Pharmacy Practice <p><strong>Pharmacy Practice</strong> is a free full-text peer-reviewed journal with a scope on pharmacy practice. <strong>Pharmacy Practice</strong> is published quarterly. <strong>Pharmacy Practice <span style="text-decoration: underline; color: #ff0000;">does not charge any publication fee to the author</span><span style="text-decoration: underline;"><span style="color: #ff0000; text-decoration: underline;">s</span></span></strong>.</p> Centro de Investigaciones y Publicaciones Farmaceuticas en-US Pharmacy Practice 1885-642X <p>The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to <strong>Pharmacy Practice</strong> with this document.</p><p>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="" target="_blank">Creative Commons Attribution License</a> (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</p> Scholarly publishing depends on peer reviewers Fernando Fernandez-Llimos ##submission.copyrightStatement## 2018-04-02 2018-04-02 16 1 1236 1236 Development and Validation of a Survey Instrument to Measure Factors that Influence Pharmacist Prescribing <p><strong>Objective</strong>: Study objectives were to develop a questionnaire to assess factors influencing pharmacists’ adoption of prescribing (i.e., continuing, adapting or initiating therapy), describe use of pre-incentive and mixed mode survey, and establish survey psychometric properties.</p> <p><strong>Methods</strong>: Questions were developed based on prior qualitative research and Diffusion of Innovation theory. Expert review, cognitive testing, survey pilot, and main survey were used to test the questionnaire. Six content experts reviewed the questionnaire to establish face and content validity. Ten pharmacists from diverse practice settings were purposefully recruited for a cognitive interview to verify question readability. Content analysis was used to analyze the results. A pre-survey introduction letter with a monetary incentive was mailed via post to 100 (i.e. pilot) and 700 (i.e., main survey) randomly selected pharmacists. This was followed by an e-mail with a personalized link to the online questionnaire, e-mail reminders, and a telephone reminder if required. The psychometric properties of scales were evaluated with an exploratory factor analysis and Cronbach’s alpha. Scale responses were described.</p> <p><strong>Results</strong>: Engagement of six experts and ten pharmacists clarified definitions (e.g., prescribing), terminology, recall periods, and response options for the 34-item response scale. Fifty-six pharmacists completed the online pilot survey. Based on this data, ambiguous questions and routing issues were addressed. Three hundred and seventy-eight pharmacists completed the online main survey for a response rate of 54.6%. The factors analysis resulted in 27 questions in eight scales: (1) self-efficacy, (2) support from practice environment, (3) support from interprofessional relationship, (4) impact on professionalism, (5) impact on patient care), (6) prescribing beliefs, (7) technical use of electronic health record (EHR) and (8) patient care use of the EHR. Prescribing beliefs and technical use of the EHR scales had low reliability while the remaining six scales had strong evidence for reliability and validity.</p> <p><strong>Conclusion</strong>: Through a multi-stage process, a survey instrument was developed to capture pharmacists’ perceptions of prescribing influences. This questionnaire may support future research to develop interventions to enhance adoption of prescribing and enhance direct patient care by pharmacists.</p> Lisa M. Guirguis Christine A. Hughes Mark J. Makowsky Cheryl A. Sadowski Theresa J. Schindel Nese Yukesel Chowdhury F. Faruquee ##submission.copyrightStatement## 2018-03-16 2018-03-16 16 1 1068 1068 Type B adverse drug reactions reported by an immunoallergology department <p><strong>Objective</strong>: Characterization of the adverse drug reactions (ADR) reported by the immunoallergology department (IAD), Centro Hospitalar de São João (Porto), to the Northern Pharmacovigilance Centre (NPC).</p> <p><strong>Methods</strong>: An observational, descriptive and retrospective study was conducted, based in a spontaneous report system. Participants were all the patients from the IAD, with suspected ADR, reported to NPC by specialists after the study was completed.</p> <p><strong>Results</strong>: Studied population had a median age of 41 years, with the predominance of the female gender (73.2%). Allergic rhinitis and asthma were the most frequent comorbidities. All studied ADR were type B, 89.6% were serious, 86.4% unexpected and 2.6% associated with drugs that presented less than 2 years in the market. The most represented drug classes were the non-steroidal anti-inflammatory drugs (NSAIDs) (52.6%) and antibiotics (25.2%). Skin symptoms represented 61.2% of the reported complaints. About 52.9% of these ADR occurred in less than one hour after intake. The most frequent ADR treatment at the time of the reaction was drug interruption (86.2%), followed by the prescription of anti-histamines (42.2%).</p> <p><strong>Conclusions</strong>: Reported ADR to NPC by the Drug Alert Unit were mainly serious, unexpected, associated with NSAIDs and antibiotics and related with marketing authorization medicines older than two years. These results could be very useful to develop strategies to prevent the clinical and economic consequences of ADR.</p> Maria J. Costa Maria T. Herdeiro Jorge J. Polónia Inês Ribeiro-Vaz Cármen Botelho Eunice Castro Josefina Cernadas ##submission.copyrightStatement## 2018-03-21 2018-03-21 16 1 1070 1070 Satisfaction of patients receiving value added-services compared to traditional counter service for prescription refills in Malaysia <p><strong>Background</strong>: Patients’ satisfaction is the key parameter to measure the quality of healthcare services. Value added-services (VAS) were introduced to improve the quality of medication deliveries and to reduce the waiting time at outpatient pharmacy.</p> <p><strong>Objective</strong>: This study aimed to compare the satisfaction levels of patients receiving VAS and traditional counter service (TCS) for prescription refills in Port Dickson Hospital.</p> <p><strong>Methods</strong>: A single-center, cross-sectional study was conducted in the outpatient pharmacy department of Port Dickson Hospital from 1 March to 30 June 2017. Systematic sampling method was utilized to recruit subjects into the study, except mail pharmacy in which universal sampling method was used. Data collection was done via telephone interviews for both groups.</p> <p><strong>Results</strong>: There was 104 and 105 in TCS and VAS group respectively. The response rate was 99.5%. Overall, a significant higher total mean satisfaction score in VAS group was observed as compared to TCS group (43.39 versus 40.49, p=0.002). The same finding was observed after confounding factors were controlled (VAS=44.66, 95% CI 43.07:46.24 versus TCS=39.88, 95% CI 38.29:41.46; p&lt;0.001). VAS respondents reported more satisfaction than TCS respondents for both general and technical aspects. Among the VAS offered, mail pharmacy service respondents showed highest total mean satisfaction score, but no significant different was seen between groups (p=0.064).</p> <p><strong>Conclusion</strong>: VAS respondents were generally more satisfied than TCS respondents for prescription refills. A longitudinal study is necessary to examine the impact of other dimensions and other types of VAS on patients’ satisfaction levels.</p> Boon-Tiang Lau Abdul-Rani Nurul-Nadiah-Auni Siew-Yen Ng Shuen Nie Wong ##submission.copyrightStatement## 2018-03-23 2018-03-23 16 1 1075 1075 Health literacy and knowledge in a cohort of Australian patients taking warfarin <p><strong>Objectives</strong>: To 1) characterise older patients taking warfarin, 2) assess these patients’ level of warfarin knowledge, and 3) describe their strengths and limitations in health literacy, and 4) explore relationships between participants’ characteristics, warfarin knowledge and health literacy.</p> <p><strong>Methods</strong>: A warfarin knowledge questionnaire and Health Literacy Questionnaire (HLQ) were administered to older patients (aged &gt;65 years, N=34) taking warfarin in an Australian general practice setting.</p> <p><strong>Results</strong>: Key gaps in participant knowledge pertained to the consequences of an international normalized ratio (INR) being below the target INR range and safety issues such as when to seek medical attention. A limitation for participants with a lower level of health literacy was the ability to appraise health information. Patients who needed assistance in completing the HLQs had significantly lower warfarin knowledge scores (p=0.03). Overseas-born participants and those taking 5 or more long-term medications had lower HLQ scores for specific scales (p&lt;0.05).</p> <p><strong>Conclusion</strong>: In this study warfarin knowledge gaps and a limitation of health literacy amongst a small sample of older patients were identified. The findings suggest that education and resources may need to be tailored to the needs of older patients taking warfarin and their carers to address these knowledge gaps and limitations in health literacy. Patients who may need greater support include those that need assistance in completing the HLQ, are overseas-born, or are taking 5 or more long-term medications.</p> Angela Yiu Beata V. Bajorek ##submission.copyrightStatement## 2018-03-24 2018-03-24 16 1 1080 1080 Attitudes towards continuous professional development: a study of pharmacists in Lebanon <p><strong>Objective</strong>: 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.</p> <p><strong>Methods</strong>: 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.</p> <p><strong>Results</strong>: 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).</p> <p><strong>Conclusion</strong>: 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.</p> Sylvia Saadeh Fatima Ghazale Ali Farhat Souheil Hallit ##submission.copyrightStatement## 2018-03-17 2018-03-17 16 1 1103 1103 An assessment of the impact of entrepreneurial skills of community pharmacists on pharmaceutical business performance in Jos metropolis, Nigeria <p><strong>&nbsp;</strong></p> <p><strong>Background</strong>: Community pharmacy has been a lucrative area of practice for pharmacists in Jos, Nigeria, until about the turn of the millennium where a decline in viability of the business has been observed.</p> <p><strong>Objective</strong>: This study assessed the entrepreneurial skills of community pharmacists, the business performance of community pharmacies and the impact of their entrepreneurial skills on business performance.</p> <p><strong>Methods</strong>: A cross sectional survey was conducted by administering a pretested questionnaire to 30 community pharmacists in Jos. An adaptation of the Bernelli model and the expanded Katz (1974)/Herron (1990) Skill Typology Model was used to assess nine entrepreneurial skills - product, organizational, industry, networking, leadership, executive, entrepreneurial, marketing and money skills; while sales growth, net profit and stock growth were used to assess business performance. Frequency distribution of results was presented, with further analysis done with the Epi-Info software using the chi square test of association.</p> <p><strong>Result</strong>: The results from this study showed that community pharmacies in Jos do possess requisite entrepreneurial skills, but to varying extents. Product skills ranked highest while money skills and entrepreneurial skills ranked least, portraying a need for skills enhancement in these areas. Business performance was suboptimal, being rated as average or poor by 56.6% of respondents. However, most respondents (90%) still assessed their businesses as profitable. Money skills had a significant impact on business performance (P=0.03) and stock growth (P=0.04); while stock growth was significantly affected by leadership skills (P=0.002) and entrepreneurial skills (0.02). Net profit was significantly affected by industry skills (P=0.008).</p> <p><strong>Conclusions</strong>: Community pharmacy business is still a profitable business venture in Jos though business performance is sub optimal. The entrepreneurial skills set of a community pharmacist set has an impact on business performance with money skills, leadership skills and entrepreneurial skills being most significant. This study recommended that entrepreneurial skills of community pharmacists in Nigeria are further developed to improve pharmaceutical business performance.</p> Iyeseun O. Asieba Teresa M. Nmadu ##submission.copyrightStatement## 2018-03-22 2018-03-22 16 1 1110 1110 Factors associated with smoking cessation success in Lebanon <p><strong>Objective</strong>: The objective is to assess factors associated with the success rate of smoking cessation among Lebanese smokers in a smoking cessation center.</p> <p><strong>Methods</strong>: A cross-sectional data study, conducted between March 2014 and March 2016 in an outpatient smoking cessation center with 156 enrolled patients. The patient’s nicotine dependence and motivation to quit smoking were evaluated according to the Fagerstrom Test for Nicotine Dependence and Richmond tests respectively.</p> <p><strong>Results</strong>: The number of packs smoked per year decreased the odds of smoking cessation success (p=0.004, ORa=0.982, CI 0.97-0.994), while the compliance with the offered treatment increased the odds of success by 7.68 times (p&lt;0.001, ORa=7.68, CI 3.438-17.187). Highly dependent and highly motivated smokers had more success in the quitting process compared to those with a lower dependence and motivation respectively.</p> <p><strong>Conclusion</strong>: Our findings showed that many factors can influence smoking cessation, an experience described as difficult, most significantly the number of packs per year and compliance with the smoking cessation treatment. Moreover, although these outcomes are not representative of the entire Lebanese population, we believe that health authorities could utilize these results when implementing upcoming smoking cessations programs. All attempts at cessation should have a goal of reducing the number of packs smoked per year to improve the chances of ceasing into the future.</p> Zeina A. Bacha Nelly Layoun Georges Khayat Souheil Hallit ##submission.copyrightStatement## 2018-03-20 2018-03-20 16 1 1111 1111 Challenges and opportunities of clinical pharmacy services in Ethiopia: a qualitative study from healthcare practitioners’ perspective <p>&nbsp;</p> <p><strong>Background</strong>: Currently, clinical pharmacists have in-depth therapeutic knowledge and scientific skills to act as drug therapy experts in healthcare settings.</p> <p><strong>Objective</strong>: 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.</p> <p><strong>Methods</strong>: 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.</p> <p><strong>Results</strong>: 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.</p> <p><strong>Conclusion</strong>: 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.</p> Henok G. Tegegn Ousman A. Abdela Abebe B. Mekuria Akshaya S. Bhagavathula Asnakew A. Ayele ##submission.copyrightStatement## 2018-03-21 2018-03-21 16 1 1121 1121 Nigerian pharmacists’ self-perceived competence and confidence to plan and conduct pharmacy practice research <p><strong>Background</strong>: Recent studies have revealed that pharmacists have interest in conducting research. However, lack of confidence is a major barrier.</p> <p><strong>Objective</strong>: This study evaluated pharmacists’ self-perceived competence and confidence to plan and conduct health-related research.</p> <p><strong>Method</strong>: 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.</p> <p><strong>Result</strong>: 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&lt;0.05). The only predictor of moderate-to-extreme self-competence and confidence was having at least one journal article publication during the last 5 years.</p> <p><strong>Conclusion</strong>: Nigerian pharmacists indicated interest to participate in health-related research. However, self-competence and confidence to plan and conduct research were low. This was particularly so for skills related to statistical analysis. Training programs and building of Pharmacy Practice Research Network are recommended to enhance pharmacist’s research capacity.</p> Usman Abubakar Syed A. Sulaiman Mohammed N. Usman Muhammad D. Umar ##submission.copyrightStatement## 2018-03-27 2018-03-27 16 1 1152 1152