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Background Observation studies are used in health care research, e.g. to explore behaviors of patients or health care professionals in hospitals. A methodological challenge in observation studies is the observer effect, as it can jeopardize the quality of a study. Objectives To capture different dimensions of the observer effect through health care professionals' and patients' experiences, and their reactions to being observed in a hospital setting, and in addition, observers' experiences from performing an observation study. Method Four focus group interviews (health care professionals and observers) and 10 individual interviews (patients) were conducted with participants from a Norwegian observation study focusing on medication communication at a hospital ward. In all 26 persons were interviewed, whereof 3 were observers (pharmacist, pharmacy students). Data were collected between September 2019 and January 2020 and analyzed by an inductive, thematic analysis approach. Results Five main themes were identified; Experiencing being observed; Temporarily adapting medication communication behavior; Consequences for the patients; To interact or not - reflections on the relations and Observing the observers. Respondents reported some observer effects, but also that these diminished with time. Even though minimal interaction was used as a strategy, observers and the observed still built rapport. Conclusions The observer effect in relation to medication communication seemed to be small and temporary in this specific hospital setting, among other things as staff and patients were used to extra persons (e.g. students) being around. Medication communication in hospital settings is a complex behavior, and appears to not be strongly impacted by the presence of observers, especially with a long observation time. It is important for researchers to monitor and record the observer effect in the specific setting of the study. This can be done by interviews with the observed and the observers by someone not connected to the observation study.

BackgroundAn ageing population leads up to increasing multi-morbidity and polypharmacy. This demands a comprehensive and interprofessional approach in meeting patients’ complex needs. This study describe graduate students’ experiences of working in interprofessional teams with complex patients’ care needs in nursing homes.MethodStudents from advanced geriatric nursing, clinical nutrition, dentistry, medicine and pharmacy at the University of K in Norway were joined to groups to examine and develop a care plan for a nursing home patient during a course. Focus groups were used, where 21 graduate students participated in four groups. Data were collected during spring 2018 and were inductively analysed according to a thematic analysis method (Systematic Text Condensation) and discussed using four previously proposed types of coordination practices. ResultsThree themes were identified: 1) Complex patients as learning opportunities- an eye-opener for future interprofessional collaboration 2) A cobweb of relations, and 3) Structural facilitators for new collective knowledge. Graduate university students experienced IPE on complex patients in nursing homes as a comprehensive learning arena.ConclusionsInterprofessional education in nursing homes disclose challenges and possibilities to develop the health care service for elderly patients with complex care needs. It is important to experience complex situations during professional education, even if frustrating, when students have the possibility to discuss difficulties with each other and the faculty. Educators can arrange their IPE activity to foster more collaborative practices and potentially increase learning outcomes.

Introduction: Good communication skills are essential for pharmacy students to help patients with their medicines. Students' attitudes towards communication skills learning will influence their willingness to engage in communication training, and their skills when dealing with patients later on in their professional life. Objective: The aim of this study was to explore Nordic pharmacy students' attitudes to communication skills learning, and the associations between those attitudes and various student characteristics. Method and materials: A cross-sectional questionnaire-based study was conducted in 11 Nordic pharmacy schools between April 2015 and January 2016. The overall response rate for the final study population was 77% (367 out of 479 students). Pharmacy students who had fulfilled all mandatory communication training and most of their pharmacy practical experience periods were included. The communication skills attitudes scale was the main outcome. Linear regression models were fitted with the outcome variable and various student characteristics as the predictors, using generalized estimating equations to account for clustering within pharmacy schools. Results: Nordic pharmacy students in general have moderately positive attitudes towards learning communication skills. Positive attitudes towards learning communication skills among pharmacy students were associated with being female (βadjusted 0.42, 95% CI 0.20 to 0.63, p < 0.001), following a newer pharmacy training program (βadjusted 0.81, 95% CI 0.63 to 0.98, p < 0.001), having higher self-rated need for communication skills improvement (βadjusted 0.50, 95% CI 0.30 to 0.71, p

Background Healthcare services such as diabetes risk-assessment are increasingly common in community pharmacies. Knowledge of community pharmacists’ experiences of such services could ease the implementation of a larger-scale service. Objectives To explore Norwegian pharmacists’ experience of a diabetes risk-assessment service, including analytical quality control, in a community-pharmacy setting. Methods Three focus-group interviews were conducted in Norway between August and September 2017. Systematic text condensation was used, an analytic approach well suited for thematic content analysis across interview data. Fourteen pharmacists took part, recruited from a project offering a diabetes risk-assessment service, including measurements of Glycated hemoglobin A1c (HbA1c), in Norwegian community pharmacies. Results The pharmacists emphasized the importance of using their knowledge and skills to promote good health. They considered offering this service as being compatible with their role as pharmacists. As communication is an essential part of their work, the pharmacists evaluated their communication skills as being good. Nevertheless, how to communicate the offering of this service was seen as a challenge, for instance recruiting participants and communicating in an understandable and professional way. Inclusion of the whole pharmacy staff as a team was experienced as an important success factor for implementation of a risk-assessment service. Analytical quality control was perceived as being a natural part of their job and a manageable task. Conclusions Offering a diabetes risk-assessment service is in line with the way a selected group of Norwegian community pharmacists perceived their professional role. However, they were uncomfortable recruiting participants, and expressed the wish for more support from the pharmacy chain. Our results add performance of analytical quality control as part of the ongoing development involving expansion of pharmacists' professional role. Future implementation studies may also benefit from giving both the pharmacy staff and customers sufficient time to familiarize themselves with the new service before measuring effects. Keywords Community pharmacy, healthcare services, diabetes risk assessment, focus groups, pharmacists' experiences, analytical quality control publishedVersion

Background Little is known about patients’ Perceived Sensitivity to Medicines (PSM), “the belief that one is especially sensitive to the actions and side effects of medicines”. Objective (i) To explore the extent of and factors associated with high Perceived Sensitivity to Medicines in a Norwegian population of chronic medicine users; (ii) to assess the psychometric characteristics of the tool to measure PSM. Setting Community pharmacies in the Oslo area, Norway. Method A cross-sectional, questionnaire-based study was conducted between October 2015 and January 2016. Patients filling prescriptions for chronic disorders were recruited. Main outcome measure Perceived sensitivity to medicines. Results The study population included 214 patients (response rate 36.7%). In total 20.1% of the patients reported low, 61.7% moderate and 18.2% high perceived sensitivity to medicines. Factors positively associated with high perceived sensitivity were female gender (Adjusted Odds Ratio (aOR) 5.33, 95% CI 1.52 to 18.72, p

Background: Generic substitution (GS), is a cost-containment strategy meant to contain pharmaceutical expenditure without compromising health objectives. In order to shape GS into a policy that is both efficient and safe it is crucial to understand which factors are most important for patients' trust in GS. Objective: To assess Swedish patients' level of trust in the bioequivalence of cheap and expensive generic medicines, and the association between trust and various factors. Methods: A cross-sectional study was conducted. Questionnaires were handed out at 12 community pharmacies in Sweden, selected through stratified sampling, between March and April 2015. The questionnaire included seven socio-demographic questions in addition to 18 items divided into three sections: the 'views on generic medicine'-scale, information on and prior experiences of GS, financial aspects and change of color/name. Odds Ratios (ORs) were estimated applying adjusted logistic regression analyses with trust in the bioequivalence of generic medicines used as outcome variable and various factors as predictors. Results: A total of 719 patients participated (response rate 85.7%). The results show that 70.7% of the respondents' trust that cheap and expensive interchangeable generic medicines are equal. Of the respondents 36.0% considered the change in appearance and 40.8% the change in names to complicate adherence. Lower trust in the bioequivalence of generic medicines were associated with being female (aOR=1.82, 95%CI 1.20:2.75, p

Objective: To assess communication skills training at Nordic pharmacy schools and explore ways for improvement. Methods: E-mail questionnaires were developed and distributed with the aim to explore current practice and course leaders’ opinions regarding teaching of patient communication skills at all the 11 master level Nordic (Denmark, Finland, Iceland, Norway and Sweden) pharmacy schools. The questionnaires contained both closed- and open-ended questions. Results: There was a variation of patient communication skills training among schools. In general, communication skills training was included in one to five courses (mode 1); varied in quantity (6-92 hours); had low use of experiential training methods; and had challenges regarding assessments and acquiring sufficient resources. However, some schools had more focus on such training. Conclusion: The results show room for improvement in patient communication skills training in most Nordic pharmacy schools and give insights into how to enhance communication skill building in pharmacy curricula. Suggestions for improving the training include: early training start, evidence-based frameworks, experiential training, and scaffolding.

Objective The development of more patient-centred care is not always visible in community pharmacies. The aim of this study was to explore Norwegian pharmacists' motivation and perceived responsibility regarding role development and involvement in patient-centred care. Methods A semi-structured interview guide was developed. Four focus group interviews were conducted with a heterogeneous sample of 21 community pharmacists and transcribed verbatim. An inductive analysis was performed, supplemented with an agent perspective. Key findings Two main categories and nine subcategories were identified, with the main categories being ‘reality vs. vision’ and the overall ‘agent’ category. A gap was found between what the pharmacists said they were doing in their day-to-day work and what they expressed as their ideal tasks in the pharmacy. The pharmacists seem to transfer the need for their role as active medicine experts in patient-centred care to other agents such as authorities and pharmacy chains. Conclusions There is a gap between what the Norwegian community pharmacists express as their vision and current practice. The identified agent relationships appear to hamper the pharmacists' perceived ability to be active and take full responsibility in their role development and further implementation of patient-centred care. Adopting a fairly inactive position when it comes to increasing patient-centred care might be a result of a traditional product-focused pharmacy culture.

Objective. To describe Nordic pharmacy students’ opinions of their patient communication skills training (PCST), and the association between course leaders’ reports of PCST qualities and students’ perceptions of their training. Secondary objective was to determine what factors influence these associations. Methods. A cross-sectional questionnaire-based study was performed. The various curricula were categorized into three types (basic, intermediate and innovative training) and students were divided into three groups according to the type of training they had received. Multivariable logistic regression models were fitted with different opinions as outcomes and three types of training as exposure, using generalized estimation equations. Results. There were 370 students who responded (response rate: 77%). Students within the innovative group were significantly more likely to agree that they had received sufficient training, and to agree with the assertion that the pharmacy school had contributed to their level of skills compared to students in the basic group. Conclusion. There appears to be an association between larger and varied programs of training in patient communication skills and positive attitudes toward this training on the part of the students, with students reporting that they received sufficient training, which likely enhanced their skills.