Research Proposal on "Pharmacy - Interview Analyses and Synthesis"

Quoted Instructions for "Pharmacy - Interview Analyses and Synthesis" Assignment:

Note to the *****:Very Impoartant

This paper is written for Dr. level pharmacy .

I need a ***** who can provide with that level of standard of writing .He/She can review three interviews and provide an organized ideas in looking at profession of pharmacy in regards of the interviews provided.

I have provided three interviews . Two of them being with pharmacist and one with the patient. The first interview was with a Dr. of pharmacy in hospital and the 2nd interview was with a pharmacist who's worked in community pharmacy and third one being the interview with the patient. ( briefly mention that one of the pharmacist was 72 years old) that means he*****s been in practice for more than 20 years.)

I need the ***** to review these interviews. The review SHOULD not be a series of questions and answers . The ***** should express the person*****s perceptions , opinions and feelings in narrative format. Please discuss the important topics of the interviews. Explain where the comments were similar and where they were different. How are their perceptions are similar to and or different from aspects of pharmacy . Finally is the *****s reflection which is was it what he expected or something different ? How? Why do you think they were the same or different?

It should be organized and clearly differentiate one section from another in a logical fashion. The review should be cohesive and flows well from one section to another. The review should provide a comprehensive analysis of the interviewee*****s responses. Please address all of the reflection questions and discuss the points.

Contact me ahead of time if any questions.

-------------------------------------------------------

Dr. M

Position you are holding in the organization : In Patient Pharmacy Supervisor

When and Where did you Graduate from Pharmacy School ?

University of South California ,and I graduated in 2002

How long have you been working on your current position:

Almost 2 years now.

Could you give brief description of your duties and responsibilities at your work place:

In patient pharmacy is responsible for providing medication and medication related services to our437 bed hospital at Los Angels medical center. We provide not only distributed pharmacy work which is providing the medication to the floors but also provide monitoring for antibiotics and anticoagulant . We also do majority of patient discharges and patient consultation as well.

Since you have graduated, what has changed in fundamental of pharmacy practice:

I think, the biggest focus is much more patient care focus, and that is to say we always try to tailor therapies to individual patient which in practice we see what is right for this patient might not be for the next patient.

Also, pharmacist taking more proactive role in those services. Moving away the simple distributing just the medication towards monitoring, dosage, and outcome approaches.

What do you think are the most important services that the patient expects from the pharmacist?

Everything we do is built on distributed role, some people don*****t like that . But we have to remember that pharmacist are responsible for making sure that the right patient gets the right medication at the right time. Everything else that we do is built upon that but not the replacement for that . That is the core responsibility and that*****s something that hasn*****t change and will not change.

The other thing that has impact patient care, are no less important . But those thing are making sure drugs are dose appropriately , if there is any interaction between medication that the patient is taking, make sure that any kind of patient education that we provide is the best quality.

The perfect example of this is Coumadin, which is blood thinner.

We provide patient education for patient who are taking this so they would understand why are they taking this medicine . How they are suppose to take this and all the other drugs and food that they should watch for while taking this drug after they get discharged. So in regarding the patient education for drug therapy that*****s the area we could help.

What do you think the services that the pharmacist could provide that the patient might not know or expect that it cold be beneficial to them?

I think , to large extend it depends to the setting. Again for our work at the hospital, distribution is core service that we provide . There are million antibiotics ,but if its not right for that patient its not going to help .

Also, people in the hospital are sicker .those medicines and interaction with each other becomes very very important. Little things can make big difference.

The other things that is seen more is discharge counseling, which is very important.

How do you think right communication between physician and pharmacist and patient can have beneficial outcomes?

I believe its very important. You might know everything but if you cant communicate effectively isn*****t worthless. And for us, its very important that we have very good open channel of communication with providers in the hospital with other staff and with the patient. And it works in every step. Patients need to tell us what*****s important, physicians needs to tell us what is important and what is it that we do or don*****t know . And we as pharmacist need to provide the information that they might not be aware of.

How to you carry on to methods of your communication that you use with other health care to providers.

I think face to face communication is ultimately the most important thing.

Now we are talking about how we communicate. Now we have different ways of communicating. We certainly talk to people face to face, we spend a lot of time on the phone, we also email and things like that. But nice thing about our facility is that we have electronic chart. That chart enables my notes to be seen by everyone else when I come in contact with the patient.

What are some methods that used in your practice to avoid miscommunication and mistreatment errors.

Most common error in the hospital is a pharmacy related error, but its not a pharmacy error. Its when a note or order is written , which is not appropriate or incorrect and that mistake is not caught and its carried forward.

One of the things that we do in our facilities, we maintain a list of abbreviations that physicians should avoid. We also have a set ways of referring to different medicine. For example, blood pressure medicine rather than referring to something by brand name , we refer to it by generic name.

If it*****s a something that a combination drug. For example , Vicodin which is combination of Tyanol and hydroquinone. The order is written for Vicodin not Tyanol and hydroquinone. Because it*****s a two name and it might get confusing.

Abbreviation, like qd ( every day ) and qod ( every other day ) and they must be written out. Other things, Leading zeros are ok but trailing zeros are not ok. Little things like that actually help a lot.

Do you find any difference from out patient pharmacy care and in patient pharmacy care in hospital setting?

In terms of work flow its very similar, you receive an order you check order and then you and you fill the order. The difference is the level of acuity of the patient ,because the patient are sicker , they*****re more sensitive so we have to make be specially careful that the right thing get to patient. But that doesn*****t mean in out patient you can be any less careful but if god forbidden you make mistake the chances are much graver inside the hospital . Another thing is the medicines that are used inside the hospital is much stronger that the medicine ones in out patient ,once again because patient is sicker. But the responsibility aspect is always the same.

Do you have anything to add Dr. M?

I think pharmacy is the beautiful profession, one where that you can help people every day that you go to work. And that*****s something that few profession can actually say.

----------------------------------------------------------------------------------------------------------

Please State your name , age , current employee and position you are holding in current organization ?

Dr. X, Pharmacist at ASAP pharmacy in Glendale . Age 72

When and where you graduate from pharmacy school?

University of California in 1960.

How long ago have you been working in current position here.

November of last year.

Can you give us a description of your duties and responsibilities at your work place.

As a pharmacist , filling prescriptions , checking for accuracy , checking for allergies , checking for interaction with other medications patient is taking and making sure what patient is taking is right.

Since you have graduated what has changed in fundamental methods of practice of pharmacy?

In 1960, mostly was manual and now its high technology . No faxes, no internet, no email and orders were called by dr . and spend a lot of time on the phone. Everything is speed up now with all the technology which is in better direction .An overview of the role of technology-based interventions in improving medication regimen adherence was also provided.. Through the delivery of wireless information, problems associated with human memory and conjecture in decision making may be eliminated. When we consider that the current definition of the Internet is "every computer, cell phone, PDA, and pager in the world being able to communicate with every other computer, cell phone, PDA, and pager in the world," we can begin to understand technology's huge potential to improve health care delivery processes and treatment adherence behaviors in patients.

As far as attitude of pharmacist , , back then we didn*****t have quality of drugs we have now. Now a days there are so many potent drugs and more side effect and interactions. Now we have more patient consultation and being actively involved

What do you think is main responsibility towards the patient?

The most important thing Is the patient is compliant. Monitoring the patient so we can have them out of trouble and avoid emergency hospital settings.

Do you see patient expectations are totally different from pharmacist responsibilities?

I think ,sometimes patients expect more from medications and they expect that things get done right away. When pharmacist explain to them this medication can take several weeks . So as a pharmacist its our role to explain everything very careful ,so they have enough information and knowledge and they can be an active member in their own health care . And we have to bring their expectations to the expectable level.

Judging from your work experience, what are some services that the patient might like to get from the pharmacist that they are not getting right now.

Since the time is limited , if we can shift the role from more distributating drugs towards more patient education and more towards helping patient with monitoring their help to prevent emergency setting . Like helping with blood pressure and diabetic education would be helpful.

How do you feel about state policies giving more responsibilities to clerk and give pharmacist to take time more with patient ?

I think it would be great, because now we have to do a lot of volume. Every extra help from technician and more clerk would be beneficial to pharmacist . So pharmacist can take more active role in vaccination , helping diabetic patients and generally more consulting time with each patient so we can catch a lot of mistakes and errors which happens and can cause problem for the patient.

Why do you think effective communication between physician, pharmacist and patient is important ?

The effective communication is the key. Many pharmacists do not routinely document their comments in a patient*****s notes. Encouraging pharmacists to document their input in patients***** notes may help to ensure that information is transferred, acknowledged and acted on. Indeed, with the current change in doctors***** working shift patterns, a doctor who is given a verbal message today may not be the doctor who manages the patient tomorrow. documentation should be legible, objective and useful to the care of the patient. Also, face-to-face interaction establishes or enhances the pharmacist-patient relationship. This interaction allows the pharmacist the optimal ability to observe signs of and visual cues to the patient's health problems, such as adverse reactions to medications, lethargy, alopecia, extrapyramidal symptoms, jaundice, and disorientation. The pharmacist's observations can result in early detection of medication-related problems and thus can reduce emergency room visits, hospitalizations, and medication misadventuring

Do you have anything to add on how pharmacy changed over years?

It changed quit a bit from when I started. As I mentioned pharmacist are becoming more involved in counseling patients and planning drug therapy programs. Something that

Has changed over years is the pharmacist

completes a medication therapy review (MTR) consultation with the patient. Pharmacist-provided MTR and consultation in various settings has resulted in reductions in unscheduled physician visits, emergency room visits, hospital days, and overall costs

Patient Interview :

Please Introduce yourself.?

Mr. S , 53 years old

Can you tell me what are the changes that you*****ve seen over the years as a patient in role of pharmacist ?

The time has come to unify the profession in pursuit of its patient care mission. Pharmacy is maturing as a clinical profession and presently is well positioned to transform itself from a product-***** to a patient-***** profession.

What are the issues facing the profession of pharmacy today ?

Pharmacists gradually are embracing changing professional roles. However, several factors may serve to impair the adoption of new roles, including lack of consensus regarding the profession's goals, resistance to broadening the pharmacist's responsibilities beyond dispensing functions, lack of professional competence and/or self-confidence, the false impression that managed care invariably will decrease pharmacist demand, dissension surrounding adoption of the doctor of pharmacy as the sole professional degree, work environments that provide little or no opportunity for patient-centered practice, lack of reimbursement for pharmacists' clinical services, and underdevelopment of practitioners' interpersonal skills. Factors that appear likely to promote changing professional roles include opportunities to positively impact patients' drug therapy outcomes through disease state management, expanded use of technology and technicians in the dispensing process, increased demand for drug information among health professionals and consumers, new opportunities for creating tailored drug therapy as the field of pharmacogenomics is better understood, and expanded practice roles in community, ambulatory, long-term care, and home care settings. Regardless of the issues confronting future practitioners, it is clear that we will be called upon to provide evidence that justifies these new professional roles.

Can you name example of your experience with your pharmacist?

Well, I*****ve personally have seen a lot of patients when going through their community pharmacy expect their medications to be ready right there .And many complains that I*****ve seen regarding pharmacist taking too much time, but what they don*****t understand is if that pharmacist doesn*****t take enough time its their life that would be in danger and risk .

As you mentioned to me earlier you are 53 years old , what changes have you seen in profession of pharmacy from older days.

Well compare to older days when a Pharmacist spends most of his or her day counting and dispensing medications in a little room at the local drug store. While this may have been true at various times and to various extents over the last hundred years, the duties of today's pharmacist are decidedly more complex. The Role has altered more towards knowledge of the product, and interaction with the patient *****” so more focus on treatment rather than just the dispensing and the preparation of the product. "The role manifests itself is with more patient contact and more patient counseling, greater involvement in disease state management, greater involvement in assisting patients with managing their disease states and serving a greater information source role for the patient." Advances in pharmaceuticals have also played a part. "Pharmacists are much more involved in modifying patient behavior and physician prescribing behaviors and practices today than they were 20 years ago,"