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Peled O, Vitzrabin Y, Beit Ner E, Lazaryan M, Berlin M, Barchel D, Berkovitch M, Beer Y, Tamir E. Acceptance rate of clinical pharmacists' recommendations-an ongoing journey for integration. Front Pharmacol 2023; 14:1253990. [PMID: 37781706 PMCID: PMC10535001 DOI: 10.3389/fphar.2023.1253990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction: Multidisciplinary expert team collaboration in the clinical setting, which includes clinical pharmacist involvement can facilitate significant improvements in outcomes and optimize patient management by preventing drug-related problems (DRP). This type of collaboration is particularly valuable in patients with multi-morbidity and polypharmacy such as diabetic foot patients. Evidence regarding the successful integration of a new clinical pharmacist, without previous experience into a unit is still scarce. Therefore, this study aimed to describe and evaluate the actual successful integration process of the clinical pharmacist into a diabetic foot unit by measuring the change in recommendation acceptance rate over time. Methods: A prospective, exploratory treatment effectiveness study based on the recommendation acceptance rate of a new clinical pharmacist introduced into the diabetic foot unit was conducted over a 9- month period. The clinical pharmacist identified medical and drug-related problems (DRP) or any discrepancies in the prescribing and administration of medications. Each identified DRP was documented and formulated as a recommendation by the clinical pharmacist. The main outcome measure was the acceptance rate of recommendations over time. Results: A total of 86 patients, of which 67% were men, averagely aged 66.5 (SD 11.8) years were evaluated. Calculated BMI was 30.2 (SD 6.2). The average number of medical diagnoses was 8.9 (SD3.2), and 11.1 (SD 3.7) prescribed drugs for each patient. Cardiovascular disease was presented by 95% (n = 82) of the patients and 33% of them (n = 28) had uncontrolled hyperglycemia. Averagely, 3.3 (SD 1.9) DRPs were identified pre patient. The efficacy-related DRP recommendation acceptance rate increased over the study period from 37.8% in the first 4 months to 79.4% after a period of 4.75 months. Safety-related DRP recommendation acceptance rate increased from 56% to 67.6%. Conclusion: Improved clinical outcomes and optimized pharmacologic patient management may be achieved by the successful integration of a clinical pharmacist into the team. This study provides evidence of the increasing recommendation acceptance rate of integrated, pharmacist-driven comprehensive medication management in an unexperienced unit. To overcome challenges, team members should collaborate to fully integrate the clinical pharmacist into the team-based structure and utilize proper strategies to minimize and transcend barriers.
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Affiliation(s)
- Orit Peled
- Department of Pharmacy, Schneider Children’s Medical Center of Israel, Affiliated to School of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Yael Vitzrabin
- Pharmacy Department, Yitzhak Shamir Medical Center, Zerifin, Affiliated to School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Beit Ner
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Affiliated to School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Lazaryan
- Pharmacy Department, Yitzhak Shamir Medical Center, Zerifin, Affiliated to School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Berlin
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Zerifin, The Andy Lebach Chair of Clinical Pharmacology and Toxicology, Tel-Aviv University, Tel-Aviv, Israel
| | - Dana Barchel
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Zerifin, The Andy Lebach Chair of Clinical Pharmacology and Toxicology, Tel-Aviv University, Tel-Aviv, Israel
| | - Matitiahu Berkovitch
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Zerifin, The Andy Lebach Chair of Clinical Pharmacology and Toxicology, Tel-Aviv University, Tel-Aviv, Israel
| | - Yiftah Beer
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Affiliated to School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Tamir
- Diabetic Foot Unit, Yitzhak Shamir Medical Center, Zerifin, Affiliated to School of Medicine, Tel Aviv University, Tel Aviv, Israel
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de Souza EV, Vieira LJSC, dos Santos SNP, Cerqueira-Santos S, Rocha KSS, de Oliveira Santos Silva R, de Lyra Jr DP. Evaluation of pharmacist's practices regarding the antimicrobials dispensing: a simulated patient study. BMC Health Serv Res 2022; 22:1576. [PMID: 36564839 PMCID: PMC9788868 DOI: 10.1186/s12913-022-08853-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The indiscriminate use of antimicrobials is considered a major contributing factor to the increase in antimicrobial resistance. Community pharmacies are the main source of access to antimicrobials, and pharmacists are in a strategic position to promote rational use of these medicines. Therefore, it is important to know dispensing service quality. OBJECTIVE To evaluate the behavior of pharmacists in dispensing antimicrobials in community pharmacies in northeast Brazil. METHODS This cross-sectional pilot study was conducted from August to October 2021 in a private community pharmacy chain in Sergipe. Dispensing was evaluated using the simulated patient (SP) technique. Two SP asked the pharmacists for the antimicrobials (case clinic 1: upper respiratory infection; case clinic 2: urinary tract infection) and recorded the service through audio. Dispensing practices were independently analyzed by two researchers based on the tools available in the literature. Data were presented using descriptive statistics. RESULTS A total of 54 simulated patient visits were conducted. Based on the 12 steps recommended by the research team for good dispensing, pharmacists asked an average of 1 (±1.17) question for upper respiratory infections and 0.3 (±0.54) for urinary tract infections, as well as provided counseling (mean number of recommendations, 2.6 (±1.44) and 4.5 (±2.35), respectively). As for communication skills, pharmacists had a regular score (3.07 ± 0.34). Furthermore, there was no significant difference in the number of steps and counseling recommendations by pharmacists in dispensing clinical cases 1 and 2 (p = 0.0674). CONCLUSION The quality of antimicrobial dispensing was evaluated as suboptimal, requiring improvements in practice and multifaceted strategies to promote continuing education of these professionals. In addition, awareness actions for the population must be implemented to promote the rational use of antimicrobials and reduce microbial resistance.
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Affiliation(s)
- Elindayane Vieira de Souza
- grid.411252.10000 0001 2285 6801Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Avenue Marechal Rondon, Jd. Rosa Elze, São Cristóvão, Sergipe State 49100-000 Brazil
| | - Lara Joana Santos Caxico Vieira
- grid.411252.10000 0001 2285 6801Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Avenue Marechal Rondon, Jd. Rosa Elze, São Cristóvão, Sergipe State 49100-000 Brazil
| | - Sylmara Nayara Pereira dos Santos
- grid.411252.10000 0001 2285 6801Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Avenue Marechal Rondon, Jd. Rosa Elze, São Cristóvão, Sergipe State 49100-000 Brazil
| | - Sabrina Cerqueira-Santos
- grid.411252.10000 0001 2285 6801Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Avenue Marechal Rondon, Jd. Rosa Elze, São Cristóvão, Sergipe State 49100-000 Brazil
| | - Kérilin Stancine Santos Rocha
- grid.411252.10000 0001 2285 6801Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Avenue Marechal Rondon, Jd. Rosa Elze, São Cristóvão, Sergipe State 49100-000 Brazil
| | - Rafaella de Oliveira Santos Silva
- grid.411252.10000 0001 2285 6801Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Avenue Marechal Rondon, Jd. Rosa Elze, São Cristóvão, Sergipe State 49100-000 Brazil
| | - Divaldo Pereira de Lyra Jr
- grid.411252.10000 0001 2285 6801Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Avenue Marechal Rondon, Jd. Rosa Elze, São Cristóvão, Sergipe State 49100-000 Brazil
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Seiberth S, Mannell H, Birkenmaier C, Neuerburg C, Smolka V, Andraschko M, Strobach D. Benefit of medication reviews by renal pharmacists in the setting of a computerized physician order entry system with clinical decision support. J Clin Pharm Ther 2022; 47:1531-1538. [DOI: 10.1111/jcpt.13697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/05/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah Seiberth
- Hospital Pharmacy University Hospital, LMU Munich Munich Germany
- Doctoral Program Clinical Pharmacy University Hospital, LMU Munich Munich Germany
| | - Hanna Mannell
- Doctoral Program Clinical Pharmacy University Hospital, LMU Munich Munich Germany
| | - Christof Birkenmaier
- Department of Orthopaedics and Trauma Surgery Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich Munich Germany
| | - Carl Neuerburg
- Department of Orthopaedics and Trauma Surgery Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich Munich Germany
| | - Vera Smolka
- Department of Orthopaedics and Trauma Surgery Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich Munich Germany
| | | | - Dorothea Strobach
- Hospital Pharmacy University Hospital, LMU Munich Munich Germany
- Doctoral Program Clinical Pharmacy University Hospital, LMU Munich Munich Germany
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