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Farghali AA, Borycki EM. A Preliminary Scoping Review of the Impact of e-Prescribing on Pharmacists in Community Pharmacies. Healthcare (Basel) 2024; 12:1280. [PMID: 38998815 PMCID: PMC11241554 DOI: 10.3390/healthcare12131280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
OBJECTIVE This scoping review aims to map the available literature and provide an overview of the published articles discussing the impact of electronic prescribing on medication errors and pharmacy workflow. METHODS The literature search was conducted using PubMed®, Web of Science®, and the Cochrane Database of Systematic Reviews®, as well as grey literature reports, using the search terms and related components of "pharmacists", "electronic prescribing", "medication errors", and "efficiency". The search included all articles that were published from January 2011 to September 2023. Twenty-two relevant articles were identified and fully reviewed, ten of which were included in this review. RESULTS Electronic prescribing (e-prescribing) provides a solution for some of the challenges that are associated with handwritten and paper prescriptions. However, the implementation of e-prescribing systems has been recognized as a source of new unforeseen medication errors in all the reviewed articles. Productivity in community pharmacies has been affected with receiving electronic prescriptions (e-prescriptions) and having to deal with the issues that arise from them. The pharmacists' interventions were not eliminated with e-prescriptions compared to other prescription formats. The most frequently reported reason for intervention was related to incomplete instructions in the field of directions of use. Other common challenges with e-prescriptions were related to missing information, quantity, inappropriate dose, dosage form, and drug. DISCUSSION This review demonstrates the scarcity of research about the impact of electronic prescribing on medication error and efficiency in community pharmacies. In the literature, most of the studies had mainly focused on hospital pharmacies. The literature search demonstrated that there are still some barriers to overcome with e-prescribing systems and that medication errors were not fully eliminated with e-prescriptions. New errors have been identified with e-prescriptions, all of which caused delays in processing, which affected the productivity of the pharmacy staff, and could have negatively impacted patients' safety if not properly resolved. CONCLUSION e-Prescribing solved some of the challenges associated with illegibility of handwritten prescriptions. However, more time is required to allow e-prescribing systems to mature. Further training for prescribers and pharmacists is also recommended before and after the implementation.
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Affiliation(s)
- Amr A Farghali
- School of Health Information Science, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Elizabeth M Borycki
- School of Health Information Science, University of Victoria, Victoria, BC V8P 5C2, Canada
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Alsahali S, Almutairi G, Aedh R, Alanezi S, Almutairi H, Anaam M, Alshammari M, Alhabib A, Alowayed A, Abdulsalim S. Perceptions of Community Pharmacists toward the National E-Prescribing Service (Wasfaty) and Exploring the Benefits and Challenges of the Service: A Descriptive Study from Qassim Region, Saudi Arabia. PHARMACY 2023; 11:152. [PMID: 37736924 PMCID: PMC10514789 DOI: 10.3390/pharmacy11050152] [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: 06/26/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Electronic prescribing systems (e-prescription) for medications have many benefits, including patient safety, increase in patient satisfaction, efficiency of pharmacy work, and quality of patient care. However, few studies have been conducted to evaluate the national e-prescription system "Wasfaty" service in Saudi Arabia, which was recently adopted. OBJECTIVE The aims of this study were to explore the benefits observed through the use of the system and most frequent challenges experienced by community pharmacists in the Qassim region of Saudi Arabia. METHODS This study was conducted using a descriptive survey on a web-based platform. The target population of the study included community pharmacists in the Qassim region of Saudi Arabia who worked in pharmacy chains utilizing the e-prescription service between September 2022 and November 2022. Descriptive statistics along with multiple ordinal regression were used for data analysis. RESULTS The study population consisted of 124 pharmacists, of which 62.9% (78/124) were males and 37.1% (46/124) were females. Most of the participants had a positive perception of the e-prescription system with regard to medication safety, with 68.6% (85/124) indicating that e-prescriptions reduce the risk of dispensing errors. However, 81.5% (101/124) did not agree that the e-prescription system resulted in a reduction in workload, and 70.2% (87/124) disagreed that the service increased patient satisfaction. CONCLUSIONS The results of this study indicated that the national e-prescription system has many benefits to healthcare employees and improves their work, particularly for patient safety, reducing medication errors, and improving the management of patient medications. The participants believe that there is a need to improve communication with prescribers, showing concern about the unavailability of some medications; thus, it is important for policymakers to encourage other pharmacy chains and suppliers to join the service to increase patient access to medications.
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Affiliation(s)
- Saud Alsahali
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, P.O. Box 5888, Unaizah 51911, Qassim, Saudi Arabia; (G.A.); (R.A.); (S.A.); (H.A.); (M.A.); (M.A.); (A.A.); (S.A.)
| | - Ghazwaa Almutairi
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, P.O. Box 5888, Unaizah 51911, Qassim, Saudi Arabia; (G.A.); (R.A.); (S.A.); (H.A.); (M.A.); (M.A.); (A.A.); (S.A.)
| | - Raghad Aedh
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, P.O. Box 5888, Unaizah 51911, Qassim, Saudi Arabia; (G.A.); (R.A.); (S.A.); (H.A.); (M.A.); (M.A.); (A.A.); (S.A.)
| | - Sarah Alanezi
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, P.O. Box 5888, Unaizah 51911, Qassim, Saudi Arabia; (G.A.); (R.A.); (S.A.); (H.A.); (M.A.); (M.A.); (A.A.); (S.A.)
| | - Hanan Almutairi
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, P.O. Box 5888, Unaizah 51911, Qassim, Saudi Arabia; (G.A.); (R.A.); (S.A.); (H.A.); (M.A.); (M.A.); (A.A.); (S.A.)
| | - Mohammed Anaam
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, P.O. Box 5888, Unaizah 51911, Qassim, Saudi Arabia; (G.A.); (R.A.); (S.A.); (H.A.); (M.A.); (M.A.); (A.A.); (S.A.)
| | - Mohammed Alshammari
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, P.O. Box 5888, Unaizah 51911, Qassim, Saudi Arabia; (G.A.); (R.A.); (S.A.); (H.A.); (M.A.); (M.A.); (A.A.); (S.A.)
| | - Abdulmalik Alhabib
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, P.O. Box 5888, Unaizah 51911, Qassim, Saudi Arabia; (G.A.); (R.A.); (S.A.); (H.A.); (M.A.); (M.A.); (A.A.); (S.A.)
| | - Abdullah Alowayed
- Department of Pharmaceutical Care, Alrass General Hospital, Qassim Health Cluster, P.O. Box 58883, Alrass 51921, Qassim, Saudi Arabia;
| | - Suhaj Abdulsalim
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, P.O. Box 5888, Unaizah 51911, Qassim, Saudi Arabia; (G.A.); (R.A.); (S.A.); (H.A.); (M.A.); (M.A.); (A.A.); (S.A.)
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Rude TA, Kelsch MP, Fingarson M, Eukel HN. Hello Operator? A Pharmacy Practice Simulation to Increase Student Confidence in Telephone Communication Skills. J Pharm Technol 2023; 39:16-22. [PMID: 36755753 PMCID: PMC9899963 DOI: 10.1177/87551225221135794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Communicating interprofessionally using the telephone is an essential skill within pharmacy practice. Student pharmacists' ability to perform this task effectively and efficiently may be hindered by generational changes, social anxiety, and very few opportunities to practice these skills. Objective: The purpose of this study was to develop and implement a simulation allowing students to practice interprofessional communication and assess the simulation's impact on students' confidence in providing pharmacy-related interventions to another health care professional via telephone. Methods: Faculty developed a simulation focused on interprofessional telephone communication. Baseline student information was collected to quantify pharmacy work experience in terms of practice setting, duration of employment, and skills. Presimulation and postsimulation surveys evaluated self-assessed telephone-related skills, attitudes, and confidence. Quantitative data were analyzed with descriptive statistics. Qualitative data were evaluated through a thematic analysis of students' reflective responses to 2 open-ended questions. Results: Of the 53 pharmacy students that participated in the simulation, 44 (83%) and 43 (81%) completed the anonymous presimulation and postsimulation surveys. Students significantly improved as reflected in the following response: "I have confidence in my ability to provide pharmacy-related interventions to another health care professional in a logical and concise manner via telephone call." Significant improvement also occurred in the ability to work independently, communicate an order change to another health care professional, justify recommendations, answer a drug information question, and discuss recommendations in a logical and concise manner. Conclusion: The simulation discussed in this article provided students an opportunity to practice interprofessional telephone communication in a low-risk environment and resulted in significant growth in confidence and skills.
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Affiliation(s)
- Tori A. Rude
- School of Pharmacy, North Dakota State
University, Fargo, ND, USA
| | | | | | - Heidi N. Eukel
- School of Pharmacy, North Dakota State
University, Fargo, ND, USA
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Clinical Pharmacy Services Enhanced by Electronic Health Record (EHR) Access: An Innovation Narrative. PHARMACY 2022; 10:pharmacy10060170. [PMID: 36548326 PMCID: PMC9781377 DOI: 10.3390/pharmacy10060170] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patient care in the community pharmacy setting is often hindered due to limited access to adequate patient health information (PHI). Various studies suggest that lack of access to PHI is a main reason for delay in pharmaceutical care, medication dispensing errors, and lacking interprofessional relationships between prescribers and pharmacists. Literature has shown that interprofessional collaboration and improved access to PHI can improve transitions of care and communication for pharmacists, but literature is sparse on implementation of electronic health record (HER) access within independent community pharmacies. METHODS This observational study follows implementation of HER access into a rural community pharmacy to enhance common clinical services carried out by pharmacy staff. Metrics include number of enhanced consultations by pharmacy staff, type of consultations provided, potential reimbursement, decreased need to follow up with other providers, potential for decreased time to treatment or refills, and aspects of EHR most utilized during search. RESULTS Two-hundred sixty three patients' profiles were assessed, with 164 (62.4%) deemed appropriate for EHR access and searching. Most interventions made were related to cardiovascular, endocrinologic, neuropsychiatric, and COVID-19 therapy medications. CONCLUSION EHR access in community pharmacy has the potential to improve both the quality and availability of clinical patient interventions through enhanced knowledge of PHI.
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Campbell C, Morris C, McBain L. Electronic transmission of prescriptions in primary care: transformation, timing and teamwork. J Prim Health Care 2021; 13:340-350. [PMID: 34937647 DOI: 10.1071/hc21050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION During the coronavirus disease 2019 (COVID-19) pandemic lockdown in New Zealand in March 2020, there was a rapid shift to virtual consultations in primary care. This change was supported by system adjustments to enable electronic transmission of prescriptions without a handwritten signature if they met certain security criteria. International research suggests potential for unintended consequences with such changes, so it is important to understand the effect on professional practice in New Zealand general practice and community pharmacy. AIM The purpose of this study was to undertake a preliminary exploration of the experiences of New Zealand general practitioners and community pharmacists when prescriptions are transmitted electronically directly from prescriber to pharmacy. METHODS Semi-structured interviews with a purposive sample of four pharmacists and four general practitioners gathered qualitative data about their experiences of the shift to electronic transmission of prescriptions. Participants' perceptions of effect on professional workflow, interprofessional interactions between general practitioners and pharmacists, and interactions with patients were explored. Interviews were audio-recorded, and the data analysed thematically using an inductive approach. RESULTS Four themes were identified: workflow transformation; mixed impact on interactions with patients; juggling timing and expectations; and new avenues for interprofessional communication (with some cul-de-sacs). DISCUSSION Both general practitioners and pharmacists experienced transformational changes to workflow. This was positive for general practitioners due to saved time and increased work flexibility. Pharmacists noted potential benefits but also some challenges. To fully reap teamwork benefits, more work is needed on managing the timing issues and patient expectations, and to refine the new modes of communication between health-care practitioners.
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Affiliation(s)
- Chloë Campbell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand; and Corresponding author.
| | - Caroline Morris
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Lynn McBain
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Implementation of a shared medication list in primary care - a controlled pre-post study of medication discrepancies. BMC Health Serv Res 2021; 21:1335. [PMID: 34903215 PMCID: PMC8670071 DOI: 10.1186/s12913-021-07346-8] [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: 06/11/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
Background Access to medicines information is important when treating patients, yet discrepancies in medication records are common. Many countries are developing shared medication lists across health care providers. These systems can improve information sharing, but little is known about how they affect the need for medication reconciliation. The aim of this study was to investigate whether an electronically Shared Medication List (eSML) reduced discrepancies between medication lists in primary care. Methods In 2018, eSML was tested for patients in home care who received multidose drug dispensing (MDD) in Oslo, Norway. We followed this transition from the current paper-based medication list to an eSML. Medication lists from the GP, home care service and community pharmacy were compared 3 months before the implementation and 18 months after. MDD patients in a neighbouring district in Oslo served as a control group. Results One hundred eighty-nine patients were included (100 intervention; 89 control). Discrepancies were reduced from 389 to 122 (p < 0.001) in the intervention group, and from 521 to 503 in the control group (p = 0.734). After the implementation, the share of mutual prescription items increased from 77 to 94%. Missing prescriptions for psycholeptics, analgesics and dietary supplements was reduced the most. Conclusions The eSML greatly decreases discrepancies between the GP, home care and pharmacy medication lists, but does not eliminate the need for medication reconciliation.
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Informing collaborative relationships between community pharmacists and health care professionals in primary care practices. J Am Pharm Assoc (2003) 2021; 61:778-784.e1. [PMID: 34303615 DOI: 10.1016/j.japh.2021.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/02/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Collaborative relationships between community pharmacists and health care professionals in primary care practices can assist with the provision of medication and disease management services in community pharmacy settings. OBJECTIVES The objective was to describe the attitudes of providers working in primary care practices with on-site pharmacist collaborators to understand how to facilitate similar collaborations with pharmacists in community pharmacy settings. METHODS This qualitative study was conducted among physicians, nurse practitioners, and nurses of 3 primary care practice sites in the Commonwealth of Pennsylvania. A demographic survey and a semistructured interview were conducted to elicit feedback on participant perceptions about building relationships with community pharmacists. Interviews were audio-recorded and transcribed. A qualitative analysis was performed to identify emerging themes using an inductive approach. Demographic data were summarized using descriptive statistics. This study was approved by the University's Institutional Review Board. RESULTS Nineteen interviews were conducted. Fifty-eight percent of participants were physicians and 68% were female with a mean age of approximately 46 years. Five themes were identified: (1) Pharmacists were highly valued and were effective team members to promote coordination of medication-related care; (2) Direct access to pharmacists facilitates efficient communication and effective patient care; (3) Trust is the foundation of an effective collaboration between pharmacists and providers; (4) Pharmacists demonstrating responsibility for patients enables collaboration with providers who view themselves as stewards of patient care; and (5) Providers believe that community pharmacists' dispensing requirements may limit their ability to participate in patient care. CONCLUSIONS The following strategies to establish relationships with primary care practices are suggested: pharmacists should initiate face-to-face relationships with providers in practices; communication and patient interventions should be conveyed directly to providers and be conducted by the same person; and pharmacists need to demonstrate their commitment to patient care by following up promptly on patient interventions.
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Adie K, Fois RA, McLachlan AJ, Chen TF. Medication incident recovery and prevention utilising an Australian community pharmacy incident reporting system: the QUMwatch study. Eur J Clin Pharmacol 2021; 77:1381-1395. [PMID: 33646375 DOI: 10.1007/s00228-020-03075-9] [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: 07/26/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To identify factors in community pharmacy that facilitate error recovery from medication incidents (MIs) and explore medication safety prevention strategies from the pharmacist perspective. METHODS Thirty community pharmacies in Sydney, Australia, participated in a 30-month prospective incident reporting program of MIs classified in the Advanced Incident Management System (AIMS) and the analysis triangulated with case studies. The main outcome measures were the relative frequencies and patterns in MI detection, minimisation, restorative actions and prevention recommendations of community pharmacists. RESULTS Participants reported 1013 incidents with 831 recovered near misses and 165 purported patient harm. MIs were mainly initiated at the prescribing (68.2%) and dispensing (22.6%) stages, and most were resolved at the pharmacy (76.9%). Detection was efficient within the first 24 h in 54.6% of MIs, but 26.1% required one month or longer; 37.2% occurred after the patient consumed the medicine. The combination of specific actions/attributes (85.5%), appropriate interventions (81.6%) and effective communication (77.7%) minimised MIs. An array of remedial actions were conducted by participants including notification, referral, advice, modification of medication regimen, risk management and documentation corrections. Recommended prevention strategies involved espousal of medication safety culture (97.8%), better application of policies/procedures (84.6%) and improvements in healthcare providers' education (79.9%). CONCLUSION Incident reporting provided insights on the human and organisational factors involved in the recovery of MIs in community pharmacy. Optimising existing safeguards and redesigning certain structures and processes may enhance the resilience of the medication use system in primary care.
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Affiliation(s)
- Khaled Adie
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Romano A Fois
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy F Chen
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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From Paper to E-Prescribing of Multidose Drug Dispensing: A Qualitative Study of Workflow in a Community Care Setting. PHARMACY 2021; 9:pharmacy9010041. [PMID: 33669475 PMCID: PMC7931093 DOI: 10.3390/pharmacy9010041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 01/28/2023] Open
Abstract
E-prescribing is now widespread and, in some countries, has completely replaced paper prescriptions. In Norway, almost all prescribing is electronic, except for multidose drug dispensing (MDD), which is still sent to the pharmacy by fax or ordinary mail. MDD is an adherence aid used by one-third of all patients receiving home care services. In this paper, we present results from a qualitative study evaluating the introduction of e-prescribing for MDD in a community health care setting. The focus is on the work and workflow for the pharmacists and nurses involved in the medication-handling process. We used the pragmatic process evaluation framework and the systematic text condensation method to analyse the data. We conducted 12 interviews with 34 nurses and pharmacists. This study shows that the e-prescribing of MDD led to greater integration between systems, both within the existing MDD system and across care levels, potentially improving patient safety. However, the structured prescriptions increased the need for clarifications, resulting in an increased overall workload. A greater understanding of the roles and responsibilities of the different professionals in the medication management chain and their needs would improve the workflow of the nurses and pharmacists involved.
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Vik S, Weidemann P, Gangås IEM, Knapstad SE, Haavik S. Pharmaceutical interventions on prescriptions in Norwegian community and hospital pharmacies. Int J Clin Pharm 2020; 43:872-877. [PMID: 33155093 PMCID: PMC8352812 DOI: 10.1007/s11096-020-01188-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/26/2020] [Indexed: 12/31/2022]
Abstract
Background Pharmacists in community and hospital pharmacies assess prescriptions to prevent prescription errors and adverse drug events. There are, however, few reports on prevalence of clinical important pharmaceutical interventions for patients located within primary care. Objective To study documented pharmaceutical interventions on prescriptions in Norwegian pharmacies for patients located in primary care. Setting Data were collected in 11 community pharmacies during a 3 months period in 2016, and the outpatient department of four hospital pharmacies in Norway during a 6 months period of 2018. Method Retrospective analysis of electronically documented pharmaceutical interventions on prescriptions for patients located in primary care. Main outcome measure The number and classification of pharmaceutical interventions in relation to the total number of prescriptions. Results An intervention was documented in 124,178 (45.1%) of the 275,339 prescriptions dispensed during the study period. Interventions of potential clinical importance were performed and documented in 0.8% (2262) of the prescriptions. Conclusion A substantial number of pharmaceutical interventions are performed on prescriptions in Norwegian pharmacies after introduction of electronic prescriptions. A potentially clinical important intervention is performed in one of every 125 prescriptions (0.8%). This result indicates that pharmacists at Norwegian pharmacies prevent more than 400,000 prescription errors of potential clinical importance each year.
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Affiliation(s)
- Steinar Vik
- Department of Quality and Development, Hospital Pharmacies Enterprise in Western Norway, Bergen, Norway
| | | | | | - Stein-Erik Knapstad
- Department of Quality and Development, Hospital Pharmacies Enterprise in Western Norway, Bergen, Norway
| | - Svein Haavik
- Centre for Pharmacy, Department of Clinical Science, University of Bergen, Bergen, Norway.
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Barnett BS, Bodkin JA. A Survey of American Psychiatrists Concerning Medication Prior Authorization Requirements. J Nerv Ment Dis 2020; 208:566-573. [PMID: 32604163 DOI: 10.1097/nmd.0000000000001171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined opinions of American psychiatrists regarding prior authorization (PA) requirements for third-party payer coverage of medications and quantified perceived impact of these requirements on clinical practice. One thousand selected psychiatrist members of the American Psychiatric Association were invited to participate in a survey. Response rate was 33.1%. Respondents predominantly believed the obligation to obtain PA reduces job satisfaction and negatively impacts patient care. A total of 59.9% of respondents reported employing either diagnosis modification or falsification of previous medication trials at least occasionally in order to obtain PA. A total of 66.6% refrained at least occasionally from prescribing preferred medications due to PA requirement or expectation of one. On multivariate analysis, risk factors for refraining at higher frequency included seeing 300 or more patients in the previous 3 months, engaging more frequently in diagnosis modification, and reporting increased perception that obtaining PA reduces time for patient care.
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Affiliation(s)
- Brian S Barnett
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Alaula LS, Al-Kadi M, Almajed A, Alhedaithy R. Atropine toxicity caused by erroneous intranasal administration in a pediatric patient: case report. Ann Saudi Med 2019; 39:279-282. [PMID: 31381360 PMCID: PMC6838643 DOI: 10.5144/0256-4947.2019.279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/24/2019] [Indexed: 11/22/2022] Open
Abstract
A 28-month-old boy mistakenly received intranasal atropine sulfate instead of Otrivin (xylometazoline hydrochloride) for the treatment of adenoid hypertrophy. Later on, he came to the emergency department with anticholinergic manifestations after the administration of multiple drops. The child presented with a tonic-clonic seizure lasting for a few minutes, followed by a brief loss of consciousness, vomiting, agitation, and irritability, all of which were stabilized by a dose of intravenous lorazepam. Subsequently, he was admitted to the pediatric intensive care unit for observation. Afterwards, he developed agitation and unsteady gait, both of which resolved after receiving neostigmine. Eventually, the child became asymptomatic and was discharged home. To the best of our knowledge, only one similar case has been reported in the literature. SIMILAR CASES PUBLISHED: 1.
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Affiliation(s)
- Lama S. Alaula
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammad Al-Kadi
- From the Department of Surgery, Division of Otorhinolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah Almajed
- From the Department of Surgery, Division of Otorhinolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Riyadh Alhedaithy
- From the Department of Surgery, Division of Otorhinolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Community pharmacists’ lack of access to health records and its impact on targeted MTM interventions. J Am Pharm Assoc (2003) 2019; 59:S81-S84. [DOI: 10.1016/j.japh.2019.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 11/17/2022]
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Bauer M, Monteith S, Geddes J, Gitlin MJ, Grof P, Whybrow PC, Glenn T. Automation to optimise physician treatment of individual patients: examples in psychiatry. Lancet Psychiatry 2019; 6:338-349. [PMID: 30904127 DOI: 10.1016/s2215-0366(19)30041-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 12/12/2018] [Accepted: 01/16/2019] [Indexed: 12/12/2022]
Abstract
There is widespread agreement by health-care providers, medical associations, industry, and governments that automation using digital technology could improve the delivery and quality of care in psychiatry, and reduce costs. Many benefits from technology have already been realised, along with the identification of many challenges. In this Review, we discuss some of the challenges to developing effective automation for psychiatry to optimise physician treatment of individual patients. Using the perspective of automation experts in other industries, three examples of automation in the delivery of routine care are reviewed: (1) effects of electronic medical records on the patient interview; (2) effects of complex systems integration on e-prescribing; and (3) use of clinical decision support to assist with clinical decision making. An increased understanding of the experience of automation from other sectors might allow for more effective deployment of technology in psychiatry.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany.
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Michael J Gitlin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Paul Grof
- Mood Disorders Center of Ottawa, ON, Canada; Department of Psychiatry, University of Toronto, ON, Canada
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
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Trovato A, Choudhary K, Fox ER. Development and implementation of a strategy to ensure outpatient access to medications started in the inpatient setting. Am J Health Syst Pharm 2019; 76:334-335. [PMID: 30689696 DOI: 10.1093/ajhp/zxy056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Kavish Choudhary
- Inpatient and Infusion Pharmacy Services University of Utah Health Salt Lake City, UT
| | - Erin R Fox
- Drug Information and Support Services University of Utah Health Salt Lake City, UT
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Curran GM, Freeman PR, Martin BC, Teeter BS, Drummond KL, Bradley K, Thannisch MM, Mosley CL, Schoenberg N, Edlund M. Communication between pharmacists and primary care physicians in the midst of a U.S. opioid crisis. Res Social Adm Pharm 2018; 15:974-985. [PMID: 30170901 DOI: 10.1016/j.sapharm.2018.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/11/2018] [Accepted: 08/09/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Effective communication between prescribers of opioids and community pharmacists can contribute to maximizing appropriate pain management and reducing opioid misuse and diversion. While much of the education and training available on reducing opioid misuse and diversion stresses the importance of interprofessional communication between prescribers and pharmacists, few studies have been explored those communication patterns directly. OBJECTIVE The objectives of this manuscript are to present and explore key emergent themes from a qualitative study around the nature, frequency, and content of communication between primary care physicians (PCPs) and pharmacists focusing on opioids. METHODS Interviews were conducted with 48 PCPs and 60 community pharmacists across four states in the U.S.: Washington, Idaho, Kentucky and Arkansas. RESULTS Convergent results from both samples indicated that the content of communication usually centers on questions of dosing, timing of the prescription, and/or evidence of potential misuse/diversion. When communication was focused on relaying information about a patient and/or clarifying questions around the prescription, it appeared positive for both parties. Results also indicated that close physical proximity between PCPs and dispensing pharmacists contributed to more positive and useful communication, especially when the clinics and pharmacies were part of the same healthcare system. Many pharmacists reported hesitancy in "questioning" a physician's judgement, which appeared related to commonly held beliefs of both pharmacists and physicians about the respective roles of each in providing patient care. Pharmacists reported difficulty in reaching PCPs for discussion, while PCPs reported it was easy to reach pharmacists. CONCLUSIONS Physician and pharmacist communication around opioids can be mutually beneficial. When prescribers and pharmacists are co-located, higher levels of trust and teamwork are reported, which in turn seems to be related to more open and positive communication. Additional research is needed to identify interventions to increase mutually-valued communication that improves the quality of decision-making around opioids.
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Affiliation(s)
- Geoffrey M Curran
- University of Arkansas for Medical Sciences, 4301 West Markham St., #522-4, Little Rock, AR, 72205-7199, United States; Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, 72114, United States.
| | - Patricia R Freeman
- University of Kentucky, College of Pharmacy, 789 South Limestone Street, Lexington, KY, 40536, United States
| | - Bradley C Martin
- University of Arkansas for Medical Sciences, 4301 West Markham St., #522-4, Little Rock, AR, 72205-7199, United States
| | - Benjamin S Teeter
- University of Arkansas for Medical Sciences, 4301 West Markham St., #522-4, Little Rock, AR, 72205-7199, United States
| | - Karen L Drummond
- University of Arkansas for Medical Sciences, 4301 West Markham St., #522-4, Little Rock, AR, 72205-7199, United States; Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, 72114, United States
| | - Katharine Bradley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1466, United States
| | - Mary M Thannisch
- University of Arkansas for Medical Sciences, 4301 West Markham St., #522-4, Little Rock, AR, 72205-7199, United States
| | - Cynthia L Mosley
- University of Arkansas for Medical Sciences, 4301 West Markham St., #522-4, Little Rock, AR, 72205-7199, United States
| | - Nancy Schoenberg
- University of Kentucky, College of Pharmacy, 789 South Limestone Street, Lexington, KY, 40536, United States
| | - Mark Edlund
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, United States
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17
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Implementation of a medication therapy management collaborative within a pediatric health system. J Am Pharm Assoc (2003) 2018; 58:S114-S119. [DOI: 10.1016/j.japh.2018.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 04/10/2018] [Accepted: 04/10/2018] [Indexed: 11/22/2022]
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18
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Castronovo A, Gervais F, Mongaret C, Slimano F. Pharmacists' interventions on prescription problems in one French community pharmacy: A prospective pilot study. ANNALES PHARMACEUTIQUES FRANÇAISES 2018; 76:299-305. [PMID: 29555106 DOI: 10.1016/j.pharma.2018.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES While many international studies widely describe pharmacists' interventions (PIs) on drug-related problems (DRP) in community pharmacies, in France, these activities are underreported. The aim of this study is to describe the PI rate, given as the number of interventions in among all prescriptions reviewed during the study period. MATERIAL AND METHODS This study was conducted in one French rural community pharmacy during a 7-month period. Age, sex, type of prescriber, type of problems, intervention and the outcome were prospectively recorded. PIs were prospectively formalized and classified using the validated tool from the French Society of Clinical Pharmacy. In addition, all interventions were reviewed by an independent pharmacist. RESULTS Among the 20,238 prescriptions, n=211 pharmacists' interventions on 159 prescriptions (0.79%) were performed. Prescriptions were ordered by general practitioners in 78.6%. The most common DRP were the improper prescription (30.8%), a drug or medical device not received by the patient (21.8%, all linked to drug shortages) or a dosage problem (18.9%). Antibiotics were the most common drugs involved in DRP (13.3%). The main PI were the drug switch/establishment of a therapeutic alternative (38.4%), dose adjustment (25.6%) and optimization of the dispensing/administration modalities (25.1%). The overall acceptance rate of PIs was 93.4%. CONCLUSION We found a PI rate, as well as acceptance rate by prescribers, in the same range than as reported in studies performed in other countries. A consequent large part percentage of PIs can be classified as "administrative". This first prospective French study needs to be further supported by multi-site studies.
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Affiliation(s)
- A Castronovo
- Ferrieres' Pharmacy, 82, rue de Ferrières, 76220 Gournay-en-Bray, France
| | - F Gervais
- Pharmacy, Edouard-Herriot Hospital, 5, place d'Arsonval, 69003 Lyon, France
| | - C Mongaret
- Faculty of Pharmacy, Reims University, 51, rue Cognacq-Jay, 51100 Reims, France; Department of Pharmacy, CHU de Reims, avenue du Général-Koenig, 51100 Reims, France
| | - F Slimano
- Faculty of Pharmacy, Reims University, 51, rue Cognacq-Jay, 51100 Reims, France; Department of Pharmacy, CHU de Reims, avenue du Général-Koenig, 51100 Reims, France.
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