A systematic review on the impact of pharmacist-provided services on patients' health outcomes in Arab countries

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 Effects of Diverse Interventions on Diabetes Management Among Arabs With Diabetes: A Systematic Review

AIM

To identify, describe, and critically evaluate the effects of various interventions on diabetes management outcomes among Arabs with diabetes.

DESIGN

A systematic review.

DATA SOURCES

The search was conducted across three databases: PubMed, CINAHL and the Cochrane Collaboration in December 2023.

REVIEW METHODS

Screening involved randomised controlled trials and nonrandomised studies that focused on the effects of interventions on diabetes management among Arab with diabetes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guided the review process. Two researchers independently applied eligibility criteria. Data extraction captured key study details, and methodological quality was assessed using Downs and Black's checklist. This review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42024555668).

RESULTS

Thirty-five articles were reviewed, yielding 65 outcomes. Effective interventions included personalised care, patient-centred education and direct patient contact through lifestyle modifications, advice, feedback, motivational conversations and calls. These approaches improved haemoglobin A1c, fasting blood glucose, physical activity and medication adherence. Conversely, nonpersonalised remote monitoring and social media interventions showed no significant improvements. Notably, tailored nutritional and physical activity advice positively impacted body mass index and systolic blood pressure among Arab women with diabetes.

CONCLUSION

The findings underscore the effectiveness of personalised care and direct patient contact in optimising diabetes management among Arabs with diabetes.

IMPACT

This review highlights the importance of prioritising direct patient contact over remote methods such as social media in interventions on diabetes management among Arabs with diabetes. It emphasises the need for culturally sensitive approaches, particularly for women.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution, as this study constitutes a review of existing research.

Characteristics of the clinical pharmacist interventions at the National Center for Cancer Care and Research Hospital in Qatar

INTRODUCTION

Drug-related problems (DRPs) affect the health outcomes of patients during hospitalization. We sought to analyze the clinical pharmacist-documented interventions among hospitalized patients in the cancer hospital in Qatar.

METHODS

A retrospective analysis of electronically reported clinical pharmacist interventions of patients admitted to cancer units at Hamad Medical Corporation, Qatar was conducted. Extracted data was based on an overall 3-month follow-up period; March 1-31, 2018, July 15-August 15, 2018 and January 1-31, 2019. Categorical variables were expressed as frequencies and percentages, while continuous variables were expressed as mean ± standard deviation (SD).

RESULTS

A total of 281 cancer patients with 1354 interventions were included. The average age of the study participants was 47 years (SD ± 17.36). The majority of the study population was females (n = 154, 54.80%). The prevailing pharmacist intervention was the addition of a drug therapy (n = 305, 22.53%), followed by medication discontinuation (n = 288, 21.27%) and the addition of a prophylactic agent (n = 174, 12.85%). This pattern was similar across all subgroups (i.e., gender, age, ward), except for the urgent care unit, where an increase in medication dose was the third highest frequently identified intervention (n = 3, 0.22%). The two medication groups associated with the majority of interventions were the anti-infective and fluid/electrolyte agents. Most of the interventions documented were in the oncology ward (73.19%), while the urgent care unit had the least documented interventions (1.62%).

CONCLUSIONS

Our analysis showed that clinical pharmacists can effectively identify and prevent DRPs among hospitalized cancer patients.

Multifaceted pharmacist-led interventions in secondary care settings between countries of various income levels: a scoping review protocol

INTRODUCTION

Clinical pharmacy services often involve multifaceted pharmacist-led interventions. However, current pharmacy practice models vary across different countries. Despite the documented benefits of clinical pharmacy services, the characteristics of pharmacist-led interventions in different countries have not yet been adequately explored and described. Therefore, this protocol outlines the methodology for a proposed scoping review aiming to investigate various types of multifaceted pharmacist-led interventions and the outcomes used to evaluate their effectiveness within secondary care settings. Additionally, the scoping review will map the current evidence surrounding the characteristics of interventions and outcomes reported across various countries of socioeconomic status.

METHODS AND ANALYSIS

The scoping review will be conducted according to the JBI Methodology for Scoping Reviews and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Extension for Scoping Reviews. We will systematically search the following electronic databases: MEDLINE (Ovid), CINAHL (EbscoHost), Embase (embase.com), Scopus (scopus.com), Cochrane Library (cochranelibrary.com) and APA PsycInfo (Ovid). Additionally, the reference lists of identified reviews and included full texts will be searched for relevant papers. Grey literature sources, such as International Pharmaceutical Abstracts and the International Pharmaceutical Federation (FIP) website, will be searched. We will include primary studies published in the English language from January 2013 to December 2023, involving secondary care multifaceted pharmacist-led interventions. Two independent reviewers will screen studies against eligibility criteria and use a piloted data extraction form to extract relevant information. We will extract relevant data, complete a tabular summary from each included publication and analyse it.

ETHICS AND DISSEMINATION

Ethical approval is not required as we will be using data from publicly available literature sources. Findings will be disseminated in publications and presentations with relevant stakeholders. We aim to map available evidence across the breadth of studies that have reported multifaceted pharmacist-led interventions and their outcomes.

Evaluation of the Impact of a Pharmacist-Conducted Hypertension Clinic

Background

Hypertension can lead to cardiovascular and other health complications. Many hypertensive patients in the community may receive poor care and monitoring due to financial and other concerns. Pharmacists could support patients in improving their health outcomes. This research aims to assess the impact of pharmacist-led hypertensive clinics in a community pharmacy setting.

Methods

The study was an interventional exploratory design in a community pharmacy in Dubai, UAE. All eligible patients who consented were enrolled in the study, making it a population-based study. Patients' blood pressure (BP) was measured before starting the intervention and measured monthly for a minimum of 6 months of care. Measuring BP, physician referral for management of hypertension, lifestyle, diet, and medication counseling were the interventions provided by the researcher on a case-to-case basis as needed in each patient encounter. Toward the end of the study, a patient satisfaction survey was conducted. The survey form showed internal consistency, Cronbach's alpha = 0.895.

Results

About 30 patients were provided pharmacy services by a pharmacist for 613 months. All patients'' BP were monitored monthly. Patients showed reductions in their systolic and diastolic BP levels with the continued care of the pharmacist. (The mean systolic BP significantly decreased from 155 mmHg (standard deviation (SD) = 14.4, median = 151) at baseline to 128 mmHg (SD = 3.1, median = 129) with a P = 0.001. The mean diastolic BP showed a decrease from 95 mmHg (SD = 8.4, Median = 93) at baseline to 82 mmHg (SD = 1.2, Median = 81) with a P = 0.17. The participants showed a high level of patient satisfaction. Some were willing to pay for the pharmacist's professional service.

Conclusion

In conclusion, the study has shown the impact of pharmacist-led antihypertensive clinics in systolic BP control and achieving high patient satisfaction. The study generated insights into participant cooperation with pharmacist services and needs. More research on different outcomes is planned for future studies, including systematic pharmacotherapy work-up, patient medication adherence, and other clinical outcomes in the study population.

Prevalence, contributing factors, and interventions to reduce medication errors in outpatient and ambulatory settings: a systematic review

BACKGROUND

Medication errors are common events that compromise patient safety. Outpatient and ambulatory settings enhance access to healthcare which has been linked to favorable outcomes. While medication errors have been extensively researched in inpatient settings, there is dearth of literature from outpatient settings.

AIM

To synthesize the peer-reviewed literature on the prevalence, nature, contributory factors, and interventions to minimize medication errors in outpatient and ambulatory settings.

METHOD

A systematic review was conducted using Medline, Embase, CINAHL, and Google Scholar which were searched from 2011 to November 2021. Quality assessment was conducted using the quality assessment checklist for prevalence studies tool. Data related to contributory factors were synthesized according to Reason's accident causation model.

RESULTS

Twenty-four articles were included in the review. Medication errors were common in outpatient and ambulatory settings (23-92% of prescribed drugs). Prescribing errors were the most common type of errors reported (up to 91% of the prescribed drugs, high variations in the data), with dosing errors being most prevalent (up to 41% of the prescribed drugs). Latent conditions, largely due to inadequate knowledge, were common contributory factors followed by active failures. The seven studies that discussed interventions were of poor quality and none used a randomized design.

CONCLUSION

Medication errors (particularly prescribing errors and dosing errors) in outpatient settings are prevalent, although reported prevalence range is wide. Future research should be informed by behavioral theories and should use high quality designs. These interventions should encompass system-level strategies, multidisciplinary collaborations, effective integration of pharmacists, health information technology, and educational programs.

Patterns in counselling services provided at Saudi Ministry of Health medication counselling clinics - Reasons for referrals and subjects discussed: A cross-sectional study

Background

Pharmacists provide medication counselling services to improve patient knowledge and their adherence to prescription instructions, and to achieve the best possible health-related outcomes. Our study aim was to describe the patterns of the reasons for referral to counselling and the subjects discussed between pharmacists and patients, and the possible associations related to the susceptible patient groups (chronic and elderly), in Saudi Ministry of Health (MOH) medication counselling clinics.

Method

This was a descriptive cross-sectional study. An electronic data collection form was developed to document details about the medication counselling services that were provided to patients. The form consisted of three main areas: (1) patient demographics and counselling services characteristics; (2) reasons for referrals to the medication counselling clinics; and (3) the subjects that were discussed between pharmacists and patients in the counselling session. A comparison was conducted between chronic and non-chronic, and elderly and non-elderly patients.

Results

From May 2020 to December 2021, a total of 36,672 counselling service sessions were provided to 28,998 patients. The greatest proportion of reasons for referrals to counselling was that patients had chronic diseases (50.84%), patients were added a new medication (33.69%) or patients received multiple medications (polypharmacy) (22.71%). The most frequent subject discussed during counselling was general knowledge about medication (85.62%), the duration of therapy (68.42%) and the action that patients should take if they missed a dose of their medication (44.51%). Patients with chronic diseases showed a significantly greater frequency of referral to counselling compared to patients without chronic disease, due to polypharmacy, medication use during Ramadhan, adverse drug reactions (ADRs), dosing/interactions, high-alert medication and suspected nonadherence (P < 0.001). This led to a significantly greater frequency of discussions with patients with chronic conditions about their general medication knowledge, the duration of their therapy, missed doses, ADRs, medication reconciliation and medication use during Ramadhan (P < 0.001). Elderly patients recorded significantly more referrals to counselling related to chronic diseases and polypharmacy than their younger counterparts (P < 0.001); however, there was no significant difference between the elderly and non-elderly in the patterns of subjects discussed that were related to polypharmacy and chronic disease consequences. A significant spike was also reported in the frequency of delivery of counselling services to caregivers for the elderly (P < 0.001).

Conclusion

The current state of medication counselling services in Saudi MOH facilities indicates that chronic disease and polypharmacy are the most significant reasons for referral to counselling, and that the subjects discussed the most during counselling are general knowledge about medication, duration of therapy and missed doses. Patients with chronic diseases have a higher frequency of referral to counselling and discussion about polypharmacy and its consequences than those without chronic conditions. Elderly patients also show a high frequency of referral to counselling about chronic diseases and polypharmacy. Caregivers of elderly patients require more education to maximise counselling effectiveness as they attend the majority of elderly patient counselling sessions.

Disaster Preparedness Amongst Emergency Pharmacists for the FIFA World Cup Qatar 2022™: A Cross-Sectional Survey

Purpose

The aim of this study is to assess the level of preparedness of pharmacists working in the emergency department at Hamad Medical Corporation (HMC) for any emergency disasters that may take place during the FIFA World Cup Qatar 2022™ by evaluating their awareness (A), attitude (A), and readiness (R).

Methods

A cross-sectional quantitative observational study was conducted through a web-based survey. The survey was distributed among emergency pharmacists working in general hospitals under HMC. The questionnaire was composed of three major domains assessing awareness, attitude, readiness, as well as an additional domain to collect the participants' demographics. Student's t-test, analysis of variance, Pearson's correlation, and linear regression were used with an alpha level of 0.05.

Results

Most pharmacists working in the emergency departments at HMC had high levels of awareness (76.9%), attitude (92%), and readiness (53.8%) for any emergency disasters that may occur during the FIFA World Cup 2022. Nonetheless, almost half of the respondents reported moderate level of readiness for emergency events. Pharmacists with >10 years' practice experience had significantly higher AAR score compared to those with <5 years' experience (P = 0.002). Significant direct positive correlations were found among the 3 AAR parameters (P < 0.05). Attitude was found to be a significant predictor of readiness (P < 0.05). A model composed of attitude and awareness could predict 12% of readiness score.

Conclusion

Emergency pharmacists at HMC have high level of preparedness for any emergency disaster event during the World Cup. Future research should focus on the development of theory-based action framework for pharmacy departments during mass gathering events.

Prevalence and global trends of polypharmacy in patients with chronic kidney disease: A systematic review and meta-analysis

Background and objectives: Polypharmacy and chronic kidney disease (CKD) are becoming increasingly common due to an ageing population and the rise of multimorbidity. In line with the therapeutic guidelines, managing CKD and its complications necessitates prescribing multiple medications, which predisposes patients to polypharmacy. The aim of this systematic review and meta-analysis is to describe the prevalence of polypharmacy in patients with CKD and to explore the global trends of factors driving any apparent variability in prevalence estimates. Methods: PubMed, Scopus, the Cochrane Database of Systematic Reviews (CDSR), and Google Scholar were searched from 1999 to November 2021. Study selection, data extraction, and critical appraisal were conducted by two independent reviewers. The pooled prevalence of polypharmacy was estimated utilizing the random effects model using the default double arcsine transformation. Results: This review involved 14 studies comprising of 17 201 participants, a significant proportion of which were males (56.12%). The mean age of the review population was 61.96 (SD ± 11.51) years. The overall pooled prevalence of polypharmacy amongst patients with CKD was 69% (95% CI: 49%-86%) (I² = 100%, p < 0.0001), with a proportionately higher prevalence in North America and Europe as compared to Asia. Conclusion: The results from this meta-analysis showed a high pooled prevalence estimates of polypharmacy amongst patient cohorts with CKD. The exact interventions that are likely to significantly mitigate its effect remain uncertain and will need exploration by future prospective and systematic studies. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42022306572].