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      A global survey on trends in advanced practice and specialisation in the pharmacy workforce

      1 , 2 , 3
      International Journal of Pharmacy Practice
      Wiley

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          Abstract

          Objectives

          Despite the increasingly complex care and demanding health challenges shaping pharmacy, little work has been carried out to understand the global status of advanced and/or specialised pharmacy practice scopes and the models in which they exist. This study aims to describe the current global status of initiatives relating to advancement of pharmacy practice.

          Methods

          A global survey was conducted between January and May 2015 to collect country-level data from member organisations of the International Pharmaceutical Federation (FIP), and national-level contacts from regulatory, professional and government agencies or universities; data requests were sent to 109 countries. The collected data were triangulated (comparing multiple sources from single countries, e.g.), cleaned and analysed by descriptive and comparative statistics.

          Key findings

          Full data sets from 48 countries and territories were obtained. The findings demonstrate varying systems of advanced pharmacy practice and specialisation often linked to income level. The study found that there are variations within terminology and definitions, frameworks for specialisation and advanced practice, professional recognition mechanisms and benefits across countries.

          Conclusions

          This survey of 48 countries and territories was the first of its kind to describe the range of specialisation and professional recognition systems for advanced pharmacy practice worldwide. Despite the variance, it is clear from this global study that professional advancement and the recognition of advancement in practice are developing around the world and this could be due to the increasingly complex nature of pharmaceutical care delivery and a consequent need to be able to endorse professional capabilities.

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          Most cited references20

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          Human resources and health outcomes: cross-country econometric study.

          Only a few studies have investigated the link between human resources for health and health outcomes, and they arrive at different conclusions. We tested the strength and significance of density of human resources for health with improved methods and a new WHO dataset. We did cross-country multiple regression analyses with maternal mortality rate, infant mortality rate, and under-five mortality rate as dependent variables. Aggregate density of human resources for health was an independent variable in one set of regressions; doctor and nurse densities separately were used in another set. We controlled for the effects of income, female adult literacy, and absolute income poverty. Density of human resources for health is significant in accounting for maternal mortality rate, infant mortality rate, and under-five mortality rate (with elasticities ranging from -0.474 to -0.212, all p values < or = 0.0036). The elasticities of the three mortality rates with respect to doctor density ranged from -0.386 to -0.174 (all p values < or = 0.0029). Nurse density was not associated except in the maternal mortality rate regression without income poverty (p=0.0443). In addition to other determinants, the density of human resources for health is important in accounting for the variation in rates of maternal mortality, infant mortality, and under-five mortality across countries. The effect of this density in reducing maternal mortality is greater than in reducing child mortality, possibly because qualified medical personnel can better address the illnesses that put mothers at risk. Investment in human resources for health must be considered as part of a strategy to achieve the Millennium Development Goals of improving maternal health and reducing child mortality.
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            Effect of outpatient pharmacists' non-dispensing roles on patient outcomes and prescribing patterns.

            The roles of pharmacists in patient care have expanded from the traditional tasks of dispensing medications and providing basic medication counseling to working with other health professionals and the public. Multiple reviews have evaluated the impact of pharmacist-provided patient care on health-related outcomes. Prior reviews have primarily focused on in-patient settings. This systematic review focuses on services provided by outpatient pharmacists in community or ambulatory care settings. This is an update of the Cochrane review published in 2000. To examine the effect of outpatient pharmacists' non-dispensing roles on patient and health professional outcomes. This review has been split into two phases. For Phase I, we searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (January 1966 through March 2007). For Phase II, we searched MEDLINE/EMBASE (January 1966 through March 2008). The Phase I results are reported in this review; Phase II will be summarized in the next update. Randomized controlled trials comparing 1. Pharmacist services targeted at patients versus services delivered by other health professionals; 2. Pharmacist services targeted at patients versus the delivery of no comparable service; 3. Pharmacist services targeted at health professionals versus services delivered by other health professionals; 4. Pharmacist services targeted at health professionals versus the delivery of no comparable service. Two authors independently reviewed studies for inclusion, extracted data, and assessed risk of bias of included studies. Forty-three studies were included; 36 studies were pharmacist interventions targeting patients and seven studies were pharmacist interventions targeting health professionals. For comparison 1, the only included study showed a significant improvement in systolic blood pressure for patients receiving medication management from a pharmacist compared to usual care from a physician. For comparison 2, in the five studies evaluating process of care outcomes, pharmacist services reduced the incidence of therapeutic duplication and decreased the total number of medications prescribed. Twenty-nine of 36 studies reported clinical and humanistic outcomes. Pharmacist interventions resulted in improvement in most clinical outcomes, although these improvements were not always statistically significant. Eight studies reported patient quality of life outcomes; three studies showed improvement in at least three subdomains. For comparison 3, no studies were identified meeting the inclusion criteria. For comparison 4, two of seven studies demonstrated a clear statistically significant improvement in prescribing patterns. Only one included study compared pharmacist services with other health professional services, hence we are unable to draw conclusions regarding comparisons 1 and 3. Most included studies supported the role of pharmacists in medication/therapeutic management, patient counseling, and providing health professional education with the goal of improving patient process of care and clinical outcomes, and of educational outreach visits on physician prescribing patterns. There was great heterogeneity in the types of outcomes measured across all studies. Therefore a standardized approach to measure and report clinical, humanistic, and process outcomes for future randomized controlled studies evaluating the impact of outpatient pharmacists is needed. Heterogeneity in study comparison groups, outcomes, and measures makes it challenging to make generalised statements regarding the impact of pharmacists in specific settings, disease states, and patient populations.
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              An international survey on advanced practice nursing education, practice, and regulation.

              To describe international trends on the developing role of the nurse practitioner-advanced practice nurse (NP-APN), including nomenclature, levels and types of NP-APN education, practice settings, scope of practice, regulatory policies, and political environment.
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                Author and article information

                Contributors
                Journal
                International Journal of Pharmacy Practice
                Wiley
                0961-7671
                2042-7174
                April 2020
                March 16 2020
                March 16 2020
                April 2020
                March 16 2020
                March 16 2020
                : 28
                : 2
                : 173-181
                Affiliations
                [1 ]UCL-FIP Collaborating Centre, School of Pharmacy, University College London, Bloomsbury, London, UK
                [2 ]Lead for Workforce Transformation & Development, International Pharmaceutical Federation, The Hague, The Netherlands
                [3 ]Experiential Development & Graduate Education (EDGE), Monash Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
                Article
                10.1111/ijpp.12611
                32176415
                bc503843-f2ba-4859-8260-37d9afdbf8ef
                © 2020

                https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model

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