued written patient information to a much higher extent than the patients., Conclusions: The pharmacy staff' awareness of the major problems HIV patients are experiencing seems incomplete and may lead to lack of concordance between the patients and pharmacy staff. This in turn may lead to non-adherence and poor therapy outcomes. Pharmacy staff should be encouraged to improve and systematically assess patient issues regarding antiretroviral therapy. Through assessing patient needs and concerns, the pharmacists can better identify patient needs and thus better tailor their educational and behavioural interventions to improve therapy outcomes.