Informal caregivers play a vital role in ensuring safe and appropriate medication use by older adults. Medication management is complex and involves many activities that are supported through the use of a variety of tools and strategies that have been adapted and individualized to each specific caregiving scenario. Caregivers should be an important component of interventions that aim to improve medication use among older adults.
Background
Workload has been described both objectively (e.g., number of prescriptions dispensed per pharmacist) as well as subjectively (e.g., pharmacist’s perception of busyness). These approaches might be missing important characteristics of pharmacist workload that have not been previously identified and measured.
Objectives
To measure the association of community pharmacists’ workload perceptions at three levels (organization, job, and task) with job satisfaction, burnout, and perceived performance of two tasks in the medication dispensing process.
Methods
A secondary data analysis was performed using cross-sectional survey data collected from Wisconsin (US) community pharmacists. Organization–related workload was measured as staffing adequacy; job-related workload was measured as general and specific job demands; task-related workload was measured as internal and external mental demands. Pharmacists’ perceived task performance was assessed for patient profile review and patient consultation. The survey was administered to a random sample of 500 pharmacists who were asked to opt in if they were a community pharmacist. Descriptive statistics and correlations of study variables were determined. Two structural equation models were estimated to examine relationships between the study variables and perceived task performance.
Results
From the 224 eligible community pharmacists that agreed to participate, 165 (73.7%) usable surveys were completed and returned. Job satisfaction and job-related monitoring demands had direct positive associations with both dispensing tasks. External task demands were negatively related to perceived patient consultation performance. Indirect effects on both tasks were primarily mediated through job satisfaction, which was positively related to staffing adequacy and cognitive job demands and negatively related to volume job demands. External task demands had an additional indirect effect on perceived patient consultation performance, as it was associated with lower levels of job satisfaction and higher levels of burnout.
Implications/Conclusions
Allowing community pharmacists to concentrate on tasks and limiting interruptions while performing these tasks are important factors in improving quality of patient care and pharmacist work life. The results have implications for strategies to improve patient safety and pharmacist performance.
Using nationwide data, this study estimated and compared annual health care expenditures per person between noncancer and cancer patients, and among patients with the 4 most common cancers. Two-part models were used to estimate mean expenditures for each group by source of payment and by service type. We found that cancer patients had nearly 4 times higher mean expenditures per person ($16 346) than those without cancer ($4484). These differences were larger among individuals aged 18 to 64 years than those ≥65 years. Medicare was the largest source of payment for cancer patients, especially among those ≥65 years. Among the 4 most common cancers, the most costly cancer was lung cancer. Ambulatory care visits accounted for the majority of health care expenditures for those with breast cancer, while for those with other cancers, inpatient services also contributed to a significant portion of expenditures especially among younger patients. This study demonstrates that cancer patients experience a substantially higher health care expenditure burden than noncancer patients, with lung cancer patients having the highest expenditures. Expenditure estimates varied by age group, source of payment, and service type, highlighting the need for comprehensive policies and programs to reduce the costs of cancer care.
High financial burden among patients with cancer was significantly associated with lower HRQOL and poor mental health. Along with efforts to reduce health care costs for cancer survivors, additional interventions are necessary to ensure the HRQOL and psychological health of cancer survivors.
A lack of standardized naloxone training requirements for naloxone-dispensing pharmacists may affect the rate of adoption of enhanced pharmacy naloxone dispensing practices at community pharmacies and suboptimal education of patients at risk of opioid overdose. Ensuring pharmacists' preparedness to serve as naloxone providers is necessary to meaningfully prevent opioid overdose deaths in their communities.
Background
The U.S. Agency for Healthcare Research and Quality (AHRQ) developed a hospital patient safety culture survey in 2004, and has adapted this survey to other healthcare settings, such as nursing homes and medical offices, and most recently community pharmacies. However, it is unknown if safety culture dimensions developed in hospital settings can be transferred to community pharmacies. The aim of this study was to assess the psychometric properties of the Community Pharmacy Survey on Patient Safety Culture.
Method
The survey was administered to 543 community pharmacists in [state], United States. Confirmatory factor analysis was used to assess the fit of our data with the proposed AHRQ model. Exploratory factor analysis was used to determine the underlying factor structure. Internal consistency reliabilities were calculated.
Results
A total of 433 usable surveys were returned (response rate of 80%). Results from the confirmatory factor analysis showed inadequate model fit for the original 36 item, 11-factor structure. Exploratory factor analysis showed that a modified 27 item, 4-factor structure better reflected the underlying safety culture dimensions in community pharmacies. The communication openness factor, with 3 items, dropped in its entirety while 6 items dropped from multiple factors. The remaining 27 items redistributed to form the 4-factor structure: safety related communication, staff training and work environment, organizational response to safety events, and staffing, work pressure and pace. Cronbach's α of 0.95 suggested good internal consistency.
Conclusion
Dimensions related to safety culture in a community pharmacy environment may differ from those in other healthcare settings such as in hospitals. Our findings suggest that validation studies need to be conducted before applying safety dimensions from other healthcare settings into community pharmacies.
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