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Clinical Pharmacogenetics Implementation

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Discuss about the Clinical Pharmacogenetics Implementation.



Quality management is a critical requirement across all healthcare organizations. Building patient centric quality management is considered of utmost importance. Several tools and standards are imposed by healthcare managers to achieve quality management. The primary role of pharmacy professionals and healthcare managers is to provide high quality healthcare, while ensuring that the patient is taken care of (Lee et al., 2012). The managers are responsible for ensuring that the regulations and processes are being adhered to. They keep a check on adaptation of the standards and instill the processes into the healthcare setting, with the aim of assuring patient safety and satisfaction.  The job of a healthcare manager is undoubtedly demanding and difficult (Batalden et al., 2015). The topic is essential in IT industry owing to the fact that healthcare management is one of the fastest growing industries. The need for comprehensive healthcare practices is ever-increasing due to population explosion and development in science.

Thus, the practices involved in healthcare management need to be continuously improved to satisfy the ever-increasing market. With rise in health expenses and increase in competition, managers must be prepared to effectively lead the hospital settings. Managers combine a sound understanding of healthcare system with business expertise and work toward increasing effectiveness and efficiency. Rapid reforms and innovation have made delivery of quality care central to hospital management (Kirkpatrick et al., 2013). This can be accounted for the fact that the federal government and the patients expect delivery of results by skilled management professionals.

However, the managers need to overcome several challenges to improve patient care and maintain fiscal responsibility. This report will therefore illustrate on the different challenges faced by pharmacy professionals and healthcare managers in hospital settings. The report will focus on a literature review to illustrate the several challenges faced by healthcare managers across large hospitals.

A particular study aimed to formally evaluate the healthcare programs to understand the challenges that occur in healthcare settings while improving care quality. The study further tried to identify the ways by which the challenges could be addressed. Lessons from the Health Foundation’s improvement programmes were integrated with relevant literature. Several reports were read and carefully analysed. NVivo software was used to undertake the analysis. This was followed by conduction of a narrative review of the organizational factors that would likely hinder efforts of improvement. The analysis helped in the identification of 10 key challenges that were related to improvement interventions and professional context. The fundamental challenge identified was failure to convince people that there was a need to address the real problem. While planning and designing interventions, the healthcare managers must carefully target the problems that are more likely to be accepted across the hospital setting. The study identified other challenges at the planning stage, which included contest of the chosen interventions due to lack of sufficient evidence, poor data collection and lack of adequate monitoring, lack of expertise and inadequate financial support, managerial skills and infrastructure. The findings also provided evidence that lack of work culture, inadequate organizational capacity can create emotional exhaustion create adverse outcomes. Lack of engagement of staff and failure to overcome lack of ownership and low leadership skills were also recognized by the study as one of the biggest challenges (Dixon-Woods, McNicol & Martin, 2012).


Another study was conducted to identify the roles of pharmacists in pharmacogenomics implementation. The specific resources and responsibilities needed for pharmacy professionals to execute their roles had not yet been defined. The study identified the roles of pharmacy professionals by summarizing the results obtained from a clopidogrel-CYP2C19 pilot project. The project involved administration of antiplatelet therapies for patients who had undergone percutaneous coronary intervention and stent placement. More than 1000 patients were genotyped. The results revealed the essential roles of pharmacy professionals. These roles and responsibilities included expertise in developing electronic medical records and clinical decision support system (pharmacy informatics), implementing medication safety, adhering to medication regulations and policies, developing educational strategies and logistically using all drug related information and database management approaches in patient care centres. Pharmacy professionals are also involved in solving ethical issues related to patient care. The results suggested that 14 pharmacists were involved in the program during the first 2 years of study and needed to develop an expertise in pharmacokinetics, pharmacogenomics and informatics to achieve holistic patient care (Owusu?Obeng et al., 2014).

The role of healthcare managers in implementation of innovative healthcare was demonstrated by another study. The study results proved that these managers play a key role in implementing healthcare innovation. The gap that existed between practice and effective care evidences was attributed to poor implementation of healthcare innovations. The study suggested that managers are involved in influencing healthcare innovation implementation by actively synthesizing and diffusing information, mediating between daily activities and strategies, and selling the innovations to important stakeholders. It emphasized on the fact that teamwork designs are essential for the functioning of healthcare organizations. It showed that healthcare managers are entitled with the responsibility of overseeing team initiatives. This enhances their potential to influence implementation of innovative techniques (Birken, Lee & Weiner, 2012).

Another study attempted to evaluate the attitude, knowledge, and proficiency of pharmacy graduates in the practice of evidence based medicine. Pre and post survey studies and skill tests were conducted among the sample with the help of a valid questionnaire with the aim of comprehending the transformation in the knowledge of pharmacy professionals during their transition to a hospital setting. The skills gained by pharmacy undergraduates were assessed and statistically analysed. A series of Problem Based Learning were conducted followed by administration of pre and post-test and the competencies were assessed. On analysis of the data using IBM SPSS v20.0 ANCOVA software, it was found that majority of the students could formulate PICO questions and apply them in the healthcare setting after taking the pharmacy course. One of the major challenges identified was the lack of adequate role models who would promote the culture of evidence based practice on the hospital wards. A change in the behavior of senior pharmacists on the use of EBP methods was needed to create a significant impact in the minds of junior pharmacy professionals that would in turn improve the quality of patient care in near future. Another challenge that pharmacy professionals face is the lack of exposure to pharmacy informatics. This weakens their approach to searching for drug information. Moreover, they are often unable to handle statistical information in large hospital settings (Abu-Gharbieh et al., 2015).

A systematic content analysis was performed to identify the challenges and opportunities in social pharmacy and pharmacy practice. Narrowly focused pharmacy services, lack of consensus, pressure on publishing the research results and reduction in research funding add to the challenges. The study suggested that creating provisions for patient-oriented healthcare services and dispensing medication in a proper manner are some of the key issues that are faced by pharmacy professionals and healthcare managers (Almarsdóttir, Kaae & Traulsen, 2014).

The research challenges faced in context awareness and computation communication for ubiquitious healthcare were investigated by another study. The study stated that specialized instructions and rising costs of hospitalizations created major problems for healthcare manages in real-time hospital settings. The major challenges faced by them as identified by the research are the discovery and provision of computing resources and wireless grid computing. The unpredictability and high mobility of the device acts as a barrier in the interaction between data providers. Reliable transmission and prioritization of vital signs of the patients posed another challenge. Additional interference occurs due to proliferation of electronic devices that are used in the hospitals. Thus, the study provided an overview of the factors that create difficulty for healthcare managers to deliver personalized healthcare solutions in large hospital settings (Viswanathan, Chen & Pompili, 2012).

Development of a researchable question is one of the major challenging tasks that are encountered while initiating a project. A researchable question can therefore be defined as an uncertainty about a particular problem, which can be examined, challenged, and analyzed with the aim of providing useful information. Thus, a successful research depends upon good formulation of the research question based on the several problems that are faced in research activities (Lang et al., 2012).

The main purpose of this literature search was to evaluate the available literature and formulate a research question that would help in future research. The research problem was of some familiarity and a topic of interest. There was a need to channelize the question by focusing on information that was yet to be explored. Once the problem was narrowed down, the existing literature was analysed and seeked and it helped to straighten research approach.

The hypothesis carefully created a testimony of how the research was expected to proceed. It acted as one of the most essential tools that assisted in answering the research question. Although, the literature search was time-consuming and exhaustive, some simple steps were adopted that helped in managing the process. The steps used for the methodology are stated below:


Formulating the research question

A well-focused question was formulated and acted as a critical step for facilitating clinical research. There were several general and patient-oriented questions that arose from clinical issues. However, this study aimed to investigate the potential challenges that are faced by healthcare managers and pharmacy professionals in real-time hospital settings. While formulating a research question, the FINER criteria was considered (F-Feasible, I-Interesting, N-Novel, E-Ethical and R-Relevant). The idea was interesting and relevant to clinical research. It would have helped in adding information to already completed research work (Cook & West, 2012).

A PICO framework was used to develop the research question. It helped to focus on the exact information that was needed (Cooke, Smith & Booth, 2012). The study population, intervention or indicator, comparison or benchmark and the primary outcome of the anticipated results were used for framing the question. In this particular case scenario:

Population (P)

Intervention (I)

Comparison (C)

Outcome (O)

Graduate pharmacy professionals; healthcare managers; managers in hospitals

Healthcare service challenges; Barriers in hospital settings

Opportunities in hospital settings

Effect of challenges in hospitals; preventing of barriers in healthcare settings

The electronic databases used for the literature search were Medline, CINAHL and SCOPUS. The research question was translated into keywords. This increased the chance of retrieving valuable information from the search strategy. Synonyms and alternate terms were considered for eliciting further information, such as, opposition or difficulties in place of challenges, and pharmacists in place of pharmacy professionals. The spellings were also taken into account. A word-stock is used by most databases to establish common keywords or search-terms. Some of the alternative keywords were searched from database thesaurus. Another strategy used to refine the search of relevant literature was the combination of the keywords with Boolean operators. ‘AND’ and ‘OR’ are the three Boolean operators that were used.

Combining two key terms using ‘AND’ fetched articles that mentioned both the words, such as, healthcare managers AND opposition. Using ‘OR’ widened the search and helped to fetch more articles that mentioned either of the terms, such as healthcare managers OR pharmacists AND opposition (Jukna & Sergeev, 2013). Filters were also used to refine the search. Articles that were similar to the research topic were found and specific terms were looked for in them to use for the search. Using the abovementioned three databases provided full-text articles and reduced time for manual searching of articles. The most recent issues of journals were first searched. Articles that were peer reviewed and published in English, not prior to 2012 were selected from the databases. Articles that contained only abstracts and had a publishing date before 2012 were excluded from the literature review. A follow-up was done on the references present at the end of each article to examine more related sources.  The authenticity and quality of the selected articles were also checked to determine whether they represented systematic research (Grewal, Kataria & Dhawan, 2016).


Relevance of the topic

The topic selected for this study intersects with management and healthcare. Health care managers are entrusted with the responsibility of overseeing the business aspects such as operations and finances of a health care organization. Their primary responsibility is to ensure that all patients admitted to the hospital or healthcare centre receive high quality care. This can be only achieved by providing all necessary resources and tools that help nurses and physicians to deliver great health care (Sanii et al., 2016). Their duties also require them to ensure that the healthcare organization is operationally and financially sound, the personnel issues are managed well and the community members are taught properly on the different health issues. Thus, they play an essential role in reducing hospitalization costs while maintaining patient satisfaction. Pharmacy professionals are also involved in dispensing medications and monitoring the health and progress of patients by optimizing their response to medication interventions. The patients are educated on proper use of prescriptions and are provided holistic based care in institutional settings (Tripathi et al., 2014).

Thus, if these healthcare managers and pharmacists face challenges while carrying out their duties in a hospital setting, the overall health of the patient will deteriorate. There will be a delay in cure of the disease and elimination of symptoms, which in turn will create adverse health outcomes. Thus, the research question for this study is of extreme importance to managing patient health as identification of the key barriers or challenges on performing a literature search would assist healthcare practitioners to work towards improving the flaws, minimizing risks and maintaining overall patient health.

Primary sources basically provide information that is closely related to the research topic. However, it was difficult to collect such data from interviews, surveys or questionnaires due to low sample size in the population. Therefore, secondary sources that included academic journals, books, e-journals and websites were used to gather extensive information on the challenges and barriers encountered by pharmacists and healthcare managers.  The journals had a greater validity and authenticity than websites. They provided up-to-date information on the specific topic that formed the research question. The authenticity of the information presented in the websites was checked before using them.


Findings and Discussion

All the findings from the secondary data sources that were used for the research study suggested that pharmacy professionals and healthcare managers are involved in ensuring that a particular healthcare organization will provide direct care to the patients with the aim of improving their outcome (Oishi & Murtagh, 2014). Pharmacy graduates often face transition of care that involves continuity and coordination of healthcare when patients are transferred between different settings (Gradel et al., 2016). The findings suggested that such transition in large hospital settings leads to the occurrence of frequent medication errors. These errors can be accounted for the several challenges that are faced by the professionals in the form of inadequate patient education, miscommunication, and missed patient follow-up, lack of access to computerized data entry methods and absence of patient involvement in management of medication (Oshima Lee & Emanuel, 2013).

Such challenges lead to inconsistent care coordination and contribute to patient admission. Thus, it can be deduced from the findings that keeping the patients central to the focus of care, enhancing inter-professional communication and collaboration and evaluating the outcomes of healthcare manager and pharmacist involvement can counterchallenge the situation (Sassoli & Day, 2017). The reasons that contribute to low success rates of the pharmacy professionals and healthcare managers need to be improved in the form of promoting medication therapy management, medical reconciliation, and patient education. Minimum collaboration between the hospitals and the pharmacists and healthcare managers worsen the situation. An improvement in the hospital management will lead to financial justification that would bring more investment in pharmacist resources (Schadewaldt et al., 2014).

Healthcare managers and pharmacists should involve patients in the decision-making process and should initiate conversation with them to ascertain their health literacy, attitudes, goals and preferences (Miller et al., 2014). An effective collaboration will also facilitate patient-centred care. Hospital pharmacists and healthcare managers can provide patients with reconciled medication lists that often help in eliminating the challenges faced by them (Burgess & Currie, 2013). Furthermore, although they are entitled with the responsibility of identifying, preventing and correcting medication problems, an effective communication with health care providers can only help them in accomplishing their goals (Birken et al., 2016). Thus, all barriers to communication and efficient patient-centred healthcare delivery should be identified at the earliest and worked upon to promote holistic patient growth and wellbeing.


Thus, it can be concluded from the research study that the job of a pharmacist and healthcare manager is undoubtedly difficult and demanding. With the increase in competition among hospital settings and health expenses, the executives are expected to prepare themselves for effectively leading the healthcare centre during a transformational change in the system. They must overcome the key challenges that arise in such settings in order to successfully maintain fiscal responsibility and improve patient care. The pharmacy professionals and managers should put a plan in proper place to address shortage of hospital staff and competition among employees. Enhancing the skills of hiring, recruiting, and retaining qualified healthcare professionals would also help them in meeting the challenges. There is a need to build strong interprofessional relationships with institutes that offer degrees in pharmacy and healthcare administration and the local hospital settings. Additionally, collaborative work to make the hospitals attractive, thinking beyond competitive benefits and pay and will also ensure that all individual employees feel connected to the hospital and exhibit a passion for working towards improvement of the organization.

In order to compete for patients, the healthcare managers should be prepared for setting the hospitals apart by formulating specialized care strategy. They must investigate other specialty healthcare services in the region and identify the areas of opportunity.  Technology also acts as a major barrier. Electronic medical record systems are now being used to seamlessly share patient information. The pharmacists and healthcare managers must ensure effective implementation of EMRs within the healthcare organization. They need to develop IT skills to make evidence-based decisions while integrating technological information. This will largely abolish the prevalence of the key challenges and will improve organizational and patient outcomes.

Thus, it can be concluded that pharmacists and healthcare managers are responsible for ensuring that the hospitals operate efficiently. They also work towards providing quality medical care to their patients. Thus, they should keep up with the advances in technology and medicine to accomplish their goals.



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