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Alkadhimi A, Dawood OT, Khan AH. The role of community pharmacists and their perception towards antimicrobial stewardship in Baghdad, Iraq. HEALTH CARE SCIENCE 2024; 3:114-123. [PMID: 38939617 PMCID: PMC11080847 DOI: 10.1002/hcs2.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/23/2024] [Accepted: 03/07/2024] [Indexed: 06/29/2024]
Abstract
Background This study aimed to assess the role of community pharmacists and their perception toward antimicrobial stewardship, in addition to identifying factors influencing their perception and practices in community pharmacy. Methods A cross-sectional study was carried out among community pharmacists regarding antimicrobial stewardship. Convenience sampling was used to obtain the required sample from a community pharmacy in Baghdad. In total, 381 participants have completed the survey. Results The majority of the participants (85.6%) strongly agreed/agreed that "antimicrobial stewardship programs reduce the problems of antibiotic resistance"; and 85.5% of them strongly agreed/agreed that community pharmacists required adequate training on antibiotics use. In addition, high percent of community pharmacists (88.4%) strongly agreed/agreed that pharmacists have a responsibility to take a prominent role in antimicrobial stewardship programs and infection-control programs in the health system. The total score of perception was significantly influenced by older age groups, postgraduate degrees, and experience of 6-10 years (p < 0.001). This study also showed that 65.4% of pharmacists always/often advise patients to continue the full course of antimicrobials, and 64.9% of them reported always/often considering clinical and safety parameters before dispensing antibiotics. The role of pharmacists was significantly influenced by the younger age group, females, higher degree in pharmacy, experience of 3-5 years, and medical complex pharmacy (p < 0.001). Conclusion Community pharmacists have a good perception toward antimicrobial stewardship programs, but their role is still limited. More efforts are needed to design better strategies for antimicrobial stewardship in community pharmacy.
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Affiliation(s)
- Akram Alkadhimi
- Discipline of Clinical Pharmacy, School of Pharmaceutical SciencesUniversiti Sains MalaysiaPenangMalaysia
| | | | - Amer H. Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical SciencesUniversiti Sains MalaysiaPenangMalaysia
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Marque P, Le Moal G, Labarre C, Delrieu J, Pries P, Dupuis A, Binson G, Lazaro P. Assessment of the impact of pharmacist-led intervention with antibiotics in patients with bone and joint infection. Infect Dis Now 2023; 53:104671. [PMID: 36738825 DOI: 10.1016/j.idnow.2023.104671] [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: 07/01/2022] [Revised: 12/19/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The management of patients with bone and joint infections (BJIs) is complex. To improve this care, we carried out pharmaceutical actions in the orthopedic unit, including pharmacist-led-intervention (PLI) for patients requiring prolonged antibiotics. Few data exist regarding patient compliance, adherence and knowledge in cases of BJI. Data on hospital readmission are likewise limited, even though it is considered as a major determinant of clinical impact. The aim of this study was to assess the effectiveness of PLI regarding six-month readmissions. PATIENTS AND METHODS Patients were assigned to two groups, both receiving standardized care. Two periods were compared: control group (CG) without PLI and interventional group (IG) with PLI throughout. The analysis was based on patient records and included: proportion of rehospitalizations at 6 months for infectious causes, reasons for antibiotic dose modification or antibiotic switch after 6 weeks, and descriptive analysis of data on pharmaceutical interventions in care pathways. RESULTS Analysis was performed on 164 patients: 105 CG (64 %) patients and 59 IG (36 %) patients. There were no significant differences between IG and CG in patients' socio-demographic characteristics, infectious factors and antibiotic regimens. Amongst the CG patients, 23 were readmitted (22 %) versus 3 patients in the IG (5 %), (p = 0.002). There were significantly fewer treatment changes after 6 weeks (28.6 % versus 15.3 %, p = 0.05) for IG patients. CONCLUSION In this retrospective survey, our results suggest a positive impact of PLI on 6-month readmission for all causes in BJI patients. These results need to be confirmed in a multicentric study.
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Affiliation(s)
| | - Gwenael Le Moal
- Department of infectious and tropical diseases, Poitiers Hospital University, France
| | - Chloé Labarre
- Department of orthopaedical, Poitiers Hospital University, France
| | | | - Pierre Pries
- Department of orthopaedical, Poitiers Hospital University, France; Faculty of Medicine and Pharmacy, University of Poitiers, France
| | - Antoine Dupuis
- Clinical Pharmacy, Poitiers Hospital University, France; Faculty of Medicine and Pharmacy, University of Poitiers, France
| | - Guillaume Binson
- Clinical Pharmacy, Poitiers Hospital University, France; Faculty of Medicine and Pharmacy, University of Poitiers, France
| | - Pauline Lazaro
- Clinical Pharmacy, Poitiers Hospital University, France.
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Hovey SW, Cho HJ, Kain C, Sauer HE, Smith CJ, Thomas CA. Pharmacist-Led Discharge Transitions of Care Interventions for Pediatric Patients: A Narrative Review. J Pediatr Pharmacol Ther 2023; 28:180-191. [PMID: 37303760 PMCID: PMC10249976 DOI: 10.5863/1551-6776-28.3.180] [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: 03/23/2022] [Accepted: 06/28/2022] [Indexed: 06/13/2023]
Abstract
Transitions of care (TOC) before, during, and after hospital discharge are an opportune setting to optimize medication management. The quality standards for pediatric care transitions, however, are lacking, leading to reduced health outcomes in children. This narrative review characterizes the pediatric populations that would benefit from focused, TOC interventions. Different types of medication-focused TOC interventions during hospital discharge are described, including medication reconciliation, education, access, and adherence tools. Various TOC intervention delivery models following hospital discharge are also reviewed. The goal of this narrative review is to help pediatric pharmacists and pharmacy leaders better understand TOC interventions and integrate them into the hospital discharge process for children and their caregivers.
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Affiliation(s)
- Sara W. Hovey
- Department of Pharmacy Practice (SWH), University of Illinois at Chicago, College of Pharmacy, Chicago, IL
| | - Hae Jin Cho
- Department of Pharmacotherapy (HJC), College of Pharmacy, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX
| | - Courtney Kain
- Department of Pharmacy (CK), Nemours Children's Hospital, Wilmington, DE
| | - Hannah E. Sauer
- Department of Pharmacy (HES), Texas Children's Hospital, Houston, TX
| | - Christina J. Smith
- Department of Pharmacy (CJS), Loma Linda University Children's Hospital, Loma Linda, CA
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Jantarathaneewat K, Camins B, Apisarnthanarak A. The role of the clinical pharmacist in antimicrobial stewardship in Asia: A review. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e176. [PMID: 36386007 PMCID: PMC9641507 DOI: 10.1017/ash.2022.310] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Clinical pharmacist-driven antimicrobial stewardship programs (ASPs) have been successfully implemented. Although relevant guidance and several studies suggest that clinical pharmacists be integrated into the current ASP team model, barriers still exist in Asia, primarily due to lack of dedicated personnel and lack of career advancement. We review the effectiveness and the ideal role of clinical pharmacist among ASPs in Asia. Several studies conducted in Asia have shown the effectiveness of pharmacist-led ASP interventions in hospitals and other healthcare settings. However, opportunities to expand the role of clinical pharmacists in ASPs in Asia exist in the implementation of rapid diagnostic test and drug allergies.
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Affiliation(s)
- Kittiya Jantarathaneewat
- Center of Excellence in Pharmacy Practice and Management Research, Faculty of Pharmacy, Thammasat University, Pathum Thani, Thailand
- Research Group in Infectious Diseases Epidemiology and Prevention, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Bernard Camins
- Division of Infection Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Anucha Apisarnthanarak
- Research Group in Infectious Diseases Epidemiology and Prevention, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
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Mahmood RK, Gillani SW, Alzaabi MJ, Gulam SM. Evaluation of inappropriate antibiotic prescribing and management through pharmacist-led antimicrobial stewardship programmes: a meta-analysis of evidence. Eur J Hosp Pharm 2021; 29:2-7. [PMID: 34848531 PMCID: PMC8717790 DOI: 10.1136/ejhpharm-2021-002914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose This meta-analysis aims to evaluate inappropriate antibiotic prescribing in the Gulf region and determine the effect of pharmacist-led antimicrobial stewardship (AMS) programmes on reducing inappropriateness. Method Articles were searched, analysed, and quality assessed through the risk of bias (ROB) quality assessment tool to select articles with a low level of bias. In step 1, 515 articles were searched, in step 2, 2360 articles were searched, and ultimately 32 articles were included by critical analysis. Statistical analysis used to determine risk ratio and standard mean differences were calculated using Review manager 5.4; 95% confidence intervals were calculated using the fixed-effect model. The I2 statistic assessed heterogeneity. In statistical heterogeneity, subgroup and sensitivity analyses, a random effect model was performed. The α threshold was 0.05. The primary outcome was inappropriateness in antibiotic prescribing in the Gulf region and reduction of inappropriateness through AMS. Result Detailed review and analysis of 18 studies of inappropriate antibiotic prescribing in the Gulf region showed the risk of inappropriateness was 43 669/100 846=43.3% (pooled RR 1.31, 95% CI 1.30 to 1.32). Test with overall effect was 58.87; in the second step 28 AMS programmes led by pharmacists showed reduced inappropriateness in AMS with pharmacist versus pre-AMS without pharmacist (RR 0.36, 95% CI 0.32 to 0.39). Conclusion Inappropriate antibiotic prescribing in the Gulf region is alarming and needs to be addressed through pharmacist-led AMS programmes.
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Affiliation(s)
- Rana Kamran Mahmood
- Gulf Medical University Ajman UAE, Ajman, UAE.,Pharmacy, Response Plus medical, Abu Dhabi, UAE
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Wong LH, Tay E, Heng ST, Guo H, Kwa ALH, Ng TM, Chung SJ, Somani J, Lye DCB, Chow A. Hospital Pharmacists and Antimicrobial Stewardship: A Qualitative Analysis. Antibiotics (Basel) 2021; 10:1441. [PMID: 34943655 PMCID: PMC8698014 DOI: 10.3390/antibiotics10121441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Antimicrobial stewardship programmes (ASPs) in hospitals are predominantly led by specific ASP physicians and pharmacists. Limited studies have been conducted to appreciate non-ASP-trained hospital pharmacists' perspectives on their roles in antimicrobial stewardship. Focus group discussions (FGDs) were conducted with 74 pharmacists, purposively sampled from the 3 largest acute-care public hospitals in Singapore, to explore facilitators and barriers faced by them in antimicrobial stewardship. Applied thematic analysis was conducted and codes were categorised using the social-ecological model (SEM). At the intrapersonal level, pharmacists identified themselves as reviewers for drug safety before dispensing, confining to a restricted advisory role due to lack of clinical knowledge, experience, and empowerment to contribute actively to physicians' prescribing decisions. At the interpersonal level, pharmacists expressed difficulties conveying their opinions and recommendations on antibiotic therapy to physicians despite frequent communications, but they assumed critical roles as educators for patients and their caregivers on proper antibiotic use. At the organisational level, in-house antibiotic guidelines supported pharmacists' antibiotic interventions and recommendations. At the community level, pharmacists were motivated to improve low public awareness and knowledge on antibiotic use and antimicrobial resistance. These findings provide important insights into the gaps to be addressed in order to harness the untapped potential of hospital pharmacists and fully engage them in antimicrobial stewardship.
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Affiliation(s)
- Lok Hang Wong
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore 308433, Singapore; (L.H.W.); (E.T.); (H.G.)
| | - Evonne Tay
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore 308433, Singapore; (L.H.W.); (E.T.); (H.G.)
- Infectious Disease Research and Training Office, National Centre for Infectious Diseases, Singapore 308443, Singapore;
| | - Shi Thong Heng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore 308433, Singapore; (S.T.H.); (T.M.N.)
| | - Huiling Guo
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore 308433, Singapore; (L.H.W.); (E.T.); (H.G.)
| | - Andrea Lay Hoon Kwa
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore;
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Tat Ming Ng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore 308433, Singapore; (S.T.H.); (T.M.N.)
| | - Shimin Jasmine Chung
- Department of Infectious Diseases, Singapore General Hospital, Singapore 169608, Singapore;
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Jyoti Somani
- Division of Infectious Diseases, National University Hospital, Singapore 119074, Singapore;
| | - David Chien Boon Lye
- Infectious Disease Research and Training Office, National Centre for Infectious Diseases, Singapore 308443, Singapore;
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore
| | - Angela Chow
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore 308433, Singapore; (L.H.W.); (E.T.); (H.G.)
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore
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