Clinical pharmacy definition, required education, training and practice in Saudi Arabia: A position statement by the Saudi society of clinical pharmacy

Exploration of 'micro' level factors that affect the involvement of clinical pharmacists in interprofessional ward rounds in hospitals: Through the lens of social cognitive theory

BACKGROUND

Macro and meso level factors that influence the participation by clinical pharmacists in ward rounds include pharmacy management culture, commitment to ward rounds and adequate time for ward rounds being included in workload models. The 'micro' level factors that affect the involvement of clinical pharmacists in ward rounds have not been widely explored.

OBJECTIVE

Explore 'micro' level factors to gain insight into clinical pharmacists' participation in interprofessional ward rounds in inpatient settings through the lens of social cognitive theory.

METHOD

A qualitative focused ethnographic study with five clinical pharmacists, four medical practitioners, one allied health professional and one nurse was conducted in three metropolitan hospitals in Southern Australia. Seven hours of semi-structured interview (n = 11) and 76-h of observations (n = 5) were conducted. A qualitative descriptive analysis was conducted (guided by Spradley) followed by reflexive thematic-analysis (according to Braun and Clarke's technique).

RESULTS

Three micro level factors influencing clinical pharmacist participation in ward rounds are: (1) Cognitive mindset of clinical pharmacists, (2) Behavioural conduct of clinical pharmacists, and (3) Social rules of the ward. Clinical pharmacists that did not participate in ward round reconciled their moral distress by transferring information without clinical judgement or interpretation of the patient scenario to medical practitioners. Clinical pharmacists that did participate in ward rounds demonstrated credibility by making relevant recommendations with a holistic lens. This enabled clinical pharmacists to be perceived as trustworthy by medical practitioners. Positive experiences of participating in ward rounds contributed to their cognitive upward spiral of thoughts and emotions, fostering continued participation.

CONCLUSION

Clinical pharmacists participate in ward rounds when they develop a positive mindset about ward round participation and perceive ward rounds as an enabler to the establishment of trusted professional relationships with medical practitioners. This trusted relationship creates an environment where the pharmacist develops confidence in making relevant recommendations.

The impact of Saudi Arabia - United States clinical pharmacy post-graduate training programs agreements on clinical pharmacy faculty in Saudi universities: A retrospective descriptive study focused on history and future recommendations

Background

There has been a growing demand for clinical pharmacy services in the Kingdom of Saudi Arabia (KSA) in the past 3 decades. The Ministry of Education has established agreements with several institutions in the United States to secure clinical pharmacy residency and research fellowship programs opportunities for Saudi scholars. The aims of this study were to describe the Saudi scholars' clinical pharmacy training pathways and their contribution to the pharmacy profession in KSA.

Methods

This is a retrospective, descriptive study conducted on clinical pharmacy faculty in governmental Saudi universities who graduated from the US until 2023. The study outcomes included the post-graduate year-1 (PGY-1) residency match rate, post-graduate year-2 (PGY-2) acceptance rate, the PGY-2 specialties of Saudi scholars, and the number of clinical pharmacy programs established in KSA.

Results

In total, 115 Saudi scholars have pursued clinical pharmacy pathway in the US. The PGY-1 residency match rate was 80 % (92/115). In contrast, the PGY-2 acceptance rate was 60.9 % (70/115). The most common PGY-2 specialty was in infectious diseases (N = 17; 24 %). Two pharmacy colleges had established residency programs and 1 pharmacy college had established a research fellowship.

Conclusion

The Ministry of Education's efforts for clinical pharmacy program agreements were fundamental for advancing clinical pharmacy in Saudi universities. A significant number of Saudi scholars returned to KSA with clinical pharmacy degrees. There are more opportunities for further development, including expanding the clinical pharmacy program collaboration in the US and increasing the number of residency and research fellowship positions in KSA.

Assessing the accuracy and consistency of ChatGPT in clinical pharmacy management: A preliminary analysis with clinical pharmacy experts worldwide

BACKGROUND

ChatGPT conversation system has ushered in a revolutionary new era of information retrieval and stands as one of the fastest-growing platforms. Clinical pharmacy, as a dynamic discipline, necessitates an advanced comprehension of drugs and diseases. The process of decision-making in clinical pharmacy demands accuracy and consistency in medical information, as it directly affects patient safety.

OBJECTIVE

The objective was to evaluate ChatGPT's accuracy and consistency in managing pharmacotherapy cases across multiple time points. Additionally, input was gathered from global clinical pharmacy experts, and the agreement between ChatGPT's responses and those of clinical pharmacy experts worldwide was assessed.

METHODS

A set of 20 cases of pharmacotherapy was entered into ChatGPT at three different time points. Reliability analysis was performed using inter-rater reliability to measure the accuracy of the output generated by ChatGPT at each time point. Test-retest reliability was performed to measure the consistency of the output generated by ChatGPT across the three time points. Pharmacy expert performance was evaluated, and the overall results were compared.

RESULTS

ChatGPT achieved a hit rate of 70.83% at week 1, 79.2% at week 3, and 75% at week 5. The percent agreement between weeks 1 and 3 was 79.2%, whereas it was 87.5% between weeks 3 and 5, and 83.3% between weeks 1 and 5. In contrast, accuracy rates among clinical pharmacy experts showed considerable variation according to their geographic location. The highest agreement between clinical pharmacist responses and ChatGPT responses was observed at the last time point examined.

CONCLUSIONS

Overall, the analysis suggested that ChatGPT is capable of generating clinically relevant pharmaceutical information, albeit with some variation in accuracy and consistency. It should be noted that clinical pharmacy experts worldwide may provide varying degrees of accuracy depending on their expertise. This study highlights the potential of AI chatbots in clinical pharmacy.

Knowledge, Attitude, and Perception of Health Care Providers Providing Medication Therapy Management (MTM) Services to Older Adults in Saudi Arabia

INTRODUCTION

Medication Therapy Management (MTM) is identified as a group of services provided to the patient in order to optimize the medication use in order to mitigate adverse drug reactions (ADRs), drug-drug interaction (DDI), and polypharmacy. Elderly populations above 60 years old are at high risk for Medication-related Problems (MRPs) due to several factors. Therefore, MTM programs showed good contributions globally regarding enhancing medication use in the elderly population. Thus, evident information regarding its implementation in Saudi Arabia is lacking in the literature.

OBJECTIVE

Our objective is to assess community pharmacists' knowledge, attitude, and barriers to providing MTM services to the older adult population in Saudi Arabia.

METHODOLOGY

A cross-sectional study has been conducted among community pharmacists across the Kingdom. It was survey-based research that was designed and conducted through (QuestionPro). The survey was distributed for the community pharmacists from Feb-May 2023 via (QuestionPro). Descriptive analysis was performed using SAS OnDemand to analyze the categorical variables and test it with the outcome of interest.

RESULTS

Out of the 528 participants who have viewed our questionnaire, 319 participants have completed the survey in 5 min average time. Most of our participants were male, holding a bachelor's degree, and had an average working load of more than 40 h a week, respectively (84.95%, 92.48%, and 76.18%). In addition, the participants were from different regions of the Kingdom, which enhanced the generalizability of our findings. Moreover, 65.52% have reported a higher level of knowledge, while 34.48% have reported a moderate to low level of knowledge regarding MTM service. Most of those with a higher level of knowledge maintain a positive attitude regarding MTM service, its implementation, and dealing with older adult patients in the community pharmacy. In addition, lacking the time, training, and presence of a private consultation room were the top barriers to provide MTM services in the community pharmacy in Saudi Arabia.

CONCLUSION

Educational sessions regarding MTM services among the older adult population are highly recommended for community pharmacists before its implementation.

Pharmacists' knowledge of drug food administration and their appropriate patient counseling a cross-sectional study from Palestine

Pharmacists have a responsibility in the treatment of patients. Interactions between food and drugs may lead to a loss of therapeutic effectiveness or drug toxicity. Our study's objectives were to assess pharmacists' knowledge of patient counseling with regard to informing the patient about taking the drug in relation to food, as well as community pharmacists' knowledge of any pharmaceutical instructions that must be given to patients when delivering the drug. The pharmacists were assessed using an interview questionnaire. The results showed a variation in the pharmacist's knowledge about the administration of the drug with food. The chief pharmacists had better knowledge of the proper food administration counseling than that of assistant pharmacists; the percentage of those who did not give the proper food counseling was 24 vs. 58%, respectively (P < 0.05). Only (21%) of pharmacists with more work experience provided proper counseling, while only 18.2 and 18.7% of pharmacists with moderate and low work experience provided proper counseling, respectively. The study showed the pharmacists' limited knowledge of drug administration with food and outdated counseling information. It is highly recommended that a continuous education system be encouraged and enforced by the ministry of health to update pharmacist's knowledge of dispensed drugs.

Clinical and economic impact of clinical oncology pharmacy in cancer patients receiving injectable anticancer treatments: a systematic review

PURPOSE

Clinical pharmacy can reduce drug-related iatrogenesis by improving the management of adverse effects of drugs, limiting drug-drug interactions, and improving patient adherence. Given the vulnerability of cancer patients and the toxicity of injectable anticancer drugs, clinical pharmacy service (CPS) could provide a significant clinical benefit in cancer care. This review aims to synthesize existing evidence on clinical pharmacy's impact on patients treated with intravenous anticancer drugs.

METHODS

A comprehensive search was performed in the PubMed/Medline database from January 2000 to December 2021, associating the keywords: clinical pharmacy, pharmaceutical care, pharmacist, oncology, and chemotherapy. To be eligible for inclusion, studies have to report clinical pharmaceutical services for patients treated with intravenous chemotherapy with a clinical and/or economic impact.

RESULTS

Forty-one studies met the selection criteria. Various CPS were reported: medication reconciliation, medication review, and pharmaceutical interview with patient. There was a lack of randomized study (n = 3; 7.3%). In one randomized controlled trial, pharmaceutical intervention significantly improved quality of life of patients receiving pharmaceutical care during injectable anticancer drugs courses. Economical results appear to show positive impact of clinical pharmacy with cost savings reported from 3112.87$ to 249 844€. Although most studies were non-comparative, they highlighted that clinical pharmacy tend to limit chemotherapy side effects and drug-related problems, improve quality of life and satisfaction of patients and healthcare professional, and a positive economic impact.

CONCLUSION

Clinical pharmacy can reduce adverse drug events in cancer patients. More robust and economic evaluations are still required to support its development in everyday practice.

Clinical pharmacists' participation in ward rounds in hospitals: responses from a national survey

OBJECTIVES

The inclusion of clinical pharmacists in ward rounds (WRs) can reduce adverse drug events, improve communication and enable collaborative decision-making. The aim of this study is to investigate the level of and factors that influence WR participation by clinical pharmacists in Australia.

METHODS

An online administered, anonymous survey of clinical pharmacists in Australia was conducted. The survey was open to pharmacists aged ≥18 years, who had worked in an Australian hospital in a clinical role in the previous two weeks. It was distributed via The Society of Hospital Pharmacists of Australia and on pharmacist-specific social media threads. Survey questions related to the extent of WR participation and factors that influence WR participation. Cross-tabulation analysis was conducted to determine whether there was an association between WR participation and factors that influence WR participation.

KEY FINDINGS

Ninety-nine responses were included. The level of WR participation by clinical pharmacists in Australian hospitals was low, with only 26/67 (39%) pharmacists who had a WR in their clinical unit actually attending the WR in the previous 2 weeks. Factors that influenced WR participation included having recognition of the role of the clinical pharmacist within the WR team, support from pharmacy management and the broader interprofessional team, and having adequate time and expectation from pharmacy management and colleagues to participate in WRs.

CONCLUSIONS

This study highlights the need for ongoing interventions such as restructuring workflows and increasing the awareness of the role of a clinical pharmacist in WR to increase participation of pharmacists in this interprofessional activity.

Assessment of Knowledge, Attitude and Practices of the Hospital and Community Pharmacists in Saudi Arabia (Jeddah) towards Inappropriate Medication Use in Older Adults

In Saudi Arabia, the older adult population is growing and is projected to increase three-fold by 2030. Potentially inappropriate medications (PIMs) are harmful to older adults' and have a direct impact on clinical, health and economic outcomes. Pharmacists have a vital role in medication tailoring for older adults as multidisciplinary team members. However, there is also a paucity of research regarding pharmacists' participation in detecting and avoiding PIMs use among older adults in Saudi Arabia. A cross-sectional, self-administered survey was conducted to assess the knowledge, practices, and attitude of pharmacists from seven hospitals and ten community pharmacies in Jeddah, Saudi Arabia. The survey comprised three sections; (i) identifying participants' general characteristics, (ii) assessing their knowledge of PIMs use in older adults and (iii) examining the pharmacist's attitude towards the procedures followed in dispensing for older adults. Inferential and descriptive statistics were used to analyse the survey data. A total of 157 community and hospital pharmacists participated in this study. Most of them dispensed medication weekly to older adults (85.4%), and 43.3% had relevant work experience of six to ten years. Though 44.6% of the participants were aware of PIMs that older adults should avoid, only 10.8% claimed adequate knowledge about PIMs. From the given three clinical case scenarios, a minority of pharmacists (21.7%) chose the correct answers, with a mean score of 2.38 ± 2.91 (95% CI 2.35-3.15). Participants who claimed to have knowledge of PIMs had a significantly higher mean score than those who did not, 4.59 ± 2.81 25 (95% CI 2.35-2.61). A minority of the pharmacists (14.7%) used screening tools such as STOPP, Beers criteria, or Medication Appropriateness Index (MAI) to detect PIMs in older adults. No statistically significant differences were detected when comparing the levels of knowledge of pharmacists with 1 to 5 years of practice to pharmacists with 6 to 15 and more years of experience (p = 0.431). Pharmacists' knowledge, attitude and practices toward PIMs use in older adults in Saudi Arabia should be improved. The application of PIMs detection tools such as STOPP/START or Beers criteria currently has no place in day-to-day pharmacists' roles in Saudi Arabia. Therefore, concerned stakeholders should develop educational programs to improve pharmacists' knowledge of PIMs and promote the effective use of PIM screening tools such as Beers and STOPP criteria in their practice.

Infectious diseases pharmacy practice, education, and research in Saudi Arabia: A review and future perspectives by the Infectious Diseases Pharmacy Specialty Network at the Saudi Society of Clinical Pharmacy

Background

Infectious diseases (ID) pharmacy is one of the rapidly evolving clinical pharmacy specialties in the Kingdom of Saudi Arabia (KSA). There are gaps in the literature on ID pharmacy status in KSA. This review aimed to provide an update on the current status of several areas related to ID pharmacy in KSA, including practice, education, and research, and make pertinent recommendations for future development to achieve the KSA Vision, 2030, KSA Vision, 2030.

Methods

This review was developed by a group of ID pharmacists working in different sectors under the umbrella of the ID Pharmacy Specialty Network (PSN) of the Saudi Society of Clinical Pharmacy (SSCP). The authors evaluated domains related to ID pharmacy in KSA and searched the literature for relevant articles. Based on the experts' assessment of the current gaps and challenges, recommendations were made for future improvement.

Results

Several aspects of ID pharmacy in KSA were evaluated, including history and development, antimicrobial resistance (AMR), antimicrobial stewardship programs (ASP), roles of ID pharmacists, ID pharmacy education, and research. The biggest challenges include AMR, the varying levels of ASP implementation, and the low number of ID-trained pharmacists, especially in non-major cities. Several recommendations for improvement were discussed.

Conclusion

Infectious diseases pharmacy has sustained remarkable progress in KSA in several areas. However, more efforts are needed to increase ASP implementation, increase the number of ID-trained pharmacists, and encourage ID pharmacists in publishing and participating in practice guidelines, which will eventually help achieve the KSA Vision, 2030, KSA Vision, 2030.

Assessing the Perception of Pharmacy Students on Launching a Doctor of Pharmacy/Master of Public Health Dual Degree Program in Saudi Arabia: A Multi-Institutional Cross-Sectional Study

There is a lack of Doctor of Pharmacy (PharmD) and Master of Public Health (MPH) dual degree programs in Saudi Arabia. This study aims to examine current pharmacy students’ perceptions regarding establishing such a program and the perceived limitations and advantages of pursuing such a degree. We conducted a cross-sectional web-based short survey to assess the feasibility of establishing a PharmD/MPH dual degree program in several randomly selected pharmacy schools in Saudi Arabia. Our cohort consisted of 657 students. Almost 56% were males, and nearly 58% were fourth-year pharmacy students. Close to 85% had a “very well” or “well” understanding regarding the pharmacist’s role in the public health area, and almost 70% stated that they see themselves playing a role in public health as a future pharmacist. Nearly 93% reported that they are either “very likely” or “likely” to enroll in such a program if given the opportunity. Almost 80% felt it would increase their job opportunities. On the other hand, close to 70% felt it would increase workload and stress. This study highlights pharmacy students’ positive perceptions regarding establishing a PharmD/MPH dual degree program in Saudi Arabia. The study results could be utilized as the starting point to propose and establish this program to health education policymakers in Saudi Arabia.

Pharmacy Practice Research in Saudi Arabia; A Bibliometrics Analysis from (2000 to 2021)

Background

Pharmacy is a growing profession in the Kingdom of Saudi Arabia which has experienced tremendous changes in the past 20 years. Pharmacy practice or clinical pharmacy have an attention ever since the emerging of PharmD programs throughout the Saudi universities. As a result, the number of affiliated faculty in the pharmacy practice departments has increased dramatically in the past 20 years and thus significant changes in research output were observed.

Objectives

The main objective is to conduct a bibliometric analysis and evaluate the research output of pharmacy practice faculty in Saudi Universities from 2000 to 2021

Methods

A systematic search was conducted using Scopus database to explore the research output from pharmacy practice affiliated faculty from 2000 to 2021. The following search terms AFFILORG (“Pharmacy Practice Department” OR “Department of Pharmacy practice” OR “Clinical Pharmacy Department” OR “Department of Clinical Pharmacy” OR “Department of Pharmacy Services”) AND AFFILCOUNTRY (“Saudi Arabia” OR “KSA” OR “Kingdom of Saudi Arabia”) were used. Only original research papers were retrieved and analyzed using MS Excel (v16.0), MS Access (v16.0), Bibexcel (v2017), VOS viewer, and Biblioshiny.

Results

In the past two decades, most publications with pharmacy practice departments affiliation were pharmacy practice research irrelevant (only 1075 out of 2809). King Saud University and King Abdulaziz University were the top performing institutes, and median of 5-year impact factor for journals was more than 3 for most of the top 10 institutes. 19% of the total retrieved articles were review publications were the rest majorly classified as cross-sectional studies.

Conclusion

The research contribution of pharmacy practice departments in Saudi Arabia has been improving. Key recommendations are to promote more applied and interventional research, increase publications in top journals, and enhance national collaborations.

Pharmacy education in Saudi Arabia: Achievements and challenges during the last two decades with a focus on Taif University as a case study

Basic expectation from graduates of any pharmacy program is to be able to provide pharmaceutical care at both patients and community levels, be able to solve problems arising during practice, be able to improve quality and outcomes of the services provided continuously and be able to respond effectively to patients and community changing needs. Pharmacy education in Saudi Arabia established in 1959 by founding the first college in Riyadh (King Saud University) followed by establishing two pharmacy colleges in Jeddah (King Abdulaziz University, 2001) and Abha (King Khalid University, 2001), then a college in Al Ahsa (King Faisal University, 2002), followed by four colleges three-years later in each of Buraydah (Qassim University, 2005), Madinah (Taibah University, 2005), Taif (Taif University, 2005) and Makkah (Umm Al-Qura University, 2005). Up to date the number of pharmacy colleges offering basic degrees in pharmacy are 21 governmental and eight privates. This review describes pharmacy education in Saudi Arabia, the historical perspective, current situation, and the important features. The report focuses on the changes during the last two decades covering three main aspects (1) Clinical education and training, (2) Research output, and (3) Quality and accreditation.