Maintaining competence throughout a career is a lifelong challenge for all health care professionals. Being aware of the fast evolution of knowledge and the responsible function in the health care sector should raise concerns about one's own competences. This moral sense however, has not always sufficiently motivated health care professionals to undertake actions to this end. Consequently, professional associations and authorities alike started developing formal lifelong learning (LLL) systems, with the aim of sustaining the practitioner's competence and ensuring the provision of quality patient care. Traditionally, these systems were based on continuing education (CE) whereas nowadays there tends to be a shift toward continuing professional development (CPD). In the General Introduction is explained why this CPD approach is thought to be superior to the traditional CE approach. In Belgium, CPD is not yet implemented. To keep pharmacists up to date, various CE offerings are available, such as lectures, workshops, and e-learning. In order for these CE programs to be effective, they must meet pharmacists' needs. During this PhD, we tried to find out what these needs are, how the outcomes of CE on the practice may be increased, and how a regulated LLL system for Belgian community pharmacists could look like. This translated into the following major research questions:1) How can we optimize CE offerings for community pharmacists?2) How can we increase the effect of CE on practice improvements?3) How can we organize CE in order that pharmacists' competency will be maintained and improved? The initial phase of this PhD-project consisted of a postal survey in which 1032 pharmacists participated. Chapter 2 reports on this survey. The survey enquired about motivation to attend CE courses, topics of interest, preferred methods of instruction, and opinion on mandatory CE. The results are reported for Attenders and Non-Attenders of CE courses. A response rate of 62.8% was obtained after three mailings. The results indicated that lectures remained the most favourite course format. Topics related to pharmaceutical care were the most wanted. The strongest facilitators for attending CE courses were 'gathering practical knowledge to improve information provision skills' and 'keeping scientific knowledge up to standard'. 'Social contact with colleagues' and 'receiving a syllabus' were perceived as moderately motivating factors. Most frequently mentioned barriers were 'lack of time', 'family matters', 'distance to the classes', and 'uninteresting subjects'. Around 2/3rd of questioned pharmacists were willing to invest more time in CE when participation would be rewarded. When it comes to opinion on mandatory CE, disagreement existed between Attenders and Non-attenders, the latter being less in favour. The second phase of this PhD-project included further in-depth research based on the results of the survey.In this respect, we were able to profile the responders of the survey, based on their interest in different CE formats. In Chapter 3 is explained why cluster analysis was considered to be a good method for doing this. Cluster analysis generated three groups of pharmacists. Pharmacists not preferring lectures (cluster one; n=133) were more likely to be older male pharmacy owners and had the greatest interest in distance learning. Their participation in CE was inhibited by a lack of intrinsic motivation, lack of time, and coincidence with other activities. Pharmacists interested in lectures as well as workshops (cluster two; n=595) exhibited the highest intrinsic motivation to engage in CE. Pharmacists preferring lectures but not workshops (cluster three; n=304) were more likely to be women and disliked active involvement in CE.We also elicited the opinion of pharmacists themselves on optimization of CE offerings. In six focus groups, pharmacists discussed about optimization of CE courses, new CE formats such as e-learning, and how the ideal CE system for pharmacists could look like. Chapter 4 describes in detail how this qualitative study was carried out, and reports extensively on the conducted focus group discussions (FGDs). The results of the FGDs revealed that to optimize live courses, CE providers should select skilled speakers, provide extensive courses notes, and focus on issues that are relevant to day-to-day pharmacy practice. The interest in distance learning as a CE format was limited, as opposed to the results of the survey. Non-attenders were likely to need a formal obligation to engage in CE, with the preferred format being live courses. By increasing patients' awareness and appreciation of pharmacists' capabilities, pharmacists could be more motivated to counsel patients, to engage in CE, and to accept a system of mandatory CE. Chapter 5 describes how we conducted a drug interaction intervention study to meet research question 2. In this study, which had a controlled before-and-after design, pharmacy students and internship pharmacists from both the KULeuven (n=10 pharmacies) and the University of Ghent (n=10 pharmacies, control group) participated. The intervention for the 'Leuven'-group consisted of an interactive CE course during which practice-oriented guidelines were offered. Before and after the intervention, students registered interactions with _-blockers during two weeks. A total number of 288 interactions were detected during both study periods. Most _-blockers causing an interaction were prescribed for hypertension, and interacted with anti-hypoglycemic agents, NSAIDs, or _2-agonists. Pharmacists' intervention rate was low (14% in the pre-test compared to 39% in the post-test), but increased significantly in the post-test in the intervention group. Reasons for overriding the interaction included limited clinical relevance, refill prescriptions, not being aware of the interaction, and communication problems with the prescriber. The CE course raised pharmacists' awareness of drug interactions, and affected their short-term behaviour at the counter in dealing with interactions of _-blockers. In the survey and the focus group study, Flemish pharmacists' opinion on the organization of CE was already elicited. In Chapter 6 is described how LLL for pharmacists is organized in other countries. The countries that we studied were the Netherlands, Germany, France, Great Britain, Australia, New Zealand, Canada (Ontario), and the United States. The aim of this literature review was to compare the LLL frameworks for community pharmacists from these countries, and to determine to what extent the concept of CPD has been implemented. From this study it appeared that the concept of CPD has been implemented primarily in countries that have already a long tradition in LLL, such as Great Britain. Other countries tend to opt for the CE approach, e.g. France, or for a combination of both CE and CPD, e.g. New Zealand. The findings of this international comparisons study together with pharmacists' opinion as elicited in the focus groups, resulted in a proposal for a regulated LLL system for Belgian pharmacists. This proposal is described in detail in the General Discussion and Conclusion. In this final part of the thesis, the three research questions are discussed in light of the results obtained from all the studies of this thesis. In addition to the general conclusion, suggestions for future research are formulated.. Doctor in de Farmaceutische Wetenschappen. Ond.centr. Farm.Zorg & Farmaco-economie. Dept. Farmaceutische Wetenschappen. Faculteit Farmaceutische wetenschappen. Doctoral thesis. Doctoraatsthesis
| Datum prijs | 20 dec. 2006 |
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| Originele taal | English |
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| Begeleider | Liesbeth Leemans (Promotor) |
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