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Sin CMH, Huynh C, Maidment ID. Physicians' and nurses' perceptions of the factors influencing the implementation of paediatric clinical pharmacy services in Hong Kong: a qualitative study. Eur J Hosp Pharm 2023:ejhpharm-2023-003796. [PMID: 37541776 DOI: 10.1136/ejhpharm-2023-003796] [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: 04/06/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES To identify barriers and facilitators that influence the implementation of paediatric clinical pharmacy services in Hong Kong public hospitals from physicians' and nurses' perspectives. METHODS A qualitative study was conducted based on semistructured interviews of physicians and nurses who worked in the field of paediatrics in four public hospitals in Hong Kong. Interviews were held via telephone conversations using spoken Cantonese which were audio recorded, then translated and transcribed directly into English by the research team. Thematic analysis was used for data analysis and reflexivity was engaged through member checking, making field notes and reporting using the Consolidated Criteria for Reporting Qualitative Studies checklist. RESULTS A total of six barriers and five facilitators were identified from interviewing 17 participants, which included 7 physicians and 10 nurses. The barriers identified were the public's lack of understanding and recognition of clinical pharmacists, a culture of medical dominance, lack of resources and heavy workload, the need for a more transparent and defined role of clinical pharmacist at the institutional level, lack of proactive approach and involvement in direct patient care activities. The facilitators identified were the belief in the improvement of patient outcomes and the overall pharmaceutical service efficiency, trust and confidence in clinical pharmacy services, filling the clinical gap as a medicine information provider, and direct and coherent communication as a multidisciplinary team member. CONCLUSIONS Physicians and nurses reported that the implementation of paediatric clinical pharmacy services was adequate, but several key barriers were identified at both the external and internal levels.
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Affiliation(s)
- Conor Ming-Ho Sin
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
- Pharmacy Department, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
| | - Chi Huynh
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Ian D Maidment
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
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Herath KB, Rodrigo UAA, Senadheera GPSG, Samaranayaka S, Samaranayake NR. Impact of selected clinical pharmacy services on medication safety and prescription cost of patients attending a selected primary healthcare setting: a translational experience from a resource-limited country. Postgrad Med J 2023; 99:223-231. [PMID: 37222060 DOI: 10.1136/postgradmedj-2021-140583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/05/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE OF THE STUDY The impact of clinical pharmacy (CP) services on primary healthcare (PH) is less well studied in resource-limited countries. We aimed to evaluate the effect of selected CP services on medication safety and prescription cost at a PH setting in Sri Lanka. STUDY DESIGN Patients attending a PH medical clinic with medications prescribed at the same visit were selected using systematic random sampling. A medication history was obtained and medications were reconciled and reviewed using four standard references. Drug-related problems (DRPs) were identified and categorised, and severities were assessed using the National Coordinating Council Medication Error Reporting and Prevention Index. Acceptance of DRPs by prescribers was assessed. Prescription cost reduction due to CP interventions was assessed using Wilcoxon signed-rank test at 5% significance. RESULTS Among 150 patients approached, 51 were recruited. Nearly half (58.8%) reported financial difficulties in purchasing medications. DRPs identified were 86. Of them, 13.9% (12 of 86) DRPs were identified when taking a medication history (administration errors (7 of 12); self-prescribing errors (5 of 12)), 2.3% (2 of 86) during reconciliation, and 83.7% (72 of 86) during medication reviewing (wrong indication (18 of 72), wrong strength (14 of 72), wrong frequency (19 of 72), wrong route of administration (2 of 72), duplication (3 of 72), other (16 of 72)). Most DRPs (55.8%) reached the patient, but did not cause harm. Prescribers accepted 65.8% (56 of 86) DRPs identified by researchers. The individual prescription cost reduced significantly due to CP interventions (p<0.001). CONCLUSIONS Implementing CP services could potentially improve medication safety at a PH level even in resource-limited settings. Prescription cost could be significantly reduced for patients with financial difficulties in consultation with prescribers.
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Affiliation(s)
- Kaumada Binoli Herath
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - U A A Rodrigo
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - G P S G Senadheera
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Shyamalee Samaranayaka
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Department of Family Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Nithushi R Samaranayake
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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Bagyawantha NMY, Coombes ID, Gawarammana I, Fahim M. Impact of a clinical pharmacist on optimising the quality use of medicines according to the acute coronary syndrome (ACS) secondary prevention guidelines and medication adherence following discharge in patients with ACS in Sri Lanka: a prospective non-randomised controlled trial study protocol. BMJ Open 2023; 13:e059413. [PMID: 36759028 PMCID: PMC9923319 DOI: 10.1136/bmjopen-2021-059413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES Ensuring quality use of medicines (QUM) through clinical pharmacy services can improve therapeutic outcomes of patients diagnosed with acute coronary syndrome (ACS). The major objective of this study is to demonstrate the added value of a clinical pharmacist to the medical and nursing team providing care to patients with ACS on the continuation of quality use of the patients' medicine after discharge. STUDY DESIGN This protocol outlines a prospective, non-blinded, non-randomised, controlled interventional study. STUDY SETTING The study will be conducted at the professorial medical wards of a tertiary care teaching hospital in Sri Lanka. PARTICIPANTS Sample size will be 746 patients in both control and intervention arms. Patients diagnosed with ACS who are 18 years old or above and expected to visit the hospital for their routine clinic follow-ups after discharge will be recruited and randomised 1:1 to either the intervention group or the control group. Patients who are diagnosed and suffering from psychological disorders will be excluded from this study. INTERVENTIONS The planned interventions that will be delivered at discharge include review and optimisation of medications, assessing patient adherence and providing discharge medication counselling. Data will be collected at recruitment, 1 month, 3 months and 6 months' time intervals in both groups. Improvement of patients' medication adherence, reduction of hospital readmissions, reduction of drug-related problems, the attitude of doctors and nurses towards clinical pharmacy services and the cost-effectiveness of the clinical pharmacy services will be the major outcomes of this study. ETHICS AND DISSEMINATION Ethical approval for this study has been obtained from the ethics review committee, Faculty of Medicine, University of Peradeniya (2019/EC/26) and the trial is registered at the Sri Lanka Clinical Trials Registry. The results of this study will be disseminated via conference proceedings, journal publications and thesis presentations. TRIAL REGISTRATION NUMBER SLCTR/2019/039.
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Affiliation(s)
- Nanayakkara Muhandiramalaya Yasakalum Bagyawantha
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Central, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ian D Coombes
- School of Pharmacy, The University of Queensland, Saint Lucia, Queensland, Australia
- Collaboration of Australians and Sri Lankans for Pharmacy Practice, Education and Research (CASPPER), Brisbane, Queensland, Australia
| | - Indika Gawarammana
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Central, Sri Lanka
| | - Mohamed Fahim
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
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Dong PTX, Pham VTT, Dinh CT, Le AV, Tran HTH, Nguyen HTL, Hua S, Li SC. Implementation and Evaluation of Clinical Pharmacy Services on Improving Quality of Prescribing in Geriatric Inpatients in Vietnam: An Example in a Low-Resources Setting. Clin Interv Aging 2022; 17:1127-1138. [PMID: 35903286 PMCID: PMC9314755 DOI: 10.2147/cia.s368871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Geriatric inpatients generally have a high risk of drug-related problems (DRP) in prescribing following hospital admission, which are likely to cause negative clinical consequences. This is particularly evident in developing countries such as Vietnam. Therefore, clinical pharmacy service (CPS) aims to identify and resolve these DRPs to improve the quality use of medicines in the older population following hospital admission. Patients and Methods The study was conducted as a prospective, single-center study implemented at a general public hospital in Hanoi. Patients aged ≥60 years with at least three chronic diseases admitted to the Internal Medicine Department between August 2020 and December 2020 were eligible to be enrolled. A well-trained clinical pharmacist provided a structured CPS to identify any DRP in prescribing for each patient in the study. Clinical pharmacist interventions were then proposed to the attending physicians and documented in the DRP reporting system. Results A total of 255 DRP were identified in 185 patients during the study period. The most frequent types of DRP were underuse (21.2%), dose too high (12.2%), and contraindication (11.8%). There was a very high rate of approval and uptake by the physicians regarding the interventions proposed by the clinical pharmacist (82.4% fully accepted and 12.5% partially accepted). Of the interventions, 73.4% were clinically relevant (pADE score ≥0.1). In general, 9 out of 10 physicians agreed that CPS has significant benefits for both patients and physicians. Conclusion Improving clinical pharmacy services can potentially have a positive impact on the quality of prescribing in elderly inpatients. These services should officially be implemented to optimize the quality use of medicines in this population group in Vietnam.
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Affiliation(s)
- Phuong Thi Xuan Dong
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.,School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Van Thi Thuy Pham
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.,Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Chi Thi Dinh
- Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Anh Van Le
- Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Ha Thi Hai Tran
- Department of Internal Cardiology, Friendship Hospital, Hanoi, Vietnam
| | | | - Susan Hua
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Shu Chuen Li
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
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Ouweini AE, Karaoui LR, Chamoun N, Assi C, Yammine K, Ramia E. Value of pharmacy services upon admission to an orthopedic surgery unit. J Pharm Policy Pract 2021; 14:103. [PMID: 34872605 PMCID: PMC8646011 DOI: 10.1186/s40545-021-00384-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 11/24/2021] [Indexed: 11/26/2022] Open
Abstract
Background In Lebanon, the role of the pharmacist remains underestimated in the medication reconciliation process, especially in surgical departments. This study aims to assess the impact of pharmacist-conducted medication reconciliation performed within 48 h of hospital admission to the orthopedic surgical department. Methods This was a prospective single-arm study conducted in a tertiary-care teaching hospital in Lebanon between October 2019 and April 2020. Participants were adult inpatients hospitalized for orthopedic surgeries with ≥ 1 outpatient medications. Properly trained pharmacy resident obtained the Best Possible Medication History (BPMH) and led the reconciliation process. The primary endpoint was the number of reconciliation errors (REs) identified. Descriptive statistics were used to report participants’ responses and relevant findings. Linear regression was performed with the number of REs as a continuous dependent variable using backward method. Results were assumed to be significant when p was < 0.05. Results The study included 100 patients with a mean age of 73.8 years, admitted for elective (54%) or emergency (46%) surgeries. Half of the study population had ≥ 5 home medications. The mean time for taking BPMH was around 8 min. A total of 110 REs were identified in 74 patient cases. The most common discrepancies consisted of medication omission (89.1%) and the most common medications involved were antihyperlipidemic agents. Twenty-four REs were judged as clinically significant, and four as serious. The most common interventions included the addition of a medication (71.9%). Most of the relayed interventions (84.5%) were accepted. The number of home medications was the only variable significantly associated with the number of REs (β 0.492; p < 0.001). Conclusion Pharmacy-led medication reconciliation upon admission to orthopedic surgery department can reduce reconciliation errors and improve medication safety. Trial registration Retrospectively registered in the Lebanon Clinical Trials Registry (LBCTR2020124680). Supplementary Information The online version contains supplementary material available at 10.1186/s40545-021-00384-x.
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Affiliation(s)
- Ahmad El Ouweini
- Lebanese American University, School of Pharmacy, P.O. Box S-23, Byblos, Lebanon.,Lebanese American University Medical Center - Rizk Hospital (LAUMC-RH), Beirut, Lebanon
| | - Lamis R Karaoui
- Lebanese American University, School of Pharmacy, P.O. Box S-23, Byblos, Lebanon
| | - Nibal Chamoun
- Lebanese American University, School of Pharmacy, P.O. Box S-23, Byblos, Lebanon.,Lebanese American University Medical Center - Rizk Hospital (LAUMC-RH), Beirut, Lebanon
| | - Chahine Assi
- Lebanese American University Medical Center - Rizk Hospital (LAUMC-RH), Beirut, Lebanon.,Lebanese American University - School of Medicine, Byblos, Lebanon
| | - Kaissar Yammine
- Lebanese American University Medical Center - Rizk Hospital (LAUMC-RH), Beirut, Lebanon.,Lebanese American University - School of Medicine, Byblos, Lebanon
| | - Elsy Ramia
- Lebanese American University, School of Pharmacy, P.O. Box S-23, Byblos, Lebanon.
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Factors influencing the implementation of pharmaceutical care in outpatient settings: A systematic review applying the Consolidated Framework for Implementation Research. Res Social Adm Pharm 2021; 18:2579-2592. [PMID: 34158263 DOI: 10.1016/j.sapharm.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 05/18/2021] [Accepted: 06/13/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pharmaceutical care in outpatient settings is a type of health service that has been shown to contribute to decreasing drug-related morbidity and mortality rates. However, every process of implementing a new service brings about changes and transformations in the work routine, thus posing challenges. OBJECTIVES This systematic review aims to identify barriers to and facilitators for the implementation of pharmaceutical care in outpatient settings by applying the CFIR method, a framework based on the theory of health services, used to analyze and synthesize research data, which can direct strategies for the service to work as planned. METHODS A systematic review was conducted exploring the barriers to and facilitators for the implementation of pharmaceutical care in outpatient settings. The MEDLINE, EMBASE, CINAHL, COCHRANE, and LILACS databases were consulted. RESULTS Eight studies were included: five qualitative ones, two mixed-method ones, and a quantitative one. The most frequent CFIR constructs identified were Patient Needs and Resources (n = 30, 10.75%), Knowledge and Beliefs about the Intervention (n = 31, 11.11%), Networks and Communications (n = 34, 12.19%), and Available Resources (n = 56, 20.07%). The most cited barriers were: insufficient human resources, patients' unawareness of the existence of the pharmaceutical care service, and pharmacists' resistance to changes. Facilitators included: the opportune presentation of the service to the healthcare team; the use of electronic devices for specific guidance; and the assessment of patient satisfaction. CONCLUSIONS This systematic review allowed detecting key guidelines to improve the implementation process, including (1) defining an implementation method and exploring it extensively during the pre-implementation phase, (2) ensuring human and financial resources, (3) determining how the new service will interact with other existing services. More research is needed to understand how these factors can affect the implementation of clinical services.
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Joshi G, Kabra A, Goutam N, Sharma A. An Overview on Patient-Centered Clinical Services. BORNEO JOURNAL OF PHARMACY 2021. [DOI: 10.33084/bjop.v4i2.1978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Drug-related problems (DRPs) had often been a concern in the system that needed to be detected, avoided, and addressed as soon as possible. The need for a clinical pharmacist becomes even more important. He is the one who can not only share the load but also be an important part of the system by providing required advice. They fill out the patient's pharmacotherapy reporting form and notify the medical team's head off any drug-related issues. General practitioners register severe adverse drug reactions (ADRs) yearly. As a result of all of this, a clinical pharmacist working in and around the healthcare system is expected to advance the pharmacy industry. Its therapy and drugs can improve one's health quality of life by curing, preventing, or diagnosing a disease, sign, or symptom. The sideshows, on the other hand, do much harm. Because of the services they offer, clinical pharmacy has grown in popularity. To determine the overall effect and benefits of the emergency department (ED) clinical pharmacist, a systematic review of clinical practice and patient outcomes will be needed. A clinical pharmacist's anatomy, toxicology, pharmacology, and medicinal chemistry expertise significantly improves a patient's therapy enforcement. It is now important to examine the failure points of healthcare systems as well as the individuals involved.
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Affiliation(s)
- Gaurav Joshi
- University Institute of Pharma Sciences, Chandigarh University
| | - Atul Kabra
- University Institute of Pharma Sciences, Chandigarh University
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Dos Santos Júnior GA, Silva ROS, Onozato T, Silvestre CC, Rocha KSS, Araújo EM, de Lyra-Jr DP. Implementation of clinical pharmacy services using problematization with Maguerez Arc: A quasi-experimental before-after study. J Eval Clin Pract 2021; 27:391-403. [PMID: 32790199 DOI: 10.1111/jep.13448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/07/2020] [Accepted: 07/03/2020] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The growth of clinical pharmacy services (CPS) has positively impacted clinical, economic, and humanistic health outcomes. However, detailed studies on the process of implementing CPS in healthcare systems are incipient. Thus, the present study aimed to evaluate the CPS implementation in certain public health units in a metropolis in northeast Brazil. METHODS A quasi-experimental before-and-after study was carried out in Recife City, from July 2015 to March 2016. The study was carried out using the Methodology of Problematization with Maguerez Arc and was divided into: initial evaluation (before), planning, interventions, and preliminary evaluation (after). The participants were pharmacists, patients, health professionals, and local health managers. Descriptive statistics were used to report data. The statistical significance of the comparison between variables was evaluated using the Wilcoxon test (95% CI; P ≤ .05). RESULTS Initial evaluation: Identified incipient CPS, a lack of structure and work process of pharmacists. Planning: Sixteen brainstorming meetings were held with the different actors resulting in a strategic plan. INTERVENTION Twenty-two political-administrative meetings were held with managers and health teams and 768 hours of theoretical and practical training with mentoring for pharmacists. Preliminary evaluation: Structure indicators presented a statistically significant difference, differently from the process indicators. Pharmacists attended 842 patients and performed 1465 pharmaceutical consultations in 6 months. Regarding the outcome indicators, it was possible to identify changes in the clinical status of the most prevalent diseases among those patients who attended three pharmaceutical consultations. CONCLUSIONS It was possible to evaluate the CPS implementation in certain public health units in a metropolis in Brazil, through the Methodology of Problematization with Maguerez Arc. This methodology may be part of models for future implementations of CPS in health systems.
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Affiliation(s)
| | - Rafaella Oliveira Santos Silva
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Sergipe, Brazil
| | - Thelma Onozato
- Department of Pharmacy and Nutrition, Federal University of Espírito Santo, Espírito Santo, Brazil
| | | | - Kérilin Stancine Santos Rocha
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Sergipe, Brazil
| | - Elton Matos Araújo
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Sergipe, Brazil
| | - Divaldo Pereira de Lyra-Jr
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Sergipe, Brazil
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Gona OJ, Shambu SK, Madhan R. Frequency and nature of drug‐related problems in patients with acute coronary syndrome: role of the clinical pharmacist in coronary care practice. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Oliver Joel Gona
- Research Scholar Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education and Research Mysore India
| | - Sunil Kumar Shambu
- Department of Cardiology JSS Medical College and Hospital JSS Academy of Higher Education and Research Mysore India
| | - Ramesh Madhan
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education and Research Mysore India
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Nguyen-Thi HY, Nguyen-Ngoc TT, Do-Tran MT, Do DV, Pham LD, Le NDT. Job satisfaction of clinical pharmacists and clinical pharmacy activities implemented at Ho Chi Minh city, Vietnam. PLoS One 2021; 16:e0245537. [PMID: 33481846 PMCID: PMC7822262 DOI: 10.1371/journal.pone.0245537] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/30/2020] [Indexed: 11/24/2022] Open
Abstract
Ho Chi Minh City (HCMC) in Vietnam pioneered the practice of clinical pharmacy; however, hospitals in HCMC have faced numerous challenges that might influence the job satisfaction of clinical pharmacists (CPs). Additionally, there have been no official statistics about clinical pharmacy activities that have been reported so far. Therefore, this study was conducted to examine the current status of the clinical pharmacy profession and to analyze the key factors affecting job satisfaction of CPs in HCMC. This was a cross-sectional study. Self-administered questionnaires were distributed to all the CPs in all the 128 hospitals in HCMC via an online survey tool from May to June 2020. Only about 30% of the respondents were full-time CPs. The percentage of CPs participating in clinical wards was relatively low (52.79%). “Provide drug information for patients and medical employees” was the most common clinical pharmacy activity, with the percentage of CPs participating in it being nearly 90%. Overall, 74.1% of the 197 CPs surveyed were satisfied with their current job. The factors that they were satisfied with the most and the least were “Inter & Intra professional relationships” (95.9%) and “Income” (59.9%), respectively. The only demographic and work-related characteristic that had a statistically significant association with overall job satisfaction was “Ward round participation”. Most clinical pharmacy tasks noted a high rate of participation from the CPs. Nevertheless, hospitals in HCMC was found to be experiencing a shortage of CPs and low levels of participation of CPs in ward rounds, and most CPs were unable to completely focus on clinical pharmacy tasks. Regarding CPs’ job satisfaction-related aspects, income and ward round participation appear to be the two factors that should be increased, in order to enhance CPs’ job satisfaction.
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Affiliation(s)
- Hai-Yen Nguyen-Thi
- Pharmaceutical Administration Department, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- * E-mail:
| | - Thuy-Tram Nguyen-Ngoc
- Pharmaceutical Administration Department, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Minh-Thu Do-Tran
- Pharmaceutical Administration Department, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Dung Van Do
- Ho Chi Minh City Department of Health, Ho Chi Minh City, Vietnam
| | - Luyen Dinh Pham
- Pharmaceutical Administration Department, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Dang Tu Le
- Pharmaceutical Administration Department, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Naseef H, Amria A, Asrawi A, Al-Shami N, Dreidi M. The acceptance and awareness of healthcare providers towards doctor of pharmacy (Phram D) in the Palestinian health care system. Saudi Pharm J 2020; 28:1068-1074. [PMID: 32922137 PMCID: PMC7474161 DOI: 10.1016/j.jsps.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/24/2020] [Indexed: 02/05/2023] Open
Abstract
Clinical pharmacy (Pharm.D or MSc Clinical Pharmacy graduates) is a patient care oriented specialty. It aims to improve patient therapeutic outcomes and minimize medication errors. In Palestine, it is a new specialty taught at two universities. In order to implement this new specialty in healthcare settings, healthcare providers should have a high awareness about it, its role and importance in clinical settings. This study aimed to evaluate the awareness and acceptance levels among healthcare providers' about clinical pharmacy specialty. A cross sectional study carried out using a self-administered questionnaire that was developed and tested by a panel of experts for validity and reliability, then it was distributed and filled by the convenient sample of health care providers in the northern and middle of Palestine between January and March 2019. An awareness scale and acceptance scale were developed from the questions used to identify the healthcare providers' awareness and acceptance. Chi-square (X2) -testing was performed to check for the significant association. Data were analyzed using SPSS (version22). Among 309 respondents, 203(65.7%) were male, 67(21.7%) were working at Jerusalem, 229(74.1%) of them completed their first degree at Arab countries and 69(54.7%) completed higher education. Regarding their work, 169(54.7%) were physicians, followed by 85(27.5%) nurses and 55(17.8%) pharmacists. Results revealed that the majority of healthcare providers had a moderate 182(58.9%) and good 81(26.2%) awareness level toward the Clinical pharmacy specialty roles and 217 (70.2%) had a good acceptance level toward their implementation among the health worker team. Significant differences were found between healthcare providers' awareness level and their sex (P = 0.001), professions (P = 0.006) and job descriptions (P = 0.013). There were no significant differences between the health care providers' acceptance level and their age, sex, qualification, profession and job descriptions. Our results revealed the ability to collaborate in the integration of such specialty within the Palestinian healthcare system. Additional interest from the Ministry of Health is recommended to integrate clinical pharmacy workers among the health system and promote their relations with other disciplines.
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Affiliation(s)
- Hani Naseef
- Department of Pharmacy, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, West Bank, State of Palestine
| | - Afnan Amria
- Department of Pharmacy, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, West Bank, State of Palestine
| | - Alaa' Asrawi
- Department of Pharmacy, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, West Bank, State of Palestine
| | - Ni'Meh Al-Shami
- Department of Pharmacy, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, West Bank, State of Palestine
| | - Mutaz Dreidi
- Department of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, West Bank, State of Palestine
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12
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Naseef H, Amria A, Asrawi A, Al-Shami N, Dreidi M. The acceptance and awareness of healthcare providers towards doctor of pharmacy (Phram D) in the Palestinian health care system. Saudi Pharm J 2020. [DOI: https://doi.org/10.1016/j.jsps.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Fernandes BD, Almeida PHRF, Foppa AA, Sousa CT, Ayres LR, Chemello C. Pharmacist-led medication reconciliation at patient discharge: A scoping review. Res Social Adm Pharm 2020; 16:605-613. [DOI: 10.1016/j.sapharm.2019.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 07/22/2019] [Accepted: 08/01/2019] [Indexed: 11/28/2022]
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14
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Factors influencing the implementation of clinical pharmacy services for hospitalized patients: A mixed-methods systematic review. Res Social Adm Pharm 2020; 16:437-449. [DOI: 10.1016/j.sapharm.2019.06.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 05/16/2019] [Accepted: 06/26/2019] [Indexed: 12/24/2022]
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15
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Scrimenti A, Seabury RW, Miller CD, Ruangvoravat L, Darko W, Probst LA, Cwikla GM. Pharmacist recommendations for prophylactic enoxaparin monitoring and dose adjustment in trauma patients admitted to a surgical intensive care unit. Pharm Pract (Granada) 2019; 17:1541. [PMID: 31897248 PMCID: PMC6935549 DOI: 10.18549/pharmpract.2019.4.1541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/06/2019] [Indexed: 11/26/2022] Open
Abstract
Background: There is limited information describing pharmacist participation in prophylactic enoxaparin monitoring in the surgical intensive care unit (SICU). Objective: Our study sought to: 1) characterize pharmacist recommendations for enoxaparin monitoring in trauma patients admitted to the SICU, 2) describe the frequency that medical providers accept pharmacist recommendations for enoxaparin monitoring in trauma patients admitted to the SICU, and 3) illustrate the frequency that trauma patients admitted to our SICU service achieve anti-factor Xa trough concentrations (AFXa-TRs) of 0.11 - 0.20 IU/mL following pharmacist recommendation to adjust prophylactic enoxaparin dosing. Methods: Adult patients who had an AFXa-TR drawn after at least three consecutive prophylactic enoxaparin doses between June 1, 2017 and March 1, 2018 were identified through chart review and included in this study. Patients were excluded based on the following criteria: 1) age less than 18 years, 2) anti-factor Xa (AFXa) level not representative of a trough concentration, 3) AFXa-TR not representative of steady state concentration, and 4) non-trauma based prophylactic enoxaparin dosing. This study was exempt from IRB review. Results: The final analysis consisted of 42 patients. A pharmacist provided at least one recommendation in 97.6% (41/42) of trauma patients with enoxaparin monitoring during their SICU stay. In total, a pharmacist made 170 recommendations, mean of 4.2 (SD 1.8) recommendations per patient. Recommendations were: 1) obtain an AFXa-TR, n=90; 2) adjust enoxaparin dose based on AFXa-TR, n=58; and 3) maintain enoxaparin dose based on AFXa-TR, n=22. Medical providers accepted 89.4% (152/170) of pharmacist recommendations for enoxaparin monitoring. Dose adjustments were made in 33 patients following pharmacist recommendation; of these, 27 had a repeat AFXa-TR following at least one dose adjustment. Target AFXa-TRs were achieved in 19/27 patients, indicating 70.4% had recommended AFXa concentrations. Conclusions: Pharmacists provided recommendations for prophylactic enoxaparin monitoring and dose adjustment in trauma patients admitted to the SICU. Medical providers regularly accepted pharmacist recommendations and trauma patients commonly achieved target AFXa-TR following pharmacist recommendation for dose adjustment. Further research is required to identify the optimal enoxaparin dose for VTE prophylaxis in trauma patients.
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Affiliation(s)
- Ali Scrimenti
- PharmD, BCPS. Clinical Pharmacist. Department of Pharmacy, Upstate University Hospital. Syracuse, NY (United States).
| | - Robert W Seabury
- PharmD, BCPS, DABAT. Clinical Pharmacist. Department of Pharmacy, Upstate University Hospital. Syracuse, NY (United States).
| | - Christopher D Miller
- PharmD, BCPS. Associate Director of Clinical Pharmacy Services and Research. Department of Pharmacy, Upstate University Hospital. Syracuse, NY (United States).
| | - Lucy Ruangvoravat
- MD. Assistant Professor of Surgery. Division of General Sugery, Trauma, and Surgical Critical Care. Yale School of Medicine. New Haven, CT (United States).
| | - William Darko
- BPharm, PharmD, BCCCP. Clinical Pharmacist. Department of Pharmacy, Upstate University Hospital. Syracuse, NY (United States).
| | - Luke A Probst
- PharmD, BCPS. Director of Pharmacy. Department of Pharmacy, Upstate University Hospital. Syracuse, NY (United States).
| | - Gregory M Cwikla
- PharmD, BCCCP. Clinical Pharmacist. Department of Pharmacy, Upstate University Hospital. Syracuse, NY (United States).
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Sakeena MHF, Bennett AA, McLachlan AJ. The Need to Strengthen the Role of the Pharmacist in Sri Lanka: Perspectives. PHARMACY 2019; 7:E54. [PMID: 31195755 PMCID: PMC6631506 DOI: 10.3390/pharmacy7020054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 12/15/2022] Open
Abstract
The role of the pharmacist in healthcare has evolved greatly over the last half-century, from dispensing to providing direct patient-oriented activities not associated with dispensing. However, pharmacist-led healthcare services in Sri Lanka must undergo reform to fully take advantage of their expertise and training in medicine management and related outcomes in Sri Lankan patients. As befits a profession's role development and value, professional and educational standards for pharmacists need ongoing development and growth. Currently, university curricula and continuing professional education in Sri Lanka require further development and optimisation to provide the theoretical and practical knowledge and skills regarding quality use of medicines and patient-oriented care. Furthermore, pharmacists' roles in Sri Lankan hospital and community pharmacist settings need to be recognised and should include the pharmacist as an integral part of the multidisciplinary healthcare team in Sri Lanka. Studies from developed countries and some developing countries have demonstrated that expanded pharmacists' roles have had a significant positive cost-effective impact on the population's health. Therefore, the availability of qualified Sri Lankan pharmacists trained to deliver expanded professional services accompanied by greater pharmacist integration into healthcare delivery is crucially important to ensure quality use of medicines within the Sri Lankan healthcare system and optimise the medication-related needs of Sri Lankans.
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Affiliation(s)
- M H F Sakeena
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya KY 20400, Sri Lanka.
- Sydney Pharmacy School, The University of Sydney, New South Wales 2006, Australia.
| | | | - Andrew J McLachlan
- Sydney Pharmacy School, The University of Sydney, New South Wales 2006, Australia.
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17
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Sakeena MHF, Bennett AA, Carter SJ, McLachlan AJ. A comparative study regarding antibiotic consumption and knowledge of antimicrobial resistance among pharmacy students in Australia and Sri Lanka. PLoS One 2019; 14:e0213520. [PMID: 30865726 PMCID: PMC6415829 DOI: 10.1371/journal.pone.0213520] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/24/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a major global health challenge. Pharmacists play a key role in the health care setting to support the quality use of medicines. The education and training of pharmacy students have the potential to impact on patterns of antibiotic use in community and hospital settings. The aim of this study was to investigate and compare antibiotic use and knowledge of antibiotics and AMR among undergraduate pharmacy students in Australian and Sri Lankan universities. METHODS A cross-sectional survey was conducted in Australian and Sri Lankan universities that offer a pharmacy degree. A paper-based survey was utilised in Sri Lanka and an identical survey distributed online among pharmacy students in Australia. Descriptive and comparative data analyses were performed. RESULTS 476 pharmacy students from 14 universities in Australia and 466 students from 6 universities in SL completed the survey. Participants commonly reported previous antibiotic use [Australia (88%) and Sri Lanka (86%)]. The majority of students [Australia (89%) and Sri Lanka (77%)] reported they obtained antibiotics with a prescription. Australian pharmacy students correctly reported regarding optimal antibiotic use for certain disease conditions when compared to Sri Lankan students (P<0.05). A greater antibiotic knowledge level regarding AMR was found among Australian students compared to Sri Lankan students (p<0.05). CONCLUSION This study provides an understanding about antibiotic consumption and knowledge on AMR among pharmacy students in a developed country, Australia and a developing country, Sri Lanka. These findings identify possible misconceptions about antibiotics and a lower level of knowledge of AMR amongst Sri Lankan undergraduate pharmacy students. Future research should focus on implementation of a strategic education plan for undergraduate pharmacy students in Sri Lankan universities. The curricula of pharmacy courses in Australian universities may inform such a plan.
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Affiliation(s)
- M. H. F. Sakeena
- Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Stephen J. Carter
- Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J. McLachlan
- Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
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Lombardi N, Wei L, Ghaleb M, Pasut E, Leschiutta S, Rossi P, Troncon MG. Evaluation of the implementation of a clinical pharmacy service on an acute internal medicine ward in Italy. BMC Health Serv Res 2018; 18:259. [PMID: 29631587 PMCID: PMC5891983 DOI: 10.1186/s12913-018-2988-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 03/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Successful implementation of clinical pharmacy services is associated with improvement of appropriateness of prescribing. Both high clinical significance of pharmacist interventions and their high acceptance rate mean that potential harm to patients could be avoided. Evidence shows that low acceptance rate of pharmacist interventions can be associated with lack of communication between pharmacists and the rest of the healthcare team. The objective of this study was to evaluate the effect of a structured communication strategy on acceptance rate of interventions made by a clinical pharmacist implementing a ward-based clinical pharmacy service targeting elderly patients at high risk of drug-related problems. Characteristics of interventions made to improve appropriateness of prescribing, their clinical significance and intervention acceptance rate by doctors were recorded. METHODS A clinical pharmacy intervention study was conducted between September 2013 and December 2013 in an internal medicine ward of a teaching hospital. A trained clinical pharmacist provided pharmaceutical care to 94 patients aged over 70 years. The clinical pharmacist used the following communication and marketing tools to implement the service described: Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis; Specific, Measurable, Achievable, Realistic and Timely (SMART) goals; Awareness, Interest, Desire, Action (AIDA) model. RESULTS A total of 740 interventions were made by the clinical pharmacist. The most common drug classes involved in interventions were: antibacterials for systemic use (11.1%) and anti-parkinson drugs (10.8%). The main drug-related problem categories triggering interventions were: no specific problem (15.9%) and prescription writing error (12.0%). A total of 93.2% of interventions were fully accepted by physicians. After assessment by an external panel 63.2% of interventions (96 interventions/ per month) were considered of moderate clinical significance and 23.4% (36 interventions/ per month) of major clinical significance. The most frequent interventions were to educate a healthcare professional (20.4%) and change dose (16.1%). CONCLUSIONS To our knowledge this is the first study evaluating the effect of a structured communication strategy on acceptance rate of pharmacist interventions. Pharmaceutical care delivered by the clinical pharmacist is likely to have had beneficial outcomes. Clinical pharmacy services like the one described should be implemented widely to increase patient safety.
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Affiliation(s)
- Nicola Lombardi
- Department of Pharmacy, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK.
| | - Li Wei
- Department of Pharmacy Practice and Policy, University College London School of Pharmacy, 29-39 Brunswick Square, Bloomsbury, London, WC1N 1AX, UK
| | - Maisoon Ghaleb
- School of Life and Medical Science, Department of Pharmacy, Pharmacology & Postgraduate Medicine, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Enrico Pasut
- Department of Pharmacy, Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330-33100, Udine, Friuli Venezia Giulia, Italy
| | - Silvia Leschiutta
- Department of Pharmacy, Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330-33100, Udine, Friuli Venezia Giulia, Italy
| | - Paolo Rossi
- Division of Internal Medicine, Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330 - 33100, Udine, Friuli Venezia Giulia, Italy
| | - Maria Grazia Troncon
- Department of Pharmacy, Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330-33100, Udine, Friuli Venezia Giulia, Italy
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Shanika LGT, Jayamanne S, Wijekoon CN, Coombes J, Perera D, Mohamed F, Coombes I, De Silva HA, Dawson AH. Ward-based clinical pharmacists and hospital readmission: a non-randomized controlled trial in Sri Lanka. Bull World Health Organ 2017. [PMID: 29531414 PMCID: PMC5840627 DOI: 10.2471/blt.17.198366] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To assess if a ward-based clinical pharmacy service resolving drug-related problems improved medication appropriateness at discharge and prevented drug-related hospital readmissions. Method Between March and September 2013, we recruited patients with noncommunicable diseases in a Sri Lankan tertiary-care hospital, for a non-randomized controlled clinical trial. The intervention group received usual care and clinical pharmacy service. The intervention pharmacist made prospective medication reviews, identified drug-related problems and discussed recommendations with the health-care team and patients. At discharge, the patients received oral and written medication information. The control group received usual care. We used the medication appropriateness index to assess appropriateness of prescribing at discharge. During a six-month follow-up period, a pharmacist interviewed patients to identify drug-related hospital readmissions. Results Data from 361 patients in the intervention group and 354 patients in the control group were available for analysis. Resolutions of drug-related problems were higher in the intervention group than in the control group (57.6%; 592/1027, versus 13.2%; 161/1217; P < 0.001) and the medication was more appropriate in the intervention group. Mean score of medication appropriateness index per patient was 1.25 versus 4.3 in the control group (P < 0.001). Patients in the intervention group were less likely to be readmitted due to drug-related problems (44 patients of 311 versus 93 of 311 in the control group; P < 0.001). Conclusion A ward-based clinical pharmacy service improved appropriate prescribing, reduced drug-related problems and readmissions for patients with noncommunicable diseases. Implementation of such a service could improve health care in Sri Lanka and similar settings.
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Affiliation(s)
| | | | | | - Judith Coombes
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Dhineli Perera
- Department of Pharmacy, Austin Health, Melbourne, Australia
| | - Fahim Mohamed
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ian Coombes
- School of Pharmacy, University of Queensland, Brisbane, Australia
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