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Shrestha S, Gan SH, Paudyal V, KC B, Sapkota S. Current practices, gaps, and opportunities on the role of clinical pharmacists in cancer pain management: Perspectives from Nepal. J Oncol Pharm Pract 2023; 29:2049-2056. [PMID: 37847760 PMCID: PMC10687799 DOI: 10.1177/10781552231205025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/08/2023] [Accepted: 09/10/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham Edgbaston, Birmingham, UK
| | - Bhuvan KC
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Simit Sapkota
- Department of Clinical Oncology, Kathmandu Cancer Center, Tathali, Bhaktapur, Bagmati Province, Nepal
- Department of Clinical Oncology, Civil Service Hospital, Minbhawan, Kathmandu, Bagmati Province, Nepal
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Dee J, Dhuhaibawi N, Hayden JC. A systematic review and pooled prevalence of burnout in pharmacists. Int J Clin Pharm 2023; 45:1027-1036. [PMID: 36446993 PMCID: PMC9707850 DOI: 10.1007/s11096-022-01520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Burnout is an occupational phenomenon caused by ineffectively managed work-related stress. Burnout is common among healthcare professionals and has the capacity to compromise patient care, but is not well characterised in pharmacists. AIM This systematic review aimed to establish the prevalence of burnout among pharmacists, and its associated risk factors. METHOD A systematic search of Embase, PubMed, CINAHL and PsychInfo was carried out. Studies were included using the following eligibility criteria; original research investigating burnout prevalence in pharmacists in patient-facing roles in any jurisdiction, using any validated burnout measurement instrument. No language or date barriers were set. Data were extracted by the first author and accuracy checked by co-authors. A pooled prevalence was estimated, and narrative synthesis provided. RESULTS Burnout prevalence data were extracted from 19 articles involving 11,306 pharmacist participants across eight countries. More than half (51%) of pharmacists were experiencing burnout. Associated risk factors included longer working hours, less professional experience, high patient and prescription volumes, excessive workload and poor work/life balance. The COVID-19 pandemic has negatively impacted pharmacist burnout and resilience. Involvement in education and training and access to burnout management resources were associated with lower rates of burnout, but burnout intervention effectiveness is unknown. CONCLUSION Burnout remains high among pharmacists and may negatively affect the quality of patient care. There is significant heterogeneity pertaining to the definition and assessment of burnout and there remains a need to identify and evaluate effective individual and organisational burnout interventions.
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Affiliation(s)
- Jodie Dee
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Nabaa Dhuhaibawi
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - John C Hayden
- RCSI University of Medicine and Health Sciences, Dublin, Ireland.
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Borthwick M, Barton G, Ioannides CP, Forrest R, Graham-Clarke E, Hanks F, James C, Kean D, Sapsford D, Timmins A, Tomlin M, Warburton J, Bourne RS. Critical care pharmacy workforce: a 2020 re-evaluation of the UK deployment and characteristics. HUMAN RESOURCES FOR HEALTH 2023; 21:28. [PMID: 37004069 PMCID: PMC10064945 DOI: 10.1186/s12960-023-00810-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/18/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Critical care pharmacists improve the quality and efficiency of medication therapy whilst reducing treatment costs where they are available. UK critical care pharmacist deployment was described in 2015, highlighting a deficit in numbers, experience level, and critical care access to pharmacy services over the 7-day week. Since then, national workforce standards have been emphasised, quality indicators published, and service commissioning documents produced, reinforced by care quality assessments. Whether these initiatives have resulted in further development of the UK critical care pharmacy workforce is unknown. This evaluation provides a 2020 status update. METHODS The 2015 electronic data entry tool was updated and circulated for completion by UK critical care pharmacists. The tool captured workforce data disposition as it was just prior to the COVID-19 pandemic, at critical care unit level. MAIN FINDINGS Data were received for 334 critical care units from 203 organisations (96% of UK critical care units). Overall, 98.2% of UK critical care units had specific clinical pharmacist time dedicated to the unit. The median weekday pharmacist input to each level 3 equivalent bed was 0.066 (0.043-0.088) whole time equivalents, a significant increase from the median position in 2015 (+ 0.021, p < 0.0001). Despite this progress, pharmacist availability remains below national minimum standards (0.1/level 3 equivalent bed). Most units (71.9%) had access to prescribing pharmacists. Geographical variation in pharmacist staffing levels were evident, and weekend services remain extremely limited. CONCLUSIONS Availability of clinical pharmacists in UK adult critical care units is improving. However, national standards are not routinely met despite widely publicised quality indicators, commissioning specifications, and assessments. Additional measures are needed to address persistent deficits and realise gains in organisational and patient-level outcomes. These measures must include promotion of cross-professional collaborative working, adjusted funding models, and a nationally recognised training pathway for critical care pharmacists.
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Affiliation(s)
- Mark Borthwick
- Departments of Pharmacy and Critical Care, Oxford University Hospitals NHS Foundation Trust, Oxford, England, United Kingdom.
| | - Greg Barton
- Pharmacy Department, St Helens and Knowsley Teaching Hospitals NHS Trust, England, Prescot, United Kingdom
| | - Christopher P Ioannides
- Pharmacy Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, United Kingdom
| | - Ruth Forrest
- Departments of Pharmacy and Critical Care, NHS Greater Glasgow and Clyde, Glasgow, Scotland, United Kingdom
| | - Emma Graham-Clarke
- Department of Anaesthetics, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, England, United Kingdom
| | - Fraser Hanks
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, London, England, United Kingdom
| | - Christie James
- Pharmacy Department, Aneurin Bevan University Health Board, Cwmbran, Wales, United Kingdom
| | - David Kean
- Pharmacy Department, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - David Sapsford
- Pharmacy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, United Kingdom
| | - Alan Timmins
- Pharmacy Department, NHS Fife, Kirkcaldy, Scotland, United Kingdom
| | - Mark Tomlin
- Pharmacy Department, University Hospital Southampton NHS Foundation Trust, Southampton, England, United Kingdom
| | - John Warburton
- Pharmacy Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England, United Kingdom
| | - Richard S Bourne
- Pharmacy Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, United Kingdom
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Mantzourani E, Deslandes R, Hodson K, Evans A, Taylor L, Lucas C. Community Pharmacists' Views on the Early Stages of Implementation of a National Pilot Independent Prescribing Service in Wales: A Qualitative Study. Integr Pharm Res Pract 2023; 12:11-23. [PMID: 36733975 PMCID: PMC9888007 DOI: 10.2147/iprp.s395322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/23/2022] [Indexed: 01/28/2023]
Abstract
Background A pilot Independent Prescribers' Service (IPS) was introduced in 13 community pharmacies across Wales in June 2020. Independent Pharmacist Prescribers (IPPs) could prescribe in the areas of management of acute conditions, contraception, or opioid withdrawal, as agreed with local commissioners. Access to the patients' medical records was provided via Choose Pharmacy, the national community pharmacy IT platform. Objective To explore the experiences of IPPs delivering the service and commissioners responsible for financial resources regarding the IPS in Wales. Methods A qualitative methodology was employed, with purposive sampling, semi-structured interviews, and inductive thematic analysis. Results Five themes were constructed from 13 interviews (n=9 IPPs; n=4 commissioners): (i) patient experience and safety; (ii) professional enablement and rebalancing workload of GPs; (iii) role and limitations of remote consultations; (iv) funding and business model; (v) functionality on Choose Pharmacy to support patient care. The design of the service allowed pharmacists to determine how best to deliver the IPS, maximizing access for patients and promoting a sense of professional value amongst pharmacists. Conclusion This study builds on the body of evidence on enhanced patient experience with prescribing services in the community, reinforcing that IPPs have a key role in rebalancing management of common conditions from GP surgeries to community pharmacies. Several considerations need to be addressed to ensure future success of the service implementation, delivery and enhanced sustainability, such as formal referral pathways and access to medical records. These can be used by other commissioning bodies in the UK and internationally to build a network of suitably supported IPPs, confident to appropriately deal with uncomplicated acute and chronic conditions; and liaise with primary and/or secondary care when referrals are needed.
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Affiliation(s)
- Efi Mantzourani
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK,Primary Care, Digital Health and Care Wales, NHS Wales, Cardiff, Wales, UK,Correspondence: Efi Mantzourani, Redwood Building, Cardiff School of Pharmacy and Pharmaceutical Sciences, King Edward VII Avenue, Cardiff, Wales, CF10 3NB, UK, Tel +44 2920 870452, Email
| | - Rhian Deslandes
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Karen Hodson
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Andrew Evans
- Primary Care Services, Welsh Government, Cardiff, Wales, UK
| | - Lydia Taylor
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Cherie Lucas
- Graduate School of Health (Pharmacy Discipline), University of Technology Sydney, Sydney, New South Wales, Australia
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Qin W, Yuan S, Zhao L, Liu Y, Xu L, Zhang Y, Liu L, Fan B. Pain Physicians' Attitudes and Experiences Regarding Clinical Pharmacy Services in China: A National Cross-Sectional Survey. J Multidiscip Healthc 2023; 16:21-29. [PMID: 36644709 PMCID: PMC9836825 DOI: 10.2147/jmdh.s397039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
Purpose Pharmacists are key members of the pain management interdisciplinary team in many developed countries. However, the implementation of clinical pharmacy services in pain management is impeded by the imbalance between the pain physicians and clinical pharmacists specializing in pain management in China. The purpose of this study was to elucidate the perceptions, expectations and current experience of Chinese pain physicians regarding clinical pharmacy services. Patients and Methods An anonymous, self-administered questionnaire was designed according to previously published studies with minor modifications and distributed online to 1100 pain physicians selected randomly in hospitals across all 31 provinces of mainland China in 2021. Data were analyzed using descriptive and inferential statistics. Results A total of 1071 valid questionnaires were included for analysis. The pain physicians were from all 31 provinces of mainland China and most of them were from tertiary hospitals holding an undergraduate degree. Among listed kinds of clinical pharmacy services, pain physicians were less comfortable with pharmacists treating minor illnesses (p < 0.001). Pain physicians' experiences with clinical pharmacy services were far less than their expectations (p < 0.001), which is in line with the results that most of pain physicians (65.9%) interacted with pharmacists at a frequency of less than once a week. Significant differences in the experiences were found among ages (p < 0.01) and among years of work experience (p < 0.05) of pain physicians. Pain physicians' expectations of pharmacists were positively correlated with their experiences with clinical pharmacy services (p < 0.001). Conclusion Pain physicians in China had positive perceptions and high expectations, but relatively low experiences regarding clinical pharmacy services. Expanding clinical pharmacist pain management credentialing and increasing pain physicians' exposure to clinical pharmacy services are favourable to support the interdisciplinary collaboration in pain management in China.
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Affiliation(s)
- Wangjun Qin
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Siyu Yuan
- Department of Pharmacy, Siping Central Hospital, Siping, Jilin Province, People’s Republic of China
| | - Li Zhao
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Ying Liu
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Liyuan Xu
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Yi Zhang
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Lihong Liu
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, People’s Republic of China,Correspondence: Lihong Liu; Bifa Fan, China-Japan Friendship Hospital, 2 Yinghua Road, Heping District, Beijing, 100029, People’s Republic of China, Tel +860184205959, Fax +860184205559, Email ;
| | - Bifa Fan
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, People’s Republic of China
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Grant A, Rowe L, Kennie-Kaulbach N, Bishop A, Kontak J, Stewart S, Morrison B, Sketris I, Rodrigues G, Minard L, Whelan AM, Woodill L, Jeffers E, Fisher J, Ricketts J, Isenor JE. Increased self-reported pharmacist prescribing during the COVID-19 pandemic: Using the Theoretical Domains Framework to identify barriers and facilitators to prescribing. Res Social Adm Pharm 2022; 19:133-143. [PMID: 36038458 PMCID: PMC9392557 DOI: 10.1016/j.sapharm.2022.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/28/2022] [Accepted: 08/14/2022] [Indexed: 11/11/2022]
Abstract
Background Community pharmacists are positioned to improve access to medications through their ever-expanding role as prescribers, with this role becoming more pronounced during the COVID-19 pandemic. Objectives Our research aimed to determine the extent of self-reported pharmacist prescribing pre-COVID-19 and during the COVID-19 pandemic, to identify barriers and facilitators to pharmacist prescribing, and to explore the relationship between these factors and self-reported prescribing activity. Methods A questionnaire based on the Theoretical Domains Framework (TDFv2) assessing self-reported prescribing was electronically distributed to all direct patient care pharmacists in NS (N = 1338) in July 2020. Wilcoxon signed-rank tests were used to examine temporal differences in self-reported prescribing activity. TDFv2 responses were descriptively reported as positive (agree/strongly agree), neutral (uncertain), and negative (strongly disagree/disagree) based on the 5-point Likert scale assessing barriers and facilitators to prescribing from March 2020 onward (i.e., ‘during’ COVID-19). Simple logistic regression was used to measure the relationship between TDFv2 domain responses and self-reported prescribing activity. Results A total of 190 pharmacists (14.2%) completed the survey. Over 98% of respondents reported prescribing at least once per month in any of the approved prescribing categories, with renewals being the most common activity reported. Since the pandemic, activity in several categories of prescribing significantly increased, including diagnosis supported by protocol (29.0% vs. 58.9%, p < 0.01), minor and common ailments (25.3% vs 34.7%, p = 0.03), preventative medicine (22.1% vs. 33.2%, p < 0.01). Amongst the TDFv2 domains, Beliefs about Consequences domain had the largest influence on prescribing activity (OR = 3.13, 95% CI 1.41–6.97, p < 0.01), with Social Influences (OR = 2.85, 95% CI 1.42–5.70, p < 0.01) being the next most influential. Conclusion Self-reported prescribing by direct patient care community pharmacists in Nova Scotia increased during the COVID-19 pandemic, particularly for government-funded services. Key barriers to address, and facilitators to support pharmacist prescribing were identified and can be used to inform future interventions.
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Affiliation(s)
- Amy Grant
- Maritime SPOR SUPPORT Unit, Research, Innovation & Discovery Nova Scotia Health, 5790 University Ave., Halifax, Nova Scotia, B3H1V7, Canada.
| | - Liam Rowe
- Maritime SPOR SUPPORT Unit, Research, Innovation & Discovery Nova Scotia Health, 5790 University Ave., Halifax, Nova Scotia, B3H1V7, Canada.
| | | | - Andrea Bishop
- Nova Scotia College of Pharmacists, 1801 Hollis St, Halifax, Nova Scotia, B3J 3N4, Canada.
| | - Julia Kontak
- Maritime SPOR SUPPORT Unit, Research, Innovation & Discovery Nova Scotia Health, 5790 University Ave., Halifax, Nova Scotia, B3H1V7, Canada.
| | - Sam Stewart
- Dalhousie University, Nova Scotia, B3H 4R2, Canada.
| | - Bobbi Morrison
- St. Francis Xavier University, 3090 Martha Drive, Antigonish, Nova Scotia, B2G 2W5, Canada.
| | - Ingrid Sketris
- Nova Scotia College of Pharmacists, 1801 Hollis St, Halifax, Nova Scotia, B3J 3N4, Canada.
| | - Glenn Rodrigues
- Pharmacy Association of Nova Scotia, 210-238A Brownlow Ave, Dartmouth, Nova Scotia, B3B 2B4, Canada.
| | - Laura Minard
- Nova Scotia Department of Health and Wellness, 1894 Barrington Street, Halifax, Nova Scotia, B3J 2R8, Canada.
| | | | - Lisa Woodill
- Pharmacy Association of Nova Scotia, 210-238A Brownlow Ave, Dartmouth, Nova Scotia, B3B 2B4, Canada.
| | - Elizabeth Jeffers
- Maritime SPOR SUPPORT Unit, Research, Innovation & Discovery Nova Scotia Health, 5790 University Ave., Halifax, Nova Scotia, B3H1V7, Canada.
| | - Judith Fisher
- Nova Scotia Department of Health and Wellness, 1894 Barrington Street, Halifax, Nova Scotia, B3J 2R8, Canada.
| | - Juanna Ricketts
- Maritime SPOR SUPPORT Unit, Research, Innovation & Discovery Nova Scotia Health, 5790 University Ave., Halifax, Nova Scotia, B3H1V7, Canada.
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Hayat K, Mustafa ZU, Godman B, Arshed M, Zhang J, Khan FU, Saleem F, Lambojon K, Li P, Feng Z, Fang Y. Perceptions, Expectations, and Experience of Physicians About Pharmacists and Pharmaceutical Care Services in Pakistan: Findings and Implications. Front Pharmacol 2021; 12:650137. [PMID: 34054528 PMCID: PMC8160509 DOI: 10.3389/fphar.2021.650137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Optimal collaboration between pharmacists and other healthcare professionals such as physicians is integral in implementing pharmaceutical care. However, there are concerns regarding the role of pharmacists, especially among low- and middle-income countries. This study explored the perceptions, expectations, and experience of physicians working in various hospital settings of Punjab, Pakistan, about pharmacists and their roles. Methods: A self-administered questionnaire consisting of four sections was administered from October to December 2020. Descriptive and inferential statistics such as Kruskal-Wallis and Mann-Whitney tests were used for data analysis using SPSS. Results: Six hundred and seventy-eight physicians participated in this study with a response rate of 77.9%. Most of the physicians reported minimal to no interaction with pharmacists (n = 521, 76.8%). However, more than three-quarters of physicians (n = 660, 97.3%) accepted pharmacists as evidence-based sources of drug information. In addition, many physicians (n = 574, 84.7%) strongly agreed that pharmacists should attend patient care rounds to respond promptly to questions related to patient medication. A limited number of physicians (n = 124, 18.3%) assumed that pharmacists were advising their patients regarding the judicial use of their drugs. Median expectation and experience score had a significant association with age, experience, and education of physicians (P < 0.05). Conclusions: The perception of physicians was positive toward certain roles of pharmacists, coupled with high expectations. However, their experience was low, with most of the activities of pharmacists due to inadequate interprofessional coordination.
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Affiliation(s)
- Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Zia Ul Mustafa
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital Pakpattan, Pakpattan, Pakistan
| | - Brain Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Muhammad Arshed
- Department of Emergency Medicine, Lifeline Hospital, Lahore, Pakistan.,Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Selangor Darul Ehsan, Malaysia
| | - Jiaxing Zhang
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Fahad Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Krizzia Lambojon
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Pengchao Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Zhitong Feng
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China
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8
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Wu JHC, Khalid F, Langford BJ, Beahm NP, McIntyre M, Schwartz KL, Garber G, Leung V. Community pharmacist prescribing of antimicrobials: A systematic review from an antimicrobial stewardship perspective. Can Pharm J (Ott) 2021; 154:179-192. [PMID: 34104272 PMCID: PMC8165883 DOI: 10.1177/1715163521999417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Pharmacist prescribing authority is expanding, while antimicrobial resistance is an increasing global concern. We sought to synthesize the evidence for antimicrobial prescribing by community pharmacists to identify opportunities to advance antimicrobial stewardship in this setting. Methods: We conducted a systematic review to characterize the existing literature on community pharmacist prescribing of systemic antimicrobials. We searched MEDLINE, EMBASE and International Pharmaceutical Abstracts for English-language articles published between 1999 and June 20, 2019, as well as hand-searched reference lists of included articles and incorporated expert suggestions. Results: Of 3793 articles identified, 14 met inclusion criteria. Pharmacists are most often prescribing for uncomplicated urinary tract infection (UTI), acute pharyngitis and cold sores using independent and supplementary prescribing models. This was associated with high rates of clinical improvement (4 studies), low rates of retreatment and adverse effects (3 studies) and decreased health care utilization (7 studies). Patients were highly satisfied (8 studies) and accessed care sooner or more easily (7 studies). Seven studies incorporated antimicrobial stewardship into study design, and there was overlap between study outcomes and those relevant to outpatient antimicrobial stewardship. Pharmacist intervention reduced unnecessary prescribing for acute pharyngitis (2 studies) and increased the appropriateness of prescribing for UTI (3 studies). Conclusion: There is growing evidence to support the role of community pharmacists in antimicrobial prescribing. Future research should explore additional opportunities for pharmacist antimicrobial prescribing and ways to further integrate advanced antimicrobial stewardship strategies in the community setting. Can Pharm J (Ott) 2021;154:xx-xx.
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Affiliation(s)
| | | | | | - Nathan P Beahm
- the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
| | - Mark McIntyre
- the Sinai Health-University Health Network Antimicrobial Stewardship Program, University Health Network, Toronto
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Kabba JA, James PB, Hanson C, Chang J, Kitchen C, Jiang M, Yang C, Fang Y. Sierra Leonean doctors' perceptions and expectations of the role of pharmacists in hospitals: a national cross-sectional survey. Int J Clin Pharm 2020; 42:1335-1343. [PMID: 32772304 DOI: 10.1007/s11096-020-01096-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
Background The effective implementation of pharmaceutical care requires pharmacists' collaboration with other healthcare providers, especially doctors. However, doctor's perceptions and expectations may not be in line with the tasks and responsibilities of pharmacists. Objectives We aim to explore doctors' expectations and perceptions of pharmacists while working together in a multi-disciplinary team in Sierra Leone. Setting Twelve public hospitals in Sierra Leone. Method A national cross-sectional survey was conducted between July and September 2018. Anonymous self-administered questionnaires were distributed to all doctors at randomly selected public hospitals. Data were analyzed in Excel and SPSS using descriptive and inferential statistics, and a p > 0.05 was taken as statistically significant. Main outcome measure Doctors' perceptions and expectations towards pharmacists role in patient care. Results A total of 119 out of 150 questionnaires were returned. Doctors hold a mixed perception of pharmacists. The majority of medical doctors believed that pharmacists are vital (n = 98; 82.4%) as they provide services that foster better patients outcomes (n = 78; 65.6%). However, about half (n = 58; 48.8%) expressed uncertainty or perceived pharmacists as incompetent in providing clinical pharmacy services. Our findings also showed a large proportion of doctors expect pharmacists to review medication order (n = 110; 92.4%) for appropriateness and monitoring patients' response to therapy and possible adverse drug effects (n = 112; 92.2%). M ore than three quarters (n = 104, 87.4%) were in favour of collaborating with pharmacists in the process of developing patients' treatment plans. Doctors (n = 116; 97.5%) were of the view that doctor-pharmacist collaborations can be improved by developing trust relationships through dialogue. No demographic characteristics were independently associated with doubt in pharmacist clinical competence. Conclusion Reservations regarding pharmacists' clinical competency still prevail amongst medical doctors. Conversely, they view pharmacists as crucial players in the healthcare delivery system in Sierra Leone. Doctors also have high expectations of pharmacists in terms of contributing to better patient outcomes and therefore wish to collaborate. Possible interventions to settle doctors' discontent regarding pharmacists may include fostering interprofessional training, practice, and constructive dialogue.
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Affiliation(s)
- Johna Alimamy Kabba
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, #76 Yanta West Road, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Peter Bai James
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, 2007, Australia.,Pharmacy Board, Ministry of Health and Sanitation, New England, Freetown, Sierra Leone
| | - Christian Hanson
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Pharmacy Board, Ministry of Health and Sanitation, New England, Freetown, Sierra Leone.,Pharmacy Department, Well Star Atlanta Medical Centre South, East Point, GA, USA.,Pharmacy Department, Emory Johns Creek Hospital, 6325 Hospital Pkwy, Johns Creek, GA, 30097, USA
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, #76 Yanta West Road, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Chenai Kitchen
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, #76 Yanta West Road, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, #76 Yanta West Road, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, #76 Yanta West Road, Xi'an, 710061, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, #76 Yanta West Road, Xi'an, 710061, China. .,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China. .,Shaanxi Center for Health Reform and Development Research, Xi'an, China. .,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, 710061, China.
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10
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Kempen TGH, Kälvemark A, Sawires M, Stewart D, Gillespie U. Facilitators and barriers for performing comprehensive medication reviews and follow-up by multiprofessional teams in older hospitalised patients. Eur J Clin Pharmacol 2020; 76:775-784. [PMID: 32076745 PMCID: PMC7239809 DOI: 10.1007/s00228-020-02846-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 02/07/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE There is a lack of knowledge about factors that influence the performance of comprehensive medication reviews (CMRs) by multiprofessional teams in hospital practice. This study aimed to explore the facilitators and barriers for performing CMRs and post-discharge follow-up in older hospitalised patients from the healthcare professional perspective. METHODS Physicians and ward-based pharmacists were recruited from an ongoing trial at four hospitals in Sweden. Semi-structured interviews were conducted with 16 physicians and 7 pharmacists. Interview topics were working processes, resources, competences, medication-related problems, intervention effects and collaboration. The interviews were audio-recorded, transcribed verbatim and thematically analysed using the Consolidated Framework for Implementation Research (CFIR). Identified subthemes were categorised as facilitators or barriers and grouped into overarching main themes. RESULTS In total, 21 facilitators and 25 barriers were identified across all CFIR domains and grouped in 6 main themes: (a) CMRs and follow-up are needed, but not in all patients; (b) there is a general belief in positive effects; (c) lack of resources is an issue, although the performance of CMRs may save time; (d) pharmacists' knowledge and skills are valuable, but they need more clinical competence; (e) compatibility with hospital practice is challenging, and roles and responsibilities are unclear and (f) personal contact at the ward is essential for physician-pharmacist collaboration. CONCLUSION Multiple facilitators and barriers for performing CMRs and post-discharge follow-up in older hospitalised patients exist. These factors should be addressed in future initiatives with similar interventions by multiprofessional teams to ensure successful implementation and performance in hospital practice.
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Affiliation(s)
- Thomas Gerardus Hendrik Kempen
- Hospital Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden.
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Amanda Kälvemark
- Hospital Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden
| | - Maria Sawires
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Derek Stewart
- College of Pharmacy, Qatar University Health, Qatar University, Doha, Qatar
| | - Ulrika Gillespie
- Hospital Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
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11
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Mohiuddin AK. The Excellence of Pharmacy Practice. Innov Pharm 2020; 11. [PMID: 34017646 PMCID: PMC8132542 DOI: 10.24926/iip.v11i1.1662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Over the past 50 years, the role of pharmacists has evolved along with the health care needs of our population. In addition to dispensing medications and ensuring patient safety, today’s pharmacists are taking a larger role as medical counselors, educators and advocates. They are integral part of the health care team, and are among the most trusted and accessible health care professionals. This accessibility allows them to perform more patient care activities, including counseling, medication management, and preventive care screenings. Beyond the care provided to individual patients, pharmacists have expanded their reach to influence the public health of communities. A pharmacist is uniquely positioned to provide disease state management through appropriate medication therapy management that has been demonstrated to improve patient outcomes and decrease overall health care costs. This role is more important than ever as the environment is demanding new practice and payment models that are required to further optimize care and outcomes while addressing the unsustainable increases in health care costs.
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Affiliation(s)
- A K Mohiuddin
- Department of Pharmacy, World University of Bangladesh, Bangladesh
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12
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Abstract
OBJECTIVES We assessed job satisfaction, work commitment and intention to leave among pharmacists working in different healthcare settings in Saudi Arabia. DESIGN This was a cross-sectional study utilising a previously validated questionnaire. SETTING We surveyed the workforce at different healthcare settings in Riyadh, Saudi Arabia. PARTICIPANTS The participants were pharmacists licensed by the Saudi Commission for Health Specialties. OUTCOME MEASURES We examined job satisfaction, work commitment and intention to leave. RESULTS In total, 325 out of 515 pharmacists completed the questionnaire, yielding a response rate of 63%. Over half of them were women (57.8%), 78.2% were Saudi Arabian nationals and 61.8% were married. The majority (88.1%) worked between 36 and 44 hours per week; 96.6% were full-time employees, and 63.4% were government employees working in public hospitals or primary healthcare centres. Although most of the pharmacists were satisfied (satisfied and slightly satisfied) with their current job (39.1% and 24.6%, respectively), about two-thirds (61.9%) had the intention to leave. Multiple logistic regression analysis showed that the most important predictors of pharmacists' intentions to leave were related to job satisfaction and work commitment (OR=0.923; 95% CI 0.899 to 0.947; p<0.001 and OR=1.044; 95% CI 1.014 to 1.08; p=0.004, respectively), whereas respondents' demographic characteristics had no effect. CONCLUSIONS Although the pharmacists surveyed were satisfied and committed to their current job, they had the intention to leave. Further research is recommended to clarify why pharmacists in Saudi Arabia have the intention to leave their pharmacy practice job.
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Affiliation(s)
- Nedaa Al-Muallem
- Department of Health System Management, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khaled Mohammed Al-Surimi
- Department of Health System Management, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Primary Care and Public Health, School of Public Health, Imperial College London School of Public Health, London, UK
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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13
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Zhou M, Desborough J, Parkinson A, Douglas K, McDonald D, Boom K. Barriers to pharmacist prescribing: a scoping review comparing the UK, New Zealand, Canadian and Australian experiences. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:479-489. [DOI: 10.1111/ijpp.12557] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/07/2019] [Accepted: 06/03/2019] [Indexed: 12/01/2022]
Abstract
Abstract
Objectives
Non-medical prescribers, including pharmacists, have been found to achieve comparable clinical outcomes with doctors for certain health conditions. Legislation supporting pharmacist prescribing (PP) has been implemented in the United Kingdom (UK), Canada and New Zealand (NZ); however, to date, Australian pharmacists have not been extended prescribing rights. The purpose of this review was to describe the barriers to PP found in the literature from the UK, Canada, NZ and Australia, and examine the implications of these for the development of PP in Australia.
Methods
We conducted a scoping review, which included peer-reviewed and grey literature, and consultation with stakeholders. Sources – Scopus, PubMed and CINAHL; Google Scholar, OpenGrey and organisational websites from January 2003 to March 2018 in the UK, Canada, NZ and Australia. Inclusion criteria – articles published in English, related to implementation of PP and articulated barriers to PP.
Key findings
Of 863 unique records, 120 were reviewed and 64 articles were eligible for inclusion. Three key themes emerged: (1) Socio-political context, (2) Resourcing issues and (3) Prescriber competence. The most common barriers were inadequate training regarding diagnostic knowledge and skills, inadequate support from authorities and stakeholders, and insufficient funding/reimbursement.
Conclusions
If implementation of PP is to occur, attention needs to be focused on addressing identified barriers to PP implementation, including fostering a favourable socio-political context and prescriber competence. As such, a concerted effort is required to develop clear policy pathways, including targeted training courses, raising stakeholder recognition of PP and identifying specific funding, infrastructure and resourcing needs to ensure the smooth integration of pharmacist prescribers within interprofessional clinical teams.
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Affiliation(s)
- Mingming Zhou
- People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Kirsty Douglas
- Academic Unit of General Practice, ANU Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - David McDonald
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Katja Boom
- Independent Consultant/Accredited Australian Pharmacist Working in General Practice, Canberra, ACT, Australia
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14
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CAPABLE: Calgary zone usage of Additional Prescribing Authorization By pharmacists in an inpatient setting: review of the prescribing Landscape and Environment. Res Social Adm Pharm 2019; 16:342-348. [PMID: 31227474 DOI: 10.1016/j.sapharm.2019.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/28/2019] [Accepted: 05/28/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND In Alberta, Canada, pharmacists have been granted the ability to prescribe most medications independently after completing an additional authorization process. While there are data to support the use of pharmacists' prescribing in the community setting, little is known about its use in the inpatient hospital setting. OBJECTIVES To describe the prescribing patterns of pharmacists in an inpatient setting including the percentage of pharmacists using their prescribing authority, the care areas where prescribing occurred, and the frequency of prescribing. Secondary objectives included describing the medications prescribed, and to determine if pharmacists are documenting their prescribing interventions. METHODS A descriptive, retrospective, cross-sectional study of medications ordered by pharmacists through the electronic order entry system in Calgary, Alberta, Canada. Prescriptions were examined in the context of how often each pharmacist prescribed, the medications prescribed, and an audit of documentation practices was performed using patient charts. RESULTS A total of 64,293 orders from 172 pharmacists were included in the analysis, of which 51% (n = 32,681) were discontinuation orders. It was found that 90% of pharmacists used their prescribing authority, ordering a median of 11.3 prescriptions monthly (interquartile range 4.3-32.8). Clinical areas with the most overall prescribing included critical care (854.8), oncology and palliative care (463.0), and surgery (409.3) prescriptions per pharmacist Full-Time Equivalent per year. CONCLUSIONS This study demonstrates a broad range of prescribing from pharmacists within acute care practice and a wide variety of medication prescribed. Future areas for research include barriers and enablers to pharmacist prescribing and examination of where prescribing pharmacists have the greatest value.
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15
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The development of a role description and competency map for pharmacists in an interprofessional care setting. Int J Clin Pharm 2019; 41:391-407. [DOI: 10.1007/s11096-019-00808-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
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16
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Effectiveness and cost effectiveness of pharmacist input at the ward level: a systematic review and meta-analysis. Res Social Adm Pharm 2018; 15:1212-1222. [PMID: 30389320 DOI: 10.1016/j.sapharm.2018.10.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/09/2018] [Accepted: 10/12/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pharmacists play important role in ensuring timely care delivery at the ward level. The optimal level of pharmacist input, however, is not clearly defined. OBJECTIVE To systematically review the evidence that assessed the outcomes of ward pharmacist input for people admitted with acute or emergent illness. METHODS The protocol and search strategies were developed with input from clinicians. Medline, EMBASE, Centre for Reviews and Dissemination, The Cochrane Library, NHS Economic Evaluations, Health Technology Assessment and Health Economic Evaluations databases were searched. Inclusion criteria specified the population as adults and young people (age >16 years) who are admitted to hospital with suspected or confirmed acute or emergent illness. Only randomised controlled trials (RCTs) published in English were eligible for inclusion in the effectiveness review. Economic studies were limited to full economic evaluations and comparative cost analysis. Included studies were quality-assessed. Data were extracted, summarised. and meta-analysed, where appropriate. RESULTS Eighteen RCTs and 7 economic studies were included. The RCTs were from USA (n = 3), Sweden (n = 2), Belgium (n = 2), China (n = 2), Australia (n = 2), Denmark (n = 2), Northern Ireland, Norway, Canada, UK and Netherlands. The economic studies were from UK (n = 2), Sweden (n = 2), Belgium and Netherlands. The results showed that regular pharmacist input was most cost effective. It reduced length-of-stay (mean = -1.74 days [95% CI: 2.76, -0.72], and increased patient and/or carer satisfaction (Relative Risk (RR) = 1.49 [1.09, 2.03] at discharge). At £20,000 per quality-adjusted life-year (QALY)-gained cost-effectiveness threshold, it was either cost-saving or cost-effective (Incremental Cost Effectiveness Ratio (ICER) = £632/QALY-gained). No evidence was found for 7-day pharmacist presence. CONCLUSIONS Pharmacist inclusion in the ward multidisciplinary team improves patient safety and satisfaction and is cost-effective when regularly provided throughout the ward stay. Research is needed to determine whether the provision of 7-day service is cost-effective.
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Courtenay M, Deslandes R, Harries-Huntley G, Hodson K, Morris G. Classic e-Delphi survey to provide national consensus and establish priorities with regards to the factors that promote the implementation and continued development of non-medical prescribing within health services in Wales. BMJ Open 2018; 8:e024161. [PMID: 30232116 PMCID: PMC6150146 DOI: 10.1136/bmjopen-2018-024161] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/09/2018] [Accepted: 08/18/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To provide national consensus and establish priorities with regards to the factors that promote the implementation and continued development of non-medical prescribing within health services. DESIGN Classic e-Delphi survey. SETTING National study in Wales. PARTICIPANTS Pharmacists, nurses and allied health professionals with the independent/supplementary prescribing qualification. RESULTS A total of 55 non-medical prescribers agreed to become members of the expert panel of whom 42 (76%) completed the round 1 questionnaire, 40/42 (95%) completed round 2 and 34/40 (85%) responded to round 3. Twenty-one statements were developed, and consensus was achieved on nine factors representing those necessary for the successful implementation of non-medical prescribing and five representing actions required for its continued development. Strategic fit between non-medical prescribing and existing service provision, organisation preparedness, visible benefits, good managerial and team support, and a clear differentiation of roles were each important influences. CONCLUSION Given the high degree of consensus, this list of factors and actions should provide guidance to managers and commissioners of services wishing to initiate or extend non-medical prescribing. This information should be considered internationally by other countries outside of the UK wishing to implement prescribing by non-medical healthcare professionals.
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Affiliation(s)
- Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Rhian Deslandes
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Gail Harries-Huntley
- Workforce Education and Development Service, NHS Wales Shared Services Partnership, Cardiff, UK
| | - Karen Hodson
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Gary Morris
- School of Healthcare Sciences, Cardiff University & HywelDda University Health Board, Carmarthen, SA31, Cardiff University, Cardiff, UK
- Advanced Physiotherapy Practitioner, Hywel Dda University Health Board, Carmarthen, UK
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18
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What supports hospital pharmacist prescribing in Scotland? – A mixed methods, exploratory sequential study. Res Social Adm Pharm 2018; 14:488-497. [DOI: 10.1016/j.sapharm.2017.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 06/01/2017] [Accepted: 06/15/2017] [Indexed: 11/23/2022]
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19
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Djerbib A. A qualitative systematic review of the factors that influence prescribing decisions by nurse independent prescribers in primary care. ACTA ACUST UNITED AC 2018. [DOI: 10.7748/phc.2018.e1355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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Cross VJ, Parker JT, Law Min MCYL, Bourne RS. Pharmacist prescribing in critical care: an evaluation of the introduction of pharmacist prescribing in a single large UK teaching hospital. Eur J Hosp Pharm 2018; 25:e2-e6. [PMID: 31157059 PMCID: PMC6457156 DOI: 10.1136/ejhpharm-2017-001267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the introduction of pharmacist independent prescribing activity across three general critical care units within a single large UK teaching hospital. To identify the prescribing demographics including total of all prescriptions, number prescribed by pharmacists, reason for pharmacist prescription, range of medications prescribed, pharmacist prescribing error rate and the extent of pharmacist second 'clinical check'. METHODS Retrospective evaluation of e-prescribing across all general critical care units of a single large UK teaching hospital. All prescribing data were downloaded over a 1-month period (May to June 2016) with analysis of pharmacist prescribing activity including rate, indication, therapeutic class and error rate. RESULTS In total, 5374 medicines were prescribed in 193 patients during the evaluated period. Prescribing pharmacists were available on the units on 60.4% (58/96) of days, during their working hours and accounted for 576/5374 (10.7%) of medicines prescribed in 65.2% (126/193) of patients. The majority (342/576) of pharmacist prescriptions were for new medicines. Infections, central nervous system, and nutrition/blood were the top three British National Formulary (BNF) therapeutic categories, accounting for 63.4% (349/576) of all pharmacist prescriptions. The critical care pharmacist prescribing error rate was 0.18% (1/550). CONCLUSIONS Pharmacist independent prescribers demonstrated a high degree and wide-ranging scope of prescribing activity in general critical care patients. Pharmacists contributed a significant proportion of total prescribing, despite less than full service coverage. Prescribing activity was also safe with a very low error rate recorded.
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Affiliation(s)
- Verity J Cross
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - James T Parker
- Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Marie-Christine Y L Law Min
- Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Richard S Bourne
- Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
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21
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Onatade R, Sawieres S, Veck A, Smith L, Gore S, Al-Azeib S. The incidence and severity of errors in pharmacist-written discharge medication orders. Int J Clin Pharm 2017; 39:722-728. [PMID: 28573438 PMCID: PMC5541123 DOI: 10.1007/s11096-017-0468-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/18/2017] [Indexed: 11/17/2022]
Abstract
Background Errors in discharge prescriptions are problematic. When hospital pharmacists write discharge prescriptions improvements are seen in the quality and efficiency of discharge. There is limited information on the incidence of errors in pharmacists’ medication orders. Objective To investigate the extent and clinical significance of errors in pharmacist-written discharge medication orders. Setting 1000-bed teaching hospital in London, UK. Method Pharmacists in this London hospital routinely write discharge medication orders as part of the clinical pharmacy service. Convenient days, based on researcher availability, between October 2013 and January 2014 were selected. Pre-registration pharmacists reviewed all discharge medication orders written by pharmacists on these days and identified discrepancies between the medication history, inpatient chart, patient records and discharge summary. A senior clinical pharmacist confirmed the presence of an error. Each error was assigned a potential clinical significance rating (based on the NCCMERP scale) by a physician and an independent senior clinical pharmacist, working separately. Main outcome measure Incidence of errors in pharmacist-written discharge medication orders. Results 509 prescriptions, written by 51 pharmacists, containing 4258 discharge medication orders were assessed (8.4 orders per prescription). Ten prescriptions (2%), contained a total of ten erroneous orders (order error rate—0.2%). The pharmacist considered that one error had the potential to cause temporary harm (0.02% of all orders). The physician did not rate any of the errors with the potential to cause harm. Conclusion The incidence of errors in pharmacists’ discharge medication orders was low. The quality, safety and policy implications of pharmacists routinely writing discharge medication orders should be further explored.
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Affiliation(s)
- Raliat Onatade
- Institute of Pharmaceutical Sciences, King's College London, London, UK. .,Pharmaceutical Sciences Clinical Academic Group, King's Health Partners, London, UK. .,Pharmacy Department, Barts Health NHS Trust, London, E1 2ES, UK.
| | - Sara Sawieres
- Pharmaceutical Sciences Clinical Academic Group, King's Health Partners, London, UK.,Pharmacy Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Alexandra Veck
- Pharmacy Department, Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - Lindsay Smith
- Pharmaceutical Sciences Clinical Academic Group, King's Health Partners, London, UK.,Pharmacy Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Shivani Gore
- Pharmacy Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Sumiah Al-Azeib
- Pharmaceutical Sciences Clinical Academic Group, King's Health Partners, London, UK.,Pharmacy Department, King's College Hospital NHS Foundation Trust, London, UK
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22
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Onatade R, Miller G, Sanghera I. A quantitative comparison of ward-based clinical pharmacy activities in 7 acute UK hospitals. Int J Clin Pharm 2016; 38:1407-1415. [DOI: 10.1007/s11096-016-0386-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 10/11/2016] [Indexed: 11/28/2022]
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