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> en-US <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" rel="noopener">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> (Fernando Fernandez-Llimos) (Administration) Wed, 07 Nov 2018 21:25:29 +0000 OJS 60 Gender, age, and pharmacists’ job satisfaction <p>A comprehensive literature review was conducted on the concept of job satisfaction in the pharmacist workforce field and the facets it comprises, as well as its measurement, aiming to (i) review the nature, mechanisms, and importance of job satisfaction in the context of the pharmacist workforce, (ii) survey some of the most salient facets that configure job satisfaction, and (iii) discuss validity and measurement issues pertaining to it.</p> <p>Although female pharmacists generally hold less appealing jobs, earn lower wages and salaries, and are promoted less frequently than their male counterparts, they report higher levels of job satisfaction. Age has a U-shape effect on job satisfaction, with middle-age pharmacists less satisfied than both younger and older practitioners. Workload, stress, advancement opportunities, job security, autonomy, fairness in the workplace, supervisors, coworkers, flexibility, and job atmosphere are facets contributing to pharmacists’ job satisfaction. Finally, discrepancy exists among researchers in measuring job satisfaction as a single global indicator or as a composite measure derived from indices of satisfaction with key aspects of a job.</p> <p>Understanding the mechanisms that affect pharmacists’ job satisfaction is important to employers in their pursuit to respond to practitioners’ needs, decrease turnover, and increase productivity. As pharmacists’ response to work-related conditions and experiences depends on gender and age, a unique set of rewards and incentives may not be universally effective. Additional research into the dynamics of the forces shaping pharmacists’ perceptions, opinions, and attitudes is needed in order to design and implement policies that allocate human resources more efficiently within the various pharmacy settings.</p> Manuel J. Carvajal, Ioana Popovici ##submission.copyrightStatement## Wed, 28 Nov 2018 19:55:31 +0000 Improving warfarin therapy through implementation of a hospital-based pharmacist managed clinic in Jamaica <p><strong>Background</strong>: Pharmacist managed warfarin clinics can improve the anticoagulation status of non-valvular patients. The first of such services was implemented at the Cornwall Regional Hospital in Jamaica in 2013.</p> <p><strong>Objectives</strong>: To assess the anticoagulation control of patients on warfarin therapy over six months in the pharmacist managed warfarin clinic at Cornwall Regional Hospital.</p> <p><strong>Methods</strong>: Retrospective docket review for the period January 2014 to December 2016 was done to include data of patients attending routine clinic appointments for at least six months. Age, gender, date of visit, indication for warfarin therapy, warfarin dose and International Normalized Ratio readings were extracted. Percentage time spent in therapeutic range (TTR) was calculated by month for six months using the Rosendaal linear interpolation method. Patient anticoagulation status was categorized as poor (TTR&lt;40%), moderate (TTR=40-64%) or good (TTR≥65%) and anticoagulation status at three months and six months was compared.</p> <p><strong>Results</strong>: For the period of assessment, 52 patients were identified; the median age was 58 years and 36 patients were males. Deep vein thrombosis was the main indication for therapy (22 of 52) and median warfarin weekly dose ranged was 15.0-130 mg. At time of recruitment most of the patients were outside the target INR range (43 of 52). Within one month, the median TTR attained was 31% [IQR 62-10]. This significantly improved by second month to 60% [IQR 82-23] (p=0.001). By month three, the proportion of patients in good, moderate and poor anticoagulant status was 19/51, 15/51 and 17/51 respectively, which at six months changed to 23/51, 12/51. 16/51 respectively; thus, although coagulation status improved from month one to three, there was no significant improvement from month three to month six (p=0.31).</p> <p><strong>Conclusions</strong>: The pharmacist managed warfarin clinic monitoring services were successful in attaining TTRs &gt;40% and sustaining these values over six months. The services should therefore be encouraged.</p> Jodi Ann McKenzie, Cameil Wilson-Clarke, Jennifer Prout, Jacqueline Campbell, Rhea Danielle Douglas, Maxine Gossell-Williams ##submission.copyrightStatement## Wed, 07 Nov 2018 21:24:55 +0000 Health promotion of bowel cancer and breast cancer screening in community pharmacies: Pharmacists’ perceptions of their role, knowledge and confidence <p><strong>Objectives</strong>: To identify community pharmacists’ perceptions of their role, knowledge and confidence in relation to bowel cancer and breast cancer screening health promotion.</p> <p><strong>Methods</strong>: This was a mixed-methods study with community pharmacists and key informants in the Metro South Health (MSH) region of Brisbane, Queensland, Australia. In Part 1, quantitative data was collected from community pharmacists via an electronic survey. In Part 2, qualitative data was collected from community pharmacists and key informants via in-depth interviews. This paper reports the findings of community pharmacists’ perceptions of their role, knowledge and confidence to promote bowel cancer and breast cancer screening in community pharmacies.</p> <p><strong>Results</strong>: A total of 27 community pharmacists (13 males, 14 females) completed the survey. Most (71%) either ‘agreed’ or ‘strongly agreed’ discussing health advice, such as cancer screening, with their consumers was valuable and integral to their broader role. An average of 60% described their confidence as ‘average’ or ‘good’ when discussing bowel and breast cancer screening and prevention with consumers. In eight knowledge questions about bowel and breast cancer and cancer screening, an average of 82% of community pharmacists responded with correct answers (range 52% to 100%). Community pharmacists were consistently more confident and knowledgeable about bowel cancer services than breast cancer services. Five (5) community pharmacists participated in in-depth interviews. The interview findings supported the quantitative findings. Most community pharmacists described their confidence to promote bowel cancer and breast cancer screening as moderate, and consistently reflected they felt more knowledgeable and confident about bowel cancer topics than breast cancer topics.</p> <p><strong>Conclusions</strong>: Overall, this research supports the feasibility of promoting bowel cancer screening in community pharmacies. It suggests further training is warranted for community pharmacists to increase their knowledge of breast cancer and their confidence in promoting breast cancer referral and screening services. It highlights the important role community pharmacists have in increasing engagement in the national bowel cancer and breast cancer screening programs, and in potentially decreasing the mortality rates of these cancers.</p> Marguerite C. Sendall, Liz Ostermann, Carolyn Brown, Laura McCosker ##submission.copyrightStatement## Thu, 08 Nov 2018 19:20:52 +0000 Evaluation of students’ attitudes towards pharmacist–physician collaboration in Brazil <p><strong>Objective</strong>. To measure undergraduate pharmacy and medical students’ collaborative attitudes regarding Pharmacist–Physician collaboration.</p> <p><strong>Methods</strong>. A cross-sectional descriptive study was conducted from September 2016 to February 2017 in Northeast Brazil. Pharmacy and medical students from the first and the last year of courses were invited to complete Portuguese version of Scale of Attitudes Toward Pharmacist-Physician Collaboration (SATP<sup>2</sup>C). Descriptive and comparative analyses were performed using IBM SPSS (22 version). Differences were considered significant when p&lt;0.05.</p> <p><strong>Results</strong>. Three hundred seventy students completed the SATP<sup>2</sup>C. Overall, the students had positive attitudes towards physician-pharmacist collaboration. There was no significant correlation between age and score (p=0.79). Women showed a more positive collaborative attitude than men (53.1, SD=6.8 vs. 55.1, SD=6.3). Pharmacy students had a higher score than medical students (57.5, SD=4.7, vs. 51.1, SD=6.4). The first-year medical students had a higher score than last-year medical students (52.3, SD=6.0 vs. 49.5, SD=6.6; p&lt;0.007). There was no significant difference in the attitudes between the first and last year pharmacy students (p&lt;0.007).</p> <p><strong>Conclusions</strong>. Pharmacy and medical students showed positive attitudes towards physician-pharmacist collaboration. However, pharmacy students presented more collaborative attitudes than medical ones. Additionally, the first-year medical students had more collaborative attitudes than last-year medical students. Studies should be conducted to provide recommendations to improve interprofessional education efforts to further enhance the positive attitudes toward physician-pharmacist collaboration.</p> Fernanda O. Prado, Kérilin S. Rocha, Dyego C. Araújo, Luiza C. Cunha, Tatiane C. Marques, Divaldo P. Lyra, Jr ##submission.copyrightStatement## Tue, 04 Dec 2018 20:34:25 +0000 A retrospective analysis of prescription medications as it correlates to falls for older adults <p><strong>Objectives</strong>: To determine the correlation between falls and two medication factors: the class of medications and potentially inappropriate medications (PIMs) prescribed to community-dwelling older adults aged 55 and older.</p> <p><strong>Methods</strong>: Retrospective, cross-sectional study. Home health patients residing in a Texas/Mexico border community and reporting at least one fall within the past month. Medication use, medication classification, and potentially inappropriate medications (PIM) recorded by level of falls; non-fallers and recurrent fallers.</p> <p><strong>Results</strong>: Of 99 participants, 13.1% reported falling once and 86.9% reported two or more falls. Participant’s average number of medications used was 10.51 (SD 5.75) with 93.9% having four or more prescribed medications. Average number of PIMs prescribed per participant was 1.42 (SD 1.51) with at least one PIM prescribed to 65.6% of participants. Twenty three out of 83 identified classes of prescribed medications met criteria for the study’s analyses but resulted in no significant association to falls when comparing NF to RF. Agents acting on the renin-angiotensin system and lipid modifying agents were the most frequently prescribed medication classes (N=55, 55.6%). Ibuprofen was the PIM most frequently prescribed (n=13, 13.1%). The correlation between use of a prescribed PIM and number of falls was not statistically significant (p=0.128).</p> <p><strong>Conclusions</strong>: There was no correlation between classes of medication and level of falls. Recurrent fallers were more likely to have been prescribed a PIM than non-fallers (not significant). Although the analyses conducted for this study did not result in statistical significance, the high prevalence of polypharmacy and prescribed PIMs observed in these participants warrants a thorough review of medications to reduce fall risks among older adults.</p> Katherine A. Lawson, Celeste M. Vinluan, Aida Oganesyan, Eugenia C. Gonzalez, Amanda Loya, Justin J. Strate ##submission.copyrightStatement## Tue, 13 Nov 2018 19:11:16 +0000 Evaluation of medication adherence among Lebanese diabetic patients <p><strong>Background</strong>: Diabetes type 2 is considered one of the main public health concerns. Lack of adherence to treatment leads to poor therapeutic outcome, poor glycemic control, and high risk for developing diabetes complications.</p> <p>Objectives: The aim of this study is to evaluate adherence to oral antidiabetic medication in Diabetes type 2 Lebanese patients, and to evaluate factors leading to low adherence.</p> <p><strong>Methods</strong>: A cross-sectional study was conducted in outpatients endocrinology clinics of two hospitals and four private clinics located in Beirut-Lebanon. Data was collected using a well-structured questionnaire by trained pharmacists. Adherence level was measured by the Lebanese Medication Adherence Scale (LMAS-14). Bivariate and multivariate analyses were conducted using SPSS version 20.</p> <p><strong>Results</strong>: Overall, 245 patients were included in the study with the majority being females (54.3%) and obese (47.8%). Only 29% of the participants had controlled glycemia (HbA1c &lt;7%) with 31.8% of subjects had high adherence to their medication compared to 68.2% with low adherence. Increased working hours/day was associated with a decrease in adherence to oral antidiabetic medication (OR=0.31; 95% CI 0.11:0.88; p=0.029). Other factors significantly associated with decreased adherence to treatment were forgetfulness, high drug costs, complex treatment regimens, experiencing side effects, and perception of treatment inefficacy. Postponing physician office visits also decreased the probability of being adherent to oral antidiabetic medication (OR=0.36; 95% CI 0.15:0.86; p=0.022). Skipping or doubling the dose in case of hypo/hyperglycemia and the sensation of treatment burden also decreased medication adherence (OR=0.09; 95% CI 0.02:0.34; p=0.001, and OR=0.04; 95% CI 0.01:0.13; p&lt;0.001 respectively).</p> <p><strong>Conclusions</strong>: Adherence to oral antidiabetic medication is low for Lebanese patients, which leads to a poor glycemic control and increases the diabetes complications. Intervention programs including patient education strategies are essential to improve medication adherence.</p> <p>&nbsp;</p> Lara Mroueh, Dana Ayoub, Maya El-Hajj, Sanaa Awada, Samar Rachidi, Salam Zein, Amal Al-Hajje ##submission.copyrightStatement## Tue, 04 Dec 2018 20:13:27 +0000 Assessment of diarrhea treatment and counseling in community pharmacies in Baghdad, Iraq: A simulated patient study <p><strong>Background</strong>: Because community pharmacists are the most accessible healthcare professionals, they are often involved in managing minor ailments within the community setting.</p> <p><strong>Objective</strong>: This study evaluated the community pharmacists’ history taking practice, medicine dispensing and advice in response to acute diarrhea.</p> <p><strong>Methods</strong>: Authors conducted a simulated-patient study in 75 community pharmacies in Baghdad, Iraq from February to May 2015. The female simulated-patient complained of acute diarrhea that had lasted for one day and requested for medicine to treat her condition. After exiting each pharmacy, she then assessed the practices of the community pharmacists through the use of a specially designed checklist adopted with modifications from relevant guidelines. For history taking, a maximum total of eight was the highest obtainable score. Data collected was quantitatively analyzed and Mann-Whitney, Chi-square or Fishers exact tests were used at an alpha level of 0.05.</p> <p><strong>Results</strong>: All of the 75 pharmacies visited were managed by professionally qualified pharmacists. The most common questions asked during history taking were number of diarrheal episodes (n=62; 82.7%); duration of symptoms (n=59; 78.7%) and presence of other diseases and if any drug had been taken (n=58; 77.3%). Female pharmacists had a higher total mean score (6.45, SD=1.33) for history taking when compared to their male counterparts (4.34, SD=2.13); p &lt;0.001. Medicine combination of diphenoxylate HCl 2.5mg + atropine sulphate 0.025mg (n=34; 27.9%) was most frequently dispensed while the least was oral rehydration salt (n=1; 0.8%). Around 20% (n=15) of pharmacists dispensed antimicrobial agents. Over half (n=46; 61.3%) of pharmacists indicated the frequency of use on the medicine packet. Conversely, less than half (n=33; 44.0%) gave any advice on food and fluid intake.</p> <p><strong>Conclusions</strong>: Majority of the community pharmacists asked at least four questions while taking patient history and was very likely to recommend antidiarrheal medicines as first line treatment options. The authors recommend the development of a minimum standard of practice as well as enhanced training for Iraqi community pharmacists.</p> Inas R. Ibrahim, Subish Palaian, Mohamed I. Ibrahim ##submission.copyrightStatement## Mon, 10 Dec 2018 13:37:15 +0000