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Araújo-Neto FDC, Dosea AS, Tavares TMA, Santos DDM, Mesquita AR, de Araújo DCSA, de Lyra-Jr DP. "Opportunities and responsibilities": how do pharmacists assess their professionalism? BMC MEDICAL EDUCATION 2024; 24:831. [PMID: 39090712 PMCID: PMC11295506 DOI: 10.1186/s12909-024-05767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 07/11/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Professionalism is fundamental to the existence of professions. In pharmacy, interest in this theme improved with events that examined the resocialization of pharmacists in care. With this, evaluating professionalism can help the operationalization of the theme and, consequently, the development of strategies for pharmacy consolidation before its challenges. Therefore, this study aimed to evaluate the professionalism of Brazilian pharmacists. METHODS To meet the objective, a cross-sectional study was conducted between March 2022 and August 2023. Data were collected using the Brazilian version of the "Modification of Hall's Professionalism Scale for Use with Pharmacists". The scale has 39 items grouped into the domains: autonomy, vocation, professional council, self-regulation, continuing education, and altruism. Data were analyzed using descriptive statistics and an ANOVA analysis of variance with post-hoc Hochberg or Games-Howell tests with Bootstrapping was conducted to verify differences between groups. RESULTS 600 pharmacists participated in this study. The majority (69%) was female and carried out their professional activities in community pharmacies (50%). Professionalism scores ranged between 14 and 29 points, with an average of 22.8 points. Pharmacists working in outpatient clinics had higher scores in most factors, namely, altruism, continuing education, professional council, vocation, and autonomy. This indicates that the inclination of pharmacists to occupy areas focused on care can be significant to assess professionalism. CONCLUSIONS The data obtained indicate that pharmacists working in outpatient clinics had higher professionalism scores compared to others. This corroborates the worldwide trend experienced by pharmacy in recent decades, which is the execution of increasingly patient-centered practice models.
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Affiliation(s)
- Fernando de Castro Araújo-Neto
- Health Sciences Graduate Program, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Aline Santana Dosea
- Health Sciences Graduate Program, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Thaís Maria Araújo Tavares
- Graduate Program in Pharmaceutical Sciences, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Douglas de Menezes Santos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Alessandra Rezende Mesquita
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Dyego Carlos Souza Anacleto de Araújo
- Department of Pharmaceutical Sciences, Laboratory of Innovation in Pharmaceutical Care, Federal University of Espírito Santo - Maruípe Campus, Vitória, Espírito Santo, Brazil
| | - Divaldo Pereira de Lyra-Jr
- Health Sciences Graduate Program, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, Sergipe, CEP: 49100-000, Brazil.
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Babu D, Marotti S, Rowett D, Lim R, Wisdom A, Kalisch Ellett L. What is impacting clinical pharmacists' participation in an interprofessional ward round: a thematic analysis of a national survey. J Interprof Care 2024; 38:444-452. [PMID: 38151971 DOI: 10.1080/13561820.2023.2289506] [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: 05/10/2023] [Accepted: 11/25/2023] [Indexed: 12/29/2023]
Abstract
The ward round (WR) is an important opportunity for interprofessional interaction and communication enabling optimal patient care. Pharmacists' participation in the interprofessional WR can reduce adverse drug events and improve medication appropriateness and communication. WR participation by clinical pharmacists in Australia is currently limited. This study aims to explore what is impacting clinical pharmacists' participation in WRs in Australian hospitals. A self-administered, anonymous national survey of Australian clinical pharmacists was conducted. This study describes the outcomes from qualitative questions which were analyzed thematically in NVivo-2020 according to Braun and Clarke's techniques. Five themes were constructed: "Clinical pharmacy service structure", "Ward round structure", "Pharmacist's capabilities", "Culture" and "Value". A culture supportive of pharmacist's contribution with a consistent WR structure and flexible delivery of clinical pharmacy services enabled pharmacists' participation in WR. Being physically "absent" from the WR due to workload, workflow, and self-perception of the need for extensive clinical knowledge can limit opportunities for pharmacists to proactively contribute to medicines decision-making with physicians to improve patient care outcomes. Bidirectional communication between the interprofessional team and the pharmacist, where there is a co-construction of each individual's role in the WR facilitates consistent and inter-dependent collaborations for effective medication management.
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Affiliation(s)
- Dona Babu
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Sally Marotti
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Debra Rowett
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Alice Wisdom
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Fan X, Chen D, Bao S, Dong X, Fang F, Bai R, Zhang Y, Zhang X, Tang W, Ma Y, Zhai X. Prospective prescription review system correlated with more rational PPI medication use, better clinical outcomes and reduced PPI costs: experience from a retrospective cohort study. BMC Health Serv Res 2023; 23:1014. [PMID: 37730673 PMCID: PMC10512621 DOI: 10.1186/s12913-023-09931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Proton pump inhibitor (PPI) abuse poses an overwhelming threat to the allocation of medical resources and places a heavy burden on global medical expenses. In this study, we put forward our prospective prescription review system and evaluated the effects of this system on clinical outcomes, rational medication use and costs related to PPIs. METHODS A retrospective cohort study was conducted in which the included patients were divided into a preintervention group (2019.10-2020.09) and a postintervention group (2020.10-2021.09). To reduce the bias of patients' baseline characteristics, the propensity score matching (PSM) method was employed. The primary endpoints were the incidence of stress ulcers (SUs), the improvement and cure rates of gastrointestinal haemorrhage, the defined daily dose (DDD), the drug utilization index (DUI) and the DDD/100 patient-days. The secondary endpoints included the types of unreasonable medication orders for PPIs, the PPI utilization rate and PPI costs. RESULTS A total of 53,870 patients were included to evaluate the secondary endpoints, and 46,922 patients were paired by PSM and assessed to evaluate the primary endpoints. The number of PPIs used and PPI costs were significantly lower in the postintervention group than in the preintervention group (P < 0.001). The rationality evaluation results showed that the frequency of PPI use and the number of drug interactions were significantly higher in the preintervention group than in the postintervention group (P < 0.01). The proportion of patients taking oral PPIs was significantly increased in the postintervention group (29.30% vs. 34.56%, p < 0.01). For the utilization of PPIs both for prevention and treatment, the DUI and DDD/100 patient-days were substantially decreased in the postintervention group (P < 0.001 and P < 0.05, respectively). The incidence of SUs in the postintervention group was 44.95%, and that in the preintervention group was 51.93% (p < 0.05). CONCLUSION The implementation of the prospective prescription review system on rational PPI use correlated with reduced PPI costs, more rational PPI medication use and better clinical outcomes, and this system is worthy of long-term implementation for further improvement of rational drug use.
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Affiliation(s)
- Xiucong Fan
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Danxia Chen
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Siwei Bao
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Xiaohui Dong
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Fang Fang
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Rong Bai
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Yuyi Zhang
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Xiaogang Zhang
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Weijun Tang
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Yabin Ma
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China.
| | - Xiaobo Zhai
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China.
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Wang C, Li M, Huang Y, Xi X. Factors influencing clinical pharmacists' integration into the clinical multidisciplinary care team. Front Pharmacol 2023; 14:1202433. [PMID: 37377923 PMCID: PMC10291231 DOI: 10.3389/fphar.2023.1202433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Objectives: To investigate the factors influencing clinical pharmacists' integration into the clinical multidisciplinary care team, using interprofessional collaboration between clinical pharmacists and physicians as the focus. Methods: Through stratified random sampling, a cross-sectional questionnaire survey was conducted among clinical pharmacists and physicians in secondary and tertiary hospitals in China from July to August 2022. The questionnaire, comprising the Physician-Pharmacist Collaborative Index (PPCI) scale to reflect the collaboration level and a combined scale to measure influencing factors, was made available in two versions for clinical pharmacists and physicians. Multiple linear regression was adopted to analyze the association between the collaboration level and influencing factors, as well as the heterogeneity of the significant factors in hospitals of different grades. Results: Valid self-reported data from 474 clinical pharmacists and 496 paired physicians were included, who were serving in 281 hospitals from 31 provinces. In terms of participant-related factors, standardized training and academic degree, respectively, exerted significant positive effects on the perceived collaboration level by clinical pharmacists and physicians. In terms of context characteristics, manager support and system construction were the main factors for improving collaboration. In terms of exchange characteristics, clinical pharmacists having good communication skills, physicians trusting others' professional competence and values, and both parties having consistent expectations had significant positive effects on collaboration. Conclusion: The study provides a baseline data set on the current level and associated factors of clinical pharmacists' collaboration with other professionals in China and other countries with a related health system, providing references for individuals, universities, hospitals, and national policymakers to facilitate the development of clinical pharmacy and multidisciplinary models and further improve the patient-centered integrated disease treatment system.
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Affiliation(s)
| | | | | | - Xiaoyu Xi
- *Correspondence: Xiaoyu Xi, ; Yuankai Huang,
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Lee KMK, Page A, Kim S, Al-Diery T, Koeper I, Singh I, Hawthorne D, Johnson J. Perceptions and expectations of health professionals regarding hospital pharmacy services and the roles of hospital pharmacists: A qualitative systematic review and meta-synthesis. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 10:100264. [PMID: 37193372 PMCID: PMC10182321 DOI: 10.1016/j.rcsop.2023.100264] [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: 03/09/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/18/2023] Open
Abstract
Background Pharmacists have become increasingly integrated within the interprofessional hospital team as their scope of practice expanded in recent decades. However, limited research has explored how the roles of hospital pharmacists are perceived by other health professionals. Aim/Objectives To identify what is known about the perceptions of hospital pharmacists' roles and hospital pharmacy services held by non-pharmacist health professionals. Methods A systematic literature search was conducted in August 2022 in MEDLINE, Embase, and CINAHL to identify peer-reviewed articles published between 2011 and 2022. Title/abstract and full-text screening, by two independent reviewers, identified eligible articles. Inclusion criteria included qualitative studies in hospital settings that reported perceptions regarding the roles of hospital pharmacists held by non-pharmacist health professionals. Data were extracted using a standardised extraction tool. Collated qualitative data underwent inductive thematic analysis by two independent investigators to identify codes, which were reconciled and merged into over-arching themes through a consensus process. Findings were assessed to measure confidence using the GRADE-CERQual criteria. Results The search resulted in 14,718 hits. After removing duplicates, 10,551 studies underwent title/abstract screening. Of these, 515 underwent full-text review, and 36 were included for analysis. Most studies included perceptions held by medical or nursing staff. Hospital pharmacists were perceived as valuable, competent and supportive. At an organisational level, the roles of hospital pharmacists were perceived to benefit hospital workflow and improve patient safety. Roles contributing to all four domains of the World Health Organization's Strategic Framework of the Global Patient Safety Challenge were recognised. Highly-valued roles include medication reviews, provision of drug information, and education for health professionals. Conclusion This review describes the roles hospital pharmacists performed within the interprofessional team, as reported by non-pharmacist health professionals internationally. Multidisciplinary perceptions and expectations of these roles may guide the prioritisation and optimisation of hospital pharmacy services.
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Affiliation(s)
- Kyung Min Kirsten Lee
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- Corresponding author.
| | - Amy Page
- WA Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
| | - Sangseo Kim
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | | | - Ivanka Koeper
- SA Pharmacy, Central Adelaide Local Health Network, SA Health, Adelaide, Australia
| | - Isabella Singh
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Deborah Hawthorne
- WA Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
| | - Jacinta Johnson
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
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Long-term care professionals' views on pharmacists: a qualitative study using Role Theory. Int J Clin Pharm 2023; 45:97-107. [PMID: 36306060 PMCID: PMC9614740 DOI: 10.1007/s11096-022-01482-9] [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: 03/24/2022] [Accepted: 08/29/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Qualitative research investigating pharmacists' participation in Long-Term Care (LTC) within interdisciplinary teams is scarce. AIM To characterize how pharmacists' participation in a national network of LTC is perceived by healthcare professionals and other key stakeholders. METHOD Individual, in-depth, semi-structured interviews of participants (nurses, physicians, pharmacists, and LTC researchers) enrolled purposively or through snowballing sampling techniques, with the final sample being comprised of fourteen participants. Data analysis followed a deductive coding approach framed by Role Theory and supplemented with an inductive coding for additional themes. RESULTS Four Role Theory constructs were identified from the primary data-role identity, overqualification, ambiguity, underqualification. Clinical pharmacy services, logistics and educational activities were pointed out as representing the identity of pharmacists' interventions. Despite the clear identification of LTC pharmacists' interventions, pharmacist expertise on medicine optimization seemed to be underused (role overqualification), as a result of lack of time, lower proactivity in healthcare teams' integration, and the absence of a legal framework targeted to LTC pharmacy practice (role ambiguity). Additional clinical training, including in the management of older people's health conditions, nutrition, and palliative care were missing (role underqualification). CONCLUSION LTC pharmacists can provide essential services (e.g., clinical pharmacy, logistics, educational interventions), although additional training and a clearer legal framework are missing to better define pharmacists' roles in LTC pharmacy practice.
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Chetty D, Leigh-de Rapper S. Exploring the discord between pharmacy education and practice in antimicrobial stewardship. Health SA 2023; 28:2114. [PMID: 36873778 PMCID: PMC9982462 DOI: 10.4102/hsag.v28i0.2114] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/17/2023] [Indexed: 03/06/2023] Open
Abstract
Background Antimicrobial stewardship (AMS) is a critical global intervention aimed at optimising antimicrobial use and decreasing antimicrobial resistance (AMR) with pharmacists playing a pivotal role within AMS teams. However, AMS is not comprehensively taught in pharmacy curricula and little is known about the relevance of pharmacists' training to meet AMS needs in South Africa. Aim This study aimed to explore the attitudes, knowledge and perceptions of clinical pharmacists towards AMS participation and training in South Africa. Setting This study was conducted among clinically practicing pharmacists in public and private healthcare sectors in South Africa. Methods A quantitative exploratory research design was selected for this study. The study was conducted using a self-administered structured survey. Categorical variables were analysed using simple descriptive statistics. Mann-Whitney and Kruskal-Wallis tests were applied to determine differences between variables. Results Pharmacists demonstrated good attitudes knowledge and perceptions towards AMS (median 4.3). There was statistical significant differences in AMS participation between pharmacists of different years of experience (p = 0.005), sector of employment (p = 0.01), position of employment (p = 0.015) and presence of AMS programmes (p = 0.004). Pharmacists indicated that their Bachelor of Pharmacy undergraduate studies inadequately prepared them for their role in AMS (median 4.3). Conclusion Pharmacists show positive attitudes, knowledge and perceptions towards AMS. Education and training in AMS principles is obtained through master's programmes, short courses, Continued Professional Development (CPDs) and workshops and insufficiently incorporated in undergraduate programmes. Contribution This study confirms that undergraduate pharmacy programmes inadequately prepare pharmacists for their role in AMS.
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Affiliation(s)
- Devina Chetty
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Leigh-de Rapper
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Sin CMH, Huynh C, Maidment ID. Clinical pharmacists' perceptions of the barriers and facilitators to the implementation of paediatric clinical pharmacy services in Hong Kong. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2022; 30:466-471. [PMID: 35900004 DOI: 10.1093/ijpp/riac058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/20/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To identify barriers and facilitators that influenced the implementation of paediatric clinical pharmacy service (CPS) in Hong Kong's public hospitals from clinical pharmacists' perspective. METHODS A qualitative study based on semi-structured interviews of clinical pharmacists who practiced in paediatrics in public hospitals in Hong Kong. Interview schedule was designed based on determined themes identified in previous research and pilot testing was performed. The coding process was performed by two researchers with the resulting topics organised by thematic analysis. Consensus was reached amongst the researchers for the identification of themes that emerged during the interviews. The Consolidated Criteria for Reporting Qualitative Research guideline was followed to ensure the complete and transparent reporting of this research. Ethical approval for this study was obtained from the research ethics committee of the relevant institutions. KEY FINDINGS Of the 32 clinical pharmacists from across the study sites, 12 were interviewed. Five barriers and three facilitators were identified as main themes. The barriers that were identified which hindered service implementation include the service penetration into the healthcare system, practice environment constraints, lack of affirmation from the administrative stakeholders, governance of the profession and partnership with universities. The facilitators that were identified which enabled service implementation include other healthcare professionals' trust and confidence in the service, the support from the pharmacy management team and clinical pharmacists' self-efficacy. CONCLUSIONS Clinical pharmacists interviewed reported that the successful implementation of CPS in paediatrics in public hospitals in Hong Kong is an area of continued development with several key barriers identified.
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Affiliation(s)
- Conor Ming-Ho Sin
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK.,Pharmacy Department, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
| | - Chi Huynh
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Ian D Maidment
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
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Fan X, Chen D, Bao S, Bai R, Fang F, Dong X, Zhang Y, Zhang X, Ma Y, Zhai X. Integrating Multidisciplinary Individualized Medication Recommendations Into the Traditional Pharmacists' Consultation Method: A Retrospective Study Using Propensity Score Matching Analysis. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221081437. [PMID: 35610968 PMCID: PMC9136448 DOI: 10.1177/00469580221081437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chinese clinical pharmacists consider improving the quantity and quality of consultations to be an important task in providing better pharmaceutical care. To achieve this goal, we developed a clinical pharmacist consultation method using multidisciplinary individualized medication recommendations (MIMRs) and studied the effects of its implementation. A retrospective study of 812 clinical pharmacist-led consultations was conducted. In the pre-intervention group, medication advice was given based on the purpose of the consultation. In the post-intervention group, a consultation method using MIMRs was implemented, in which clinical pharmacists with specialties in anticoagulation, gastroenterology, and nutrition were asked to give individualized medication recommendations. Outcomes, including the effectiveness rate of consultations (ERC) and acceptance rate of consultations (ARC), were compared between the two groups using propensity score matching method. Patterns and numbers of consultations and individualized medication recommendations were also compared. The results showed that the ERC in the post-intervention group compared with the ERC in the pre-intervention group was 83.3% vs 74.0%, respectively (P < .05). Significant difference was also shown between the two groups in ARC (98.4% vs 92.2%, P < .05). The total number of consultations increased, as did the number of general consultations, multidisciplinary/difficult consultations, anti-infection consultations, and non–anti-infection consultations specifically. As a result, we proposed that the implementation of MIMRs can improve the effects of treatment and increase the number of consultations by pharmacists, which is worthy of further promotion to better serve physicians and patients.
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Affiliation(s)
- Xiucong Fan
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Danxia Chen
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Siwei Bao
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Rong Bai
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Fang Fang
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Xiaohui Dong
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Yuyi Zhang
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Xiaogang Zhang
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Yabin Ma
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - Xiaobo Zhai
- Department of Pharmacy, 66324Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
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Dalton K, Fleming A, O'Mahony D, Byrne S. Factors affecting physician implementation of hospital pharmacists' medication appropriateness recommendations in older adults. Br J Clin Pharmacol 2021; 88:628-654. [PMID: 34270111 DOI: 10.1111/bcp.14987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 12/01/2022] Open
Abstract
AIMS Non-implementation of pharmacist recommendations by physician prescribers may prolong potentially inappropriate prescribing in hospitalised older adults, increasing the risk of adverse clinical outcomes. The aim of this study was to ascertain the key factors affecting physician prescriber implementation of pharmacists' medication appropriateness recommendations in hospitalised older adults. METHODS Semi-structured interviews were conducted with hospital pharmacists and physicians who provided care to older adults (≥65 years) in 2 acute university teaching hospitals in Ireland. Content analysis was employed to identify the key themes that influence physician prescriber implementation of pharmacist recommendations. RESULTS Fourteen interviews were conducted with 6 hospital pharmacists and 8 hospital physicians between August 2018 and August 2019. Five key factors were found to affect physician implementation of pharmacist recommendations: (i) the clinical relevance and complexity of the recommendation-recommendations of higher priority and those that do not require complex decision-making are implemented more readily; (ii) interprofessional communication-recommendations provided verbally, particularly those communicated face to face with confidence and assertion, are more likely to be implemented than written recommendations; (iii) physician role and identity-the grade, specialty, and personality of the physician significantly affect implementation; (iv) knowing each other and developing trusting relationships-personal acquaintance and the development of interprofessional trust and rapport greatly facilitate recommendation implementation; and (v) the hospital environment-organisational issues such as documentation in the patient notes, having the opportunity to intervene, and the clinical pharmacy model all affect implementation. CONCLUSION This study provides a deeper understanding of the underlying behavioural determinants affecting physician prescriber implementation of pharmacist recommendations and will aid in the development of theoretically-informed interventions to improve medication appropriateness in hospitalised older adults.
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Affiliation(s)
- Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Aoife Fleming
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.,Pharmacy Department, Mercy University Hospital, Cork, Ireland
| | - Denis O'Mahony
- Geriatric Medicine, Cork University Hospital, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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Falconer N, Monaghan C, Snoswell CL. The pharmacist informatician: providing an innovative model of care during the COVID-19 crisis. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:152-156. [PMID: 33729527 PMCID: PMC7953964 DOI: 10.1093/ijpp/riaa017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The global coronavirus pandemic has expedited digitisation in every industry, especially healthcare, and has highlighted the potential for informatics pharmacists to provide valuable input into crisis management. Informatics pharmacists can combine their clinical and information technology skills to help provide essential patient safety services related to medication management, procurement and analytics. The objective of this study was to determine the key opportunities for a pharmacist informatician to improve patient care and outcomes during the COVID-19 pandemic. METHODS Fourteen expert informatics professionals involved in the provision of digital health in Queensland, Australia, were invited to participate in a brief semistructured interview. Transcripts were manually coded, through iterative readings of the text to identify participant responses related to opportunities for a pharmacist informatician to assist during COVID-19. Inductive thematic analysis as described by Braun and Clarke, was used to identify groups of text related to the provision of digital health, informatics and change of practice during a pandemic. The relevant codes were then grouped into themes to help answer the research question. KEY FINDINGS Twelve experts agreed to participate, they included nine informatics pharmacists and three digital health experts from hospital and community. Two key themes and 13 codes related to enabling safer and more efficient workflow and use of data analytics to optimise care were identified. The first theme related to 'social distancing without compromising care' for example, by using the electronic capabilities of digital hospitals and telehealth services. The second theme related to the use of real-time data streaming to optimise patient flow and timely medication procurement and management. Examples of quotes from transcripts were used to provide context and answer the research question. CONCLUSIONS The experts interviewed identified areas where informatics pharmacists have the potential to assist with maintaining high quality patient care during this pandemic, and in future disasters. Improving awareness, training, and the integration about informatics roles as a result of this global pandemic will likely assist with future patient management in the event of future disasters.
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Affiliation(s)
- Nazanin Falconer
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Corey Monaghan
- Digital Business Solutions, Queensland University of Technology, Brisbane, Australia
| | - Centaine L Snoswell
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Australia
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12
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Hatton K, Bhattacharya D, Scott S, Wright D. Barriers and facilitators to pharmacists integrating into the ward-based multidisciplinary team: A systematic review and meta-synthesis. Res Social Adm Pharm 2021; 17:1923-1936. [PMID: 33676862 DOI: 10.1016/j.sapharm.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pharmacists who are integrated into the ward team are involved in initial decision making, therefore pre-empting pharmaceutical problems and optimising therapy from the outset. Identifying the barriers and facilitators (determinants) to successful pharmacist integration within a multidisciplinary ward team will facilitate design of strategies to support integration. OBJECTIVE The study aimed to identify the modifiable barriers and facilitators to pharmacist integration into the ward-based multidisciplinary team. METHOD Searches were conducted in May 2018 across 5 databases: MEDLINE, Embase, CINAHL, PsychINFO and ASSIA, combined with grey literature and manual searches. Qualitative and mixed-methods studies using a qualitative method of data collection and analysis were eligible if reporting at least 1 modifiable determinant. Framework synthesis using the Theoretical Domains Framework (TDF) as the a priori coding framework was undertaken. Behaviour change techniques for addressing the identified determinants were selected. RESULTS Twenty studies were included indicating 9 facilitators and 5 barriers to pharmacist integration. These were grouped into 3 themes. Professional knowledge and skills of the pharmacist were a facilitator to integration; interpersonal skills and relationships when representing positive interactions with team members were a facilitator whilst hierarchy was a barrier; working patterns were a facilitator when pharmacists were co-located with team members whilst profession-specific goals and excessive workload were barriers. These mapped to the TDF domains 'knowledge', 'social/professional role and identity', 'skills', 'reinforcement', 'social influence', 'goals', and 'environmental context and resources' respectively. CONCLUSION The identified determinants within TDF domains and their associated behaviour change techniques now enable researchers to design theory- and evidence-based interventions to facilitate pharmacist integration into the ward-based multidisciplinary team. Pharmacist integration is facilitated by their knowledge and skills being valued and through demonstrating effective interpersonal skills. Re-structuring pharmacist responsibilities and working patterns to align with those of multidisciplinary team members also promotes integration.
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Affiliation(s)
- Katie Hatton
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Debi Bhattacharya
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, United Kingdom
| | - Sion Scott
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, United Kingdom
| | - David Wright
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, United Kingdom
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13
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Marques TC, Silva RDOS, Dos Santos Júnior GA, de Jesus Júnior FC, Silvestre CC, Rocha KSS, da Rocha CE, Brito GDC, de Lyra-Jr DP. Evaluation of process indicators of a medication review service between pharmacists and physicians. J Eval Clin Pract 2020; 26:1448-1456. [PMID: 31883204 DOI: 10.1111/jep.13332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Literature have showed inconclusive or contradictory results regarding medication review services effectiveness in optimizing process indicators. Thus, this study aimed to evaluate the process indicators of a medication review service between pharmacists and physicians. METHOD This quasi-experimental study was conducted between March 2013 and February 2014 with patients who were receiving care in a medication review service in a teaching hospital in northeastern Brazil. The main process indicators were number of pharmaceutical consultations; identification and resolution of drug-related problems (DRP) and pharmaceutical interventions that were classified according to type and degree of acceptance. Descriptive statistics were used to report data. The statistical significance of the association between variables was evaluated using the Mantel-Haenszel chi-square test. The 95% confidence interval was considered, and differences were deemed statistically significant if P ≤ .05. RESULTS A total of 146 patients attended the medication review service. The number of consultations per patient ranged from one to five (2.1 ± 1.1). The service identified 366 DRP, most of which were indication (67.5%). Patients who had four to five pharmaceutical consultations were 1.14 times more likely to have their DRP identified (χ2 = 33.83, P < .0001). Of the DRP identified, 183 (42.33%) were resolved. Patients who had between one and two pharmaceutical consultations were 1.22 times more likely not to have their DRP resolved compared with the group with more than three consultations (χ2 = 3.44, P < .05). Of the 173 pharmaceutical interventions made to the medical students and physicians, the majority (98.7%) was accepted. CONCLUSION The collaborative medication review service optimized the process indicators. Drug-related problems identification and resolution required more than three pharmaceutical consultations. Most of the pharmaceutical interventions were accepted by prescribers. Thus, collaborative medication review services may be fundamental to the construction of more effective and safe health systems.
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Affiliation(s)
- Tatiane C Marques
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Rafaella de Oliveira Santos Silva
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Genival A Dos Santos Júnior
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Francisco C de Jesus Júnior
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Carina C Silvestre
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Kérilin S S Rocha
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Chiara E da Rocha
- Department of Pharmacy, Federal University of Sergipe, Lagarto, Brazil
| | | | - Divaldo P de Lyra-Jr
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
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14
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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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15
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Scott S, Twigg MJ, Clark A, Farrow C, May H, Patel M, Taylor J, Wright DJ, Bhattacharya D. Development of a hospital deprescribing implementation framework: A focus group study with geriatricians and pharmacists. Age Ageing 2019; 49:102-110. [PMID: 31711097 PMCID: PMC6939289 DOI: 10.1093/ageing/afz133] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/29/2019] [Accepted: 09/05/2019] [Indexed: 01/21/2023] Open
Abstract
Background over 50% of older people in hospital are prescribed a pre-admission medicine that is potentially inappropriate; however, deprescribing by geriatricians and pharmacists is limited. This study aimed to characterise geriatricians’ and pharmacists’ barriers and enablers to deprescribing in hospital. It also intended to develop a framework of intervention components to facilitate implementation of hospital deprescribing. Methods fifty-four geriatricians and pharmacists representing four UK hospitals attended eight focus groups. We designed a topic guide to invite discussions about barriers and enablers to deprescribing. After thematic analysis, themes were mapped to the theoretical domains framework (TDF), enabling prioritisation of domains for behaviour change. We then identified evidence-based intervention components for changing behaviour within prioritised TDF domains. Results geriatricians and pharmacists described several deprescribing enablers in the hospital setting including alignment with their role and generalist knowledge, and routine patient monitoring. Five prioritised TDF domains represent the key barriers and enabler: patient and caregiver attachment to medication (social influence); perceptions that deprescribing is riskier than continuing to prescribe (beliefs about consequences); pharmacists’ working patterns limiting capacity to support deprescribing (environmental context and resources); deprescribing being a low hospital priority (goals) and incentives to deprescribe (reinforcement). Prioritised TDF domains aligned with 44 evidence-based intervention components to address the barriers and enabler to hospital deprescribing. Conclusion the behavioural determinants and their associated intervention components provide a hospital deprescribing implementation framework (hDIF). Intervention components should be selected from the hDIF to provide a theory and evidence-based intervention tailored to hospital contexts.
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Affiliation(s)
- Sion Scott
- School of Pharmacy, University of East Anglia, Norwich NR4 7TJ, UK
- Pharmacy Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Michael J Twigg
- School of Pharmacy, University of East Anglia, Norwich NR4 7TJ, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Carol Farrow
- Pharmacy Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Helen May
- Older People’s Medicine Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Martyn Patel
- Older People’s Medicine Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Johanna Taylor
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - David J Wright
- School of Pharmacy, University of East Anglia, Norwich NR4 7TJ, UK
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16
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Prescriber Implementation of STOPP/START Recommendations for Hospitalised Older Adults: A Comparison of a Pharmacist Approach and a Physician Approach. Drugs Aging 2019; 36:279-288. [DOI: 10.1007/s40266-018-0627-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Myers MK, Jansson-Knodell CL, Schroeder DR, O'Meara JG, Bonnes SL, Ratelle JT. Using knowledge translation for quality improvement: an interprofessional education intervention to improve thromboprophylaxis among medical inpatients. J Multidiscip Healthc 2018; 11:467-472. [PMID: 30271162 PMCID: PMC6149937 DOI: 10.2147/jmdh.s171745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Low-molecular-weight heparin (LMWH) is an effective means of preventing venous thromboembolism (VTE) among medical inpatients. Compared with unfractionated heparin, LMWH is equivalent or superior in efficacy and risk of bleeding. Despite its advantages, LMWH is underused in VTE prophylaxis for general-medicine patients hospitalized at our institution. Thus, a quality improvement (QI) initiative was undertaken to increase LMWH use for VTE prophylaxis among medical patients hospitalized on resident teaching services. Methods A QI team was formed, consisting of resident and attending physicians with pharmacy leaders. A systems analysis was performed, which showed gaps in resident knowledge as the greatest barrier to LMWH use. A knowledge translation framework was used to improve prescribing practices. Several Plan–Do–Study–Act cycles were executed, including resident-of-resident and pharmacist-of-resident education with performance audit and feedback. Results Pharmacist-of-resident education elicited the largest improvement and was sustained through a recurring pharmacist-led, interprofessional educational session as part of the monthly hospital orientation for incoming residents. Data analysis showed a statistically significant increase in LMWH use among treatment-eligible hospitalized medical patients, from 12.1% to 69.2%, following intervention (P<0.001). Extrapolated over 1 year, this improvement conserved 9,490 injections and nearly 791 hours of nurse time. Conclusions This QI project indicates that an interprofessional education intervention can lead to sustainable improvement in resident prescribing practices. This project also highlights the value of knowledge translation for the design of tailored interventions in QI initiatives.
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Affiliation(s)
| | | | - Darrell R Schroeder
- Department of Health Sceinces Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - John G O'Meara
- Department of Pharmacy Services, Mayo Clinic, Rochester, MN, USA
| | - Sara L Bonnes
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - John T Ratelle
- Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA,
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18
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Is It Necessary for Pharmacists to Evaluate Other Health Professionals' Satisfaction with Pharmacist Services? Can J Hosp Pharm 2018; 71:338-340. [PMID: 30402000 PMCID: PMC6209502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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19
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Béchet C, Pichon R, Giordan A, Bonnabry P. A cross-sectional comparison between the perception of physicians and pharmacists concerning the role of the pharmacist in physician training. ANNALES PHARMACEUTIQUES FRANÇAISES 2018; 76:408-417. [DOI: 10.1016/j.pharma.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 11/28/2022]
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