Implementation of pharmaceutical care for older adults in the brazilian public health system: a case study and realistic evaluation

Characteristics of the studies using realist evaluation to assess interventions that address psychosocial healthcare issues in older adults: a scoping review

OBJECTIVES

Interventions to address psychosocial healthcare issues in older adults are increasing. Realist evaluation (RE) helps us understand how these interventions work for their issues. It is significant to obtain implications for further developing such research. We aimed to identify the characteristics of studies using RE to assess interventions that address psychosocial healthcare issues in older adults by mapping relevant literature.

DESIGN

Scoping review.

DATA SOURCES

MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, Cochrane Library, ICHUSHI (a Japanese database) and Google Scholar were used for searches between 5 January 2022 and 4 January 2024.

ELIGIBILITY CRITERIA

(1) Showing that most of the participants were older adults or their stakeholders; (2) stating in the research background or aim sections that the target interventions aimed at addressing older adults' psychosocial healthcare issues and (3) using RE to assess these interventions.

DATA EXTRACTION

Data on country of origin, type of research, study design, qualitative data collection and analysis methods, desirable items for RE and intervention aims and purposes were extracted and summarised using descriptive statistics.

RESULTS

Fifty-four studies were analysed. Most studies were conducted in the UK (54.5%). Mixed methods were used in 28 studies (51.9%), while only qualitative methods were used in 25 studies (46.2 %). Fourteen intervention aims and purposes were identified: improving dementia care, avoiding emergency admissions, preventing social isolation and promoting family involvement in the care of older adults.

CONCLUSION

RE is useful for promoting an understanding of how interventions work for addressing psychosocial healthcare issues in older adults. RE also promotes the updating of plausible theories that lead to improving interventions. Our findings show the implications of managing time and resources to address the challenge of RE's time and resource intensiveness and carefully considering the data collection methods to reduce burdens on older adults.

Pharmaceutical Care in Mental Health: Pharmacists' Barriers, Collaborations, Attitudes, and Perceptions

Background

Pharmaceutical care is an essential component of mental healthcare.

Objectives

The study assessed pharmacists' collaborations, barriers, perceptions on therapeutic relationships and attitudes toward pharmaceutical care to persons with mental illness.

Methods

A questionnaire-based descriptive cross-sectional survey was conducted among 175 pharmacists in a Nigerian state via purposive sampling. Average mean score of >3 (±SD) was considered positive attitude toward pharmaceutical care, and positive for respondents' perception of pharmacists-patient relationship during consultations. Data were analyzed using SPSS version 25.0 for descriptive statistics.

Results

A total of 140 (80.0%) respondents participated in the study. Access to patients' medical records 90 (64.3%) was the major barrier to the provision of pharmaceutical care to persons with mental illness. Almost half of the study participants 69 (49.3%) desired collaboration with only general practitioners and psychiatrists. Only 44 (31.4%) had full co-operation from their desired collaborators. Average score for respondents' attitude toward provision of pharmaceutical care to the patients, and perception of pharmacist-patient relationship were 4.5 (±0.7) and 3.8 (±0.9) respectively.

Conclusions

Study participants' attitude toward pharmaceutical care, and perception on therapeutic relationship in persons with mental disorder were positive. Lack of access to patients' records mostly hindered provision of pharmaceutical care, and full collaboration with other mental health experts was mostly lacking. Appropriate policies are required to improve these vital components of mental healthcare for desired outcomes.

Clinical Communication Within Hospital Pharmacy Practice: Exploring Pharmaceutical Oncological Consultations

This exploratory study aimed to identify communication trends typical of pharmacists' clinical communication in the context of hospital consultations. A cross-sectional design was used to investigate the pharmacist-patient exchange, applying the Roter Interaction Analysis System (RIAS). Communication variables and RIAS composites were assessed, including therapeutic information complexity, estimated through the ad-hoc score CTICS (Cancer Therapy Information Complexity Score). The study comprised 13 consultations of cancer patients with one female pharmacist, of which 6 included a patient family member, lasting on average 22.74 minutes and presenting repeated or overlapping consultation phases. The pharmacist's talk dominance reached 53.49%, slightly higher in dyadic consultations (U = 6.0, p = .032), and with an overall predominance of closed-ended questioning (W = 81.0, p = .013). Patients' questioning on biomedical issues was higher in dyadic consultations. The level of the pharmacist's rapport-building with the relative was higher when the patient's age was ≥80 years. Several strong correlations, both positive and negative, were found between composites, including between patient positive rapport-building and relative lifestyle/psychosocial information giving (Rho = -0.971, p = .001). Pharmaceutical consultations seem to be lengthier than other hospital practitioners' interviews, indicating a lack of  clear organization and flow, thus challenging their efficiency regarding therapy management. Still, several positive communication features were found regarding the pharmaceutical care of older cancer patients. Further studies are needed, involving larger samples and other hospital consultation settings.

Comprehensive Medication Management Services with a Holistic Point of View, a Scoping Review

Implementing Comprehensive Medication Management (CMM) services uncovered the importance of the totality of the patient's perspective in this process. The holistic approach takes into account the physical, mental and emotional well-being of individuals, as well as their socioeconomic circumstances. The aim of this study was to characterize the scientific evidence associated with CMM services that included this holistic approach. A scoping review was conducted based on Arksey and O'Malley's method. Searches were performed in Google Scholar for papers published between 2010 and 2020 in English, Spanish and Portuguese. Study design, health contexts, sample of patients, results obtained, barriers and facilitators, and the integration of a holistic approach were determined. Two hundred and eighteen papers were evaluated, most of which focused on the implementation of this service through prospective observational studies. A minority of studies reported on a holistic approach, a smaller number examined the effect of social determinants of health, the patient's medication experiences and the pharmacotherapy outcomes from the patient's perspective. Despite the progress achieved, most of the referents do not yet reflect a broader view of the patient's life situation and its relationship to pharmacotherapy and the ways in which the pharmacist implements holistic elements to solve or prevent drug-related problems.

Hospital pharmacists' awareness and perspective toward the management of COVID-19 pandemic in the Kingdom of Saudi Arabia

Objectives

This study investigates the hospital pharmacists' awareness of important facts about the COVID-19 disease and their source of information, as well as their perception.

Methods

This cross-sectional study using a self-administered questionnaire was conducted from November 2020 to March 2021 in the Kingdom of Saudi Arabia (KSA). The questionnaire was developed via electronic platform and invitations were sent to pharmacists working in private and government hospitals. A multivariate logistic regression was used to identify factors associated with awareness of COVID-19.

Results

A total of 272 pharmacists submitted their responses via weblink. Many pharmacists (n=228, 84%) followed the latest COVID-19 updates on treatment and updated their information mainly through World Health Organization documents (n=151, 56%). Pharmacists working in secondary and tertiary hospitals were relatively five-times times (AOR = 4.59; 95% CI: 1.69-12.8; p-value = 0.003) and three-times (AOR = 2.93; 95% CI: 1.35-6.72; p-value = 0.008) more aware of COVID-19 than those working in primary hospitals. Pharmacists with prior adequate knowledge regarding epidemics and pandemics were two-times more likely to have a good awareness of COVID-19 compared to those who had received none (AOR = 2.15; 95% CI: 1.09-4.35; p-value = 0.030).

Conclusions

Half of the pharmacists believed that they received required education in the past about epidemics and pandemics, and many follow the recent COVID-19 updates on medicines predominantly from the WHO followed by the government awareness campaigns. Many pharmacists believed they have a key role in the management of epidemics/pandemics via their hospital pharmacy. However, this study identified certain awareness gaps regarding COVID-19, highlighting areas of improvement.

Implementation of Medication Reconciliation conducted by hospital pharmacists: A case study guided by the Consolidated Framework for Implementation Research

BACKGROUND

Medication reconciliation (MR) implementation in hospital care transitions has proved to be a challenge for health professionals and managers. It points to the need to conduct Implementation Research with a view to understanding the tasks of the real world and knowing how they impact this process. Guided by the Consolidated Framework for Implementation Research (CFIR), this study aims to analyze the factors that influenced the MR implementation process conducted by pharmacists at a hospital setting.

METHODS

A qualitative case study was carried out in the cardiology and gastroenterology units of a teaching hospital in Brazil, involving participant observation and semi-structured interviews with physicians, pharmacists, nurses, nutritionists and a social worker. The CFIR was used to guide data collection and thematic analysis. The constructs were classified according to their influence and strength.

RESULTS

Sixteen health professionals involved directly or indirectly with MR implementation participated in the study. Based on the analysis of the participants' quotes and of the field diary, 18 constructs of the CFIR were identified as influencing MR implementation. The constructs that most strongly influenced MR implementation concerned "Inner Setting", "Characteristics of Individuals" and "Characteristics of Intervention". The participating professionals showed little knowledge of MR and had different points of view on its scope, weakly relating MR to patient safety. The tools used to conduct MR were adapted according to the hospital's needs, thus facilitating its implementation. However, MR proved to be complex and require clinical knowledge and aligned teamwork to identify and resolve undocumented medication discrepancies, being as well intertwined with culture and organizational communication.

CONCLUSIONS

The results point to implementation failures and highlight that MR is a complex intervention, requiring specific knowledge from the multidisciplinary team and alignment with other existing workflows. The barriers and facilitators identified may serve to design and test implementation improvement strategies.

EMDIA Case Series-Effective Medication Therapy Management (MTM) for Diabetes Type 2 Patients-A Proof of Concept Study

Background: A 2016 meta-analysis of pharmaceutical care for patients with diabetes mellitus showed that the following four components were most effective: (a) individual goal setting, (b) sending feedback to the physician, (c) reviewing the medication, and (d) reviewing blood glucose measurements. Methods: To formulate a hypothesis regarding the effect of these four pharmaceutical care components on glycemic control in patients with diabetes mellitus and the feasibility of these components in practice. Ten patients with type 2 diabetes were included in the case series and received medication therapy management over four months. Results: The four care components were feasible in everyday practice and could be implemented within one patient visit. The average visits were 49 and 28 min at the beginning and end of the study, respectively. The glycated hemoglobin values did not change over the study period, though the fasting blood glucose decreased from 142 to 120 mg/dl, and the number of unsolved drug-related problems decreased from 6.9 to 1.9 per patient by the study end. Conclusions: This case series supports the hypothesis that community pharmacists can implement structured pharmaceutical care in everyday pharmacy practice for patients with type 2 diabetes mellitus.

Pharmacists' readiness to deal with the coronavirus pandemic: Assessing awareness and perception of roles

Background

The 2019 Coronavirus infection (COVID-19) caused by a novel strain of coronavirus was detected in China in December 2019, and declared a public health emergency of international concern on January 30, 2020. Community pharmacists have an important role in supporting the local health emergency preparedness and response arrangements.

Objectives

To investigate pharmacists and pharmacy students' awareness and source of their information regard the management of the coronavirus pandemic, and their perspective of their role during this emergent situation.

Methods

This descriptive cross-sectional online survey study was conducted in Jordan during the COVID-19 outbreak (from 15 to 30 March 2020). A validated online questionnaire addressing participants' current awareness about epidemics/pandemics and COVID-19, source of information and their perspectives of their role. Data were analyzed using statistical package for social science (SPSS).

Results

Participants (n = 726) had a mean age of 26.9 (8.0) years with 71.9% females. Pharmacy students made 35.3% of the sample while the rest were pharmacists. Only 54.3% of participants believed that they got enough education about epidemics/pandemics, and 94.6% of them follow on the latest coronavirus updates on treatments, and that is mainly from the media (59.5%) followed by the World Health Organization reports (58.7%) and then the published researches (57%). Awareness score (out of 20) of pharmacists (n = 470) was significantly higher (p < 0.001) than that of students (n = 256). Better Awareness scores were also associated with higher age of participants, graduating from a public versus a private university, and attending more educational workshops.

Conclusion

The majority of pharmacists and pharmacy students reported that they have a major role in the management of epidemics/pandemics through the community pharmacies but the majority follow on the latest coronavirus updates from the media. This fact rings bills considering the numerous conflicting messages publicized during the pandemic through the media.

Patients Satisfaction with Pharmaceutical Care and Associated Factors in the Southwestern Ethiopia

BACKGROUND

An evaluation of patient satisfaction with service provided in the health care system has been globally recognized as the measure of health care service quality. However, there is a lack of research findings that indicate patient satisfaction with newly implemented patient-oriented pharmaceutical care (PC) service provided by clinical pharmacists in Ethiopia. Therefore, the current study is aimed to determine the level of patient satisfaction and associated factors with PC service provided by clinical pharmacists in the Southwestern Ethiopia.

METHODOLOGY

A facility-based cross-sectional study design was employed among patients admitted to Medical wards in Jimma University Medical Center (JUMC) (n=219) from May to June 2021. The pretested interviewer-administered questionnaire containing structured questions on a 5-point Likert scale was appropriately completed and returned for statistical analysis. For the analysis of data, Statistical Package for Social Sciences (SPSS) was used. The associations between status of patient satisfaction and predictors were determined at 5% (p<0.05) level of significance by employing multivariate logistic regression.

RESULTS

The current study revealed that more than half (56%) of the respondents were satisfied with clinical pharmacy service. From 30% of drug therapy problems (DTPs) reported, non-adherence was the most prevalent (11.4%), while the dose being too low and adverse effects (0.9%) were the least reported. Moreover, the assignment particular clinical pharmacist (AOR: 2.091, 95% CI: 1.028, 4.255), previous admission (AOR: 0.459, 95% CI: 0.244, 0.86), number of medications taken per day (AOR: 1.929, 95% CI: 1.996, 3.739) and length of hospital stay (AOR: 2.236, 95% CI: 1.124, 4.446) were significantly associated with patient satisfaction.

CONCLUSION

The present study revealed that patient satisfaction towards PC was low. Lack of specific clinical pharmacist assignment, previous history of admission, number of medications taken per day and length of hospital stay are revealed as the major factors affecting the level of satisfaction. In addition, current findings implicate that clinical pharmacist collaboration with a multidisciplinary team is essential to increase patient satisfaction.