Community Pharmacy Staff's Knowledge, Educational Needs, and Barriers Related to Counseling Cancer Patients and Cancer Survivors in Denmark

OBJECTIVE

The study aimed to determine Danish community pharmacy staff's knowledge, educational needs, and barriers when communicating with cancer patients/survivors. Furthermore, the study investigated whether pharmacy staff was interested in participating in education about cancer.

METHODS

A cross-sectional questionnaire survey was conducted among community pharmacy staff (pharmacists and pharmaconomists) in Denmark. Descriptive and bivariate (t-test and chi-square) statistics were used to analyze the data.

RESULTS

In total, 134 staff members responded to the questionnaire. Their self-reported knowledge of cancer-related topics was between 'very little knowledge' and 'some knowledge'. The most well-known topics concerned risk factors for cancer and side effects from cancer treatments. The importance of learning more about the same topics was rated between 'important' and 'very important'. The largest barriers identified in counseling cancer patients/survivors were a lack of knowledge about cancer, a focus on healthcare problems other than cancer, and a traditional view of community pharmacies as a place to pick up medication. Pharmacy staff expressed interest in participating in educational programs about cancer treatment (91.0%), communication with cancer patients (88.1%), and late effects of cancer (93.3%).

CONCLUSION

Community pharmacy staff show interest in participating in education regarding cancer, but need more knowledge to properly counsel cancer patients and survivors at the community pharmacies. This important barrier should be addressed in future educational programs for community pharmacy staff.

Improving and Expanding Research on Burnout and Stress in the Academy

Objective. To conduct an integrative review of existing literature evaluating burnout and stress to identify reliable, valid, psychometrically sound survey instruments that are frequently used in published studies and to provide best practices in conducting burnout and stress research within academic pharmacy.Findings. We reviewed 491 articles and found 11 validated reliable surveys to be most frequently cited in the literature that can be used in future burnout and stress research. We also noted frequent misunderstandings and misuse of burnout and stress terminology along with inappropriate measurement. Additionally, we identified a variety of useful websites during the review. Lastly, we identified a relative dearth of published research evaluating organizational solutions to burnout and stress beyond personal factors, ie, resilience.Summary. Burnout and stress among student pharmacists, faculty, and staff is an important research area that necessitates more robust, rigorous evaluation using validated reliable surveys with appropriate contextualization within psychological frameworks and theory. Future research evaluating organizational-level attempts to remedy sources of burnout and stress is also needed.

ANALYSIS OF THE WORLD'S BEST PRACTICES IN TRAINING PHARMACISTS FOR PROVIDING MENTAL HEALTH CARE TO PATIENTS

The article analyzes and systematizes international documents and research results, which reveal the experience of implementing the best practices in mental health into the educational process of training pharmacists at various levels of education. Available foreign educational programs were analyzed in terms of their form and content. According to the results of the research, it was found out that the practice of professional training of pharmacists on mental health issues is quite widespread at the world level and is presented in various scientific publications. The results of their analysis also indicate different forms of training process organization.

Pharmacists' Medication Counseling Practices and Knowledge and Satisfaction of Patients With an Outpatient Hospital Pharmacy Service

The degree of communication between patients and pharmacists has a significant impact on the process of medication counseling. The purpose of this study was to evaluate pharmacists' practices of medication counseling and to assess patients' knowledge of medications and satisfaction with pharmacy services at Woldia Comprehensive Specialised Hospital (WCSH). A cross-sectional study involving 23 pharmacists and 339 patients was carried out between February and May 2022 at WCSH. A self-administered structured questionnaire was used to assess the medication counseling activities of pharmacists, whereas interview-based questionnaires were used to evaluate patients' knowledge of the drugs prescribed to them and their level of satisfaction with outpatient hospital pharmacy services. The Statistical Package for Social Sciences (SPSS) Version 25.0 was used to analyze the data. Around two-thirds of pharmacy professionals (73.9%) agreed that they were satisfied with their counseling activities. But a very low number of them always provided counseling regarding the purpose of medications (13%), major drug-drug interactions (26.1%), possible side effects (30.4%), the importance of compliance (30.4%), storage conditions (34.8%), and drug-food interactions (39.1%). Among the 339 patients involved in the study, less than half (46.3%) of them had sufficient knowledge of their dispensed medication at the exit interview. Only nearly half of the patients (54.3%) agreed that they were satisfied with the pharmacy service. Despite the fact that a significant proportion of the pharmacy professionals agreed that they were satisfied with their counseling practices, their level of involvement in major counseling activities was limited, which impacted the knowledge of patients about their medication and patients' satisfaction with pharmacy services. This might be because of potential barriers in terms of workload and lack of resources. The findings may indicate that pharmacy services need to improve through identifying potential gaps and tackling barriers.

Mental health training programs for community pharmacists, pharmacy staff and students: A systematic review

BACKGROUND

Primary care is often the first point of contact for people living with mental disorders. Community pharmacists, pharmacy staff and students are increasingly being trained to deliver mental health care. However, there is still a gap in the literature exploring the characteristics of all available mental health training programs and their components and their influence on pharmacists, pharmacy staff and students' outcomes.

OBJECTIVES

To summarize the evidence evaluating mental health training programs completed by community pharmacists, pharmacy staff and students. More specifically, to explore the components of mental health training programs and identify those that facilitate significant improvements in outcomes.

METHODS

A systematic review was conducted following the Cochrane handbook and reported according to PRISMA guidelines. A search for published literature was conducted in three databases (PubMed, Scopus, and Web of Science) in July 2021. Eligible studies were included if they described and evaluated the impact of mental health training programs delivered to community pharmacists, pharmacy staff and pharmacy students regardless of design or comparator. The methodological quality of included studies was appraised using both the NIH quality assessment, to evaluate studies with an uncontrolled pre-post design, and the Cochrane EPOC risk of bias assessment, to evaluate studies with a controlled (randomized and non-randomized) study design.

RESULTS

Thirty-three studies were included. Most of the identified mental health training programs contained knowledge-based components and active learning activities. Changes in participants' attitudes, stigma, knowledge, confidence and skills were frequently assessed. An extensive range of self-assessment and observational instruments used to evaluate the impact of the training programs were identified. Positive improvements in participants' attitudes, knowledge and stigma were frequently identified following participation in training programs.

CONCLUSIONS

This systematic review highlights the importance of mental health training programs in increasing pharmacists', pharmacy staff and pharmacy students' skills and confidence to deliver mental health care in community pharmacy. Future research should build upon this basis and further focus on finding the most efficient measures to evaluate these training programs and assess their long-term effectiveness, allowing comparison between programs.

The Role of Educators in Supporting the Mental Well-being of Postgraduate Pharmacist Distance Learners

Frontline health care professionals have experienced rapid changes to workloads and work-related pressures during the COVID-19 pandemic, resulting in anxiety, depression, and mental health stressors. For working professionals engaged in postgraduate pharmacy distance learning, access to educators was seen as a means to relay some of these stories and offload the stress caused by these unprecedented circumstances. The postgraduate pharmacy education team at De Montfort University felt a moral responsibility to provide extra support and extended their roles toward offering greater well-being support. In this commentary, we detail the emergence of this new role and offer insights into how this was fashioned and its significance for catering to the mental health needs of pharmacists. This role has largely gone undetected, and research is needed to investigate the acceptability and feasibility of such a model and its plausibility and sustainability in the long-term.

Clinical reasoning by pharmacists: A scoping review

BACKGROUND

Clinical reasoning is considered a core competency for pharmacists, but there is a lack of conceptual clarity that complicates teaching and assessment. This scoping review was conducted to identify, map, and examine evidence on used cognitive processes and their conceptualization of clinical reasoning by pharmacists.

METHODS

In March 2021, seven databases were searched for relevant primary research studies. Included were studies that examined cognitive processes in pharmacists while addressing a clinical scenario in a pharmacy-related setting. Using descriptive analysis, study characteristics, conceptualizations, operationalizations, and key findings were mapped, summarized, and examined. Results were reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

RESULTS

From 2252 abstracts, 17 studies were included that examined clinical reasoning in the context of forming a diagnosis (n = 9) or determining medication appropriateness (n = 4). Most studies conceptualized clinical reasoning as a context-dependent cognitive process whereby pharmacists apply and integrate knowledge and clinical experience to interpret available clinical data. Different terms labelled pharmacists' reasoning that showed analytical and intuitive approaches to clinical scenarios, either separately or combined. Medication review studies reported a predominance of analytical reasoning. The majority of diagnosis-forming studies in primary care identified no distinct cognitive reasoning pattern when addressing self-care scenarios.

IMPLICATIONS

This overview reflects a small but growing body of research on clinical reasoning by pharmacists. It is recommended that this competence be taught by explicating and reflecting on clinical reasoning as separate stage of the clinical decision-making process with transparent cognitive processes.

Knowledge, Attitude, and Practices (KAPs) of Community Pharmacists Regarding COVID-19: A Cross-Sectional Survey in 2 Provinces of Pakistan

OBJECTIVE

The 2019 coronavirus disease (COVID-19) is a global pandemic with no therapy, and pharmacists being a part of the health care system have a vital role in the management of COVID-19. The purpose of this study is to assess the knowledge, attitude, and practices of community pharmacists (CPs) regarding COVID-19.

METHOD

An online survey was conducted among 393 CPs in 2 provinces of Pakistan during the lockdown period. A validated questionnaire (Cronbach's alpha, 0.745) was used for data collection. All statistical analyses were analyzed by using SPSS, version 21 (IBM Corp, Armonk, NY).

RESULTS

Among 393 participants, 71.5% (n = 281) had good knowledge, 44% (n = 175) had a positive attitude, and 57.3% (n = 225) had good practices regarding COVID-19. Social media (45.29%, n = 178) were reported as the main source to seek information of COVID-19. Good knowledge, age ≥ 26 years, and a PhD degree level were the substantial determinants (P = < 0.05) of a good attitude. Similarly, a CP with experience of > 5 years, a PhD degree, good knowledge, and a good attitude has higher odds of having good practices as compared with reference categories (P = < 0.05).

CONCLUSION

In short, a majority of the CPs had good knowledge but had a poor attitude and practice toward the management of COVID-19. Standard-structured educational and counseling programs for CPs regarding COVID-19 are needed for effective management.

Emotional Burden among Pharmacists and Pharmacy Technicians during the COVID-19 Lockdown: A Cross Sectional Study

This study aims to investigate the prevalence of depression and anxiety symptoms among Spanish community pharmacists and pharmacy technicians during the coronavirus disease 2019 (COVID-19) lockdown. A descriptive cross-sectional quantitative study was designed. An online survey was administered to participants from 4 to 21 April 2020 using a questionnaire assessing sociodemographic information and the Spanish version of the Hospital Anxiety and Depression Scale (HADS). Informed consent to participate was requested. Participants comprised 1162 pharmacy staff from Spain with an average age of 39.15 ± 9.718, from 20 to 65 years old, of whom 83% were women, and 50.6% were married. More than half of the participants expressed symptoms of depression (62.7%) and anxiety (70.9%). An important prevalence of anxiety and depression symptoms has been detected among Spanish pharmacists and pharmacy technicians during the COVID-19 lockdown. Being a woman, smoking, feeling fear, feeling stress and believing that pharmacists/pharmacy technicians are very exposed to COVID-19 seem to be associated with higher HADS scores.

Pharmacists' Knowledge, and Insights in Implementing Pharmacogenomics in Saudi Arabia

BACKGROUND

Pharmacogenomics (PGx) and personalized medicine embrace the potential to optimize drug treatment and improve the patient's quality of life. Pharmacists' roles include contributing to genetic testing, patient counseling, and pharmacotherapies selection for superior treatment outcomes. The aim of this study is to assess the pharmacists' knowledge, insight, and self-confidence toward PGx testing, identify their future preferred education patterns, and determine the barriers to pharmacogenomic testing implementation.

METHOD

A cross-sectional study was conducted using a previously validated questionnaire among pharmacists working in the Kingdom of Saudi Arabia (KSA). The questionnaire was designed in seven major categories, consisting of 26 questions.

RESULTS

A total of 671 pharmacists participated in this survey. As for knowledge, only 29.8% of pharmacists had good knowledge regarding PGx, while 42.9% had poor knowledge levels. Respectable PGx knowledge was significantly higher among outpatient dispensing pharmacists (33.6%; p = 0.049) and among pharmacists who had completed PGx testing-related training or education (40.3%; p = 0.001). Considering perception, it was positive among 50% of pharmacists and negative among 19.8%. With regard to self-confidence, it was high among 39.2% of male pharmacists (p = 0.042), among 43% of clinical pharmacists (p = 0.006), and among 44.8% of pharmacists who had extra credentials (p = 0.001). The utmost favored continuing-education learning approaches were workshops or seminars. The barriers to the implementation of PGx testing included a lack of testing devices, clinical guidelines, training or education, and personnel.

CONCLUSION

The present study revealed that pharmacists in KSA had inadequate knowledge and understanding of PGx. Nevertheless, the majority established that PGx is a valuable tool for augmenting drug efficacy and safety.

Opinions on hypertension care and therapy adherence at the healthcare provider and healthcare system level: a qualitative study in the Hague, Netherlands

OBJECTIVES

Hypertension is a common cause of cardiovascular morbidity and mortality. Although hypertension can be effectively controlled by blood pressure-lowering drugs, uncontrolled blood pressure is common despite use of these medications. One explanation is therapy non-adherence. Therapy non-adherence can be addressed at the individual level, the level of the healthcare provider and at the healthcare system level. Since the latter two levels are often overlooked, we wished to explore facilitators and barriers on each of these levels in relation to hypertension care for people with hypertension, with a specific focus on therapy adherence.

DESIGN

Qualitative study using focus groups of healthcare providers. Data were analysed using the theoretical domains framework (TDF) and the behaviour change wheel.

SETTING AND PARTICIPANTS

Participants were from a highly urbanised city environment (the Hague, Netherlands), and included nine primary care physicians, six practice nurses and five secondary care physicians involved in hypertension care.

RESULTS

Nine domains on the TDF were found to be relevant at the healthcare provider level ('knowledge', 'physical, cognitive and interpersonal skills', 'memory, attention and decision processes', 'professional, social role and identity', 'optimism', 'beliefs about consequences', 'intention', 'emotion' and 'social influences') and two domains ('resources' and 'goals') were found to be relevant at the system level. Facilitators for these domains were good interpersonal skills, paying attention to behavioural factors such as medication use, and the belief that treatment improves health outcomes. Barriers were related to time, interdisciplinary collaboration, technical and financial issues, availability of blood pressure devices and education of people with hypertension.

CONCLUSIONS

This study highlighted a need for better collaboration between primary and secondary care, for more team-based care including pharmacists and social workers, tools to improve interpersonal skills and more time for patient-healthcare provider communication.

Implementation and evaluation of social determinants of health practice models within community pharmacy

BACKGROUND

While community pharmacies are an ideal setting for social needs screening and referral programs, information on social risk assessment within pharmacy practice is limited.

OBJECTIVES

Our primary objective was to describe 2 social determinant of health (SDOH) practice models implemented within community pharmacies. The secondary objective was to evaluate implementation practices utilizing the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

PRACTICE DESCRIPTION

Two pharmacy groups participated in a 3-month study, one in New York (9 pharmacies) and another in Missouri (1 pharmacy). The New York pharmacies implemented an SDOH specialist practice model, in which pharmacy staff members facilitate the program. The Missouri pharmacy implemented a community health worker (CHW) model by cross training their technicians. Each pharmacy developed their program using the Community Pharmacy Enhanced Services Network Care Model.

PRACTICE INNOVATION

Both programs expanded the technician role to take on additional responsibilities. The SDOH specialist model partnered with a local independent practice association to create a social needs referral program using a technology platform for closed-loop communication. All workflow steps of the self-contained CHW program were completed within the pharmacy, placing additional responsibility on the CHW and pharmacy staff.

EVALUATION METHODS

RE-AIM framework dimensions of Reach, Effectiveness, and Adoption.

RESULTS

Social challenges were identified in 49 of 76 (65%) generated SDOH screenings. The most prevalent social needs reported were affordability of daily needs (33%) and health care system navigation (15%). While most pharmacy staff indicated that workflow steps were clearly defined, assessments and referral tools were identified as potential gaps. While approximately 50% of pharmacy staff were comfortable with their assigned roles and in addressing SDOH challenges, physical and mental health concerns required additional education for intervention.

CONCLUSION

The successful implementation of community pharmacy SDOH programs connected patients with local resources. Community pharmacies are ideally positioned to expand their public health footprint through SDOH interactions that consequently improve patient care.

Investigating pharmacy students' therapeutic decision-making with respect to antimicrobial stewardship cases

BACKGROUND

Antimicrobial stewardship programs (ASPs) play a big role in minimizing antimicrobial resistance. Pharmacists are essential members of the health care team and in order for them to fulfill roles on ASP teams and become antimicrobial stewards, they must be prepared adequately by pharmacy schools prior to entry into actual practice. Although programming has been implemented into entry-to-practice programs worldwide, little is known about how students interpret antimicrobial stewardship (AMS) data and arrive at clinical decisions. We aimed to explore students' cognitive processes and determine how they formulate therapeutic decisions when presented with AMS cases.

METHODS

This was a qualitative study conducted using a case study approach, in which a sample (n=20) of pharmacy students was recruited to interpret AMS cases. Semi-structured 1-on-1 interviews were arranged with each participant. A think-aloud procedure with verbal protocol analysis was adopted to determine students' decision-making processes. Thematic analysis was used to interpret themes from the interview data.

RESULTS

Two themes were interpreted from the data: students' focus and students' approach to case interpretation. Students' focus relates to external factors students consider when interpreting AMS case data and use to make and justify therapeutic decisions including patient-centered factors, drug-related factors, AMS interventions, and pharmacist's role. Students' clinical reasoning describes the approach that students use to interpret the data and the decision-making processes they employ to arrive at a clinical decision including a systematic approach versus non-systematic approach.

CONCLUSIONS

Students vary in their focus and the cognitive strategies used to interpret AMS cases. Findings support the notion that clinical reasoning and decision-making should be explicitly taught in pharmacy curricula, in order to help students become aware of their own cognitive processes and decision-making abilities.

The development of a taxonomy to support goal setting between mental health consumers and community pharmacists

BACKGROUND

Goal setting is widely used in mental healthcare, yet there is limited information about goal development between community pharmacists and people experiencing mental health conditions.

OBJECTIVES

i) To review goals developed in partnership between Australian community pharmacists and people experiencing depression/anxiety, and ii) categorize goals and develop a taxonomy.

METHODS

Community pharmacists (n = 142) who had completed a mental health training program provided an individualized medication support service and documented goal planning for 350 people experiencing anxiety and/or depression. Goals were reviewed using a general inductive content analysis to develop themes which were then grouped, categorized, and coded. This involved three researchers in different phases of the coding, repeated review and redrafting of the taxonomy, and inter-rater reliability consistency checks.

RESULTS

The goals (n = 749) represented a diverse range of health behaviors and outcomes (e.g., medication adherence, relationships, leisure activities). The resulting taxonomy involved five overarching domains: improved health; satisfaction with life; manage physical illnesses; manage mental health; and use of medicines.

CONCLUSIONS

Pharmacists have a role in providing person-centered care and addressing social determinants of health by considering factors that contribute to a person's overall wellbeing. While further testing is necessary, the taxonomy is valuable for pharmacists unfamiliar with supporting goal development with people experiencing anxiety and/or depression.

A report on pharmacists with the NCMP credential

OBJECTIVE

To characterize the demographics and practices of pharmacists with The North American Menopause Society Certified Menopause Practitioner (NCMP) credential.

METHODS

A cross-sectional electronic survey was disseminated to pharmacists with the NCMP credential in June 2018. Twenty-four items were posed to respondents regarding demographics, educational background, and employment, in addition to perspectives regarding the utility of the credential in practice. The questions consisted of multiple choice, as well as open-ended responses.

RESULTS

Of the 40 pharmacists who were invited to participate, 26 (65%) responded. The majority of respondents were women (84%), practicing for at least 10 years (range 5-47 y), based in Canada (70%), and practicing in the community (43%) or compounding (39%) pharmacies. Most pharmacists reported pursuing the credential for credibility with patients (81%), to increase their knowledge about menopause (77%), and for credibility with other healthcare providers (73%). Almost all (88%) plan to renew their credential. Among these pharmacists, many are presently counseling about treatment options (78%) and educating about selected treatment (78%). Pharmacists are most interested in initiating systemic hormonal therapy (61%) and modifying or continuing systemic hormonal therapy (57%).

CONCLUSIONS

Pharmacists find the NCMP credential to be valuable. Although pharmacists are engaged in counseling and recommendations, they desire prescriptive authority related to menopause care. Future studies should explore the various pharmacist care models and evaluate the impact of pharmacist care on organizational operations and patient outcomes.

Assessment of an intensive education program for pharmacists on treatment of tobacco use disorder using an objective structured clinical examination: a randomized controlled trial

BACKGROUND

Tobacco use is one of the major public health threats globally. Community pharmacists are uniquely positioned to offer tobacco cessation services owing to their easy accessibility by the public. To prepare Qatar community pharmacists to develop the competencies and skills required to offer smoking cessation services, an intensive tobacco control education program was designed and implemented. The study aimed to assess the impact of the tobacco education program on the pharmacists' skills and competence.

METHODS

A random sample of community pharmacists in Qatar was chosen for participation in the program. Consenting participants were randomly assigned to either intervention or control groups. The intervention group received an intensive education program on treatment of tobacco-use disorder, while a short didactic session on a non-tobacco-related topic was delivered to the control group. The pharmacists' tobacco cessation skills and competencies were assessed using an Objective Structured Clinical Examination (OSCE).

RESULTS

A total of 54 and 32 community pharmacists in the intervention group and the control group, respectively, completed the OSCE. The intensive tobacco education group achieved significantly higher total scores than the control group in all the OSCE cases. Specifically, the mean total scores for the intervention group were 15.2, 15.3, 14.2, 14.6, 16.3, and 15.2 compared to 8.8, 6.2, 7.7, 9.2, 8.3, and 11.3 for the control group (p < 0.001) for cases one to six respectively.

CONCLUSION

The study demonstrated that an intensive tobacco cessation education program can improve pharmacists' tobacco cessation skills and increase their tobacco cessation counseling abilities.

TRIAL REGISTRATION

Clinical Trials NCT03518476 ( https://clinicaltrials.gov/ct2/show/NCT03518476 ) Registration date: May 8, 2018.

Engaging consumers in wise use of over-the-counter medications in Taiwan: Development and evaluation of a structured medication counseling approach

OBJECTIVE

To evaluate the impact of a tailored Symptom Allergy Indication Direction Self-care (SAIDS) counseling by pharmacists on consumers' correct understanding of over-the-counter (OTC) medication use.

METHODS

This study used a time-based sampling of two independent cohorts at a single community pharmacy in Taiwan for two years beginning in December 2018. In the control cohort, participants received conventional counseling for the OTCs they selected. In the intervention cohort, participants received SAIDS counseling along with pointing out OTC package label instructions. A paper-and-pencil survey was administered face-to-face to evaluate participants' understanding for the correct use of OTCs. Descriptive statistics and chi-square tests were used to evaluate the effect of the SAIDS approach on cohorts' understanding of OTC use.

RESULTS

Compared with conventional OTC counseling, participants reported better understanding regarding potential side effects of OTCs that they acquired (p < 0.001) and were more aware of strategies to cope with the associated side effects (p < 0.001).

CONCLUSIONS AND PRACTICE IMPLICATIONS

Despite the time constraints that pharmacists often can offer to each customer, the SAIDS counseling approach may refine the structure and effectiveness of pharmacists' OTC counseling skills and thereby improve consumers' understanding of their ailments and self-care medications in Taiwan.

Antimicrobial stewardship: Attitudes and practices of healthcare providers in selected health facilities in Uganda

Though antimicrobial stewardship (AMS) programmes are the cornerstone of Uganda’s national action plan (NAP) on antimicrobial resistance, there is limited evidence on AMS attitude and practices among healthcare providers in health facilities in Uganda. We determined healthcare providers’ AMS attitudes, practices, and associated factors in selected health facilities in Uganda. We conducted a cross-sectional study among nurses, clinical officers, pharmacy technicians, medical officers, pharmacists, and medical specialists in 32 selected health facilities in Uganda. Data were collected once from each healthcare provider in the period from October 2019 to February 2020. Data were collected using an interview-administered questionnaire. AMS attitude and practice were analysed using descriptive statistics, where scores of AMS attitude and practices for healthcare providers were classified into high, fair, and low using a modified Blooms categorisation. Associations of AMS attitude and practice scores were determined using ordinal logistic regression. This study reported estimates of AMS attitude and practices, and odds ratios with 95% confidence intervals were reported. We adjusted for clustering at the health facility level using clustered robust standard errors. A total of 582 healthcare providers in 32 healthcare facilities were recruited into the study. More than half of the respondents (58%,340/582) had a high AMS attitude. Being a female (aOR: 0.66, 95% CI: 0.47–0.92, P < 0.016), having a bachelor’s degree (aOR: 1.81, 95% CI: 1.24–2.63, P < 0.002) or master’s (aOR: 2.06, 95% CI: 1.13–3.75, P < 0.018) were significant predictors of high AMS attitude. Most (46%, 261/582) healthcare providers had fair AMS practices. Healthcare providers in the western region’s health facilities were less likely to have a high AMS practice (aOR: 0.52, 95% CI 0.34–0.79, P < 0.002). In this study, most healthcare providers in health facilities had a high AMS attitude and fair AMS practice.

Study protocol: Effectiveness of patient centered pharmacist care in improving medication adherence, clinical parameters and quality of life among hemodialysis patients

BACKGROUND

Patients requiring hemodialysis (HD) often have several chronic comorbidities, which necessitate the use of several medications and hence put them at high risk of polypharmacy. Medication-related problems (MRPs) among HD patients are a serious issue as they can increase morbidity and nonadherence with medications. To overcome this issue, a unique pharmacy practice model including medication review (MR) and motivational interviewing (MI) is needed to improve medication adherence, by reducing MRPs and optimizing therapeutic outcomes. The present study aims to assess the effectiveness of MR and MI in improving medication adherence, quality of life (QOL) and clinical outcomes among end-stage renal disease (ESRD) patients who are on dialysis.

METHOD AND DESIGN

This pre-post study will be conducted prospectively among patients with ESRD who have been on dialysis at the Hemodialysis Unit, Hospital Kuala Lumpur and the Hemodialysis Affiliated Centers of the University Malaya Medical Centre, from August 2020 till August 2021. Medication adherence will be assessed using the General Medication Adherence Scale (GMAS), whilst patients' HRQOL will be assessed using the Kidney Disease Quality of Life Short Form 36 (KDQOL-36). Clinical parameters such as blood glucose level, calcium, phosphate, hemoglobin and serum low-density lipoprotein (LDL) levels will be obtained from medical records. A total of 70 patients will be recruited.

DISCUSSION

We hypothesize that the implementation of pharmacy-based MR and MI may expect an increase in medication adherence scores and increase in HRQOL scores from baseline as well as achieving the clinical lab parameters within the desired range. This would indicate a need for a pharmacist to be involved in the multidisciplinary team to achieve a positive impact on medication adherence among hemodialysis patients.

TRIAL REGISTRATION

Ethical approval has been obtained from the National Medical Research and Ethics Committee NMRR: 20-1135-54435 and Medical Research Ethics Committee, University Malaya Medical Centre MREC ID NO: 202127-9811.

An exploratory survey on community pharmacists’ service provision for pregnant and lactating women in Sharjah, United Arab Emirates

Over-the-counter (OTC) medications are generally deemed safe to be used during pregnancy and lactation. However, some products can be harmful to the mother, fetus or breast-fed child, which presents a challenge to health professionals and consumers. This study was aimed at assessing the practice of OTC medication dispensing and counseling services provided to pregnant and lactating by community pharmacists (CPs). A cross-sectional descriptive questionnaire-based survey was answered during February—November 2020, by licensed CPs practicing in Sharjah, United Arab Emirates. The determination of the significant factors associated with the CPs’ views and OTC medication dispensing during pregnancy and breastfeeding was carried out using logistic regression. Among 256 respondents, dispensing medicines and referral to a physician were the predominant services provided to pregnant and lactating women. Respondents dispensed medications mostly to treat headache (74.2%), fever (62.5%) in pregnant women, and headache (81.3%) and fever (65.2%) in lactating mothers. Referral to a physician was common in pregnant women in the following cases: varicose veins (72.7%), swelling of the feet and legs (71.9%), and vaginal itching (53.9%). In breastfeeding women, the referrals were commonly for varicose veins (79.7%), swelling of the feet and legs (73.0%) and mastitis (70.3%). Most participants came to an agreement that CPs are capable of counselling and providing pregnant and lactating women the best OTC treatment. Around 35% of the respondents stated that OTC medicines are not safe to be used during pregnancy. One in five respondents stated that OTC medicines are not safe for breastfeeding women. CPs were confident to counsel and provide advice to pregnant and breastfeeding women to address medication and health problems. Proper utilization of CPs can contribute largely to the healthcare system in managing common minor ailments in pregnant and lactating women, reducing the need to visit the physician and enhancing patient safety.

Development of a Metric to Detect and Decrease Low-Value Prescribing in Older Adults

IMPORTANCE

Metrics that detect low-value care in common forms of health care data, such as administrative claims or electronic health records, primarily focus on tests and procedures but not on medications, representing a major gap in the ability to systematically measure low-value prescribing.

OBJECTIVE

To develop a scalable and broadly applicable metric that contains a set of quality indicators (EVOLV-Rx) for use in health care data to detect and reduce low-value prescribing among older adults and that is informed by diverse stakeholders' perspectives.

DESIGN, SETTING, AND PARTICIPANTS

This qualitative study used an online modified-Delphi method to convene an expert panel of 15 physicians and pharmacists. This panel, comprising clinicians, health system leaders, and researchers, was tasked with rating and discussing candidate low-value prescribing practices that were derived from medication safety criteria; peer-reviewed literature; and qualitative studies of patient, caregiver, and physician perspectives. The RAND ExpertLens online platform was used to conduct the activities of the panel. The panelists were engaged for 3 rounds between January 1 and March 31, 2021.

MAIN OUTCOMES AND MEASURES

Panelists used a 9-point Likert scale to rate and then discuss the scientific validity and clinical usefulness of the criteria to detect low-value prescribing practices. Candidate low-value prescribing practices were rated as follows: 1 to 3, indicating low validity or usefulness; 3.5 to 6, uncertain validity or usefulness; and 6.5 to 9, high validity or usefulness. Agreement among panelists and the degree of scientific validity and clinical usefulness were assessed using the RAND/UCLA (University of California, Los Angeles) Appropriateness Method.

RESULTS

Of the 527 low-value prescribing recommendations identified, 27 discrete candidate low-value prescribing practices were considered for inclusion in EVOLV-Rx. After round 1, 18 candidate practices were rated by the panel as having high scientific validity and clinical usefulness (scores of ≥6.5). After round 2 panel deliberations, the criteria to detect 19 candidate practices were revised. After round 3, 18 candidate practices met the inclusion criteria, receiving final median scores of 6.5 or higher for both scientific validity and clinical usefulness. Of those practices that were not included in the final version of EVOLV-Rx, 3 received high scientific validity (scores ≥6.5) but uncertain clinical usefulness (scores <6.5) ratings, whereas 6 received uncertain scientific validity rating (scores <6.5).

CONCLUSIONS AND RELEVANCE

This study culminated in the development of EVOLV-Rx and involved a panel of experts who identified the 18 most salient low-value prescribing practices in the care of older adults. Applying EVOLV-Rx may enhance the detection of low-value prescribing practices, reduce polypharmacy, and enable older adults to receive high-value care across the full spectrum of health services.

Predicting dispensing errors in community pharmacies: An application of the Systematic Human Error Reduction and Prediction Approach (SHERPA)

Introduction

The objective of this study was to use a prospective error analysis method to examine the process of dispensing medication in community pharmacy settings and identify remedial solutions to avoid potential errors, categorising them as strong, intermediate, or weak based on an established patient safety action hierarchy tool.

Method

Focus group discussions and non-participant observations were undertaken to develop a Hierarchical Task Analysis (HTA), and subsequent focus group discussions applied the Systematic Human Error Reduction and Prediction Approach (SHERPA) focusing on the task of dispensing medication in community pharmacies. Remedial measures identified through the SHERPA analysis were then categorised as strong, intermediate, or weak based on the Veteran Affairs National Centre for Patient Safety action hierarchy. Non-participant observations were conducted at 3 pharmacies, totalling 12 hours, based in England. Additionally, 7 community pharmacists, with experience ranging from 8 to 38 years, participated in a total of 4 focus groups, each lasting between 57 to 85 minutes, with one focus group discussing the HTA and three applying SHERPA. A HTA was produced consisting of 10 sub-tasks, with further levels of sub-tasks within each of them.

Results

Overall, 88 potential errors were identified, with a total of 35 remedial solutions proposed to avoid these errors in practice. Sixteen (46%) of these remedial measures were categorised as weak, 14 (40%) as intermediate and 5 (14%) as strong according to the Veteran Affairs National Centre for Patient Safety action hierarchy. Sub-tasks with the most potential errors were identified, which included ‘producing medication labels’ and ‘final checking of medicines’. The most common type of error determined from the SHERPA analysis related to omitting a check during the dispensing process which accounted for 19 potential errors.

Discussion

This work applies both HTA and SHERPA for the first time to the task of dispensing medication in community pharmacies, detailing the complexity of the task and highlighting potential errors and remedial measures specific to this task. Future research should examine the effectiveness of the proposed remedial solutions to improve patient safety.

Assessment of Impostor Phenomenon in Student Pharmacists and Faculty at Two Doctor of Pharmacy Programs

Objective. To evaluate the prevalence of impostor phenomenon in student pharmacists and faculty members at two educational institutions in the United States.Methods. Participants anonymously completed an electronic self-report survey instrument that included the validated Clance Impostor Phenomenon Scale (CIPS) from April 2020 to May 2020. Demographic data including age range, gender, and other characteristics were collected. The Clance Impostor Phenomenon Scale scores were reported as means (SDs), and data were compared between institutions and demographic groups using t tests.Results. The overall mean CIPS survey score (N=209, 35.5% response rate) was 63.8 (SD=15.1). The mean student pharmacist CIPS score for Northeast Ohio Medical University (NEOMED) was 64.7 (SD=14.4) vs 63.8 (SD=16.1) for Sullivan University College of Pharmacy and Health Sciences (SUCOPHS), which was statistically similar. Mean faculty CIPS score for NEOMED was 59.2 (SD=14.0) vs 64.7 (SD=16.8) for SUCOPHS, which was statistically similar. Mean CIPS score for the combined student pharmacist group (NEOMED and SUCOPHS) was 64.3 (SD=15.1) vs 61.2 (SD=15.1) for the combined group of faculty members, which was statistically similar. Overall, most respondents fell in the "moderate" to "frequent" CIPS score classification range (36.4% and 44%, respectively).Conclusion. Impostor phenomenon feelings were common among responding student pharmacists and faculty members at the institutions surveyed; however, little is known about the implications of these findings. Future research should seek to elucidate factors predictive of or associated with impostor phenomenon as well as assess the impact of strategies to prevent or manage impostor phenomenon.

'They eat it like sweets': A mixed methods study of antibiotic perceptions and their use among patients, prescribers and pharmacists in a district hospital in Kabul, Afghanistan

BACKGROUND

Antibiotic resistance is a growing public health threat. In Afghanistan, high levels of indiscriminate antibiotic use exist, and healthcare programmes are not informed by understanding of local attitudes towards rational antibiotic use. Médecins Sans Frontières is an international non-governmental organization providing healthcare services to the Ahmad Shah Baba (ASB) District Hospital in Kabul, Afghanistan, since 2009. This mixed-methods study aimed to explore the perceptions and attitudes toward antibiotics among patients, prescribers, and pharmacists in the ASB District hospital outpatient department.

METHODS AND FINDINGS

Knowledge of antibiotics including their purpose and function, how and why they are used, and drivers for choice of antibiotic was examined at patient, prescriber, and provider-level. The first phase of the study, an exploratory qualitative component using an interpretative approach, was used to inform the second phase, a structured survey. Thirty-six interviews were conducted with 39 participants (21 patients or caretakers and 18 hospital health workers). Three hundred and fifty-one (351) patients and caretakers completed the second phase, the structured survey. This study found that poor knowledge of antibiotics and antibiotic resistance is a driving factor for inappropriate use of antibiotics. Participant perceptions of living in a polluted environment drove the high demand and perceived 'need' for antibiotics: patients, doctors and pharmacists alike consider dirty and dusty living conditions as causes of 'disease' in the body, requiring antibiotics to 'clean' and 'strengthen' it.

CONCLUSIONS

Findings highlight the need for strategies to improve awareness and knowledge of the general public, improve practice of doctors and pharmacists, regulate antibiotic dispensing in private pharmacies, and implement antibiotic stewardship in hospitals.