A cross-sectional survey to map Clinical Pharmacy Education and Practice in Europe

A cross-sectional survey of viral hepatitis education within pharmacy curricula in the United States

BACKGROUND

The Viral Hepatitis National Strategic Plan emphasizes the importance of a collaborative provider workforce trained in hepatitis prevention and treatment to eliminate viral hepatitis in the United States by 2030. Although pharmacists play a key role in hepatitis management, literature lacks documentation of the amount of viral hepatitis education provided to pharmacy students.

AIM

Our study goal was to describe viral hepatitis education provided at United States pharmacy schools.

METHOD

In this cross-sectional survey study, investigators developed a 19-item Qualtrics questionnaire, sent questionnaire links to curricula content experts at 140 accredited pharmacy colleges/schools in May-June 2022, and allotted 28 days for completion. Questions assessed the viral hepatitis instruction provided to students and hepatitis instructors' training/experience. We used descriptive statistics for analysis.

RESULTS

Forty-eight pharmacy institutions across 29 states/territories responded; 44% had 50-99 students/class, and 58% used lecture and discussion to provide required hepatitis education. Students received more lecture (average = 3.4 h, range 0.8-1.6 h/hepatitis topic) than discussion (average = 1.7 h, range 0.6-0.9 h/hepatitis topic), with the most time spent on hepatitis C, followed by hepatitis B virus. Respondents reported 93% of their instructors had post-graduate training/certifications and 67% worked in clinical settings with hepatitis patients.

CONCLUSION

Survey results demonstrate variability in hepatitis education across United States pharmacy curricula. Data offer stakeholders in hepatitis elimination efforts knowledge about the viral hepatitis education provided to Doctor of Pharmacy students. Future directions include consideration of implementation of minimum hepatitis education standards to further support work toward national hepatitis elimination.

Perceptions of formal pharmacy leadership on the social role of the profession and its historical evolution: A qualitative study

Background

In recent years, pharmaceutical professionalism has been questioned due to the social role of pharmacy, which is ambiguous in the literature. This raises questions about the purpose of the profession among pharmacists, despite the efforts of their professional organizations and formal leaders to consolidate the occupational status of the profession.

Objective

To understand the social role of pharmacy in Brazil through its historical evolution based on the perceptions of formal leaders of the profession.

Methods

A qualitative study was conducted between July 2020 and February 2021 with pharmacists who held leadership positions in formal and professional pharmacy organizations in Brazil. The data obtained from the interviews were submitted to content analysis.

Results

A total of 17 pharmacists participated in this study. The data analyzed presented perceptions about the social role of the pharmaceutical profession in Brazil, which promotes access to health through different means. These include the manager pharmacist, who facilitates access to public health policies; the caring pharmacist, who promotes health education and the rational use of medicines; and the technologist pharmacist, who researches, develops, and promotes access to safe and cost-effective medicines. The interviewees also discussed the evolution of this social role based on influential factors such as legislation, clinical movement, pharmaceutical education, labor market, behaviors, and attitudes of pharmacists.

Conclusion

In this study, pharmaceutical professionalism was conceptualized based on its social role, which should be centered on the patient. Understanding such issues is part of the evolutionary purpose of the profession in Brazil and should be encouraged in the behaviors and attitudes of pharmacists despite the challenges faced by the profession.

A cross-sectional study examining the nature and extent of interprofessional education in schools of pharmacy in the United Kingdom

BACKGROUND

Interprofessional education can prepare the workforce for collaborative practice in complex health and social care systems.

AIM

To examine the nature and extent of interprofessional education in schools of pharmacy in the United Kingdom.

METHOD

An online questionnaire was developed using systems theory, published literature and input from an interprofessional expert panel; it included closed and open-ended questions and a demographic section. Following piloting, it was distributed to 31 schools of pharmacy. Descriptive statistics were used for quantitative data, and a content analysis approach for qualitative data.

RESULTS

Ten schools of pharmacy responded. All reported delivering compulsory interprofessional education. Most (80%) reported an interprofessional steering group overseeing development. Formative and/or summative assessment varied depending on year of study. Mechanism and purpose of evaluation varied with respondents reporting Kirkpatrick Evaluation Model Levels 1-3 (100%; 80%; 70%). Two themes were identified: "Variation in Interprofessional Education Approaches and Opportunities" and "Factors Influencing Development and Implementation of Interprofessional Education". Formal teaching was mainly integrated into other modules; various pedagogic approaches and topics were used for campus-based activities. Respondents referred to planned interprofessional education during practice-based placements; some still at pilot stage. Overall, respondents agreed that practice-based placements offered opportunistic interprofessional education, but a more focused approach is needed to maximise student pharmacists' learning potential.

CONCLUSION

Most interprofessional education offered in undergraduate pharmacy curricula in the United Kingdom is campus-based; the nature and extent of which varies between programmes. Very few examples of practice-based activities were reported. Results may inform future interprofessional education curricular development.

Scope, content and quality of clinical pharmacy practice guidelines: a systematic review

BACKGROUND

Guidelines for pharmacy practitioners regarding various clinical pharmacy activities have been published in a number of countries. There is a need to review the guidelines and identify the scope of activities covered as a prelude to developing internationally acceptable common guidelines.

AIM

To review the scope of clinical pharmacy guidelines and assess the extent to which these guidelines conform to quality standards as per the AGREE II instrument.

METHOD

Medline, Embase, Guideline Central, International Pharmaceutical Abstracts, Google Scholar and Google (for grey literature) were searched for the period 2010 to January 2023. Guidelines which focused on any health care setting and any clinical pharmacy activity were included. Data were extracted and quality assessed independently by two reviewers using the English version of the AGREE II instrument.

RESULTS

Thirty-eight guidelines were included, mostly originating from Australia (n = 10), Ireland (n = 8), UK (n = 7) and USA (n = 5). Areas covered included medication reconciliation, medicines optimisation, medication management and transition of care. As per the AGREE II assessment, the highest score was obtained for the scope and purpose domain and the lowest score for rigour of development, mainly due to non-consideration of literature/evidence to inform guideline development.

CONCLUSION

Clinical pharmacy guidelines development processes need to focus on all quality domains and should take a systematic approach to guideline development. Guidelines need to further emphasise person-centred care and clinical communication. There is a scope to harmonise the guidelines internationally considering the diverse practices, standards and legislations across different geographies.

Bedside check of medication appropriateness (BED-CMA) as a risk-based tool for bedside clinical pharmacy services: A proof-of-concept study at the trauma surgery ward

Background

Bedside clinical pharmacy prevents drug-related problems, but is not feasible in many countries due to limited resources. Hence, clinical rules using structural information in the electronic health record can help identifying potentially inappropriate prescriptions (PIPs). We aimed to develop and implement a risk-based clinical pharmacy service and evaluate its impact on prescribing at the trauma surgery ward.

Methods

The proportion of residual PIPs per day, i.e. the number of PIPs that persisted up to 24 h after pharmacist intervention divided by the number of PIPs at T0, was evaluated before and after implementation of the intervention in an interrupted time series analysis. The pre-intervention cohort received usual pharmacy services, i.e. a 0.3 FTE clinical pharmacist trainee. Fifteen clinical rules, targeting antimicrobial, anticoagulant and analgesic therapy were implemented in the post-intervention period. The pre-intervention period was compared to two post-intervention scenarios: A) clinical rule alerts reviewed by a 0.3 FTE clinical pharmacist trainee; and B) clinical rule alerts reviewed daily for approximately 1 h by a clinical pharmacist trainee.

Results

Pre-intervention, a median proportion of 67% (range 0%-100%) residual PIPs per day was observed. Scenario A showed an immediate relative reduction of 14% (p = 0.72) and scenario B a significant immediate relative reduction of 85% (p = 0.0015) in residual PIPs per day. In scenario A, recommendations were provided for 19% of clinical rule alerts, of which 67% was accepted by the surgeon within 24 h. In scenario B, recommendations were given for 56% of alerts, of which 84% was accepted.

Conclusions

Using clinical rules is an effective approach to organize bedside clinical pharmacy services and improves prescribing at the trauma surgery ward. Advanced training and daily follow-up of the clinical rules are two requirements to be considered.

Clinical pharmacy services in mental health in Europe: a commentary paper of the European Society of Clinical Pharmacy Special Interest Group on Mental Health

A large proportion of the world's disease burden is attributable to mental illnesses. Although effective interventions are available, many patients still have limited access to evidence-based treatments. Aside from access, treatment gaps, including inappropriate medication selection and monitoring, are also routinely recognised. Mental health clinical pharmacists can help address these gaps and enable patients to receive optimised pharmaceutical care, particularly appropriate medication selection and monitoring. The European Society of Clinical Pharmacy (ESCP) Special Interest Group on Mental Health was established to improve standardised service provision in mental health settings across Europe. The Special Interest Group identified significant barriers (predominantly associated with reimbursement and position within the multidisciplinary team) to effective pharmaceutical care amongst those with mental illnesses. This commentary presents recommendations to address these gaps through improved mental health clinical pharmacy service provision.

Recommendations for wider adoption of clinical pharmacy in Central and Eastern Europe in order to optimise pharmacotherapy and improve patient outcomes

Clinical pharmacy as an area of practice, education and research started developing around the 1960s when pharmacists across the globe gradually identified the need to focus more on ensuring the appropriate use of medicines to improve patient outcomes rather than being engaged in manufacturing and supply. Since that time numerous studies have shown the positive impact of clinical pharmacy services (CPS). The need for wider adoption of CPS worldwide becomes urgent, as the global population ages, and the prevalence of polypharmacy as well as shortage of healthcare professionals is rising. At the same time, there is great pressure to provide both high-quality and cost-effective health services. All these challenges urgently require the adoption of a new paradigm of healthcare system architecture. One of the most appropriate answers to these challenges is to increase the utilization of the potential of highly educated and skilled professionals widely available in these countries, i.e., pharmacists, who are well positioned to prevent and manage drug-related problems together with ensuring safe and effective use of medications with further care relating to medication adherence. Unfortunately, CPS are still underdeveloped and underutilized in some parts of Europe, namely, in most of the Central and Eastern European (CEE) countries. This paper reviews current situation of CPS development in CEE countries and the prospects for the future of CPS in that region.

The Impact of Hospital Pharmacy Operation on the Quality of Patient Care

This paper presents the role, tasks, and place of a hospital pharmacy in the structure of the entire facility. The role of hospital drug management and pharmacy seems to be extremely important in providing patients with high-quality care. Particular emphasis was placed on the distribution systems of medicinal products and medical devices in the hospital. The advantages and disadvantages of the classical distribution system and modern systems such as unit-dose and multi-dose-and the most important differences between them-are presented. Difficulties related to implementing modern distribution systems in hospitals were also discussed. The information provided is presented in the context of the legal regulations in Poland.

Clinical pharmacy undergraduate education in China: a comparative analysis based on ten universities' training programs

BACKGROUND

In recent years, the scale of personnel training for clinical pharmacy professionals in China has expanded increasingly, however, the shortage of clinical pharmacists is still prominent. In 2018, the Ministry of Education of China released national standards for the teaching quality of undergraduate majors at regular colleges and universities, which has developed a core policy for undergraduate clinical pharmacy training. To explore the training methods for clinical pharmacy professionals in China and to promote the healthy and sustainable development of the clinical pharmacy education system. This study comparatively analyzed the training programs for clinical pharmacy undergraduates in China's ten universities, discussed training programs suitable for clinical pharmacy professionals in China.

METHODS

The clinical pharmacy education programs in these ten universities were obtained through official school websites or by interviewing relevant people, and then compared and analyzed.

RESULTS

The school with the largest number of courses and the most class hours in general courses is University A1 (34 courses, 1316 class hours), and the school with the most credits is University B1 (75.5 credits). The schools with the largest number of courses and the most class hours in the basic courses are University A1 (50 courses, 1997 class hours), and the schools with the most credits are University B3 and University B1 (105.5 credits). The schools with the largest number of courses in the core courses are University C1 (23 courses), and the school with the most credits and class hours is University B2 (51 credits, 914 class hours). The school with the most class hours in practical teaching is University B6 (1406 class hours), and the schools with the longest internship time are University A1 and University B6 (52 weeks).

CONCLUSIONS

There was substantial variation in programs. There remains a gap between the existing educational model and clinical training in pharmacy in China and developed countries. China should explore the most appropriate method for undergraduate education in clinical pharmacy based on studying foreign excellent educational models and the experience of China.

Incorporating 'reason for use' into the prescribing process of medication: a survey on the opinion of patients in Flanders, Belgium

Background

A longstanding debate exists about including a ‘reason for use’ on prescriptions for medication. Little is known, however, about patients’ opinions on this subject.

Methods

An internet-based questionnaire, consisting mainly of Likert scale questions, was distributed online to the general public in Belgium. Results from 1034 responses were analyzed using descriptive statistics.

Results

Opinions from patients toward including a ‘reason for use’ on medication prescriptions were generally positive. A clear majority of 62% increased to 74% after providing information about the possible link between indication and medication dose. A majority of the participants expressed a positive attitude regardless of the pathology involved, although sexually transmitted diseases were of greatest concern. Other important aspects differentiating the opinion positively was the transmission of this information in an electronic-only form and limiting it to the regular pharmacist excluding further use by third parties such as other pharmacies or insurance companies. Patients using multiple medicines and those frequenting the same pharmacy also had a more favorable opinion about including the reason for use. In addition, analysis of physician and pharmacist questionnaire responses, explicitly excluded from the main analysis, confirmed the known contrasting opinions in these subgroups.

Conclusions

Patients have strong support for transferring information on the ‘reason for use’ of their prescriptions to their regular pharmacy if this is done in a secure and privacy-conscious way enabling increased patient safety and improved pharmaceutical care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08596-w.