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Chapter 6 How Pharmacy Education Contributes to Patient and Pharmaceutical Care

Publication date: 2018
Source:Pharmacy Education in the Twenty First Century and Beyond

Author(s): Ahmed Awaisu, David R. Mottram

In recent years, pharmacy practice has undergone a significant evolution toward patient-centered care. These changes have occurred primarily as a result of demographic changes in population as well as political and economic forces modulating the healthcare systems in many countries. Pharmacy education has undoubtedly made a significant contribution to practice advancement. For the future pharmacy education, globally, needs to develop the educational outcomes, professional competencies, curricular content and processes that are required to prepare competent graduates to assume an integrated and accountable role in the healthcare system by having defined responsibilities for direct patient care. This will result in the development of effective patient care practitioners with appropriate skills, knowledge, and competencies to provide optimal pharmaceutical care and to advance health outcomes. This chapter is primarily intended to provide insight into the evolution of patient and pharmaceutical care as a new model of practice and how pharmacy education contributes in these transformations around the world.

Categorías: Investigaciones

Chapter 14 Capacity Building in Pharmacy Education

Publication date: 2018
Source:Pharmacy Education in the Twenty First Century and Beyond

Author(s): Claire Anderson, Arijana Meštrović

Having a competent and capable pharmacy workforce depends on the capacity of the academic workforce to teach and train. Careful planning of the academic workforce is a critical component of developing academic capacity. Quality assurance requirements are addressing academic workforce development and capacity building in many different aspects, but certainly as one of the main perquisites for accreditation and international recognition. Academic capacity is one of the International Pharmaceutical Federation (FIP) Workforce Development Goals launched in Nanjing in 2016 (FIP, 2017), positioned in the first place among other goals. There remain a number of barriers to achieving academic capacity on a global scale and this chapter discusses those barriers and some solutions to them.

Categorías: Investigaciones

Measuring patient-provider communication skills in Rwanda: Selection, adaptation and assessment of psychometric properties of the Communication Assessment Tool

Publication date: Available online 23 April 2018
Source:Patient Education and Counseling

Author(s): Vincent Kalumire Cubaka, Michael Schriver, Peter Vedsted, Gregory Makoul, Per Kallestrup

Objective To identify, adapt and validate a measure for providers’ communication and interpersonal skills in Rwanda. Methods After selection, translation and piloting of the measure, structural validity, test-retest reliability, and differential item functioning were assessed. Results Identification and adaptation: The 14-item Communication Assessment Tool (CAT) was selected and adapted. Validity and reliability testing Content validation found all items highly relevant in the local context except two, which were retained upon understanding the reasoning applied by patients. Eleven providers and 291 patients were involved in the field-testing. Confirmatory factor analysis showed a good fit for the original one factor model. Test-retest reliability assessment revealed a mean quadratic weighted Kappa = 0.81 (range: 0.69-0.89, N = 57). The average proportion of excellent scores was 15.7% (SD: 24.7, range: 9.9-21.8%, N = 180). Differential item functioning was not observed except for item 1, which focuses on greetings, for age groups (p = 0.02, N = 180). Conclusion The Kinyarwanda version of CAT (K-CAT) is a reliable and valid patient-reported measure of providers’ communication and interpersonal skills. K-CAT was validated on nurses and its use on other types of providers may require further validation. Practice implication K-CAT is expected to be a valuable feedback tool for providers in practice and in training.

Categorías: Investigaciones

“I wanted a skeleton … they brought a prince”: a qualitative investigation of factors mediating the implementation of a Performance Based Incentive program in Malawi

Publication date: Available online 23 April 2018
Source:SSM - Population Health

Author(s): Shannon A. McMahon, Adamson S. Muula, Manuela De Allegri

While several evaluations have examined the extent to which performance based financing (PBF) programs induce changes in the quantity and quality of health services provided, less is known about the process of implementing PBF. We conducted a process evaluation of a PBF intervention in Malawi that focused on understanding moderators of program implementation. Informed by a seminal theory of implementation, we first created a timeline and taxonomy of key events in the program lifeline and then undertook 25 in-depth interviews with stakeholders including implementers, central-level ministry officials and district-level health staff. While seven “moderator categories” emerged in this study, two categories (program complexity and quality of delivery) proved especially crucial in terms of moderating implementation and sparking adaptations. Complexity refers primarily to the manner in which PBF requires that those implementing the program have business acumen and forecasting skills, which are often beyond the purview of a clinician’s training and thus proved challenging. Regarding quality of delivery, the program struggled to issue rewards in a timely and adequate manner, which proved highly problematic as it undermined a bedrock feature of PBF. Adaptations and adaptability refers here to a program’s ability to make changes; the program proved rigid in several respects although nimble in terms of adjusting the verification process (upon noticing revengeful behaviors in peer verification). This PBF program is unique in several respects and findings cannot be generalized to all PBF programs. Nevertheless, process evaluations that draw from or expand upon existing implementation theories can allow researchers to better disentangle complex programming. We hope that more process evaluations, which track both core elements and necessary adaptations of PBF implementation, can further advance understandings of why PBF implementation functions or fails within a given setting, thereby enhancing implementers’ abilities to replicate facilitators and bypass barriers.

Categorías: Investigaciones

Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40

Publication date: Available online 17 April 2018
Source:The Lancet

Author(s): Global Burden of Disease Health Financing Collaborator NetworkJoseph LDielemanNafisSadatAngela YChangNancyFullmanCristianaAbbafatiPawanAcharyaArsène KouablanAdouAliasgharAhmad KiadaliriKhurshidAlamRezaAlizadeh-NavaeiAla'aAlkerwiWalidAmmarCarl Abelardo TAntonioOlatundeAremuSolomon WeldegebrealAsgedomTesfay MehariAteyLeticiaAvila-BurgosRakeshAyerHamidBadaliMaciejBanachAmritBanstolaAleksandraBaracAbate BekeleBelachewCharlesBirungiNicola LBragazziNicholas J KBreitbordeLuceroCahuana-HurtadoJosipCarFerránCatalá-LópezAbigailChapinCatherine SChenLalitDandonaRakhiDandonaAhmadDaryaniSamath DDharmaratneManishaDubeyDumessaEdessaErikaEldrenkampBabakEshratiAndréFaroAndrea BFeiglAma PFennyFlorianFischerNataliyaFoigtKyle JForemanMamataGhimireSrinivasGoliAlemayehu DesalegneHailuSamerHamidiHilda LHarbSimon IHayDeliaHendrieGloriaIkileziMehdiJavanbakhtDennyJohnJost BJonasAlexanderKaldjianAmirKasaeianYawukal ChaneKasahunIbrahim AKhalilYoung-HoKhangJagdishKhubchandaniYun JinKimJonas MKingeSoewartaKosenKristopher JKrohnG AnilKumarAlessandraLafranconiHiltonLamStefanListlHassanMagdy Abd El RazekMohammedMagdy Abd El RazekAzeemMajeedRezaMalekzadehDeborah CarvalhoMaltaGabrielMartinezGeorge AMensahAtteMeretojaAngelaMicahTed RMillerErkin MMirrakhimovFitsum WeldegebrealMlashuEbrahimMohammedShafiuMohammedMarkMosesSeyyed MeysamMousaviMohsenNaghaviVinayNangiaFrida NamnyakNgalesoniCuong TatNguyenTrang HuyenNguyenYirgaNiriayoMehdiNorooziMayowa OOwolabiTejasPatelDavid MPereiraSuzannePolinderMostafaQorbaniAnwarRafayAlirezaRafieiVafaRahimi-MovagharRajesh KumarRaiUshaRamChhabi LalRanabhatSarah ERayRobert CReinerHaniye SadatSajadiRoccoSantoroJoão VascoSantosAbdur RazzaqueSarkerBennSartoriusMaheswarSatpathySadaf GSepanlouMasood AliShaikhMehdiSharifJunSheAzizSheikhMark GShrimeMekonnenSisaySamirSonejiMoslemSoofiReed J DSorensenHenokTadesseTianchanTaoTaraTemplinAzeb GebresilassieTesemaSubashThapaRuoyanTobe-GaiRomanTopor-MadryBach XuanTranKhanh BaoTranTung ThanhTranEduardo AUndurragaTommiVasankariFrancesco SViolanteAndreaWerdeckerTissaWijeratneGelinXuNaohiroYonemotoMustafa ZYounisChuanhuaYuMaysaa El SayedZakiBiancaZlavogChristopher J LMurray

Background Achieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040. Methods We extracted historical data on gross domestic product (GDP) and health spending for 188 countries from 1995 to 2015, and projected annual GDP, development assistance for health, and government, out-of-pocket, and prepaid private health spending from 2015 through to 2040 as a reference scenario. These estimates were generated using an ensemble of models that varied key demographic and socioeconomic determinants. We generated better and worse alternative future scenarios based on the global distribution of historic health spending growth rates. Last, we used stochastic frontier analysis to investigate the association between pooled health resources and UHC index, a measure of a country's UHC service coverage. Finally, we estimated future UHC performance and the number of people covered under the three future scenarios. Findings In the reference scenario, global health spending was projected to increase from US$10 trillion (95% uncertainty interval 10 trillion to 10 trillion) in 2015 to $20 trillion (18 trillion to 22 trillion) in 2040. Per capita health spending was projected to increase fastest in upper-middle-income countries, at 4·2% (3·4–5·1) per year, followed by lower-middle-income countries (4·0%, 3·6–4·5) and low-income countries (2·2%, 1·7–2·8). Despite global growth, per capita health spending was projected to range from only $40 (24–65) to $413 (263–668) in 2040 in low-income countries, and from $140 (90–200) to $1699 (711–3423) in lower-middle-income countries. Globally, the share of health spending covered by pooled resources would range widely, from 19·8% (10·3–38·6) in Nigeria to 97·9% (96·4–98·5) in Seychelles. Historical performance on the UHC index was significantly associated with pooled resources per capita. Across the alternative scenarios, we estimate UHC reaching between 5·1 billion (4·9 billion to 5·3 billion) and 5·6 billion (5·3 billion to 5·8 billion) lives in 2030. Interpretation We chart future scenarios for health spending and its relationship with UHC. Ensuring that all countries have sustainable pooled health resources is crucial to the achievement of UHC. Funding The Bill & Melinda Gates Foundation.

Categorías: Investigaciones

Human Resources for Health: The Best Learning, the Best Skill Mix, and the Most Impact.

Glob Health Sci Pract;6(1): 6-7, 2018 Mar 21. . [Artigo]

Categorías: Investigaciones

Pushing the boundaries of research on human resources for health: fresh approaches to understanding [...]

WHO South East Asia J Public Health;7(1): 13-17, 2018 Apr. . [Artigo]

Categorías: Investigaciones

Physician’s sociodemographic profile and distribution across public and private health care: an insight into physicians’ dual practice in Brazil

Abstract Background

The intertwined relation between public and private care in Brazil is reshaping the medical profession, possibly affecting the distribution and profile of the country’s medical workforce. Physicians’ simultaneous engagement in public and private services is a common and unregulated practice in Brazil, but the influence played by contextual factors and personal characteristics over dual practice engagement are still poorly understood. This study aimed at exploring the sociodemographic profile of Brazilian physicians to shed light on the links between their personal characteristics and their distribution across public and private services.


A nation-wide cross-sectional study using primary data was conducted in 2014. A representative sample size of 2400 physicians was calculated based  on the National Council of Medicine database registries; telephone interviews were conducted to explore physicians’ sociodemographic characteristics and their engagement with public and private services.


From the 2400 physicians included, 51.45% were currently working in both the public and private services, while 26.95% and 21.58% were working exclusively in the private and public sectors, respectively. Public sector physicians were found to be younger (PR 0.84 [0.68–0.89]; PR 0.47 [0.38–0.56]), less experienced (PR 0.78 [0.73–0.94]; PR 0.44 [0.36–0.53]) and predominantly female (PR 0.79 [0.71–0.88]; PR 0.68 [0.6–0.78]) when compared to dual and private practitioners; their income was substantially lower than those working exclusively for the private (PR 0.58 [0.48–0.69]) and mixed sectors (PR 0.31 [0.25–0.37]). Conversely, physicians from the private sector were found to be typically senior (PR 1.96 [1.58–2.43]), specialized (PR 1.29 [1.17–1.42]) and male (PR 1.35 [1.21–1.51]), often working less than 20 h per week (PR 2.04 [1.4–2.96]). Dual practitioners were mostly middle-aged (PR 1.3 [1.16–1.45]), male specialists with 10 to 30 years of medical practice (PR 1.23 [1.11–1.37]).


The study shows that more than half of Brazilian physicians currently engage with dual practice, while only one fifth dedicate exclusively to public services, highlighting also substantial differences in socio-demographic and work-related characteristics between public, private and dual-practitioners. These results are consistent with the international literature suggesting that physicians’ sociodemographic characteristics can help predict dual practice forms and prevalence in a country.

Categorías: Investigaciones