The changing face of pharmacy practice and the need for a new model of pharmacy education

Effectiveness of pharmacist-led antimicrobial stewardship programs in perioperative settings: A systematic review and meta-analysis

OBJECTIVE

We sought to characterize and evaluate the effectiveness of pharmacist-led AMS interventions in improving antimicrobial use and subsequent surgical site infections (SSI) in perioperative settings.

METHODS

A systematic review and meta-analysis was conducted by searching PubMed, Embase and CINAHL. Two independent reviewers extracted the data using the Descriptive Elements of Pharmacist Intervention Characterization Tool and undertook quality assessment using the Crowe Critical Appraisal. A meta-analysis was conducted using a random-effect model.

RESULTS

Eleven studies were included in this review. Pharmacists were found to have various roles in AMS, including educational sessions, ward rounds, audits and feedback, and guidelines development. The discussion of interventions lacked details on the development. A meta-analysis revealed that pharmacist-led AMS programs in perioperative settings was associated with a significant improvement in antibiotic selection (OR 4.29; 95 % CI 2.52-7.30), administration time (OR 4.93; 95 % CI 2.05-11.84), duration (OR 5.27; 95 % CI 1.58-17.55), and SSI (OR 0.51; 95 % CI 0.34-0.77).

CONCLUSION

Pharmacist-led AMS programs were effective in improving antimicrobial prescribing while reducing SSI; however most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions, therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. High-quality, multicomponent, theory-derived, interventional studies using appropriate methodology and standardized data collection, are needed.

The impact of artificial intelligence on the knowledge, attitude, and practice of pharmacists across diverse settings: A cross-sectional study

The pharmacy practice landscape is undergoing a significant transformation with the increasing integration of artificial intelligence (AI). As essential members of the healthcare team, pharmacists' readiness and willingness to adopt AI technologies is critical. This cross-sectional study explores pharmacists' knowledge, attitudes, and practices (KAP) regarding AI in various practice settings. Utilizing a descriptive survey methodology, we collected data through a structured questionnaire targeting pharmacists across diverse working environments. Statistical analyses were conducted to calculate KAP scores. Results revealed that 44.8 % of participants possessed a moderate level of knowledge about AI, while 49.1 % expressed positive attitudes toward its potential applications in pharmacy. However, their current practices related to AI were rated as adequate (57.3 %). Notably, a significant association was found between knowledge, attitudes, and practices (p < 0.001). This study provides valuable insights into pharmacists' readiness to incorporate AI into their practice, emphasizing the need for targeted educational interventions to enhance knowledge and promote positive attitudes. Furthermore, efforts must be directed towards facilitating the integration of AI into pharmacy workflows to fully leverage this transformative technology and improve patient care outcomes.

Barriers to pharmaceutical care provision in the community and hospital pharmacies of Motta town, Northwest Ethiopia: a cross-sectional study

BACKGROUND

Although pharmaceutical care has tangible positive importance in ensuring patient pharmacotherapy safety, its provision encounters several barriers. Therefore, this study investigated the obstacles pharmacy professionals faced while providing pharmaceutical care in Motta town, Northwest Ethiopia.

METHODS

A cross-sectional study was conducted from July 30, 2022, to August 30, 2022, at all community and hospital pharmacies in Motta town, Northwest Ethiopia. The data were collected via a self-administered questionnaire and analyzed via SPSS version 26.0. Descriptive statistics and statistical analysis tests, such as the independent t-test, variance, and multiple linear regressions, were employed to analyze the data.

RESULTS

The study had a 97.7% response rate. Among the 130 participants, 71 (54.6%) were females. The mean (± SD) total score of pharmaceutical care provision barriers was 85.06 (± 20.2). The highest and lowest mean subscale scores of pharmaceutical care provision barriers were related to lack of resources and skill, respectively. Among resource-related barriers, lack of time and money, lack of trained staff, and lack of private space for consultation scored higher than other barriers. Concerning vision/attitudinal barriers, patients and other healthcare workers' inappropriate attitudes toward pharmaceutical care obtained the highest scores. The lack of clinical education in pharmaceutical care, lack of communication, and lack of documentation skills of pharmacists scored higher than other barriers in the educational and skill-related barriers subscales. For the regulatory/environmental subscale, a lack of clinical practice guidelines and legal barriers scored higher than the other subscales did. Pharmaceutical care provision barriers were significantly associated with age (B = 14.008), years of practice (B = 13.009), and graduating institution (B=-16.773).

CONCLUSIONS

Resource and attitudinal/vision-related barriers were reported to be the most common barriers to pharmaceutical care implementation. Stakeholders should work together to develop strategic solutions to overcome these barriers and thus achieve optimal pharmaceutical care provision. These strategies should include optimizing the number of trained pharmacy staff, time and financial problems should be resolved, communication and documentation skills should be improved, pharmacy layouts should incorporate private counseling rooms, policies that support the pharmacist's role in patient care should be developed, and effective training and continuing professional education programs should be offered.

Developing and validating development goals towards transforming a global framework for pharmacy practice

INTRODUCTION

In light of the expanding role of pharmacy in addressing global health challenges of Universal Health Coverage, advancing pharmacy practice to provide more effective pharmaceutical services has become imperative. This study aims to develop and validate a global goals-oriented pharmaceutical development framework to support and guide a systematic practice transformation that can widen access to better health for all.

METHODS

A mixed methods approach was used to conduct a series of exploration, development, and consensus phases. The exploratory stage included desk research focused on innovative pharmaceutical provision globally. Focus groups with 14 international pharmacists were held, selected via convenience sampling, to obtain primary data on perceptions of the proposed global FIP "Development Goals" framework. The consultation stage was followed by a modified nominal group technique (mNGT) with 61 global pharmacy leaders from 35 countries across six WHO regions, selected through purposive sampling, to further develop the content of the framework's first iteration. Lastly, an online two-round modified Delphi approach with 28 global pharmacy leaders, also selected via purposive sampling, was used to ensure the credibility and content validity of the outputs, generating consensus on the final framework matrix.

RESULTS

The exploratory stage produced a draft set of 13 unvalidated FIP Practice Development Goals (DGs) Framework (v0). Initial analysis of the mNGT showed complex intersections between the proposed set of goals, necessitating further modifications by embedding the previously published global Pharmaceutical Workforce Development Goals framework. This resulted in an amended FIP DGs Framework (v1) with 21 DGs. The evidence-led adjustment and distinctive format of the global consensus stage helped generate the validated, systematic FIP DGs Framework (final version), comprising 21 discrete global development goals ready for policy deployment.

CONCLUSION

A systematic goals-oriented development framework was developed to respond to pharmaceutical development needs and support a needs-based roadmap for a sustainable pharmacy practice transformation globally, regionally and nationally.

Pharmacy professionals' understanding, attitude and practice toward pharmaceutical care in Motta town, Northwest Ethiopia: A cross-sectional study

Objective

Although pharmaceutical care provision is the primary goal of the pharmacy profession, its actual implementation has been lacking in developing nations. Therefore, this study investigated pharmacy professional's understanding, attitudes, and practice toward pharmaceutical care.

Methods

A cross-sectional study was conducted from 30 July 2022 to 30 August 2022, at all community and hospital pharmacies in Motta town, Northwest Ethiopia. Data were gathered using a self-administered questionnaire and analyzed using SPSS version 26.0. A logistic regression model with a p-value of 0.05 and a 95% confidence interval was applied to identify factors associated with understanding, attitude, and practice.

Result

The study had a 97.7% response rate. Of the 130 participants, 71 (54.6%) were females. Slightly more than half (56.2%) of the participants were aware of the aim (56.2%) of pharmaceutical care and responsibilities (56.9%) of pharmacy professionals in the pharmaceutical care process. However, most participants lack awareness of the similarities and differences between clinical pharmacy and pharmaceutical care. Concerning their attitude, most participants (66.9%) believed that pharmaceutical care provision should be the primary responsibility of pharmacy professionals, and it will benefit patients (61.6%) and the healthcare system (60.8%). Pharmacy professionals frequently evaluate their patients and identify health or drug therapy-related problems and potentially available therapeutic alternatives. However, they rarely engaged in any health screening activities or provided feedback to the doctor on the patient's progress. Training status, sex, and years of practice/understanding were significantly related to pharmacy professionals' level of understanding, attitudes, and practice toward pharmaceutical care, as both years of practice and understanding are related to practice.

Conclusion

Our study revealed a deficit in pharmacy professionals' understanding, attitude, and practice toward pharmaceutical care in Motta town, Northwest Ethiopia. Policymakers, health authorities, and educational institutions should work together to develop strategies and instructional initiatives that optimize pharmaceutical care provision and thus achieve optimal patient outcomes and lower healthcare costs.

Validation of a Questionnaire to Assess Patient Satisfaction with an Automated Drug Dispensing System

BACKGROUND AND OBJECTIVES

Automated drug dispensing systems (ADDs) have been introduced to improve the efficiency of dispensing and patient safety. The available questionnaires measure patient satisfaction with particular aspects of ADDs. Also, the level of patient satisfaction with ADDs is not widely established. This study aimed to develop and validate a novel questionnaire to assess patient satisfaction with ADDs.

METHODS

Content and construct validity procedures were used to validate the 20-item questionnaire with four domains, including pharmacy administration, dispensing practice, patient education, and the dispensing system. Two hundred consenting participants took part in this study, from those who visited the outpatient pharmacy in a government hospital.

RESULTS

The internal consistency of all four scale items shows acceptable reliability (>0.7). In the exploratory factor analysis, three items were removed due to poor factor loading and cross-loading. In the confirmatory factor analysis, the model has acceptable fit indices, including the comparative fit index (0.937), Tucker-Lewis's index (0.924), standardized root mean square residual (0.051), root mean square error of approximation (0.057), and χ2/df (1.67). The convergent and discriminant validity were established, since the average variance extracted (AVE) was ≥0.5 and the squared correlation (SC) values of one construct with other constructs were less than the AVE of the specific construct.

CONCLUSION

This study offered a reliable and valid 17-item questionnaire incorporating a multi-dimensional four-factor model to evaluate patient satisfaction with ADDs. The validated questionnaire can be utilized to explore patients' perspectives on ADDs.

Comparison of Community Pharmacist and Non-Community Pharmacist Perceptions of a Community Pharmacy Specialty Board Certification

Background: Pharmacy board certification provides pharmacists with formal recognition of their careers and their involvement in direct and comprehensive patient care. Credentialing as a board-certified pharmacist demonstrates that the pharmacist has specialized expertise and is able to provide advanced level patient care in a specific pharmacy practice specialty. There is currently not a community pharmacy board certification available in the United States. With the expanding role and clinical expectations of community pharmacists nationwide, perspectives regarding the utility of a community pharmacy specialty board certification are necessary. Methods: A cross-sectional survey with demographic and perception questions (5-point Likert scale) was distributed electronically via Qualtrics. A random sample of pharmacists registered in Rhode Island, Ohio, and Nebraska were selected and surveyed. Results: 53 survey responses were collected. There was a statistically significant difference in board certification history (P = .001) and history of post-graduate training (P < .001) between community pharmacists and non-community pharmacists. Community pharmacists were more likely to simultaneously see community pharmacists as general practitioners (P = .030) and as pharmacy practice specialists (P = .001). Non-community pharmacists were more likely to be familiar with current maintenance requirements for pharmacy board certifications (P < .001) and to feel that a board certification is an appropriate indicator of experience in a pharmacy specialty area (P = .016). Conclusion: Views regarding community pharmacy and board certification differed between community and non-community pharmacists. There was not a statistically significant difference in the perceived value of community pharmacy board certification between community and non-community pharmacist.

Integrated curriculum in the United States pharmacy programs

INTRODUCTION

In the last decade, significant changes in pharmaceutical sciences have influenced the delivery of pharmacy education in Pharmacy programs. Integrated curriculum is one such method considered. We aimed to describe the perceived level of integrated curriculum among PharmD programs in the US.

METHODS

From October 26th, 2021, until January 18th, 2022, faculty administrators across 138 US pharmacy colleges were surveyed. Data was collected regarding each program's perceived curriculum integration and assessment integration. Characteristics of each college, including region and the type of school (public/private), were obtained from the PharmCAS website. Programs were categorized into high-integration and low-integration groups for analysis purposes. Descriptive and comparative analysis by the level of curriculum integration was performed.

RESULTS

Overall, 60 colleges completed surveys (participation rate = 43.48%). Most schools were from the South region (38.33%) and public colleges (53.33%). The average perceived curriculum integration was 45% (SD = 23.69), while the average perceived assessment integration was 36% (SD = 25.52). Pharmacy practice [clinical sciences] (76.67%) was the most common discipline considered for integration, and the social and administrative sciences (21.67%) was the discipline least commonly considered for integration. Case-based learning (95%) was the most common pedagogy strategy to integrate knowledge from different disciplines.

CONCLUSIONS

Integrated curriculum implementation in the US PharmD programs varied across colleges. While most programs integrated their clinical practice courses, social and administrative sciences was the course least commonly integrated. Very limited progress in assessment integration was perceived.

Development of an adaptation framework to implement a new professional pharmacy service (PPS) to a new environment

The effective provision of professional pharmacy services is critical to support the delivery of primary health care. Structured frameworks and theoretical strategies are required to facilitate successful service implementation processes, outcomes and sustainability. This commentary discusses the considerations of what framework (adoption versus adaptation) would be suitable when implementing a new professional pharmacy service to a new environment. Utilizing Minor Ailments Services (MASs) as an exemplar as a professional pharmacy service case study, the research that underpinned these considerations enabled the development of a sequential, phased framework. There is the potential to utilize this framework for future evolving professional pharmacy services in the new setting.

Exploring career choices of pharmacy graduates over 15 years: A cross-sectional evaluation

INTRODUCTION

Career opportunities for pharmacists beyond those commonly associated with the degree continue to emerge. A paucity of literature regarding evaluation of pharmacy graduate career paths over extended periods is apparent. Considering international pharmacy workforce capacity pressures, the primary study aim was to evaluate trends in career paths of pharmacy graduates.

METHODS

This study utilised a multimethod approach to access graduate career data using publicly accessible information from LinkedIn® profiles and an online survey. The survey was distributed to all pharmacy graduates of a university (2007-2022). Data from both methods was combined, cross-checked, coded and analysed quantitatively using descriptive and inferential statistics.

RESULTS

Data from 69.7% of the university's pharmacy graduates was collected. Community pharmacy was the most prevalent employment sector (47.7%), followed by industry (21.5%) and hospital (17.7%). A higher proportion of more recent graduates (≤5 years post-graduation) work in a community or hospital pharmacy role versus those who graduated greater than five years ago (χ2 = 8.44, df = 2, p < 0.05). Post-graduate education was undertaken by 41.3% of graduates. Career satisfaction was high (88.2%) but was lower (χ2 = 11.31, df = 1, p < 0.05) for those in community and hospital (82%) versus other sectors (97.5%).

CONCLUSION

This study provides the first analysis of graduate career paths over an extended period, highlighting a novel approach to track pharmacist workforce. While almost two thirds of pharmacy graduates occupy community or hospital roles, a trend of leaving these settings five years post-graduation was evident. Accordingly, this work represents a springboard for additional research to inform future pharmacist workforce planning worldwide.

Knowledge of community pharmacists on infantile haemangioma: Gaps and lack confidence to deliver propranolol still need to be filled

AIM

To evaluate the knowledge, practices and self-confidence of community pharmacists, pharmacy technicians and pharmacy students about infantile haemangioma (IH) and propranolol treatment.

METHODS

A national survey was conducted in France from May 2022 to October 2022. A 42-item online questionnaire was used to assess pharmacists' knowledge of the epidemiology, clinical features and management of IH and propranolol treatment.

RESULTS

The survey included 255 participants. The mean age was 34.9 years (±9.0); 225 (88%) were women. In all, 193 (76%) practised in urban pharmacies. Altogether, 83 participants (33%) had delivered oral propranolol solution for IH in the last 6 months. Participants' median score for self-confidence regarding propranolol dispensing was five (interquartile range, 2.5-6) on a scale of 1 to 10. Overall, 96 (38%) had more than 50% correct answers on the questionnaire. Multinomial regression models showed high scores on the questionnaire associated with high self-confidence when delivering oral propranolol solution, low number of years since graduation and having already delivered propranolol treatment.

CONCLUSION

This study highlights a lack of knowledge of IH and modalities of propranolol treatment by community pharmacists and slight self-confidence when delivering propranolol. Greater cooperation between healthcare professionals could improve the proper use of medicine.

Impact of pharmacist-led interventions on medication-related problems among patients treated for cancer: A systematic review and meta-analysis of randomized control trials

BACKGROUND

Medication-related problems (MRPs) continue to impose a voluminous health impact, particularly among patients on anti-cancer therapy, due to the nature and complexity of the care. Pharmacists have a pivotal role in ensuring the safe, effective, and rational use of medicines in this group of patients.

OBJECTIVES

To examine the impact of pharmacist-led interventions in resolving MRPs among patients treated for cancer.

METHODS

This systematic review and meta-analysis was conducted and reported following the PRISMA protocol and registered in PROSPERO (Registration number: CRD42022311535). Four database searches, PubMed, EMBASE, Cochrane, and International Pharmaceuticals Abstracts, were systematically searched from August 2022 to January 2023. Only randomized control trials (RCTs) were included. The Cochrane risk of bias assessment tool was used to check the quality of the included studies. The outcome measures were overall MRPs, adherence, medication errors, and adverse drug events (ADEs). Data for meta-analysis were analyzed used using STATA version 17 and standardized mean difference effect sizes were calculated for continuous outcomes and odds ratio for categorical outcomes.

RESULTS

Out of the 90 studies screened for eligibility, 20 RCT studies were included for the systematic review and 15 for the meta-analysis. Close to two-thirds of the studies were from Europe (n = 7) and Asia (n = 6). A combination of educational and behavioral intervention strategies were used for a period ranged from 8 days to 12 months. The pharmacist-led intervention improved adherence to treatment by 4.79 times (AOR = 4.79; 95%CI = 2.64, 8.68; p-value<0.0001), reduced the occurrence of ADEs by 1.28 (SMD = -1.28; 95%CI = -0.04-2.52; p-value = 0.04) and decreased the overall MRPs by 0.53 (SMD = -0.53; 95%CI = -0.79, -0.28; p-value<0.0001) compared to control groups.

CONCLUSION

This study found out that pharmacist-led interventions can significantly lower MRPs among patients treated for cancer. Hence, a global concerted effort has to be made to integrate pharmacists in a multidisciplinary direct cancer care.

Knowledge, attitude and practice among pharmacy students and faculty members towards artificial intelligence in pharmacy practice: A multinational cross-sectional study

BACKGROUND

Modern patient care depends on the continuous improvement of community and clinical pharmacy services, and artificial intelligence (AI) has the potential to play a key role in this evolution. Although AI has been increasingly implemented in various fields of pharmacy, little is known about the knowledge, attitudes, and practices (KAP) of pharmacy students and faculty members towards this technology.

OBJECTIVES

The primary objective of this study was to investigate the KAP of pharmacy students and faculty members regarding AI in six countries in the Middle East as well as to identify the predictive factors behind the understanding of the principles and practical applications of AI in healthcare processes.

MATERIAL AND METHODS

This study was a descriptive cross-sectional survey. A total of 875 pharmacy students and faculty members in the faculty of pharmacy in Jordan, Palestine, Lebanon, Egypt, Saudi Arabia, and Libya participated in the study. Data was collected through an online electronic questionnaire. The data collected included information about socio-demographics, understanding of AI basic principles, participants' attitudes toward AI, the participants' AI practices.

RESULTS

Most participants (92.6%) reported having heard of AI technology in their practice, but only a small proportion (39.5%) had a good understanding of its concepts. The overall level of knowledge about AI among the study participants was moderate, with the mean knowledge score being 42.3 ± 21.8 out of 100 and students having a significantly higher knowledge score than faculty members. The attitude towards AI among pharmacy students and faculty members was positive, but there were still concerns about the impact of AI on job security and patient safety. Pharmacy students and faculty members had limited experience using AI tools in their practice. The majority of respondents (96.2%) believed that AI could improve patient care and pharmacy services. However, only a minority (18.6%) reported having received education or training on AI technology. High income, a strong educational level and background, and previous experience with technologies were predictors of KAP toward using AI in pharmacy practice. Finally, there was a positive correlation between knowledge about AI and attitudes towards AI as well as a significant positive correlation between AI knowledge and overall KAP scores.

CONCLUSION

The findings suggest that while there is a growing awareness of AI technology among pharmacy professionals in the Middle East and North Africa (MENA) region, there are still significant gaps in understanding and adopting AI in pharmacy Practice.

Availability of self-care products for sexual and reproductive health provided by community pharmacists in Rwanda: A cross-sectional study

Access to and use of sexual and reproductive health (SRH) services remain a global public health concern, particularly in developing countries. This study aimed to understand the attitudes and perceptions of pharmacists in Rwandan community pharmacies and to assess the availability of sexual and reproductive health products in these pharmacies.In a cross-sectional study conducted in Rwanda from 1 September 2023 to 30 November 2023, registered and licensed pharmacists from 864 community pharmacies were surveyed, employing a quantitative research approach. Systematic sampling was used to collect the data. A chi-square test was conducted for relationships between variables.SRH products for self-care were widely available in Rwandan community pharmacies, ranging from 82.3% to 97.3%, except for ovulation tests (28.4%). Chi-square tests indicated that married pharmacists were more likely to provide educational guidance on SRH products (χ2 =  8.81, P-value = 0.012). Community pharmacists had positive attitudes and self-reported confidence in dispensing and providing education to pharmacy-based SRH users.The Rwandan community pharmacies had extensive availability of SRH products for self-care use. Pharmacists in these pharmacies had positive attitudes and self-reported confidence in dispensing and guiding the community on SRH products. Continuous professional training is recommended to enhance the quality and standards of SRH.

Competency-based pharmacy education definition: What components need to be defined to implement it?

OBJECTIVES

This study aimed to define the essential elements in the proposed competency-based pharmacy education (CBPE) definition, provide the key defining components of each essential element on the basis of educational theory and evidence, and define how the essential elements meet the identified needs for CBPE.

METHODS

best-practice integrative review was conducted as part of the work of the American Association of Colleges of Pharmacy CBPE Task Force to define the essential elements in the CBPE definition and how these elements fit with the need for CBPE. The definition was compared with other published competency-based education definitions across K-12, higher education, medical education, and veterinary education. Task Force members then met to develop a consensus on the core components of the 5 essential elements in the definition. Next, the Task Force evaluated the fit of CBPE by matching the identified needs, discussed in detail elsewhere, across each of the stakeholder perspectives with the core components of the 5 essential elements in the derived definition of CBPE.

FINDINGS

Upon review of the proposed CBPE definition, the Task Force identified 5 essential elements. These elements include the following: meeting health care and societal needs, outcomes-based curricular model, de-emphasized time, learner-centered culture, and authentic teaching and learning strategies aligned to assessments.

SUMMARY

This article helps to establish a common language for CBPE by defining the essential elements of the core components of the definition, and provides a starting point for further exploration of CBPE.

Competence in Sports Pharmacy among Pharmacy Students in Norway

Pharmacists are competent to promote the proper use of medicines. According to the International Pharmaceutical Federation, pharmacists must develop competence in sports pharmacy and the contents of the World Anti-Doping Agency code. This explorative study aimed to identify the status of sports pharmacy in pharmacy education in Norway and competence in sports pharmacy among Norwegian pharmacy students. The study curricula of pharmacy education were examined for the content of sports pharmacy. An online questionnaire was also developed and distributed among pharmacy students. The anonymous survey collected demographic information and data on competence in sports pharmacy. Data from 122 participants were analyzed. Only 22.5% of pharmacy students had acquired a form of training in sports pharmacy and 91.7% wished to gain higher competence. In total, 40.2% of respondents were uncomfortable in advising athletes and trainers on medication use in sports. Study year was found to correlate with competence level with a significant difference between the 3rd year (bachelor) and 5th year (master) students. Age, institution, and number of years engaged in sports were not associated with competence level. The inclusion of sports pharmacy in pharmacy programs holds practical relevance for enhancing competency levels. This implementation can be realized through the integration of sports pharmacy modules and/or the incorporation of research-based activities.

Task shifting to nonphysician health workers for improving access to care and treatment for cancer in low- and middle-income countries- a systematic review

BACKGROUND

Cancer is a complex global health issue overburdening health systems especially in low- and middle-income countries (LMICs). This burden is becoming more severe and complex as the global shortage of cancer care workforce persists. Since task shifting offers an alternative to address workforce shortages, a systematic review with the following research question was carried out: What is the scope of roles and tasks shifted to nonphysician health workers in improving access to cancer control services? The aim of this review is to critically identify, appraise and present evidence on how task shifting could be integrated and scaled to expand access to quality cancer control services in LMICs.

OBJECTIVE

The aim of this review is to critically identify, appraise and present evidence on how task shifting could be integrated and scaled to expand access to quality cancer control services in LMICs.

METHODS

Four databases were searched - CINAHL, EMBASE, MEDLINE and SCOPUS from inception to October 15, 2022, and included all studies that reported task shifting of cancer control services to nonphysician health workers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines was followed to report the review process. Risk of bias was assessed using the National Heart, Lung, and Blood Institute quality assessment scale. The studies were summarized using narrative synthesis. A meta-analysis could not be carried out because the review only assessed the scope of roles that were shifted to nonphysician health workers and because of the heterogeneity in the characteristics of the studies included in the review.

RESULTS

The search identified 170 articles out of which 16 were included in the review. Three studies were randomized controlled trials, four were cluster randomized trials, while 9 were cross-sectional. Tasks were shifted to primary healthcare workers, nurses, and community health workers. Tasks shifted included screening, patient education, and diagnostic procedures. Evidence from the studies showed that the quality and effectiveness of tasks performed were comparable, and in some cases, better than usual care.

CONCLUSIONS

Findings showed that tasks in certain areas of cancer control services such as screening, education, and diagnosis can be shifted to nonphysician health workers and that it could be effective in improving access to certain cancer control services. Therefore, this review has shown that task shifting could be an effective strategy in addressing current workforce shortages in cancer care and that there is a need to examine the care required along the cancer continuum to better understand which interventions can most effectively be shifted to more advanced health professionals such as pharmacists to improve access to cancer control services in LMICs.

A call for action: Educating pharmacists and pharmacy students in behaviour change techniques

The increasing impact of chronic disease, including cancer and heart disease on mortality signifies a need for the upskilling of health professionals in health behaviour change. Solely providing education and information to patients is generally not sufficient to change behaviour, and for any change to be sustained. The nature of pharmaceutical practice allows pharmacists to have frequent contact with patients in the community. Historically, pharmacists have often effectively engaged with patients to assist with behaviour change initiatives related to smoking cessation, weight loss or medication adherence. Unfortunately, such initiatives do not work for everyone, and more tailored and varied interventions are urgently needed to reduce the effects of chronic disease. In addition, with greater inaccessibility to hospitals and GP's (e.g., appointment wait times), it is imperative that pharmacists are upskilled in providing opportunistic health behaviour change techniques and interventions. Pharmacists need to practice to their full scope consistently and confidently, including the use of behavioural interventions. The following commentary therefore describes and provides recommendations for the upskilling of pharmacists and pharmacy students in opportunistic behaviour change. We outline nine key evidence-based behaviour change techniques, the active-ingredients of a behaviour change intervention, that are relevant to common encounters in professional practice by pharmacists, such as improving adherence to medications/treatments and health promotion initiatives. These include social support (practical and emotional), problem solving, anticipated regret, habit formation, behaviour substitution, restructuring the environment, information about others' approval, pros and cons, and monitoring and providing feedback on behaviour. Recommendations are then provided for how this upskilling can be taught to pharmacists and pharmacy students, as well as how they can use these techniques in their everyday practice.

Assessing the impact of a leadership and advocacy elective course in a college of pharmacy curriculum

INTRODUCTION AND LEADERSHIP FRAMEWORK

While the scope of a pharmacist's work has grown, continued advocacy is needed to ensure that their skillset is used to the best advantage of the patient. To accomplish this aim, the University of Utah College of Pharmacy created an elective advocacy and leadership class to train students in leadership and advocacy methods, with a focus on enabling students to practice advocacy within the state of Utah throughout the class.

EDUCATIONAL CONTEXT AND METHODS

In addition to traditional lectures, this class asked students to apply the knowledge learned in class to projects within their sphere of influence. Activities included drafting their own bill, writing to a legislator, attending state legislative and board of pharmacy meetings, and a longitudinal quality improvement project. Students answered a pre- and post-class survey to assess their attitudes towards advocacy efforts and how those attitudes were affected by participation in the class.

FINDINGS AND DISCUSSION

As expected, a positive change in attitude towards advocacy was observed, and students indicated that they were more likely to engage in advocacy activities in the future after participating in the course. Moreover, a real legislative outcome has been observed as the result of class projects.

IMPLICATIONS

Enabling students to engage in advocacy activities and guiding them to effect real change is a valuable technique in pharmacy education. Similar efforts can be replicated in other institutions, and similar training should be expanded to required portions of the pharmacy curriculum.

Investigating How Preregistrant Pharmacists Respond in Job Interviews

OBJECTIVE

To investigate what competencies and attributes preregistrant pharmacists draw upon in job interviews.

METHODS

We used a virtual mock job interview assessment asking preregistrant pharmacists to apply for an entry-level pharmacist position. Data were analyzed using a team-based framework analysis using an inductive and deductive approach and mapping responses to the National Competency Standards.

RESULTS

A total of 143 interview transcripts were included in the analysis. The top skills mentioned were leadership of self (98.6%) and communication and collaboration (96.5%). Despite graduating from a course with an integrated research curriculum, participants rarely reflected on research skills (31.5%) and no participant discussed any expertise in clinical topics or knowledge of specific professional services. Responses generally lacked specific skills and skills were spoken about broadly without relating to evidence/experience and were often not targeted to the job description. A proposal for educators aligned with competency standards was also developed based on the findings.

CONCLUSION

Preregistrant pharmacists perceive experience within the workforce and communication and collaboration as the most desired by employers for entry-level pharmacy positions. Education and research competencies were seen as least useful to the job. There was a disconnect between skills gained in university and translation to practice. Academics could enhance the better preregistrant pharmacists' reflection of the skills and competencies they have developed employability by (1) providing portfolio management from the beginning of the course that collects evidence and maps to competencies; (2) integrating learning opportunities across all competencies; and (3) regular skills coaching/mentoring from practicing pharmacists to ensure students are aware of current needs in the job market.

Building Bridges between Pharmacy and Psychosocial Care: Supporting and Referring Patients with Psychosocial Needs in a Pilot Study with Community Pharmacists

Introduction

Community pharmacists are accessible primary care providers and therefore in a good position to detect unmet psychosocial needs of their patients and pharmacy visitors.

Description

A collaboration between pharmacists and psychosocial work was set up in Flanders, Belgium. Community pharmacists were trained to discuss psychosocial needs, to inform patients about possible help and refer them to a Center for General Wellbeing if needed. During the pilot of the project between October 2021 and January 2022, the feasibility and potential of this collaboration were examined.

Discussion

A total of 79 patient contacts about psychosocial wellbeing were reported using an online registration form, the majority of which concerned women. Family problems and mental health problems were most often reported. Focus group discussions with 28 participating pharmacists showed that they experience their role in psychosocial care as fulfilling and of valuable. Patient satisfaction was mentioned to be a major motivating factor, while time and privacy are barriers. Adequate training in psychosocial wellbeing and care was considered crucial.

Conclusion

Pharmacists can be valuable partners in the recognition and referral of patients with unmet psychosocial needs. Structural collaborations between community pharmacy and psychosocial care should be further supported.

Patients' Satisfaction With Pharmaceutical Care Services Provided During COVID Pandemic: Experience From Greece

Introduction Private pharmacies can contribute to the health care system through primary care. Purpose The purpose of this study is to determine patients' expectations of pharmaceutical care services during covid pandemic in order to measure the level of patient satisfaction provided by the Greek healthcare system. Also, it is important to identify the associated factors that might affect patient satisfaction. Material and Method The sample of the study consisted of 168 customers of pharmacies in Athens. A patient satisfaction survey was conducted at health facilities operating in Athens. Data regarding socio-demographic characteristics and parameters that measure patients' expectations and satisfaction were collected through a closed-ended questionnaire that had been tested for validity and reliability. The patient's point of view was evaluated based on their expectation and perception of the pharmaceutical care services they had received. Data were entered into SPSS version 22 (IBM Corp, Armonk, NY ), and descriptive statistics, cross-tabs, and binary logistic regressions were utilized. P < 0.05 was used to declare association. Results About 89.3% of the participants were insured in the Greek health system. The main reason for visiting the pharmacy was the purchase of medicines and products (95.2%), vaccinations (19.6%), and consulting services for first aid (17.3%). The pharmacist was rated for his courtesy, willingness, friendliness, and reliability. Only 48.2% of participants knew that the pharmacy provided primary care services during the pandemic. The most common services provided were blood pressure measurement and intramuscular injections. Around 64.2% of them were fully satisfied. Pharmacists in primary care teams are uniquely positioned to facilitate practice expansion and make medicine a trusted resource for physicians, as well as improve health outcomes for patients. Conclusions The pharmacy has a leading role in health care due to easy access, and fast and immediate service. Patient-clients in Greek society trust their pharmacist as a health professional. Further research is suggested to ensure that through the delivery of health services by pharmacies, the cost of primary care could be lower.

Illustrating How to Use the Validated Alsayed_v1 Tools to Improve Medical Care: A Particular Reference to the Global Initiative for Asthma 2022 Recommendations

Purpose

The current research aimed to illustrate a real case using the validated Alsayed_v1 tools as tutorial training to improve the knowledge and skills of healthcare practitioners in the clinical problem-solving process necessary to implement medical and pharmaceutical care.

Patients and Methods

The Alsayed_v1 instruments consist of principal components: data collection, assessment of treatments, the medical problem oriented plan (MPOP), as well as a care plan and patient education.

Results

This study illustrated a real case of asthma patient using the validated Alsayed_v1 tools. These validated and clinically tested tools provide a coding system for the MPOP that permits easy documentation with an open hierarchical structure where higher levels are broad and lower levels are particular, and the possibility to enter free text. The section dedicated to treatment assessments is intended to synthesize patient information to facilitate the identification of the MPOPs. Effective management requires the development of a partnership between the patient with asthma (or the patient's caregivers) and his healthcare professional(s). This partnership aims to allow the patient to control his condition with guidance from the healthcare professional(s), discuss and agree on therapy goals, and develop a personalized, written, self-management asthma care plan.

Conclusion

By implementing Alsayed_v1 tools, the clinical practitioner can actively give the best practice for optimal patient outcomes.

A Review on Pharmacy Practice in South Africa-A Higher Education Perspective

In April 1994, South Africa underwent the most significant change in its recent history with the disbandment of the policy of apartheid and the attendant race-based politics, which affected most aspects of the country and, of relevance to this review, the education, health delivery, and career choices that race groups could pursue. In the past 28 years, the South African government has tried to implement policies in order to advance political and socioeconomic shifts toward a more equitable society. The healthcare sector was an early target for transformation that was aimed at increasing access to services and the expansion of primary healthcare and hospital facilities to previously underserved areas. This paper seeks to discuss these changes in broad terms, but with specific reference to general health care and pharmacy practice in particular. It will look at the changes in the legislative framework and pharmacy education and factors impacting the pharmacy practices in South Africa over the past 28 years. A discussion of the critical issues that have affected the profession in the last three decades will also be delineated, and future prospects for the profession as a whole, in terms of pharmacy practice and perspectives, will be discussed. We review the current aspects of the pharmacy profession in South Africa today and how the education of those future professionals is a major contribution to the pharmaceutical climate.

Comparison of the University Pharmacy Education Programs in Germany and Vietnam

During the global COVID pandemic, the importance of professionals in the health care sector has been put in a new light, including pharmacists. In this context, the focus is also on how pharmacists are trained in different countries. Through an exchange of pharmacy teaching staff from a German to a Vietnamese university, the pharmacy education programs in both countries were compared. Aspects such as access to studies, structure of studies, and further training opportunities were considered. Differences and similarities emerged. In both countries, students first acquire basic knowledge and then delve deeper into pharmaceutical content in main studies. There is, expectedly, a great overlap in the content of the courses. Overall, the education at Vietnamese universities seems to be more practice-oriented due to a large number of placements. This also allows a specialization, which can be pursued in Germany with self-interest after graduation. There, the preparation for everyday work in the community pharmacy is separated from the university by a mandatory practical year. For the future, efforts are being made in both countries to strengthen the importance of clinical pharmacy in the curriculum. To this end, the Vietnamese are taking their inspiration from abroad in many cases, including Germany.

Motivation, satisfaction, and future career intentions of pharmacy students: A cross-sectional preliminary analysis

INTRODUCTION

In recent years, the pharmacy profession has undergone many changes that impacted pharmacy educational programs and students' needs and experiences. In Lebanon, no previous studies have addressed students' perspectives of pharmacy studies and their future aspirations.

METHODS

A cross-sectional survey was randomly sent to all pharmacy students at the main campus of the Lebanese International University. Questions included demographics, students' reasons for choosing pharmacy, satisfaction regarding choice of pharmacy, and future career plans.

RESULTS

Pharmacy as a study major was the first choice for 61% of respondents, and reasons for this choice were family recommendations (87%), friends' encouragement (26%), and schoolteachers' endorsements (20%). Looking for a job with various career opportunities, flexible working hours, security, good salary, and wishing to provide public service and improve health were the main incentives to join the pharmacy program. Concerning their satisfaction, 88% were proud of studying pharmacy and 66% would choose to study pharmacy if they were to select their program of study again. As for career intentions, 68% were considering community pharmacy, 66% hospital pharmacy, and 60% academic pharmacy.

CONCLUSIONS

While the attitudes, perceptions, and career intentions of the respondents were variable, the majority were aspired by family or societal factors to study pharmacy, were satisfied by their choice, and intended to work in the community pharmacy sector. Pharmacy curricula should be regularly assessed to meet students' expectations and society's needs.

Pharmaceutical care and telemedicine during COVID-19: A cross-sectional study based on pharmacy students, pharmacists, and physicians in Jordan

Lack of access to the patient medical record (90.6%) was the major barrier for the integration of pharmaceutical care into practice. The majority of participants (93.0%) encouraged creating a website that provides pharmaceutical care. Furthermore, 45.1% would pay for such a service if present. Moreover, the majority (89.8%) agreed that creating a comprehensive database for patients’ data will help in decreasing medical errors. Among the four aspects of pharmaceutical care (technical, psychosocial, communication and administrative) that were assessed for students and pharmacist’s, general weakness in all aspects was noticed. This study highlights that absence of proper documentation of patient medical information raises the risk of medical problems and is considered the most documented barrier for the integration of pharmaceutical care. This emphasizes the future role of telemedicine and the availability of a specialized website and database repository that stores patient’s information to ensure the continuity of care even during pandemics.

Comparison of Patient's Satisfaction with Pharmaceutical Care Services in Ownership-Based Pharmacies in Semarang, Indonesia

Implementation of pharmacists services provided in all pharmacies must meet the standard of pharmaceutical services guidelines, including the provision of drug information. The study aims to compare the patient's perception of drug counseling services by pharmacy staff based on the type of pharmacy ownership (franchise/non-franchise) in Semarang. This research is an observational study with a cross-sectional design. Samples were taken of 286 respondents with a quota sampling technique. Data were collected using an online google form questionnaire tested for validity and reliability. The statistical analysis results used the Mann-Whitney test with a p-value of <0.05. There is no significant difference between the patient's perception of the drug information counseling services by pharmacy staff at the franchise or non-franchise pharmacies in Semarang with a p-value of 0.264. This study also found that the standard information given by pharmacy staff is healthy eating and education about antibiotics used in the common cold. In addition, only 55% of respondents were sure that the pharmacy staff who gave them drug information in pharmacies was a pharmacist. Consequently, we humbly recommend that pharmacists consistently wear their pharmacist identification.

Impact of Pharmacist Education on Incoming Medical Residents

Introduction: The graduating medical student transitioning to the role of a first-year medical resident is expected to know the proper medications and dosages for routine patient conditions. Pharmacists on an interdisciplinary health care team can be effective teachers of medical residents. Given the small amount of pharmacy-based education included in medical school curricula, it is important that medical residents have a basic foundation of pharmacotherapeutic knowledge. The purpose of this study was to assess the effectiveness of a pharmacist-led education session in improving medical resident pharmacotherapy knowledge. Methods: During orientation in 2016 to 2019, first-year medical residents completed an 8-item pre-test assessing their choices of medications and dosages on 8 patient conditions. A post-test assessing these same items was taken after a 50-minute lecture from a pharmacist experienced in resident education. First-year medical residents at a separate institution within the university system completed the pre-test only. Results: Overall, 243 medical residents received the lecture and took both tests and 170 medical residents at the other institution completed the pre-test only (100% response rate). Using descriptive statistics, the 2 groups of medical residents were comparable in age, gender, and scores on the pre-test. Medical residents receiving the lecture showed an average 32% point change improvement in performance on the post-test. The pharmacist-led lecture consistently received the highest ratings (4.7 ± 0.5 out of 5) from residents of all the orientation topics presented. Conclusions: A pharmacist-led education session increased the pharmacotherapy knowledge of first-year medical residents at their resident orientation. Medical residents value reinforcement of basic pharmacotherapy knowledge to start their training.

Pharmacy practice and clinical pharmacy research in the Middle East: a scoping review of studies from Bahrain, Iraq, Jordan, Kuwait, Lebanon, Oman, Palestine, Qatar, Saudi Arabia, Syria, United Arab Emirates, and Yemen

Background

Pharmacy practice research publications has increased significantly in the last decade. This is also true for Middle Eastern countries.

Aims

The aim of this study was to document and review pharmacy practice literature in the Middle Eastern Arab countries.

Materials and methods

A scoping review was conducted using PRISMA-ScR guidelines. Medline/PubMed and Scopus were used to screen the articles. All published original research articles concerning any facet of pharmacy practice in 12 Arabic Middle Eastern countries during 2009–2019 were included. A thematic analysis was performed to classify the articles.

Results

Nine hundred and eighty-one articles were included in this study. Eight themes emerged from the selected articles. Medication use was the predominant theme 30.78% (302), followed by pharmacy practice and pharmacist services 22.94% (225), and then pharmacy education and professional development 16.31% (160). The KSA, Jordan, Qatar, and the UAE were the leading countries to publish pharmacy practice research.

Conclusions

Pharmacy practice research is growing and significantly adding to enhance pharmaceutical health services in the Middle East Region. There is a need to develop a research agenda. This will help in enriching the practice, as well as to avoid repetitive ideas.

The current trends and challenges towards good community pharmacy practice and the way forward

Background

The practice of pharmacy continues to evolve. Comprehensive research to monitor and assess the development of the practice is needed. Good Pharmacy Practices (GPP) have been adopted by many countries to enhance the quality of services. Little information is available concerning how pharmacy practices are being implemented in developing countries. Lebanon being a developing country is a good example where community pharmacy practice doesn't follow clear guidelines and no evidence of good clinical practice.

Objectives

This study aims to highlight GPP implementation, to identify obstacles impeding implementation, and to suggest how its application could be facilitated in Lebanon.

Methods

The review included studies published in English during the last five years covering aspects of pharmacy practice in relation to GPP standards. The search excluded research related to hospital pharmacy practice and primary health care centers since they have their own quality standards.

Results

The research identified 20 recent studies that covered aspects of community pharmacy practice in Lebanon in relation to GPP standards. Eight of the studies related to research and professional development,5 related to the provision of medicines,4 related to interaction and communication,1 related to trainees,1 related to pharmacotherapy monitoring, and 1 related to documentation systems. An additional 6 studies provided insight into factors that affect the pharmacy practice in general. It is apparent that the pharmacy practice would benefit if pharmacists were better supported with financial incentives and a readjustment of their working conditions as this would have a positive impact on their productivity, job satisfaction, and overall well-being. The review indicated that the standard of research and professional development was the most studied topic and it was recommended that pharmacists develop their research capabilities. It was observed that there is a tendency towards implementing Continuous Education for pharmacists and obstacles primarily included work and family commitments, lack of interest, lack of time, difficulties in commuting, and lack of competence in the use of technology. This standard is aligned with the FIP's developmental goal of continuing professional development strategies. The search also identified only one pilot study to assess GGP compliance among community pharmacies in Lebanon. This pilot study was limited and showed low adherence of community pharmacies in Lebanon to GPP standards.Barriers to implementation are lack of enforcing laws,inadequate dissemination of the standards among the community pharmacists, poor public perception, and the financial and soscioeconomically crisis facing Lebanon.

Conclusion

Collaborated efforts are needed to implement GPP standards in Lebanon.It is recommended to undergo training and awareness sessions to community pharmacists thus enhancing their commitment and motivation. It is also recommended to establish key performance indicators to monitor the implementation. İndicators should include structure indicators for regulating the storage of medications, process indicators for regulating the dispensing, and outcome indicators for reporting patient safety incidents, measuring public satisfaction and the provision and use of medicines.These recommendations can be used by Health authorities and Pharmacy educational institutions in Lebanon and in all similar low-income countries.

Impact of Pharmacist-Led Interventions to Improve Clinical Outcomes for Adults With Type 2 Diabetes at Risk of Developing Cardiovascular Disease: A Systematic Review and Meta-analysis

OBJECTIVE

The aim of this systematic review and meta-analysis of randomised controlled trials is to evaluate the impact of pharmacist-led interventions on cardiovascular disease (CVD) risk factors among patients with type 2 diabetes.

METHOD

A literature review was conducted according to PRISMA guidelines using 4 electronic databases: Embase, MEDLINE, CINHAL and the Cochrane Central Register of Controlled Trials. We searched for pharmacist interventions among adults with type 2 diabetes and cardiovascular disease in randomised controlled trials from inception to May 2021 in primary care, diabetes clinics and hospitals. The clinical outcomes measured glycosylated haemoglobin (HbA1c), blood pressure (BP) and lipid profile. The non-clinical outcomes included medication adherence, smoking, health-related quality of life and the cost of the intervention. For the meta-analysis, clinical outcomes were pooled with the random effect model in RevMan 5.3. The Cochrane risk-of-bias tool was used to assess the quality of the included studies.

RESULTS

We retrieved 223 studies,141 of which were included in the review. Ten published articles met the inclusion criteria and were included in the meta-analysis. The pharmacists delivered the interventions alone or collaboratively with other healthcare professionals in hospitals or similar settings. The overall result showed a significant reduction in HbA1c (n = 10; standard deviation in mean value [SDM]: -.53%, 95% CI: -.84, -.23) and systolic BP (n = 10; [SDM]: -.35 mmHg, 95% CI: -.51, -.20) in pharmacist intervention groups. For the non-clinical outcomes, the review revealed variable results from pharmacist intervention compared with those standard care.

CONCLUSION

Pharmacy interventions provide evidence for pharmacists' decisive role in diabetes care management and reducing cardiovascular risk factors among adults with type 2 diabetes.

Community pharmacy professionals' practice in responding to minor symptoms experienced by pregnant women in Ethiopia: results from sequential mixed methods

BACKGROUND

In countries with limited access to healthcare services, community pharmacists' management of minor symptoms experienced by pregnant women could be beneficial in terms of alleviating the burden of other health professionals and cost of services. However, evidence is limited regarding the practice of community pharmacy professionals in responding to minor pregnancy-related symptoms more generally, particularly in Ethiopia.

OBJECTIVE

The aim of this study was to evaluate actual and self-reported practice of community pharmacists in the management of minor symptoms during pregnancy in Ethiopia.

METHODS

A sequential mixed method study using self-reported survey from 238 community pharmacists followed by 66 simulated client visits was conducted from March to July 2020 in six towns of the Amhara regional state in Ethiopia. Independent samples t-test and one-way Analysis of Variance was used to test the mean difference of practice score among subgroups of study participants.

RESULTS

The self-reported survey showed that most community pharmacist would 'always' gather most symptom-related information particularly about 'duration of symptoms,' 'frequency of symptoms,' and 'gestational age' and provide medication-related information on 'how to use the medication' and 'duration of use.' The highest mean practice scores were observed in relation to information gathering about 'gestational age' and information provision on 'how to use the medication.' In contrast, the lowest mean practice scores were observed in relation to information gathering about 'weight of the woman' and information provision on 'dosage form.' However, the actual practice, as revealed by the simulated client visits, demonstrated that most community pharmacists would rarely gather symptom-related information nor provide medication-related information. In addition, dispensing of non-prescribed medications to pregnant women was also common. The extent of self-reported practice differed among subgroups of study participants.

CONCLUSIONS

This study highlights extent of practice of community pharmacy professionals during the management of minor symptoms in pregnancy in Ethiopia. Discrepancies of results between self-reported and actual practices of community pharmacy professionals were observed. The inadequate actual practice of symptom-related information gathering and medication-related information provisions needs considerations of implementing interventions to minimize potential harms.

Pharmacists' preferences for the provision of services to improve medication adherence among patients with diabetes in Indonesia: Results of a discrete choice experiment

Little is known about pharmacists' preferences for services to improve medication adherence in patients with diabetes in Indonesia. Identification of such preferences can provide valuable insights on suitable services from a pharmacist's perspective. This study elicits pharmacists' preferences for services to improve medication adherence among their patients. A discrete choice experiment (DCE) method was used to survey pharmacists in all community health centres and three hospitals in Surabaya, Indonesia. Four attributes of consultation, namely duration of consultation, place of consultation, access to a pharmacist and patient copayment, and two attributes on additional services (educational and behavioural-based services) were included. The 16 profiles generated for DCE were partially balanced and partially without overlap. A random-effect logistic regression was used in the analysis. In total, 99 pharmacists completed the questionnaire, but only 80 were included in the study based on a consistency check. All attributes were found to determine preferences for a pharmacist service package. Pharmacists preferred a consultation with a shorter duration accompanied by flexible access to the pharmacist as well as a private consultation room and a lower patient copayment. Providing the patient with a brochure/leaflet was the most preferred additional service to help improve medication adherence. Patient group discussion and medication review were also preferred in combination with a consultation. Pharmacists' socio-demographic background characteristics influence preferences. These findings can be considered in evaluating current practice and designing pharmacist services to help improve medication adherence among patients with diabetes.

The role of community pharmacists in immunisation: a national cross-sectional study

Background Austrian pharmacists are not authorised to administer immunisations, and evidence about their willingness to immunise is lacking. Aim The aim of this study is to investigate Austrian community pharmacists’ willingness to administer immunisations in the future. Method This study is designed as a cross-sectional online survey based on the theoretical domains framework (TDF). The validated and piloted questionnaire obtained ethical approval by Robert Gordon University. Outcome measures included pharmacists’ willingness to immunise, service requirements, barriers and education needs. Results The questionnaire was sent out to 3086 community pharmacists of which 380 responses were included in the final analysis (12.3%). Willingness to administer immunisations after appropriate training and legislative regulation was stated by 82.6% (n = 314) of participants. It was demonstrated that pharmacists willing to immunise were significantly younger than their counterpart (38 [IQR 31–49] years vs. 45 [IQR 37.5–54] years; OR 1.06; 1.03–1.09, 95% CI; p < 0.001). ‘Legal liability’ was considered the most critical barrier to service implementation, ‘seeing blood’ and ‘close patient contact’ as least critical. Pharmacists not willing to immunise showed a higher probability to evaluate personnel resources (OR 2.98; 1.35–6.58, 95% CI; p = 0.007), close patient contact (OR 2.79; 1.46–5.34, 95% CI; p = 0.002) and management of side effects (OR 2.62; 1.21–5.67, 95% CI; p = 0.015) as (highly) critical. The majority assessed the ‘right timing for training’ to be after the foundation training with a 2-yearly renewal. Conclusion Austrian community pharmacists show a strong willingness to administer immunisations while highlighting important requirements and barriers towards service implementation.

Pharmacists' and patients' perceptions about the importance of pharmacist services types to improve medication adherence among patients with diabetes in Indonesia

BACKGROUND

Various pharmacist services are available to improve medication adherence, including consultation, brochure, etc. Challenges arise on which services are best implemented in practice. Knowledge about patients' and pharmacists' preferences can help to prioritize services. This study explores the pharmacists' and patients' perceptions about the importance of pharmacist services to improve medication adherence among patients with diabetes in Indonesia.

METHODS

This questionnaire-based cross-sectional study involved adult outpatients with diabetes type 2 and pharmacists from community health centers (CHCs) and hospitals in Surabaya, Indonesia. Random sampling was used to identify 57 CHCs in the study. In addition, based on convenient sampling, three hospitals participated. All pharmacists working at the CHCs and hospitals, who were willing to participate, were included in the study. For patients, minimum sample size was calculated using Slovin's formula. Patients and pharmacists were asked to rank five pharmacist service types (consultation, brochure/leaflet, patient group discussion, medication review, and phone call refill reminder) according to their importance to improve medication adherence. A face validity test of the self-developed questionnaire was conducted before the data collection. Rank ordered probit models were estimated (STATA 15th software).

RESULTS

A total of 457 patients from CHCs, 579 patients from hospitals, and 99 pharmacists from both medical facilities were included. Consultation (CHC patients 56.0% vs hospital patients 39.7% vs pharmacists 75.2%) and brochure (CHC patients 23.2% vs hospital patients 27.5% vs pharmacists 11.9%) were the most preferred pharmacist services. Patients with experience getting medication information from pharmacists valued consultation higher than brochure and patient group discussions. Older patients ranked a brochure higher than other services. Patients without formal education in CHCs had a lower probability of giving a high rank to a brochure to improve medication adherence. There was significant positive correlation between the ranking of phone call refill reminder and medication review (0.6940) for patients in CHCs.

CONCLUSION

For both patients and pharmacists, consultation, brochure, and group discussion were the highest-ranked services. Education, age, experience with pharmacist services, and medical facility features need to be considered when evaluating which pharmacist services to implement in Indonesia.

Impact of a novel project management course sequence on innovative thinking in pharmacy students

BACKGROUND

As healthcare continues to become more complex, pharmacist innovators have worked to advance the profession and expand the role of the pharmacist on the healthcare team. Accreditation standards for schools of pharmacy recognize the importance of developing future pharmacist innovators capable of making positive change in the profession, but there are limited resources available on how to best instill innovative thinking in student pharmacists.

EDUCATIONAL ACTIVITY

A two-semester elective course sequence was created for third-year doctor of pharmacy students requiring completion of a longitudinal quality improvement project at a partnering health system. Students collaborated with key stakeholders to design a project plan and charter, identify deliverables, and deliver project results. Innovative thinking was assessed using a mixed methods approach including questionnaires with forced choice and open response items, focus group data, and semi-structured interviews. Each questionnaire item mapped specifically to an element of a validated model for employee innovation. From the beginning to the end of the course sequence, there were significant improvements in student-perceived project management self-efficacy and innovative thinking.

CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY

Student learning outcomes and the course structure mapped closely with a validated model of innovative behavior, demonstrating the effectiveness of utilizing project management to instill innovative thinking in student pharmacists. These findings support the concept that innovative thinking can be taught in pharmacy didactic curricula by situating students in the environment of real-world pharmacy practice.

Establishing consensus for the education, training and assessment requirements of community pharmacy staff to deliver minor ailments services: A modified Delphi study

INTRODUCTION

Minor ailments services (MASs) are pharmacy-based and support individuals to manage minor conditions. MASs are delivered by community pharmacists and non-pharmacist staff. Limited information exists regarding education, training, assessment requirements, and suitability of existing processes to support MAS delivery. The purpose of this study was to determine consensus amongst multiple stakeholder participants regarding these processes.

METHODS

A modified Delphi process was utilized. Phase 1 consisted of stakeholder participants completing two rounds of an online questionnaire responding to Likert-items (Round 1 [R1] [n = 46]; Round 2 [R2] [n = 34]). Phase 2 consisted of three teleconference rounds discussing items that did not achieve consensus in the previous two rounds. Consensus was defined as ≥80% panel agreement.

RESULTS

Forty MASs stakeholders participated in the study. MASs stakeholder participants included community pharmacists (n = 7), pharmacy student graduate pharmacist (n = 4), non-pharmacist staff (n = 13), faculty staff/academics (n = 5), general practitioners (n = 5), and individuals affiliated with pharmacy professional organizations (n = 6). Consensus was achieved on 22 of 46 statements in R1, 8 of 34 statements in R2, and 21 of 27 statements in Phase 2.

CONCLUSIONS

It may be useful for MAS education and training to consider the clinical and non-clinical elements of service delivery. Training should be available to all community pharmacy staff. The results of this study may be useful to policymakers and professional organizations to enhance existing curricula or inform training guidelines for MAS delivery.

Effect of Evidence-Based Pharmacy Care on Satisfaction and Cognition in Patients with Non-Valvular Atrial Fibrillation Taking Rivaroxaban

PURPOSE

We aimed to determine the effects of using evidence-based pharmacy care on satisfaction and cognition among patients with non-valvular atrial fibrillation (NVAF) and taking rivaroxaban.

PATIENTS AND METHODS

Between July 2018 and June 2019, 200 consecutive hospitalized patients taking oral rivaroxaban, who were diagnosed with NVAF and registered in the hospital information management system, were randomly assigned to a control group (n=100) and a study group (n=100) in a single-blind manner. The control group received pharmaceutical care based on the general pharmaceutical care model whereas the study group received care based on an evidence-based pharmaceutical care model. Patients' satisfaction and cognition were evaluated regularly using questionnaires. The follow-up time was 1 year. We compared differences in satisfaction and cognition between the two groups after pharmaceutical-related care administered by clinical pharmacists.

RESULTS

The study group had higher satisfaction scores than the control group after the EBP intervention (14.58±0.88 vs.13.81±1.01, p<0.01); cognition scores were also higher in the study group (22.58±2.19 vs 20.80±3.02, p<0.01) after the intervention. In the study group, satisfaction was increased from a score of 10.15±1.33 before the EBP intervention. Cognition also increased after the intervention in the study group, from a score of 9.88±4.09 pre-intervention. In the control group, satisfaction was 10.04±1.29 before the traditional pharmaceutical care intervention, smaller than the 13.81±1.01 after the intervention (p<0.01). Cognition in the control group was 9.83±3.51 before traditional pharmaceutical care, smaller than the 20.80±3.02 after the intervention (p<0.01).

CONCLUSION

The care model based on evidence-based pharmacy care can improve patient satisfaction and cognition, providing more comprehensive safety and efficacy of subsequent medication.

Exploration of health professional stakeholders' views and experiences regarding minor ailments services' education, training and assessment

Background Minor ailments services are structured pharmacy-based primary health care services that manage minor conditions. Limited training, education and assessment exists to promote the delivery of minor ailments services by pharmacy staff and it is unclear if the existing training and education processes meet professional requirements. Objective To explore the views and experiences of health professional stakeholders such as community pharmacists, intern pharmacists, medicines counter assistants and general medical practitioners with regards to minor ailments services education, training and assessment practices and preferences. Setting This study explored the views and experiences of health professional stakeholders in Australia. Method Semi-structured interviews were conducted, audio recorded, transcribed verbatim and then coded thematically using QSR Nvivo12. Main outcome measure Stakeholders' views and experiences regarding minor ailments services education, training and assessment practices and preferences. Results Twenty-eight interviews were conducted (community pharmacists n = 12; medicines counter assistants n = 4; intern pharmacists n = 9; general medical practitioners n = 3). Thematic analysis generated three themes: (1) pharmacy staff who require minor ailment service training; (2) acceptability and willingness to complete additional training; (3) learning preferences and approaches. Stakeholders reported considerations for the diverse roles in service delivery and fit for purpose tailored training. Conclusion Detailed practice guidelines may facilitate clarity of an individual staff member's role. Education and training in both clinical and non-clinical aspects of the service may be beneficial and may improve minor ailments service uptake and outcomes.

Educational needs of community pharmacy staff in minor ailment service delivery: A systematic scoping review

BACKGROUND

Minor ailment services (MASs) are structured, protocol driven pharmacy services established locally or nationally. Community pharmacy staff may benefit from education and training to deliver MASs. Our objective was to examine the evidence regarding training, education, and assessment requirements associated with the delivery of MASs by community pharmacists and other community pharmacy staff.

METHODS

Two independent literature search strategies were conducted to examine the grey literature and scientific literature. Inclusion criteria consisted of English written literature related to the training of pharmacists, medicine counter assistants (MCAs), pharmacy technicians, and pharmacy students in the context of MASs.

RESULTS

Sixty-six grey literature records (n = 57) and scientific articles (n = 9) met inclusion criteria. Most trainings targeted community pharmacists and focused on clinical care aspects that did not include guidance on service parameters and MAS delivery. Training lacked uniformity and varied in terms of time commitment, cost, curricula, and assessment processes. Limited training was identified for community pharmacy staff, particularly MCAs.

IMPLICATIONS

MAS training is primarily provided for community pharmacists, with scant MAS training for community pharmacy support staff. Furthermore, existing training for any stakeholder group did not include guidance pertaining to service delivery. A structured training approach for the entire community pharmacy team is recommended to promote MAS outcomes and deliver a robust, high quality service. Detailed protocols and guidelines may be needed to ensure skilled MAS providers can deliver quality patient care.

Patient experiences in managing non-communicable diseases in Namibia

INTRODUCTION

The prevalence of non-communicable diseases (NCDs) is rising in Namibia, and with it, the need for pharmacists to empower patients. This research aims to 1) identify patient-reported barriers and facilitators to managing chronic NCDs for Namibians, and 2) characterize common patient-reported medication and health-related needs of Namibians with chronic NCDs.

METHODS

This qualitative study used semi-structured interviews to elicit participant perspectives regarding NCDs. The study used the conceptual frameworks of the Health Belief Model, the Theory of Planned Behavior, and the Explanatory Models of Illness to identify and understand key factors necessary to develop relevant patient-centered interventions. Participants were recruited from pharmacies throughout Namibia. Data were analyzed using thematic analysis from the transcribed interviews.

RESULTS

A total of 23 interviews were conducted, with 20 being included in the final analysis. Themes identified included: 1) participants were motivated to seek care when they were symptomatic; 2) participants felt motivated to care for their condition to improve their own lives and their families for their family's sake; 3) participants integrated information from a variety of sources into their disease knowledge; 4) participants describe wanting to be more engaged in managing their health and wanting support to help manage their condition; 5) participants describe awareness of lifestyle changes necessary to improve health, but face many barriers to achieving them.

CONCLUSION

This study identified key factors that are essential for pharmacists and other health care professionals to be aware of in order to support patients who are diagnosed with an NCD. Health care providers should consider strategies to engage patients to harness their motivations, enhance health education, and create systems to reduce barriers to addressing lifestyle.

Clinical Pharmacy Education and Practice in Nepal: A Glimpse into Present Challenges and Potential Solutions

This commentary article highlights the challenges in providing clinical pharmacy education in Nepal and suggests a few ways forward. Contrary to other health care professions, clinical pharmacy practice is a new healthcare discipline in the country which is currently undergoing transition. The existing pharmacy curriculum and training in the country can provide competencies needed for pharmacists in industrial settings. Considering the importance of clinical pharmacists in patient care, the Government of Nepal has implemented a policy recommending the recruitment of clinical pharmacists in hospitals. However, the education and training for pharmacists provided in the country are not sufficient enough for optimum patient care and for delivering clinical pharmacy services. International collaborations in terms of faculty and student exchanges, preceptor training, and accreditation by international organizations such as Accreditation Council for Pharmacy Education (ACPE), establishment of need-based curriculum, incorporating clinical pharmacy department under the organizational structure of hospitals, etc., may be the right approaches to improve the current status of clinical pharmacy education in the country.

Developing Physical Assessment Skills in Pharmacy Students through Participation in a Creative Movement Workshop: An Interdisciplinary Study between Pharmacy and Dance

The role a pharmacist plays in the care of patients is continually changing and expanding. Most recently, there is movement towards including pharmacists in the physical assessment of patients. We developed a creative movement workshop with the purpose of increasing students' levels of comfort with touch, ability to interpret non-verbal mannerisms, to increase empathy for the patient, and to increase student comfort in conducting physical exams. In this interventional study, surveys were administered to third year pharmacy students, before and after the creative movement workshop, in order to assess participant's change in level of comfort with a variety of behaviors needed to conduct effective physical assessment. The two hour workshop involved: partner stretching, mirroring, and creative spatial exploration between bodies. The 11-item survey evaluated students' perceptions on touch, nonverbal communication, and sharing personal space. Our results showed that the level of comfort improved for the ability to give touch (p = 0.001), the ability to receive touch (p = 0.002), and the ability to share personal space (p = 0.001). Participants commented that the workshop increased their understanding of how important confidence is when performing physical assessment and reported an increased appreciation for how much non-verbal mannerisms can communicate to another. This study explores how an interdisciplinary workshop between pharmacy and dance has the potential to increase student effectiveness as future healthcare professionals, by targeting skills not often focused on within traditional pharmacy curriculums, including: sharing personal space, displaying empathy, and providing a comforting and confident touch.

The Role of Hospital and Community Pharmacists in the Management of COVID-19: Towards an Expanded Definition of the Roles, Responsibilities, and Duties of the Pharmacist

Since late December 2019, a novel, emerging coronavirus was identified as the infectious agent responsible for a generally mild but sometimes severe and even life-threatening disease, termed as "coronavirus disease 2019" (COVID-19). The pathogen was initially named as "2019 novel coronavirus" (2019-nCoV) and later renamed as "Severe Acute Respiratory Coronavirus type 2" (SARS-CoV-2). COVID-19 quickly spread from the first epicenter, the city of Wuhan, province of Hubei, mainland China, into neighboring countries, and became a global pandemic. As of July 15th 2020, the outbreak is still ongoing, with SARS-CoV-2 affecting 213 countries and territories. The coronavirus has caused a dramatic toll of deaths and imposed a severe burden, both from a societal and economic point of view. COVID-19 has challenged health systems, straining and overwhelming healthcare facilities and settings, including hospital and community pharmacies. On the other hand, COVID-19 has propelled several changes. During the last decades, pharmacy has shifted from being products-based and patient-facing to being services-based and patient-centered. Pharmacies have transitioned from being compounding centers devoted to the manipulation of materia medica to pharmaceutical centers, clinical pharmacies and fully integrated "medical-pharmaceutical networks", providing a significant range of non-prescribing services. Moreover, roles, duties and responsibilities of pharmacists have paralleled such historical changes and have known a gradual expansion, incorporating new skills and reflecting new societal demands and challenges. The COVID-19 outbreak has unearthed new opportunities for pharmacists: community and hospital pharmacists have, indeed, played a key role during the COVID-19 pandemic, suggesting that a fully integrated, inter-sectoral and inter-professional collaboration is necessary to face crises and public health emergencies. Preliminary, emerging evidence seems to suggest that, probably, a new era in the history of pharmacies ("the post-COVID-19 post-pharmaceutical care era") has begun, with community pharmacists acquiring more professional standing, being authentic heroes and frontline health workers.

Physicians' and pharmacists' perception and practice of hospital pharmacist professional role in Egypt

OBJECTIVES

This study aimed to investigate physicians' and pharmacists' perceptions of the importance of pharmacists' role in healthcare in Egypt, and actual delivery of these roles in practice. Identifying any differences and inconsistencies between these will inform future strategies that maximize pharmacists' professional contribution to hospital practice.

METHODS

A self-administered questionnaire using a 5-point Likert scale was distributed to a convenience sample of physicians (500) and pharmacists (500) practicing in selected private or public hospitals in Egypt. The main sections of the questionnaire comprised statements that pertained to physicians'/pharmacists' views on the importance of pharmacists' roles and their actual delivery in practice.

KEY FINDINGS

In this study, physicians showed low scores for both the importance of and the delivery of advanced patient-facing clinical pharmacy roles such as suggesting prescription medications, and designing treatment plans. In comparison, pharmacists were more positive on both of these aspects of their roles. High mean scores were reported by the physicians for pharmacist's traditional roles such as patient counselling, assessing compliance, preventing medication errors and treating minor illnesses. Both physicians and pharmacists reported poor pharmacists practice as drug information resources despite their high perception of the importance of that role.

CONCLUSION

This study suggested that in hospitals in Egypt, there are significant differences between physicians' and pharmacists' perception and practice, and pharmacists' clinical skills are underutilized in health care.

Primary health care policy and vision for community pharmacy and pharmacists in Lebanon

Within a crippling economic context and a rapidly evolving healthcare system, pharmacists in Lebanon are striving to promote their role in primary care. Community pharmacists, although held in high esteem by the population, are not recognised as primary health care providers by concerned authorities. They are perceived as medication sellers. The role of the pharmacist in primary health care networks, established by the Ministry of Public Health (MOPH) to serve most vulnerable populations, is limited to medication delivery. The practice of the pharmacy profession in Lebanon has been regulated in 1950 by the Lebanese Pharmacists Association [Order of Pharmacists of Lebanon] (OPL). In 2016, the OPL published its mission, vision, and objectives, aiming to protect the pharmacists' rights by enforcing rules and procedures, raise the profession's level through continuous education, and ensure patients' appropriate access to medications and pharmacist's counseling for safe medication use. Since then, based on the identified challenges, the OPL has suggested several programs, inspired by the World Health Organization and the International Pharmaceutical Federation guidelines, as part of a strategic plan to develop the pharmacy profession and support patient safety. These programs included the application of principles of good governance, the provision of paid services, developing pharmacists' core and advanced competencies, generation of accreditation standards for both community pharmacy and pharmacy education, suggesting new laws and decrees, continuing education consolidation and professional development. There was an emphasis on all decisions to be evidence assessment-based. However, OPL faces a major internal political challenge: its governing body, which is reelected every three years, holds absolute powers in changing strategies for the three-year mandate, without program continuation beyond each mandate. Within this context, we recommend the implementation of a strategic plan to integrate pharmacy in primary health centers, promoting the public health aspect of the profession and taking into account of critical health issues and the changing demographics and epidemiological transition of the Lebanese population. Unless the proposed blueprint in this paper is adopted, the profession is unfortunately condemned to disappear in the current political, economic and health-related Lebanese context.